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N444: Test 2 by Mind Map: N444: Test 2
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N444: Test 2

Cardiovascular Disease

Leading COD

Nearly half of all American deaths

Leading COD in both genders, Men dominate ages 20-54, Women dominate ages 55-75+

Due to lifestyle

Review of CV system

Two-part circulation, Pulmonary (R), Systemic (L)

Heart supply, Vena cava (blood in), Pulmonary artery/vein, Artery: Blood away from heart, Branch from the heart, Turn into smaller blood vessels, Arterioles, Capillaries, Site of gas, nutrient, waste exchange, Vein: Blood to heart, Carry CO2 and wastes to kidneys and lungs, Aorta (blood out to systemic), Coronary arteries

Movement, Systole (contraction) & diastole (relaxation), SA node (RA) controls heart action

Conduction system

Action potential, Depolarization, Repolarization, Refractory periods, Effective RP, Relative RP

Cardiac output, Stroke volume, Cardiac output, Preload, Contractility, Afterload, Ejection fraction

Types of CVD

Atherosclerosis/CAD, Deposits accumulate in arterial lumen, Plaque buildup >> Damage in artery, Various other causes, High BP surges, Elevated cholesterol/tri, Cigarrete smoking

CHD

Angina pectoris

Arrhythmia

CHF

Stroke/CVA

Risk factors

Inflammatory processes

Abdominal obesity (>40 inches)

Triglycerides >150

Low HDL: <40M-50F

BP >130/85

Fasting glucose >100

Assessment

Health history, Demographic info, Genetic history, Cultural/social factors

Risk factors, Modifiable, Non-modifiable

Manifestations, Chest pain, Dyspnea, Peripheral edema, Weight gain, Fatigue, Dizziness, Syncope, Altered LOC

Other areas, Medications, Nutrition, elimination, Activity, rest, Self-concept, Roles, relationships, Sexuality, Coping skills, Prevention strategies

Lab data

Cardiac biomarkers

CK, CK-MB

Myoglobin

Troponin T and I

Lipid profile

Brain (b-type) natriuretic peptide)

C-reactive protein

Homocysteine

Diagnostic studies

ECG, 12-lead, Various monitoring styles, Cardiac stress test

Radionuclide imaging, Myocardial perfusion imaging, Ventricular function, wall motion tests, CT, PET, MRI

Treatment

Cardiac cath

Hemodynamic monitoring

Coronary bypass surgery

Balloon angioplasty

Cardiovascular Disorders

Analyzing cardiac rhythm

Rate, rhythm, regularity

Measure ECG intervals, P-wave: A. depol., PR-wave, Start of atrial depol to start of ventricular depol, Time required to send impulse through atria and AV node, Lasts 0.12-0.20 sec, QRS complex: V. depol., May not have all 3 waves, Q - First downward deflection, R - First upward deflection, S - Second downward deflection, Lasts 0.04-0.12 seconds, ST segment: Isolectric line, "At rest point" b/w ventricular depol & repol, Elevation OR depression >0.5, Very significant, QT interval: Beginning of QRS to end of T, Ventricular depol & repol, 0.38-0.42 seconds, Less than half of R-R interval, T wave: Rounded deflection slightly larger than P-wave, Ventricular repol, U-wave: Small, rounded; after T wave, Late depol of papillary muscle

