Than 30 ml of urinehr labs increased hematocrit

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than 30 ml of urine/hr) Labs: increased hematocrit, increased BUN above25 mg/dL; increased urine specific gravity usually above 1.030 o Hypervolemia : ECV excess Body fluids have increased volume but normal osmolality Causes: too much intake, not enough output. Renal retention of Na+ and water: HF, some meds, too much IV fluid or blood, cirrhosis, aldosterone or glucocorticoid excess, acute or chronic oliguric renal disease S&S: peripheral edema, decreased urine output initially, SOB, weight gain, crackles in lungs, confusion, pulmonary edema is severe Labs: decreased hematocrit, decreased BUN below 10 mg/dL Sodium : o Hyponatremia Sodium levels lower than 135 Fluid volume excess (FVE) Causes: FVE, water intoxication, increase in ADH, hyperosmolar imbalance, imbalances in blood sugar (water exceeds salt) S&S: seizures, confusion, altered mental status, dry mucous membranes, cool & clammy skin, personality changes Management : managing fluids!! Know what they’re on. Might need to take off or put on a med o Hypernatremia Sodium levels greater than 145 Causes: water deficit. Low ADH (diabetes insipidus), loss of water > salt. Osmotic diuresis- pulls fluid from the brain if it is affecting the brain S&S: seizures, confusion, twitching, intense thirst, weakness, lethargy, weight loss, altered mental status Management: manage fluids!! Might need to give diuretics D 5 ½ normal saline at 125 mL/hr will be ordered Potassium o Hypokalemia Potassium levels less than 3.5 Causes: diuretics. Diarrhea, repeated vomiting, sweating, dialysis, diet low in K S&S: dysrhythmias, weak, irregular pulse, muscle weakness , leg cramps, polyuria Management: teach! Foods high in K = potatoes, bananas, oranges & juice, avocado, etc. (foods with skin); IV piggyback potassium
o Hyperkalemia Potassium levels greater than 5.0 Causes: meds, diet high in K, renal failure , salt substitutes S&S: abdominal cramp, diarrhea, irregular pulse, LE weakness, paresthesia Management: education! Pt w/ HTN or heart failure – don’t add salt. Caution about salt substitutes (low in Na but high in K). Stay away from foods high in K Calcium o Hypocalcemia Calcium levels less than 8.4 Causes: malnourished, chronic kidney dz, hypoparathyroid, Mg or Vitamin D deficit S&S: affects bone density & thyroid. Muscle cramps, Tetany Management: education! Foods = dairy. Sunlight & vit D. check BD & thyroid o Hypercalcemia Calcium levels greater than 10.5 Causes: hyperparathyroid. Too much vitamin D. thiazide diuretics S&S: bone pain, fractures, confusion, depressed reflexes, weakness, lethargy Management: education! Check thyroid. Increase weight bearing exercises to enhance bone mineralization Magnesium: Normal 1.5-2.5. you want it > 1.6 in cardiac pts o Low: Less than 1.5 Causes: dietary, diarrhea, vomiting, increase urine output, NG, alcoholism S&S: seizures, confusion, insomnia, muscle cramps, hyperactive deep tendon reflexes o High Greater than 2.5 Causes: dietary. Laxatives high in aluminum. Renal failure. DKA o Management: manage crisis & fluid balance. Educate!

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