Medical Surgical Nursing 1 Lecture - Midterms PDF

MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER DISORDERS RELATING TO FLUIDS AND ELECTROLYTES ANATOMY AND PHYSIOLOGY BODY FLUIDS AND FLUID COMPARTMENTS Aqueous Solution The internal environment of the human body is an aqueous (watery) solution Water is...

MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER DISORDERS RELATING TO FLUIDS AND ELECTROLYTES ANATOMY AND PHYSIOLOGY BODY FLUIDS AND FLUID COMPARTMENTS Aqueous Solution The internal environment of the human body is an aqueous (watery) solution Water is the major solvent in the body Contains dissolved substances – solutes ❖ Proteins ❖ Carbohydrates ❖ Electrolytes – any mineral with a charge Na+ - Sodium Cl- - Chloride K+ - Potassium Ca++ - Calcium Nucleus Water Movement in the Human Body Location: Variable location within cell Osmosis Function: Contains genetic material of cell (DNA) & nucleoli; ❖ Movement of Water is a result of osmotic gradients site of RNA Synthesis and ribosomal subunit assembly ❖ Moves from areas of lower solute concentration (high water concentration) to areas of higher solute Ribosomes concentration (low water concentration) Location: In cytoplasm Water will enter cells if water concentration is Function: Site of Protein Synthesis higher outside of cells Rough Endoplasmic Reticulum Water will exit cells if water concentration is higher Location: In cytoplasm inside of cells. Function: Has many ribosomes attached; involved with the Balance of solutes and water inside and outside of cells must production, folding, quality control, and dispatch of some be maintained. proteins. Body Water Content Smooth Endoplasmic Reticulum Majority of body mass is water Location: In cytoplasm Varies with age: Function: Site of lipid synthesis; participates in detoxification ❖ Infants – 75% of body mass is water ❖ Adults – 50% to 60% of body mass is water Golgi Apparatus Water content varies with location: Location: In cytoplasm ❖ Teeth and Adipose: 8-10% water Function: Modifies protein structure & packages proteins in ❖ Brain and Kidneys: 80-85% water secretory vesicles Fluid Compartments Secretory Vesicle Contain body fluids; separated from other compartments by a Location: In cytoplasm physical Function: Contains materials produced in the cell; formed by ❖ Intracellular Fluid (ICF) – All fluid within cells the Golgi apparatus ❖ Extracellular Fluid (ECF) – Fluid that surrounds all Lysosome cells Location: In cytoplasm Plasma and Interstitial Fluid are two major divisions of ECF Function: Contains enzymes that digest material taken into cell; formed by the Golgi apparatus Total Body Water – Sum of ICF and ECF (TBW= ICF+ECF) Peroxisome INTRACELLULAR FLUIDS Two-thirds of total water in human body Location: In cytoplasm Function: Breaks down fatty acids, amino acids, and hydrogen Mainly cytosol and cytoplasm found in cells peroxide Regulated to maintain health of cells: Mitochondrion To much fluid causes cells to lyse Location: In cytoplasm Too little fluid causes cells to shrink Function: Site of aerobic respiration and the major site of ATP Also lack water for chemical reactions synthesis D.F.R. VILLAREAL | BS NURSING 1 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Microtubule EXTRACELLULAR FLUID Location: in cytoplasm One-third of total water in human body Function: Supports cytoplasm; assist in cell division and forms 20% of ECF is plasma components of cilia and flagella 80% of ECF is interstitial fluid (IF) Centrioles Location: In cytoplasm Includes cerebrospinal fluid (CSF), lymph, synovial fluid, pleural Function: Facilitate the movement of chromosomes during cell fluid, pericardial fluid, peritoneal fluid, and aqueous humor division Cilia Location: On cell surface with many on each cells Functions: Moves substances over surfaces of certain cells; locomotion of cells whiplike movement Flagella Location: On sperm cell surface with one per cell Functions: Propel sperm cells Microvilli Location: Extension of cell surface with many on each cell Function: Increases surface are of certain cells HYPOTONIC-ISOTONIC-HYPERTONIC Total Body Water (TBW) The sum of intracellular fluid (ICF) and extracellular fluid (ECF) Varies from one individual to the next ❖ Hormones like estrogen increase water retention and increase TBW ❖ Progesterone promotes water