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135 - 147 mEq/L
- HYPOnatremia is low total body sodium caused by vomiting, diarrhea, fistula, sweating, diuretics. Fluid moves from vascular compartment to cells & tissue causing swelling of cells. CNS. Confusion, hypotension, edema, muscle cramp, weakness, seizures (from cerebral edema).
- HYPERnatremia is high total body sodium in ECF caused by too little fluid consumption, diarrhea, insensible water loss, high salt intake, poor renal f(x). Fluid shifts from cells to ECF. Neuro impairment, restless, weakness, disorientation, delusion, hallucination.
3.5 - 5.2 mEq/L
- HYPOkalemia is low total body potassium in ECF caused by vomiting, diarrhea, diuretics, gastric suctioning, sweating, furosemide. K+ move fr cell leaving excess intracellular Na+ and H+ causing abnormal cellular f(x). Muscle weakness, leg cramp, fatigue, decreased DTR (deep tendon reflex), dysrhythmia, decreased bowel motil.
- HYPERkalemia is high total body potassium in ECF caused by renal failure, KCl- supplement, heparin, ACE inhibitors, K-sparing diuretics. Less freq. than HYPO but more dangerous. Dysrhythmia (ventricular arrhythmia), asystole, areflexia, skel muscle weakness/ paralysis, cardiac irregular (incl MI), decreased HR (heart rate).
8.5 - 10.3 mg/dL
HYPOcalcemia is low total body calcium in the ECF caused by inadequate intake, impaired absorption, excess loss, sepsis, hypoparathyroidism, ETOH, osteoporosis. Numbness/ tingling (fingers, mouth, feet), tetany (invol muscle contraction), muscle cramps/ tremors, seizures.
HYPERcalcemia is high total body calcium in the ECF caused by cancer, hyperparathyroidism, Paget's Disease, prolonged immobilization. Nausea, vomiting, constipation, bone pain, polyuria, polydipsia, confusion, lethargy, slurred speech, dysrhythmia. If severe can be emergent: cardiac arrest.
1.5 - 2.5 mEq/L
HYPOmagnesemia is low total body magnesium in the ECF caused by nasogastric suction, diarrhea, ETOH withdrawal, tube feedings/ parenteral nutrition, sepsis, burns. Muscle weakness, tremors, tetany (invol muscle contraction), seizurs, heart block, chg in mental status, hyperactive DTR (deep tendon reflex), respiratory paralysis.
HYPERmagnesemia is high total body magnesium caused by renal failure, excessive Mg intake due to antacids or laxatives. Nausea, vomiting, weakness, flushing, lethargy, loss of DTR (deep tendon reflex), respiratory deprssion, coma, cardiac arrest.
2.5 - 4.5 mg/dL
HYPOphosphatemia is low total body phosphate in the ECF caused by administration of calories to malnourished pts., ETOH withdrawal, DKA (diabetic ketoacidosis), hyperventilation, insulin release, absorption problems, diuretics. Note: Serum PO4 levels may be low but total body stores may be normal. Irritability, fatigue, weakness, parasthesia, confusion, seizures, coma.
HYPERphosphatemia is high total body phospate caused by impaired kidney excretion, hypoparathyroidism, tissue damage, chemotherapy. Tetany (invol msl contract), anorexia, nausea, weakness, tachycardia, numbness, tingling (@mouth and fingertips).
95 - 108 mEq/L
HYPOchloremia is lot total body chloride in the ECF caused by vomiting, diarrhea, drainage of gastric fluid (GI tube), metabolic alkalosis, diuretics, burns. Hyperexcitability of muscles, tetany (invol msl contract), DTR (deep tendon reflex), weakness, muscle cramps.
HYPERchloremia is high total body chloride caused by metabolic acidosis, head trauma, increased perspiration, excess adrenocortical hormone production, decreased glomerular filtration. Tachypnea, weakness, lethargy, diminished cognitive ability, hypertension, decreased cardiac output, dysrhythmia, coma.
22 - 26 mEq/L
Tell me about Magnesium.
- Metabolize carbs and proteins.
- Vital actions involving enzymes.
- Produces vasodilation.
- Most abundant cation after K+.
Tell me about Chloride.
- Maintains osmotic pressure in blood.
- Produces HCl (hydrochloric acid).
- Regulates acid/ base balance.
Tell me about Phosphate.
- (Involved in) chemical reactions in the body,
- Cell division, and
- Hereditary traits.
- Promotes energy storage.
Tell me about Sodium.
- Controls and regulates volume of body fluids.
- Important for muscle contraction, nerve impulses.
- Most abundance electrolyte in ECF.
Tell me about Potassium.
- Chief regulator of cellular enzyme activity and water content.
- Important in transmission of electrical impulses (especially in heart, nerve, muscle, intestinal, lung tissue).
- Major intracellular (ICF) electrolyte.
