susan hench, rn, msn assistant professor of nursing n102
TRANSCRIPT
![Page 1: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/1.jpg)
Susan Hench, RN, MSNAssistant Professor of Nursing
N102
![Page 2: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/2.jpg)
ReviewThis section is a review of fluid
balance and IV fluid. This should not be new material.
![Page 3: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/3.jpg)
Parenteral SolutionsIV fluidHow it works depends on how its osmolarity compares to the patient’s serum osmolarity
Involves osmotic pressureOsmolarity of body fluids is between 280 and 295
![Page 4: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/4.jpg)
Three ways IV fluids workExpand the intravascular fluid volume
Expand the intravasular fluid volume and deplete the intracellular and interstitial fluid volume
Expand the intracellular fluid volume and deplete the intravascular fluid volume
![Page 5: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/5.jpg)
Isotonic FluidConcentration of solute equal to that of intracellular fluid
Osmotic pressure same inside and outside cells – cells neither shrink or swell
Fluid stays in the blood vessels
![Page 6: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/6.jpg)
Isotonic FluidExamples
0.9% Sodium Chloride (NSS)5% Dextrose In Water (D5W)0.2% Dextrose And 0.9% NACL
(1/4DNSS)5% Dextrose And 0.2% NACL
(D51/4NSS)Lactated Ringers (LR or RL)
![Page 7: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/7.jpg)
Isotonic FluidCaution
Can cause circulatory overloadFluids do not cause shifts into other compartments
Can lower H & H and electrolytes by diluting them
![Page 8: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/8.jpg)
Hypotonic FluidTonicity less than that of intracellular fluid
Osmotic pressure draws water into the cells from the extracellular fluid
Body fluids shift out of the blood into the interstitial areas and into the cells
![Page 9: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/9.jpg)
Hypotonic FluidExamples
0.45% NaCL (1/2 NS)0.33% NaCL (1/3 NS)0.2% NaCL (1/4 NS)2.5% Dextrose In Water
![Page 10: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/10.jpg)
Hypotonic FluidCaution
Infusing too much can cause intravascular fluid depletion, lower BP, cause edema, and damage cells
Use cautiously in patients with heart, renal and liver disease
![Page 11: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/11.jpg)
Hypertonic FluidTonicity is greater than that of intracellular fluid
Shifts fluid from ICF to ECF to intravascular space so blood volume expands
![Page 12: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/12.jpg)
Hypertonic FluidExamples
5% Dextrose In 0.45% NSS (D5 1/2NS)
5% Dextrose In NSS (D5NS)5% Dextrose In LR (D5LR)10% Dextrose In Water (D10W)
![Page 13: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/13.jpg)
Hypertonic FluidCaution
Give slowly – use an IV pump and monitor for circulatory overload
![Page 14: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/14.jpg)
Maintaining Fluid BalanceA number of body processes work together to maintain fluid balance
A problem in any of those processes can affect the entire fluid-maintenance system
![Page 15: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/15.jpg)
A problem in any one of these areas can create fluid and electrolyte imbalancesKidneysPituitary GlandHypothalamusHormone
Levels
![Page 16: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/16.jpg)
HypovolemiaFluid volume deficitIsotonic fluid loss from extracellular space to interstitial space
Children and older adults prone to this condition
![Page 17: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/17.jpg)
HypovolemiaResults from excessive fluid loss
Bleeding with or without reduced fluid intake
VomitingExcessive diarrheaExcessive perspiration with too little
fluid intakeDrainage from wounds or burns
![Page 18: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/18.jpg)
HypovolemiaClinical Manifestations
Weight lossOrthostatic hypotensionConfusion, irritability, thirstRapid pulse, drop in BPSkin cool and clammyDecreased urine output
![Page 19: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/19.jpg)
FLUID AND ELECTROLYTE BALANCEHypovolemia
Diagnostic findingsIncreased urine specific gravity
Increased H & HElevated BUN
![Page 20: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/20.jpg)
FLUID AND ELECTROLYTE BALANCEHypovolemia
Nursing implicationsProvide fluids-both PO and IVMonitor vital signs
![Page 21: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/21.jpg)
HypovolemiaCan also result from third space fluid shiftCalled third spacingFluid shift from intravascular space into interstitial space of the peritoneal, pleural, or pericardial space causing edema
![Page 22: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/22.jpg)
Third space fluid shiftWater and solutes in the third space are not available to maintain normal body fluid and electrolyte balances
Caused by acute bowel obstruction, ascites, pancreatitis, peritonitis
![Page 23: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/23.jpg)
HypervolemiaFluid overloadFluid volume excessExcess of isotonic fluids in the extracellular compartment
Edema
![Page 24: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/24.jpg)
HypervolemiaCauses
Excessive administration of oral or IV fluids
Syndrome of inappropriate antidiuretic hormone (SIADH)
Excessive water intakeHeart failureRenal failure
![Page 25: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/25.jpg)
HypervolemiaClinical Manifestations
Cardiovascular changesRespiratory changesEdemaConfusion or altered locSkeletal muscle weakness
![Page 26: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/26.jpg)
HypervolemiaDiagnostic Findings
H & H tend to be lowerDecreased urine specific gravityIf renal failure is the cause, electrolytes, BUN, and creatinine levels are increased because the kidneys are unable to excrete them
![Page 27: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/27.jpg)
HypervolemiaNursing Implications
May be given diureticsFluid and/ or sodium restrictionDaily weightsI & OMonitor edema, lung sounds, vital
signsGoal is to restore fluid balance
![Page 28: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/28.jpg)
Any Questions So Far?
