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k Loss of fluid exceeds intake of water, and electrolytes are lost in the same proportion (losing more fluid than is taken in and Causes: electrolyte in equal amounts so electrolytes k Heart failure levels stay constant). k Renal failure Not able to filter the water or k Third spacing is an example because fluid leaves sodium. the extracellular and goes into a body cavity so it k Cirrhosis of the liver The body makes excessive cannot be used in osmosis. amounts of adolsterone, which retains sodium. k Dehydration refers to loss of water alone with Manifestations: increased serum sodium level (Do not lose k Edema (makes skin very fragile) electrolytes) k Distended neck veins (Jugular venous Causes: distention) k Fluid Loss from vomiting k Abnormal lung sounds Crackles-fluid in lungs. k Diarrhea k Tachycardia k GI Suctioning k Increased Blood pressure k Sweating k Increased Pulse pressure (difference between k Decreased Intake of Fluids systolic and diastolic) k Diabetes Insifitus Not enough ADH made, which k Increased Weight causes increased urination and they lose a lot of k Increased Urine Output fluid) k Decreased Urine specific gravity Manifestations: k Shortness of breath k Rapid Weight Loss (1 lb [1/2 kg] of loss of k Cough weight= 500 mL of fluid) Laboratory data: k Increased Specific Gravity (concentrated urine) k Decreased BUN k Rapid and Weak Pulse (because of decreased k Decreased Hematocrit blood pressure) k Decreased Hemoglobin k Decreased Skin Turgor Medical management: k Oliguria (less urine produced) k Measure Intake and Output k Postural Hypotension k Check lung sounds k Thirst k Check for edema (common in the sacrum k Confusion [bedrest], ankles, and feet) restrict fluids and sodium (may be contained in bottle waters or Laboratory data: tap water or even water softeners) k Increased Hematocrit k administration of diuretics k Increased BUN (out of proportion to 20:1 to k Pt should be in semi-fowlers to allow lungs to creatinine) because of less fluid, which causes expand better and promote oxygen increased concentration exchange.Medications can be used Diuretics Medical management: provide fluids to meet body needs k Oral fluids k Isotonic IV solutions k Monitor vital signs k Fluid volume deficit pt. can have low temperatures k Monitor Intake and Output
Manifestations:
k k k k k k k k k k Poor skin turgor Dry mucosa Headache Decreased Salivation Decreased BP Nausea Abdominal cramping Hyperactive bowel wounds Neurologic changes (confusion) Seizures
Medical management:
k Hypotonic electrolyte solution Less particles than blood, so fluid is going to leave the extracellular into intracellular.D5W k Older patient loss the thirst response, so offer water frequently. k Inform patients that OTC medications are sometimes high in sodium (alka-seltzers).
Medical management: k Sodium replacement, k Water restriction (usually no more than 800
ml/day)
Hyperkalemia- Potassium Excess Serum Potassium > 5.0 mEq/L Contributing Factors:
k Serum potassium greater than 5.0 mEq/L k Usually related to kidneys problems k ECG will show wide QRS, wide, flat P wave, and peaked T wave. k Patients should not use a salt substitute. k Hyperkalemia will increase the excitability of the muscles. k If a tourniquet is left on too long, or if blood is drawn above a IV site with potassium infusing it can cause a false high reading of hyperkalemia.
Causes:
k Impaired renal function (primary cause) k Aldosterone deficiency k Burns -Cells are destroyed which release potassium k Medications k Potassium-sparing diuretics and ace inhibitors which end in prile
Causes:
k GI losses (GI contains large amounts of potassium) k Gastric suctioning k Vomiting k Diarrhea k Medications k Poor dietary intake
Signs/Symptoms: k Fatigue k Anorexia (loss of appetite) k Nausea k Vomiting k Dysrhythmias k Muscle weakness k Cramps k Decreased muscle strength k Decreased deep tendon reflexes (DTRs) Medical Management:
k Increased dietary potassium bananas, citrus fruits, tomatoes, raisins, spinach, and salt substitutes k Potassium supplement Are not very tasty and can upset stomach, so mixed with a juice, so don t take on an empty stomach. k All IV potassium is always diluted (usually in 1000 mL bag), never IV pushed and always needs to be agitated [mixed]. k IV for severe deficit
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Causes: k Hypoparathyroidism k Inadequate vitamin D intake k Renal failure (high phosphorus and low calcium) k Immobility or the elderly with osteoporosis
(bone is going to decrease the re-absorption and cause Hypocalcemia)
Medical Management:
k Treat underlying cause k Administer fluids 3 to 4 quarts of fluid and lots of fiber because of the constipation and to try to flush the calcium out of the system. k Diuretics Lasix (furosemide) k Phosphates k Calcitonin
Medical Management:
k IV of Calcium Gluconate- Do not administer to quickly and make sure it is diluted because it can cause cardiac arrest.Make sure pt. has patent IV because it can leak into the tissue (infiltration) it can cause tissue necrosis and death (extravasation). k Calcium and Vitamin D Supplements k Encourage a high calcium diet
Causes:
k Alcoholism k GI losses NG suctioning (high) Diarrhea Or anything from the small intestine (bowel) k Low intake of magnesium
Causes:
k Renal failure k Dehydration k Excessive administration of magnesium
Signs/Symptoms: k Neuromuscular irritability k Muscle weakness k Tetany k Tremors k ECG changes and dysrhythmias k Alterations in mood and level of consciousness k Trousseau s sign k Chovstek s sign Medical Management:
k Diet k Oral magnesium k Magnesium sulfate IV Should be administered slow and patient should be monitored. Rapid or too much can cause cardiac dysrhythmias.
Medical Management:
k IV calcium gluconate k Loop diuretics Are used if the cause in not kidney failure. Causes magnesium to be excreted in the urine. k Increase fluids Causes magnesium to be diluted in the fluid. k Hemodialysis Reduce magnesium to a safer level by filtering it out of the fluid.