Ch. 40 Electrolytes Flashcards
What are the names of the major electrolytes?
Hint: there are 7
Sodium Potassium Calcium Magnesium Chloride Bicarbonate Phosphate
Main function of sodium?
controls of body fluids
Main function of potassium?
cellular enzyme activity and water content and cardiac rhythm
Main function of calcium?
Nerve impulse, blood clotting, muscle contraction
Main function of magnesium?
metabolism of carbohydrates and proteins, vital actions involving enzymes. aids in dilating arteries and facilitating circulation, may prevent calcification of vessels, lowers total cholesterol, raises HDL cholesterol, inhibits platelet aggregation
Main function of chloride?
maintains osmotic pressure in blood, produces hydrochloric acid
Main function of bicarbonate?
body’s primary buffer system
Main function of phosphate?
cell division, hereditary traits
What is the normal range for sodium?
135-145 mEq/L
What is the normal range for potassium?
3.5-5 mEq/L
What is the normal range for calcium?
8.6-10.2 mg/dL
What is the normal range for magnesium?
1.5-2.5
What is the normal range for bicarbonate?
22-26
What is the normal range for phosphate?
2.5-4.5
Hypovolemia stands for ____ ____ ____
What symptoms can a patient experience if they have hypovolemia?
List 3-5 symptoms
Fluid Volume Deficit
dry mucous membranes urine output <30mL/hr postural hypotension weak, rapid pulse increased urine specific gravity Sunken eyes flat neck veins poor skin and tongue turgor thirst weight loss over short period
What can cause hypovolemia? Risk factors
GI: Vomiting, diarrhea,
Hemorrhage
Excessive sweating
burns, draining wounds
Excessive laxative or diuretic use
Polyuria
What are nursing interventions/assessments that are to be done with a patient with hypovolemia?
Assess for presence or worsening of FVD.
Administer oral fluids if indicated.
If patient unable to eat and drink, anticipate TPN or tube feedings to be ordered.
Monitor patient’s response to fluid intake, either oral or parenteral.
Be alert for signs of fluid overload.
Provide appropriate skin care
Hypervolemia stands for ____ ___ _____
What symptoms/sign can you experience with hypervolemia?
list 3-5 symptoms/signs
Weight gain over short period Peripheral edema (may be pitting) Increased BP Shortness of breath Crackles and wheezes in lungs Full, bounding pulse Neck vein distention
Pulmonary edema
↓Urine specific gravity
What can cause hypervolemia? risk factors
Compromised regulatory mechanisms: renal failure, CHF,
Excess IV fluids with sodium
Corticosteroid therapy
Excessive ingestion of sodium-containing substances in diet or sodium-containing medications
Nursing interventions or assessment that can be done for a patient with hypervolemia
Assess for presence or worsening of FVE.
Encourage adherence to sodium-restricted and fluid-restricted diet, if ordered.
Encourage rest periods. Monitor patient’s response to diuretics. Teach self-monitoring of weight and intake and output. Attentive skin care. Monitor respiratory status
T/F hyponatremia is due to increased amounts of sodium
FALSE. Due to loss of sodium
What are symptoms of hyponatremia? List 3-5
Anorexia Nausea and vomiting Lethargy Confusion Muscle cramps Muscular twitching Seizures Coma Serum Na below 135 mEq/L Urine specific gravity <1.010
What can cause hyponatremia? risk factors
Loss of sodium, as in: Loss of GI fluids Use of diuretics Water intoxication Disease states associated with SIADH (a form of hyponatremia)
SIADH- Syndrome of Inappropriate Antidirurectic Hormone
Which patient is likely to be experiencing dehydration? Hypovolemia or hypervolemia?
Hypovolemia
Nursing interventions/assessments for hyponatremia?
Monitor fluid losses and gains.
Monitor for the presence of GI and CNS symptoms.
Monitor serum Na levels.
Check urine-specific gravity.
If able to eat, encourage foods and fluids with high sodium content.
Be aware of sodium content of common IV fluids.
Avoid giving large water supplements to patients receiving isotonic tube feedings.
Take seizure precautions when hyponatremia is severe.
What are symptoms of hypernatremia? list 3-5
Thirst Elevated body temperature Tongue dry and swollen, sticky mucous membranes Severe hypernatremia Disorientation Hallucinations Lethargy when undisturbed Irritable and hyperactive Focal or grand mal seizures Coma Serum Na above 145 mEq/L Urine specific gravity >1.015
What can cause hypernatremia? risk factors
Water deprivation
Increased sensible and insensible water loss
Ingestion of large amount of salt
Excessive parenteral administration of sodium-containing solutions
Profuse sweating
Diabetes insipidus
Nursing interventions/assessments for Hypernatremia
Monitor fluid losses and gains.
