Perez, Paul Joshua C.

DISEASE ETIOLOGY PATHOGENESIS CLINICAL DIAGNOSTIC TEST MED/SURG NURSING MANAGEMENT

MANIFESTATIONS INTERVENTIONS
Hypovolemia  Diabetes insipidus 1.Loss of body fluid and • Acute weight loss  BUN  Isotonic electrolyte  Monitor intake and
(Fluid Volume Deficit)  Adrenal insufficiency decreased in fluid intake • Decreased skin turgor  Hematocrit level solutions for output every 8
 Osmotic diuresis • Oliguria  Potassium and sodium hypotensive patients. hours/hourly
levels  Hypotonic electrolyte
 Hemorrhage • Concentrated Urine  Monitor body weight
 Coma • Postural hypotension solutions is often used daily
to provide both
• Weak, rapid heart rate  Monitor vital signs
electrolytes and water
• Flattened neck veins for renal excretion of  Assess skin and tongue
• Increased temperature metabolic wastes turgor
• Decreased central
venous pressure
• Cool, clammy skin
related to peripheral
vasoconstriction
• Thirst
• Anorexia
• Nausea
• Lassitude
• Muscle weakness
 Cramps
Hypervolemia  Heart failure 1.Simple fluid overload  Edema  BUN and Hematocrit  Diuretics  Monitor intake and
(Fluid Volume Excess)  Renal failure 2.Diminished function of  Distended neck veins levels  Potassium supplements output at regular
 Cirrhosis of the liver the homeostatic  Crackles  Urine sodium levels can be prescribed to intervals
 Tachycardia
 Consumption of mechanism  CXR avoid Hypokalemia  Monitor weight daily
 Increased blood caused by the diuretics
excessive amounts of 3.Fluid imbalance
pressure
 Assess breath sound
table or other sodium 4.Excessive fluid volume  Hemodialysis or and interval
 Increased weight
salts peritoneal dialysis
 Increased urine output
 Excessive administration  Shortness of breath  Continuous renal
and wheezing replacement therapy
of sodium-containing
fluids  Dietary restriction of
sodium
Hyponatremia (Sodium  Hyperglycemia 1.Sodium lost through  Poor skin turgor  Serum sodium level  Sodium Replacement  Monitor intake and
defecit)  Increased water intake vomiting, diarrhea or  Dry mucosa  Serum osmolality  Lactated Ringer’s output
(parenteral) sweating  Headache  Urine sodium solution or isotonic  Monitor weight daily
 Use of tap-water  Decreased saliva saline  Assess patients
production  Water restriction
enemas consciousness
 Orthostatic fall in BP
 Irrigation of NGT with  Nausea
water instead of NSS  Abdominal cramping
 Syndrome of  Altered mental status
inappropriate secretion  Status epilepticus
of antidiuretic hormone  Coma
(SIADH)  Obtundation
 Cerebral enema
 Anorexia
 Muscle cramps
 Feeling of exhaustion
 Lethargy
 Confusion
 Muscle twitching
 Focal weakness
 Hemiparesis
 Papilledema
 Seizures
Hypernatrimea (Sodium  gain of sodium in excess 1.gain of sodium in excess  Restlessness  Serum sodium level  Infusion of hypotonic  Monitor intake and
Excess) of water or by a loss of of water  Weakness  Urine specific gravity electrolyte solution or output
water in excess of 2.more water is retain  Disorientation  Urine osmolality an isotonic non-saline  Assess behavioural
sodium than sodium  Delusions and solution changes
hallucinations  D5W is indicated when
 Thirst water needs to be
replaced w/o sodium
Hypokalemia (Potassium  GI loss of potassium 1.  Anorexia  ECG  Oral or IV replacement  Monitor Intake and
