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Questions and Answers
What condition is defined as the loss of extracellular fluid (ECF) volume exceeding fluid intake?
What condition is defined as the loss of extracellular fluid (ECF) volume exceeding fluid intake?
Which of the following is not a cause of hypovolemia?
Which of the following is not a cause of hypovolemia?
What is a sign of hypovolemia identified by the acronym 'FEWCHART'?
What is a sign of hypovolemia identified by the acronym 'FEWCHART'?
Which type of therapy is appropriate for a patient experiencing severe hypovolemia with hypotension?
Which type of therapy is appropriate for a patient experiencing severe hypovolemia with hypotension?
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What should be monitored in patients with hypovolemia as indicated in nursing management?
What should be monitored in patients with hypovolemia as indicated in nursing management?
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What is the appropriate action for a nurse when administering IV fluids to a hypovolemic patient?
What is the appropriate action for a nurse when administering IV fluids to a hypovolemic patient?
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What major electrolyte is typically lost in proportion during hypovolemia?
What major electrolyte is typically lost in proportion during hypovolemia?
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Which medication may be administered to a patient experiencing hypovolemia associated with diarrhea?
Which medication may be administered to a patient experiencing hypovolemia associated with diarrhea?
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What is the first-line treatment for sodium correction in hypernatremia?
What is the first-line treatment for sodium correction in hypernatremia?
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Which dietary adjustment should be made for patients with hyperkalemia?
Which dietary adjustment should be made for patients with hyperkalemia?
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Which of the following is NOT a clinical manifestation of hyperkalemia?
Which of the following is NOT a clinical manifestation of hyperkalemia?
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What relationship does potassium have with sodium?
What relationship does potassium have with sodium?
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In the management of hypernatremia, which solution is used when water needs to be replaced without sodium?
In the management of hypernatremia, which solution is used when water needs to be replaced without sodium?
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What is a common cause of hypervolemia?
What is a common cause of hypervolemia?
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Which clinical manifestation is NOT associated with hypervolemia?
Which clinical manifestation is NOT associated with hypervolemia?
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Which medication is typically used for severe hypervolemia?
Which medication is typically used for severe hypervolemia?
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What should be monitored to prevent rapid weight gain in patients with fluid overload?
What should be monitored to prevent rapid weight gain in patients with fluid overload?
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What is the serum sodium level for hyponatremia?
What is the serum sodium level for hyponatremia?
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Which of the following is a recommended treatment for severe hyponatremia?
Which of the following is a recommended treatment for severe hyponatremia?
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What dietary change is recommended for patients experiencing hypervolemia?
What dietary change is recommended for patients experiencing hypervolemia?
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Which of the following describes a clinical manifestation of hypernatremia?
Which of the following describes a clinical manifestation of hypernatremia?
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Which electrolyte is the most abundant in extracellular fluid (ECF)?
Which electrolyte is the most abundant in extracellular fluid (ECF)?
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What is a safety precaution that should be implemented for patients with hyponatremia?
What is a safety precaution that should be implemented for patients with hyponatremia?
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What is the maximum normal value for ionized calcium?
What is the maximum normal value for ionized calcium?
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What is a potential clinical manifestation of hypocalcemia?
What is a potential clinical manifestation of hypocalcemia?
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Which condition is NOT a cause of hypocalcemia?
Which condition is NOT a cause of hypocalcemia?
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Which sign is associated with overt tetany in hypocalcemia?
Which sign is associated with overt tetany in hypocalcemia?
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Which of the following is a characteristic of latent tetany?
Which of the following is a characteristic of latent tetany?
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What dietary substance should be avoided by patients with hyperkalemia?
What dietary substance should be avoided by patients with hyperkalemia?
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Which of the following calcium types can be found complexed to anions?
Which of the following calcium types can be found complexed to anions?
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What effect does hypocalcemia have on cell membrane permeability?
What effect does hypocalcemia have on cell membrane permeability?
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What is a potential side effect of Pamidronate disodium?
What is a potential side effect of Pamidronate disodium?