![Page 29: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/29.jpg)
Disturbance in the electrolyte balance is common in clients requiring nursing care
![Page 30: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/30.jpg)
ElectrolytesElectrically charged solutes in body fluids
Necessary to maintain balanceAlso called ions
Anions have a negative chargeCations have a positive charge
![Page 31: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/31.jpg)
Functions of ElectrolytesMaintain acid-base balancePromote neuromuscular activityMaintain body fluid osmolarityRegulate and distribute body fluids among the compartments
![Page 32: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/32.jpg)
SODIUM136-145 MEQ/LVery important, a major cationMost abundant in ECF Helps transmit impulses in nerve and
muscle fibersComines with chloride and bicarbonate
to regulate acid-base balanceRegulated by the kidneys
![Page 33: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/33.jpg)
HyponatremiaSodium deficitDilutional – loss of sodium or excessive water gain
Depletional – not taking in enough sodium
![Page 34: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/34.jpg)
HyponatremiaCauses
Prolonged diuretic therapyExcessive diaphoresisInsufficient sodium intakeExcessive sodium loss from trauma
Severe fluid loss
![Page 35: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/35.jpg)
HyponatremiaCauses
Administration of hypotonic solutions
Compulsive water drinkingLabor induction with oxytocinSIADH – Syndrome of Inappropriate Anti-Diuretic Hormone secretion
![Page 36: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/36.jpg)
HyponatremiaClinical Manifestations
General – abdominal cramps, nausea, headache, altered loc, muscle twitching, tremors, and weakness
Depletional – orthostatic hypotension, poor skin turgor, dry mucous membranes, tachycardia
Dilutional – hypertension, weight gain, bounding pulse
![Page 37: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/37.jpg)
HyponatremiaDiagnostic Findings
Serum sodium levels lowSerum chloride levels may be lowUrine specific gravity less than
1.010
![Page 38: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/38.jpg)
HyponatremiaNursing Implications
Monitor clients at riskMonitor VSMonitor neurological statusI & O, daily weightMonitor labsMay restrict fluidClient and family teaching
![Page 39: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/39.jpg)
HypernatremiaSodium excessHappens less frequently than hyponatremia
![Page 40: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/40.jpg)
HypernatremiaCauses
Inadequate intake or excessive loss of water
Administration of hypertonic solutionsHigh intake of sodiumEnteral nutritionTPN
![Page 41: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/41.jpg)
HypernatremiaCauses
Severe watery diarrheaSevere insensible water lossSevere burnsDiabetes InsipidusCushing’s SyndromeSevere renal failure
![Page 42: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/42.jpg)
HypernatremiaDiagnosis
Serum sodium levels above 145Urine specific gravity above 1.030
TreatmentAdminister hypotonic solutions
![Page 43: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/43.jpg)
HypernatremiaClinical manifestations
Extreme thirstTachycardiaNeuromuscular signsHyperactive deep tendon reflexesHypertensionLow-grade temperatureOliguria or anuria
![Page 44: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/44.jpg)
HypernatremiaNursing implications
Monitor I & ODaily weightsAssess for mental function Monitor labs Provide good oral hygieneTeach family and client about low sodium diet
![Page 45: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/45.jpg)
Potassium3.5 to 5.0 mEq/L-narrow rangeMajor cation in the ICFAffects nerve impulse transmissionAffects skeletal and cardiac muscle
contraction and conductivityAffects acid-base balanceThe body cannot conserve potassium as
it can sodium
![Page 46: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/46.jpg)
HypokalemiaCauses of low serum potassium:
Drug therapyInadequate K intakeSevere GI fluid lossesExcessive diaphoresisHigh stress
![Page 47: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/47.jpg)
