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Questions and Answers
What is the first-line treatment for correcting hypernatremia?
Which dietary precaution should be taken for a patient with hyperkalemia?
Which of the following is a common cause of hyperkalemia?
What is the normal serum potassium concentration range?
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In the context of hyperkalemia, which of the following clinical manifestations is considered a late sign?
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What is hypovolemia primarily characterized by?
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Which of the following is a clinical manifestation of hypovolemia?
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What type of fluid is indicated for severe hypovolemia with hypotension?
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In managing hypovolemia, which medication is used for nausea?
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Which condition is a potential cause of hypovolemia?
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The nursing management of hypovolemia includes which of the following?
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What does dehydration refer to in the context of fluid imbalances?
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Which of the following is not a symptom of hypovolemia?
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What could be a potential cause of hypervolemia?
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Which clinical manifestation is associated with hypervolemia?
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Which type of diuretic is recommended for severe hypervolemia?
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What is the primary effect of sodium in the extracellular fluid?
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What is a potential cause of hyponatremia?
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What management technique is NOT typically used for hyponatremia?
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Which clinical manifestation is indicative of hypernatremia?
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What is the first sign of hypernatremia?
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Which nursing management step is crucial for patients with hyponatremia?
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What role do ‘vaptans’ play in the treatment of hyponatremia?
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What is the primary action of pamidronate disodium?
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Which symptom is typically associated with hypomagnesemia?
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What dietary changes are recommended for managing mild hypomagnesemia?
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What nursing intervention is crucial when administering magnesium sulfate IV?
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What is a common cause of hypomagnesemia?
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Which clinical manifestation is indicative of hypermagnesemia?
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How does magnesium deficiency affect acetylcholine (ACh) release?
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What is an important nursing responsibility when managing a patient with hypermagnesemia?
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What is a potential ECG change seen with hypomagnesemia?
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What is advised regarding the use of magnesium in patients with kidney injury?
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What is a common clinical manifestation of hypocalcemia related to cardiovascular effects?
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Which medication is used for medical management of hypocalcemia?
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In patients with hypocalcemia, which solution should NOT be used for dilution during IV administration?
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Which dietary recommendations are appropriate for managing hypocalcemia?
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What precaution is essential for patients experiencing hypocalcemia?
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Which of the following is NOT a potential cause of hypercalcemia?
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What does the acronym 'BACK ME UP' represent in the context of hypercalcemia clinical manifestations?
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Which of the following treatments is used specifically for oncologic origin hypercalcemia?
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Which of these is considered a common symptom of hypercalcemia?
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Which medication increases calcium excretion by the kidneys in hypercalcemia management?
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Study Notes
Fluid Imbalances
- Hypovolemia occurs when the loss of ECF volume exceeds intake, resulting in water and electrolyte loss proportional to their normal concentrations. Dehydration refers to water loss only.
- Causes of Hypovolemia: Abnormal fluid loss (vomiting, diarrhea, GI suctioning, profuse diaphoresis), decreased intake (nausea, lack of access to fluids), and third spacing (edema in burns, ascites in liver dysfunction). Other causes include diabetes insipidus, adrenal insufficiency, hyperglycemia, hemorrhage, and coma.
- Clinical Manifestations of Hypovolemia (FEWCHART): Flat neck veins, Eyes sunken, Weight loss, Concentrated urine (SG> 1.025, oliguria), Hypotension, Anxiety, Rapid, weak pulse; Respirations increased, Temperature elevated.
- Medical Management of Hypovolemia: Mild-moderate cases: increase oral fluids, oral rehydration salts (e.g., Hydrite). Severe cases: IV therapy — isotonic fluids with hypotension, hypotonic fluids once normotensive. Additionally, antidiarrheals (e.g., Loperamide) and antiemetics (e.g., Metoclopramide) may be administered.
- Nursing Management of Hypovolemia: Monitor I&O and daily weights, monitor vital signs (WOF hypotension and tachycardia), monitor skin and tongue turgor, encourage small, frequent sips of oral fluids, regulate IV fluid to prescribed rate, administer medications as prescribed.