Specific alterations

CHD, aka CHD or IHD, Obstructed blood flow, Atherosclerosis, Reduced blood flow to myocardium, Most prevalant CVD in adults, Statistics, 500K deaths, 2 M hospitalizations, $8.5B for meds, $133.2B total, Manifestations, Chest pain (most common), Angina pectoris, MI, HF, Sudden cardiac death, May be asymptomatic, May have "atypical" presentation, Weakness, Dyspnea, Nausea, Risk factors, Hyperlipidemia, Smoking, Sedentary lifestyle, Alcohol, Hyperhomocystinemia, Oral contraceptives, Stress, Lab tests, (see pp. 706), Cardiac enzymes, biomarkers, Creatinine kinase, CK-MB for heart, Rises 4-8 hrs after MI, Peaks at 10-18 hours, Balances out 3-4 days later, Troponin, Esp. Troponin 1 for MI, Elevated 3-4 hours after MI, Peaks after 4-24 hours, Takes 1-3 weeks to balance out, Myoglobin (nonspecific sign), Lipid profile, Electrolytes, CRP, Coag studies, ABGs, Thyroid studies, Urine protein, Diagnostic tests, ECG, Ischemia: Depressed ST, inversion of T, Injury: ST elevation, STEMI, Infarction: Q waves over 1-3 days, Cardiac cath, Flow sheet post-op, High risk for injury, altered perfusion, Bleeding, Occlusion, VS, pulse check, dressing check q15-30-60, Keep leg straight for 2-6 hours, HOB <30 degrees for pain management, Myocardial imaging, Thallium, MUGA, MRI, PET, CT, Stress test, X-Ray, EKG

Angina, Episodes or paroxysmal pain, Tightness, choking, heavy sensation, Retrosternal pain that may radiate, Often accompanied by anxiety, Usually subsides with rest or nitroglycerin, Unstable type is the exception, Requires medical intervention, Caused by insufficient coronary blood flow, Triggered by physical or emotional stress, Associated symptoms, Dyspnea/SOB, Dizziness, N/V, Treatment, Decrease myocardial oxygen demand, Increase oxygen supply, Medications, Nitroglycerin, Beta-adrenergic blockers, Ca-channel blockers, Antiplatelet and anticoagulant meds, Aspirin, Clopidogrel, Ticlopidine, Heparin, Glycoprotein IIB/IIIA agents, Oxygen therapy, Address risk factors, Reperfusion therapy, Nursing care, Assessment, S/S, Related activities, Risk factors, Lifestyle, health promotion, knowledge, Adherence, Diagnoses, Collaborative problems, Acute pulm. edema, HF, Cardiogenic shock, Dysrhythmias, Cardiac arrest, MI, Planning, Treatment, Priority nursing concern, Stop all activities and rest, Address anxiety, Assess while performing tasks, VS, RR status, Pain assessment, ECG reading*, Give oxygen and meds as ordered, Educate the person, Lifestyle changes, modifying risk factors, Adapting behaviors to fit health, Teaching about the disease process, Meds, stress reduction, What to do in an emergency

MI, Permanent destruction of a part of myocardium, Caused by rupture of plaque >> thrombus >> obstruction, Same disease process as unstable angina but at different stages, ACS = MI + UA, Manifestations, Chest pain, Other symptoms, Diagnosis, ECG, Lab tests, CK-MB, Myoglobin, Troponin T or I, Treatment, Diagnostic studies w/i 10 min of admission, Oxygen, medications, Aspirin, Nitro, Morphine, BBs, ACEI w/i 24 hours, Bed rest!, Need for percutaneous coronary intervention, Need for thrombolytic therapy, Dissolves clot to increase blood flow, Door to needle in less than 30 minutes, Use t-PA and retaplase, High risk for FVD r/t bleeding, High risk for poor perfusion r/t reocclusion, Give IV heparin or LMWH, clopidogrel/ticlopidine, glycoprotein 2B/3A inhibitors

ACS, Assessment, Vital component, Review all symptoms, Compare to baseline and recent data, Watch the ECG, Diagnoses, Collaborative problems, Acute pulm. edema, HF, Cardiogenic shock, Dysrhythmias, cardiac arrest, Pericardial effusion, Cardiac tamponade, Planning, Relieve pain, ischemic signs, Limit damage, Reduce anxiety, Maintain tissue perfusion and good RR, Adherence/compliance, Recognize complications early

