Volume Deficit
Urine specific gravity >1.030
Hypotension
Increased Hgb, hct, Na+, serum osmolality
Increased Temp.
Volume Overload
Urine specific gravity <1.010
Decreased hct, BUN, Hgb, Na+, serum osmolality
Hypertension
Increased Respirations, SOB, dyspnea, rales (crackes)
Peripheral edema
Jugular Vein distention
Volume Deficit Tx
Force fluids
Isotonic Fluids (LR or 0.9 NS)
Assess uring specific gravity
Volume Overload Tx
Administer Diuretics
Restrict fluids
Sodium restricted diet (6-15mg Na+/day)
Semi-fowlers if dyspneic
Diabetes Insipidus
Decreased ADH
Excessive urine output
Chronic-Severe dehydration
Excessive thirst
Diabetes Insipidus Tx
Record I/O
Monitor urine of specific gravity, BP, HR, Temp
Administer PITRESSIN
Syndrome of Inappropriate Antidiuretic Hormone Secretion - SIADH
Increased ADH
Anorexia, N/V, HA, Change in LOC
Decreased urinary output
Increased blood volume
Syndrome of Inappropriate Antidiuretic Hormone Secretion - SIADH - TX
Restrict water intake (500-600ml/24h)
Administer diuretics
Hypertonic solutions (3%Nacl) IV
DEMECLOCYCLINE (DECLOMYCIN)
Monitor Na+ levels
Assess LOC
Potassium Level
3.5-5.0 mEq/L
Main intracellular ion - involved in cardiac rhythm, nerve transmission
Hypokalemia
<3.5 mEq
Anorexia, N/V, muscle weakness, paresthesias, dysrhythmias
Decreased sensitivity to digitalis
Hyperkalemia
>5.0 mEq/L
EKG changes, Dysrythmias, cardiac arrest, muscle weakness
Caused by: Renal failure, use of potassium supplements, burns, crushing injuries
Hypokalemia Tx
Oral Potassium supplements (dilute in juice to avoid gastric irritation)
Increase in diet:
raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery.
Increase risk of digoxin toxicity
Hyperkalemia Tx
Restrict dietary potassium
Kayexelate - Cation exchange resin (causes diarhea)
Emergency - CALCIUM GLUCONATE, SODIUM BICARBONATE, Reg Insulin, Dextrose
Insulin and dextrose shift potassium into the cells
Diuretics
Sodium Level
135-145mEq/L
Main extracellular ion; responsible for water balance.
Hyponatremia
<135
Nausea, muscle cramps, increased ICP, confusion, muscular twitching, convulsions
Hyponatremia Tx
Sodium Rich foods:
beef broth, tomatoe juice
IV Isotonic - Lactated Ringer or 0.9 Nacl
Water Restriction (safer method)
I/O, Daily weight.
Hypernatremia
>145
Elevated Temp
Weakness
Disorientation
Delusion and Hallucination, thirst, dry swollen tongue
Hypotension
Tachycardia
Hypernatremia Tx
Hypotonic IV - 0.3% NaCl or 0.45% NaCl or 5% Dextrose in water
Offer fluids at regular intervals
Decrease sodium in diet
Daily wt
Calcium
ionized serum calcium - 4.5-5.2mg/dl
Total serum calcium - 10.5mg/dl
Needed for blood clotting, skeletal muscle contraction.
Regulated by parathyroid hormone and vit D, which facilitates reabsorption of calcium from bone and enhances absorption from GI tr
Hypocalcemia
Ionized serum calcium <4.5
Total serum calcium <8.5
Nervous system becomes increasingly excitable
Tetany:
Trousseau's sign (BP cuff - carpal spasm)
Chvosteks sign (tap facial nerve - twitching of facial muscles)
Seizures
Confusion
Paresthesia
Irritability
Hypercalcemia
Ionized serum cacium >5.1 mg/dL
Total serum calcium > 10.5 mg/dL
Sedative effects on CNS and PNC
Muscle weakness, lack of coordination
Constipation, abdominal pain and distention
Confusion
Depressed or absent endon reflexes
Dysrhythmias
Hypocalcemia Tx
Calcium Gluconate or Calcium Chloride (administer with OJ to maximize absorption.
Avoid high serum concentrations and cardiac depression.
Seizure precautions
Regular exercise
Hypercalcemia Tx
IV 0.45NaCl or 0.9% Na Cl
Encourage Fluids
Lasix
CALCITONIN (decreases calcium level)
Mobilize the pt
Restict dietary calcium
Maintain acidic urine
Limit calcium carbonate antacids
Magnesium
1.5-2.5 mEq/L
It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong
Hypomagnesemia
<1.5 mEq/L
Mg acts as a depressant, Increased neuromuscular irritability, tremors, tetany, seizures, dysrythmias, depression, confusion, dysphagia
Causes:
Alcoholism, GI suction, diarrhea, intestinal fistulas, abuse of diuretics or laxatives.
Hypomagnesemia Tx
Increased intake of dietary Mg (green veggies, nuts, bananas, oranges, peanut butter, chocolate)
-MAGNESIUM SULFATE
-Monitor Cardiac rhythm and reflexes to detect depressive effects of Mg.
-Keep a self-inflating breathing bag, monitor respiratory status a
Hypermagnesemia
>2.5 mEq/L
Depresses the CNS
Depresses cardiac impulse transmission
Hypotension
Facial flushing, muscle weakness
Absent deep tendon reflexes, paralysis
Shallow respirations
Causes:
Renal failure, excessive mg, administration of antacids, cathartics)
Hypermagnesemia Tx
Emergency support ventilation
IV CALCIUM GLUCONATE
Hemodialysis
Monitor reflexes
Monitor Cardiac rhythm
Volume Deficit
Urine specific gravity >1.030
Hypotension
Increased Hgb, hct, Na+, serum osmolality
Increased Temp.
