Electrolyte & Acid-Base Imbalances Quiz

Factors Affecting Electrolyte Imbalance

• Intake greater than output or shift of electrolytes from cells or bone into the ECF causes plasma electrolyte excess.
• Intake less than output or shift from ECF into cells and bones causes a blood plasma deficit.

Acid Base Imbalances

• Respiratory Acidosis - Caused by excessive carbonic acid due to alveolar hypoventilation.
  • Impaired gas exchange can lead to this.
  • Causes: COPD, pneumonia, airway obstruction, atelectasis, severe asthma, neuromuscular dysfunction like muscle weakness, respiratory muscle fatigue, chest wall injury, brainstem respiratory control dysfunction like drug overdose or head injury.
  • Signs and Symptoms: Headache, lightheadedness, decreased consciousness, confusion, lethargy, coma, dysrhythmias.
  • Lab Findings: Decreased pH, increased PaCO2, normal or increased HCO3- depending on compensation.
• Respiratory Alkalosis - Caused by deficiency of carbonic acid due to alveolar hyperventilation.
  • Causes: Hypoxemia, acute pain, anxiety, psychological distress, inappropriate mechanical ventilator settings, stimulation of brainstem respiratory control.
  • Signs and Symptoms: Light headedness, numbness, tingling in fingers and toes, increased rate and depth of respirations, excitement, confusion, decreased consciousness, dysrhythmias
  • Lab Findings: Increased pH, decreased PaCO2, normal or decreased HCO3- depending on compensation.
• Metabolic Acidosis - Caused by excessive metabolic acids or decreased base bicarbonate.
  • Causes: Increased metabolic acids (high anion gap) from ketoacidosis, hypermetabolic states, oliguric renal disease, circulatory shock, or acid ingestion; or loss of bicarbonate (normal anion gap) from diarrhea, pancreatic fistula, intestinal decompression or renal tubular acidosis.
  • Signs and Symptoms: Decreased consciousness, lethargy, confusion, coma, abdominal pain, dysrhythmias, increased rate and depth of respirations.
  • Lab Findings: Decreased pH, normal or decreased PaCO2 depending on compensation, decreased HCO3-.
• Metabolic Alkalosis - Caused by an increase in bicarbonate or a loss of metabolic acid.
  • Causes: Increased bicarbonate from sodium bicarbonate administration, blood transfusion, mild ECV deficit; or loss of metabolic acid from excessive vomiting, gastric suctioning, hypokalemia, excessive aldosterone.
  • Signs and Symptoms: Lightheadedness, numbness, tingling, muscle cramps, excitement, confusion, decreased consciousness, dysrhythmias, concurrent hypokalemia.
  • Lab Findings: Increased pH, normal or increased PaCO2 depending on compensation, increased HCO3-.

Risk Factors of Imbalances

• Age: Young children are at risk for ECV deficit, osmolality imbalances, and clinical dehydration. Older adults at risk for ECV excess or deficit, osmolality imbalances.
• Environmental: Sodium-rich diet can cause ECV excess, electrolyte-poor diet can cause deficits, hot weather can lead to dehydration.
• Gastrointestinal Output: Diarrhea, drainage, and vomiting can lead to electrolyte imbalance.
• Chronic Disease: Cancer, COPD, cirrhosis, heart failure, oliguric renal disease can contribute to imbalances.
• Trauma: Burns, crash injuries, head injuries, hemorrhage can lead to electrolyte imbalance.
• Therapies: Diuretics, IV therapy, and PN can cause imbalances if not carefully monitored.

Different Types of RN Diagnoses

• Fluid Imbalance
• Dehydration
• Acid Base Imbalance
• Lack of knowledge of fluid regimen

Enteral Fluid Replacement (By Mouth)

• Remember ice chips represent ½ of a volume measurement.

Religious Dietary Restrictions

• Pork: Some faiths, like Baptists, allow minimal or no pork consumption.
• All meats: Fish, shellfish, and fowl are allowed, with some restrictions, on many diets.
• Predatory fowl: Only fish with scales allowed.
• Alcohol: Consumed in some faiths.
• Caffeine: Present in some faiths, such as in teas, coffees, and sodas.
• Shellfish: Allowed in some faiths, prohibited in others.
• Vegetarian and Ovolactovegetarian diets: Practiced by some religions.

Ramadan

• Ramadan fasting occurs from sunrise to sunset.
• Observed for a month.

Jewish Dietary Restrictions

• Kosher food preparation required.
• Mixing of milk or dairy products with meat dishes prohibited.
• 24 hours of fasting on Yom Kippur. Day commemorates atonement.
• No leavened bread eaten during Passover (8 days).

Sabbath

• No cooking on Sabbath from sundown Friday to sundown Saturday.

Anorexia Nervosa

• Characterized by significantly low body weight.
• Intense fear of gaining weight.
• Distorted body image.
• Self-evaluation is influenced by body weight and shape.

Bulimia Nervosa

• Recurrent episodes of binge eating.
• Feeling of lack of control during binge eating periods.
• Inappropriate compensatory behaviors.
• Self-evaluation influenced by body shape and weight.

Dysphagia - Causes

• Myogenic (Muscle-related):
  • Myasthenia gravis
  • Aging
  • Muscular dystrophy
  • Polymyositis
• Neurogenic (Nerve- related):
  • Stroke
  • Cerebral palsy
  • Guillain- Barre Syndrome
  • Multiple Sclerosis
  • Amyotrophic Lateral Sclerosis
  • Diabetic Neuropathy
  • Parkinson's Disease
• Obstructive (Blockage):
  • Benign peptic stricture
  • Lower esophageal ring
  • Candidiasis
  • Head and neck cancer
  • Inflammatory masses
  • Trauma/surgical restriction
• Other:
  • Gastrointestinal or esophageal resection
  • Rheumatological disorders
  • Connective tissue disorders
  • Vagotomy