Deficit)  vomiting and gastric  Nausea and vomiting  24 hour urinary therapy output
suctioning  Muscle weakness potassium excretion  Dietary intake of  Encourage patient to
 Leg cramps test potassium take potassium rich
 Decreased bowel food
motility
 Parethesias
  Dysrhythmias
 Excessive thirst
Hyperkalemia  Decreased renal  Skeletal muscle  Serum potassium levels  Restriction of dietary  Monitor for signs of
(Potassium Excess) excretion of potassium weakness and paralysis  ECG potassium containing muscle weakness
 iatrogenic causes medications  Instruct patient to avoid
 administration of cat- potassium containing
ion exchange resins food
 IV calcium gluconate
Hypocalcemia (Calcium  Bone resorption  Tetany  Serum Calcium levels  Parenteral Calcium Salts  Monitor for signs of
Deficit)  Renal failure  Tingling Sensation seizure
 Inadequate Vitamin D  Spasms
consumption  Trousseau’s sign
 Nausea and Vomiting
 Convulsions
Hypercalcemia (Calcium  Immobilization  Muscle weakness  Serum Calcium levels  Administering fluids  Encourage patients
Excess)  Increased Parathyroid  Incoordination  0.9% Sodium Chloride mobility
hormone  Anorexia solution 
 Dysrhythmias  Calcitonin
Hypomagnesemia  Starvation  hyperexcitability with  Serum Magnesium  IV administration of  monitor vital signs
(Magnesium Deficit )  Malnutrition muscle weakness level Magnesium Sulfate  monitor intake and
 tremors  ECG  diet output
 athethous movement)  encourage patient to
 Tenany take magnesium rich
 Gneralized tonic-clonic food
or focal seizure
Hypermagnesemia  Renal Failure.  Lowered BP  Serum Magnesium  Hemodialysis  Monitor vital signs
(Magnesium Excess)  Efficient excretion of  Nausea & vomiting level  Loop diuretics  Monitor intake and
magnesium of the  Weakness  Potassium and Calcium  Sodium Chloride & output
kidneys.  Soft tissue levels Lactated ringer’s IV
 Lithium Intoxification. calcifications  ECG solution
 Platelet clumping  Facial flushing  IV Calcium gluconate
 Delayed thrombin  Warmth sensation
formation  Lethargy
 Dysarthria &
 drowsiness
Hypophosphatemia  Increased urinary  Irritability  Serum phosphorus  Neutra-phos capsule  Monitor phosphorus
(Phosphorus deficit ) excretion of potassium  Fatigue levels  Fleet’s phosphosoda serum level
 Decreased intestinal  Apprehension  X-rays  Encourage to drink milk
absorption of potassium.  Weakness & numbness if possible
 Heat stroke  Paresthesias  Encourage to take food
 Prolonged intense  Dysarthria, dysphagia, such as meat, fish,
hyperventilation diplopia poultry and/or whole
 DKA  Confusion grain
 Hepatic encephalopathy  Seizures
 Coma
 Hypoxia
 Increased RR & resp.
alkalosis
Hyperphosphatemia  Renal failure  Tetany  Serum phosphorus  Vit. D preparations  Monitor intake and
(Phosphorus excess)  Chemotherapy for  Tingling sensations in level (calcitriol) output
neoplastic disease the fingertips & around  X-ray may  Phosphate-binding gels  Instruct patient to avoid
 Hypoparathyroidism the mouth.  Bone studies & or antacids potassium rich food
 DKA  Anorexia coronary calcification  Dietary restriction such as banana
 Acute hemolysis  Nausea & vomiting studies  diuretics  Avoid laxatives and
 High phosphate intake  Bone & joint pain  Dialysis enemas
 Muscle weakness
 Hyperflexia
 Tachycardia
 Soft tissue calcification
 Decrease urine output
 Impairing vision
 Palpitations.

