Chapter 17 Electrolytes: Med Surg Flashcards
normal level of sodium
135-145, regulates osmolality, blood pressure, and nerve impulses to muscle and tissue
sources of sodium
salt, hypertonic NaCl, soda, processed foods
causes of hypernatremia
excess sodium intake, inadequate water intake, excessive water loss, disease (diabetes, primary hyperaldosteronism)
signs and symptoms of hypernatremia
restless, thirsty, weight loss, postural hypotension, sticky mucous membranes
treatment for hypernatremia
water replacement, hypotonic saline (5% dextrose in water), no sodium in diet,
causes of hyponatremia
excess sodium loss, inadequate sodium intake, excess water gain, disease (SIADH, heart failure)
signs and symptoms of hyponatremia
irritable, apprehension, dry mucous membranes and cold and clammy, tachycardia, bounding pulse
treatment for hyponatremia
fluid restriction, small amounts of hypertonic saline (3%), drugs that block ADH e.g. Vaprisol
normal level of potassium
3.5-5.0, 98% of potassium is in cells and regulates cardiac rhythm, fluid balance, ICF osmolality
sources of potassium
potatoes, brocolli, bananas
serious low for sodium
110
what type of diuretic for hyperkalemia?
loop
causes of hyperkalemia
excess potasium, shift of potassium out of cells due to acidosis or injury, failure to eliminate potassium, RENAL FAILURE, tourniquet left on too long and shaking the vial
signs and symptoms of hyperkalemia
irritable, tummy and leg cramps, weakness of lower extremities, irregular pulse
treatment for hyperkalemia
PUT ON CARDIAC MONITOR, no potassium in diet, increase elimination through loop diuretic (Lasix) or Kayexalate (sodium polystyrene sulfonate), and force potassium from ECF to ICF through insulin and maintainence glucose, calcium gluconate to reduce cardiac dysrhythmia
what EKG change is significant with hyperkalemia?
tall peaked T wave
causes of hypokalemia
potassium loss, shift of potassium into cells (too much insulin, alkalosis, stress), decreased potassium intake
signs and symptoms of hypokalemia
fatigue, muscle weakness, leg cramps, vomiting, decreased reflexes, weak pulse, polyuria, hyperglycemia
treatment of hypokalemia
KCl supplments (IV must be diluted, not IV push, inverted several times to properly mix, never add to current hanging bag) and increase potassium in diet
what EKG change is significant with hypokalemia?
shallow T wave
normal level of calcium
8.6-10.2, transmits nerve impulses, myocardial contractions, blood clotting, formation of teeth and bone, 99% of calcium is combined with phosphorus and concentrated in skeletal system
significant amounts of calcium
12= coma 14= death
causes of hypercalcemia
too much calcium, malignancies with bone metastasis, prolonged immobilization, Vit D overdose
signs and symptoms of hypercalcemia
lethargy, decreased reflexes, decreased memory, anorexia, bone pain, polyuria, stupor, coma
treatment of hypercalcemia
excrete through urine through loop diuretic (lasix), drink 3000-4000 mL fluid/day, isotonic IV fluids, calcitonin
causes of hypocalcemia
decreased parathyroid hormone, acute pancretitis, multiple blood transfusions, alcoholism, increased phosphate, decreased Vit D
signs and symptoms of hypocalcemia
easy fatigued, numb around mouth, hyperflexia, laryngeal spasms (“eeeeee!”)
chvostek’s sign
tap facial nerve and muscles contract; indicative of hypocalcemia
trousseau’s sign
carpal spasm induced by blood pressure cuff above systolic; indicative of hypocalcemia
treatment of hypocalcemia
increased calcium and Vit D in diet, TUMS
what is the effect of phosphate on calcium
inverse relationship; high phosphate = low calcium, low phosphate = high calcium
normal phosphorus level
2.4-4.4, essential to fx of muscle, RBCs, nervous system, bone and tooth structure, ATP, glucose, metabolism of carbs, proteins, and fat
sources of phosphorus
dairy, greens, lentels
causes of hyperphosphatemia
renal failure, excess ingestion, too much Vit D, chemotherapeutic agents
signs and symptoms of hyperphosphatemia
hypocalcemia, muscle tetany, not may signs unless gets out of control
treatment of hyperphosphatemia
no dairy, hydrate, calcium supplements, phosphate-binding agents or gels
causes of hypophosphatemia
malnourished, glucose administration, alcohol withdrawal, total parenteral nutrition, phosphate-binding antacids, diabetic ketoacidosis
signs and symptoms of hypophosphatemia
decreased CNS, muscle weakness, cardiac issues, osteomalacia
treatment of hypophosphatemia
oral supplements, diet in phosphorus, IV sodium phosphate or potassium phosphate (watch for hypocalcemia)
normal magnesium level
1.5-2.5, second most abundant intracellular cation, acts directly on myoneural junction, CNS, and cardiac fx
sources of magnesium
green stuff, chocolate, milk of magnesia
causes of hypermagnesemia
increased magnesium intake, renal insufficiency/failure, too much mag sulfate
signs and symptoms of hypermagnesemia
lethargy, decreased deep tendon relflexes, decreased respirations, decreased urine
treatment for hypermagnesemia
don’t continue the mag drugs, calcium gluconate, diuretics to increase urine
causes of hypomagnesemia
prolonged fasting, starvation, chronic alcoholism, poor diabetes, prolonged parenteral nutrition
signs and symptoms of hypomagnesemia
confusion, hyperactive deep tendon relflexes, tremors, seizures, cardiac dysrhythmias
treatment for hypomagnesemia
diet in green veggies, nuts, bananas, oranges, peanut butter, IV or IM mag sulfate
how is calcium regulated?
PTH moves Ca out of bone, increases GI absorption, and tubule reabsorption, which then Vit D aids absorption of Ca from the GI tract and calcitonin is produced by the thyroid gland and inhibits PTH & Vit D ALL MUST BE PRESENT FOR HOMEOSTASIS
what do you hold when giving a corticosteroid?
salt
what do antibiotics do?
decrease Mg, dehydrate, pretty much throws all electrolytes off
who do you not give Digoxin to?
hypokalemic patients because of dysrhythmia
what should you look for with electrolytes?
cardiac monitoring, daily weights, LOC, safety, oral hygeine
what do electrolytes effect?
mobility, nutrition, elimination, cognition, perfusion, gas exchange, acid base balance
you should get what if you suspect electrolyte issues?
BMP (basal metabolic panel) or CMP (comprehensive metabolic panel)
