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## Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th Ed., Hinkle & Cheever | Registered Nurse (RN) School Study Aid

13 - Fluid and Electrolytes: Balance and Disturbance
32 Picmonics to Learn | 53 mins
Calcium (Ca2+) Lab Value
8.5 to 10.5 mg/dL
26 secs
Chloride (Cl-) Lab Value
95-105 mEq/L
28 secs
Creatinine Lab Values
Measures Renal Function
0.6 - 1.3 mg/dL
1 min
Normal Electrolyte Lab Values
Potassium (K+)
3.5 to 5.0 mEq/L
Calcium (Ca2+)
8.5 to 10.5 mg/dL
Phosphate (PO43–)
2.5 to 4.5 mg/dL
Magnesium (Mg2+)
1.5 to 2.5 mEq/L
Sodium (Na+)
135 to 145 mEq/L
Chloride (Cl)
95 to 105 mEq/L
2 mins
pH - Blood and Urine Lab Value
Blood
7.35 - 7.45
Urine
4.0 - 8.0
1 min
Phosphate (PO43-) Lab Value
2.5 to 4.5 mg/dL
29 secs
Potassium (K+) Lab Value
3.5 to 5.0 mEq/L
20 secs
Sodium (Na+) Lab Value
135-145 mEq/L
24 secs
Urine Specific Gravity Lab Value
1.003-1.030
1 min
IV Solutions
Hypotonic (< 280 mOsm/L)
1/4 Normal Saline (0.225% NaCl)
1/2 Normal Saline (0.45% NaCl)
Isotonic (280-300 mOsm)
Normal Saline (0.9% NaCl)
Lactated Ringer's (LR)
Dextrose 5% in Water (D5W)
Hypertonic (> 300 mOsm)
3% or 5% NaCl
Dextrose 5% in 0.45% NaCl
Dextrose 10% in Water (D10W)
3 mins
Metabolic Acidosis Assessment
Characteristics
Decreased pH < 7.35
Decreased HCO3 < 22
Signs & Symptoms
Abdominal Pain
CNS Depression
Coma
Hypotension
Arrhythmias
Increased Respirations
Kussmaul Respirations
Flushed, Warm, Dry Skin
Muscle Weakness
2 mins
Metabolic Acidosis Interventions
Interventions
Raise Plasma pH > 7.20
Treat Underlying Cause
Sodium Bicarbonate
Considerations
Continuously Monitor Patient
2 mins
Metabolic Alkalosis Assessment
Signs and Symptoms
Increased pH > 7.45
Increased HCO3 > 26
Excitable State
Arrhythmias
Paresthesias
Muscle Cramps
Muscle Weakness
Decreased Respiratory Effort
1 min
Metabolic Alkalosis Interventions
Interventions
Treat Underlying Cause
Stop Potassium (K+) Wasting Diuretics
Spironolactone
Acetazolamide
IV Fluids
Sodium Chloride
Replace Potassium (K+)
Considerations
Monitor Respiratory Rate
Monitor Heart Rate
Seizure Precautions
2 mins
Respiratory Acidosis Assessment
Assessment
Decreased pH < 7.35
Increased PaCO2 > 45
Reduced Respirations
Anxiety
Change in LOC
Tachycardia
Cyanosis
Increased Electrolytes
ECG Changes
Muscle Weakness
Hyporeflexia
2 mins
Respiratory Acidosis Interventions
Improve Respiration
Pharmacologic Interventions
Bronchodilators
Respiratory Stimulants
Drug Antagonists
Nonpharmacologic Interventions
Oxygen
Assisted Ventilation
Prevent Complications
1 min
Respiratory Alkalosis Assessment
Assessment
Increased pH > 7.45
Decreased PaCO2 < 35 mmHg
Hyperventilation
Brainstem Stimulation
Shock
Tingling Lips or Fingers
Trousseau's
Chvostek's Sign
Anxiety
2 mins
Respiratory Alkalosis Interventions
Treat Underlying Cause
Mechanically Ventilated Patients
Decrease Tidal Volume and/or Respiratory Rate
Give Adequate Pain Control and Sedation
Hyperventilation Syndrome
Sedatives
Antidepressants
Considerations
Compensatory Drop in Serum Bicarbonate
Calming Breathing Exercises
Correct CO2 Slowly
2 mins
How to Interpret Acid Base Disorders
pH, pCO2, HCO3 (Bicarbonate)
Step 1
pH
Acidosis
Alkalosis
Step 2
pCO2
Opposite Direction As pH
Respiratory Acidosis
Respiratory Alkalosis