Hypervolemia
- Hypervolemia refers to an isotonic expansion of ECF caused by the abnormal retention of water and sodium in their usual proportions.
- Causes of Hypervolemia: Heart failure, kidney injury, liver cirrhosis, excessive salt intake, excessive administration of sodium-containing fluids in patients with impaired regulatory mechanisms.
- Clinical Manifestations of Hypervolemia: Edema, distended neck veins, puffy eyelids, crackles, weight gain, hypertension, bounding pulse, tachypnea, dyspnea, increased urine output (dilute urine).
- Medical Management of Hypervolemia: Low sodium diet (mild to severe restriction), diuretics (thiazide for mild-moderate, loop for severe), potassium supplementation to prevent hypokalemia with diuretic use, dialysis for severe renal impairment.
- Nursing Management of Hypervolemia: Monitor I&O and daily weights, monitor breath sounds (especially with IV therapy), monitor edema (feet and ankles for ambulatory patients, sacral area for bedridden), encourage bed rest, regulate IVF as prescribed, place in semi-Fowlers position with dyspnea, reposition at regular intervals to prevent pressure ulcers, emphasize reading food labels, encourage a low sodium diet with seasoning substitutes such as lemon juice, onions, and garlic.
Electrolyte Imbalances
Sodium
- Sodium is the most abundant electrolyte in the ECF, with a normal concentration of 135-145 mEq/L.
- Functions of Sodium: Controls body water distribution, establishes the electrochemical state necessary for muscle contraction and nerve impulse transmission.
Hyponatremia
- Hyponatremia occurs when serum sodium level is less than 135 mEq/L.
- Causes of Hyponatremia: Vomiting, diarrhea, gastric suctioning, medications (diuretics, lithium, cisplatin, heparin, NSAIDs), decreased aldosterone (Addison’s disease), water intoxication, CHF, chronic renal failure.
- Development of Hyponatremia: Develops when there is too much water or too little sodium.
- Medical Management of Hyponatremia: Sodium replacement (sodium-rich diet for those who can eat and drink, NaCl tablets, PLR or PNSS IV infusion for those unable to take sodium orally), water restriction (indicated for hyponatremic patients with normal or excess fluid volume), hypertonic saline solution (for severe hyponatremia), AVP receptor antagonists (“vaptans”) - Conivaptan HCl (Vaprisol) IV for hospitalized patients with moderate to severe hyponatremia, Tolvaptan (Samsca) oral medication for clinically significant hypervolemic and euvolemic hyponatremia.
- Nursing Management of Hyponatremia: Monitor I&O and daily weights, monitor laboratory values, monitor the progression of manifestations, encourage food and fluids with high sodium content (broth made with one beef cube or 8 oz tomato juice) for patients who are able to consume by mouth, administer IV fluids as prescribed, WOF signs of circulatory overload (cough, dyspnea, puffy eyelids, dependent edema, excessive weight gain in 24 hours, crackles), institute safety precautions.
Hypernatremia
- Hypernatremia occurs when the serum sodium level is greater than 145 mEq/L.
- Causes of Hypernatremia (MODEL): Medications, meals, Osmotic diuretics, Diabetes insipidus, Excessive water loss, Low water intake.
- Clinical Manifestations of Hypernatremia: Extreme thirst (first sign), dry, sticky mucous membranes, oliguria, firm, rubbery turgor, red, dry, swollen tongue, restlessness, tachycardia, fatigue, disorientation, hallucinations.
- Medical Management of Hypernatremia: Safety Alert! Serum sodium correction should be done gradually. TREAT THE UNDERLYING CAUSE, Sodium correction: hypotonic electrolyte solution (first line) – IV of choice 0.3% NaCl, isotonic non-saline solution (second line) – D5W indicated when water needs to be replaced without sodium.
