health care
Chapter 11: Care of Patients with Fluid and Electrolyte Balance
Hypervolemia
S/S: pitting edema, increased HR/BP/HR, distended neck and hand veins, weight gain, SOB, lung crackles,
pale/cool skin, decreased lab values, alter LOC
Treatment: patient safety (assess every 2 hours for PE), assess for skin breakdown (skin care), provide
supplemental O2 and position patient in semi-fowler’s to improve SOB, furosemide, fluid restriction,
monitor daily weight and output, restrict Na/low sodium diet (water follows)
Hypovolemia
S/S: increased HR, orthostatic hypotension (increased risk for falls), weak/thready pulse, flattened
neck/hand veins, increased RR, decreased turgor, warm/dry skin, dry mucous membranes, fever,
decreased urine and increased concentration, increased lab values
Treatment: fluid replacement (monitor pulse rate/quality and urine output of 30 ml/hr. during
rehydration), antidiarrheals, antiemetics, antipyretics
Calcium: Hypercalcemia
Causes: hyperparathyroidism/hyperthyroidism, dehydration, use of thiazide diuretics, use of
glucocorticoids, kidney failure, malignancy, excessive intake of calcium or vitamin D
S/S: (EKG CHANGES FROM CLOT): cyanosis, pallor, EKG changes, increased risk for blood clots, profound
muscle weakness, decreased DTR, decreased peristalsis/bowel sounds, constipation, kidney stone
formation
Calcium: Hypocalcemia
Causes: lactose intolerance, Crohn’s disease, celiac disease, acute pancreatitis, ESKD, diarrhea, wound
drainage, alkalosis (hyperventilation), hyperproteinemia
S/S: (HYPERACTIVE CRAMPS): muscle spasms (“charley horses”), tetany, hyperactive reflexes, +
Trousseau’s and Chvostek’s signs, arrythmias, weak/thready pulse, painful abdominal cramping,
diarrhea, loss of bone density (osteoporosis), brittle/fragile bones (may break with slight trauma),
confusion
Normal Calcium (Ca+): 9.0-10.5mg/dL
Potassium: Hypokalemia
Causes: diuretics, alkalosis (hyperventilation), TPN, NPO, Cushing’s syndrome, vomiting, wound drainage,
prolonged NG suctioning, heat-induced/excessive diaphoresis, corticosteroids, increased aldosterone
S/S: (SLOW, LOW, + LETHAL): low/shallow respirations, muscle weakness, reduced DTR, leg cramps, limp
muscles, lethal cardiac changes, low BP and HR, increased urine output, decreased bowel sounds
(constipation)
Normal Potassium (K+): 3.5-5.0 mEq/L
,Magnesium: Hypomagnesemia
S/S: (HYPERACTIVE TWITCHING/SEIZING): HTN, dysrhythmias, constipation, hyperactive DTRs,
involuntary movements, + Trousseau’s and Chvostek’s signs, Torsade’s de Pointes, weak respirations
Normal Magnesium (Mg+): 1.8-2.6 mEq/L
Sodium: Hyponatremia
S/S: (SALT LOSS): confusion, trouble concentrating, seizures, stupor, muscle weakness/spasms,
diminished DTRs, abdominal cramping, increased urine output, loss of appetite, shallow respirations,
orthostatic hypotension, diarrhea
Normal Sodium (Na+): 136-145 mEq/L
Chapter 12: Care of Patients with Problems of Acid-Base Balance
ABG Interpretation
1. Is the pH out of range? (in range and opposite direction-fully compensated; out of range and opposite
direction-partially compensated; same direction-uncompensated)
2. Is the PaCO2 normal/out of range? (respiratory)
3. Is the HCO3 normal/out of range? (metabolic)
4. Match the one (PaCO2 or HCO3) that is the same as the pH. (acidosis or alkalosis)
5. Does the one that does not match/remains go in the opposite direction of pH? (compensation)
6. Is PaO2 and O2 sat out of range? (hypoxemia)
Respiratory Acidosis/Metabolic Acidosis
Interpretation: Kussmaul breathing, hyperkalemia, warm/dry/pink skin
