Electrolyte Cocepts Flashcards
1
Q
ADH
A
- water only
- helps regulate water in response to serum osmolarity(sodium) levels
2
Q
Aldosterone
A
Helps retain sodium and water
-down effect is that aldosterone pushes out potassium
3
Q
How much sodium do we need per day
A
- 0.5-2.7 grams/day
- African American/hypertensive 1.5g/day
- average in US 6g/day
4
Q
How do we get sodium
A
Sports drinks
Cheese
Canned foods
Processed meats
5
Q
Hyponatremia
A
depletional(hypovolemia): water and Na loss
- dilutional(hypervolemia,isovolemia) too much water Na diluted
- SIADH: heart failure stimulates aldosterone and eventually saves more water than sodium
6
Q
Na less than 115-120
A
Anorexia and nausea
7
Q
Sodium less than 110
A
Stupor,delirium,ataxia
8
Q
What does hyponatremia look like?
A
- Neurological changes may lead to cerebral edema
- depends on speed of development
- watch when Na falls to 125
9
Q
Hypovolemic hyponatremia
A
- orthostatic hypotension
- poor skin turgor
- weak thready pulse
- tachycardia
- weight loss
- give hypertonic or isotonic IV solutions and offer salty foods
10
Q
Hypervolemic hyponatremia
A
- elevated BP,HR
- bounding pulse
- edema
- weight gain
- restrict fluids especially free fluids(water,apple juice,coffe,tea)
- if SIADH use lithium
- may use diuretics that excrete water but hold on to sodium
11
Q
With both hypo/hypervolemic hyponatremia monitor…
A
- daily weight
- I&O
- muscle strength
- monitor labs(aim for 25meq/L per 48hours)
- neurochecks
12
Q
Hypernatremia>145
A
- most often seen with dehydration
- diabetes insipidus
- pulmonary infections
- decreased water intake
13
Q
S/S of hypernatremia
A
- neurochanges(may be hard to hold attention)
- muscle irritability, then to progressive weakness
- restlessness
- VS reflect hypovolemia
- thirst
- serum osmolarity>300
14
Q
Hypernatremia management
A
- gradual correction to prevent cerebral edema
- expect hypotonic IV fluids
- supply water
- sodium restriction
- daily weights
- I&O
- oral care
15
Q
Potassium (K+)
A
- 3.5-5 mEq/L
- assists in muscle contraction
- affects cardiac tissue responsiveness
- affects acid base imbalance
16
Q
How much potassium per day
A
- people need 40 mEq/L per day
- body does not conserve potassium so it is important to take it in everyday
17
Q
Aldosterone and potassium
A
- potassium is affected by aldosterone because it causes excretion of potassium
- also affected by age,kidney function,
18
Q
Sources of potassium
A
- chocolate
- meat and potatoes
- bananas and oranges
19
Q
Hypokalemia
A
- diuretics(especially Lasix and hctz)
- GI fluid loss:diarrhea
- steroids(anti inflammatory) loss from kidneys
- insulin
- alkalosis(K shifts into cells)
20
Q
Hypokalemia indicators
A
- muscle weakness:hand
- arrhythmias
- leg weakness
- constipation
- access respiratory status
- may give PO potassium supplements
21
Q
Hypokalemia on ECG
A
Flattened or inverted T wave
22
Q
When giving potassium
A
- know the patients K level
- take with adequate water
- monitor urine output
- don’t forget food sources of K
23
Q
Potassium IV
A
- it is a vesicant
- comes in liter bags with 20 or 40 mEq/L
- KCL riders
- infuse no faster than 10 mEq/L
- monitor ECG with telemetry
- NEVER give potassium IV push: a bolus may cause cardiac arrest
24
Q
Sodium
A
- 135-145 mEq/L
- transmits nerve pulses in nerve and muscle fibers
- loves mostly outside of cells thanks to Na-K pump
- sodium imbalances often reflect hydration problems
25
Hyperkalemia>5
- kindness problems
- blood draw can effect
- K+ sparing diuretics
- chemo or trauma
- blood transfusions have a lot of broken cells
26
S/S of hyperkalemia
- muscle weakness
- leg weakness