HF, Overview, Inability of heart to meet perfusion needs, Fluid overload OR inadequate tissue perfusion, Indicates a myocardial disease, Either systolic (contraction) or diastolic (filling), May be reversible, but usually progressive, Manifestations, R. side, RV cannot eject enough blood >> Backs up, Peripheral edema, hepatomegaly, ascites, A/N, weigh tgain, Weakness, L. side, LV cannot supply systemic needs >> Increased PV pressures, Pulmonary congestion >> Dyspnea, cough, crackles, impaired O2 exchange, Chronic HF = biventricular, Classification, NYHA, ACC/AHA, Type = treatment, Medical management, Address the cause, Reduce AL/PL >> Reduce workload, Optimize therapy, Prevent exacerbations, Utilize medications, ACE inhibitors, AT 2 receptor blockers, Beta-blockers, Diuretics, Digitalis, Others, Nursing care, Health history, Personal patterns, Physical exam, Mental status, Lung sounds, Extraneous heart sounds (S3), Fluid status, Response to meds, Diagnoses, Collaborative problems, Cardiogenic shock, High mortality rate, Decreased CO >> Decreased TP >> Shock syndrome, Appears as HF, shock, hypoxia, Treat with diuretics, +++ inotropic agents, May use circulatory assistive devices (e.g. IABP), Dysrhythmias, Thromboembolism (esp. pulmonary embolism), Pericardial effusion, Accumulation of fluid, Cardiac tamponade, Restricted fxn due to fluid accumulation >>, Decreased venous return and CO, Manifests as fullness, pulsus paradoxus, engorged neck veins, SOB, altered BP, Cardinal signs, Falling systolic BP, Narrowing PP, Rising VP, Distant heart sounds, Activity intolerance, FVE, Pulmonary edema, Acute event where LV cannot handle overload of blood, Increased pressure >> fluid out of pulm capillaries into lungs >> hypoxemia, Clinical manifestations, Restlessness, Dyspnea, Cool, clammy, cyanotic, Cough and congestion, Weak, rapid pulse, Increased sputum, Decreased LOC, Planning

Cardiac rehab

Phase 1, Inpatient, Soon after stable, Recognize emergency, Rest-activity balance

Phase 2, Outpatient for 2-6 weeks, Individualized exercise plan, Support, teaching

Phase 3, Outpatient, For life

Genitourinary Dysfunction

BPH

Normal prostate characteristics, Large walnut to kiwi size, Round, rubbery, free of nodules or masses, Two lateral lobes separated by palpable groves, 3 zones, Peripheral, Distal urethra, Site of most prostate cancer, Central (EJD), Transitional, Proximal urethra, Grows throughout life, Site of BPH

Disease overview, Non-malignant, Increases with age, 50% of men by age 60, 90% of men by age 85

Risk factors, Gender, age, family history, race, Smoking, heavy alcohol use, Obesity, inactivity, HTN, Western diet, Heart disease, Diabetes, Marital status

Prevention, No smoking, Moderate alcohol consumption, Healthy, balanced diet, Treat and control other dx, Weight loss or maintenance, Exercise

Pathophysiology, Tissue closest to urethra starts to grow, >> Pressure on urethra >> Restricted flow, >> More effort by bladder >> Thickened wall, >> Decreased storing capacity

Manifestations, Hesitancy, Abdominal straining, Weak stream of urine, Interrupted steam, Dribbling, Urinary retention, F/U/N, Incomplete emptying

Complications, Recurrent UTIs, Azotemia, Bladder stones, RF

Assessment, Health history, UT problems, Family history, DRE, Patient-voiding diary

Diagnostics, Urinalysis, urine culture, PSA >4.0 ng/mL, Urinary flow-rate recording, Cytoscopy, Ultrasound, AUA Symptom Index

"Look Alike" problems, Urethral stricture, Prostate or bladder cancer, Neurogenic bladder, Urinary bladder stones

Medical management, Goals, QOL, Urine flow, Obstruction, Progression, Complications, Types, Watchful waiting, Pharm therapy, Minimally invasive procedures, Surgical resection, Treatment, Medications, Alpha-adrenergic blockers (relax SM), 5-alpha reductase inhibitors (shrink gland), Combo therapy, MITs, TUMT (microwaves to tissue via probe), TUNA (needles placed in gland to produce heat), Prostatic stents (open urethra), Surgery, Open or endoscopic, Electrocautery vs. laser, TURP is benchmark for surgical tx

Prostate cancer

2nd most common cancer in men

2nd most common COD in American men

High risk group: AA men (2x more likely)

