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Med Surg 1 > Electrolyte Disturbances (Online Lecture) > Flashcards

Electrolyte Disturbances (Online Lecture) Flashcards

1
Q

calcium is ECF, ICF or both

A

both

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2
Q

where is majority of calcium located

A

bones and teeth

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3
Q

role of calcium

A

neuromuscular function, heart muscle depolarization, and contraction, coagulation and bone and teeth development

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4
Q

calcium is regulated by

A

PTH and calcitonin

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5
Q

what occurs when low levels of ionized calcium

A

increase PTH
- increase absorption from GI
- Increased released of CA by bones
- Increase reabsorption of CA by kidneys

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6
Q

what occurs when high levels of ionized calcium

A

decrease PTH
Calcitonin secreted
- bones reabsorb more calcium
- more calcium to be excreted via kidney
- less calcium to be absorbed via GI tract

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7
Q

what should we consider Ca levels with

A

albumin
- low ablumin = low ca

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8
Q

symptoms for hypocal are the same as

A

hypomag

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9
Q

causes of hypocal
hypoparathyroidism

A

para thy regulates levels

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10
Q

causes of hypocal
malabsorption (gastric bypass)

A

receive ca from GI

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11
Q

causes of hypocal
massive transfusion of citrated blood

A

citrate is added to packed RBC which binds to Ca and prevents blood from clotting

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12
Q

causes of hypocal
renal failure

A

kidneys regulate

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13
Q

causes of hypocal
medications

A

aluminum antacids
phosphates
loop diuretics
aminoglycosides
steroids
chemo

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14
Q

causes of hypocal
vit d deficiencies

A

necessary for absorption of ca

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15
Q

causes of hypocal

A

hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications, vit d deficiencies, peritonitis, chronic diarrhea, decreased PTH, alcoholism, radical neck dissection

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16
Q

manifestations of hypocal

A

hyperactive DTRs (deep tendon reflexes, trousseau sign, chvostek, seizures (very severe), abnormal clotting, prolonged QT, anxiety, irritability, pulmonary cardiopulmonary arrest

tetany, circumoral numbness, parestehias, dyspnea, laryngospasms

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17
Q

chvostek

A

twitching of facial nerve

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18
Q

trousseau

A

blood pressure cuff on upper arm and carpal spasm will occur

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19
Q

what other lyte should we check when we suspect hypocal

A

mag (usually hypomag)