HypokalemiaOther causes
High blood glucose levelsCushing’s SyndromeAlkalosisHepatic diseaseAlcoholismHeart failureNephritis
![Page 48: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/48.jpg)
HypokalemiaClinical Manifestations
Skeletal muscle weaknessParesthesias and leg crampsDeep tendon reflexes may be
decreased or absentAnorexia, N/VDrowsiness, lethargyCardiac arrhythmias
![Page 49: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/49.jpg)
HypokalemiaDiagnostic Findings
Serum K levels below 3.5Elevated blood pH and bicarbonate levels
EKG changes
![Page 50: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/50.jpg)
HypokalemiaNursing Implications
Identify clients at riskMonitor VS, labs, EKGAssess for signs of metabolic alkalosisMonitor I & OProvide safe environmentProvide teaching
![Page 51: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/51.jpg)
HyperkalemiaSerum levels over 5.0Not as common as hypokalemia
![Page 52: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/52.jpg)
HyperkalemiaCauses
Most common related health problem is renal failure
Excessive oral or parenteral administration of K
Severe widespread cell damage (from burns, trauma, crushing injuries) that causes K to leak from cells into bloodstream
Certain meds – Beta Blockers, some types of chemotherapy
Metabolic acidosisAddison’s Disease
![Page 53: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/53.jpg)
HyperkalemiaClinical manifestations
Skeletal weakness that may lead to flaccid paralysis
Muscle hyperactivity in the GI tract N/V and abdominal cramping
Cardiac complicationsArrhythmias, bradycardia, hypotension,
cardiac failureConfusion, slurred speechDecreased deep tendon reflexes
![Page 54: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/54.jpg)
HyperkalemiaDiagnostic Findings
Serum potassium above 5Decreased arterial pHEKG abnormalities
![Page 55: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/55.jpg)
HyperkalemiaNursing Implications
Emergency therapyHypertonic solutionKayexalate
Monitor VS, Labs, EKGMay give loop diureticsMonitor neuro statusMonitor for S/S of acidosisMonitor medsDiet teaching – avoid foods high in potassium
![Page 56: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/56.jpg)
Calcium9.0-10.5 MG/DL (some tests 11.0)Most abundant ion in the bodyCation in ICF and ECFResponsible for formation and structure
of bones and teethMaintains cell structure and functionAffects all muscle types Participates in blood clotting
![Page 57: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/57.jpg)
HypocalcemiaCalcium deficit with serum levels below 8.9
Risk factorsPoor dietary intakeElderlyCertain diseases
![Page 58: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/58.jpg)
HypocalcemiaCauses
Poor PO intakeProlonged immobilityStressProlonged diarrheaThyroidectomyGI tract problems
![Page 59: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/59.jpg)
HypocalcemiaCauses
Pancreatic insufficiencyMedicationsHypomagnesiaHyperphosphatemiaAlkalosisClients receiving massive blood
transfusions
![Page 60: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/60.jpg)
HypocalcemiaClinical Manifestations
Muscle cramps, spasms, or tremorsHyperactive deep tendon reflexesTetanyPositive Trousseau’ signPositive Chvostek’s signConfusion, memory lossArrhythmiasSeizures
![Page 61: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/61.jpg)
HypocalcemiaDiagnostic Findings
Serum levels less than 8.9EKG changes
![Page 62: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/62.jpg)
HypocalcemiaNursing Implications
Mild to moderate-educate client to consume food high in Ca and take a supplement
If recovering from parathyroid or thyroid surgery keep Ca gluconate at the bedsideMay have a rapid drop in Ca and need
immediate replacementMonitor persons at risk – eg those receiving
blood transfusions
![Page 63: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/63.jpg)
HypocalcemiaNursing Implications
Monitor VS and EKGBe prepared in the event of laryngospasm
Keep airway at bedsideSeizure precautions may be necessaryEvaluate for Chvostek or Trousseau Signs
http://www.youtube.com/watch?v=qHIL3pK_Nao
