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Med Surg > Electrolyte Imbalances > Flashcards

Electrolyte Imbalances Flashcards

1
Q

Major electrolyte found in ECF. Essential for acid-base, fluid balance, active and passive transport mechanism, irritability and conduction of nerve-muscle tissue

A

Sodium (Na+)

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2
Q

Explain thirst compensatory mechanism

A

Experience dehydration
Decrease in blood volume
Increase in Na+ osmolality (concentration)
Osmoreceptors in hypothalamus stimulates thirst centre
Pituitary releases ADH to increase water absorption in kidney to decrease osmolality and increase ECF volume

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3
Q

Explain ADH mechanism in response to low blood volume and increased blood osmolarity

A

Hypothalamus as a receptor responds to stimuli
Hypothalamus stimulates posterior pituitary to release ADH into the blood
ADH binds to effectors:
Hypothalamus - activating thirst centre to stimulate fluid intake increasing blood volume and pressure
Kidneys- increase water reabsorption, decrease water loss in kidneys to maintain blood volume and decrease blood osmolarity
Blood vessels - cause vasoconstriction to increase peripheral resistance and bp

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4
Q

Explain RAAS compensatory mechanism in response to low blood pressure and sympathetic division stimulation

A

Receptor juxtaglomerular apparatus responds to stimuli
JG apparatus release renin enzyme into the blood
Renin activates angiotensinogen to AT I
Angiotensin converting enzyme (ACE) in the lungs converts AT I to AT II
AT II binds to effectors:
Systemic blood vessels - causing vasoconstriction increasing peripheral resistance and increasing BP
Kidneys - decrease glomerular filtration rate (GFR), decreasing UO to maintain blood volume and BP
Hypothalamus - activate thirst centre to increase fluid intake, release ADH to maintain blood volume and decrease UO
Adrenal cortex - release aldosterone to maintain blood volume and decrease UO

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5
Q

Explain Aldosterone mechanism in response to decreased Na+ and increased K+ blood plasma levels

A

Receptor adrenal cortex responds to stimuli
Adrenal cortex releases aldosterone into the blood
Aldosterone binds to effectors:
Kidney - to increase Na+/ H20 reabsorption into blood, decrease Na+/H20 and increases K+ UO, increases K+ secretion into tubular fluid
Na+ is maintained and K+ decreases in the blood plasma, therefore, blood volume and BP is maintained

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6
Q

S&S of fluid volume deficit

A 
Low BP and high HR
Dry mouth, thirsty
Rapid weight loss
Low UO
Confusion and lethargic
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7
Q

Nursing intervention for fluid volume deficit

A

Oral fluids
IV (normal saline - no K until UO is increased)
daily weight and strict vital signs

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8
Q

causes of fluid volume excess

A

Hypervolemia - too much IV fluid, kidney failure, corticosteroids
Water intoxication - CHF, ADH problems
Excess sodium intake - salt intake excess

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9
Q

S&S of fluid volume excess

A 
rapid weight gain
Oedema
High BP, bounding pulses
Increased UO
JVD, crackles and dyspnea
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10
Q

Nursing intervention for fluid volume excess

A

Diuretics
fluid restriction (no IV fluids)
sodium intake restriction
daily weights and strict I&O

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11
Q

Causes of Hypernatraemia

A

Excess Na+ intake
Inadequate H2O intake
excess water loss

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12
Q

Hypernatraemia results in

A

fluid shift from ICF to ECF where water follows sodium

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13
Q

S&S of Hypernatraemia

A 
Thirsty
Fever (flushed skin)
Restless, anxious, confused and irritable
Increased BP and fluid retention
Pitting oedema
Decreased UO
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14
Q

Nursing intervention for Hypernatraemia

A

Restrict Na intake
Diuretics
Seizure precautions
Dialysis if severe

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15
Q

Causes of Hyponatraemia

A 
excess water and loss of Na
Increased Na excretion due to diaphoresis, diarrhoea, NGT suction and diuretics 
Low Na diet
Kidney failure
Heart failure
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16
Q

S&S of Hyponatraemia

A 
Stupor/ coma
anorexia 
lethargy
tachycardia
Limp muscle weakness
orthostatic hypotension
seizures/ headache
stomach cramping
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17
Q

Nursing intervention for Hyponatraemia

A

Add Na to diet
administer IV sodium chloride infusions (hypovolemia)
administer diuretics (hypervolemia)
restrict fluid if caused by hypervolemia
Daily weights for fluid excess (as where Na goes H2O follows)
Safety precautions for orthostatic hypotension
Limit water intake

