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dino - Unit 7 lecture 1-3
Nutritional-metabolic pattern: basic fluid, electrolyte, & Acid Base Concepts:
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09/01/2010

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Term
Hypotonic
Definition
Term
Definition
lower thabn normal concentration of sodium in the blood, which can occur with a net sodium loss or net water excess. As sodium loss continues, the body continues to preserve the blood and interstersticial, lab results will be below 135
Term
Intracellular Fluid ( ICF)
Definition
Fluid found inside cells
Term
Ion
Definition
a particle that is electrically charged (positive or negative)
Term
Isotonic
Definition
is when both sides of the membrane are in equilibrium
Term
Intravenous (IV)
Definition
_ refers to giving medications or fluids (solutions) through a needle or tube inserted into a vein, which allows immediate access to the blood supply.
Term
Metabolic acidosis
Definition
_ is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body. There is an increase in hydrogen ion production and is characterized by a pH below 7.35 and a bicarbonate level below 22 mEq/L
Term
Metabolic alkalosis
Definition
is a pH imbalance that occurs when the body accumulates too much of an alkaline substance, such as bicarbonate, and does not have enough acid to effectively neutralize the effects of the alkali. The body has more base than acid in the system There is a decrease in hydrogen ion production, characterized by a blood pH above 7.45 and accompanied by a bicarbonate level above 26
mEq/L
Term
Edema
Definition
an accumulation of excess fluid in the interstitial space
Term
Electrolyte
Definition
minerals and salts contained in water moving throughout the compartments of the body.
Term
Electrolyte Imbalance
Definition
Occurs when imbalance is present in one or all of the following: Sodium, Potassium,Calcium, Magnesium, and Chloride
Term
Enteral Feeding_
Definition
Nutrients given in the GI tract. Preferred method of meeting nutritional needs if clients GI tract is functioning by providing physiological, safe, and economical nutritional support.
Term
Extracellular Fluid (ECF)
Definition
all the fluid outside the cell, which is
divided into three smaller compartments: interstitial fluid,
intravascular fluid, and transcellular fluid.
Term
hyper-
Definition
above normal
Term
hypo-
Definition
below normal
Term
(Na) sodium
Definition
90% primarily extracellular, regulated by dietary intake and aldosterone secretion.
Term
Na function
Definition
maintain fluid balance, H2o balance & the effect of serum osmolarity.
RDA 500mg NaCl/day.

maintain acid base balance
acts as a buffer base.
Term
Na excretion
Definition
by urine, sweat & feces.
Term
hyponatremia
Definition
< 136 mEq/L

Normal 136-145mEq/L
Term
Hyponatremia: etiology
Definition
Na+ deficits: excessive diaphoresis, diuretics, wound drainage, renal disease, hyperlipidemia, dec. secretion of aldosterone.
Term
hyponatremia: manifestations
Definition
does not appear until Na+ <125mEq/L.

pt. having acute dec. in serum Na levels have higher mortality rates than a PT. who more slowly develops hyponatremia.

early s/s: HA, faintness & giddiness

s/s changes in LOC, weakness in the muscle, decrease in dia. BP, severe hypotension, inc. urinary output.
Term
hyponatremia: (NI)
Definition
*priority NI, monitoring the Pt. response to Tx to prevent hypernatremia & fluid overload.

fluid deficit: IV solutions
fluid excess: osmotic diuretics.

encourage intake of foods c high Na.
SIADH = fluid restriction (fluid restriction 1000ml-1200w 24hrs)
Term
hypernatremia
Definition
sodium > 145mEq/L

normal 136-145mEq/L
Term
Hypernatremia: Etiology
Definition
hyperaldosteronism, renal failure, corticosteroids, cushing's syndrome; excess intake of Na, excessive intake of Na-containing IV fluids
Term
Hypernatremia (NI)
Definition
- priority: monitor the Pt. responce to therapy & prevent hyponatremia & dehydration.
- offer pt. fluids hourly - 6-8 8oz glasses daily.
- monitor Na+ I&O
Term
Hypernatremia manifestation
Definition
c/o thirsty, dry skin, rough red tonge, dry sticky mucos membranes, fever, muscle twitching, distended neck veins.
Term
Potassium (K)
Definition
3.5-5mEq/L

found primarily intracellular.
Term
Potassium (K): FxN and elimination
Definition
maintain normal HR, transmission and condition of nerve impulses, contraction of skeletal and smooth muscle, excreted by the kidneys. regulation of protein synthesis.
Term
hypokalemia
Definition
<3.5 mEq/L

normal 3.5-5mEq/L
Term
Hypokalemia: etiology
Definition
excessive use of diuretics, digitalis, corticosteroids; D.V. and wound drainage, prolonged NG suction,, inadequate intake of K, NPO status, excess heath--> diaphorosis.
Term
Hypokalemia: relative K+ deficits
Definition
alkalosis, hyperinsulinism, hyeralimentation, TPN, excessive diaphoresis,, H2O intoxication, IV Tx c inadequate K+ solutions.
Term
Hypokalemia s/s
Definition
early s/s: hypotension, lethargy, mental confusion, muscle weakness.

