Electrolyte Imbalances

Question 1

Sodium is essential for the maintenance of:

Answer 1

Acid-base and fluid balance
Active and passive transport
Irritability
Conduction of nerve and muscle tissue

Question 2

Hyponatremia levels, cause, result:

Answer 2

<136 mEq/L
Excess H20 or plasma OR loss of sodium rich fluids
Delay of depolarization of membranes, H20 moves from ECF to ICF, which causes brain and nervous system to swell.

Question 3

Risk factors for Hyponatremia:

Answer 3

Excessive GI loss; Renal loss; Skin burns and sound drainage, peripheral edema, ascites, GI obstruction; EFV; HF, Cirrhosis, nephrotic syndrome; Increased IV admin of 5% dextrose in water; NPO status; use of hypotonic solution irrigation; hyperglycemia

Question 4

Major risk factor of hyponatremia for Older Adults

Answer 4

chronic illness, diuretics, insufficient salt intake

Question 5

Vitals for hyponatremia:

Answer 5

Hypothermia, increased thready pulse, hypotension, orthostatic hypotension
Headache, confusion, muscle contractions, POSSIBLE RESP. COMPROMISE, DECREASED DEEP TENDON REFLEXES, SEIZURE, COMA
Increased motility, bowel sounds, abdm cramping

Question 6

Most important Nursing Care for Hyponatremia

Answer 6

1. monitor LOC, respiratory status if muscle weakness is present.
2. Restrict water when FV is normal-high
3. Administer hypertonic oral and IV fluids as prescribed.

Question 7

Hypernatremia: Levels, important info

Answer 7

> 145 mEq/L

• Neuro, endocrine, cardia disturbances
• Hypertonicity of the blood, cell dehydration

Question 8

Hypernatremia: Risks

Answer 8

• NPO, heat stroke, increased sodium intake, hypertonic fluids, hypertonic tube feeding, bicarb intake
• Sodium retention, kidney failure, Cushing’s disease, aldosteronism, gluccocorticosteroids, fluid loss

Question 9

Hypernatremia: Findings

Answer 9

Hypothermia, tachycardia, orthostatic hypotension

• restlessness, disorientation, muscle twitching, SEIZURES, decreased LOC, SWOLLEN TONGUE
• Edema, warm flushed skin, Oliguria.

Question 10

Hypernatremia: Top Nursing Care

Answer 10

Monitor LOC and ensure safety.

Administer hypotonic or isotonic fluids.

Question 11

Potassium is essential for:

Answer 11

cell metabolism, TRANSMISSION OF NERVE IMPULSES, functioning of CARDIAC, LUNG, MUSCLE TISSUES
acid-base balance
RECIPRICOL ACTION WITH SODIUM

Question 12

Hypokalemia: Level, Cause, Result

Answer 12

<3.5

• Increased loss (diuretic), decreased intake (rare) absorption, or movement of K+ into cells
• HEART Misfunction

Question 13

Risk for Hypokalemia:

Answer 13

-Hyperaldosteronism, prolonged admin of non-electrolyte dextrose 5% with water, total parenteral feeding, METABOLIC ALKALOSIS, GI issues, DIURETICS

Question 14

What meds can cause hypokalemia?

Answer 14

Furosemide, Corticosteroids, Digoxin

Question 15

Hypokalemia: Findings

Answer 15

Weak and irregular pulse, hypotension, RESPIRATORY DISTRESS, ASCENDING BILATERAL WEAKNESS W/ RESPIRATORY DISTRESS AND COLLAPSE AND PARALYSIS, ECG findings

Question 16

Hypokalemia: ECG Findings

Answer 16

Premature muscle contractions, slow heart rate, ventricular tachycardia, flattened T waves, Increased U waves, ST depression

Question 17

Important Nursing Care Reminder

Answer 17

NEVER IV BOLUS (high risk for cardio arrest)

Question 18

Hyperkalemia: Level, Cause, Result

Answer 18

> 5.0 mEq/L

• Increased intake, inadequate excretion
• Uncommon in functioning kidney
• RISK OF CARDIAC ARRYTHMIA AND CARDIAC ARREST

Question 19

Hyperkalemia: Risk Factors

Answer 19

-IV K+ admin, salt substitutes, blood transfusion
DIABETIC ACIDOSIS, Tissue catabolism (burns, sepsis, severe dehydration, MI)
-UNCONTROLLED DIABETIC MELLITUS
-kIDNEY FAILURE, POTASSIUM SPARING DIURETICS, ace INHIBIRTORS, ADRENAL INSUFFICIENCY

Question 20

Hyperkalemia: Older Adult Higher Risk

Answer 20

-Kidney disease, meds, salt substitutes, angiotensin-converting Enzyme Inhibitors (ACE), potassium-sparing diuretics

Question 21

Hyperkalemia: Findings

Answer 21

Decreased irregular pulse, hypotension, irritability, confusion, weakness w/ ascending flaccid paralysis, paresthesia, decreased reflexes
Increased motility, BS, diarrhea, abdm cramping

Question 22

Hyperkalemia: ECG Findings

Answer 22

Peak T waves, widened PR and QRS.

Dysrhythmias and asystole are possible.

Question 23

Hyperkalemia: Nursing Care

Answer 23

Dialysis may be required

-Use Sodium Polystyrene Sulfonate–> binds to K+ in digestive tract and excretes it