magnesium and calcium

8/22/2019 Magnesium and Calcium

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Fluid & Electrolyte

Imbalances

N4935


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Alterations in Fluid Volume

Dehydration

Fluid Volume Deficit (Hypovolemia)

Fluid Volume Excess (Hypervolemia)


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Age

Disease

Medications

Who is at Risk for Fluid

Volume Alterations?


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Types of Fluid Loss

Insensible Loss

Skin ~ 400 mL/day

Lungs ~ 500 mL/day

Sensible Loss

Excess perspiration


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How does it happen?

Loss of water only

Dehydration


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Loss of fluids and solutes

Caused by:

Excessive fluid loss

Fluid loss with reduced intake

Third spacing (where it cannot be readily

regulated) Excessive diuretic therapy

Fluid Volume

Deficit/Deficient


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Dry mucous membranes Thirst Decreased skin turgor

Tachycardia Orthostatic hypotension - hypotension Urine output decreased increased

concentration (color & specific gravity) Restless/ anxious/drowsy/confusion Weight loss Increased urine specific gravity Shock/seizure/coma

Fluid Volume DeficitManifestations


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Oral fluids are generally not enough.

Isotonic IV solutions

Treat cause: albumin, blood, surgery

Vasopressors

O2Monitor for over correction &/or

progression of condition

Safety

Management


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Excess water and sodium in theextracellular space.

This can occur in the intravascularspace or in the interstitial space

Who is at risk?

The elderly and anyone with cardiac or renalproblems, IV replacement (overcorrection)

Fluid Volume Excess(Hypervolemia)


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Bounding pulse, increased BP

Neck vein distention

Dyspnea

Crackles, Cough, Frothy sputum

Edema (dependent)Headache, confusion, lethargy

Weight gain (1 liter=2.2 lbs)

Seizure, coma

Fluid ExcessManifestations


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Treat the cause

Restrict Na and fluid intake.

Diuretics

Morphine

O2Bedrest, HOB up

Monitor

Management


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Acid-Base BalanceAcid production, buffering, and excretion interplay to

create balance.

Acids release hydrogen (H+) ions; bases (alkaline

substances) take up H+

ions.Degree of acidity is reported as pH.

pH scale: 1.0 (very acid) to 14.0 (very base)

pH of 7.0 is neutral; normal arterial blood is 7.35 to

7.45.Maintaining pH within this normal range is very

important for optimal cell function.


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Quick Quiz

When a nurse evaluates a patients 24

hour I & O, the fluid intake should be:

a. Slightly more that the output

b. Lower than the urine output

c. Higher than the fluid output

d. Equal to the urine output


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Acid-Base Balance

(contd)Acid production

CO2 +H2O H2CO3 H+ + HCO3

Carbon dioxide + water Carbonic acid

Hydrogen ion + BicarbonateAcid buffering: Buffers are pairs of chemicals that

work together to maintain normal pH of body fluids

HCO3 + H+ H2CO3

Bicarbonate + Hydrogen ion Carbonic acid H2CO3 H

+ + HCO3

Carbonic acid Hydrogen ion + Bicarbonate


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Acid-Base Balance

(contd)Acid excretion systems: lungs and kidneys

Lungs excrete carbonic acid.

Kidneys excrete metabolic acids.

Excretion of carbonic acid

When you exhale, you excrete carbonic acid in the

form of CO2and water.

Excretion of metabolic acids The kidneys excrete all acids except carbonic

acid.


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Quick Quiz!The bodys fluid and electrolyte balance is maintained

partially by hormonal regulation. You will express an

understanding of this mechanism in which of the

following statements?

A. The pituitary secretes aldosterone.

B. The kidneys secrete antidiuretic hormone.

C. The adrenal cortex secretes antidiuretic hormone.D. The pituitary gland secretes antidiuretic hormone.


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Quick Quiz

Which assessment indicates deficient

fluid volume?

a. Negative balance of intake & output

b. Decreased body temperature

c. Increased blood pressure

d. Shortness of breath


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Calcium (Ca++)

Normal serum level = Lewis 8.6-10.2

mg/dL; P & P 8.4 10.5 mg/dL

Ionized Ca++ = 4.5 5.3 mg/dL

99% stored in bones and teeth

50% of Ca in blood is bound to albumin

Has an inverse relationship with PO4(When Ca++ increase, PO4 levels decrease

and visa versa)


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Calcium

Influenced by dietary intake (Dairy

products, legumes, green leafy

vegetables, sardines, salmon, clams,

oysters, rhubarb)

Regulated by

Parathyroid hormone

Calcitonin

Vitamin D


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Calcium

Functions in

Development of bones and teeth

Also requires Vitamin D and Phosphorous

Muscle contractility (skeletal, smooth, & cardiac)

Transmission of nerve impulses

Blood clotting

Cell structure & membrane permeability


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Hypocalcemia Causes


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Hypocalcemia Findings -Reflect excitability of cells

Anxiety, irritability

Muscle twitching

Numbness & tingling in toes, fingers, oraround mouth

Positive Trousseaus and Chvostekssign

TetanyArrhyhythmias/ EKG changes


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Hypocalcemia Management

Give Ca++--oral or IV (slowly) If PO, give 30 min. ac (to increase absorption)

