N105: Essentials of Nursing Care - Health Differences

Essentials of Nursing Study Guide

• Risk factors: loss of fluid (insensible loss, fever, hyperventilation, diarrhea); water deprivation or increased salt intake (IV administration of saline, hypertonic tube feedings, or excess table salt use) • Signs and symptoms: dry mucus membranes; thirst; oliguria; fever; tachycardia; behavioral changes; hypotension; decreased cardiac output; seizures, coma; mucous membranes are dry and sticky; tongue is red, dry, and swollen; decreased level of consciousness; convulsions • Treatment: fluid administration with non-electrolyte solutions such as D5W Occasionally hypernatremia may be caused by a fluid volume excess containing high sodium content. Signs and symptoms with sodium and fluid excess include edema, hypertension, and weight gain. Treatment for hypernatremia associated with fluid overload includes diuretics and fluid restriction. Hyponatremia is commonly due to an excessive amount of water or sodium depletion. Hypervolemic hyponatremia is commonly caused by SIADH (syndrome of inappropriate ADH release) but can also be caused by repeated tap water enemas or by drinking excessive amounts of water. Other causes include thiazide diuretics, furosemide, diarrhea, Addison’s disease, gastric suctioning, hyperglycemia, vomiting, extreme diaphoresis, adrenal insufficiency, severe burns or wound drainage. Neurological signs do not appear until the sodium is less than 120-125 mEq/L. • Risk factors : loss of sodium (gastric suctioning, vomiting, sweating, use of diuretics); gain of water is caused by hypotonic tube feeding, drinking water, excess IV D5W administration, or syndrome of inappropriate ADH (head injury, AIDS, or malignant tumors) • Signs and symptoms: apathy; hyperreflexia; confusion; convulsion; coma; hypertension; headache; edema; generalized weakness; elevated urine specific gravity • Treatment: replacement of sodium and fluid losses; replacement of other electrolyte losses (i.e. potassium, bicarbonate); possible hypertonic saline if sodium is dangerously low Hypokalemia is due to a loss of total body potassium or movement of potassium into the cells. • Risk factors for total body potassium: hyperaldosteronism; diuretics; abnormal urine losses; increased GI losses; excessive diaphoresis • Risk factors for intracellular hypokalemia: increased insulin administration; alkalosis; during periods of tissue repair in burns, trauma or starvation • Signs and symptoms: drowsiness; paresthesia; decreased bowel sounds; enhanced digitalis effect; soft flabby muscles; nausea; vomiting and ileus; ECG signs (ST depression, flattened T waves, presence of U waves, and ventricular irritability) • Treatment: IV KCL via central line at 20-40 mEq/hour; oral supplementation with potassium to correct alkalosis

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