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sign of what imbalance?
shortness of breath
effervescent medications can cause what fluid imbalance?
- ECV Excess
- lots of sodium -> retain fluids
what fluid do you give for ECV deficit?
normal saline (isotonic)
what solution do you need to treat hypernatremia?
in clinical dehydration, what solutions do you use to treat?
- first normal saline (address low blood volume first)
- then address concentration problem with 1/2 normal saline, 1/2 d5w
low urine output
what effect would renal failure have on fluid levels?
decrease Na+/H20 output
cirrhosis and congestive heart failure both prompt what hormonal change? What does this do to fluid levels?
- secretion of excessive aldosterone
- decrease Na+/H20 output
excessive output of urine
bedrest can cause what to happen to fluid balances?
diuresis- increased urine output (legs are at same level of heart -> increased renal output)
crackles and rales are a a sign of which fluid imbalance?
dyspnea/orthopnea are signs of which fluid imblance?
lightheadedness may be a sign of which fluid imbalance?
soft, sunken eyeballs and longitudinal furrows in tongue are a sign of which fluid imbalance?
serum sodium concentration reflects osmolality of just blood, or whole body?
just blood/other body fluids
diabetes insipidus may cause which fluid imbalance?
- lose more water than salt
with excess sweating and diarrhea (without replacement), do you lose more water, more salt, or equal amounts of both?
more water than salt -> hypernatremia
if an older adult is on diuretic therapy, are they at risk to lose more water, more salt, or equal amounts of both?
lose more salt than water
seizures and coma may be a sign of what osmolality imbalance?
hypernatremia AND hyponatremia
nausea and emesis: which osmolality imbalance?
why do both hyper and hyponatremia cause confusion and lethargy?
- alter the way neurons function
- hypo: brain cell swells
- hyper: cell shrivels
which hormone puts calcium into blood?
which hormone removes calcium from blood?
is calcium that is bound to albumin in blood physiologically active?
no, needs to be free
which electrolyte imbalances are floppy?
which electrolyte imbalances are twitchy?
what do you need for optimal absorption of calcium?
what can cause a deficit of calcium, potassium or magnesium? (general)
take in less than put out, supply shifts from available form to storage pool
what can cause an electrolyte excess? (general)
greater intake than output, supply shifts from storage pool into plasma
how does steatorrhea affect calcium levels?
- undigested fats bind to calcium
- may decrease intake/absorption
- may increase output
acute diarrhea may lead to which electrolyte imbalance?
hypokalemia (increased excretion)
how does pancreatitis affect electrolyte levels?
- can't digest fat -> undigested fat in colon
- calcium and magnesium bind to fat and are excreted
what hormone do low magnesium levels affect? What does this cause?
hypomagnesium -> low parathyroid -> calcium does not shift from bone to available blood
signs of hypocalcemia
- positive Chvostek sign
- positive Trousseau sign
- muscle twitching, cramping
- carpopedal spasm
- cardiac dysrhythmias
signs and symptoms of hypercalcemia
- muscle weakness, fatigue
- PERSONALITY AND MOOD CHANGES
if hypercalcemia, what should you do to your fluid intake?
drink a lot of fluid to keep urine dilute (prevents renal damage)
calcium rich foods
- cream of wheat
- fish with bones (salmon, sardines)
- corn tortillas
what 3 things cause potassium to move out of plasma and into cells?
insulin, alkalosis, epinephrine
high levels of potassium in the blood stimulate the release of what hormone?
factors that decrease K+ intake
- NPO status
- unusual weight-loss diet w/o K+
- IV therapy w/o K+
factors that increase K+ intake
- too much/too fast IV with KCl
- insufficient mixing of IV bag
- administration of stored blood
cushing's syndrome (glucocorticoid excess) make cause what electrolye imbalance?
increased output of potassium
hypomagnesemia may cause increased output of which electrolyte?
- (also causes shift of calcium into bone)
potassium imbalances affect what?
smooth, skeletal and cardiac muscles
bilateral and ascending flaccid paralysis may indicate what?
- hyperkalemia (doesn't ascend as far)
dysrhythmias caused by _______ are among the potentially most dangerous ones
abdominal distension, decreased bowel sounds, constipation, polyuria, flaccid skeletal muscle weakness and cardian dysrhythmias
flaccid skeletal muscle weakness, transient intestinal cramping and diarrhea, cardiac dysrhythmias
salt substitutes put you at risk for which imbalance?
hyperkalemia (contain KCl)
potassium rich foods
- beets/green beans
- carrots, cauliflower, celery, potatoes
- pumpkin, squash
- almonds, brazil nuts, cashews, sunflower seeds
- instant coffee
chronic alcoholism and magnesium
causes increased output (undigested fats from liver failure?)
unbound fats may bind to magnesium or calcium -> decreased intake/absorption, increased output
aspiration of sea water may increase levels of which electrolyte?
positive chvostek and trousseau sign are signs of what imbalances?
magnesium imbalances affect what?
neuromuscular excitability, deep tendon reflexes
an exaggerated patellar reflex may be a sign of
decreased reflex response
magnesium rich foods
- egg yolk
- DGLV's -> have chlorophyll
- whole grain cereals