jcmendiola_Achievers2013

Care of Clients with Problems In Oxygenation,

Fluids and Electrolytes, Metabolism and Endocrine
(NCM103)
Patients With Fluids and Electrolytes (Renal) Alteration III

Electrolyte Imbalances

1. Sodium (Na
+
) [Normal: 135 145 mEq/L]
a. Hyponatremia
Sodium Deficit
Less than 135 mEq/L
Water: Na

Causes:
- Na Intake (Na is lost but more entry of Water)
How is Na Lost?
- Urine:
Exemplified by patients with excessive urine output (DM,
DI, Diuretics )
Excessive entry of water
+ Water Supplement D
5
W (Glucose 5% +
Water)
+ Excessive Compulsive Intake of Water
Manifestations:
1. Anorexia
2. N/V
3. Headache
4. Lethargic Looking

Diagnostic Findings
- Level of Serum Na
- Specific Gravity (N: 1.000 1.03)
- Concentrated Urine

Management:
- Na intake
- Restrict fluid intake
- Normal saline solution

b. Hypernatremia
Sodium Excess
More than 145 mEq/L
Water: Na

Causes: (Similar to HYPOVOLEMIA)
- Intake of water
- Inadequate water supplement (Tube Feedings)
- Diarrhea
- Vomiting
- Burns
- Excessive diaphoresis

Manifestations:
- Thirst
Topics Discussed Here Are:
1. Electrolyte Imbalances
a. Sodium Imbalances
b. Potassium Imbalances
c. Calcium Imbalances
2. Acid-Base Balance
LOOKY
HERE

jcmendiola_Achievers2013
- Body temperature
- Pulse / BP

Diagnostic Findings:
- Level of Na in blood (HIGH)
- Level of Na in urine (LOW)

Management:
Fluid intake (48 hours)
If cannot take in fluid orally, use IV Fluid (D
5
W)

2. Potassium (K
+
) [Normal: 3.5 5.0 mEq/L]
K+ gets in the body though the food
Gets out of the body by:
GUT via Urine~ (90% of K+)
GIT via Feces~ (10% of K+)

a. Hypokalemia
Potassium Deficit
Less than 3.5 mEq/L

Causes:
- Intake of food HIGH in K+
o Patients with starvation diet
Banana, Citrus Fruits, Green Leafy Veggies
Potassium Content!
Beef, Pork and Chicken Potassium Content!
- Gastric suctioning
- Vomiting (Hyperemesis Gravidarum)
- Cushings Syndrome (Hyperaldosteronism K+ Excretion!)

Manifestations:
1. Easy Fatigability
2. Peristalsis of the stomach muscles (ANOREXIA)
3. Constipation
4. ECG Tracings:
a. U-Wave~
+ For children its normal = Extra excitability
+ Abnormal for adults
b. Flattened T-Wave
c. Depressed ST-Segment

Plan of Care:
Food with HIGH Potassium Content!
Augmenting of K+ Supplements
o [Calcium Dural] per orem
o Potassium Chloride (KCl)
If cannot take orally, use IV form of KCl
In the form of IV Drip!
Assess the URINE OUTPUT!
UO: NO K+

b. Hyperkalemia
Potassium Excess
More than 5.0 mEq/L


jcmendiola_Achievers2013
Causes:
- Intake of food HIGH with Potassium
- Disorders:
o UO (Renal Failure)
o Addisons Disease ( Aldosterone)
K+ EXCRETION
K+ RETENTION
o Destruction of Cells (Escape of K+ from the cells)
Burns
Metastatic Cancer
Large Bed Sore














Diagnostic Findings:
- Serum Potassium is greater than 5 mEq/L
- ECG
o Affectation of T-Wave
Tall T-wave
Prolonged QRS Complex (QRS only occupies 2 small
squares 0.08s)
Prolonged PR Interval

Manifestations:
Presence of muscle cramps
Intestinal colic (Due to hypermotility)
Muscular weakness

Plan of Care:
- Intake of food HIGH in Potassium
- Diuretics (K+ Wasting Diuretics)
- The MD will order insulin
o (Short-acting/Rapid Acting) Regular Insulin
o Administer: IV not SQ
o Insulin transports K+ back to the cell to decrease the K+ in the
ECF
o Administer with D
10
W / D
50
W
- Give Cation-Exchange Resin (Kayexalate)
o It is effective if there are 2 3 bowel movements during the day
o Potassium is being excreted if more bowel movements

3. Calcium (Ca+) [Normal: 8.5 10.5 mg/dL]
a. Hypocalcemia
Calcium Deficit
Less than 8.5 mg/dL
How Does Potassium Perform Acid-Base Balance

Normal Balance: Under normal conditions, the K+ content in
the ICF is greater than in the ECF. H+ Ions is low in both
compartments

Acidosis: H+ Ions in the ECF increases due to some conditions,
and the H+ ions move into the ICF. To have balance, K+ ions
leave the cell and move into the ECF, causing
HYPERKALEMIA