Causes: hypoventilation, asthma, COPD, pneumonia, in table below
Respiratory Alkalosis/Metabolic Alkalosis
Interpretation: hypocalcemia and hypokalemia, dizziness, twitching, tingling, increased HR and RR
Causes: in table below
Common Causes of Alkalosis
Metabolic Alkalosis
Increase of base components Oral ingestion of bases:
Antacids
Parenteral base administration:
Blood transfusion
Sodium bicarbonate
Total parenteral nutrition
Decrease of acid components Prolonged vomiting
Nasogastric suctioning
Hypercortisolism
Hyperaldosteronism
Thiazide diuretics
Respiratory Alkalosis
Excessive loss of carbon dioxide Hyperventilation, fear, anxiety
Mechanical ventilation
Salicylate toxicity
High altitudes
Shock
Early-stage acute pulmonary problems
, Common Causes of Acidosis
Metabolic Acidosis
Overproduction of hydrogen ions Excessive oxidation of fatty acids:
Diabetic ketoacidosis
Starvation
Hypermetabolism:
Heavy exercise
Seizure activity
Fever
Hypoxia, ischemia
Excessive ingestion of acids:
Ethanol or methanol intoxication
Salicylate intoxication
Under-elimination of hydrogen ions Kidney failure
Underproduction of bicarbonate Kidney failure
Pancreatitis
Liver failure
Dehydration
Over-elimination of bicarbonate Diarrhea
Respiratory Acidosis
Under-elimination of hydrogen ions Respiratory depression:
Anesthetics
Drugs (especially opioids)
Electrolyte imbalance
Inadequate chest expansion:
Muscle weakness
Airway obstruction
Alveolar-capillary block
Acid-Base Assessment
TEST ARTERIAL SIGNIFICANCE OF ABNORMAL FINDINGS
pH Increased: Metabolic alkalosis, loss of gastric fluids, decreased potassium intake,
diuretic therapy, fever, salicylate toxicity, respiratory alkalosis, hyperventilation
7.35-7.45 Decreased: Metabolic or respiratory acidosis, ketosis, renal failure, starvation,
diarrhea, hyperthyroidism
Chapter 11: Care of Patients with Fluid and Electrolyte Balance
Hypervolemia
S/S: pitting edema, increased HR/BP/HR, distended neck and hand veins, weight gain, SOB, lung crackles,
pale/cool skin, decreased lab values, alter LOC
Treatment: patient safety (assess every 2 hours for PE), assess for skin breakdown (skin care), provide
supplemental O2 and position patient in semi-fowler’s to improve SOB, furosemide, fluid restriction,
monitor daily weight and output, restrict Na/low sodium diet (water follows)
Hypovolemia
S/S: increased HR, orthostatic hypotension (increased risk for falls), weak/thready pulse, flattened
neck/hand veins, increased RR, decreased turgor, warm/dry skin, dry mucous membranes, fever,
decreased urine and increased concentration, increased lab values
Treatment: fluid replacement (monitor pulse rate/quality and urine output of 30 ml/hr. during
rehydration), antidiarrheals, antiemetics, antipyretics
Calcium: Hypercalcemia
Causes: hyperparathyroidism/hyperthyroidism, dehydration, use of thiazide diuretics, use of
glucocorticoids, kidney failure, malignancy, excessive intake of calcium or vitamin D
S/S: (EKG CHANGES FROM CLOT): cyanosis, pallor, EKG changes, increased risk for blood clots, profound
muscle weakness, decreased DTR, decreased peristalsis/bowel sounds, constipation, kidney stone
formation
Calcium: Hypocalcemia
Causes: lactose intolerance, Crohn’s disease, celiac disease, acute pancreatitis, ESKD, diarrhea, wound
drainage, alkalosis (hyperventilation), hyperproteinemia
S/S: (HYPERACTIVE CRAMPS): muscle spasms (“charley horses”), tetany, hyperactive reflexes, +
Trousseau’s and Chvostek’s signs, arrythmias, weak/thready pulse, painful abdominal cramping,
diarrhea, loss of bone density (osteoporosis), brittle/fragile bones (may break with slight trauma),