Age = primary risk factors

Survival rates, 98% five years, 84% ten years, 56% fifteen years

Risk factors, Diet, hormones, Gender, age, race, family history, HPC1, BRCA1 and 2

Prevention, Avoid excessive red meat and high-fat dairy, 5-alpha reductase inhibitors can lower risk

Pathophysiology, Starts in peripheral zone near the rectum, Uncontrolled tumor growth >> mutations >> progression, Usually adenocarcinomas, Slow-growing, 47% asymptomatic until advanced, Urinary problems, Dysuria, frequency, nocturia, Weak stream, Starting and stopping flow, Urinary retention, Pain or burning, Sexual dysfunction, Hematuria or blood in semen, Frequent pain in lower back, hips, upper thighs

Assessment, Health history, DRE, PSA >4, TRUS with biopsy

Diagnostics, Gleason score 2-10, Lower: Less aggressive, Higher: More aggressive, Staging, 1-2 localized, 3: Advanced, outside gland, 4: Metastasis to lymph nodes or organs, Bone scans, X-Ray, MRI, CT

Prostate surgery

Treatment, Highly variable, Watchful waiting, Surgery, Radiation therapy, Teletherapy (for low-risk), Brachytherapy, Hormonal therapy, ADT (surgical or medical), Chemotherapy, Variable ADRs, Other therapy, Cryosurgery, Repeated TURPs, Transurethral or suprapubic cath, CAM, (see pp. 1522), Radical prostatectomy, Standard, First-line therapy, Localized tumor, Post-op complications, Bleeding, Clots/DVT, Cath obstruction, Sexual dysfunction, incontinence, Infection, Transurethral resection syndrome, Absorption of irrigation used during TURP, Hyponatremia and hypovolemia, Increased ammonia in blood

Nursing care, Activity tolerance, ADLs, HPI, specific symptoms, FH, Anxiety, Knowledge deficit, Pain, discomfort, Maintain FVB, Stop complications from occuring, Patient education, Expectations, Equipment, Wound care, Monitoring for complications, Bleeding, Infection, Thrombosis, What to report to MD, Hematuria, Decreased UOP, Fever, drainage, Calf tenderness, Perineal exercises, Activity limitations post-op, Prevent dehydration, Ambulation

Testicular cancer

Great survival rate if localized

Most common cancer in young men

Modifiable risk factors, Cryptochoridism, Occupational exposure to chems

Prevention, Treat undescended testis, Avoid occupational exposure

Classification, Germinal, 90% of cases, In sperm-producing tissues, Seminomas, Slow, Localized, Non-seminomas, More common, Quickly growing, Nongerminal, Supportive and hormonal tissues

Manifestations, Mass, swelling, enlargement, Usually painless, Heaviness or ache in lower areas

Assessment, History, phys exam, Elevated tumor markers, AFP, Beta-hCG, Inguinal orchiectomy required to diagnosis

Treatment, Remove testis via orchiectomy through inguinal incision, Can bank sperm BEFORE treatment (not after), Radiation is usually for sperminomas (can preserve fertility in unafffected testis), Chemo is for all types, Combo therapy is best

Chronic Renal Dysfunction

Normal kidney functions

Body water regulation, Urinary output, Blood pressure

Excretory regulation, Nitrogenous wastes, Drug metabolites, Other wastes, Uric acid

Metabolic/endocrine regulation, E-poietin, RAA, Vitamin D

Acid-base balance, Metabolic compensation

Electrolyte balance

Renal dysfunctions

Chronic kidney disease (CKD), Umbrella term, Kidney damage, May be caused by prolonged acute inflammation, Can have lots of damage without sx, Need early detection, Caused by and causes HTN, Must keep BP lower than 130/80 mmHg, Decreased GFR over >3 months, Decreased QOL; increased $$$, Premature death, Can progress to ESRD >> dialysis/transplant, Risk factors, Diabetes**, CVD, HTN, Obesity, Family history, Cancer, Stages, 1) GFR = 90, 2) GFR = 60-89, 3) GFR = 30-59, 4) GFR = 15-29, 5) GFR = <15, Clinical appearance, Elevated serum creatinine, Anemia, Metabolic acidosis, Electrolyte abnormalities, Fluid retention, HTN, Diagnostic findings, GFR, Creatinine, Medical management, Treat cause, Routine visits, Prevention, Control risk factors, Gerontological considerations, Increased kidney dysfunction and renal failure, Predisposed b/c of systemic diseases, Medication precautions

