intro abg and electrolytes

7/27/2019 Intro ABG and Electrolytes

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Fluid & Electrolytes Calcium & Magnesium

Calcium:

Normal serum Calcium level = 8.9 10.1 mg/dL Stored in BONES, TEETH, & MUSCLE CELLS

List functions of Ca+: BONE STRENGTH & DENSITY, SKELETAL MUSCLE CONTRACTION, CARDIACMUSCLE CONTRACTION, TRANSMITS NERVE IMPULSES, HELPS WITH CLOTTING

Half of all Ca+ is bound to PROTEIN (ALBUMIN) List foods with Ca+: DAIRY PRODUCTS, KELP, NUTS & SEEDS, MOLASSES, BEANS, FIGS, QUINOA,

COLLARD GREENS, OKRA, BROCCOLI, ORANGE JUICE, SOYMILK (FORTIFIED)

Recommended daily requirements = 800 1000 MG If Ca+ is low, PARATHYROID HORMONE is released to draw Ca+ from the bones into the serum = Ca+

If Ca+ is high, CALCITONIN is released to inhibit Vitamin D activation & increase Ca+ excretion = Ca+

o VITAMIN D is needed to absorb calcium Ca+ has an inverse relationship with PHOSPHORUS Critical level for Ca+ is below 8.1 MG/DL

Magnesium:

Normal serum magnesium level = 1.5 2.5 mEq/L Absorbed from FOOD, lost in URINE & STOOL (regulated by the kidneys) Stored in BONE, MUSCLE, & SOFT TISSUE List functions of Mg+: CARBOHYDRATE METABOLISM, PRODUCES ATP, MOVES Na+ and K+

ACROSS CELL MEMBRANES, VASODILATION, CARDIAC & SKELETAL MUSCLE CONTRACTILITY

(LESS THAN CA+), CLOTTING

List foods that contain Mg+: MEATS, NUTS, SEEDS, GREEN VEGGIES, BANANAS, ORANGES,PEANUT BUTTER, CHOCOLATE

ELECTROLYTE

IMBALANCE

CAUSES SIGNS & SYMPTOMS TREATMENT/INTERVENTION

S

HYPOCALCEMIA

1. Insufficient intake2. Hypoparathyroidism

(not enough PTH

produced to helpCa+)

3. Impaired absorption(laxatives)

4. Chronic renal failure5. Chronic alcoholism6. Pancreatitis7. Multiple blood

transfusions

1. Anxiety/confusion/irritability

2. Muscle twitching3. Parathesia (tingling) in

toes, fingers, or face

4. Spasm of abdominal orlaryngeal muscles

5. Tetany6. Arrythmias / ECG changes7. Altered blood clotting8. Positive Trousseaus (carpal

spasms of hands)

9. Positive Chvosteks sign(facial spasms)

10. Ca+ below 8.9THINK OVERACTIVE

1. TREAT THE CAUSE2. Give Ca+ oral (30 mins

prior to food) or IV

(calcium gluconate or

calcium chloride) GIVE

IT SLOWLY BY PUSH

3. Give Vitamin D if needed4. Encourage dietary intake5. Avoid laxatives6. Avoid seizure

precautions

7. Injury prevention (weakbones)

8. Monitor: Ca+, albumin,clotting levels

9. MONITOR THE IV SITEextravasation can lead


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RESPONSE to tissue death

HYPERCALCEMIA

1. Hyperparathyroidism (too much PTH

moving Ca+ into

serum)

2. Bone tumors(osteometastisis)

3.

Loss of Ca+ frombone into plasma

4. Prolongedimmobility (bone

mineral loss)

5. Osteoporosis6. Excess intake

(antacids)

7. Renal failure,prolonged use of

thiazide diuretics

8. Vitamin D overdose9. Acidosis

1. Spontaneous fractures2. Confusion, personality

changes, depression

3. Lethargy, drowsiness,apathy, coma

4. Muscle weakness, slowreflexes5. Tachycardia -> bradycardia-> heart block

6. Anorexia, N/V/C7. Polyuria, polydipsia8. Renal calculi (kidney

stones)

9. Hypertension10. Excessive clotting11. Ca+ above 10.1THINK DEPRESSED RESPONSE

1. Loop diuretics toexcrete extra Ca+

2. IV NS to replace Na+lost with loop diuretics

3. WEIGHT BEARINGACTIVITY

4.

