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A specific gravity will detect if the paitnet has a fluid volume deficit or a fluid volume excess.

This is important when dealing with a patient with Inappropriate antidiuretic hormone secretion.
To gauge a patients magnesium status the nurse should check deep tendon reflexes. If the reflex
is absent, this may indicate high serum magnesium.
Third spacing fluid shift, which occurs when fluid moves out of the intravascular space but not
into the intracellular space, can cause hypovolemia. Burns typically cause acidosis.
The most common cau8se of acute respiratory alkalosis is hyperventilation. Extreme anxiety can
lead to hyperventilation. Acute respiratory acidosis occurs in emergency situations, like
pulmonary edema, and is exhibited by hypoventilation and decreases in Carbon dioxide.
Infiltration is the administration of nonvesicant solution or medication into the surrounding
tissu7e. Infiltration is characterized by edema around the insertion site, leakage of IV fluid form
the insertion site, or discomfort and coolness in the area of infilitraion.
Inelastic skin is a normal change of aging.
Osmosis is the movement of fluid from a region of low solute concentration to a region of high
solute concentration across a semipermeable membrane. Hydrostatic pressure refers to changes
in water or volume relatd to water pressure. Diffusion is the movement of solute from an area of
greater concentration to lesser concentration.
Tetany is the most characterisitic manifestation of hypocalcemia and hypomagnesemia.
Sensations of tingling may occur in the tips of the fingers, around the mouth, and less commonly
in the feet. Hypophospatemia creates central nervous dysfunction, resulting in seizures and
coma. Hypermagnesemia creats hypoactive revflexes and somnolence. Signs of hyperkalemia
include paresthesias and anxiety.
The kidneys regulate the bicarbonate level in the extracellular fluid, they can regenerate
bicarbonate ions as well as reabsorb them form the renal tubular cells. In respiratory acidosis and
most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate
ions to help restore balance. The lungs regulate and reabsorb carbonic acid to change and
maintain pH. The kidneys do not buffer acids through electrolyte changes. Buffering occurs in
reaction to changes in pH. Carbonic acids works as the chemical medium to exchange oxygen
and carbon dioxide in the lungs to maintain a stbale pH whereas the kidneys use bicarbonate as
the chemical medium to maintain a stbale pH by moving and eliminating Hydrogen.
The most common cause of metabolic alkalosis is vomiting or gastric suction with loss of
hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric
fluid is lost. Vomiting gastric suction and pyloric stenosis all remove potassium and can cause
hypokalemia.
Cancer and hyperparathyuroidism account for almost all cases of hypercalcemia.
If a patient is not exreting enough urine the health care provider needs to determine whether the
depressed renal function is the result of reduced renal blood flow which is a fluid volume deficit

or acute tubular necrosis that results in necrosis or cellular death from prolonged fluid volume
deficit.
Increased serum sodium causes increased thirst and the release of antidiuretic hormone by the
posterior pituitary gland. When serum osmolality decreases and thirst and antidiuretic hormone
secretions are suppressed, the kidney excretes more water to restore normal osmolality. Levels of
potassium, hemoglobin, and platelets do not directly affect ADH release.
In COPD the use of oxygen may results in the patient developing carbon dioxide narcosis and
hypoxemia.
Sympathetic stimulation constricts renal arterioles, this decreases glomerular filtration, increases
the release of aldosterone and increases sodium and water reabsorption.
Normal physiologic changes of aging including reduced cardiac, renal, and respiratory function
and reserve and alterations in the ratio of body fluids to muscle mass, may alter the responses of
elderly people to fluid and electrolyte changes and acid base disturbances. Renal function
declines with age, as do muscle mass and aily exogenous creatinine production. Therefore, high
normal and minimally elevated serum creatinine valvues may indicate substaintially reduced
renal function in older abults.
Manifestations of hypokalemia include fatigue, anorexia, nausea, vomiting, muscle weakness,
leg cramps, decreaed bowel motility, paresthesias, and dysrhythmias. If prolonged hypokalemia
can lead to an inability of the kidneys to concentrate urine causing dilute urine resulting in
polyuria and nocturia and excessive thirst.
Respiratory acidosis is always due to an inadequate excretion of carbon dioxide, rsulting in
elevated plasma concentrations. Acute respiratory acidosis occurs in emergency situations like
acute pulmonary edema, aspiration of a foreign object, atelectasis, pneumothorax, and overdose
of sedatives. It can also occurs in diseases like Guillain Barre syndrome, muscular dystrophy,
myasthenia gravis.
Dehydration in the elderly is common as a result of decreased kidney mass, decreased
glomerular filtration rate, decreased renal blood flow, decreased ability to concentrate urine, and
inability to conserve sodium and decreased excretion of potassium and a decreased in total body
water.
Elderly have low total body fluid than adults, and children.
Elderly have a decrease in kidney mass and a decrease in filtration rate.
They also have a decrease in renal blood flow.
The signs and symptoms of hyperchloremia area the same as those of metabolic acidosis,
hypervolemia, and hypernatremia. Tachypnea, weakness, lethargy, deep rapid respirations,
diminished cognitive ability, and hypertension. If untreated hyperchloremai can lead to a
decrease in cardiac output, dysrhythmias, and coma. A high chloride levels is accompanied by a
high sodium level and fluid retention.

