RNUR 238 - Adult 2 Final Exam Questions and Answers Verified 100% Graded A

CLINICAL MANIFESTATIONS OF FVD - CAN DEVELOP RAPIDLY SEVERITY DEPENDS ON DEGREE OF LOSS weight loss, decreased skin turgor, oliguria, delayed cap refill, decreased BP, low CVP, flattened neck veins, dizziness, weakness, thirst, confusion, muscle cramps, increased pulse, sunken eyes, increased temp cool, clammy skin, increased hgb, hct, BUN, creatnine, urine specific gravity CLINICAL MANIFESTATION OF FVE - EDEMA, DISTENDED NECK VEINS, CRACKLES, weight gain, distended jugular vein, elevated CVP, shortness of breathe, increased BP, increased urine output, increased RR, bounding pulse decreased hgb, hct, urine sodium and specific gravity Hyponatremia causes - "Serum sodium below 135 mEq/L (normal 135-145) Increased sodium excretion -Excessive diaphoresis, diuretics, vomiting, diarrhea, wound drainage (Especially GI), kidney disease, decreased secretion of aldosterone (Addison's) Inadequate sodium intake - Fasting, NPO Dilution of serum sodium - Excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids, kidney disease, syndrome of inappropriate antidiuretic hormone secretion, hyperglycemia, HF" Hyponatremia Signs/symptoms - "SALT LOSS" - mEq/L 135 Seizures/stupor, Abdominal cramping, Lethargic, Tendon reflex diminished Loss of urine/appetite, Orthostatic hypotension, Shallow respirations, Spasms Hypernatremia Causes - Sodium levels 145 mEq/L Causes Decreased sodium excretion Corticosteroids, Excessive Cortisol (Cushing's syndrome - causes high Na, low K), Kidney disease, Hyperaldosteronism (Conn's syndrome), excessive sodium intake (oral or IV), decreased h20 intake Increased water loss - fever, infection, excessive diaphoresis, watery diarrhea, diabetes insipidus "Hypernatremia Signs and symptoms ""FRIED""" - "FRIED" Fatigue, Restless & agitated, Increased reflexes, Extreme thirst, Decreased urinary output, dry mouth/skin Electrolytes Cations and their ranges (Na, K, Ca, H, Mg) - Cations - positive charge ions Na - 135-145 mEq/L K - 3.5-5 mEq/L Ca - 8.6-10.2 mg/L H - 7.35-7.45 pH Mg - 1.3-3 mg/dL Electrolytes Anions and their ranges (Cl, Hc03, PO43−) - Anions - negative charged ions Cl - 97-107 mEq/L Hc03(Bicarb) - 22-26 mEq/L Phosphate (PO43−) - 2.5 to 4.5 mg/dL. Non-electrolytes Glucose, Urea "Hypokalemia Range Causes Signs/symptoms Lotta ""Ls""" - Hypokalemia - deficit in ECF - common 3.5 mEq/L Caused by vomiting, gastric suction(NG), diarrhea, alkalosis and diuretic use (K+ wasting like Lasix). Cushing's syndrome - (causes high Na, low K) K+ moves from cell to ECF to maintain balance - causes an ICF deficit s/sx - muscle weakness(seen first), leg cramps, fatigue, paresthesia, arrhythmias (cardiac abnormalities) Low and slow - Lethargic, Low & shallow respirations, Lethal dysrhythmias, Lots of urine, Leg cramps, Limp muscles, Low BP/HR Treatment - supplemental K+ PO - Do not crush/chew Liq - must be mixed with water IV - NEVER EVER EVER IV push IV potassium is diluted/piggybacked,and given slowly. Hyperkalemia Range Signs symptoms MURDER Mnemonic - Excess K+ in the ECF 5 mEq/L Caused by excessive K+ intake, kidney disease, Addison's (low aldosterone), meds (NSAIDs, ACE inhibitors, K+ sparing diuretics) s/sx - leads to cardiac arrhythmias and cardiac irregularities, renal failure (90% of K+ excreted through kidneys) Mnemonic - MURDER Muscle weakness, Urine/oliguria/anuria, Respiratory distress, Decreased cardiac contractility, ECG changes (Tall T, Flat P, Wide QRS, Prolonged PR), Reflexes: hyperreflexia or areflexia Calcium Range & Function. Relationship with Phosphorus - Calcium - 8.6-10.2 mg/dl Absorbed in GI, stored in bones. Used for muscles/nerve impulses, bones, clotting. Has an inverse relationship with Phosphorus. Regulated by the parathyroid, Calcitonin & Vitamin D sources Hypocalcemia Definition Range CATS CRAMPS - Hypocalcemia - Deficit of calcium in extracellular fluid - 8.6 mg/dl Tends to accompany hypomagnesemia, calcium and magnesium move the same However, calcium directly or indirectly competes with magnesium for intestinal absorption and transport Risks & causes: inadequate Ca intake, impaired Ca absorption, excessive Ca loss, loss of GI fluids Signs: CATS: Convulsions, Arrhythmias, Tetany, Spasms Alternative Mnemonic - CRAMPS Convulsions, Reflexes hyperactive, Arrhythmias, Muscle spasms, Positive signs (Chvostek's & Trousseau's), Sensation/tingling/numbness (paresthesia) Chvostek's - Facial muscle twitch in response to light or light facial poke near ear Trousseau's - Carpel spasm induced by BP cuff inflation