Alkalosis: More H+ ions are in the ICF than in the ECF. So, the
H+ ions move out of the ICF and into the ECF, to have balance,
the K+ in the ECF move into the ICF, causing HYPOKALEMIA

jcmendiola_Achievers2013

Causes:
- Intake of Ca+
- Due to poverty, decreased socio-economic status
- Lactose intolerance
- Malabsorption syndrome
o Small intestines are affected
- Hypoparathyroidism
o PTH
Chvosteks Sign
Trousseaus Sign
o Vitamin D Deficiency
Intake of MILK

Manifestations:
- Numbness of fingers and toes
- Tingling sensation
- Seizures
- Trousseaus Sign
- Chvosteks Sign

Plan of Care
- Level of Ca+ (Milk)
- Ca Supplement
o Calcium Chloride
o Calcium Gluconate

b. Hypercalcemia
Calcium Excess
More than 10.5 mg/dL

Causes:
1. Intake of Ca+ (Milk / Cheese)
2. Prolonged immobilization Build up of Ca on bone
3. Massive fractures Bone cannot store Calcium
4. Bone disorders (Osteomyelitis, Bone Cancer)
5. Hyperparathyroidism ( PTH)

Manifestations:
1. Muscle weakness
2. N/V
3. Constipation

Diagnostic Test:
- Level of Serum Calcium

Management:
- Mobilize client
- Treat the underlying cause

STUDY OTHER ELECTROLYTES~


jcmendiola_Achievers2013
Acid Base Balance

2 Important Systems in the Regulation of Acid-Base Balance
1. Lungs Compensates FASTER
a. Respiration Exchange of O
2
and CO
2

b. Ventilation Actual taking in and taking out of air
2. Kidney Compensates BETTER

R
e
s
p
i
r
a
t
o
r
y


Situations:
Climb from ground floor and then to the top floor; Hyperventilation, what will happen?
Respiratory Alkalosis or Respiratory Acidosis??
Duty at around 2 10 PM, Walking on the streets at 10:30 PM, then someone suddenly followed you, what
will happen?
Respiratory Alkalosis or Respiratory Acidosis??
Someone is strangling you, what will happen?
Respiratory Alkalosis or Respiratory Acidosis??
You are choking on your food, what will happen?
Respiratory Alkalosis or Respiratory Acidosis??
From being choked, someone gave you CPR, what will happen?
Respiratory Alkalosis or Respiratory Acidosis??

3 Parameters Are Used in Acid-Base Balance
1. pH
It is the ACIDITY / ALKALINITY of the blood
It is the RATIO between BASE and ACID
A more precise definition is the negative representation of Hydrogen ion concentration
within the body
HYDROGEN is an ACID DONOR



pH H
2
Acidosis pH H
2
Alkalosis
Acidosis Alkalosis

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Normal pH: 7.35 7.45
STRICT VALUE of pH
7.4 NORMAL
7.41 7.45 ALKALOTIC
7.35 7.39 ACIDOTIC
pH Compatible with LIFE is 7 7.9!! ACCORDING TO MAM YAN

2. pCO
2
(Partial Pressure of Carbon Dioxide)
A measure of respiratory functioning
pCO
2
is an ACID!
Normal pCO
2
: 35 45 mmHg


3. HCO
3
(Bicarbonate )
= A measure of metabolic functioning
= HCO
3
Is a BASE!
= Normal HCO
3
: 22 26 mEq/L



DIFFERENT TYPES OF ACID-BASE BALANCE
1. Uncompensated
a. Metabolic Acidosis Uncompensated
Parameter Amount Interpretation
pCO
2
41 Normal
HCO
3
20 Metabolic Acidosis
pH 7.31 Acidosis

b. Respiratory Alkalosis Uncompensated
Parameter Amount Interpretation
pCO
2
30 Respiratory Alkalosis
HCO
3
24 Normal
pH 7.58 Alkalosis
In uncompensated acid-base imbalance, there is ONE ABNORMAL SYSTEM
The other system is NORMAL and is MADAMOT (Does nothing to compensate )
The pH remains abnormal and it follows the condition of the existing abnormal system

2. Compensated
a. Respiratory Acidosis Partially Compensated
Parameter Amount Interpretation
pCO
2
50 Respiratory Acidosis
HCO
3
29 Metabolic Alkalosis
pH 7.33 Acidosis

b. Metabolic Alkalosis Fully Compensated
Parameter Amount Interpretation
pCO
2
60 Respiratory Acidosis
HCO
3
31 Metabolic Alkalosis
pH 7.41 Alkalosis (Strict Value 7.4)
In compensated acid-base imbalance, the two systems are ABNORMAL!!
The primary abnormal system influences the other system to compensate!
The pH determines if it will be considered PARTIALLY COMPENSATED or FULLY
COMPENSATED !!
- JUST REMEMBER THE STRICT VALUE OF pH WHICH IS 7.4!!!
pCO
2
Respiratory Acidosis
pCO
2
Respiratory Alkalosis
HCO
3
Metabolic Alkalosis
HCO
3
Metabolic Acidosis
Situations:
pCO
2
= 60 RAC
HCO
3
= 30 MAL
pH = 7.42 N(AL)

pCO
2
= 60 RAC
HCO
3
= 30 MAL
pH = 7.38 Acidosis