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Which statement about Magnesium is true?
Which statement about Magnesium is true?
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Which of the following is a cause of hypomagnesemia?
Which of the following is a cause of hypomagnesemia?
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What are clinical manifestations of hypomagnesemia?
What are clinical manifestations of hypomagnesemia?
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What is a likely nursing responsibility when administering magnesium sulfate IV?
What is a likely nursing responsibility when administering magnesium sulfate IV?
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Which dietary sources can help manage mild hypomagnesemia?
Which dietary sources can help manage mild hypomagnesemia?
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What characterizes hypermagnesemia?
What characterizes hypermagnesemia?
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Which of the following conditions can lead to falsely elevated magnesium results?
Which of the following conditions can lead to falsely elevated magnesium results?
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What is a common clinical manifestation of hypermagnesemia?
What is a common clinical manifestation of hypermagnesemia?
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Which intervention is crucial in nursing management for patients with severe hypermagnesemia?
Which intervention is crucial in nursing management for patients with severe hypermagnesemia?
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Study Notes
Hypovolemia
- Occurs when loss of extracellular fluid (ECF) volume exceeds intake
- Water and electrolytes lost in equal proportions as normal body fluids
- Dehydration refers to water loss only
Hypovolemia Causes
- Abnormal fluid loss:
- Vomiting
- Diarrhea
- Gastrointestinal (GI) suctioning
- Profuse diaphoresis
- Decreased fluid intake:
- Nausea
- Lack of access to fluids
- Third spacing:
- Edema in burns
- Ascites in liver dysfunction
Other Hypovolemia Causes
- Diabetes insipidus
- Adrenal insufficiency
- Hyperglycemia
- Hemorrhage
- Coma
Hypovolemia Clinical Manifestations "FEWCHART"
- Flat neck veins
- Eyes sunken
- Weight loss
- Concentrated urine (specific gravity > 1.025, oliguria)
- Hypotension
- Anxiety
- Rapid, weak pulse; Respirations increased
- Temperature elevated
Hypovolemia Medical Management
- Fluid replacement therapy:
- Mild to moderate: Increase oral fluids, oral rehydration salts (e.g., Hydrite)
- Severe: Intravenous (IV) therapy
- Hypotension: Isotonic fluids
- Normotensive: Hypotonic fluids
- Antidiarrheals (e.g., Loperamide (Diatabs)) if diarrhea present
- Antiemetics (e.g., Metoclopramide (Plasil)) if nausea/vomiting present
Hypovolemia Nursing Management
- Monitor intake and output (I&O) and daily weights
- Monitor vital signs: Watch for hypotension and tachycardia
- Monitor skin and tongue turgor
Hypervolemia
- Isotonic expansion of ECF due to abnormal water and sodium retention
- Often referred to as "fluid overload"
Hypervolemia Causes
- Heart failure
- Kidney injury
- Liver cirrhosis
- Excessive salt intake
- Excessive sodium-containing fluid administration in patients with impaired regulatory mechanisms
Hypervolemia Clinical Manifestations
- Edema
- Distended neck veins
- Puffy eyelids
- Crackles (in lungs)
- Weight gain
- Hypertension
- Bounding pulse
- Tachypnea (rapid breathing), dyspnea (shortness of breath)
- Increased urine output; dilute urine
Hypervolemia Medical Management
- Low sodium diet
- Diuretics:
- Thiazide diuretics: mild to moderate hypervolemia
- Loop diuretics: severe hypervolemia
