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NURS 205 > Electrolyte Balance & Imbalance > Flashcards

Electrolyte Balance & Imbalance Flashcards

1
Q

What is hyponatremia?

A

It’s sodium loss

Serum sodium <135 mmol/L

Considered severe at levels <125 mmol/L

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2
Q

What is the epidemiology of hyponatremia?

A

It’s the most common electrolyte abnormality in hospitalized patients

Frequently encountered in ICU & neuro units

Associated w/ increased risk of mortality

Delayed treatment or overaggressive correction can cause life-threatening complications

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3
Q

What are the causes of hyponatremia? (2)

A
  • Loss of sodium-containing fluids (Ex: GI tract, kidneys or skin)
  • Water excess (Ex: inappropriate use of sodium-free or hypotonic intravenous (IV) fluids)
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4
Q

How does hyponatremia impact osmolality?

A

Lowers plasma osmolality shifting fluid into brain cells

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5
Q

What are the clinical manifestations of hyponatremia?

A

Symptoms vary from patient to patient. It depend on how quickly the sodium level drops

Signs & symptoms primarily neurologic related to cellular swelling

Pt may complain of headache or irritability or may become disoriented. May experience muscle twitching, tremors, or weakness

Changes in level of consciousness (LOC)!

Pts will also exhibit symptoms according to whether ECF fluid volume is:

  • Abnormally decreased (hypovolemic hyponatremia) which occurs with sodium loss
    (ex: postural hypotension and tachycardia)
  • Abnormally increased (hypervolemic hyponatremia) which occurs with water gain
    (ex: hypertension)
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6
Q

How is hyponatremia treated?

A

Treatment of hyponatremia caused by water excess includes fluid restriction

Treatment of hyponatremia associated with abnormal fluid loss includes fluid replacement with sodium containing solutions

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7
Q

What is hypertonic? When should it be given?

A

It’s a saline solution.

If severe symptoms develop (e.g. seizures), small amounts of IV hypertonic saline solution (3% NaCl) may be ordered to be given

A hypertonic saline solution causes water to shift out of the cells & into the bloodstream, which may lead to intravascular volume overload and serious brain damage

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8
Q

Why does hypertonic saline need to be administered w/ caution?

A

It can cause damage to the nerve cells in the brain & you gotta monitor their blood levels continuously (pts are on ICU) as well as their neuro levels (PERLA, oriented) & vital signs, frequent blood work to see Na (increases osmolality of blood).

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9
Q

What is the safe administration of hypertonic saline (3% NaCl)?

A
  • 3% NaCl solution is THREE times more concentrated than normal saline
  • Rate of correction based on repeated assessment of clinical and laboratory data
  • There is a maximum rate
  • Must be given using an IV infusion pump
  • Central line infusion preferred
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10
Q

What is hypernatremia?

A

It’s sodium excess.

  • Serum sodium >145 mmol/L
  • May be life-threatening at levels >155 mmol/L
  • High mortality rate at levels >180 mmol/L
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11
Q

What is the epidemiology of hypernatremia?

A

Incidence of hypernatremia in hospitalized patients range from 0.3-5%

Higher prevalence seen in critically ill patients (9-26%), particularly those with neurologic conditions

Up to 1/5 of congestive heart failure patients may suffer hypernatremia due to excess diuresis

Hypernatremia due to high protein tube feedings is not uncommon in elderly, debilitated, hospitalized patients (supplementary water should be added to feeds)

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12
Q

What are the causes of hypernatremia?

A

Usually related to water deficiency, such as inadequate water supplementation or water loss (ex: associated w/ fever & heatstroke

Rarely does it represent salt excess, such as ingestion of salt or infusion of saline or hypertonic fluids

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13
Q

How does hyponatremia impact osmolality?

A

Because sodium is the major determinant of ECF osmolality, hypernatremia causes hyperosmolality

In turn, hyperosmolality > shift of water out of cells> cellular dehydration

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14
Q

How does the body normally defend against hypernatremia?

A

Body defends itself against the development of hypernatremia by increasing the release of ADH & stimulating thirst by osmoreceptors in the hypothalamus

Hypernatremia therefore occurs only in people who can’t drink voluntarily such as infants, confused patients, or immobile or unconscious patients

Hypothalamic disorders (e.g. lesion) may cause a thirst disturbance

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15
Q

What are the clinical manifestations of hypernatremia?

A

Symptoms: change in the plasma osmolality->leads to changes in the volume of cellular water->primarily neurologic

The body can tolerate a high sodium level that develops over time rather than one that occurs rapidly

Early signs & symptoms: restlessness, agitation, anorexia, nausea & vomiting

When the patient is awake, thirst is usually an early sign of hypernatremia

Patients with hypernatremia will also exhibit the symptoms according to whether ECF fluid volume is

  • Abnormally decreased (hypovolemic hypernatremia) which occurs with water loss
  • Abnormally increased (hypervolemic hypernatremia) which occurs with sodium gain
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16
Q

How is hyponatremia treated?

