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461 - Exam 4 > ATI - Electrolyte Imbalances - 58 > Flashcards

ATI - Electrolyte Imbalances - 58 Flashcards

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1
Q

_____ is the major electrolyte found in ECF and is present in most body fluids or secretions.

A

sodium (Na+)

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2
Q

Sodium is essential for maintenance of ______ and fluid balance, active and passive transport mechanisms, and irritability and conduction of _____ and ______.

A

acid-base

nerve and muscle tissue

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3
Q

Expected serum sodium levels

A

136 - 145 mEq/L

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4
Q

_____ is a serum sodium level less than 136 mEq/L

A

Hyponatremia

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5
Q

Hyponatremia results from an excess of water in the ______ or loss of _____ rich fluids.

A

plasma

sodium

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6
Q

Hyponatremia delays and slows the ______ of membranes.

A

depolorization

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7
Q

With hyponatremia water moves from the _____ into the _____, which causes cells to swell (cerebral edema)

A

ECF to ICF

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8
Q

Serious complications can result from untreated acute hyponatremia such as coma, ______, and _______).

A

seizures

respiratory arrest

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9
Q

Risk Factors of Hyponatremia

A

Deficient ECF volume
Excessive GI losses: vomiting, nasogastric suctioning, diarrhea, tap water enemas
Renal losses: diuretics, kidney disease, adrenal insufficiency, excessive sweating
Skin losses: burns, wound drainage, gi obstruction, peripheral edema, ascites
Increased or normal ECF volume: excessive oral water intake, syndrome of inappropriate antiduretic hormone secretion (SIADH)
Edematous states: heart failure, cirrhosis, nephrotic syndrome
Excessive hyponotic IV fluids
Inadequate sodium intake (NPO status)
Hyperglycemia
Age-related risk factors: older adult clients are at greater risk due to an increased incidence of chronic illnesses, use of diuretic medications, and risk for insufficient sodium intake

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10
Q

Expected Findings with Hyponatremia - Vital Signs

A 
Hypothermia
Tachycardia
Rapid thready pulse
hypotension
orthostatic hypotension
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11
Q

Expected Findings with Hyponatremia - Physical Assessment Findings

A

vary with a normal decreased or increased ECF volume

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12
Q

Expected Findings with Hyponatremia - neuromusculoskeletal

A 
headahe
confusion
lethargy
muscle weakness with possible respiratory compromise
fatigue
decreased deep tendon reflexes (DTRs)
seizures
coma
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13
Q

Expected Findings with Hyponatremia - GI

A 
increased motility
hyperactive bowel sounds
abdominal cramping 
anorexia
nausea
vomiting
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14
Q

For hyponatremia the serum sodium lab test will be ______.

A

decreased: less than 136 mEq/L

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15
Q

For hyponatremia the urine specific gravity will be _____.

A

less than 1.010 (if not due to SIADH)

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16
Q

For hyponatremia the serum osmolarity is _______.

A

decreased: less than 280 mOsm/kg

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17
Q

p348 nursing care review

A

?

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18
Q

Hypernatremia is a serum sodium level _____.

A

greater than 145 mEq/L

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19
Q

With hypernatremia the serum osmolarity is ______ to ______.

A

increased: greater than 295 mOsm/kg

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20
Q

With Hypernatremia the urine specific gravity will be ______.

A

greater than 1.030

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21
Q

Patient Centered Care for Hypernatremia

A

Report lab finding outside of the expected reference range to the provider
Monitor level of consciousness and ensure safety
Provide oral hygiene and other comfort measures to decrease thirst
Monitor I&O, and alert the provider if urinary output is inadequate

Fluid Loss: Based on serum osmolarity. Administer hypotonic IV fluids (Q.225% sodium chloride)

Excess Sodium: 
Encourage water intake and discourage sodium intake.
Administer diuretics (loop diuretics)
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22
Q

______ is the major cation in ICF.

A

Potassium (K+)

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23
Q

Potassium plays a vital role in _______; transmission of nerve impulses; functioning of cardiac, lung, and muscle tissues; and acid-base balance.

A

cell metabolism

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24
Q

Potassium has reciprocal action with _____.

A

sodium

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25
Q

Expected serum potassium levels are ______.

A

3.5 mEq/L - 5.0 mEq/L

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26
Q

______ is a serum potassium level less than 3.5 mEq/L.

A

Hypokalemia

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27
Q

Hypokalemia is the result of an increased loss of potassium from the body, decreased intake and absorption of potassium, or movement of _____.

A

potassium into the cells.