loss in urine to decrease TBW ❖ Higher amounts of adipose tissue decrease TBW Adipose contains lipids and less water Edema Accumulation of excess water in tissues A.) When a red blood cell is placed in a hypotonic solution (One having a low solute concentration), water enters the cell by Can be caused by: osmosis (black arrows), causing the cell to swell or even burst ❖ Increased filtration or inadequate reabsorption by blood (lyse; puff of red in lower part of the cell). capillaries B.) When a red blood cell is placed in an isotonic solution (one ❖ Impaired absorption of IF by lymphatic system having a concentration of solutes equal to that inside the cell), Forms of edema include peripheral pitting edema and water moves into and out of the cell at the same rate (Black pulmonary edema arrows). No net water movement occurs, and the cell shape remains normal. C.) When a red blood cell is place in a hypertonic solution (one having a high solute concentration), water moves by osmosis out of the cell and into the solution (black arrows) resulting in shrinkage (Crenation). Grade 0 – No edema Grade 1 – Mild pitting edema (rapidly disappears) Grade 2 – Moderate pitting edema (10 – 15 second) Grade 3 – Moderately severe (1 minute) Grade 4 – Severe (can be more than 2 minutes) D.F.R. VILLAREAL | BS NURSING 2 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Composition of Bodily Fluids Plasma and interstitial fluid (IF) are similar in composition ❖ Major difference is lower protein concentration in IF versus plasma ICF has higher concentration of potassium, phosphate, magnesium, and protein than ECF Bodily fluids are electrically neutral ❖ Maintained by sodium-potassium pumps Plasma, Interstitial Fluid Plasma exits blood capillaries and becomes IF IF that is not reabsorbed enters lymphatics and becomes lymph ❖ Ultimately returned to the blood via subclavian veins This is analogous to water drainage system of a fountain The Sodium-Potassium Pump Maintains high levels of potassium and low levels of sodium in ICF ❖ Uses ATP to pump sodium out of cells ❖ Potassium enters cells Helps maintain electrical neutrality of bodily fluids Sweating Fluid Movement Between Compartments Sweating influences water movement between compartments Hydrostatic and osmotic pressure gradients Water from IF enters gland to become part of sweat ❖ Hydrostatic pressure exerted by fluids Water from blood moves into IF to replace lost water ❖ Osmotic pressure exerted by solutes in fluids As more water is removed, dehydration may result Movement occurs at capillaries Amount of fluid filtered is proportional to size of gradient Osmotic gradients draw fluid toward areas of higher solute concentration Water moves toward areas of greater solute concentration or lower water concentration Water moves between ICF and ECF due to osmosis Water will move between compartments to replace water that tissues have lost ❖ Occurs during sweating as water leaves blood to replace water lost by sweat glands ❖ May lead to dehydration Capillary Exchange Hydrostatic pressure is greater at arterial end of capillary ❖ Forces fluid from capillary into IF Hydrostatic pressure decreases at venous end ❖ Osmotic pressure dominates and IF enters capillary Exchange is uneven; excess IF is drained by lymphatic system D.F.R. VILLAREAL | BS NURSING 3 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Examples: O2, CO2, Cl−, urea b.) Osmosis Transport: With the concentration gradient (for water) through the lipid portion of the cell membrane or through membrane channels. ATP: No Examples: Water c.) Facilitated Diffusion Transport: With the concentration gradient by carrier molecules ATP: No Example: Glucose in most cells Active Membrane Transport a.) Active Transport Transport: Against the concentration gradient* by carrier molecules ATP: Yes Examples: Na+, K+, Ca2+, H+, and amino acids b.) Secondary Active Transport Transport: Against the concentration gradient by carrier molecules; the energy for secondary active transport of one substance comes from the concentration gradient of another ATP: Yes Examples: Glucose, amino acids c.) Endocytosis Transport: Movement into cells by vesicles ATP: Yes SOLUTE MOVEMENT BETWEEN COMPARTMENTS Example: Ingestion of particles by phagocytosis or Passive mechanisms can be used to allow solutes to move down a receptor