- Potassium supplementation to prevent hypokalemia while on diuretics
- Dialysis for severe renal impairment
Hypervolemia Nursing Management
- Monitor I&O
- Weigh daily: Watch for rapid weight gain (1 kg = 1 L of fluid)
- Monitor breath sounds, especially with IV therapy
- Monitor for edema:
- Feet and ankles for ambulatory patients
- Sacral area for bedridden patients
- Encourage bed rest
- Regulate IV fluids as prescribed
- Place patient in semi-Fowler's position if dyspnea present
- Reposition patient regularly to prevent pressure ulcers
- Emphasize need to read food labels
- Instruct patient to avoid foods high in sodium
- Encourage use of seasoning substitutes (e.g., lemon juice, onions, garlic)
Sodium
- Most abundant electrolyte in ECF
- Normal ECF concentration: 135-145 mEq/L
Sodium Functions
- Controls body water distribution
- Establishes electrochemical state necessary for:
- Muscle contraction -Nerve impulse transmission
Hyponatremia
- Serum sodium level < 135 mEq/L
Hyponatremia Causes
- Vomiting, diarrhea, gastric suctioning
- Medications: Diuretics, lithium, cisplatin, heparin, NSAIDs
- Decreased aldosterone (Addison's disease)
- Water intoxication
- Congestive heart failure (CHF)
- Chronic renal failure
Hyponatremia Development
- Excess water relative to sodium
- Insufficient sodium relative to water
Hyponatremia Medical Management
- Sodium replacement:
- Sodium-rich diet for those who can eat and drink
- NaCl tablets
- Plasma-Lyte R (PLR) or 0.9% Normal Saline Solution (NSS) IV infusion for those who cannot take sodium by mouth
- Water restriction: Indicated for hyponatremic patients with normal or excess fluid volume
- Hypertonic saline solution: Indicated for severe hyponatremia
- AVP receptor antagonists (vaptans):
- Conivaptan HCl (Vaprisol) IV: Hospitalized patients with moderate to severe hyponatremia (Contraindicated in patients with seizure, delirium, coma)
- Tolvaptan (Samsca): Oral medication for clinically significant hypervolemic and euvolemic hyponatremia
Hyponatremia Nursing Management
- Monitor I&O and daily weights
- Monitor laboratory values
- Monitor progression of manifestations
- Encourage high sodium foods and fluids for those who can consume by mouth:
- Broth made with one beef cube (900 mg sodium)
- 8 oz of tomato juice (700 mg sodium)
- Administer IV fluids as prescribed
Hyponatremia Nursing Management, Watch For
- Signs of circulatory overload: Cough, dyspnea, puffy eyelids, dependent edema, excessive weight gain in 24 hours, crackles
- Institute safety precautions: Keep side rails up, supervised ambulation
Hypernatremia
- Serum sodium level > 145 mEq/L
Hypernatremia Causes "MODEL"
- Medications (Medications), meals
- Osmotic diuretics
- Diabetes insipidus
- Excessive water loss
- Low water intake
Hypernatremia Clinical Manifestations
- Extreme thirst (first sign)
- Dry, sticky mucous membranes
- Oliguria (decreased urine output)
- Firm, rubbery skin turgor
- Red, dry, swollen tongue
- Restlessness, tachycardia, fatigue
- Disorientation, hallucinations
Hypernatremia Medical Management
-
Safety alert! Gradual serum sodium correction
- Too rapid correction makes plasma temporarily hypo-osmotic to brain tissue
- Treat underlying cause
- Sodium correction:
- Hypotonic electrolyte solution (first line): IV of choice is 0.3% NaCl
- Isotonic non-saline solution (second line): D5W (indicated when water needs to be replaced without sodium)
Hypernatremia Nursing Management
- Provide oral fluids at regular intervals
- Restrict sodium in diet as prescribed
- Monitor behavioral changes
- Promote safety
- Monitor I&O
Potassium
- Most abundant electrolyte in the ICF
- Normal serum concentration: 3.5 to 5 mEq/L
- Inverse relationship with sodium; direct relationship with magnesium
