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Nursing Fundamentals (NURS 313) F&E & Acid Base Review

John Marsh
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F&E & Acid Base Review – Lecture notes 1

Texas A&M University

Nursing Fundamentals (NURS 313)

 FVE (2)
o Causes: excessive isotonic or hypotonic IV fluids, HF, renal failure, SIADH, primary polydipsia,
corticosteroids; hypertonic solutions cause H₂
o S/S: confusion, peripheral edema, JVD, ↑BP, polyuria, dyspnea, crackles in the lungs, weight gain,
decreased LOC, low HCT, low BUN, high NA, muscle spasm, headache
o Interventions: Diuretics, limit Na⁺ if ordered, maintain fluid restrictions if ordered, No IV’s, daily
weights, Strict I&O’s, check mental status
 Hypocalcemia (2) ↓Ca²⁺ [<8.6 mEq/L]
o Causes: Primary hypoparathyroidism, renal insufficiency, acute pancreatitis, ↑P, vitamin D deficiency, malnutrition,
↓Mg²⁺, loop diuretics, chronic alcoholism, diarrhea, alkalosis, excessive administration of citrated blood, prolonged
NG tube suctioning
o S/S: Weakness, paresthesias, fatigue, hyperreflexia, muscle cramps, ↓BP, numbness, Chvostek’s sign (contraction of
facial muscles in response to a tap over the facial nerve in front of the ear), Trousseau’s sign (carpal spasms induced
by inflating a BP cuff on the arm), laryngeal stridor, tetany; CATS: Convulsions, Arrhythmias, Tetany,
Spasms/Stridor, tingling/numbness around the mouth or extremities
o Interventions: Ca²⁺ rich foods with vitamin D supplementation, promote CO₂ retention, carpal spasms induced by
inflating a BP cuff on the arm if caused by diuretics; adequately treat pain & anxiety because hyperventilationinduced
respiratory alkalosis can precipitate hypocalcemic symptoms; give thiazide diuretic to treat; IV calcium
 Hypercalcemia (1) ↑Ca²⁺ [>10.2 mEq/L]
o Causes: Hyperparathyroidism, malignancies with bone metastasis, prolonged immobilization, vitamin A or D
overdose, Paget’s disease, renal disease, thiazide diuretics, muscle weakness, calcium-containing antacids, acidosis
o S/S: Lethargy, weakness, fatigue, ↓memory, ↓reflexes, ↑BP, confusion, psychosis, anorexia, nausea, vomiting, bone
pain, fractures, polyuria, dehydration, nephrolithiasis, seizures, muscle weakness, neuromuscular
o Interventions: Start a diet low in Ca2+, ↑weight-bearing activity, maintain adequate hydration (3,000-4,000 mL daily),
prune or cranberry juice recommended to stop formation of stones; administering saline, a bisphosphonate *takes a
few days to work*, and calcitonin *works immediately* in severe cases ; dialysis if life threatening, ↑hydration
 Hypokalemia (3) ↓K⁺ [<3.5 mEq/L]
o Causes: GI or kidney loss, diarrhea, vomiting, NG suction, ileostomy drainage, diuretics, hyperaldosteronism, Mg²⁺
depletion, dialysis, increased insulin release (ie: IV dextrose load), insulin therapy (ie: w/ diabetic ketoacidosis),
alkalosis, ↑epinephrine (ie- stress), starvation
o S/S: Fatigue, muscle weakness, paresthesias, ↓reflexes, constipation, shallow respirations, weak, irregular pulse,
hyperglycemia, loss of muscle down
o Interventions: Oral or IV potassium chloride (KCl) supplements & increased dietary intake of potassium; monitor
cardiac function, IV sodium bicarbonate – ALSO FOR SEVERE ACIDOSIS
 Mg²⁺ and K⁺ go hand in hand, if Mg²⁺ level is ↓ , K⁺ level will be ↓
 Hyperkalemia (2) ↑K⁺ [>5.0 mEq/L]
o Causes: Excessive or rapid parenteral administration, potassium-containing drugs (e.g., potassium penicillin),
acidosis, renal failure, tissue catabolism (e.g., fever, crush injury, sepsis, burns), ACE inhibitors, heparin, potassiumsparing
diuretics, NSAIDs; primary loss is through the kidneys
o S/S: Fatigue, muscle weakness, cramps, loss of muscle tone, paresthesias, ↓deep tendon reflexes, abdominal
cramping, confusion, irregular pulse, tetany, hyperactive bowels; MURDER: Muscle weakness, Urine (oliguria,
anuria), Respiratory distress, Decrease cardiac, ECG changes, Reflexes (areflexia)
o Interventions: Monitor cardiac, respiratory, neuromuscular, GI, & ECG for dysrhythmias; increase elimination of
potassium with loop or thiazide diuretics, dialysis if severe, and/or sodium polystyrene sulfonate (Kayexalate), force
K⁺ from ECF to ICF by using a combination of IV regular insulin & a β-adrenergic agonist stimulates the sodiumpotassium
pump, shifting K⁺ into cells, stabilize cardiac membranes; IV calcium chloride or calcium gluconate
reverse the membrane potential effects of the elevated ECF potassium
 Hypomagnesemia (2) ↓Mg²⁺ [<1.5 mEq/L]
o Causes: NG suction, diarrhea, chronic alcoholism (cirrhosis), malabsorption syndromes, prolonged malnutrition,
↑urine output, hyperglycemia, proton pump inhibitor therapy
o S/S: Confusion, muscle cramps, tremors, seizures, vertigo, hyperactive deep tendon reflexes, Chvostek’s and
Trousseau’s signs, ↑pulse, ↑BP, dysrhythmias
o Interventions: Oral supplements and increased dietary intake of foods high in Mg²⁺, if severe or if hypocalcemia is
present, IV magnesium sulfate is given; use an infusion pump since rapid administration can lead to hypotension and
cardiac or respiratory arrest, watch for rebound hypermagnesemia



Nursing Fundamentals (NURS 313) F&E & Acid Base Review

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