confusion
Normal Calcium (Ca+): 9.0-10.5mg/dL
Potassium: Hypokalemia
Causes: diuretics, alkalosis (hyperventilation), TPN, NPO, Cushing’s syndrome, vomiting, wound drainage,
prolonged NG suctioning, heat-induced/excessive diaphoresis, corticosteroids, increased aldosterone
S/S: (SLOW, LOW, + LETHAL): low/shallow respirations, muscle weakness, reduced DTR, leg cramps, limp
muscles, lethal cardiac changes, low BP and HR, increased urine output, decreased bowel sounds
(constipation)
Normal Potassium (K+): 3.5-5.0 mEq/L
,Magnesium: Hypomagnesemia
S/S: (HYPERACTIVE TWITCHING/SEIZING): HTN, dysrhythmias, constipation, hyperactive DTRs,
involuntary movements, + Trousseau’s and Chvostek’s signs, Torsade’s de Pointes, weak respirations
Normal Magnesium (Mg+): 1.8-2.6 mEq/L
Sodium: Hyponatremia
S/S: (SALT LOSS): confusion, trouble concentrating, seizures, stupor, muscle weakness/spasms,
diminished DTRs, abdominal cramping, increased urine output, loss of appetite, shallow respirations,
orthostatic hypotension, diarrhea
Normal Sodium (Na+): 136-145 mEq/L
Chapter 12: Care of Patients with Problems of Acid-Base Balance
ABG Interpretation
1. Is the pH out of range? (in range and opposite direction-fully compensated; out of range and opposite
direction-partially compensated; same direction-uncompensated)
2. Is the PaCO2 normal/out of range? (respiratory)
3. Is the HCO3 normal/out of range? (metabolic)
4. Match the one (PaCO2 or HCO3) that is the same as the pH. (acidosis or alkalosis)
5. Does the one that does not match/remains go in the opposite direction of pH? (compensation)
6. Is PaO2 and O2 sat out of range? (hypoxemia)
Respiratory Acidosis/Metabolic Acidosis
Interpretation: Kussmaul breathing, hyperkalemia, warm/dry/pink skin
Causes: hypoventilation, asthma, COPD, pneumonia, in table below
Respiratory Alkalosis/Metabolic Alkalosis
Interpretation: hypocalcemia and hypokalemia, dizziness, twitching, tingling, increased HR and RR
Causes: in table below
Common Causes of Alkalosis
Metabolic Alkalosis
Increase of base components Oral ingestion of bases:
Antacids
Parenteral base administration:
Blood transfusion
Sodium bicarbonate
Total parenteral nutrition
Decrease of acid components Prolonged vomiting
Nasogastric suctioning
Hypercortisolism
Hyperaldosteronism
Thiazide diuretics
Respiratory Alkalosis
Excessive loss of carbon dioxide Hyperventilation, fear, anxiety
Mechanical ventilation
Salicylate toxicity
High altitudes
Shock
Early-stage acute pulmonary problems
, Common Causes of Acidosis
Metabolic Acidosis
Overproduction of hydrogen ions Excessive oxidation of fatty acids:
Diabetic ketoacidosis
Starvation
Hypermetabolism:
Heavy exercise
Seizure activity
Fever
Hypoxia, ischemia
Excessive ingestion of acids:
Ethanol or methanol intoxication
Salicylate intoxication
Under-elimination of hydrogen ions Kidney failure
Underproduction of bicarbonate Kidney failure
Pancreatitis
Liver failure
Dehydration
Over-elimination of bicarbonate Diarrhea
Respiratory Acidosis
Under-elimination of hydrogen ions Respiratory depression:
Anesthetics
Drugs (especially opioids)
Electrolyte imbalance
Inadequate chest expansion:
Muscle weakness
Airway obstruction
Alveolar-capillary block
Acid-Base Assessment
TEST ARTERIAL SIGNIFICANCE OF ABNORMAL FINDINGS
pH Increased: Metabolic alkalosis, loss of gastric fluids, decreased potassium intake,
diuretic therapy, fever, salicylate toxicity, respiratory alkalosis, hyperventilation
7.35-7.45 Decreased: Metabolic or respiratory acidosis, ketosis, renal failure, starvation,
diarrhea, hyperthyroidism