Observe for excessive intake of high sodium foods.
Monitor sodium content of prescriptions and OTC drugs.
Monitor for changes in behavior such as restlessness, lethargy, and disorientation.
Look for excessive thirst and elevated body temperature.
Monitor serum Na levels.
Check urine specific gravity.
Give sufficient water with tube feedings to
Fatigue Anorexia, nausea, and vomiting Muscle weakness Decreased bowel motility Cardiac arrhythmias Increased sensitivity to digitalis Serum K below 3.5 mEq/L ECG changes Paresthesias or tender muscles
These are all symptoms of which electrolyte imbalance?
Hypokalemia
Diarrhea
Vomiting or gastric suction
Potassium-wasting diuretics
Steroid administration and certain antibiotics
Poor intake as in anorexia nervosa, alcoholism, potassium-free parenteral fluids
Polyuria
These are all causes/risk factors that can cause which electrolyte imbalance?
Hypokalemia
Nursing interventions/assessments for hypokalemia
Monitor for occurrence of hypokalemia.
Assess digitalized patients at risk for hypokalemia, which potentiates the action of digitalis
Prevent hypokalemia by:
Encouraging extra K intake if possible
Educating about abuse of laxatives and diuretics
Administer oral K supplements if ordered.
Be knowledgeable about danger of IV potassium administration.
Cardiac arrhythmias
Paresthesias of face, tongue, feet, and hands
Flaccid muscle paralysis
GI symptoms such as nausea, intermittent intestinal colic, or diarrhea may occur
Serum K >5.0 mEq/L
These are symptoms of which electrolyte imbalance?
Hyperkalemia
Decreased potassium excretion Oliguric renal failure Potassium-sparing diuretics Hypoaldosteronism High potassium intake
These are causes/risk factors for which electrolyte imbalance/
Hyperkalemia
Nursing interventions/assessments for Hyperkalemia
Monitor for hyperkalemia, which is life threatening.
Prevent hyperkalemia by:
Following rules for safe administration of K
Avoiding giving patients with renal insufficiency K-saving diuretics, K supplements, or salt substitutes
Cautioning about foods high in potassium content
Trousseau and Chvostek signs Numbness and tingling of fingers and toes Mental changes Seizures Spasm of laryngeal muscles ECG changes Cramps in muscles of extremities Total serum calcium <8.6 mg/dL
These are symptoms of which electrolyte imbalance?
Hypocalcemia
Surgical hypoparathyroidism Malabsorption Vitamin D deficiency Acute pancreatitis Excessive administration of citrated blood
These are causes/risk factors for which electrolyte imbalance?
Hypocalcemia
Nursing interventions/assessments for hypocalcemia
Take seizure precautions when hypocalcemia is severe.
Monitor condition of airway.
Take safety precautions if confusion is present.
Educate people at risk for osteoporosis about the need for dietary calcium intake.
Discuss calcium-losing aspects of nicotine and alcohol use.
What symptoms for hypercalcemia?
Muscular weakness Tiredness, lethargy Constipation Anorexia, nausea, and vomiting Decreased memory and attention span Polyuria and polydipsia Renal stones Neurotic behavior Cardiac arrest Serum calcium >10.5 mg/dL
What are causes for hypercalcemia? risk factors
Hyperparathyroidism
Prolonged immobilization
Large doses of vitamin D
Overuse of calcium supplements
Increase mobilization when feasible.
Encourage sufficient oral intake.
Discourage excessive consumption of milk products.
Encourage bulk in the diet.
Take safety precautions if confusion is present.
Be alert for signs of digitalis toxicity
Force fluids to prevent formation of renal stones.
These are nursing interventions/assessments you would do as a nurse for which electrolyte imbalance?
Hypercalcemia
What are symptoms of hypomagnesemia?
Cardiac manifestations Tachyarrhythmias Increased susceptibility to digitalis toxicity Mental changes Disorientation Mood changes Serum magnesium <1.3 mEq/L
What are causes for hypomagnesemia? risk factors
Chronic alcoholism Intestinal malabsorption Diarrhea Drugs Thiazide diuretics Aminoglycoside antibiotics
Assess for magnesium deficit because it predisposes patient to digitalis toxicity.
Take seizure precautions if necessary.
Monitor condition of airway because laryngeal stridor can occur.
Educate the patient if abuse of diuretics or laxatives is a problem.
Educate about intake of foods rich in magnesium
These are nursing interventions/assessments done as a nurse for which electrolyte imbalance?
