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Lecture 6

NURSING 2LA2 Lecture Notes - Lecture 6: Blood Plasma, Qrs Complex, Metabolic Alkalosis


Department
Nursing
Course Code
NURSING 2LA2
Professor
Ruth Hannon
Lecture
6

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N2J04 Week 5 - Wednesday
Week 5: Medication Administration: Part 3
Intravenous (IV) Therapy
Learning Outcomes
i.1. Describe factors affecting fluid and electrolyte balance for adults, pediatric and geriatric clients.
Regulation of body fluids
-Fluid intake:
oOsmoreceptors continually monitor the serum osmotic pressure, and when osmolality
increases, the thirst centre in the hypothalamus is stimulated
oThe average adult’s fluid intake is about 2200-2700m per day (1100-1400ml oral intake +
800-1000ml solid foods + 300ml oxidative metabolism)
oInfants, clients with neurological or psychological problems, and some older adults who are
unable to perceive or response to the thirst mechanism are at risk for dehydration
-Hormonal regulation
oADH: Released from the posterior pituitary. Promotes water conservation by acting directly
on the renal tubules and collecting ducts to make them more permeable to water  causes
water to return to the systemic circulation
oAldosterone: Release from the adrenal cortex. Acts on the distal portion of the renal tubule
to increase the reabsorption of sodium and excretion of potassium and hydrogen
oNatriuretic peptides: Released from cardiac muscles. Act on the peripheral vasculature,
other hormones and kidneys to facilitate dieresis, increase sodium excretion and block ADH
and aldosterone release
-Fluid output regulation
oKidneys: major regulatory organ of fluid balance – produce approx. 1200-1500 ml of urine
daily
oSkin: contributes to insensible water loss through perspiration of approx 600 ml daily. Also
contributes to sensible (visible) water loss
oLungs: contributes to insensible water loss though expiration of approx 400 ml daily
oGIT: contributes to 100-200 ml of water loss daily (under normal conditions)
Regulation of electrolytes
-Cations
oSodium
Contributes to nerve impulse transmission, regulation of acid-base balance, and
cellular chemical reactions
Regulated by ADH and the thirst mechanism.
oPotassium
Regulates metabolic activities, necessary for glycogen deposition,
transmission/conduction of nerve impulses, normal cardiac condition, and skeletal
and smooth muscle contraction
Regulated by dietary intake, aldosterone, changes in acidity or alkalinity of fluid and
sodium resorption
oCalcium
Necessary for one and teeth formation, blood clotting, hormone secretion, cell
membrane integrity, cardiac condition, transmission of nerve impulse and muscle
contraction
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N2J04 Week 5 - Wednesday
Regulated by parathyroid hormone, calcitriol and calcitonin
oMagnesium
Important for bone structure and neuromuscular function (including skeletal and
cardiac muscle excitability)
Regulated by dietary intake, renal mechanisms, and the actions of parathyroid
hormone
-Anions
oChloride: regulated by dietary intake and the kidneys. Chloride follows sodium
oBicarbonate: regulated by the kidneys
oPhosphate: regulated by dietary intake, renal ad intestinal excretion, and parathyroid
hormone
Regulation of acid-base balance
-Buffer systems
-Lungs: when the concentration of hydrogen ions is altered, the lungs correct imbalance by altering
the rate and depth of respiration (too acidic  increase respiration)
-Kidneys: take a few hours to days to regulate acid-base balance by reabsorbing or excreting
bicarbonate
i.2. Describe signs and symptoms of fluid and electrolyte imbalance for adults, pediatric and geriatric clients.
Electrolyte imbalances:
Imbalance Potential causes Signs and symptoms
Hyponatremia GI losses: vomiting, diarrhea,
nasogastric suction
Renal loss: kidney disease
resulting in sodium wasting,
diuretics, adrenal insufficiency