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18
Q

Causes of Hyperkalemia

A 
Kidney failure
Medications - potassium sparring diuretics, ACE inhibitors, NSAIDs
Tissue damage
Acidosis
Hypoxia
Hypercatabolism
Hyperuricemia
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19
Q

S&S of Hyperkalemia

A

Muscle cramps & weakness
Urine abnormalities - oliguria (low UO) and anuria (inability to produce urine in the kidney)
Respiratory distress
Decreased cardiac contractility (Low HR & BP)
ECG changes (tall T waves, flat P waves, widened QRS complexes and prolonged PR intervals)
Reflexes increases DTR (deep tendon reflexes)

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20
Q

Causes of Hypokalemia

A

Loss of total body K
inadequate K intake
Vomiting and diarrhoea
NG suction
Alkalosis and Hyperinsulinism causing the movement of K from ECF to ICF
Dilution of serum K caused by water intoxication and IV therapy with K deficient solution

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21
Q

S&S of Hypokalemia

A

Dysrhythmias (thready, weak and irregular pulse)
Orthostatic hypotension
shallow RR
anxiety, lethargy, confusion and coma
paresthesias (prickling sensation to extremities)
Hyporeflexia (decreased reflex response)
Constipation
N&V
ECG changes (ST depression, inverted T wave and prominent U wave)

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22
Q

Nursing intervention for Hyperkalemia

A 
Monitor ECG
Discontinue potassium IV and PO
Restrict K diet
Administer K excreting diuretics
Administer IV Ca gluconate & IV Na bicarb
Dialysis
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23
Q

Nursing intervention for Hypokalemia

A

Monitor ECG
Administer PO K supplements, liquid potassium chloride and potassium retaining diuretic
K is NEVER administered via IV push, IM and subQ (IV potassium is always diluted & administered using an infusion device)

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24
Q

Potassium imbalance if not treated can cause

A

Cardiac Dysrhythmias which is life threatening

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25
Q

Major extracellular electrolyte, controls and regulate water balance. Where ______ goes water follows.

A

Sodium (Na)

26
Q

Major intracellular electrolyte which helps maintain intracellular water balance. Transmit nerve impulses to muscles and contract skeletal and smooth muscles.

A

Potassium (K)

27
Q

Plays a vital role in cell metabolism and transition of nerve impulses, the functioning of cardiac, lung, muscle tissues and acid-base balance.

A

Potassium (K)

28
Q

found in the body’s cells, bones and teeth. Needed for proper functioning of the cardiovascular, neuromuscular, endocrine systems, blood clotting and teeth formation.

A

Calcium (Ca+)

29
Q

Causes of Hypercalcemia

A

Increased calcium absorption and decreased calcium excretion
Kidney disease
Thiazide diuretics
Increased bone resorption of calcium - Hyperthyroidism
Hemoconcentration

30
Q

S&S of Hypercalcemia

A

Bone pain
Arrhythmias (irregular heartbeat)
Cardiac arrest (bounding pulses)
Kidney stones (solid crystals formed in the kidneys which is often painful when passed)
Muscle weakness (decreased deep tendon reflexes)
Polyuria

31
Q

Nursing intervention for Hypercalcemia

A

d/c IV or PO calcium and thiazide diuretics
administer phosphorus, calcitonin, bisphosphonates and prostaglandin synthesis inhibitors (NSAIDs)
restrict calcium rich diet

32
Q

Causes of Hypocalcemia

A

Inhibition of calcium absorption from the GI tract
increased calcium excretion - kidney disease, diarrhoea, steatorrhea and wound drainage
conditions that decrease the ionised fraction of calcium

33
Q

S&S of Hypocalcemia

A

Convulsions (violent seizure)
Arrhythmias
Tetany (involuntary muscle contractions and overly stimulated peripheral nerves)
Spasms (muscle cramps) and stridor (whistling sound from obstructed airway while breathing)

34
Q

Nursing intervention for Hypocalcemia

A 
Adm. IV or PO calcium
Adm. aluminium hydroxide and Vit D
Seizure precautions
10% calcium 
Consume calcium rich diet
35
Q

mostly found in the bones which regulates BP, blood sugar, muscle contraction and nerve function

A

Magnesium (Mg)

36
Q

Causes of Hypermagnesemia

A

Increased magnesium intake - laxatives and magnesium IVs
Decreased magnesium excretion in kidneys and increased magnesium levels in the blood
DKA

37
Q

S&S of Hypermagnesemia

A 
LOW: (since Mg is a sedative)
energy
HR
BP
RR (with shallow respirations)
Bowel sounds
DTR
38
Q

Nursing intervention for Hypermagnesemia

A 
Diuretics
Adm. IV calcium chloride or gluconate
Restrict Mg rich diet
avoid laxatives and antacids containing Mg
Hemodialysis
39
Q