- arrhythmias
- nausea, abdominal cramping, diarrhea
- peaked T waves on ECG
27
Common S/S of potassium imbalances
- muscle weakness
- leg weakness
- arrhythmias
28
Lowering the levels of potassium
- restrict K in diet(salt sub)
- eat processed foods(less K+)
- adjust meds
- use diuretics(not K sparing)
- kayexalate PO or rectally: gets into bowels draws K+ to itself and pushes it out in stool
- dialysis
29
For extreme hyperkalemia>7
- use of bicarbonate if acidosis is the problem(shifts potassium into cells)
- calcium IV: helps minimize the effects on the heart and maintain normal rhythm
- insulin and glucose: insulin pushes K back into cells, glucose to counter the insulin effects
30
Calcium(Ca+)
- 8-10 mg/dL
- stored in bones/teeth(99%)
- calcium acts as a cellular membrane stabilizer(calms and slows depolarization)
- needed for effective heart contraction
- needed for blood coagulation
- calcium is a relaxer
31
Albumin and calcium
Calcium levels are affected by albumin
32
Calcium regulation
- parathyroid hormone
- PTH increases blood calcium levels(increases Ca absorption)
- calcitonin decreases blood calcium levels(tones down calcium absorption)
- Vitamin D is needed for absorption of calcium
33
How much Valium do we need
- 800-1200 daily
- kids 9-18 1300mg
- women>50 1200 mg
- men>50 1000mg
- DO NOT EXCEED 4000 mg daily
34
Sources of calcium
- dairy products
- green leafy vegetables
- whole grain
- sardines
- nuts
35
Hypocalcemia
- malnutrition
- malabsorption
- hypothyroidism(naturally or surgically) if parathyroid gland isn't working correctly then no PTH
- if natural stoppage can use calcium supplements
- renal disease: can't absorb Ca, cannot activate vitamin D
- loop diuretics
- lack of Mg: effects balance of Ca, helps to control PTH
36
S/S of hypocalcemia
- cramping in legs
- paresthesias
- DTR increases
- cardiac arrhythmias V-tach
- weak pulse
- trausseaus and chvksteks sign
- calcium is a calming agent if there is a decrease it causes excitability
37
Chronic hypocalcemia management
- give PO W/vitamin D
- calcium carbonate should be taken with food(citrate with or without food)
- encourage weight bearing exercise
- provide safe environment
- reorient if concussed
- teach S/S
38
Acute hypocalcemia management
- give IV calcium
- calcium chloride is stronger than Gluconate
- calcium is a vesicant(monitor IV site,monitor EKG for arrhythmias while recieving Ca)
39
Hypercalcium>10 mg/dL
- hyperthyroidism raises PTH levels increase Ca(most common cause)
- cancer: lung and breast release antigen that mimics PTH
- excessive use of vitamin D or calcium based anti acids
- prolonged immobilization
40
S/S of acute hypocalcemia
- fatigue,confusion,AMS
- decreased DTR
- bradycardia
- constipation
41
S/S of chronic hypercalcemia
- bone pain
- pathological FX: happens with very little tension
- kidney stones
- DVT's: Ca helps blood clotting, excess Ca may lead to clots
42
Hypercalcemia management
- decrease Ca intake for mild problems
- push fluids to dilute and excrete Ca+
- loop diuretics as prescribed
- biphosphate
- handle gently to prevent FX
43
Magnesium
- 1.5-2.5 mEq/L
- affected by albumin levels
- helps maintain Na-K pump
- produces Vasodilation
- membranes stabilizer: contractility of cardiac and skeletal muscle
44
Calcium and magnesium are buddies
Magnesium is needed to produce PTH, and PTH affects calcium
45
How much do magnesium do we need Per day
- 350 milligrams per day
| - dark chocolate, nuts,green leafy vegetables
46
Hypomagnesium
- alcohol abuse highest population of hypomagnesium: causes kidneys to over excrete Mg
- poor intake
- poor absorption
- diarrhea/laxative abuse
