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Questions and Answers
What is an early sign of hyperkalemia?
Which medication is used to antagonize hyperkalemia's action on the heart?
How does sodium polystyrene sulfonate (Kayexalate) work?
What side effect is associated with beta-2 agonist administration for hyperkalemia?
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What should be closely monitored in patients with hyperkalemia?
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What is hypovolemia primarily characterized by?
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Which of the following is NOT a cause of hypovolemia?
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Which symptom is associated with hypovolemia?
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In the case of severe hypovolemia with hypotension, which treatment should be prioritized?
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What nursing intervention is important for a patient with hypovolemia?
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Which medication may be administered for hypovolemia related to diarrhea?
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How should oral fluid intake be managed for a patient with hypovolemia?
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Which of the following is true about hypervolemia?
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What is the normal range for ionized calcium levels in mg/dL?
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Which condition is characterized by a serum calcium level less than 8.5 mg/dL?
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What is a common clinical manifestation of hypocalcemia?
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Which sign is associated with hypocalcemia and indicates a carpopedal spasm?
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Which of the following foods should be avoided to prevent hyperkalemia?
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What physiological effect does hypocalcemia have on the cell membrane?
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What happens during overt tetany in hypocalcemia?
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Which of the following is a cause of hypocalcemia?
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What is the primary action of pamidronate disodium?
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Which of the following is a common side effect of mithramycin?
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What is a characteristic sign of hypomagnesemia?
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Which substance is contraindicated in patients with kidney injury during hypermagnesemia?
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What condition is indicated by a serum magnesium level less than 1.3 mg/dL?
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Which of the following dietary sources is recommended for managing mild hypomagnesemia?
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What is a potential ECG change associated with hypomagnesemia?
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Which clinical manifestation is associated with hypermagnesemia?
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What nursing responsibility is crucial when administering magnesium sulfate IV?
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Which of the following is a common cause of hypomagnesemia?
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What is a common clinical manifestation of hypocalcemia?
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Which of the following is used in the medical management of hypercalcemia?
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What dietary advice would be appropriate for someone with hypocalcemia?
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Which of the following should be avoided in the nursing management of hypocalcemia?
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Which of these is NOT a manifestation of hypercalcemia?
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What nursing intervention is associated with managing patients with hypocalcemia?
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Which medication decreases bone turnover and tubular reabsorption in oncologic cases of hypercalcemia?
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What is a potential complication of untreated hypercalcemia?
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Which symptom is often associated with the mnemonic 'BACK ME UP' in hypercalcemia?
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What should patients be advised to do regarding smoking and caffeine consumption when managing hypocalcemia?
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Study Notes
Hypovolemia
- Definition: Loss of extracellular fluid (ECF) volume exceeding fluid intake.
- Cause: Abnormal fluid loss (vomiting, diarrhea, GI suctioning, profuse diaphoresis), decreased intake (nausea, lack of access to fluids), third spacing (edema in burns, ascites in liver dysfunction).
- Other causes: Diabetes insipidus, adrenal insufficiency, hyperglycemia, hemorrhage, coma.
- Clinical Manifestations: Flat neck veins, sunken eyes, weight loss, concentrated urine, hypotension, anxiety, rapid/weak pulse, increased respirations, elevated temperature.
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Medical Management:
- Mild-moderate: Increase oral fluids, oral rehydration salts.
- Severe: IV therapy (isotonic fluid for hypotension, hypotonic fluids once normotensive).
- Antidiarrheals (loperamide) for diarrhea.
- Antiemetics (metoclopramide) for nausea/vomiting.
- Nursing Management: Monitor I&O, daily weights, vital signs (WOF for hypotension and tachycardia), skin and tongue turgor, encourage small frequent sips of fluids, regulate IV fluid to prescribed rate, administer medications as prescribed.
Hypervolemia
- Definition: Isotonic expansion of ECF caused by abnormal retention of water and sodium.
- Causes: Heart failure, kidney failure, cirrhosis, excess IV fluid administration, high sodium intake.
- Clinical Manifestations: Edema, weight gain, distended neck veins, bounding pulses, hypertension, shortness of breath, crackles in lungs, decreased urine output.
- Medical Management: Fluid restriction, diuretics (furosemide), sodium restriction, dialysis (in renal failure).
- Nursing Management: Monitor I&O, daily weights, vital signs (WOF for hypertension and edema), assess lung sounds, elevate extremities, administer medications as prescribed.
Hyperkalemia
- Definition: Serum potassium level > 5.5 mEq/L.
- Causes: Kidney injury, dehydration, medications (ACE inhibitors, potassium-sparing diuretics), uncontrolled diabetes, severe trauma.