mediated endocytosis & liquids by concentration gradient pinocytosis Simple diffusion d.) Exocytosis Facilitated diffusion Transport: Movement out of cells by vesicles ATP: Yes Examples: Secretion pf Proteins Passive Membrane Transport a.) Diffusion Transport: With the concentration gradient through the lipid portion of the cell membrane or through membrane channels ATP: No D.F.R. VILLAREAL | BS NURSING 4 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER WATER BALANCE Thirst Receptor – Hypothalamus Regulation of Water Intake Respiratory center – Brainstem ( Medulla Oblongata) Water loss should be roughly balanced by water intake daily Osmolarity – Number of particles of solute per liter of solution ❖ ~2.5L lost and ~2.5L taken in daily Water gained by ingestion and cellular respiration Osmolality – number of particles of solute per kilogram of solvent Water intake regulated by osmoreceptors in hypothalamus Renin – produced by kidneys ❖ Stimulates thirst when blood osmolarity is high ❖ Releases ADH to conserve water Angiotensinogen – produced by liver ❖ Decreases salivation to conserve water and promote thirst ACE – Lungs Blood volume also influences water intake ❖ Low blood volume leads to low blood pressure Decrease water → Decrease blood volume → Decreased BP ❖ Detected by baroreceptors * if sodium does not leave the body, so will water. Stimulates release of hormones, angiotensin II and aldosterone to increase blood volume Increased blood osmolality – Stimulus ❖ Angiotensin II stimulates thirst Decreased blood osmolarity - Effect ❖ Aldosterone stimulates sodium and water reabsorption by kidney Alcohol inhibits ADH Dehydration Results from inadequate fluid intake or excessive fluid loss ❖ May be due to excessive sweating, diarrhea, vomiting, or hemorrhage ❖ Leads to lack of water for metabolic reactions ❖ Decreased blood pressure and possible shock Severe dehydration (>10% total body water loss) is considered a medical emergency ❖ May lead to loss of consciousness, coma, or death ❖ Fast rehydration orally or via IV required Diuresis Production of high volumes of urine Typically occurs when water intake is high or excessive ❖ Excess fluid is shed in urine Diuretics = medications that increase urine output ❖ Decrease blood volume and blood pressure ❖ Used to treat hypertension and congestive heart failure ❖ Alcohol functions as a diuretic by inhibiting ADH release D.F.R. VILLAREAL | BS NURSING 5 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Water Intoxication Results from consumption of too much pure water ❖ Water without electrolytes Consuming pure water decreases osmolarity of ECF ELECTROLYTE BALANCE Role of Electrolytes ❖ Leads to increased volume of fluids like CSF ❖ Manifests as intracranial edema The ions of the body aid in various functions: ❖ Transmission of action potentials The cranial cavity is unable to accommodate increased volume ❖ Enzymatic function ❖ Pressure placed on brain and brainstem may become ❖ Urine formation deadly ❖ Muscle contraction ❖ Release of hormones from endocrine glands ❖ pH regulation Roles of the Big Six Regulation of Water Output Water is lost via urination (main method), defecation, Reference Values for the Big Six evaporation, sweating, and exhalation Excessive water loss can lead to decreased blood pressure If blood pressure falls too low, body may go into shock Hypothalamus detects loss with osmoreceptors If blood osmolarity is too high, antidiuretic hormone (ADH) is released Role of ADH Antidiuretic Hormone (ADH) released in response to elevated Sodium blood osmolarity Most common ion in ECF ❖ Promotes insertion of aquaporins in collecting ducts ❖ Allows kidneys to reabsorb additional water Plays a role in action potentials, urine formation, bodily fluid ❖ Also promotes vasoconstriction of arterioles osmolarity, muscle contraction, and membrane transport Increases blood pressure Excess is cleared in urine Increases flow of blood to core organs to prevent Hyponatremia—low blood levels of sodium shock Hypernatremia—high blood levels of sodium D.F.R. VILLAREAL | BS NURSING 6 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Potassium ❖ Calcium removed from blood and incorporated into bony Most common ion in ICF matrix Plays a role in resting membrane potential, action potentials, and muscle contraction Hypokalemia—low blood