Electrolyte Imbalance Flashcards
Na+ - Big Deal
CNS Involvement
- if someone is hyper or hypo with sodium it will be seen in the CNS
Na+
Normal Range: 136-145 mEq/L
- main determinant of ECF osmolality
- generates and transmits impulses in nerve and muscle fibers
- kidneys are primary regulatory
- lost through GI and sweat
- diffusion and active transport via Na-K pump
Causes of Hyponatremia
Na+ loss from: diarrhea, emesis, fistulas, NG suctioning, diuretics, adrenal insufficiency, Na+ wasting from kidneys, burns, wound drainage, medications that act directly on kidneys
Inadequate intake (depletional): fasting diets, NPO
Excessive water gain (dilutional): excessive hypotonic IV solutions, polydipsia, SIADH, heart failure, hypoaldosteronism, tap water enemas
Hyponatremia S/Sx
Vital signs: hypotension/orthostatic hypotension, tachycardia, bradypnea, O2 sat decrease with bradypnea, temp is WNL
CV: w/hypovolemia = tachycardia, weak pulse; w/hypervolemia = bounding pulse, normal to elevated BP
GI: anorexia, n/v, abdominal cramping, hyperactive BS (diarrhea)
Neuro: weakness, decreased DTR’s, muscle spasms or cramps, twitching
Renal: urinary retention
Respiratory: hypoventilation
Cerebral: lethargy, fatigue, HA, irritability, confusion, restlessness, decreased LOC, hallucinations, seizures, coma, brain herniation
Hyponatremia - Important Interventions
- neuro checks
- LOC
- fall precautions
- seizure precautions
Hypernatremia S/Sx
THIRST IS USUALLY FIRST SYMPTOM TO APPEAR
Vital signs: hypotension/orthostatic or normal to elevated, tachycardia, bradypnea, temp elevated (related to FVD)
CV: tachycardia, orthostatic hypotension if hypovolemic, hypertension if hypervolemic
Cerebral: agitation, confusion, restlessness, loss of short-term memory, seizures, coma possible
Neuromuscular: muscle spasms, cramps or twitching progressing to severe weakness, decreased DTR’s with sever hypernatremia
Renal: w/hypovolemia = small amounts of dark, yellow urine; w/hypervolemia = large amounts of clear, water-like urine
Respiratory: severely decreased, arrest is possible
Hypernatremia - Important Interventions
Neuro checks, LOC
Potassium
Normal Range = 3.5-5 mEq/L
Big Deal: Cardiac
- nerve impulses
- maintains normal cardiac function
- skeletal and smooth muscle contractility
- regulates intracellular osmolality
- diet is major source
- kidneys are primary excretion
Causes of Hypokalemia
Actual K+ loss: diarrhea, emesis, fistulas, NG suction, diuretics, hyperaldosteroneism, Mg deficit, excessive diaphoresis, dialysis, medications that increase K+ excretion (insulins, diuretics like Lasix, corticosteroids)
Decreased intake: starvation, low intake, anorexia, bulimia, IV fluids without K+ and NPO, total parenteral nutrition
Relative decrease (dilutional)
Hypokalemia S/Sx
Vital signs: hypotension/orthostatic hypotension, HR normal to decreased and may be irregular due to conductivity issues with the heart, respiratory rate may decrease in severe hypokalemia from irregularity with muscle contractility, temp is WNL
CV: life threatening cardiac dysrhythmias, weak, thready pulse
GI: N/V hypoactive BS, constipation, abdominal distention
Neuromuscular: weakness (generalized), muscle aches, cramps, twitching, decreased DTR
Cerebral: fatigue, irritability, anxiety, decreased LOC
Respiratory: shallow, ineffective
ECG changes
Hypokalemia - Important Interventions
Cardiac and neuromuscular
SAFETY
Causes of Hyperkalemia
excessive K+ intake: excessive IV admin, K+ sparing diuretics, K+ containing slat substitutes or foods
shift of K+ out of cells: acidosis, tissue breakdown (burns, sepsis, fever), crush injuries
decreased excretion: renal disease, K+ sparing diuretics, adrenal insufficiency, ACE inhibitors-lisinopril, NSAIDS (ASA, ibuprofen)
Hyperkalemia S/Sx
Vital Signs: decreased BP (orthostatic or normal to elevated), HR normal to bradycardic, may be irregular, RR may decrease with severe hyperkalmeia, temp is WNL
CV: Life threatening cardiac dysrhythmias, irregular, palpations, bradycardia, slow, weak, absent pulse
GI: Nauseau, hyperactive BS, diarrhea
Neuromuscular: muscle weakness, muscle cramps and tingling
Cerebral: frequently asymptomatic fatigue
Respiratory: may produce respiratory arrest because of muscle weakness
ECG changes
Hyperkalmeia - Important Interventions
Cardia and Neuromuscular
Educate regarding restricting K+ rich foods
Promote movement of K+ into cells with IV fluids
Promote excretion of K+
May need dialysis if extremely high
Magnesium - Big Deal
Neuro and nerve transmission in heart and skeletal muscles, powers potassium pump.
If K+ is off, Mg might also be off.