- Nursing Management of Hypernatremia: Provide oral fluids at regular intervals, restrict sodium in diet as prescribed, monitor behavioral changes, promote safety, monitor intake and output.
Potassium
- Potassium is the most abundant electrolyte in the ICF, with a normal serum concentration range of 3.5 to 5 mEq/L. It has an inverse relationship with sodium and a direct relationship with magnesium.
- Functions of Potassium: Maintains ICF volume, neuromuscular excitability, regulates contraction and rhythm of the heart.
Hypokalemia
- Hypokalemia refers to a serum potassium level less than 3.5 mEq/L.
- Causes of Hypokalemia: Loss of potassium from the body (GI losses, diuretics, renal losses), inadequate intake of potassium, shifting of potassium from ECF to ICF.
- Clinical Manifestations of Hypokalemia: Muscle weakness, fatigue, lethargy, hyporeflexia, constipation, ileus, abdominal distention, cardiac dysrhythmias (bradycardia, ventricular tachycardia, fibrillation), ECG changes (flattened T wave, prominent U wave, prolonged QT interval).
- Medical Management of Hypokalemia: Potassium chloride (oral or IV), potassium supplementation (food, oral supplements, IV solutions), correction of underlying cause.
Hyperkalemia
- Hyperkalemia occurs when the serum potassium level is greater than 5 mEq/L.
- Causes of Hyperkalemia (CARED): Cellular movement of K+ from ICF to ECF, Addison’s disease (hypoaldosteronism), Renal failure, Excessive K+ intake, Drugs (Spironolactone, ACE inhibitors, NSAIDs).
- Clinical Manifestations of Hyperkalemia (MURDER): Muscle weakness (can be a late sign), Unable to calm down (irritability, anxiety), Respiratory failure (secondary to muscle weakness), Decreased heart rate, EKG changes (tall peaked T waves, depressed ST segment, widened QRS complex, bradycardia, heart block, asystole).
- Medical Management of Hyperkalemia: Correct underlying cause, IV calcium gluconate (to stabilize cardiac membrane), sodium bicarbonate (to alkalinize the blood), insulin and glucose (shift potassium into cells), diuretics (promote potassium excretion), dialysis (for renal failure).
- Nursing Management of Hyperkalemia: Monitor vital signs (WOF bradycardia), monitor ECG, restrict dietary potassium, institute safety precautions as needed.
Calcium
- Calcium is an extra-cellular cation, with a normal serum range of 8.5-10.5 mg/dL.
- Functions of Calcium: Nerve impulse transmission, muscle contraction, blood clotting, bone and teeth formation, cell membrane permeability.
Hypocalcemia
- Hypocalcemia occurs when the serum calcium level is less than 8.5 mg/dL.
- Causes of Hypocalcemia: Inadequate intake of calcium, vitamin D deficiency, impaired calcium absorption, hypoparathyroidism, chronic renal failure.
- Clinical Manifestations of Hypocalcemia: Muscle cramps, spasms, tetany, increased neuromuscular excitability, prolonged QT interval on ECG, seizures, Chvostek’s sign (facial twitching), Trousseau’s sign (carpal spasm), paresthesias, hypotension.
- Medical Management of Hypocalcemia: Oral calcium supplements, vitamin D supplements, calcium gluconate IV (most common), calcium chloride IV (more potent but can cause tissue necrosis if extravasation occurs), IV magnesium sulfate, correction of underlying cause.
- Nursing Management of Hypocalcemia: Encourage intake of calcium-rich foods, advise to quit smoking and consume alcohol and caffeine in moderation, avoid overuse of laxatives and antacids that contain phosphorus, monitor and maintain airway patency, institute seizure precautions.
Hypercalcemia
- Hypercalcemia occurs when serum calcium level is greater than 10.5 mg/dL.
- Causes of Hypercalcemia: Malignancies, hyperparathyroidism, thiazide diuretics, Vitamin A and D toxicity, chronic lithium use, theophylline toxicity.