Hypomagnesemia
Renal failure
Adrenal insufficiency
Excessive magnesium administration during treatment of eclampsia
Hemodialysis with hard water or dialysate high in magnesium content
these are causes/risk factors for which electrolyte imbalance? Hypomagnesemia Hypermagnesemia Hypovolemia Hyperkalemia
Hypermagnesemia
What symptoms of hypermagnesemia?
Early sign is serum magnesium level of 3–5 mEq/L
Flushing and sense of skin warmth
Hypotension
Depressed respirations
Drowsiness, hypoactive reflexes, and muscular weakness
Cardiac abnormalities
If _______is present, be alert for low BP and shallow respirations, lethargy, drowsiness, and coma.
Do not give magnesium-containing medications to patient with renal failure or compromised renal function.
Be cautious of OTC drugs.
Check deep tendon reflexes frequently.
These are nursing interventions/assessment for which electrolyte imbalance?
Hypermagnesemia
Cardiomyopathy Acute respiratory failure Seizures Decreased tissue oxygenation Joint stiffness Serum phosphate <2.5 mg/dL
These are symptoms of which electrolyte imbalance?
Hypophosphatemia
Parenteral nutrition
Alcohol withdrawal
Diabetic ketoacidosis
Respiratory alkalosis
These are risk factors/causes for which electrolyte imbalance?
Hypophosphatemia
Nursing interventions/assessments for hypophosphatemia
Be aware that severely hypophosphatemia patients are at greater risk for infection.
Administer IV phosphate products cautiously.
Introduce parenteral nutrition cautiously in patients who are malnourished.
Monitor for diarrhea when taking oral supplements.
Sudden increase in serum phosphate level can cause hypocalcemia.
Hyperphosphatemia can cause what type of symptoms?
list 3-5
Short-term consequences:
Symptoms of tetany, such as tingling of the fingertips and around the mouth, numbness, and muscle spasms
Serum phosphate >4.5 mg/dL
What are causes for hyperphosphatemia? riskf actors
Large intake of milk
Excessive intake of phosphate-containing laxatives (Fleet phosphosoda)
Large vitamin D intake
Hyperthyroidism
What are nursing interventions/assessments as a nurse for patients with hyperphosphatemia?
Monitor for signs of tetany.
Be aware that soft tissue calcification can be a long-term complication of chronically elevated serum phosphate levels.
Instruct patients that use of phosphate-containing laxatives can result in hyperphosphatemia.
Avoid foods high in phosphorus content.
Respiratory acidosis occurs when there is a primary excess/deficit of carbonic acid/bicarbonate in ECF
“circle” your answer
Respiratory acidosis occurs when there is a primary excess of carbonic acid in ECF
Respiratory alkalosis occurs when there is a primary excess/deficit of carbonic acid/bicarbonate in ECF
“circle” your answer
Respiratory alkalosis occurs when there is a primary deficit of carbonic acid in ECF
Metabolic acidosis occurs when there is a proportionate excess/deficit of carbonic acid/bicarbonate in ECF
“circle” your answer
Metabolic acidosis occurs when there is a proportionate deficit of bicarbonate in ECF
Metabolic alkalosis occurs when there is a primary excess/deficit of carbonic acid/bicarbonate in ECF
“circle” your answer
Metabolic alkalosis occurs when there is a primary excess of bicarbonate in ECF
What is a normal pH range?
- 45-7.55
- 35-7.40
- 35-7.45
- 25-7.35
Normal: 7.35-7.45
T/F anything below 7.35 is a base and anything above 7.45 is acidic for pH?
FALSE
anything below 7.35 is ACIDIC and anything above 7.45 is BASE
What is a normal range for PaCO2 (mm Hg) ?
(partial pressure of carbon dioxide)
35-45
30-40
32-42
25-35
35-45- Normal
What is considered acidic and base for PaCO2
Acidic: >45
Base: <35
What is a normal range for HCO3 (mEq/L) ?
(hydrogen carbonate)
20-30
25-35
22-32
22-26
22-26
T/F an acidic hydrogen carbonate (HCO3) is anything less than 22 mEq/L
TRUE
What is a base for HCO3?
> 26
FIB: Respiratory acidosis has a \_\_\_\_\_\_ pH \_\_\_\_\_\_ PaCO2 \_\_\_\_\_\_ HCO3
hint: think of what increases, what decreases, and what stays in the normal range
Decreased pH (<7.35)
Increased PaCO2
Normal HCO3
FIB: Respiratory alkalosis is \_\_\_\_\_ HCO3 \_\_\_\_\_ pH \_\_\_\_\_ PaCO2
hint: think of what increases, what decreases, and what stays in the normal range
Normal HCO3
Increased pH (>7.45)
Decreased PaCO2
Which acid-based imbalance has a decreased pH level, decreased HCO3 level, and normal PaCO2 level ?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Metabolic acidosis
Which acid-based imbalance has an increased pH, increased HCO3, and normal PaCO2?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Metabolic alkalosis
pH: 7.42
PaCO2: 38 mm Hg
HCO3: 24 mEq/L
This is an example of ?
Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis This is a normal acid-base balance
This is a normal acid-base balance
pH: 7.34
PaCO2: 43 mm Hg
HCO3: 21 mEq/L
This is an example of ?
Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis This is a normal acid-base balance
Metabolic acidosis
pH: 7.47
PaCO2: 32 mm Hg
HCO3: 24 mEq/ L
This is an example of ?
Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis This is a normal acid-base balance
Respiratory alkalosis
pH: 7.33
PaCO2: 47 mm Hg
HCO3: 25 mEq/L
This is an example of ?
Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis This is a normal acid-base balance
Respiratory acidosis
When a patient is on fluid restrictions, how many cups of fluid TOTAL can they receive in a day?
2
4
6
8
4 cups total
T/F You cannot give patients salty foods or high in sugar snacks when on fluid restrictions?
TRUE
What are foods that are recommended to patients who are hypovolemic?
Foods with high water content
citrus fruit
melons
celery
What are foods recommended to patients who are hypokalemic?
Increase foods with high potassium
bananas, citrus fruits, apricots, melons, broccoli, potatoes, raisins, lima beans
What foods are recommended to avoid for hypernatremia patients?
avoid foods high in sodium
processed cheese, lunch meats, canned soups and vegetables, salted snack foods
also eliminate table salt
Leading food sources: fruits and vegetables, dried peas and beans, whole grains, milk, meats
are an example of where which electrolyte can be found?
Potassium
Sources include milk and milk products; dried beans; green, leafy vegetables; small fish with bones; and dried peas and beans
are an example of where which electrolyte can be found?
Calcium
Sources include green, leafy vegetables; nuts; seafood; whole grains; dried peas and beans; cocoa
are an example of where which electrolyte can be found?
Magnesium
Almost all ______ in the diet comes from salt
Found in foods high in sodium, processed foods
chloride
Sources include all animal products (meat, poultry, eggs, milk, bread, ready-to-eat cereal)
for which electrolyte?
Phosphate
What are assessments/symptoms you can see in a patient who has a respiratory acidosis disturbance?
Acute respiratory acidosis Mental cloudiness Dizziness Muscular twitching Unconsciousness ABGs pH <7.35 PaCO2 >45 mm Hg (primary) HCO3− normal or only slightly elevated Chronic respiratory acidosis Weakness Dull headache ABGs pH <7.35 or low N PaCO2 >45 mm Hg (primary) HCO3− >26 mEq/L (compensatory)
What are assessments/symptoms you can see in a patient who has a respiratory alkalosis disturbance?
Lightheadedness
Inability to concentrate
Hyperventilation syndrome
Tinnitus
Palpitations
Sweating
Dry mouth
Tremulousness
Convulsions and loss of consciousness
ABGs
pH >7.45
PaCO2 <35 mm Hg (primary)
HCO3− <22 mEq/L (compensatory)
What are assessments/symptoms you can see in a patient who has a metabolic acidosis disturbance?
Headache
Confusion
Drowsiness
Increased respiratory rate and depth
Nausea and vomiting
Peripheral vasodilation
ABGs
pH <7.35
HCO3− <22 mEq/L (primary)
PaCO2 <35 mm Hg
Hyperkalemia frequently present
What are assessments/symptoms you can see in a patient who has a metabolic alkalosis disturbance?
Dizziness
Tingling of fingers and toes
Hypertonic muscles
Depressed respirations (compensatory)
ABGs
pH >7.45
HCO3− >26 mEq/L (primary)
PaCO2 >45 mm Hg (compensatory)
Hypokalemia may be present
What percentage of NaCl (normal saline) would you give for isotonic solutions?
0.9 % NaCl (normal saline)
What percentage of NaCl (normal saline) would you give for hypotonic solutions?
- 33 % NaCl (1/3- strength of normal saline)
0. 45 % (1/2- strength of normal saline)
What percentage of NaCl (normal saline)/ dextrose would you give for hypertonic solutions?
5% dextrose in Lactated Ringer’s solution
5% dextrose in 0.9 % NaCl
What are the major cations in body fluid?
sodium, potassium, calcium, hydrogen, and magnesium.
What are the major anions in body fluid?
chloride, bicarbonate, and phosphate.
