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N230 exam 1 and 2 > Electrolyte Imbalances > Flashcards

Electrolyte Imbalances Flashcards

1
Q

***Sodium

A

135-145

Main electrolyte in ecf

Major role in ecf volume/distribution in the body

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2
Q

Sodium imbalances

A

Hyponatremia <135

Hypernatremia >145

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3
Q

***Potassium

A

3.5-5
Major icf electrolyte
Transmission of nerve impulses
Skeletal and cardiac muscle contractility

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4
Q

Potassium imbalances

A

Hypokalemia <3.5

Hyperkalemia >5

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5
Q

***Calcium

A

8.8-10.4

99% of calcium is stored in bones

The rest is bound to plasma proteins (albumin) or free/ionized (active form)

Transmits nerves impulses

Muscle contraction (skeletal and cardiac)

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6
Q

Calcium imbalances

A

Hypocalcemia <8.8

Hypercalcemia >10.4

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7
Q

***Magnesium

A

1.8-2.6

Regulates muscle contraction

Metabolizes carbs and proteins

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8
Q

Magnesium imbalances

A

Hypomagnesemia <1.8

Hypermagnesemia >2.6

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9
Q

***Phosphorous

A

2.7-4.5

Most phosphorus is in bones/teeth

Involved in acid/base balance, metabolism

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10
Q

Phosphate imbalances

A

Hypophosphatemia: <2.7

Hyperphosphatemia: >4.5

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11
Q

***Hyponatremia

A

Sodium loss (GI,Renal,skin)

Water gained (excessive hypotonic ivf, psych issues, tumors/endocrine diseases)

CHF

Exercise induced

Low sodium in bv= fluid leaves and goes to cell causing edema

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12
Q

Hyponatremia symptoms ***

A

Neuro changes :
Mild:
Irritability, headache
Severe:
Confusion, seizures
Vomiting
Coma
Fatal
Severe if less than 115

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13
Q

Hyponatremia tx ***

A

NO DIURETICS (bc itll get rid of sodium too)
Sodium replacement (SLOWLY) (
*PO or LR/0.9% NS
*more sever require hypertonic saline
Fluid restriction
Strict I/O
Daily weights
Seizure precautions (edema cause seizure risk)

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14
Q

Hypernatremia ***

A

Sodium gain
Water loss or low intake
Endocrine issues (uncontrolled DM)

Sodium is high in BV (ECF) eater moves into BV (shrinks cells)

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15
Q

Hypernatremia s/s ***

A

Thirst
Sticky mucous membranes
Elevated body temp
Restlessness, irritability
Seizures

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16
Q

Hypernatremia tx ***

A

Fluid replacement: depends on cause
Slow and steady

Usually isotonic, sometimes hypotonic

Monitor neurological status

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17
Q

High Na diet ***

A

Good for hyponatremia
Processed foods
Canned
Fast foods
Chips
Chees
Lunch meat

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18
Q

Low Na foods ***

A

Good for hypernatremia
Fruits
veggies
Freshmeats, fish
Oatmeal

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19
Q

Hypokalemia ***

A

GI, Renal, Skin loss

Shift of potassium into cells
-high insulin levels
-alkalosis (ph imbalance)

20
Q

Hypokalemia s/s ***

A

Muscle weakness
Decreased reflexes
Constipation, paralytic ileus
Weal/irregular pulse
Bradycardia

*pearl: increased risk for digoxin toxicity (it also slows down heart)

21
Q

Hypokalemia tx ***

A

Oral replacement via diet or supplement

IV potassium if severe (but it could stop heart) (hard on veins could cause phlebitis)

Cautious replacement if kidney disease or decreased renal function

22
Q

IV Potassium ***

A

Always dilute and must use a pump

NEVER IV push or bolus

Use largest peripheral site possible or central if available

Cardiac monitor pt

23
Q

Hyperkalemia ***

A

Excess intake (salt substitutes, potassium in meds)

Shifts potassium out of cells because of destruction of cell membrane (burns, trauma, sepsis, intense exercise, acidosis)

Failure to eliminate extra potassium (renal disease)