levels of potassium Hyperkalemia—high blood levels of potassium ❖ Can disrupt functioning of nervous system, heart, and skeletal muscles Chloride Most common anion in ECF Plays a role in osmotic balance between ICF and ECF, electrical balance of ECF, and neuronal functioning ACID-BASE BALANCE Is also a component of hydrochloric acid in the stomach pH Scale Hypochloremia—low blood levels of chloride Maintaining acid-base balance is critical for physiological Hyperchloremia—high blood levels of chloride function ❖ Enzymes fail to function if balance not maintained Bicarbonate pH scale is a measurement of the hydrogen ion (H+ ) Most common anion in blood concentration Plays a role in buffering the pH of the bodily fluids ❖ Blood pH range is 7.35–7.45 Carbon dioxide is converted into bicarbonate for transport Buffers prevent rapid changes in pH ❖ Conversion occurs in red bloods cells using the enzyme ❖ Quickly donate hydrogen ions or remove them from carbonic anhydrase solution ❖ Converted back into carbon dioxide in the lungs for ❖ Limited capacity exhalation Respiratory and urinary systems also help maintain acid-base Calcium balance Mainly contained within bones and teeth Protein Buffer Plays a role in muscle contraction, neurotransmitter release, Proteins can use amino acids to buffer pH enzyme activity, and blood clotting ❖ Amino group can accept hydrogen ions if pH is too acidic Absorbed via the intestine using active form of vitamin D ❖ Carboxyl group can donate hydrogen ions if pH is too Hypocalcemia—low blood levels of calcium alkaline Hypercalcemia—high blood levels of calcium Aids in buffering pH of blood and ICF Phosphate Protein component of hemoglobin buffers red blood cells Present in three ionic forms within the body during formation of bicarbonate ions Major component of ICF Bicarbonate-Carbonic Acid Buffer Component of the matrix of bone and teeth, phospholipids, Bicarbonate ions and carbonic acid provide buffering for blood ATP, nucleotides and IF Plays a role in buffering body fluids ❖ Bicarbonate ions can accept hydrogen ions when pH is Hypophosphatemia—low blood levels of phosphate too acidic Hyperphosphatemia—high blood levels of phosphate ❖ Carbonic acid can donate hydrogen ions when pH is too alkaline Regulation of Sodium and Potassium Since bicarbonate ions can be converted into carbon dioxide, Homeostatic range maintained by kidneys acid can be eliminated by exhalation ❖ Excess of either ion is released in urine ❖ Kidneys reabsorb more if the level of either ion is low Respiratory Regulation of Acid-Base Balance Angiotensin II and aldosterone help the kidney regulate Changes in breathing can alter pH sodium and potassium levels in the blood If pH is too acidic, hyperventilation occurs Regulated by hormones: ❖ As carbon dioxide is exhaled, more carbonic acid is ❖ Parathyroid hormone—increases blood calcium and converted into CO2 and exhaled decreases blood phosphate If pH is too alkaline, hypoventilation occurs Stimulates osteoclasts to release calcium from bone ❖ Retained carbon dioxide is converted into hydrogen ions matrix Calcitriol—most active form of Vitamin D ❖ Aids in calcium absorption in the intestine Calcitonin—decreases blood calcium levels D.F.R. VILLAREAL | BS NURSING 7 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Metabolic Acidosis Occurs when blood pH is below 7.35 Due to loss of bicarbonate or intake of excess acid (hydrogen ion) Common causes include severe diarrhea, aspirin intoxication, and diabetic ketoacidosis – lactic acidosis from extreme exercise Metabolic Alkalosis Occurs when blood pH is above 7.45 Due to presence of excess bicarbonate ions ❖ Usually due to loss of acid (hydrogen ions) Common causes include vomiting of stomach contents, antacid overdose or abuse, and gastric suctioning Renal Regulation of Acid-Base Balance Respiratory Acidosis Kidneys can alter secretion of hydrogen and reabsorption of Occurs when blood pH is below 7.35 bicarbonate ions Due to inadequate ventilation of the lungs If pH is too acidic, kidneys increase secretion of hydrogen ions ❖ Leads to increased carbon dioxide level in the blood and reabsorption of bicarbonate ions ❖ As carbon dioxide is converted into bicarbonate ion, If pH is too alkaline, kidneys decrease secretion of hydrogen excess acid is produced ions and reabsorption of bicarbonate