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20
Q

hypocal key manifestation

A

increase neuromuscular excitability

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21
Q

medical management of hypocal
IV cal gluconate

A

IV push is life threatening, push slow
piggyback over an hour

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22
Q

medical management of hypocal

A

IV cal gluconate, calcium and vitamin D supplements, diet

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23
Q

why do we need to give vit d supplement as well

A

vit d is neccesary for cal absorption

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24
Q

nursing management hypocal

A

hypocalcemia is life threatening, weight bearing exercises

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25
hypocal level
8.6
26
cal normal level
8.6-10.2
27
hypercal level
10.2
28
hypercal main manifestation
decrease neuromuscular excitability
29
causes of hypercal
malignancy (bone cancer), hyperparathyroid, bone loss related to immobility, over use of Ca supplements, acidosis, cortisone therapy, thiazide diuretics, digoxin toxicity, excessive PTH
30
manifestations of hypercal
muscle weakness, incorrdination, constipation, abdominal and bone pain, ECG changes, dysrhythmias, heart block, arrest, bronchospasm, depression, lethargy, coma anorexia, nausea, vomiting, polyuria, thirst
31
medical management hypercal
treat underlying cause, fluids, furosemide (loops), phosphates, calcitonin (emergency). biphosphonates
32
nursing management hypercal
hypercalcemic crisis has high mortality, fluids 3-4L/d, fiber for constipation, ensure safety
33
normal mag levels
1.3-2.3
34
hypercal presents the same as
hypermag
35
hypomag level
1.3
36
causes of hypomag
alcoholism, GI losses (NG on suction, diarrhea, fistula), enteral or parental feeding deficient in mag, medications (diuretics), rapid administration of citrated blood, diabetic ketoacidosis, sepsis, burns, hypothermia
37
manifestations of hypomag
neuromuscular irritability, ecg changes
38
medical management of hypomag
diet, oral mag, magnesium sulfate IV (severe, piggyback)
39
nursing management hypomag
ensure safety, patient teaching related to diet, alcohol use, IV care
40
hypomag is normally accompanied by
hypocal
41
what is common in hypomag patients
dysphagia
42
hypermag level
2.3
43
hypermag main manifesation
decrease neuromuscular excitability
44
causes of hypermag
renal failure, DKA, excessive administration of mag, excessive use of antacids
45
manifestations of hypermag
lowered BP, muscle weakness, depressed resps, ecg changes
46
medical management of hypermag
IV calcium gluconate, loop diuretics, IV NS or RL, hemodyalisis
47
nursing management of hypermag
patient teaching regarding mag containing OTC meds
48
normal K level
3.5-5
49
K ICF or ECF or both
ICF
50
balance of K depends on
aldosterone and GFR and bowel
51
how does diabetic ketoacidosis affect K
K pushes put of of cell and treatment will push it back into cell
52
main role of K
conduction of myocardial cells
53
hypoK level
3.5
54
causes of hypoK
GI losses (severe diarrhea, vomiting, NG tube on suction), medications (loop diuretics, steroids, insulin, antibiotics, alterations of acid - base, alkalosis (serum K pushing into cell), hyperaldosterone, poor diet intake, starvation, diuretics, dig tox
55
what other lab value do we look at for hypoK
BUN and creatine (kidney function is crucial for excretion of K)
56
manifestations of hypoK
dysrhythmias, Flat T waves or U wave, muscle weakness, decreased responsiveness, tornadoes, vfib, hypotension fatigue, N/V, paresthesias, decreased muscle strength, DTR
57
medical management HypoK
increase diet potassium (orange juice, melon, banana, citrus fruit, meat, milk) K replacement, IV for severe deficit
58
nursing management hypok
monitor ECG and ABG (alkalosis may cause), diet potassium, IV care
59
IV potassium
must be given slowly through IV (60 mins) NEVER GIVE IV PUSH
60
hyperK level
5
61
causes of hyperK usually treatment related
too aggressive with hypoK treatment
62
causes of hyperK impaired renal function
kidneys are the main way of removing K - elderly - hemodialysis
63
causes of hyperK tissue trauma / crush/ burns
cells release potassium into blood
64
causes of hyperK metabolic acidosis
K leaves cells to allow hydrogen to go in
65
causes of hyperK stored PRBC
pt recieving blood transfusion if that blood has been stored for longer, when blood sits increase in K as compared to fresh blood
66
causes of hyperK
treatment, renal function, hyperaldosterone, tissue trauma, crush injury, burns, metabolic acidosis, stored PRBC, ace and NSAIDs
67
manifestations of hyperK
cardiac changes and dysrhythmias (tachy to Brady to asystole) peaked T waves, wide QRS muscle weakness, parenthesis, GI mainifestaions
68
medical management
monitor ECG, cation exchange resin (Kayexalate or Lokelma), B 2 agonists, dialysis, cocktail
69
Cocktail/shifter reason
used to temporarily shift K into cell, buys time for kayexalate and lokelam to work
70
cocktail/shifter ingredients
IV AMP push sodium bicarb (shift) AMP calcium gluconate (neutralizer) 10 units regular insulin IV push (shift) AMP D50/hypertonic dextrose (shift) follow with kayexalate, lokelma and dialysis (remover)
71
katexalate vs lokelma
Kay: exchange potassium in bowel and cause severe diarrhea Lok: does not cause diarrhea
72
nursing management
frequent electrolyte monitoring assess VS, CV, and near closely accurate I and O - foley maintain safety patient/family teaching
73
CBIGKID
calcium gluconate IV push Bicarb Glucose/Amp D50 Katexalate insulin 10 unit Iv push dialysis Lokelam
74
sodium normal
135-145
75
sodium role
neuromuscular function, water balance, cellular depolarization, acid base
76
sodium ICF, ECF, both
ECF
77
a gain or loss in sodium normally results in
gain or loss of water
78
sodium imbalances main manifestation
neuro issues
79
what systems help regulate sodium
kidneys, ADH, thirst, RAAS
80
hyponat level
135
81
what other labs to look at for hyponat
serum osmo: less than 280= dilute urine specific gravity: less than 1.010
82
what occurs because of hyponat
ecf becomes diluted, intracellular swelling because there is less ECF osmolality
83
what do symptoms of hyponat depend on
how rapid sodium change is
84
clinical effects of hyponat
neurological changes mild: N/V, irratibility, disorientation severe: stupor, comatose, seizures poor skin turgor, dry mucosa, rapid pulse, decrease BP
85
medical management of hyponat
water restriction sodium replacement mild: salt tabs, isotonic solution, high sodium foods less than 120: ICU, hypertonic saline
86
nursing management of hyponat
neuro status, I and O, patient safety, medications, lab studies
87
hypernat level
145
88
what occurs during hypernat
ECF becomes concentrated and fluid moves out of cell causing cell shrinkage
89
symptoms of hypernat are very similar to
fluid volume def - which commonalty causes hypernat
90
we see hypernat in patients who cannot regulate thirst / respond and communicate to thirst, examples of this patient
comatose unconscious dementia elderly
91
clinical effects of hypernat
neurologic symptoms weakness, lethargy, confusion as it gets worse: stupor, seizures, coma, twitching, tremor thirst, elevated temp, dry swollen tongue, restlessness, weakness
92
medical management hypernat
hypotonic electrolyte, D5W
93
some causes of hypernat
tube feeding with no free water, heat stroke, drowning in salt water
94
nursing management for hypernat
neuro status OTC sources of sodium, fluids, VS, HR, I and O
95

Med Surg 1 (47 decks)

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