Tell me about Calcium.
- Never impulse, blood clotting, muscle contraction, B12 absorption.
- Major role in transmitting nerve impulses.
- Regulated muscle contraction and relaxation.
Tell me about fluid. Why does body need water?
- Body requires water to maintain homeostasis:
- Transport nutrients/waste to/from cells.
- Allows for transport of hormones, enzymes, blood.
- Facilitates metabolism & cellular functioning.
- Acts as solvent.
- Maintains body temperature.
- Tissue lubricant.
- Aids in digestion.
Tonicity of Fluid: What is HYPERtonic fluid?
- HYPERtonic fluid = HIGH osmolality.
- Causes fluid shift out of cells.
- Leads to cell death.
- Example: 0.9% Normal Saline is ISOtonic. 3% Saline solution is HYPERtonic.
Tonicity of Fluid: What is HYPOtonic fluid?
- HYPOtonic = LOW osmolality.
- Causes fluid shift from intravascular space to interstitial and intracellular space (into cells).
- Cells will swell and burst.
- Example: 0.9% Normal Saline = ISOtonic. 0.45% Saline solution is HYPOtonic.
HYPERtonic versus HYPOtonic?
- These are relative terms; they compare two solutions of a solute dissolved in water. In terms of solute concentration, a hypertonic solution has a higher concentration of solute than another; a hypotonic solution has a lower solute concentration than another; an isotonic solution has a solute concentration the same as another.
- Since a red blood cell has a salt concentration of about 0.89%, putting it into hypertonic solution (>0.89%) would pull water out of the cell; putting it into a hypotonic solution (<0.89%) would cause water to flow into the cell, making it swell to bursting; putting it into an isotonic solution (=0.89%) would have no effect.
What happens with HYPOvolemia (Fluid Volume Deficit)?
- Colloid osmotic pressure forces fluid from interstitial space to intravascular space.
- Interstitial space becomes HYPERtonic.
- Hypertonicity forces fluid from cells to interstitial space.
- Cells become dehydrated and cannot function.
- Can lead to cell death.
- Risk factors include -- N/V, diarrhea, excess sweating, polyuria, NG suctioning, blood loss, anorexia, impaired swallowing.
What is "third spacing?"
- Mvmt of fluid from intravascular space.
- Distributional shift of body fluids into potential body spaces (peritoneal cavity--presents as ascites, pleural space, pericardial space, joint cavities, bowel, interstitial space).
- Results from -- disruption of colloid pressure, IV fluid replacement w/ kidney dysfunction, hyponatremia, burn, bowel obstruction, hypoalbumineamia, increased capillary hydrostatic pressure.
What is HYPERvolemia (Fluid Volume Overload)?
- HYPERvolemia is the retention of water (and sodium) in the ECF (either in the intravascular or insterstitial (presents as edema) compartments).
- 1+ pitting = a 2 mm indentation
- 2+ pitting = a 4 mm indentation
- 3+ pitting = a 6 mm indentation
- 4+ pitting = a 8 mm indentation.
- This can impede normal circulation (due to pressure).
Hemoglobin (g/dL) (CBC)
- Male: 13.5 - 16.5 g/dL
- Female: 12 - 15 g/dL
Hematocrit (%) (CBC)
- Male: 41 - 50 %
- (in a pinch remember 40-50)
- Female: 36 - 44 %
- (in a pinch remember 35-45)
If values are low = anemia. Monitor for fatigue, dyspnea, tachycardia, tachypnea.
Platelet count range: 100,000 - 450,000 (usually read as "100 - 450.")
White Blood Cells (WBC) (cells/mL) (CBC)
Range: 4,500 - 10,000 (usually read as "4.5 - 10.")
>10,000 indicates systemic infection (more than just local colonization).
Glucose, fasting (mg/dL)
60 - 110 mg/dL
3.2 - 5 g/dL
Blood Urea Nitrogen (BUN) (mg/dL)
7 - 20 mg/dL
0.5 - 1.4 mg/dL
This measures renal function. High values are bad and may indicate nephropathy, ESRD.
What are the ASSESSMENTS you'll do?
- Physical assessment and history (incl vitals, resp, cardiac, neuro, GI, skin/mucous, N/V/D, wounds).
- Medication incl OTC's and herbals.
- Fluid I/O.
- Daily weights (to determine fluid retention) (>2lbs in 24 hrs or >5lbs in a week)
- Labs (CBC, CMP, BUN, Creatinine, Urine pH, ABG's).
What are the nursing DIAGNOSES?
- Electrolyte imbalance
- Risk for falls
- Fluid volume overload
- Fluid volume deficit
- Decreased cardiac output
- Acute confusion
- Deficient knowledge
What are the INTERVENTIONS you'll do?
- Electrolyte replacement
- Lab monitoring
- Safety precautions
- Monitor I/O
- Nutrition teaching