24
Q

Hyperkalemia s/s ***

A

Weakness
Flaccid paralysis
Abdominal cramps
Peaked T waves (heart getting irritable)
*can progress to cardiac arrest

25
Q

Hyperkalemia tx ***

A

Obtain ECG
Potassium restrictions/med changes (PO intake)

May use kayexalate by mouth or enema

Loop diuretics (kidney removal)
*both too slow for severe

IVP insulin with IVP dextrose solution then use other methods

May require dialysis for removal

26
Q

Why do you give IVP insulin and IVP dextrose for hyperkalemia? ***

A

Ivp insulin will push K into cells
Dextrose prevents low glucose

27
Q

Hyperkalemia interventions ***

A

Monitor I/O
Monitor cardiac rhythm
Apical pulse (bc of heart arrhythmias)

Pt education diet

28
Q

Hypocalcemia ***

A

Loss thru:
Hypoparapthyroidism
Chronic kidney disease
Chronic alcohol abuse
Diarrhea
Get large amounts of citrated blood
Med SEs

29
Q

Hypocalcemia s/s ***

A

Increased nerve excitability tetany
*tetany=constant muscle contractions

Chvosteks sign=contraction of facial muscles in response to tap over facial nerve

Trousseaus sign=carpal spams when BP cuff inflated above systolic pressure

CATS: Convulsion, Arrhythmias, Tetany, Stridor and spasms

30
Q

Hypocalcemia tx ***

A

Mild: PO calcium/ vit d

Symptomatic: IV calcium gluconate

Cardiac monitor (can cause hypotension), and seizure precautions

31
Q

Hypercalcemia ***

A

Hyperparathyroidism
PTH moves calcium into plasma

Cancers

Dietary intake

Rare: prolonged immobilization

32
Q

Hypercalcemia s/s ***

A

BACKME:
Bone pain
Arrhythmia
Cardiac Arrest
Kidney stones
Muscle weakness
Excessive urination

33
Q

Hypercalcemia interventions ***

A

Mild: decrease intake of calcium

Severe:
Isotonic IVF to dilute it

Bisphosphonate(causes bone absorption of calcium moves from plasma)
*gold standard, 2-4 days for max effect

HD if life threatening

34
Q

Hypomagnesemia ***

A

GI loss
Chronic ETOH
Long term PPI use

35
Q

Hypomagnesemia s/s ***

A

Muscle cramps

Hyperactive DTR

Arrhythmia (tachycardia)

Tremors, seizures, confusion

36
Q

Hypomagnesemia management ***

A

Oral replacement

Iv replacement with: magnesium sulfate
*must use pump, rapid administration can cause hypotension and cardia/resp arrest

37
Q

Hypermagnesemia ***

A

Renal failure
IV magnesium use
Antiacids
Laxatives

38
Q

Hypermagnesemia S/S ***

A

Initial:

Hypertension
Facial flushing
Lethargy
Urinary retention

As levels increase:

Loss of DTR
Muscle paralysis
Coma

39
Q

Hypermagnesemia management ***

A

Decrease po intake

Po fluids/diuretics

HD

IV calcium gluconate (cardio protective)
*prevents heart from freaking out while removing magnesium

40
Q

Hypophosphatemia***

A

Malabsorption
Chronic diarrhea
Chronic ETOH
CKD

41
Q

Hypophosphatemia s/s ***

A

Mild to moderate often asymptomatic

Severe: CNS depression, resp/heart failure, muscle weakness

Chronic will cause osteomalacia/rickets

42
Q

Hypophosphatemia management ***

A

Mild: oral replacement

Severe: IV phosphate replacement
*any electrolyte replacement needs cardiac monitoring

43
Q

Hyperphosphatemia***

A

Renal failure
Excess intake (laxatives/enemas)
Rhabdomyolysis
Hypoparathyroidism

44
Q

Hyperphosphatemia s/s ***

A

May be asymptomatic

If calcium binds to ectra phosphate in blood=s/s of HYPOCALCEMIA

Long term can cause calcified deposits in soft tissue

45
Q

Hyperphosphatemia management ***

A

Phosphate binders (calcium carbonate)
HD

Can be chronic in pt with renal failur, managed by nephrologist

N230 exam 1 and 2 (11 decks)

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