ions Common causes include emphysema, pneumonia, and congestive heart failure Respiratory Alkalosis Occurs when blood pH is above 7.45 Due to excessive ventilation of the lungs ❖ Usually hyperventilation ❖ Excessive exhalation of carbon dioxide leads to removal of hydrogen ions from blood Common causes include anxiety attacks, high altitude sickness, fever, and infections ACID-BASE HOMEOSTASIS pH Imbalances Causes of Metabolic and Respiratory Acidosis and Alkalosis Acidosis—blood pH below 7.35 ❖ May lead to suppression of nervous system activity, coma, shortness of breath, and arrhythmias Alkalosis—blood pH above 7.45 ❖ May lead to lightheadedness, coma, tremors, and twitching Respiratory Compensation Adjustment in breathing rate in an attempt to correct pH imbalance Can compensate for metabolic imbalances within minutes Hyperventilation occurs for acidosis Hypoventilation occurs for alkalosis ❖ Limited ability to compensate Metabolic Compensation Response of the kidneys to pH imbalances Aids in compensation of respiratory imbalances, but may take several hours to three days Acidosis ❖ Kidneys increase secretion of hydrogen ions and reabsorption of bicarbonate ions D.F.R. VILLAREAL | BS NURSING 8 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Alkalosis Approximately 300 mL daily. ❖ Kidneys decrease secretion of hydrogen and reabsorption The loss is much greater with increased respiratory rate or of bicarbonate depth, or in a dry climate. Diagnosing pH Imbalances Gastro-Intestinal Tract (GIT) The clinical test used to diagnose pH imbalances is an arterial Loss of fluid is about 100 to 200 mL daily. blood gas (ABG) Approximately 8 L of fluid circulates through the GI system ❖ Gives pH, partial pressure of carbon dioxide (pCO2 ), and every 24 hours. bicarbonate level in the blood ❖ most of the fluid is reabsorbed into the bloodstream from ❖ pH will allow you to determine if there is an acidosis or the small intestine alkalosis Diarrhea and fistulas of the intestine can cause large losses of ❖ pCO2 is used to determine if cause is respiratory fluids ❖ Bicarbonate is used to determine if cause is metabolic Compensation mechanisms may complicate diagnosis Types of Acid-Base Imbalances TONICITY PARENTERAL FLUID THERAPY Ability of solutes to cause an osmotic driving force that promotes Patients need maintenance IV fluid therapy when they cannot take water movement from one compartment to another oral fluids Tonicity of a solution can be used to drive water movement between e.g., during and after surgery compartments to change the state of cellular hydration and cell size Corrective or replacement therapy Most commonly refers to the NaCl content of the solution Amount and type of solution are determined by the normal daily Determined by how it compares to physiologic fluid which is maintenance requirements and by imbalances identified by 0.9% NaCl laboratory results OSMOLALITY AND OSMOLARITY Purpose Osmolality Number of milliosmoles of solute (the standard unit of osmotic To provide water, electrolytes, and nutrients to meet daily pressure) per kilogram of solvent; requirements it is expressed as milliosmoles per kilogram (mosm/kg) To replace water and correct electrolyte deficits FLUID FACTORS FACTORS To administer medications and blood products INCREASING DECREASING SYSTEMIC ROUTES OF GAINS AND LOSSES OSMOLALITY OSMOLALITY Kidney Serum 275 - Severe dehydration Fluid volume 290 mOsm/kg Free water loss excess A well-hydrated person excretes 1 to 2 L urine per day. water Diabetes insipidus SIADH A general rule is that the output: 1 mL of urine per kilogram of Hypernatremia body weight per hour (1 mL/kg/h) in all age groups. AKI Hyperglycemia Diuretic use ❖ For example, a 70-kg adult will excrete 70 mL/h; over 24 Stroke or head injury Adrenal hours this equals approximately 1680 mL of urine. Acute tubular necrosis insufficiency Skin Consumption of Hyponatremia Chief solutes in sweat are sodium, chloride, and potassium. methanol or ethylene Overhydration Actual sweat losses can vary from 0 to 1000 mL or more every glycol (antifreeze) Paraneoplastic High ion gap syndrome hour. Continuous water loss by evaporation through the skin metabolic acidosis associated with (approximately 500 mL/day) occurs through perspiration— Mannitol therapy insensible water loss. lung cancer Advanced