- Clinical Manifestations: Muscle weakness (ascending paralysis), fatigue, decreased bowel motility, cardiac dysrhythmias (tall peaked T waves, prolonged PR interval), paresthesias, abdominal distention.
- Medical Management: Obtain ECG, potassium restriction (diet and medication), calcium gluconate IV (emergency management for extremely high K+ levels), sodium polystyrene sulfonate (Kayexalate) (cation exchange resin, increases fecal potassium excretion), regular insulin + D50W (temporary shift of potassium into cells), beta-2 agonist (salbutamol) (nebulized, moves potassium into cells), dialysis.
- Nursing Management: Monitor I&O, signs of muscle weakness and dysrhythmias, vital signs (use apical pulse), administer medications as prescribed, encourage strict adherence to potassium restriction.
Hypocalcemia
- Definition: Serum calcium level < 8.5 mg/dL.
- Causes: Primary hypoparathyroidism, surgical hypoparathyroidism, radical neck dissection, massive administration of citrated blood, pancreatitis, kidney injury, prolonged bed rest.
- Clinical Manifestations: Tetany (general muscle hypertonia, tremor, spasmodic contractions), latent tetany (numbness, tingling, cramps), overt tetany (bronchospasm, laryngospasm, Trousseau's sign, Chvostek's sign, seizures, dysrhythmias, photophobia), hypotension, ECG changes (prolonged QT interval, lengthened ST segment), labs (hypomagnesemia).
- Medical Management: Calcium salts IV (calcium gluconate, calcium chloride), vitamin D, calcium supplements, high calcium diet.
- Nursing Management: Administer calcium salts IV slowly, assess IV site for infiltration, do not use PNSS (increases renal calcium loss), do not use concurrently with phosphate or bicarbonate solutions, encourage calcium-rich foods, advise avoiding smoking and excessive alcohol/caffeine, advise avoiding overuse of laxatives and phosphorus-containing antacids, monitor and maintain airway patency, institute seizure precautions.
Hypercalcemia
- Definition: Serum calcium level > 10.5 mg/dL.
- Causes: Malignancies, hyperparathyroidism, thiazide diuretics, vitamin A and D toxicity, chronic lithium use, theophylline toxicity.
- Clinical Manifestations: Bone pain, arrhythmias (heart blocks, shortened QT interval and ST segment), cardiac arrest, constipation, kidney stones, muscle weakness, excessive urination, thirst (uhaw), pathological fractures.
- Medical Management: 0.9% NaCl solution, furosemide (in conjunction with PNSS), calcitonin IM, corticosteroids (for oncologic origin), pamidronate disodium (Aredia), mithramycin.
- 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, monitor heart rate and rhythms.
Hypomagnesemia
- Definition: Serum magnesium level < 1.3 mg/dL.
- Causes: Fistulas, alcohol withdrawal, tube feedings/TPN, prolonged gastric suctioning, uncontrolled bowel movements (diarrhea), malabsorption disorders.
- Clinical Manifestations: Cramps, spasticity, (+) Trousseau and Chvostek signs, insomnia, mood changes, anorexia, vomiting, increased tendon reflexes, hypertension, ECG changes (depressed ST segment, prolonged QRS, dysrhythmias).
- Medical Management: High-magnesium diet, magnesium supplements, magnesium sulfate IV (For patients with overt manifestations of hypomagnesemia).
- Nursing Management: Monitor vital signs, urine output, administer magnesium sulfate IV (using an infusion pump), observe for signs of magnesium toxicity, advise patients to avoid use of laxatives and antacids.
Hypermagnesemia
- Definition: Serum magnesium level > 2.3 mg/dL.
- Causes: Kidney injury, excessive intake of magnesium-containing antacids, diabetic ketoacidosis.
- Clinical Manifestations: Flushing, hypotension, muscle weakness, drowsiness, hypoactive reflexes, respiratory depression, cardiac arrest, coma, diaphoresis.
- Medical Management: Avoid giving magnesium to patients with kidney injury, discontinue magnesium sources if with severe hypermagnesemia, calcium gluconate IV, ventilatory support (for respiratory depression), hemodialysis, furosemide (for adequate renal function).
- Nursing Management: Monitor vital signs (WOF for hypotension and shallow respirations), assess deep tendon reflexes, assess level of consciousness.
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Description
Test your understanding of hypovolemia, a condition characterized by the loss of extracellular fluid volume exceeding fluid intake. This quiz covers definitions, causes, clinical manifestations, and management strategies, including medical and nursing interventions. Perfect for nursing students seeking to reinforce their knowledge on fluid balance.