variable P rate, EKG changes, irregular HR, shallow breaths, diminished breath sounds.
Term
Hypokalemia (NI)
Definition
K+ supplements, uses K+ sparing diuretics.
infusion device MUST be used and NO FASTER than 5-10mEq/L.
Term
foods with high K+
Definition
bananas
cantaloupe
kiwi
oranges
avocados
broccoli
dry beans
peas
mushrooms
soy bean
potatoes
Term
hyperkalemia
Definition
> 5mEq/L

normal: 3.5-5mEq/L
Term
hyperkalemia: manifestations
Definition
irregular and bradycardia, hypotension,hyperactive bowel sounds, diarrhea.

early stage: muscle twitching, tingling & burning sensation followed by numbness in hands.

late s/s: muscle weakness in hands and legs by flaccid paralysis.
Term
hyperkalemia: (NI)
Definition
priority: monitor cardiac status, safety, response to therapy and health teachings.

Rx: Lasix to Pt. /c normal renal FxN.
renal given Kayexalate.
Term
Ca+
Definition
9.0-10.5mg/L

most frequently preformed labs.
Term
total Ca+ serum levels
Definition
9.0-10.5mg/dL
Term
ionized serm Ca+ levels
Definition
4.5-5.6mg/dL
Term
calcium FxN & Elimination.
Definition
bone strength & density
skeletal & cardiac muscle contraction
nerve impulse transmission
blood clotting
activates enzymes
excreted in the urine and feces
stored in the bones
Term
hypocalcemia
Definition
total serum ca+ level <9.0mg/dL

normal 9.0-10.5mg/dL
Term
Hypocalcemia: etiology
actual calcium deficits
Definition
inadequate intake, lactose intolerance, malabsorption syndromes, ESRD, renal failure.
Term
Hypocalcemia: etiology
relative ca+ deficits
Definition
hyperproteinemia, alkalosis, immobility, acute pancreatitis.
Term
hypocalcemia: manifestations
Definition
arrythmias, thready pulse, severe hypotension, muscle spaisms, osteoporosis, dec. bone density, positive chvostek's sign, trousseau's sign.
Term
Positive chvostek's sign
Definition
contraction of facial muscles response to tap over facial nerve.
Term
trousseau's sign
Definition
carpal spasms induced by inflating BP cuff on arm above systolic BP 3 min spasms r/t inc. neuromuscular activity.
Term
hypocalcemia (NI)
Definition
Ca+ replacement PO or IV Rx that enhance absorption (aluminum hydroxide & vitamin D).

monitor airway, as laryngeal stridor can occur, seizure precautions, edu. osteoporosis.
Term
foods rich in Ca+
Definition
milk, cheese, yogurt.
Term
hypercalcemia
Definition
total serum Ca+ >10.5

normal 9.0-10.5mg/dL
Term
hypercalcemia: etiology
actual ca+ excesses
Definition
excessive intake of calcium or vitamin d, renal failure, use of thiazide diuretics (HZTZ)
Term
hypercalcemia: etiology
relative ca+ excesses
Definition
hyperparathyroidism, malignancy, hyperthyroidism, immobility, use glucocorticoids, hemoconcertration c dehydration.
Term
hypercalcemia: manifestations
Definition
inc. HR&BP, depression of electrical conduction slowing the HR, muscle weakness, ALOC, lethargy & coma, decreased peristalsis, hyperactive bowel sounds, N., abd. distention, constipation.
Term
hypercalcemia: (NI)
Definition
fluid replacement NS
mobilize pt asap.
force fluid to eliminate Ca+ & prevent renal calculi.
Rx: Ph+, ASA
v/s
check cap refill
assess LOC.
cranberry juice keeps urine acid- low pH favors Ca+ solubility.
Term
Phosphorus/phosphate
Definition
Phosphorus 3.0-4.5 mg/dL

found in bones, regulated by diet intake, renal excretion, intestinal absorption, and PTH.
Term
Phosphorus/phosphate: fXn and elimination
Definition
needed for activating b-complex vitamins, forming & activating ATP, cell divsion, CHO PRO & Fat metabolism.