A

If sodium excess:
- Remove sodium by restricting sodium intake

If too little water in the body is causing hypernatremia:

  • Administer oral fluids replacement (if possible)
  • Patient may receive salt-free solutions intravenously [I.V] (such as of 5% dextrose in water) to return serum sodium levels to normal
  • If too much water is given too quickly, water moves into brain cells – they get bigger, causing cerebral edema
17
Q

What are some nursing interventions for hypernatremia? (7)

A
  • 24 hour intake and output
  • Cardiovascular changes
  • Respiratory changes
  • Neurologic changes
  • Daily weights
  • Skin assessment & care
  • Other nursing measures
18
Q

What is hypokelemia?

A

It’s low serum potassium.

Occurs when potassium drops below 3.5 mmol/L. Because the normal range is narrow, a slight decrease has profound effects

19
Q

What is the normal range of serum potassium?

A

3.5-5.0 mmol

20
Q

What is the primary route for potassium loss?

A

Kidneys

21
Q

What are the causes of hypokalemia?

A

Potassium loss

  • GI losses: diarrhea, vomiting, fistulas, NG suction
  • Renal losses: diuretics, magnesium depletion, dialysis
  • Skin losses: diaphoresis

Shift of potassium into cells

  • Increased insulin (e.g. IV dextrose load)
  • Alkalosis
  • Tissue repair
  • Stress

Lack of potassium intake

  • Diet low in potassium
  • Starvation
  • Failure to include potassium in parenteral fluids if NPO
22
Q

How do diuretics function?

A

They remove excess fluid from the body

-K wasting (loss): loop diuretics (lacix or tharocimide)

K sparing (gain): amiloride or triamterene)

23
Q

What are the clinical manifestations of hypokalemia? (8)

A

Low potassium alters resting membrane potential which causes excitability in many types of tissue

  • Most serious clinical problems = CARDIAC
  • Fatigue
  • Muscle weakness
  • Leg cramps
  • Nausea, vomiting, ileus
  • Soft, flabby muscles
  • Paresthesias, decreased reflexes
  • Weak, irregular pulse
24
Q

How is hypokalemia treated?

A

Focuses on restoring K balance, preventing serious complications & removing or treating underlying cause

Give KCl supplements/increase dietary intake of K

KCl supplements added to IV solutions should never exceed 60 mmol/L – the preferred level is 40 mmol/L

Pts should be taught methods to prevent hypokalemia depending on their individual situations

25
Q

What are some examples of potassium-rich foods?

A
  • Squash, baked potatoes (skin on)
  • Spinach
  • Lentils, kidney or navy beans
  • Broccoli, brussel sprouts, zucchini
  • Raisins
  • Watermelon, cantaloupe,
  • Orange juice, bananas
  • Low-fat milk or yogurt
26
Q

What are the guidelines for IV K administration?

A

Rate of IV administration of KCl should NOT exceed 10 mEq/hr to prevent hyperkalemia & cardiac arrest

Use infusion devices to administer potassium

Never administer by IV push or bolus

When given IV, potassium may cause pain in the area of the vein where it is entering

Potassium may also be replaced with potassium phosphate (rather than KCl)

Max 200 mEq/L in 24hrs

27
Q

What should you monitor for a pt w/ hypokalemia?

A

Cardiac rhythm

Serum potassium levels

Signs & symptoms of toxic reaction
- Severe muscle weakness, arrhythmias

Signs & symptoms of infiltration, phlebitis & tissue necrosis

Urine output; if patient is not voiding K+ will accumulate.

28
Q

What is hyperkalemia?

A

It’s high serum potassium (>5.5mmol/L)

29
Q

What are the causes of hyperkalemia?

A

Excess potassium intake

  • Excessive or rapid parenteral administration
  • Potassium-containing drugs e.g. some kinds of penicillin
  • Potassium-containing salt substitute

Shift of potassium out of cells

  • Acidosis
  • Tissue catabolism (e.g. fever, sepsis)

Failure to eliminate potassium

  • Renal disease
  • Potassium-sparing diuretics
  • Adrenal insufficiency
  • ACE inhibitors
30
Q

What are the clinical manifestations of hyperkalemia?

A

Hyperkalemia causes membrane depolarization, altering cell excitability

  • Irritability/anxiety
  • Abdominal cramping, diarrhea
  • Weakness of lower extremities
  • Paresthesia (tingling/burning sensation)
  • Irregular pulse
  • Cardiac standstill if hyperkalemia sudden or severe
31
Q

How can you treat hyperkalemia? (4)

A

Eliminate oral & IV potassium intake

Increase elimination of potassium (see next slide)

Force potassium from the ECF to ICF (see slide after next)

Reverse the membrane effects of the elevated ECF potassium by administering calcium gluconate IV (it immediately reverses the effect of the depolarization on cell excitability)

32
Q

How can you increase elimination of K? (4)

A

Diuretics

Dialysis

Use of ion-exchange resins such as sodium polystyrene sulfonate (Kayexalate)

Increase fluid intake

Force potassium from the ECF to ICF
- Administration of IV insulin
(along with glucose so the client does not become hypoglycemic)
- Administration of IV sodium bicarbonate in the correction of acidosis
(alkalosis causes potassium to move from the ECF to ICF)

33
Q

True or false: Fluid & electrolyte imbalances often occur concurrently

A

True

34
Q

True or false: Many diseases & their treatments could affect fluid & electrolyte balance

A

True

NURS 205 (12 decks)

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