Potassium Functions
- Maintains ICF volume
- Neuromuscular excitability
- Regulates contraction and rhythm of heart
Hypokalemia
- Serum potassium level < 3.5 mEq/L
- Less common than hyperkalemia but more life-threatening because of increased risk of cardiac arrest
Hyperkalemia
- Serum potassium level > 5 mEq/L
Hyperkalemia Causes "CARED"
- Cellular movement of K+ from ICF to ECF
- Addison's disease (hypoaldosteronism)
- Renal failure
- Excessive K+ intake
- Drugs (Spironolactone, ACE inhibitors, NSAIDs)
Hyperkalemia Clinical Manifestations "MURDER"
- Muscle weakness (late sign)
- Unable to calm down (irritability, anxiety)
- Respiratory failure (secondary to muscle weakness)
- Decreased bowel sounds
- ECG changes (Tall, peaked T waves, widened QRS complex, prolonged PR interval)
- Elevated serum potassium levels
- Arrhythmias (ventricular tachycardia, ventricular fibrillation)
- Cardiac arrest
Hyperkalemia Nursing Management
- Avoid: Fruits, vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, cocoa
- Caution patients to use salt substitutes sparingly if taking other supplementary forms of potassium or potassium-sparing diuretics
Calcium
- Primarily located in bones and teeth, the rest circulates in serum
Calcium Functions
- Bone mineralization
- Stabilizes resting membrane potential of neurons preventing spontaneous activation
- Regulation of muscle contraction (actin and myosin filaments to slide)
- Cardiac contractility and conduction
Calcium Types
- Ionized calcium
- Protein-bound calcium
- Calcium complexed to anions
Calcium Normal Values
- Ionized calcium: 4.5 to 5.1 mg/dL
- Total calcium: 8.5 to 10.5 mg/dL
Hypocalcemia
- Serum calcium level < 8.5 mg/dL
Hypocalcemia Causes
- Primary hypoparathyroidism
- Surgical hypoparathyroidism
- Radical neck dissection
- Massive administration of citrated blood
- Pancreatitis
- Kidney injury
- Prolonged bed rest/bedridden patients
Hypocalcemia Extracellular Calcium
- Increased cell membrane permeability to sodium
- Increased neuromuscular irritability (everything is high and fast)
Hypocalcemia Clinical Manifestations
- Tetany (general muscle hypertonia, tremor, spasmodic/uncoordinated contractions)
Latent Tetany
- Numbness, tingling, cramps in extremities
- Stiffness of hands and feet
Overt Tetany
- Bronchospasm
- Laryngospasm
- (+) Trousseau's sign: Carpopedal spasm from arm blood flow occlusion for 3 minutes
- (+) Chvostek's sign: Sharp tapping over facial nerve causes spasm/twitching of mouth, nose, eye
- Seizures
- Dysrhythmias (torsades de pointes)
- Photophobia
Hypocalcemia Medical Management
- Calcium replacement:
- Oral calcium supplements
- Calcium gluconate IV
- Calcium chloride IV
- Vitamin D therapy:
- Cholecalciferol (vitamin D3)
- Ergocalciferol (vitamin D2)
- Parathyroid hormone (PTH) replacement therapy:
- Indicated for chronic hypoparathyroidism
Hypocalcemia Nursing Management
- Encourage early and frequent ambulation
- Encourage oral fluids up to 3-4 L/day
- Encourage high-fiber diet
- Implement safety precautions
- Assess for signs of digitalis toxicity (calcium enhances effects of digoxin)
- Monitor heart rate and rhythms
Hypercalcemia
- Serum calcium level > 10.5 mg/dL
Hypercalcemia Causes
- Hyperparathyroidism
- Malignancy
- Immobilization
- Thiazide diuretics
- Vitamin D toxicity
- Milk-alkali syndrome
Hypercalcemia Clinical Manifestations "MY BACKS"
- Muscle weakness
- Yawn (frequent)
- Bone pain
- Anorexia
- Constipation
- Kidney stones
- Stones (gallstones)
Hypercalcemia Medical Management
- Treat underlying cause
- Hydration: Oral fluids, saline IV fluids
- Bisphosphonates (e.g., Pamidronate disodium (Aredia), Zoledronic acid (Reclast))
- Calcitonin: Inhibits bone resorption