Hypochloremia (chloride  Hypoventilation 1. Chloride produce in the  hyperexcitability of  Blood test  Normal saline/.45%  Monitor intake and
deficit)  respiratory acidosis stomach muscle  Chloride level sodium chloride output, arterial blood
 low sodium intake 2. Chloride combines with  tetany  Sodium and potassium  Diet Modification gas values
 vomiting hydrogen to form HCl  hyperactive deep level  Ammonium chloride
 diarrhea 3. Small amount of  tendon reflexes  Arterial blood gas  Monitor serum
 chloride combines with  weakness  Urine exam electrolytes levels
the feces  twitching and muscle
4. Diarrhea and excessive crumps  Assess patients
vomiting will cause consciousness and
hypochloremia muscle strength

 Monitor vital sign and

respiratory condition

 Encourage to eat
foods with high
chloride intake
Hyperchloremia  Head trauma 1. Loss of bicarbonate  Tachypnea  Blood test  Hypotonic IV solution  monitor vital signs,
(Chloride excess)  increased perspiration ions via the kidney or  Weakness  Serum pH, serum  Lactated Ringer’s arterial blood gas
 excess adrenocortical GI tract  Lethargy chloride, serum sodium solution values
hormone production 2. Chloride ions increases  deep rapid respiration  Urine exam  IV sodium bicarbonates
 decrease glomerular 3. Chloride ions in the  diminished cognitive  diuretics  monitor intake and
filtration form of acidifying salt ability output
accumulate  hypertension
4. acidosis  asses respiratory,
neurologic and
cardiac functions

 teach patient about

the diet that should
be followed to
manage
hyperchloremia

 encourage to
maintain adequate
hydration
Acute Metabolic Acidosis  Uremia  Headache  Arterial blood gas  Bicarbonate  Monitor intake and
(Base bicarbonate  Diabetic Ketoacidosis  Confusion sampling replacement output
deficit)  lactic acidosis  Drowsiness  blood pH  alkalizing agent
 ketoacidosis  increased respiratory  Blood Serum
 chronic renal failure rate  ECG
 diarrhea  nausea and vomiting
 vomiting  decreased cardiac
output
Chronic Metabolic  Asymptomatic until
Acidosis (Base bicarbonate is
bicarbonate deficit) approximately
15mEq/L or less
Acute metabolic alkalosis  Vomiting or gastric 1.-kidneys conserve  tingling of the fingers  ABG administering sodium  Monitor intake and
(Base bicarbonate suction with loss of potassium thus and toes  serum bicarbonate chloride fluids output
Excess) hydrogen and chloride increasing the excretion  dizziness and  urine chloride levels  administer KCl
ions of H+ hypertonic muscles (potassium chloride)
 Pyloric stenosis 2.cellular potassium  depressed respirations  H2 Receptor
 diuretic therapy moves out of the cells  atrial tachycardia antagonists (Tagamet)
 excessive into the ECF in attempt  decreased motility and  carbonic anhydrase
adrenocorticoid to maintain near-normal paralytic ileus inhibitors
hormones serum levels
 excessive alkali ingestion 3.ionized fraction of
from antacids containing serum calcium
bicarbonate during decreases as more
cardiopulmonary calcium combines with
resuscitation protein
Chronic metabolic  long-term diuretic
alkalosis (Base therapy
bicarbonate Excess)  villous adenoma
 external drainage of
gastric fluids
 significant potassium
depletion
 cystic fibrosis
 chronic ingestion of milk
 and calcium bicarbonate
Acute Respiratory  acute pulmonary edema
Acidosis (Carbonic Acid  severe pneumonia
Excess)  acute respiratory
Chronic Respiratory distress syndrome
Acidosis (Carbonic Acid  Atelectasis
Excess)  Pneumothorax
 overdose of sedatives
 chronic empysema and
bronchitis
 obesity
Acute Respiratory  hyperventilation
Alkalosis (Carbonic Acid  extreme anxiety
Deficit)  hypoxemia
Chronic Respiratory  gram-negative
Alkalosis (Carbonic Acid bacteremia
Deficit)  chronic hypocapnia
1.inadequate ventilation  sudden hypercapnia  ABG analysis  mproving ventilation  monitor respiratory
2.elevated plasma CO2  increase respiratory  serum electrolyte  bronchodilators rate
concentration rate levels  antibiotics  place patient in a semi-
3.increased levels of  increase intracranial  chest x-ray  thrombolytics or fowler’s position
carbonic acid pressure  ECG anticoagulants (if
4.elevated PaCo2 ,  hyperkalemia  drug screen (if caused pulmonary emboli (+))
hypoventilation causes a by overdose)  clear respiratory tract of
decrease in PaO2 mucus and purulent
drainage
 adequate hydration
 supplemental oxygen
 mechanical ventilation
1. hyperventilation  light-headedness  ABG analysis  sedative to relieve  monitor respiratory
2. excessive “blowing off”  inability to concentrate  serum electrolytes hyperventilation rate
of the CO2  numbness and tingling  toxicology screen  instruct patient to
3. decrease in plasma  tinnitus breath slowly
carbonic acid  loss of consciousness
concentration