Volume Overload
Urine specific gravity <1.010
Decreased hct, BUN, Hgb, Na+, serum osmolality
Hypertension
Increased Respirations, SOB, dyspnea, rales (crackes)
Peripheral edema
Jugular Vein distention
Volume Deficit Tx
Force fluids
Isotonic Fluids (LR or 0.9 NS)
Assess uring specific gravity
Volume Overload Tx
Administer Diuretics
Restrict fluids
Sodium restricted diet (6-15mg Na+/day)
Semi-fowlers if dyspneic
Diabetes Insipidus
Decreased ADH
Excessive urine output
Chronic-Severe dehydration
Excessive thirst
Diabetes Insipidus Tx
Record I/O
Monitor urine of specific gravity, BP, HR, Temp
Administer PITRESSIN
Syndrome of Inappropriate Antidiuretic Hormone Secretion - SIADH
Increased ADH
Anorexia, N/V, HA, Change in LOC
Decreased urinary output
Increased blood volume
Syndrome of Inappropriate Antidiuretic Hormone Secretion - SIADH - TX
Restrict water intake (500-600ml/24h)
Administer diuretics
Hypertonic solutions (3%Nacl) IV
DEMECLOCYCLINE (DECLOMYCIN)
Monitor Na+ levels
Assess LOC
Potassium Level
3.5-5.0 mEq/L
Main intracellular ion - involved in cardiac rhythm, nerve transmission
Hypokalemia
<3.5 mEq
Anorexia, N/V, muscle weakness, paresthesias, dysrhythmias
Decreased sensitivity to digitalis
Hyperkalemia
>5.0 mEq/L
EKG changes, Dysrythmias, cardiac arrest, muscle weakness
Caused by: Renal failure, use of potassium supplements, burns, crushing injuries
Hypokalemia Tx
Oral Potassium supplements (dilute in juice to avoid gastric irritation)
Increase in diet:
raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery.
Increase risk of digoxin toxicity
Hyperkalemia Tx
Restrict dietary potassium
Kayexelate - Cation exchange resin (causes diarhea)
Emergency - CALCIUM GLUCONATE, SODIUM BICARBONATE, Reg Insulin, Dextrose
Insulin and dextrose shift potassium into the cells
Diuretics
Sodium Level
135-145mEq/L
Main extracellular ion; responsible for water balance.
Hyponatremia
<135
Nausea, muscle cramps, increased ICP, confusion, muscular twitching, convulsions
Hyponatremia Tx
Sodium Rich foods:
beef broth, tomatoe juice
IV Isotonic - Lactated Ringer or 0.9 Nacl
Water Restriction (safer method)
I/O, Daily weight.
Hypernatremia
>145
Elevated Temp
Weakness
Disorientation
Delusion and Hallucination, thirst, dry swollen tongue
Hypotension
Tachycardia
Hypernatremia Tx
Hypotonic IV - 0.3% NaCl or 0.45% NaCl or 5% Dextrose in water
Offer fluids at regular intervals
Decrease sodium in diet
Daily wt
Calcium
ionized serum calcium - 4.5-5.2mg/dl
Total serum calcium - 10.5mg/dl
Needed for blood clotting, skeletal muscle contraction.
Regulated by parathyroid hormone and vit D, which facilitates reabsorption of calcium from bone and enhances absorption from GI tr
Hypocalcemia
Ionized serum calcium <4.5
Total serum calcium <8.5
Nervous system becomes increasingly excitable
Tetany:
Trousseau's sign (BP cuff - carpal spasm)
Chvosteks sign (tap facial nerve - twitching of facial muscles)
Seizures
Confusion
Paresthesia
Irritability
Hypercalcemia
Ionized serum cacium >5.1 mg/dL
Total serum calcium > 10.5 mg/dL
Sedative effects on CNS and PNC
Muscle weakness, lack of coordination
Constipation, abdominal pain and distention
Confusion
Depressed or absent endon reflexes
Dysrhythmias
Hypocalcemia Tx
Calcium Gluconate or Calcium Chloride (administer with OJ to maximize absorption.
Avoid high serum concentrations and cardiac depression.
Seizure precautions
Regular exercise
Hypercalcemia Tx
IV 0.45NaCl or 0.9% Na Cl
Encourage Fluids
Lasix
CALCITONIN (decreases calcium level)
Mobilize the pt
Restict dietary calcium
Maintain acidic urine
Limit calcium carbonate antacids
Magnesium
1.5-2.5 mEq/L
It helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong
Hypomagnesemia
<1.5 mEq/L
Mg acts as a depressant, Increased neuromuscular irritability, tremors, tetany, seizures, dysrythmias, depression, confusion, dysphagia
Causes:
Alcoholism, GI suction, diarrhea, intestinal fistulas, abuse of diuretics or laxatives.
Hypomagnesemia Tx
Increased intake of dietary Mg (green veggies, nuts, bananas, oranges, peanut butter, chocolate)
-MAGNESIUM SULFATE
-Monitor Cardiac rhythm and reflexes to detect depressive effects of Mg.
-Keep a self-inflating breathing bag, monitor respiratory status a
Hypermagnesemia
>2.5 mEq/L
Depresses the CNS
Depresses cardiac impulse transmission
Hypotension
Facial flushing, muscle weakness
Absent deep tendon reflexes, paralysis
Shallow respirations
Causes:
Renal failure, excessive mg, administration of antacids, cathartics)
Hypermagnesemia Tx
Emergency support ventilation
IV CALCIUM GLUCONATE
Hemodialysis
Monitor reflexes
Monitor Cardiac rhythm