Step 3
HCO3 (Bicarbonate)
Same Direction As pH
Metabolic Acidosis
Metabolic Alkalosis
3 mins
Hypercalcemia
Assessment
> 10.5 mg/dL Ca2+
Pathologic Fractures
Lethargy
Hypercoagulation
Constipation
ECG Changes
QT Shortening
Interventions
No Calcium Intake
Chelating Drugs
Calcitonin
Bisphosphonates
Loop Diuretics instead of Thiazide Diuretics
Considerations
Increased Risk for Renal Calculi
Increase Fluids
3 mins
Hyperkalemia
Assessment
> 5.0 mEq/L K+
Abdominal Cramps
Muscle Weakness
Diarrhea
Arrhythmia
Tall, Peaked T Waves
Interventions
IV Calcium
Infusion of Glucose and Insulin
Loop or Thiazide Diuretics
Kayexalate
Dialysis
Prevention Education
2 mins
Hypermagnesemia
Assessment
Flushing
Lethargy
Muscle Weakness
Decreased Deep Tendon Reflexes (DTRs)
Decreased Respirations
Hypotension
Interventions
Dialysis
IV Calcium Gluconate
Diuretics
Avoid Antacids and Laxatives containing Mg2+
2 mins
Hypernatremia
Assessment
> 145 mEq/L Na+
Change in LOC
Extreme Thirst
Orthostatic Hypotension
Dry Flushed Skin
Muscle Twitching
Seizures
Priority Interventions
Treat and Prevent Dehydration
Hypotonic Solutions (0.225% or 0.45% NaCl)
Sodium Restriction
Diuretics
2 mins
Hypocalcemia
Muscle Spasms
Assessment
< 8.5 mg/dL Ca2+
Decreased Bone Density
Tetany
Chvostek's Sign
Trousseau's Sign
Increased DTR
ECG Changes
QT Prolongation
Considerations
Oral and IV Replacement of Ca2+
Seizure Precautions
2 mins
Hypokalemia
Assessment
< 3.5 mEq/L
Muscle Weakness
Arrhythmia
U Wave
Ileus
Hyporeflexia
Interventions
IV K+ Infusion at 5-10 mEq/hr
Give Orally with Food
Nursing Considerations
Monitor Respiratory Status
3 mins
Hypomagnesemia
Assessment
Confusion
Increased Deep Tendon Reflexes (DTRs)
Neuromuscular Irritability
Seizures
Muscle Cramps
Tremors
Insomnia
Tachycardia
Interventions
Magnesium Sulfate
Foods High in Magnesium
1 min
Hyponatremia
Assessment
< 135 mEq Na+
Nausea and Vomiting
Decreased LOC
Confusion / Lethargy
Seizures
Priority Interventions
Assess Airway
Reduce Diuretic Dosage
Fluid Excess Hyponatremia
Mannitol (Osmitrol)
Fluid Restriction
Fluid Deficit Hyponatremia
Hypertonic Solution (3% or 5% NaCl)
2 mins
Superficial Thrombophlebitis
Cause/Mechanism
IV Catheter Irritation
Assessment
Erythema
Cord-like Vein
Edema
Interventions
Remove IV Catheter
Elevate
Warm Compress
Considerations
Rotate Sites Q3 Days
Aseptic Technique
2 mins
Aminoglycoside Overview
End in "-mycin"
GNATS
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
Mechanism of Action
Bactericidal
Indications
Severe Gram Negative Infections
Bowel Surgery Prep
1 min
Hydrochlorothiazide HCTZ
Mechanism of Action
Inhibits Reabsorption NaCl and H2O
Indications
Edema
Mild to Moderate Hypertension
Side Effects
Hypokalemia
Hyponatremia
Dehydration
Hyperglycemia
Gout
Contraindications
Sulfa Allergy
Pregnancy and Breastfeeding
1 min
Cimetidine and Famotidine (H2 Receptor Blockers)
-tidine Suffix
Mechanism
H2 Receptor Blocker
Indications
Suppress Gastric Acid Secretion
Side Effects (All)
Pneumonia
Side Effects - Cimetidine
Anti-androgen Effects
CNS Changes
2 mins
Ergocalciferol (Vitamin D2)
Mechanism
Vitamin D2
Indications
Hypoparathyroidism
Rickets
Hypophosphatemia
Side Effects
Fatigue
Constipation
Hypercalcemia
Kidney Stones
2 mins

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