Signs and symptoms of hypophosphatemia are mainly neurologic.


Normal anion gap acidosis results from the direct loss of bicarbonate, as in diarrhea, lower
intestinal fistulas, ureterostomies, and use of diuretics, early renal insufficiency, excessive
administration of chloride, and the administration of parenteral nutrition without bicarbonate or
bicarbonate producing soultes.
H2 receptor antagonists, like Cimetidine Tagamet, reduce the production of gastric hydrochloric
acid, there by decreasing the metabolic alkalosis associated with gastric suction. Maalox is an
oral simethicone used to break up gas in the GI system.
Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories
are started too aggressively.
Milk, milk products, organ meats, nuts, fish, poultry, and whole grains should be encouraged for
someone who needs phosphate.
Hypermagnesemia results in shallow respirations and decrease in deep tendon reflexes.
Kussmaul breathing is a deep and labored breathing pattern associated with severe metabolic
acidosis.
Chvosteks sign is by tapping the patients facial nerve adjacent to the ear both hypomagnesemia
and hypocalcemia may be tested using Chvosteks sign.
Shocked is caused when the cells have lack of adequate blood supply and are depreived of
oxygen and nutrients.
In the compensatory stage of shock, the body shunts blood from the organs such as the skin and
kidneys, to the brain and heart to ensure adequate blood supply. As a results the patients skin is
cool and clammy.
Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock. Lactated
ringers and 0.( sodium chloride are isotonic crystalloids fluids.
Vasoactive medications should never be stopped abruptly because it could cause severe
hemodynamic instability.
Neurogenic shock can be cau8sed by spinal cord injury. Patients will present with low blood
pressure, bradycardia, warm dry skin due to the loss of sympathetic muscle tone and increased
parasympathetic stimulation.
Hypovolemic shock presents with tachycardia and a probably loss of blood.
A symptom of shock is shallow, rapid respirations.
Systolic blood pressure drops in shock, bradycardia occurs in neurogenic shock.

Temperature should be monitored closely to ensure that rapid fluid resuscitation does not
precipitate hypothermia. IV fluids may need to be warmed during the administration of large
volumes.
In the compensatory stage of shock the blood pressure remains within normal limits.
Nutritional energy requirements are met by breaking down lean body mass. In catabolic process
skeletal muscle mass is broken down even when the patient has large stores of fat.
Morphine dilates the blood vessels.
Signs of acute organ dysfunction are systolic blood pressure less than 90, mean arterial pressure
less than 65, drop in systolic blood pressure greater than 40, or serum lactate greater than 4.
Subclassification of circulatory shock is anaphylactic, septic, and neurogenic.
Vasoactive medications should be administered through a central venous line.
Normal CVP is 2 to 6. Elevated CVP could be caused by hypervolemia.
Pulmonary artery catheter measurs left ventricular preload.
Postive chronotropy increases the heart rate.
Atropine for a slow heart rate.

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