End-stage renal disease (ESRD), 5th and final stage of CKD, Needs permanent replacement therapy, Uremia >> Decline in function + progression of ESRD, Underlying disorder, Urinary excretion of protein, HTN, Clinical manifestations, Variable, HTN, edema, Crackles, Anemia, Cramps, weakness, Gray-bronze skin color, Dry, flaky skin, Repro/neuro alterations, Ammonia breath, Metallic taste, Diagnosed by GFR, C, BUN, Complications, Hyperkalemia, Pericardial alterations, HTN, Anemia, Bone disease, Metastatic, vascular calcifications, Treatment, Maintain function, Treat reversible factors, Meds, diet, Ca and P binders, Anti-HTN, CV drugs, Antiseizure meds, E-poietin, Restricting protein and potassium, Supplements, Dialysis, Nursing care, Fluid status, Diet education, Self-care, Emotional support, Patient knowledge, Dx, Tx, Complications, Collaborative problems, Hyperkalemia, Percarditis, pericardial effusion, Pericardial tamponade, HTN, Anemia, Bone disease, metastatic calcifications

Goals

Maintain IBW w/o excess fluid

Good nutritional intake

Increased knowledge

Participation in activity w/i tolerance

Improved self-esteem

Abscence of complications

Renal replacement therapies

Hemodialysis, Most common (80%), Acute illness, Intermittent (2-3x per week), Two main purposes, Removes toxins/wastes by..., Complications, HF, CHD, angina, stroke, PVI, HTN, vascular calcifications, Itching r/t phosphorous deposits, Sleep disturbances (very common), SOB, hTN, muscle cramps, Dysrhythmias, air embolus (rare), Dialysis disequilibrium, Leading COD = ???, Malnutrition, Anemia, Gastric ulcers, Uremia, Vomiting, Bone pain, fractures, Calcium metabolism, Renal osteodystrophy

Continuous RRT, Certain groups, Too unstable for HD, Oliguric RF >> Fluid overload, Kidneys can't handle needs, No rapid fluid shifts, arterial access, machinery

Peritoneal dialysis (PD), Goals, Remove wastes, Fluid, electrolyte balance, For those who cannot have HD or transplant, Slower rate of exchange >> fewer comlications, Utilizes the peritoneal membrane, Complications, Acute, Peritonitis***, Cloudy drainage fluid, S/S shock, Treated with C&S, antibiotics, Assess for (protein) malnutrition, Leakage (immediate), Stops after PD withheld for several days, Limit strenuous activity, Bleeding (takes 1-2 days to stop), Long-term, Hypertriglyceridemia, Abdominal hernias, Low back pain, Anorexia, Sweet taste

Nursing management, Home HD, Usually an outpatient procedure, Highly motivated and adaptable, Caregiver committment, Medications, Timing is important, Water-soluble meds removed by HD, Avoid toxicity, Patient education to dosing, timing, Use volumetric IV pump, Protecting vascular access, No BP or sticks on that side, Assess bruit or thrill q8hr, Assess site for infection and dressing, Hospitalized patients, S/S uremia, Fluid overload, HF, PE, pericarditis, Discomfort, Pain management, Site care, CAPD (assess technique), Daily or 3-4/week, shower or bath, Monitor BP (esp. HTN), Hold BP meds before dialysis, May need combination therapy, Preventing infection, Common to have decreased WBC/RBC, platelet function, Infection @ vascular site; pneumonia (most common), Avoid K or Mg supplements

Fluid & Electrolyte Balance

Fluids

60% of adult body is fluid, Variable, ICF, ECF, Intravascular, Interstitial, Transcellular

Regulation, Movement depends on pressure, HP: Exerted on walls on BVs, OP: Exerted by protein in plasma, Types of movement, Osmosis: Low to high, Diffusion: High to low, Filtration: High HP to low HP, Active transport: Pump from low to high, Requires ATP for energy, Movement against concentration gradient, Important body pump: Na (ECF) - K (ICF)

