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Nurs 186 > Electrolyte Cocepts > Flashcards

Electrolyte Cocepts Flashcards

1
Q

ADH

A
  • water only

- helps regulate water in response to serum osmolarity(sodium) levels

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2
Q

Aldosterone

A

Helps retain sodium and water

-down effect is that aldosterone pushes out potassium

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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
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4
Q

How do we get sodium

A

Sports drinks
Cheese
Canned foods
Processed meats

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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
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6
Q

Na less than 115-120

A

Anorexia and nausea

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7
Q

Sodium less than 110

A

Stupor,delirium,ataxia

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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
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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
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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
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11
Q

With both hypo/hypervolemic hyponatremia monitor…

A
  • daily weight
  • I&O
  • muscle strength
  • monitor labs(aim for 25meq/L per 48hours)
  • neurochecks
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12
Q

Hypernatremia>145

A
  • most often seen with dehydration
  • diabetes insipidus
  • pulmonary infections
  • decreased water intake
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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
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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
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15
Q

Potassium (K+)

A
  • 3.5-5 mEq/L
  • assists in muscle contraction
  • affects cardiac tissue responsiveness
  • affects acid base imbalance
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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

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17
Q

Aldosterone and potassium

A
  • potassium is affected by aldosterone because it causes excretion of potassium
  • also affected by age,kidney function,
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18
Q

Sources of potassium

A
  • chocolate
  • meat and potatoes
  • bananas and oranges
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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
Q

Hyperkalemia>5

A
  • kindness problems
  • blood draw can effect
  • K+ sparing diuretics
  • chemo or trauma
  • blood transfusions have a lot of broken cells
26
Q

S/S of hyperkalemia

A
  • muscle weakness
  • leg weakness
  • arrhythmias
  • nausea, abdominal cramping, diarrhea
  • peaked T waves on ECG
27
Q

Common S/S of potassium imbalances

A
  • muscle weakness
  • leg weakness
  • arrhythmias
28
Q

Lowering the levels of potassium

A
  • 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
Q

For extreme hyperkalemia>7

A
  • 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
Q

Calcium(Ca+)

A
  • 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
Q

Albumin and calcium

A

Calcium levels are affected by albumin

32
Q

Calcium regulation

A
  • 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
Q

How much Valium do we need

A
  • 800-1200 daily
  • kids 9-18 1300mg
  • women>50 1200 mg
  • men>50 1000mg
  • DO NOT EXCEED 4000 mg daily
34
Q

Sources of calcium

A
  • dairy products
  • green leafy vegetables
  • whole grain
  • sardines
  • nuts
35
Q

Hypocalcemia

A
  • 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
Q

S/S of hypocalcemia

A
  • 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
Q

Chronic hypocalcemia management

A
  • 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
Q

Acute hypocalcemia management

A
  • give IV calcium
  • calcium chloride is stronger than Gluconate
  • calcium is a vesicant(monitor IV site,monitor EKG for arrhythmias while recieving Ca)
39
Q

Hypercalcium>10 mg/dL

A
  • 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
Q

S/S of acute hypocalcemia

A
  • fatigue,confusion,AMS
  • decreased DTR
  • bradycardia
  • constipation
41
Q

S/S of chronic hypercalcemia

A
  • bone pain
  • pathological FX: happens with very little tension
  • kidney stones
  • DVT’s: Ca helps blood clotting, excess Ca may lead to clots
42
Q

Hypercalcemia management

A
  • decrease Ca intake for mild problems
  • push fluids to dilute and excrete Ca+
  • loop diuretics as prescribed
  • biphosphate
  • handle gently to prevent FX
43
Q

Magnesium

A
  • 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
Q

Calcium and magnesium are buddies

A

Magnesium is needed to produce PTH, and PTH affects calcium

45
Q

How much do magnesium do we need Per day

A
  • 350 milligrams per day

- dark chocolate, nuts,green leafy vegetables

46
Q

Hypomagnesium

A
  • alcohol abuse highest population of hypomagnesium: causes kidneys to over excrete Mg
  • poor intake
  • poor absorption
  • diarrhea/laxative abuse

Nurs 186 (12 decks)

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