WATCH FOR FALLS5. Increase fluid intake to3000 4000 mL/day

6. Monitor cardiac function(telemetry)

7.

HYPOMAGNESEMIA

1. Chronic alcoholism2. Uncontrolled

diabetes mellitus

(glucose moves into

cell & pushes Mg+

out to be excreted)

3. Malabsorption,starvation

4. Acute renal disease(unable to reabsorb

Mg)

5. Vomiting, diarrhea,NG suction6. Pancreatitis

7. Prolonged TPN w/osupplements

8. Diuretics

1. Irritability, seizures, tetany2. Parathesias (tingling)3. Positive Chvosteks sign

(facial spasms)

4. Positive Trousseaus sign(carpal spasms)

5. Confusion, delusions,insomnia

6. Dysrhythmias, HTN7. N/V/C, anorexia8. Hyperactive reflexes9. Mg+ less than 1.5 mEq/LTHINK: OVERACTIVE RESPONSE

1. TREAT THE CAUSE2. SLOW infusion of

MgSO4 watch tissue

damage

3. Encourage dietary intake4. Reduce stimuli5. MONITOR cardiac (tele)

& neuro status

6. Avoid laxatives &antacids

7. ASSESS DTR EVERYHOUR

8.

STOP LOOP DIURETICS9. Ca+ may be low - treat


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HYPERMAGNESEMI

A

1. Chronic renal failure(cannot excrete

Mg+)

2. Excess intake(Maalox, Milk of Mg)

3. Addisons disease4. Dehydration5. Untreated diabetic

ketoacidosis

(severely high blood

sugar & metabolic

acidosis)

6. If on TPN with IV Mgreplacement

1. Feeling warmth, sweating,depression (vasodilation)

2. Bradycardia, weak pulse,ECG changes

3. Lethargy, drowsiness,confusion, coma

4. Tremors, muscle weakness,hypoactive reflexes

5. Hypotension Low BP withvasodilation

6. CARDIAC ARREST &RESPIRATORY DEPRESSION

7. Mg above 2.5 mEq/dLTHINK: DEPRESSED REACTION

1. If renal failure Dialysis2. If renal normal IV

fluids

3. Loop diuretic - excreteMg

4. Give IV CalciumGluconate Ca+reverses effects of

excessive Mg+ on

cardiac

5. Avoid laxatives &antacids with Mg

6. Encourage fluid intake7. MONITOR cardiac &

respiratory status

8. MONITOR I & Os

FLUID IMBALANCE CAUSES SIGNS & SYMPTOMS TREATMENT/INTERVENTIONS

FLUID VOLUME

DEFECIT = body loses

water & electrolytes in

the same proportion to

normal ratio

Serum Electrolyte levels

remain NORMAL

1. Vomiting/diarrhea

(losses from GI tract)

2. GI suction (again, GI

loss)

3. Sweating-excessive

4. Inadequate Fluids

At Risk:

- Elderly forgetting to

drink - Do not feel thirst;

or dementia

- People who cannotspeak for themselves;

infants

1. Weight loss (1 pint of

fluid loss = 1 lb of weight

loss)

2. Decreased skin turgor

3. Dry/sticky mucous

membranes

4. Weak, rapid pulse

Elevated hemoglobin

and hematocrit - Blood is

more concentrated

ASSESS:

- Strict Intake & output

- Daily Weights

ISOTONIC fluid replacement,

preferably orally (less invasive)

IV if needed

What do you NOT give, but it

is easy for us to think we

should?