Gerontological considerations, Reduced homeostatic mechanisms, Decreased body fluid percentage, Medication use, May appear differently, Easily overloaded, Dehydration

Imbalances, FVD, Loss of ECF exceeds water intake, Causes, Fluid losses, Lack of access to fluids, Risk factors, Third-space shifts, DI, Adrenal insufficiency, Osmotic diuresis, Hemorrhage, Coma, Manifestations, Weight loss, Poor turgor, Oligura; concentrated urine, Orthostatic hTN, Rapid, weak pulse, Increased temperature, Thirst, Cool, clammy skin r/t VC, Lassitude, Thirst, Nausea, Muscle weakness, cramps, Lab data, Elevated BUN compared to C, Increased hematocrit, Electrolyte changes, Nursing care, Treated with PO/IV fluids, I&O, VS, weights, Oral care, S/S turgor, mucosa, UO, mental status, FVE, R/T fluid overload or diminished mechanisms, Risk factors, HF, RF, Cirrhosis, Contributing factors, Excessive dietary sodium, IV solutions w/sodium, Manifestations, Edema, Crackles, Tachy, High BP, Pulse pressure, CVP, Weight gain, Increased UO, SOB, wheezing, Nursing care, Address the cause; restrict fluids/Na; diuretics, I&O, daily weights, Lung sounds, Edema grading, Response to diuretics, Fluid restrictions (adherence, patient ed), Sodium intake, Resting, Orthopnea? >> Semi-Fowler, Skin care