liver ❖ Fever, high environmental temperature, burn injury, and disease exercise Alcoholism The lungs normally eliminate water vapor—insensible water Burns loss. D.F.R. VILLAREAL | BS NURSING 9 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Urine 200 - Fluid volume Fluid volume REPORTING 800 mOsm/kg deficit excess water SODIUM SIADH Diabetes insipidus It is a vital electrolyte that helps regulate fluid balance, nerve CHF Hyponatremia function, muscle contraction, and blood pressure. It also maintains Acidosis Aldosteronism the body ’ s water content by controlling fluid movement in and out Prerenal kidney Pyelonephritis of cells. injury Acute tubular necrosis Sodium Levels Normal - A normal sodium level is between 135 and 145 Osmolarity milliequivalents per liter (mEq/L) Number of milliosmoles (the standard unit of osmotic Hyponatremia- when sodium levels in the blood drop below pressure) per liter of solution; 135 mEq/L it is expressed as milliosmoles per liter (mosm/l) Hypernatremia- when sodium levels rise above 145 mEq/L TYPES OF INTRAVENOUS SOLUTION IMPORTANCE OF SODIUM Isotonic Solutions The importance of sodium in our body includes: Composed of 0.9% NaCl 1. Maintaining fluid balance The same sodium and chloride concentration as the 2. Aids muscle contraction bloodstream and the same water concentration as the 3. Help in Blood Pressure regulation bloodstream 4. Keep acid-base balance Do not provoke water movement between ICF or ECF 5. Enhances nutrient absorption compartments Expand the plasma volume of the blood HYPONATREMIA Hyponatremia: Low level of sodium in the blood Hypotonic Solutions Composed of less sodium chloride concentration compared to Signs and Symptoms the blood 1. Nausea and vomiting ❖ 0.45% NaCl or 0.225% NaCl 2. Headache Contain less solute but more water than the bloodstream 3. Confusion Loss of energy, drowsiness and fatigue Can be used to move water from the ECF into the ICF 4. Restlessness and irritability ❖ Used to hydrate a patient as they contain high water 5. Muscle weakness, spasms or cramps concentration HYPERNATREMIA Hypertonic Solutions Hypernatremia: High level of sodium in the blood Composed of greater concentration of NaCl compared to blood Signs and Symptoms (e.g., 3% NaCl) 1. Polydipsia Contain more solute concentration and less water than the 2. Fatigue bloodstream 3. Altered Mental State Can be infused into the bloodstream to pull water from the ICF 4. Dry Mouth and Mucous Membranes into the ECF 5. Tachycardia and Hypotension 6. Muscle Twitching and Movement of water from ICF to ECF will cause dehydration Cramps of the cells POSSIBLE COMPLICATIONS OF SODIUM IMBALANCE ❖ Useful in disorders of severe edema; particularly cerebral 1. Hypertension edema 2. Chronic Kidney Disease ❖ Sodium, glucose, and mannitol are examples of solutes 3. Heart Failure capable of affecting water movement from ICF to ECF. 4. Osmotic Demyelination Syndrome (ODS) Osmotic diuresis is the increase in urine output caused by the 5. Edema excretion of solutes, such as glucose or mannitol. ❖ These solutes exert a force that pulls water out of the ICF FOOD SOURCES OF SODIUM and brings it into the ECF (bloodstream). Table Salt (Sodium Chloride) - The greatest source of sodium is ❖ Water then is filtered out of the bloodstream at the table salt, which is used mostly to season food. One teaspoon kidneys and excreted into the urine. The urine contains comprises 2,300 mg of sodium, the maximum allowed in a day. extra water that is derived from the ICF (increased urine Processed Meats (Bacon, Ham, Sausages) - Processed meats are volume) diuresis very salty because of the preservatives and flavoring applied. Sodium is also a preservative because it does not permit the growth of bacteria to extend shelf life. D.F.R. VILLAREAL | BS NURSING 10 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Soy Sauce - Soy sauce is very salty with one tablespoon contains Renin Angiotensin Aldosterone System (RAAS) about 1,000 mg of sodium. It is used as a primary ingredient while preparing and also as a condiment. Pickled and Pickled Products - Amount of brine used in the pickling process is truly salty, and hence pickled vegetables, olives, and other food products are consequently very high in sodium. Seafood - Some of them are higher than others, including shellfish. Barbecue sauce - is quite salty as well, with 2 tablespoons (30 ml) providing 395 mg of sodium, or 17% of the RDI. Frozen meals - Many frozen meals are high in sodium, some containing at least half of your daily sodium allotment per dish. Processed Cheese - Processed cheeses, including pre-sliced FUNCTIONS OF POTASSIUM IN THE BODY American cheese and loaf-like processed cheese like Velveeta, tend Acts as a counterpart to sodium to run higher in sodium than natural cheese. Balances fluid in your body Soup - Canned, packaged, and restaurant-prepared soups often pack a lot of sodium, though you can find reduced-sodium options for Helps regulate your blood pressure some canned varieties. Allows your muscles to contract Broths and stocks - Packaged broths and stocks, which are used as Important in Nervous System the base for soups and stews or to flavor meat and vegetable dishes, are notoriously high in salt. Help prevent Osteoporosis CONCLUSION Helps your Heart beat Essential electrolytes and crucial for maintaining normal body fluids. Lowers your risk of cardiovascular disease majority found in ECF HYPOKALEMIA Maintain osmotic pressure and blood volume Causes Of Hypokalemia Excessive sodium intake can lead to health issues (hypertension, Transcellular shift of Potassium increased risk of cardiovascular diseases) GI losses Renal Losses, POTASSIUM Mineral that is essential for all of the body's functions. Value of potassium serum potassium level below 3.5 mEq/L It helps your nerves, muscles heart to function well, and also helps Signs and Symptoms move nutrients and waste around your body's cells. Mild hypokalemia: Most people get enough potassium for their daily requirements ❖ Constipation through their diet. ❖ Heart palpitations ❖ Extreme tiredness (fatigue) Both high and low levels of potassium in the body can be dangerous. ❖ Muscle weakness and spasms How Potassium Works ❖ Tingling and numbness Severe hypokalemia: ❖ Muscle twitches ❖ Muscle cramps ❖ Severe muscle weakness, leading to paralysis ❖ Low blood pressure (hypotension) ❖ Lightheadedness or faintness ❖ Abnormal heart rhythms (arrhythmias) ❖ Excessive urination (polyuria) ❖ Excessive thirst (polydipsia) Syndromes Cushing Syndrome Fanconi Syndrome Bartter Syndrome D.F.R. VILLAREAL | BS NURSING 11 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER HYPERKALEMIA Causes Of Hyperkalemia Low excretion of Potassium Transcellular shift of Potassium Pseudo hyperkalemia Value Of Potassium serum: potassium level greater than 5 mEq/L Signs and Symptoms Mild hyperkalemia: ❖ Abdominal pain ❖ Diarrhea ❖ Nausea and vomiting Severe hyperkalemia: ❖ Chest pain ❖ Heart palpitations ❖ Arrhythmia (irregular, fast or fluttering heartbeat) ❖ Muscle weakness or numbness in your limbs FOOD SOURCES OF POTASSIUM Signs and Symptoms Dry scaly skin, brittle nails, and coarse hair Muscle cramps involving the back and legs are common Neurologic or psychologic symptoms, such as: confusion, memory loss, delirium, depression, and hallucinations. Assessment and Diagnostic Findings CALCIUM Calcium concentration blood test 99% located in skeletal system and 1% is rapidly exchangeable with Identified when your total serum calcium levels are below blood. 8.8 mg/dL Hypocalcemia and hypercalcemia are common disturbances Mild hypocalcemia is discovered by chance during routine blood tests and other tests like: normal adult total serum calcium level = 8.8 - 10.4 mg/dl ❖ Checking levels of magnesium, phosphorus, It exists in plasma in 3 forms: parathyroid hormone ionized - muscle contraction and nerve function ❖ EKG (electrocardiogram) ❖ Bone imaging tests bound - proteins in blood ex. albumin complex - other compounds in blood 2 hormones that regulates calcium PTH Calcitonin HYPOCALCEMIA D.F.R. VILLAREAL | BS NURSING 12 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER Nursing Management Clinical Manifestation Assessment Common cause of Hypercalcemia is Hyperparathyroidism Medication Administration: Malignant neoplastic disease Safety Measures Prolonged immobilization (mostly in children) Monitor Electrocardiogram (ECG) Muscular weakness Pain Management Constipation Oral Care Nausea and vomiting Monitoring of the airway Nursing Assessment Educate the patient with hypocalcemia Assess the level of consciousness and neuromuscular Avoid High doses of alcohol and caffeine