- WATER - NOT ISOTONIC (ITIS HYPOTONIC)

FLUID VOLUME EXCESS

=

body retains water &

electrolytes at the same

proportion

Serum Electrolyte levels

remain NORMAL

1. HF

Renal failure

Cirrhosis, liver failure

Excessive ingestion of

table salt

Over-hydration with

sodium containing fluids

At Risk:

Poorly controlled IVtherapy for younger and

older patients

Peripheral edema

Increased, BOUNDING

pulse

Elevated BP (fluid

volume)

Distended neck and hand

veins

Dyspnea

MOIST CRACKLES HEARD

WHEN LUNGSAUSCULTATED

Frothy sputum

Hemoglobin and

hematocrit are

DECREASED - Blood is

diluted

Administer ordered diuretics

(LASIX)

Fluid restrictions

Strict I& O

Sodium restricted diet Na+

attracts water and will hold in

body

DAILY WEIGHTS

K+ serum level monitoring


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ARTERIAL BLOOD GASES (work a bunch of these right before exam!)

1. Normal levelsa. pH based on percentage of hydrogen ions (H+) in the blood

i. Normal range = 7.35 to 7.45ii. Below 7.35 acidosisiii. Above 7.45 alkalosis

b. PaCO2 35 to 45 mmHgc. HCO3 (bicarb buffer) 22 to 26 mEq/L

2. General rulesa. Anything that causes you to not blow off CO2 will lower your pH (respiratory)b. Adjustment to pH by kidneys can take hours/daysc. Compensation occurs when one system tries to adjust for the other to regulate pHd. Chemoreceptors vary the rate and depth of breathing to compensate for pH changes

3. Respiratory acidosisa. pH is low, PaCO2 is highb. Causes

i. Hypoventilationii. Neuromuscular problemsiii. Depression of the respiratory center in the brainiv. Lung diseasev. Airway obstruction

c. S/Si. Restlessness, pain, hypoxia

ii. Shallow, rapid respirations but will cycle and slow downd. Who is at risk

i. Childrenii. Mechanical ventilationiii. Post-op patientsiv. Anyone on analgesics or sedatives

e. Serum electrolytesi. High K+ because it is moving out of the cells d/t H+ moving in

f. Treatmenti. Maintain patent airway

ii. Bronchodilatorsiii. O2 as needediv. Drug therapy to treat hyperkalemiav. Antibiotics if there is an infectionvi. Chest PT

4. Respiratory Alkalosisa. pH is high, PaCO2 is lowb. Causes


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i. Hyperventilation d/t anxietyii. Hypermetabolic states (fever and sepsis)iii. Liver failureiv. Conditions that affect the brains respiratory control centerv. Hypoxia (high altitude, PE, hypotension)vi. Elevated progesterone levels (pregnancy)

vii. Nicotine, salicylates, catecholaminesc. Labs

i. Low Na+, low Ca+ii. ECG possible arrhythmias

d. Treatmenti. Undisturbed rest periods

ii. Correct underlying disorderiii. Relaxation techniquesiv. Monitor VS, ABG, electrolytesv. Report changes in cardiac, neuro, or neuromuscular function (can have seizures)

5. Metabolic acidosisa. pH is low, PaCO3 is lowb. Causes

i. Overproduction of ketone bodies (esp. diabetes)ii. Impaired kidney function (hyperkalemia)iii. GI losses (severe diarrhea, malabsorption)iv. Poisoning / drug toxicity

c. S/Si. Rapid, deep respirations (Kussmauls)

ii. Fruity breath odoriii. Skin dry, becomes cool and clammyiv. LOC deteriorationd. Treatment

i. HCO3 by IVii. Antibiotics, antidiarrheal if needediii. Rapid-acting insulin, if diabetic; dialysis if also renal failureiv. Ventilation if neededv. Safety and seizure precautions

6. Metabolic alkalosisa. pH is high, PaCO3 is highb. Causes

i. Hypokalemiaii. Acid loss from GI tract (vomiting, pyloric stenosis, NG tube suctioning, GI

surgeries)

iii. Diureticsiv. Kidney disease (renal artery stenosis)v. Transfusions / drugs (antacids that contain bicarb)

c. Labsi. Low K+, Ca2+, Cl- (d/t polyuria)

ii. Possible ECG changes


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intro abg and electrolytes

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