P Imbalances

8/9/2019 P Imbalances

1/15


2/15

Phosphate

Is the primary to intracellular anion in ICF

Normal value: 2.5-4.5 mg/dL or 1.8-2.6 mEq/L

85% of phosphorus is found in the bones and teeth, 14% is inthe tissues and less than 1% in the ECF

Essential to intracellular processes such as the production ofATP

Is vital for red blood cell function and oxygen delivery totissues, nervous system , muscle function , metabolism of fats, carbohydrates , and protein

Is ingested in the diet, absorbed in the jejunum, and primarilyexcreted by the kidneys. When phosphate intake is low, thekidneys conserve phosphorus, excreting less.

Functions: Assist in regulation of Calcium levels

Aids in renal regulation of acid and base balance

Found in the cell membranes as phospholipids that helps in the cellmembrane integrity


3/15

A CLIENT WITH HYPOPHOSPHATEMIA


4/15

HYPOPHOSPHOTEMIA

Serum phosphorus of less than 2.5 mg/dl

May indicate a total body deficit of phosphate or ashift of phosphate into the intracellular space

Decreased gastrointestinal absorption of phosphateor increased renal excretion of phosphate also cancause low phosphate levels.

Causes:

Refeeding syndrome

Medications

Alcoholism

Hyperventilation and Respiratory alkalosis

Diabetic acidosis


5/15

Pathophysiology and Manifestation:

Centralnervoussystem

Reduced oxygen and ATP synthesis in the brain causes

neurologic manifestation such as irritation, apprehension,weakness paresthesia lack of coordination, confusionseizures, and coma.

Hematologic

Oxygen delivery to the cells is reduced. Hemolytic anemia

(excessive RBC destruction) may develop due to lack of ATP inred blood cells.

Musculoskeletal

Decreased ATP causes muscle weakness and release ofcreatnine phosphokinase (CPK,a muscle enzyme); acute

rhabdomyolysis (muscle cell breakdown) can develop. Musclecell destruction, in turn, can lead to acute renal failure asmyoglobin.

A muscle cell protein exerts a toxic effect on the kidneytubule.


6/15

Respiratory

Chest muscle weakness can interfere with

effective ventilation, leading to respiratory failure.

Cardiovascular

Hypophosphatemia decreases myocardial

contractility; decreasesd oxygenation of the heartmuscle can cause chest pain and dysrhytmias.

Gastrointestinal

Anorexia can occur, as well as dysphagia(difficulty swallowing), nausea and vomiting,

decreased bowel sounds, and possible ileus due to

reduced gastrointestinal motility.


7/15

Causesand Manifestationof

Phosphate:

IMBALANCE CAUSES MANIFESTATION

Hypophosphatemia

Serum phosphorus


8/15

Nursingmanagement:

Monitor serum electrolyte values in clients at risk

Malnourished Receiving intravenous glucose or total parenteral nutrition

Client with diuretic therapy

(Discharge) teach client and family about the causes andmanifestation of hypophostamia,discussed imporatanceof avoiding phosphorus-binding antacids.

Nursing Diagnosis:

Impaired Physical Mobility Ineffective breathing Pattern

Decreased Cardiac Output

Risk for Injury


9/15

A CLIENT WITH HYPERPHOSHATEMIA


10/15

HYPERPHOSPHATEMIA

Is a serum phosphate level greater than 4.5 mg/dL.

It may be result of impaired phosphate excretion,excess intake, or a shift of phosphate from theintracellular space into extracellular fluids.

Causes:

Acute or chronic renal failure

Rapid administration of phosphate-containingsolutions

A shift phosphate from the intracellular toextracellular space can occur during:

Chemotherapy

Sepsis


11/15

Hypothermia

Extensive trauma

Heat stroke Disruption of the mechanisms that regulate Ca

levels: Hypoparathyroidism

Hyperparathyroidism

Vit. D intoxication

Clinical Manifestations: Muscle cramps and pain

Paresthesias Tingling around the mouth

Muscle spasms

Tetany


12/15

Calcification of soft tissues

Altered mental status

+ Chvostek sign + Trousseau sign

Convulsions and seizures

heart failure

hypotension

Diagnostic Tests:

serum Ca levels

serum phosphate level

urine studies

renal ultrasound

bone studies

coronary calcification studies


13/15

Medical Management:

phosphate binders (prevents intestinal

absorption):

aluminum hydroxide

calcium carbonate

calcium acetate

magnesium hydroxide

Phosphorus-containing drugs

Diuretics (furosemide)


14/15

Nursing Management:

Monitor the clients laboratory data revealing an

excess of phosphorus and a deficit of calcium.

Monitor signs of hypocalcemia.

Avoid foods that are high in phosphorus (nuts,

other high protein foods, organ meats, dairy

products and dark colas)


15/15

P Imbalances

Documents