http://www.youtube.com/watch?v=ep6IEqnyxJU
![Page 64: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/64.jpg)
HypercalcemiaSerum calcium above 11.0Calcium excesses are not commonOccurs when the rate of Ca entry into
the ECF exceeds the rate of renal Ca excretion
Risk factorsRenal abnormalitiesMetastatic cancers – especially those
involving bone
![Page 65: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/65.jpg)
HypercalcemiaCauses
Excessive intake of Ca supplements or vitamin D
Excessive use of Ca containing antacids
Piaget’s DiseaseHyperparathyroidismThyrotoxicosisMultiple fractures and prolonged
immobilizationUse of lithium or thiazide diuretics
![Page 66: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/66.jpg)
HypercalcemiaClinical manifestations
Muscle weakness or flaccidityPersonality changes progressing to psychosesAnorexia, nausea and vomitingExtreme thirstConstipationPolyuria, renal calculiCardiac changesPathologic fracturesAltered LOC, impaired memory – can lead to
coma
![Page 67: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/67.jpg)
HypercalcemiaDiagnostic Findings
Serum levels of Ca greater than 11.0 mg/dL
Digitalis toxicity if on digoxinEKG changesX-rays revealing pathologic fractures
![Page 68: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/68.jpg)
HypercalcemiaNursing Implications
Monitor clients with parathyroid disorders, cancer
Immobile clientsMonitor I & O, IV fluid = NS Observe for signs of digoxin toxicitySafety precautionsClient and family teaching
![Page 69: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/69.jpg)
Magnesium1.2 – 2.0 mEq/LMost abundant cation in ICF after
potassiumSupplied in dietFunctions include
Promoting enzyme reactions within cellsProtein synthesisRegulates muscle contractionsInfluences body’s calcium level
![Page 70: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/70.jpg)
HypomagnesemiaMagnesium deficitRelatively commonMost common cause in the United States is chronic alcoholism
![Page 71: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/71.jpg)
HypomagnesemiaCauses
Chronic alcoholismLoss from GI tract – vomiting,
diarrhea, NG suctioningLoop and thiazide diureticsBurnsSepsisPancreatitis
![Page 72: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/72.jpg)
HypomagnesemiaClinical manifestations
Tremors, seizuresConfusionWeakness, ataxiaCardiac dysrhythmiasTetanyPositive Chvostek’s and Trousseau’s
signs
![Page 73: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/73.jpg)
HypomagnesemiaDiagnostic Findings
Below normal serum levels of MgBelow normal serum levels of K or Ca
EKG changes
![Page 74: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/74.jpg)
HypomagnesemiaNursing Implications
Treatment depends on the causeOral supplementsIf severe, IV or IM administration
Identify at risk patientsDietary changesThorough assessmentMonitor VS, EKG, and labsPatient and family education
![Page 75: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/75.jpg)
HypermagnesemiaHigher than normal serum levels
Less common than hypomagnesemia
More common in adults with advanced renal failure
![Page 76: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/76.jpg)
HypermagnesemiaCauses
Advanced renal failureExcessive intake
Example – overuse of antacidsTPN with too much magnesiumTreatment of toxemia with Mg
![Page 77: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/77.jpg)
HypermagnesemiaClinical manifestations
Drowsiness, sedationLethargyRespiratory depressionMuscle weaknessSevere hypotension concurrent with
nausea and vomiting
![Page 78: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/78.jpg)
HypermagnesemiaDiagnostic Findings
Above normal serum levels of MgEKG changes
![Page 79: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/79.jpg)
HypermagnesemiaNursing Implications
Increase renal excretionLots of PO and IV fluid
Administer diureticsAdminister calcium gluconate (given IV in
emergency situations)Monitor labs, EKG, VSDiet changesPatient and family teaching
![Page 80: Susan Hench, RN, MSN Assistant Professor of Nursing N102](https://reader035.vdocuments.us/reader035/viewer/2022062423/5697bff01a28abf838cbaa9d/html5/thumbnails/80.jpg)
QUESTIONS ??