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NUR 376 Exam 1 - LM 1 & 2 with complete solutions.
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NUR 376 Exam 1 - LM 1 & 2 with complete solutions.
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NUR 376 Exam 1 - LM 1 & 2with complete solutions
Hyponatremia
CAUSES
- actual = sweating, wound drainage, burns, low sodium diet,
diuretics
- relative = syndrome of inappropriate anti diuretic hormone
(SIADH), water intoxication, psychogenic polydipsia, hypotonic
fluids
ASSESSMENT
- neuro = behavior changes, increased ICP, cerebral edema,
seizures, headache, confusion
- MS = weakness (resp muscles), cramps, twitching, decreased DTR
- GI = hyperactive BS, increased motility, cramps, nausea, vomiting,
anorexia
- CV = hypovolemia - weak pulse, tachycardia, hypotension,
dizziness; hypervolemia - bounding pulse, high BP
- OTher = lethargy, papilledema, dry skin, weight gain, edema,
cerebral edema
INTERVENTIONS
- replace slowly to prevent fluid overload, can cause neuro damage
- stop Na wasting drugs; switch to osmotic diuretics
- Iv fluids; hypertonic saline
- increase Na intake
- free water restriction
Hyponatremia - what is it
- serum sodium less than 135 mEq/L
TYPES
- euvolemic = water is retained in body so volume increases, sodium
stays the same; due to SIADH, adrenal insufficiency, Addison
disease
- hypovolemic = loss of fluid and sodium volume; casued by
vomiting, diarrhea, NG suction, diuretic therapy, burns, sweating
- hypervolemic = increase in fluid and sodium but sodium decreases
due to dilution because it is regulated separately in the body;
caused by CHF, kidney failure, IV saline, liver failure
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Sodium
- normal = 136-145 mEq/L
MAIN FUNCTIONS
- main extracellular cation
- sodium shifts in and out of vessels for balance
- controls fluid distribution between intra and extra cellular fluid*
- muscle contraction*
- nerve impulses*
- large impact on brain
Hypernatremia
- serum soduim greater than 145 mEq/L
CAUSES
- actual = steroids causes kidneys to retain sodium, ingesting
excess, hypertonic solutions, Cushing syndrome
- relative = NPO, fever, hyperventilation, dehydration, infection
ASSESSMENT
- Neuro = related to cellular dehydration in the brain cells;
hypovolemic - irritable, confused, manic, cranky; hypervolemic -
lethargic, drowsy, stupor, coma
, - MS = twitching, cramps, weakness, hyperreflexia, seizures
- CV = decreased contractility; hypovolemic - decreased BP, weak
pulses; hypervolemic - increased BP, JVD, bounding pulses
- other = extreme thirst, dry mucous membranes, dry/hot skin,
restlessness, pulmonary edema, nausea, vomiting, anorexia
INTERVENTIONS
- bring levels down slowly
- hypotonic fluids
- if hypervolemic, give Na wasting diuretics (loop, thiazide)
- Na dietary restriction
- increase free water
Potassium
- normal = 3.5-5 mEq/L
- main functions = acid base balance, most abundant Intracellular
cation, transmission of electrical impulses (heart, skeletal muscles)
- top priorities = treat the cause, protect the heart
Hypokalemia
- serum potassium less than 3.5 mEq/L
CAUSES
- endocrine disorder = Cushing syndrome
- excess insulin
- alkalosis
- vomiting/diarrhea
- diuretics (loop, thiazide)
ASSESSMENT
- resp = shallow respirations
- MS = hyporeflexia, weakness
- CV = weak/thready pulse, orthostatic hypotension, EKG changes,
dysrhythmias
- Neuro = altered mental status, lethargy, decreased LOC
- GI = hypoactive bowel sounds, constipation/ilius, distention,
anorexia
- GU = dilute urine, excessive thirst
INTERVENTIONS
- prevent more loss (treat the cause)
- potassium replacement (dietary, IV for severe)
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