Electrolytes

Carry a charge

Variable concentration by compartment

Imbalances by electrolyte, Na, Hyponatremia, <135 mEq/L, Causes, Adrenal insufficiency, Water intoxication, SIADH, Fluid losses, Manifestations, Poor turgor, Dry mucosa, Decreased saliva, Decreased BP, Nausea, cramping, Neuro changes, Nursing care, Water restriction, sodium replacement, Dietary sodium & fluid intake, At-risk patients, Effects of meds, Hypernatremia, >145 mEq/L, Causes, Excess loss, Excess Na, DI, Heat stroke, Hypertonic IVs, Manifestations, Thirst*, High temp, Dry, swollen tongue, Sticky mucosa, Neurologic symptoms, Restlessness, weakness, Nursing care, Treated with hypotonic electrolytes or D5W, Assess for OTC sodium sources, Encourage fluids, Provide enough water w/tube feeds, K, Hypokalemia, <3.5 mEq/L, Below-normal serum levels, Alkalosis >> Serum K into cells, Causes, GI losses, Medications, Altered acid-base balance, Hyperaldosteronism, Poor dietary intake, Manifestations, Fatigue, A/N/V, Disrhythmias, Muscle weakness, cramps, Parasthesias, Glucose intolerance, DTRs, Nursing care, Increase PO intake or IV, Severe hK is life-threatening, ECG, ABGs, dietary K, Flat T, U-wave, IV maintenance, Hyperkalemia, >5.0 mEq/L, Causes, Treatment-related, Impaired renal function, Hypoaldosteronism, Tissue trauma, Acidosis, Manifestations, Cardiac changes, Disrhythmias, Muscle weakness (RR!), Parasthesias, Anxiety, GI disturbances, Medical care, ECG, Peaked T, Wide, flat P, Wide QRS, Limit dietary K, Cation-exchange resin (kayexalate), IV sodium bicarb, calcium gluconate, Regular insulin, hypertonic dextrose IV, Beta-2 agonists, Dialysis, Nursing care, Serum levels, Mix drugs with K well, Monitor meds, K restriction, Dietary ed, Risk of false labs*, Drawing blood above IV site, Silent sources of K, Salt substitutes, Medications, K-sparing diuretics, Ca, Hypocalcemia, <8.5 mg/dL (incl. albumin), Causes, Hypoparathyroidism, Malbasorption, Pancreatitis, Alkalosis, Massive blood transfusion, RF, Meds, Others, Manifestations, Tetany, Circumoral numbness, Parasthesias, Hyperactive DTRs, Trousseau's / Chovstek's signs, Seizures, Dyspnea, laryngospasm, Abnormal clotting, Anxiety, Medical care, IV calcium gluconate, Ca and Vit. D supplements, Dietary intake, Nursing care, Can be life-threatening, Weight-bearing exercise to prevent loss, Patient ed re: diets, meds, Nursing care r/t IV Ca admin, Hypercalcemia, >10.5 mg/dL, Causes, Malignancy, Hyperparathryoidism, Bone loss r/t immobility, Manifestations, Muscle weakness, incoordination, A/C/N/V, Abdominal/bone pain, Polyuria, thirst, ECG changes, Dysrhythmias, Medical care, Treat underlying cause, Fluids, Furosemide, Phosphates, calcitonin, Biphosphonates, Nursing care, Mobility, 3-4 L/d of fluids, Hypercalcemic crisis - often fatal, Ambulation, Fluids w/sodium if allowed, Fiber for constipation, Safety risks, Mg, Hypomagnesmia, <1.8 mg/dL (w. albumin), Causes, Alcoholism, GI losses, Enteral feeding deficiency, Meds, Rapid admin of citrated blood, DKA, sepsis, burns, hypothermia, Manifestations, NM irritibility, Muscle weakness, Tremors, Athetoid movements, ECG changes, Dysrhythmias, Mood, LOC alterations, Medical care, Diet, PO Mg, IV Mg sulfate, Nursing care, Safety, Dysphagia common (assess swallowing), Patient ed, Diet, Meds, Alcohol use, IV Mg care, Often combined w/hypocalcemia, Hypermagnesmia, >2.7 mg/dL, Causes, RF, DKA, Excessive Mg, Manifestations, Flushing, hTN, N/V, Hypoactive reflexes, Muscle weakness (>> decreased RR), ECG changes, dysrhythmias, Medical care, IV calcium gluconate, Loop diuretics, IV NS of RL, HD, Nursing care, No Mg admin, Patient ed r/t OTC Mg, P, Hypophosphatemia, <2.5 mg/dL, Causes, Alcoholism, Refeeding syndrome, Pain, heat stroke, Hyperventilation, Resp. alkalosis, DKA, Hepatic encephalopathy, Major burns, Hyperparathyroidism, Low Mg, K, Vit D, Diarrhea, Diuretic or antacid use, Manifestations, Neuro S/S, Confusion, Muscle weakness, Tissue hypoxia, Muscle, bone pain, Increased risk of infection, Nursing care, PO or IV replacement, Dietary intake, Introduce calories gradually for TPN patients, Hyperphosphatemia, >4.5 mg/dL, Causes, RF, Excess P, Vit D, Acidosis, Hypoparathyroidism, Chemo, Manifestations, Few S/S, Caused by associated hypocalcemia, Soft-tissue calcifications, Medical care, Treat underlying, Vit-D preparations, Ca-binding antacids, P-binding gels, antacids, Loop diuretics, NS IV, Dialysis, Nursing care, Avoid dietary intake, Patient ed r/t diet, sources, s/s hypocalcemia, Cl, Hypochloremia, <96 mEq/L, Causes, Addison's disease, Reduced intake, GI loss, DKA, Excessive sweating, Fever, Burns, Meds, Metabolic alkalosis, Associated loss of K, Na, Manifestations, Agitation, Irritability, Weakness, Hyperexcitability, Dysrhythmias, Seizures, coma, Nursing care, IV NSor 0.45% NS with Cl, Avoid free water, High-chloride diet, Patient ed, Hyperchloremia, >108 mEq/L, Causes, Excess NaCl with water loss, Head injury, Hypernatremia, Dehydration, Severe diarrhea, Resp. alkalosis, Meta. acidosis, Hyperparathyroidism, Medications, Manifestations, Tachypnea, Lethargy, weakness, Rapid, deep RR, HTN, Cognitive changes, Normal serum anion gap, Medical care, Restore balance, LR, Sodium bicarb, Diuretics, Nursing care, Assessment, Patient ed r/t diet, hydration