- Clinical Manifestations of Hypercalcemia (BACK ME UP): Bone pain, Arrhythmias (heart blocks, shortened QT interval and ST segment), Cardiac arrest (most dangerous), Constipation, Kidney stones, Muscle weakness, Excessive urination, Uhaw (thirst), Pathologic fractures.
- Medical Management of Hypercalcemia: 0.9% NaCl solution (temporarily dilutes serum calcium and increases urinary excretion), furosemide (Lasix) in conjunction with PNSS (promotes diuresis and enhances calcium excretion), calcitonin IM (lowers calcium by increasing calcium and phosphorus deposition in bones), corticosteroids (reduce bone turnover and tubular reabsorption for patients with sarcoidosis, myelomas, lymphomas, and leukemia), pamidronate disodium (Aredia) - biphosphonate that inhibits osteoclastic activity, mithramycin - cytotoxic antibiotic that inhibits bone resorption, correction of underlying cause.
- Nursing Management of Hypercalcemia: Encourage early and frequent ambulation, encourage oral fluids (3-4 L/day), encourage high fiber diet, implement safety precautions, assess for signs of digoxin toxicity (calcium enhances effects of digoxin), monitor heart rate and rhythms.
Magnesium
- Magnesium is an intracellular cation with a normal serum range of 1.3-2.3 mg/dL. It has a direct relationship with potassium and calcium; 1/3 of magnesium is protein-bound and 2/3 are free cations.
- Functions of Magnesium: Activator of intracellular enzyme systems, plays a role in CHO and CHON metabolism, affects neuromuscular irritability and contractility, has a sedative effect by inhibiting acetylcholine release, vasodilator and decreases peripheral resistance.
Hypomagnesemia
- Hypomagnesemia occurs when serum magnesium is less than 1.3 mg/dL. It is frequently associated with hypokalemia and hypocalcemia.
- Causes of Hypomagnesemia (FAT GUM): Fistulas, Alcohol withdrawal, Tube feedings/TPN (magnesium deficiency), Gastric suctioning (prolonged), Uncontrolled BM (diarrhea), Malabsorption disorders (small intestine).
- Clinical Manifestations of Hypomagnesemia: Muscle cramps, spasticity, (+) Trousseau and Chvostek sign, insomnia, mood changes, anorexia, vomiting, increased tendon reflexes, hypertension (similar to hypocalcemia), ECG changes (depressed ST segment, prolonged QRS, dysrhythmias - PVCs, SVT, torsades de pointes, ventricular fibrillation).
- Medical Management of Hypomagnesemia: High magnesium diet for mild deficiencies, magnesium supplements, IV magnesium sulfate for patients with overt manifestations of hypomagnesemia. IV administration requires a controlled rate.
- Nursing Management of Hypomagnesemia: Monitor vital signs, monitor urine output, report urine output greater than 200 mL/hr, monitor for signs of toxicity.
Hypermagnesemia
- Hypermagnesemia occurs when serum magnesium level is greater than 2.3 mg/dL.
- Causes of Hypermagnesemia: Renal injury, excessive intake of magnesium-containing antacids, DKA.
- Clinical Manifestations of Hypermagnesemia: Flushing, hypotension, muscle weakness, drowsiness, hypoactive reflexes, respiratory depression, cardiac arrest, coma, diaphoresis.
- Medical Management of Hypermagnesemia: Avoid giving magnesium to patients with kidney injury, discontinue all sources of magnesium with severe hypermagnesemia, calcium gluconate IV (calcium antagonizes magnesium), ventilatory support if respiratory depression occurs, hemodialysis for renal failure, if with adequate renal function: furosemide (Lasix), PLR or PNSS.
- Nursing Management of Hypermagnesemia: Monitor vital signs, assess deep tendon reflexes, assess level of consciousness, caution on OTC medications.
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Description
Explore the key concepts of hypovolemia, including its causes, clinical manifestations, and management strategies. This quiz will test your knowledge on fluid imbalances and related medical interventions. Enhance your understanding of how fluid loss affects the body.