status Avoid Smoking Auscultate bowel sounds Avoid the overuse of laxatives and antacids Monitor cardiac rate and rhythm Medical Management Monitor intake and output; calculate the fluid balance. Emergency Pharmacologic Therapy Monitor laboratory studies such as calcium, magnesium, IV administration of a calcium salt. and phosphate. ❖ Calcium gluconate Review the drug regimen, noting the use of calcium elevating ❖ Calcium Chloride drugs, such as heparin, methicillin, phenytoin, Monitoring of the IV site and blood pressure, adjusting and tetracycline. medications Nursing Management Avoiding the use of sodium chloride, phosphate, or Monitoring of the airway bicarbonate Educate the patient with hypocalcemia solutions with calcium High doses of alcohol and caffeine inhibits calcium HYPERCALCEMIA absorption Pathophysiology Smoking increases urinary calcium excretion Malignancies: Breast, lung and renal Avoid the overuse of laxatives and antacids Hyperparathyroidism Calcium and phosphorus Nursing Interventions Immobilization Strain urine if flank pain occurs. Thiazide diuretics Provide safety measures Restrict sources of calcium intake Maintain bulk in the diet Encourage fluid intake of 3 to 4 liters per day Administer medications prescribed Encourage frequent repositioning and range-of-motion (ROM) and muscle-setting exercises with caution. Administer isotonic saline and sodium sulfate PO or IV Prepare for and assist with hemodialysis. Medical Management Treating the underlying cause is essential, treatment such as: ❖ chemotherapy for a malignancy ❖ partial parathyroidectomy for hyperparathyroidism In mild cases of hypercalcemia: ❖ Drink more water. ❖ Switch to a non-thiazide diuretic ❖ Stop taking or lower your dose of calcium-rich antacid tablets. ❖ Stop taking or lower your dose of calcium supplements and ❖ calcium-containing supplements, such as multivitamins. D.F.R. VILLAREAL | BS NURSING 13 MEDICAL SURGICAL NURSING 1 LECTURE THIRD YEAR | FIRST SEMESTER MAGNESIUM Fish: Salmon, Mackerel, Halibut Functions of Magnesium Fruits: Avocado, Banana, Figs Raisins Maintains normal nerve and muscle function. Supports a healthy immune system. Vegetables: Potatoes with skink, Sweet potatoes, Broccoli Keeps steady heartbeat. Dairy And Dairy Alternatives: Yoghurt, Fortified plant-based milk Helps bones remain strong Regulates Blood Pressure Other: Dark chocolate (70-82% cocoa), Tofu Adjust blood glucose level PHOSPHATE A form of phosphoric acid, which contains phosphorus. Aids in energy and protein Production Normal Serum Magnesium Level: 1.8 to 2.6 mg/dl (0.74 to In the body, phosphates are found in the bones and teeth. 1.07 mmol/L) Phosphates may be used to treat a high level of calcium in the blood. HYPERMAGNESEMIA Adding or removing phosphate chemical groups may affect the way Hypermagnesemia refers to a high level of magnesium in the blood. proteins act in the body. It is rare and is usually the result of renal failure or poor kidney function. It occurs primarily in patients with acute or chronic kidney Normal Serum Phosphate Level disease. The normal serum phosphorus concentration is 3.4 to 4.5 mg/dl (1.12 to 1.45 mmol/L). The levels of hypermagnesemia are categorized based on the severity of magnesium elevation: This fluctuates with age (it is higher in children than adults), dietary intake, and acid–base status Mild hypermagnesemia (less than 7 mg/dL) Child: 4.5-6.5 mg/dL or 1.45-2.1 mmol/L (SI units) Moderate hypermagnesemia (7 to 12 mg/dL) HYPERPHOSPHATEMIA Severe hypermagnesemia (greater than 12 mg/dL) Condition characterized by high levels of phosphate in the blood, Signs and Symptoms: Exceeding 4.5 mg/dL. Flushing The most common cause is kidney injury, leading to decreased Hypotension phosphate excretion. Depressed Respirations Bradycardia Approximately 70% of people with advanced chronic kidney disease Muscle Weakness have hyperphosphatemia. Hypoactive Reflexes Shift of phosphate from inside the cells to the bloodstream Drowsiness and lethargy that may develop into Coma Other causes include increased intake Cardiac Arrest excessive vitamin D, certain medications, high phosphate ECG: Prolonged PR interval and QRS, Peaked T waves. diet HYPOMAGNESEMIA Signs and Symptoms Also known as magnesium deficit, it occurs when the body has a Muscle cramps lower than normal level of magnesium (