Causes of Hypomagnesemia

A

insufficient Mg intake - malnutrition, vomiting, diarrhoea
increased magnesium excretion - diuretics
Intracellular movement of Mg - hyperglycemia and insulin adm., sepsis

40
Q

S&S of Hypocalcemia

A 
High: since Mg is sedative (everything is not sedated)
BP
HR
DTR
shallow respirations
Twitches and paresthesias
Tetany and seizures
Irritability and confusion
41
Q

Nursing intervention for Hypomagnesemia

A

Amd Mg sulfate IV or PO
seizure precautions
Consume Mg rich diet

42
Q

Ca and _____ have inverse actions

A

Phosphate - High Ca = Low PO4 vice versa

43
Q

A pt with Ca imbalance is at risk of

A

Pathological Fracture - its important to move them carefully and slowly

44
Q

Mg and ____ have the same effects

A

Ca+ where High Mg = High Ca+

45
Q

Normal blood ph lvl?

A

7.35 - 7.45

46
Q

If blood ph lvl is below 7.35?

A

Acidosis

47
Q

If blood ph lvl is above 7.45?

A

Alkalosis

48
Q

Shifts of plasma to interstitial fluid. Develops if an obstruction of lymphatic outflow causes decreased removal of interstitial fluid.

A

Oedema

49
Q

applying pressure to swollen area causing an indention that persist for some time

A

Pitting oedema

50
Q

Nursing intervention for Oedema

A

Daily weights
Position patient to reduce positional fluid accumulation
Record pitting oedema measurements
Administer diuretics if prescribed

51
Q

Explain fluid shift in heart failure causing Oedema

A

Heart Damage (CAD and HTN)
Ventricular overload decreasing ventricular contraction
Tachycardia causing ventricular dilation and myocardial hypertrophy
Cardiac output is decreased = low BP
Renal perfusion is decreased
Increasing sodium retention and osmotic pressure
ADH is released increasing water reabsorption
Fluid accumulates causing Oedema

52
Q

Occurs when ECF volume is decreased due to vomiting, diarrhoea, haemorrhage, burns, profuse sweating, water deprivation and diuretics abuse

A

Dehydration

53
Q

how to assess hydration

A 
skin turgor (decreased skin turgor occurs when it remains elevated after pinching up and released)
urine colour (dark yellowish)
54
Q

Occurs when there is insufficient intravascular fluid volume which leads to inadequate tissue perfusion

A

Hypovolaemic shock

55
Q

A life threatening condition in which tissue perfusion is compromised leading to possible cell dysfunction, cell death or necrosis and organ failure.

A

Shock

56
Q

Explain compensatory mechanisms from acute bleeding or any events leading to blood volume loss

A

CHEMORECEPTORS activated (by low blood pH) > affecting respiratory centres > increasing RR
BARORECEPTORS firing reduced (by low blood volume and pressure) > increasing HR > weak and thready pulse > skin is cold and clammy with cyanotic appearance
SYMPATHETIC NERVOUS SYSTEM is activated > intense vasoconstriction > decreased renal blood flow > renin is released > AT II is produced in the blood > Kidney retains water and salt > UO is reduced > increasing blood volume > maintaining BP
HYPOTHALAMUS activated (by low pH and blood volume) > Thirst centre affected > ADH is released in the blood targeting the kidneys to retain water > UO is reduced > increasing blood volume > maintaining BP
BRAIN - neurons are depressed by low pH > resulting in restlessness > central nervous system is depressed leading to coma (late sign)

57
Q

Explain what happens to cellular level from acute bleeding

A

Inadequate tissue perfusion
Cells begin to metabolise anaerobically (not requiring O2) and lactic acid accumulates
Water begins to leave tissue cells shifting into the bloodstream leading to cell dehydration

58
Q

Causes of Hypovolemic shock

A

Hemorrhagic (from bleeding) - trauma, GI bleed and postpartum
Non-Hemorrhagic (not from bleeding) - fluid shifts (oedema) and severe hydration (burns, vomiting, diarrhoea)

59
Q

Common S&S of Hypovolemic shock

A

Weak and thready pulse
Decreased CO, BP (hypotension), CVP and O2 SAT
Increased HR (tachycardia to compensate increasing blood flow) and SVR (vasoconstriction)
Cyanotic appearance, cool and pale skin
Capillary refill is > 3 secs

60
Q

Nursing treatment for hypovolemic shock

A 
Large gauge IVs (at least 2)
Fluids and blood replacement
	- Crystalloids (normal saline)
	- Colloids (albumin)
	- Blood plasma

Med Surg (7 decks)

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