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28
Q

Hypokalemia Risk Factors - general

A

Hyperaldosteronism
Inadequate dietary intake (rare)
Prolonged administration of non-electrolyte-containing IV solutions such as 5% dextrose in water

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29
Q

Hypokalemia Risk Factors - Excessive GI losses

A

vomiting
nasogastric suctioning
diarrhea
excessive laxative use

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30
Q

Hypokalemia Risk Factors - renal losses

A

Excessive use of potassium-excreting diuretics

i.e. furosemide (lasix), corticosteroids

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31
Q

Hypokalemia Risk Factors - skin losses

A

diaphoresis

wound losses

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32
Q

Hypokalemia Risk Factors - ICF

A

metabolic alkalosis, after correction of acidosis (treatment of diabetic ketoacidosis), during periods of tissue repair (burns, trauma, starvation), total parental nutrition

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33
Q

Hypokalemia Expected Findings - Vital Signs

A 
hyperthermia
weak irregular pulse
hypotension
orthostatic hypotension
respiratory distress
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34
Q

Hypokalemia Expected Findings - neuromusculoskeletal

A

ascending bilateral muscle weakness with respiratory collapse and paralysis
muscle cramping
decreased muscle tone and hypoactive reflexes
paresthesias
mental confusion

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35
Q

Hypokalemia Expected Findings - electrocardiogram (ecg)

A 
premature ventricular contractions (PVCs)
bradycardia
blocks
ventricular tachycardia
flattening T waves
ST depression
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36
Q

Hypokalemia Expected Findings - GI

A 
decreased motility
hypoactive bowel sounds
abdominal distention
constipation
ileus (bowel obstruction in the ileum)
nausea
vomiting
anorexia
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37
Q

Hypokalemia Expected Findings - other clinical findings

A

anxiety, which can progress to lethargy

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38
Q

Hypokalemia can be detected through what two laboratory tests?

A

serum potassium

arterial blood gases

39
Q

Hypokalemia is reflected by serum potassium tests that have _______.

A

decreased to less than 3.5 mEq/L

40
Q

Hypokalemia is reflected by arterial blood gases when the pH is _____.

A

greater than 7.45 (metabolic alkalosis)

41
Q

Hypokalemia should be monitored by a ______ to monitor for dysrhythias, such as PVCs, ventricular tachycardia, flattening T waves, and ST depression.

A

ECG

42
Q

Review patient centered care p 349

A

?

43
Q

Hyperkalemia is a serum potassium level of ____.

A

greater than 5.0 mEq/L

44
Q

Hyperkalemia is the result of an increased intake of potassium, movement of potassium out of the cell, or ________.

A

inadequate renal excretion

45
Q

Hyperkalemia is uncommon in clients who have _______ function.

A

adequate kidney function

46
Q

Hyperkalemia is potentially life-threatening due to the risk of ________ and _______.

A

cardiac arrhythmias

cardiac arrest

47
Q

Hyperkalemia Risk Factors -

A 
Increased total body potassium
ECF shift
Hypertonic States
Decreased excretion of potassium
Age
48
Q

Hyperkalemia - Risk Factors - Increased Total Body Potassium

A

IV potassium administration
salt substitutes
blood transfusion

49
Q

Hyperkalemia - Risk Factors - ECF Shift

A 
Insufficient insulin
acidosis (diabetic ketoacidosis)
tissue catabolism (sepsis, trauma, surgery, fever, myocardial infarction)
50
Q

Hyperkalemia - Risk Factors - Hypertonic States

A

uncontrolled diabetes mellitus

51
Q

Hyperkalemia - Risk Factors - decreased excretion of potassium

A 
kidney failure
severe dehydration
potassium-sparing diuretics
ACE inhibitors
adrenal insufficiency
52
Q

Hyperkalemia - Risk Factors - Age

A

Older adult cleints are at greater risk due to decreased kidney function and medical conditions resulting in the use of salt substitutes
angiotensin-converting enzyme inhibitors
potassium-sparing diuretics

53
Q

Hyperkalemia - Expected Findings - Vital signs

A

slow, irregular pulse

hypotension

54
Q

Hyperkalemia - Expected Findings - neuromusculoskeletal

A 
irritability
confusion
weakness with ascending flaccid paralysis
paresthesias
lack of reflexes
55
Q

Hyperkalemia - Expected Findings - ECG

A

ventricular fibrillation
peaked T waves
widened QRS
cardiac arrest

56
Q

Hyperkalemia - Expected Findings - GI

A

increased motility
diarrhea
abdominal cramps
hyperactive bowel sounds

57
Q

Hyperkalemia will reflect _______ on a serum potassium test.

A

an increase, greater than 5 mEq/L

58
Q

Hyperkalemia will reflect _____ on arterial blood gases.

A

metabolic acidosis; pH less than 7.35

59
Q

With Hyperkalemia and ECG will show dysrhythmias

A

ventricular fibrilation
peaked T waves
widened QRS

60
Q

Nursing Care p 350

A

?

61
Q

When do you use loop diuretics?

A

to increase potassium excretion from the renal system, if kidney function is adequate.

used with Hyperkalemia

62
Q

When you have hyperkalemia one medication that can be used is sodium polystyrene sulfonate either ______ or as an _____.