- Loop diuretics (e.g., Furosemide (Lasix))
- Hemodialysis
- Corticosteroids (e.g., Prednisone)
- Gallium nitrate (Ganite)
Hypercalcemia Nursing Managemet
- Encourage early and frequent ambulation
- Encourage oral fluids up to 3-4 L/day
- Encourage high-fiber diet
- Implement safety precautions, as necessary
- Assess for signs of digitalis toxicity, especially in patients taking digoxin
- Monitor heart rate and rhythms
Magnesium
- Intracellular cation
- Direct relationship with potassium and calcium
- Normal serum Mg++: 1.3-2.3 mg/dL
Magnesium Functions
- Activator of intracellular enzyme systems
- Plays a role in carbohydrate and protein metabolism
- Affects neuromuscular irritability and contractility
- Has a sedative effect (inhibits release of acetylcholine)
- Vasodilator and decreases peripheral resistance
Hypomagnesemia
- Serum Mg++ level < 1.3 mg/dL
- Frequently associated with hypokalemia and hypocalcemia
- Hypoalbuminemia can lead to hypomagnesemia
Hypomagnesemia Causes "FAT GUM"
- Fistulas
- Alcohol withdrawal
- Tube feedings/Total parenteral nutrition (TPN) (magnesium deficiency)
- Gastric suctioning (prolonged)
- Uncontrolled bowel movements (diarrhea)
- Malabsorption disorders (small intestine)
Hypomagnesemia Clinical Manifestations
- Cramps, spasticity
- (+) Trousseau's and Chvostek's sign
- Insomnia
- Mood changes
- Anorexia, vomiting
- Increased tendon reflexes
- Hypertension
- Similar to hypocalcemia
Hypomagnesemia ECG Changes
- Depressed ST segment
- Prolonged QRS complex
- Dysrhythmias:
- Premature ventricular contractions (PVCs)
- Supraventricular tachycardia (SVT)
- Torsades de pointes
- Ventricular fibrillation
Hypomagnesemia Medical Management
- High-magnesium diet for mild deficiencies:
- Green leafy vegetables
- Nuts
- Seeds
- Legumes
- Whole grains
- Seafoods
- Peanut butter
- Cocoa
- Magnesium supplements
- Magnesium sulfate IV: For patients with overt manifestations of hypomagnesemia, administered using an infusion pump at a controlled rate
Hypomagnesemia Nursing Responsibilities (Magnesium sulfate IV)
- Monitor vital signs
- Monitor urine output (report if < 30 mL/hour)
Hypermagnesemia
- Serum Mg++ level > 2.3 mg/dL
- Rare electrolyte abnormality
Hypermagnesemia Causes
- Kidney injury
- Excessive intake of magnesium-containing antacids
- Diabetic ketoacidosis (DKA)
Hypermagnesemia Falsely Elevated Serum Mg++ May Result From:
- Hemolyzed blood specimen
- Blood drawn from an extremity with a tourniquet applied too tightly
Serum Magnesium (Hypermagnesemia)
- Decreased acetylcholine release
- Decreased neuromuscular irritability (everything is low and slow)
Hypermagnesemia Clinical Manifestations
- Flushing
- Hypotension
- Muscle weakness
- Drowsiness
- Hypoactive reflexes
- Respiratory depression
- Cardiac arrest (in severe cases)
- Coma
- Diaphoresis
Hypermagnesemia Medical Management
- Avoid giving magnesium to patients with kidney injury
- Discontinue all sources of magnesium if severe hypermagnesemia present
- Calcium gluconate IV (calcium antagonizes magnesium)
- Ventilatory support if respiratory depression present
- Hemodialysis: if adequate renal function
- Furosemide (Lasix)
- PLR or NSS
Hypermagnesemia Nursing Management
- Monitor vital signs, noting hypotension and shallow respirations
- Assess deep tendon reflexes
- Assess level of consciousness
- Caution on use of over-the-counter (OTC) medications
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Description
This quiz covers the causes, clinical manifestations, and medical management of hypovolemia. Understanding hypovolemia is crucial for recognizing fluid loss and implementing appropriate treatments. Prepare to test your knowledge on this critical health issue.
