chronic exam 1-electrolyte imbalance

Question 1

etiology/risk factors for electrolyte imbalance

Answer 1

Decreased intake and availability or increase loss of an electrolyte
Increase intake and retention or decreased excretion of an electrolyte

Question 2

diagnosis of imbalance

Answer 2

Through plasma levels in lab studies

Through clinical manifestations (signs and symptoms)

Question 3

hyponatremia

Answer 3

sodium

Question 4

etiology/risk factors for hyponatremia

Answer 4

Results from loss of sodium containing fluids (vomiting, diarrhea, diuretics)
Or excess fluids

Question 5

clinical manifestations hyponatremia

Answer 5

confusion
nausea
seizures
coma

Question 6

nursing diagnosis: hyponatremia

Answer 6

risk for injury

potential complication

Question 7

nursing management: hyponatremia

Answer 7

for water excess causation: fluid restriction
Severe symptoms (seizures): give a small amount of IV hypertonic saline solution (3-5% NaCl)
treat underlying cause

Question 8

hypernatremia

Answer 8

Na+ >145 mEq/L

Question 9

pathophysiology: hypernatremia

Answer 9

Fluid shift causing cellular dehydration

B. Increase myocardial depolarization (increased excitability of heart muscle)

Question 10

clinical manifestations: hypernatremia

Answer 10

thirst
Dry flushed skin
Dry tongue and mucous membranes
Polyuria, anorexia, weakness, and restlessness 
cramping
\_\_\_\_\_\_\_\_\_

Agitation, confusion, lethargy
Seizures, coma
Tremors, muscle twitching, rigid paralysis
ataxia

Question 11

nursing diagnosis:hypernatremia

Answer 11

potential complication, seizures and coma leading to irreversible brain damage

Question 12

nursing management: hypernatremia

Answer 12

If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline (0.45)
Diuretics

Question 13

Hypokalemia

Answer 13

K+

Question 14

etiology/risk factors: hypokalemia

Answer 14

Low serum potassium caused by metabolic acidosis, abnormal losses of K+ via the kidneys or GI tract (Vomiting, Diarrhea, Diuretics)
i. K+ sparing (conserve K+)
ii. Thiazide (hydrochlorothiazide HCTZ)
iii. Loop diuretics (strongest, Lasix (furosemide))
Metabolic alkalosis

Question 15

clinical manifestations: hypokalemia

Answer 15

most serious are cardiac
Lose nervous impulse
•	Skeletal muscle weakness
•	Weakness of respiratory muscles
•	Decreased GI motility

Question 16

nursing diagnosis: hypokalemia

Answer 16

risk for injury

potential complications: dysrhythmias

Question 17

nursing management: hypokalemia

Answer 17

KCL Supplements orally (Give with food or diluted (PO/IV) to minimize venous or gastric irritation)
KCL Supplements IV (Should not exceed 10 to 20 mEq/hr to prevent hyperkalemia and cardiac arrest)

Question 18

hyperkalemia

Answer 18

K+ > 5.0 mEq/L

Question 19

etiology/causes: hyperkalemia

Answer 19

Massive intake
Impaired renal excretion
Shift from ICF to ECF
Common in massive cell destruction (Burn, crush injury, or tumor lysis)

Question 20

clinical manifestations: hyperkalemia

Answer 20

Weak or paralyzed skeletal muscles
Ventricular fibrillation or cardiac standstill
Abdominal cramping or diarrhea

Question 21

nursing diagnosis: hyperkalemia

Answer 21

dysrhythmias

Question 22

nursing management: hyperkalemia

Answer 22

Eliminate oral and parenteral K+ intake

Increase elimination of K+ (diuretics, dialysis, Kayexalate oral or as enema)

Question 23

hypocalcemia

Answer 23

Ca++

Question 24

etiology: hypocalcemia

Answer 24

Decreased production of PTH
Acute pancreatitis
Multiple blood transfusions
Alkalosis
Decreased intake

Question 25

clinical manifestations: hypocalcemia

Answer 25

Positive Trousseau’s or Chvostek’s sign Laryngeal stridor Dysphagia Tingling around the mouth or in the extremities (paresthesias)

Question 26

nursing diagnosis: hypocalcemia

Answer 26

Potential complication: fracture or respiratory arrest, bleeding, tetany

Question 27

nursing management: hypocalcemia

Answer 27

Treat underlying cause Oral or IV calcium supplements (Not IM to avoid local reactions) Treat pain and anxiety to prevent hyperventilation-induced respiratory

Question 28

hypercalcemia

Answer 28

Ca++ >10.5-11 mg/dL

Question 29

etiology: hypercalcemia

Answer 29

Hyperparathyroidism (2/3 of cases) Malignancy of the bone Vitamin D overdose (helps absorb calcium in the intestine) Prolonged immobilization

Question 30

clinical manifestations: hypercalcemia

Answer 30

Urinary (Polyuria r/t osmotic diuresis) GI (Anorexia, constipation, abdominal distention0 Neuromuscular (Fatigue, depression, muscle weakness)

Question 31

nursing diagnosis: hypercalcemia

Answer 31

dysrhythmias

Question 32

nursing management: hypercalcemia

Answer 32

Excretion of C2+ with loop diuretic Hydration with isotonic saline infusion Synthetic calcitonin Mobilization/Weight-bearing activity

Question 33

phosphate

Answer 33

Lab value (normal) 2.5-4.5mg/dl Primary anion in ICF Essential to function of muscle, red blood cells, and nervous system Deposited with calcium for bone and tooth structure Inversely related to calcium Inverse relationship to K+

Question 34

hypomagnesemia

Answer 34

Mg++

Question 35

clinical manifestations:

Answer 35

``` Confusion Hyperactive deep tendon reflexes Tremors Seizures Cardiac dysrhythmias ```

Question 36

nursing management: hypomagnesemia

Answer 36

Oral supplements Increase dietary intake Parenteral IV or IM magnesium when severe

Question 37

hypermagnesemia

Answer 37

mg++ >2.5 mEq/L or 3mg/dL

Question 38

etiology: hypermagnesemia

Answer 38

Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present

Question 39

clinical manifestations:

Answer 39

Lethargy or drowsiness Nausea/vomiting Impaired reflexes Respiratory and cardiac arrest