A

orally

enema

63
Q

Sodium polystyrene sulfonate increases the excretion of potassium from the _______.

A

gi system

64
Q

_______ is found in the body’s cells, bones, teeth.

A

calcium

65
Q

The expected calcium level is _____ to ____.

A

9.0 to 10.5 mg/dL

66
Q

Calcium balance is essential for proper functioning of the cardiovascular, neuromuscular, and ______ systems, as well as blood clotting and bone and teeth formation.

A

endocrine

67
Q

Hypocalcemia is a total serum calcium level less than _____.

A

9.0 mg/dL

68
Q

Risk Factors for hypocalcemia

A

increased calcium output
inadequate calcium intake or absorption
calcium shift from ECF into bone or to an inactive form

69
Q

With hypocalcemia increased calcium output can result from chronic diarrhea or _______.

A

steatorrhea as with pancreatits (binding of calcium to undigested fat)

70
Q

With hypocalcemia inadequate calcium intake or absorption occurs with _____ syndromes, such as Crohn’s disease or _____ deficiency (alcohol use disorder, chronic kidney disease)

A

malabsorptin syndromes

vitamin D deficiency

71
Q

With hypocalcemia, calcium shift from ECF into bone or to an inactive form due to rapid infusion of blood transfusion, post-throidectomy, and ______.

A

hypoparathyroidism

72
Q

Hypocalcemia - Expected Findings - Muscle Twitches/Tetany

A

Numbness and tingling (fingers and around mouth)
Frequent, painful muscle spasms at rest that can progress to tetany
hyperactive DTRs
Positive Chvostek’s sign (tapping on the facial nerve triggering facial twitching)
Positive Trousseau’s sign (hand/finger spasms with sustained bp cuff inflation)
laryngospasms

73
Q

Hypocalcemia - Expected Findings - Cardiovascular

A

weak, thready pulse, tachycardia or bradycardia

cardiac dysrhythmias: prolonged QT interval and ST segments

74
Q

Hypocalcemia - Expected Findings - GI

A

hyperactive bowel sounds
diarrhea
abdominal cramping

75
Q

Hypocalcemia - Expected Findings - Central Nervous System

A

seizures due to overstimulation of the CNS

76
Q

A calcium diagnostic test.

A

ECG

77
Q

Nursing care for hypocalcemia

A

Administer oral or IV calcium supplements (carefully monitor respiratory and cardiovascular status)
Initiate seizure precautions
Keep emergency equipment on standby
Encourage foods high in calcium, including dairy products and dark green veggies.

78
Q

Hypercalcemia is a total serum calcium level _______.

A

greater than 10.5 mg/dL

79
Q

Hypercalcemia Risk Factors

A

Decreased calcium output
Increased calcium intake and absorption
Calcium shift from bone to ECF

80
Q

With hypercalcemia, decreased calcium output can be caused by ______.

A

thiazide diuretics

81
Q

With hypercalcemia, calcium shift from bone to ECF can be caused by:

A 
Hyperparathyroidism
Bone cancer
Paget's disease
Chronic immobility
Long-term glucocorticoid use
Hyperthyroidism
82
Q

Hypercalcemia - Expected Findings - neuromuscular

A

decreased reflexes
bone pain
flank pain if renal calculi develop

83
Q

Hypercalcemia - Expected Findings - Cardiovascular

A

dysrhythmias

increased risk for blood clot

84
Q

Hypercalcemia - Expected Findings - GI

A

anorexia
nausea
vomiting
constipation

85
Q

Hypercalcemia - Expected Findings - CNS

A

weakness, lethargy

confusion, decreased level of consciousness

86
Q

Hypercalcemia Diagnostic procedures

A

ECG - Shortened QT interval

87
Q

Nursing Care - Hypercalcemia

A

increase the client’s activity level
limit dietary calcium
encourage fluids to promote urinary excretion
encourage fiber to promote bowel elimination
implement safety precautions if client is confused
monitor for pathologic fractures
encourage fluid intake to decrease the risk for renal calcium stone formation
monitor for blood clots, measure calf circumference

88
Q

Most of the body’s magnesium is found in the ____.

A

bones

89
Q

Magnesium in smaller amounts is found within the body ____.

A

cells

90
Q

A very small amount of magnesium is found in ____.

A

ECF

91
Q

The expected magnesium level range is _____.

A

1.3 to 2.1 mEq/L

92
Q

Hypomagnesemia is a serum magnesium level less than ____.

A

1.3 mEq/L

93
Q

Hypomagnesemia Risk Factors

A

Increased Magnesium Output

Inadquate Magnesium intake or absorption

94
Q

Increased magnesium output associated with hypomagnesemia can be caused by

A

GI losses (diarrhea, nasogastric suction)
Thiazide or loop diurectics
often associated with hypocalcemia

461 - Exam 4 (6 decks)

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