Assess Vit D intakeEncourage dietary intake

Avoid laxatives

Seizure precautions

Injury prevention

Monitor Ca, albumin, and clotting levels


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Hypocalcemia Nursing

ConsiderationsAssess for symptoms

Tracheotomy tray, seizure precautions

Heart monitor

IV site monitoring

Monitor lab values

Watch for overcorrection


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Hypercalcemia Causes

>10.2 mg/dlHyperparathyroidism

Malignancies (lung, breast, multiple myeloma)

Prolonged immobility

Loss of Ca++ from bone into plasma


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Hypercalcemia Manifestations relate to decreased excitability

Muscle weakness, Decreased DTRs

Fracturescan occur spontaneously (aka:pathologic fx)

Confusion, personality changes, depressionLethargy, drowsiness, apathy, coma

Anorexia, vomiting, constipation

Polyuria

Renal calculi (kidney stones cause flank pain inlow back)


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Hypercalcemia

ManagementIncrease fluids to help with excretion

IV NSto replace Na+ which follows Ca++

w/diuresis

Loop diuretics

Weight-bearing physical activitywatch

increased fall risk because of confusion

Meds to promote reabsorption


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Hypercalcemia Nursing

ManagementMonitor cardiac rhythms, VS, & lab

values

Strain urine for calculi

Activity with caution (pathological fx)

Teaching

Safety


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Quick Quiz

Which of the following influences serum

Ca levels?

A. Vitamin K

B. Sodium

C. Potassium

D. Parathyroid hormone


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Quick Quiz

What is the normal calcium serum

level?

A. 7.5-9.0 mg/dL

B. 8.0-9.5 mg/dL

C. 8.6-10.2 mg/dL

D. 9.5-11.0 mg/dL


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Quick Quiz

Which of these is a function of calcium?

A. Contraction ability of muscles

B. Renal balance

C. Regulation of water

D. Transports potassium into the cell


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Quick Quiz

Your patient has low serum calcium.

You observe for?

A. Increase urine outputB. Hypertension

C. Muscle twitching

D. Coma


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Quick Quiz

What manifestation of low serum Ca

would you check for in this patient?

A. Rough, dry skinB. Bradycardia and dysrhythmias

C. Decreased urine output

D. Constipation


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Quick Quiz

Your patient has an elevated serum

Ca++ level. What do you suspect as

the cause?A. Metabolic acidosis

B. Bone tumors

C. HypoparathyroidismD. Hyperphosphatemia


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Quick Quiz

One aspect of the treatment of

hypercalcemia is?

A. Decrease fluid intakeB. Give Ca++ supplements

C. Antacids

D. Weight bearing, walking


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Magnesium Mg ++

Normal serum level 1.5 2.5 mEq/L

Absorbed from food

Tied to Ca++ function

Primarily excreted by kidneys


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Magnesium Functions

Helps with CHO & protein metabolism

Affects cardiac and skeletal musclecontractility

Vasodilation

Regulation similar to Ca++ in GI & renalsystem

Assess Ca++, K+, albumin


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Hypomagnesemia


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Hypomagnesemia

Manifestations (CNS irritation)Confusion

Hyperactive DTRs

Tremors, twitching, tetany

Positive Trousseau and Chvosteks signs

Seizures

DysrhythmiasHTN

H i


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Hypomagnesemia

Management

Slow infusion of MgSO4 (Again, can

cause tissue damage!)

Or PO supplement

Dietary intake (Nuts, leafy greens,

bananas, oranges, peanut butter, chocolate,grains)


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Nursing Management of

HypomagnesemiaReduce environmental stimuli

Seizure precautions

Monitor cardiac and neuro status

Assess DTR every 1 4 hrs

Dysphagia


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Hypermagnesemia

>2.5mEq/LChronic renal failure

Excessive intake antacids & laxatives

Treatment of pre-eclampsia/eclampsia

(to be expected)


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Hypermagnesemia

Flushed & sensation of warmth

Lethargy, drowsiness

Hypoactive DTRs

Facial numbness

EKG changes

Respiratory depression or paralysis

Cardiac arrest

Nausea & vomiting


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Hypermagnesemia

Management

Dialysis if renal failure is the cause

IV fluidsif renal function is normal

Avoid laxatives and antacids with Mg++

IV calcium gluconateDiet therapy-reduce intake of Mg++

Prevent future episodes


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Nursing Management of

HypermagnesemiaEncourage po fluid intake

Monitor cardiac and respiratory status

Monitor I&O, VS, DTR, labs

Safety


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Quick Quiz

Magnesium functions to:

A. Prevent Ca+ absorption

B. Aid in cell metabolism

C. Regulate ECF of Ca++ and K+

D. Inhibit parathyroid function


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Quick Quiz

Which of the following in the history,

physical and review of data would lead

to a diagnosis of hypomagnesemia?A. Increased serum Ca++

B. Intake of antacids with Mg++

C. Excessive diarrhea and vomitingD. Hypoaldosteronism


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Quick Quiz

Where will you see the primary effects

of Mg++ deficit?

A. Cardiac dysrhythmias and muscle tetanyB. Hypoactive reflexes

C. Hypertension

D. Depression


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Quick Quiz

Which of the following patients should

be observed for Mg++ excess?

A. Over hydrationB. Hypoparathyroidism

C. Hyperparathyroidism

D. Chronic renal failure

magnesium and calcium

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