Chapter 17 Electrolytes: Med Surg

Question 1

normal level of sodium

Answer 1

135-145, regulates osmolality, blood pressure, and nerve impulses to muscle and tissue

Question 2

sources of sodium

Answer 2

salt, hypertonic NaCl, soda, processed foods

Question 3

causes of hypernatremia

Answer 3

excess sodium intake, inadequate water intake, excessive water loss, disease (diabetes, primary hyperaldosteronism)

Question 4

signs and symptoms of hypernatremia

Answer 4

restless, thirsty, weight loss, postural hypotension, sticky mucous membranes

Question 5

treatment for hypernatremia

Answer 5

water replacement, hypotonic saline (5% dextrose in water), no sodium in diet,

Question 6

causes of hyponatremia

Answer 6

excess sodium loss, inadequate sodium intake, excess water gain, disease (SIADH, heart failure)

Question 7

signs and symptoms of hyponatremia

Answer 7

irritable, apprehension, dry mucous membranes and cold and clammy, tachycardia, bounding pulse

Question 8

treatment for hyponatremia

Answer 8

fluid restriction, small amounts of hypertonic saline (3%), drugs that block ADH e.g. Vaprisol

Question 9

normal level of potassium

Answer 9

3.5-5.0, 98% of potassium is in cells and regulates cardiac rhythm, fluid balance, ICF osmolality

Question 10

sources of potassium

Answer 10

potatoes, brocolli, bananas

Question 11

serious low for sodium

Answer 11

110

Question 12

what type of diuretic for hyperkalemia?

Answer 12

loop

Question 13

causes of hyperkalemia

Answer 13

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

Question 14

signs and symptoms of hyperkalemia

Answer 14

irritable, tummy and leg cramps, weakness of lower extremities, irregular pulse

Question 15

treatment for hyperkalemia

Answer 15

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

Question 16

what EKG change is significant with hyperkalemia?

Answer 16

tall peaked T wave

Question 17

causes of hypokalemia

Answer 17

potassium loss, shift of potassium into cells (too much insulin, alkalosis, stress), decreased potassium intake

Question 18

signs and symptoms of hypokalemia

Answer 18

fatigue, muscle weakness, leg cramps, vomiting, decreased reflexes, weak pulse, polyuria, hyperglycemia

Question 19

treatment of hypokalemia

Answer 19

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

Question 20

what EKG change is significant with hypokalemia?

Answer 20

shallow T wave

Question 21

normal level of calcium

Answer 21

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

Question 22

significant amounts of calcium

Answer 22

12= coma 14= death

Question 23

causes of hypercalcemia

Answer 23

too much calcium, malignancies with bone metastasis, prolonged immobilization, Vit D overdose

Question 24

signs and symptoms of hypercalcemia

Answer 24

lethargy, decreased reflexes, decreased memory, anorexia, bone pain, polyuria, stupor, coma

Question 25

treatment of hypercalcemia

Answer 25

excrete through urine through loop diuretic (lasix), drink 3000-4000 mL fluid/day, isotonic IV fluids, calcitonin

Question 26

causes of hypocalcemia

Answer 26

decreased parathyroid hormone, acute pancretitis, multiple blood transfusions, alcoholism, increased phosphate, decreased Vit D

Question 27

signs and symptoms of hypocalcemia

Answer 27

easy fatigued, numb around mouth, hyperflexia, laryngeal spasms ("eeeeee!")

Question 28

chvostek's sign

Answer 28

tap facial nerve and muscles contract; indicative of hypocalcemia

Question 29

trousseau's sign

Answer 29

carpal spasm induced by blood pressure cuff above systolic; indicative of hypocalcemia

Question 30

treatment of hypocalcemia

Answer 30

increased calcium and Vit D in diet, TUMS

Question 31

what is the effect of phosphate on calcium

Answer 31

inverse relationship; high phosphate = low calcium, low phosphate = high calcium

Question 32

normal phosphorus level

Answer 32

2.4-4.4, essential to fx of muscle, RBCs, nervous system, bone and tooth structure, ATP, glucose, metabolism of carbs, proteins, and fat

Question 33

sources of phosphorus

Answer 33

dairy, greens, lentels

Question 34

causes of hyperphosphatemia

Answer 34

renal failure, excess ingestion, too much Vit D, chemotherapeutic agents

Question 35

signs and symptoms of hyperphosphatemia

Answer 35

hypocalcemia, muscle tetany, not may signs unless gets out of control

Question 36

treatment of hyperphosphatemia

Answer 36

no dairy, hydrate, calcium supplements, phosphate-binding agents or gels

Question 37

causes of hypophosphatemia

Answer 37

malnourished, glucose administration, alcohol withdrawal, total parenteral nutrition, phosphate-binding antacids, diabetic ketoacidosis

Question 38

signs and symptoms of hypophosphatemia

Answer 38

decreased CNS, muscle weakness, cardiac issues, osteomalacia

Question 39

treatment of hypophosphatemia

Answer 39

oral supplements, diet in phosphorus, IV sodium phosphate or potassium phosphate (watch for hypocalcemia)

Question 40

normal magnesium level

Answer 40

1.5-2.5, second most abundant intracellular cation, acts directly on myoneural junction, CNS, and cardiac fx

Question 41

sources of magnesium

Answer 41

green stuff, chocolate, milk of magnesia

Question 42

causes of hypermagnesemia

Answer 42

increased magnesium intake, renal insufficiency/failure, too much mag sulfate

Question 43

signs and symptoms of hypermagnesemia

Answer 43

lethargy, decreased deep tendon relflexes, decreased respirations, decreased urine

Question 44

treatment for hypermagnesemia

Answer 44

don't continue the mag drugs, calcium gluconate, diuretics to increase urine

Question 45

causes of hypomagnesemia

Answer 45

prolonged fasting, starvation, chronic alcoholism, poor diabetes, prolonged parenteral nutrition

Question 46

signs and symptoms of hypomagnesemia

Answer 46

confusion, hyperactive deep tendon relflexes, tremors, seizures, cardiac dysrhythmias

Question 47

treatment for hypomagnesemia

Answer 47

diet in green veggies, nuts, bananas, oranges, peanut butter, IV or IM mag sulfate

Question 48

how is calcium regulated?

Answer 48

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

Question 49

what do you hold when giving a corticosteroid?

Answer 49

salt

Question 50

what do antibiotics do?

Answer 50

decrease Mg, dehydrate, pretty much throws all electrolytes off

Question 51

who do you not give Digoxin to?

Answer 51

hypokalemic patients because of dysrhythmia

Question 52

what should you look for with electrolytes?

Answer 52

cardiac monitoring, daily weights, LOC, safety, oral hygeine

Question 53

what do electrolytes effect?

Answer 53

mobility, nutrition, elimination, cognition, perfusion, gas exchange, acid base balance

Question 54

you should get what if you suspect electrolyte issues?

Answer 54

BMP (basal metabolic panel) or CMP (comprehensive metabolic panel)