FxN of muscle, RBC & nervous system
deposited c Ca+ in the bones and teeth
Term
when PO4 (phosphorus)level is high, Ca+ is..
Definition
low, inverse relationship.
Term
when Ca+ level is high, PO4 is..
Definition
low, inverse relationship.
Term
hypophsphatemia
Definition
<3.0mg/dL

normal 3.0-4.5mg/dL
Term
hypophosphatemia: etiology
Definition
malnutrition, starvation, use of aluminum hydroxide-base antacids and Mg based antacids, hyperparathyroidism, hypercalcemia, renal failure, hyperalimentation, resp. alkalosis, uncontrolled DM, hyperglycemia, ETOH
Term
hypophosphatemia: manifestations
Definition
Dec. CO, peripheral pulses are slow, shallow resp., muscle weakness, dec. tendon reflexes, dec. bone density, confusion, seizures
Term
hypophosphatemia: (NI)
Definition
foods c high PO4:
fish, beef, chicken, nuts, whole-grain breads&cereal.

PO replacements
IV Ph if Ph fall < 1mg/dL
Term
hyperphosphatemia
Definition
>4.5mg/dL

normal 3.0-4.5mg/dL
Term
hyperphosphatemia: etiology
Definition
reduce renal Ph excretion r/t renal failure
shift of pH from the intracellular space into ECF r/t lysis of tumor cells i.e. secondary to chemotherapy
high Ph intake or hypocalcemia.
Term
hyperphosphatemia: manifestations
Definition
s/s of hypocalcemia & tetany, numbness 7 muscle spasms.

long term - soft tissue calcification
Term
Mg
Definition
1.3-2.1mEq/L

second most abundant intracellular ion
Term
Mg Fxn and elimination
Definition
skeletal musclar contractions
ATP formation
vitamin activation
CHO metabolism
cell growth & coagulation
Term
hypomagnesemia <1.3mEq/L
Definition
<1.3mEq/L

normal 1.3-2.1mEq/L
Term
hypomagnesemia: etiology
Definition
insufficient Mg intake: malnutrition, starvation, d., steatorrhea, crohn's & celiac dez.
Term
hypomagnesemia: mainfestations
Definition
dysrhytmias, HTN< anorexia, N. abd distention, dec. bowel sounds, shallow resp. hyperactive deep tendon reflexes, numbness &tingling.
Term
hypomagnesemia: (NI)
Definition
Mg is replaced c MgSO4, oral Mg can cause D. & worsen the problem.

d/c Rx that promotes Mg loss e.g. loopdiuretics &aminoglycoside.
Term
Mg dietary sources
Definition
tuna, raisins, beef, pork, milk, peanut butter, avocado, peas, spinach, potatoes, nuts, legumes.
Term
hypermagnesemia
Definition
>2.1mEq/L

normal 1.3-2.1mEq/L
Term
hypermagnesemia: etiology
Definition
excessive Mg intake c renal insuficiencyor failure. elderly are more prone because of inc. intake antacids & dec. renal function, almost the use of Mg+ salts.
Term
hypermagnesemia: manifestations
Definition
bradycardia, peripheral vasodilation, hypotension, drowsy, lethargic, coma, deep tendon reflexes are dec. or absent, weakness.
Term
hypermagnesemia: (NI)
Definition
d/c Rx /cMg, administer loop diuretics
HD pt. if pt has renal failure.
dietary restrictions.
Term
hypermagnesemia: food to advoid
Definition
meat, nuts, legumes, fish
Term
Cl
Definition
Cl 98-106mEq/L

80% of Cl in ECF
Term
Cl Fxn
Definition
regulation of H2O
production of HCL needed for digestion
Maintenance of pH
Term
hypochloremia
Definition
<98mEq/dL

normal 98-106meq/dL
Term
hypochloremia: etiology
Definition
D.V.
diaphoretic
GI suctioning
diuretics
dec. intake
Term
hypochloremia: mainfestations
Definition
hypoventilation
tetany
restlessness
confustion
convulsions
paresthsia of extremities
Term
hypochloremia: (NI)
Definition
assess labs
encourage high NA+ foods
Rx: anti-emetics & foods
Rx: anti-emetics & diarrheal
d/c the use of diuretics.
Term
hyperchloremia
Definition
> 106mEq/L

normal: 98-106mEq/L
Term
hyperchloremia: etiology
Definition
very rare disorder
may occure c dehydration, bicarbonate deficieny, hypernatremia, metabolic acidosis.
Term
hyperchloremia: manifestations
Definition
hyperventilation
hypotension
dec. CO
HA
lethargy
Term
hyperchloremia: (NI)
Definition
correct the fluid balance: IV hydrations and replace bicarbonate /c Nas bicarb

continually monitor LOC and labs.
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