Skin loss: excessive perspiration,
burns
Psychogenic polydipsia
Syndrome of inappropriate ADH
Physical exam: apprehension, personality
change, postural hypotension, postural
dizziness, abdominal cramping, nausea and
vomiting, diarrhea, tachycardia, dry mucous
membranes, convulsions, coma
Lab findings: serum sodium < 135 mmol/L,
serum osmolality < 285 mmol/kg, urine specific
gravity < 1.01
Hypernatremia Excessive salt intake
Excess aldosterone secretion
Diabetes insipidus
Increased sensible and
insensible water losses
Water deprivation
Physical exam: extreme thirst, dry and flushed
skin, dry and sticky tongue and mucous
membranes, postural hypotension fever,
agitation, convulsions, restlessness, irritability
Lab findings: serum sodium > 145 mmol/L,
serum osmolaity > 300 mmol/kg, and urine
specific gravity > 1.03
Hypokalemia Use of potassium-wasting
diuretics
Diarrhea, vomiting or other GI
losses
Alkalosis
Excess aldosterone secretion
Polyuria
Physical exam: weakness and fatigue, muscle
weakness, nausea and vomiting, intestinal
distension, decreased bowel sounds, decreased
deep tendon reflexes, ventricular dysrhythmias,
paraesthesia, and weak, irregular pulse
Lab findings: serum potassium < 3.5 mmol/L;
ECG abnormalities (flattened T wave, ST
segment depression, U wave); potentiated
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N2J04 Week 5 - Wednesday
Extreme sweating
Excessive use of potassium-free
intravenous solutions
Treatment of diabetic
ketoacidosis with insulin
digoxin effects (e.g. ventricular dysrhythmias)
Hyperkalemia Renal failure
Fluid volue deficit
Massive cellular damage such as
from burns and trauma
Iatrogenic administration of
large amounts of potassium IV
Adrenal insufficiency
Acidosis, especially diabetic
ketoacidosis
Rapid infusion of stored blood
Use of potassium-sparing
diuretics
Ingestion of K+ salt substitutes
Physical exam: anxiety, dysrhythmias,
paraesthesia, weakness, abdominal cramps, and
diarrhea
Lab findings: serum potassium > 5.0 mmol/L;
ECG abnormalities (peaked T wave and widened
QRS complex [bradycardia, heart block,
dysrhythmias]; eventually QRS pattern widens
and cardiac arrest occurs)
Hypocalcemia Rapid administration of blood
transfusions containing citrate
Hypoalbuminemia
Hypoparathyroidism
Vitamin C deficiency
Pancreatitis
Alkalosis
Chronic renal failure
Chronic alcoholism
Physical exam: numbness and tingling of fingers
and circumoral (around mouth) region,
hyperactive reflexes, positive Trousseau’s sign
(carpopedal spasm with hypoxia), positive
Chvostek’s sign (contraction of facial muscles
when facial nerve is tapped), tetany, muscle
cramps, and pathological fractures (chronic
hypocalcium)
Lab findings: serum ionized calcium < 1.05
mmol/L or total serum calcium < 2.25 mmol/L;
ECG abnormalities (ventricular tachycardia)
Hypercalcemia Hyperparathyroidism
Osteometastasis
Paget’s disease
Osteoporosis
Prolonged immobilization
Acidosis
Thiazide diuretics
Physical exam: anorexia, nausea and vomiting,
weakness, hypoactive reflexes, lethargy, flank
pain (from kidney stones), decreased level of
consciousness, personality changes, and cardiac
arrest
Lab findings: serum ionized calcium > 1.3
mmol/L or total serum calcium level > 2.75
mmol/L; abnormalities visible on X-ray
examination (generalized osteoporosis,
widespread bone cavitation, radiopaque urinary
stones); elevated BUN > 7.1 mmol/L; elevated
creatinine > 106 mmol/L, caused by fluid
volume deficit or renal damage causedby
urotithiasis; ECG abnormalities (heart block)
Hypomagnesemia Inadequate intake: malnutrition
and alcoholism
Inadequate absorption or loss:
diarrhea, vomiting, nasogastric
drainage, fistula, disease of small
Physical exam: muscular tremors, hyperactive
deep tendon reflexes, confusion and
disorientation, tachycardia, hypertension,
dysrehythmia, positive Chvosteks and
Trousseau’s signs
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