Med Surg

2.5 mg/dl

9.0 mg/dl b/c calcium and phosphorus have an inverse relationship

Muscle weakness and cardiac arryhthmias

• Skeletal muscle weakness
• Uwave
• Constipation (Ileus)
• Toxic effect of drugs
• Irregular weak pulse
• Ortho hypotension
• Numbness

• Agitation in pt
• Low grade fever
• Thirst

Cells to swell in the CNS

CNS issues normally indicate Sodium Imbalance

• This would indicate Respiratory Acidosis
• the RN will teach slow deep breathing to get rid of CO2 and decrease acid
• provide low does O2 if needed

pH ^ >7.45 pco2 < 22

• Symptoms:
• Tingling in extremities
• Confusion
• Deep rapid breathing
• seizures
• lightheaded/dizziness
• weak/thready pulse

• Treat Cause (Hyperventilation, Mechanical Vent, extreme anxiety)
• Sedatives
• Check electrolyte levels
• K, Ca, & Phosphate are commonly decreased

• pH < 7.35 pco2 > 45
• Symptoms:
• Rapid shallow breathing
• dyspnea
• disorientation
• muscle weakness
• ^ Pulse
• ^ BP & RR

• Vitals
• Treat cause ( hypoventilation/ inadequate ventilation, acute pneumonia, COPD)
• semi fowlers position
• quite enviornment
• bronchodiolators
• antibiotics

• ^ pH > 7.45 ^HCO3 >26
• Symptoms:
• confusion
• belligerence
• tetany
• hypertonic muscles
• slow shallow RR
• possible apnea
• nausea & vomiting
• diarrhea
• restlessness
• arrythmias

• treat cause ( N&V, excessive antacid intake, hypokalemia, hyperventilation)
• VS
• lab values
• promote hydration
• safety

• pH < 7.35 HCO3 < 22
• Symptoms:
• Disorientation
• Kussmaul respirations (deep labored breathing)
• muscle twitching
• changes in LOC
• headache
• drowsiness
• ^ RR
• hypotension
• abd. pain
• cold clammy skin

• VS
• Monitor:
• Cap. refill
• warmth & color of extremities
• LOC
• GI

• Sodium Bicarb maybe ordered by the doc.
• as well as fluids

• amt of urea nitrogen in the blood
• urea is a waste product of protein metabolism
• norm is 10-20 mg/dl
• ^ could mean poor renal perfusion or damage, dehydration, ^ protein diet, GI bleed
• low could mean low protein diet, starvation, liver disease, over hydration, ^ ADH

# of active particles in a solution

280-300 mOsm/kg H2O

• 50-1400 mOsm/kg H20 & concentration of urine
• ^ indicates dehydration or fluid vol. deficit
• low indicates excess fluid

• kidney's ability to secrete or conserve H2O range of 1.001-1.040
• low idicates dilute urine
• ^ indicates concentrated urine which could mean lack of fluids, ^ ADH secretion (caused by trauma/stress) which causes decrease in urine

• waste product of creatinine phosphate
• ^ nephron damage
• low atrophy of muscle tissue
• Norm 0.6-1.5
• Best indicator of renal function

• vol of RBCs in whole blood
• 40-54% for males
• 37-47% for females
• ^ in dehydration
• low in over hyrdration or anemia

• an abnormal loss of vol.
• caused by inadequate intake, loss during surgery, vomiting, diarrhea, fever, hemorrhage, 3rd spacing

restlessness, decreased skin turgor, concentrated urine, oliguria, ^ HR, ^ RR, thirst, clammy skin r/t peripheral vasoconstriction, decreased temp, dizziness, decreased CVP, dry mucous membranes, wt loss, lethargy

• ^ HCT (concentrated in decreased plasma vol)
• ^ BUN due to decreased renal perfusion
• ^ specific gravity

• Isotonic solutions (LR .9 NaCl) to expand plasma volume
• Monitor:
• I&Os
• CVP
• VS
• LOC
• Breath sounds
• skin turgor
• mucous membranes
• color & perfusion
• fluid vol challenges
• admin blood if loss is r/t blood

• expansion of ECF due to abnorm retention of H20 & Na
• Causes:
• CHF
• Renal faliure
• cirrhosis
• excessive salt intake

physical: edema, neck vein distention, tachycardia, crackles, ^ BP, ^ CVP, weight gain, SOB, ^ output, bounding pulses, ployurea

labs: decreased BUN and Hct (due to plasma dilution), decreased serum and urine osmolality and SG, CXR may slow pulmonary congestion

• treat cause
• monitor:
• I&Os
• daily weights
• edema
• vein distention
• breath sounds
• labs
• diuretics
• fluid restrictions
• Na restricted diets

• pitting
• 1+ slight indentation
• 2+ moderate pitting
• 3+ 6mm indent
• 4+ 8mm indent, severe

• monitor
• I&Os
• JVD
• pulses
• BP
• HR
• Lung sounds
• Daily weights
• skin assessment
• mucous membranes
• LOC

signs of hypovolemia

signs of hypervolemia

• numbness & tingling
• muscle weakness

Sodium

• S&S
• ^ thirst
• dry/sticky mucous membranes
• restlessness
• ^ temp
• disorientation
• oliguria
• flushed skin
• agitation

• Monitor:
• I&Os
• adequate H2O intake
• pts at risk
• IV fluids
• Labs
• VS
• daily weights
• skin turgor
• CVP
• LOC
• pupillary reaction

• S&S:
• nausea
• muscle/abd cramps
• lethargy
• cerebral edema
• confusion
• muscle twitching
• hemi paresis or seizures

causes of hyponatermia

• treat cause
• Na replacement ( P.O. if possible, lactated ringers, 0.9 NaCl, 100 meq/day
• H20 restriction if norm or excess fluid vol
• Hypertonic NaCl solutions if neuro effects

• resp alkalosis
• RN dx: ineffectie airway clearance/ irreg. breathing pattern r/t bronchoconstriction & mucous.

resp. acidosis

RN dx: impaired gas exchange

an emergency "quick" med

steriods are used for long term results