Chapter 40: Electrolytes Flashcards
Main Intracellular fluid (ICF) Electorlytes
Potassium (K), Phosphorus (P), Magnesium (Mg)
Calcium is less prominent
Main extracellular fluid (ECF) Electrolytes
Sodium (Na), Chlorine (Cl), Bicarb (HCO3-)
Hyponatremia clinical manifestations
Severe Hyponateremia clinical manifestations
By what mechanism?
Hypotension headache confusion apprehension edema muscle cramps weakness dry skin
Severe: muscle twitching focal weakness hemiparesis lethargy coma seizures death
mechanism is swelling of cells
severe hyponatremia = increased intracranial pressure
Hyponatremia lab level
Severe hyponatremia lab level
Serum sodium < 135
<115
Hyponatremia causes
Loss of Na Excess water intake Syndrome of inappropriate anti-diuretic hormone (SIADH) Diuretics GI suctioning Vomiting Diarrhea Excess loss from GI tract, kidneys, and skin
Hyponatremia nursing interventions
Monitor VS
Monitor I/Os and daily weights
Monitor for CNS symptoms
Monitor Na level
Hypernatremia lab level
serum sodium > 145
Hypernatremia causes
Na excess in ECF MODEL -Meds -Osmotic diuretics -Diabetes insipidus -excessive H2O loss -Low H20 intake Excess sodium intake Excess insensible water loss (hyperventilation and burns)
Hypernatremia clinical manifestations
Thirst Dry tongue Swollen dry membranes Tachycardia Bounding pulse Altered mental status
Hypokalemia lab level
Potassium < 3.5
Hypokalemia causes
K deficit in the ECF Meds (digitalis) Diuretics Increased exertion Vomiting and diarrhea GI suctioning Alkalosis? Decreased potassium intake Shift from ECF to ICF
Per Lipincott: Meds (sodium containing antibiotics, steroids, potassium wasting diuretics, adrenergics (albuterol sulfate and epi), insulin, laxatives) Chronic kidney disease w/ tubular potassium wasting Cushing syndrome Excessive GI or urinary losses Excessive licorice ingestion Hyperglycemia Primary hyperaldosteronism Prolonged potassium free IV therapy Severe serum magnesium def Trauma Hypothermia Low cal diets Dialysis Plasmapheresis
Hypernatremia nursing interventions
monitor VS monitor I/Os Daily weights Monitor/restrict sodium intake Monitor neuro changes Hypotonic IV fluids*
Hypokalemia manifestations
paresthesias arrhythmias (irregular heart beat) fatigue skeletal muscle issues decreased bowel motility nausea constipation
Hypokalemia nursing interventions
Monitor VS Monitor labs/tele Educate patient Assess Digitalis patients for risk Administer K replacement NEVER give IV push or bolus of K+
Hyperkalemia lab values
potassium > 5
Hyperkalemia causes
K excess in ECF Renal failure Acidosis Trauma Meds -oral potassium chloride -potassium sparing diuretics -ACE inhibitors -NSAIDS
Hyperkalemia clinical manifestations
muscle cramps --> weakness --> paralysis drowsiness hypotension EKG changes Cardiac arrest GI symptoms (cramping diarrhea)
Hyperkalemia nursing interventions
Monitor labs/tele D/C meds Limit potassium intake Meds -Kayexelate -IV glucose and insulin (shifts K from ECF to ICF)
What would hypotension suggest about possible electrolyte levels?
Hyponatremia
Hyperkalemia
Hypocalcemia lab values
Calcium < 8.9
Hypocalcemia causes
Ca deficit in ECF Inadequate Ca intake Impaired Ca absorption Excessive Ca loss Hypoparathyroidism
Hypocalcemia clinical manifestations
Numbness and tingling in fingers, mouth, feet Tetany: rigidity of muscles Laryngospasm Arrhythmias, tele changes Positive Chvostek's sign Positive Trousseau's sign
Hypocalcemia nursing interventions
Monitor tele Monitor airway tx underlying cause Vitamin D increases calcium absorption Oral/IV replacement
Hypercalcemia lab values
Hypercalcemia causes
calcium > 10.1
Malignant diseases
Hyperparathyroidism
Hypercalcemia clinical manifestations
Nausea, vomiting constipation Increased urination and thirst Muscle weakness Confusion and lethargy Cardiac Arrhythmias Cardiac arrest (Ca>17)
Hypercalcemia nursing interventions
Tx of underlying cause
Increasing excretion of calcium (diuretics)
Monitor vitals
Assess neuro status
Hypophosphatemia lab value
Phosphate < 2.5
Hypophosphatemia Causes
P deficit in ECF Respiratory alkalosis (hyperventilation) Diruetic uses
Hypophosphatemia Clinical Manifestations
Weakness/parasthesia Respiratory failure Irritability/confusion hypotension Chest pain
Hyperphosphatemia lab values
Phosphate > 4.5
Hyperphosphatemia causes
decreased excretion
hypoparathyroidism
Hyperphosphatemia clinical manifestations
\+ Chvosteks sign \+Trousseau's sign Confusion Tetany and muscle cramps Arrhythmias, tele
Hypomagnesia lab values
Magnesium <1.5
Hypomagnesia Causes
nasogastric suction
diarrhea
chronic alcoholism
Hypomagnesia Causes
nasogastric suction
diarrhea
chronic alcoholism
loop diuretics?
Hypomagnesia Nursing Interventions
Assess for neuro changes Seizure precautions -low stim env -pads -clustered care Oral/IV replacement Monitor vitals
Hypermagnesia lab values
Magnesium > 2.5
Hypermagnesia causes
renal dysfunction/failure
excessive magnesium intake
Hypermagnesia clinical manifestations
depressed DTRs Respiratory depression Weakness Flushing Lethargy Nausea/vomiting
Hypermagnesia nursing interventions
Tx of underlying cause Monitor tele Monitor respiratory status Fluids diuretics Dialysis if renal failure
