Electrolyte Imbalances

Question 1

Which electrolytes are higher in the extracellular fluid?

Answer 1

• Sodium
• Calcium
• Chloride

Question 2

Which electrolytes are higher in the intracellular fluid?

Answer 2

• Potassium
• Magnesium
• Phosphate

Question 3

State the main extracellular cation & its function

Answer 3

• Sodium (Na+)
• regulate & distribute fluid in the body
• maintains normal nerve & muscle activity
• regulates osmotic pressure
• preserves acid-base balance

Question 4

Normal range for sodium

Answer 4

135-145mEq/L

Question 5

Causes of hyponatremia

Answer 5

• profuse diaphoresis
• ingestion of excess plain water
• IV administration of nonelectrolyte fluid
• profuse diuresis, vomiting, diarrhea, GI suctioning
• Addison’s disease

Question 6

Signs & symptoms of hyponatremia

Answer 6

• mental confusion
• muscular weakness
• anorexia
• restlessness
• elevated temperature
• tachycardia
• nausea/vomiting
• personality changes
• convulsions or coma

Question 7

Treatment of hyponatremia

Answer 7

• oral salty foods or salted water
• IV fluids with sodium chloride

Question 8

Hypernatremia

Answer 8

excess sodium in the blood

Question 9

Causes of hypernatremia

Answer 9

• excessive salt intake
• high fever
• decreased water intake
• excessive IV solutions with sodium
• excessive water loss without loss of sodium
• severe burns

Question 10

Signs & symptoms of hypernatremia

Answer 10

• thirst
• dry & sticky mucous membranes
• decreased urine output
• fever
• rough, dry tongue
• lethargy
• coma

Question 11

Treatment for hypernatremia

Answer 11

• oral administration of plain water
• administration of hypotonic solution (0.45%NaCl or 5% dextrose)

Question 12

Nursing management for hypo- & hyper- natremia

Answer 12

• portion oral fluids throughout the day
• maintain accurate I&Os
• assess VS q1-4h
• closely monitor IV fluids
• implement prescribed dietary restrictions/supplements
• notify doctor if symptoms worsen or lab values change significantly

Question 13

State the main intracellular cation & its function

Answer 13

• Potassium (K+)
• maintains normal nerve & muscle activity
• regulates osmotic pressure
• preserves acid-base balance

Question 14

Hypokalemia

Answer 14

deficit of blood potassium

Question 15

Normal potassium levels

Answer 15

3.5-5mEq/L

Question 16

Causes of hypokalemia

Answer 16

• potassium-wasting diuretics, ex: furosemide, hydrochlorothiazide
• vomiting, diarrhea, GI suctioning, draining intestinal fistula
• large doses of corticosteroids
• administration of IV insulin & glucose
• prolonged admin of nonelectrolyte parenteral fluids

Question 17

Signs & symptoms of hypokalemia

Answer 17

• fatigue, weakness,
• anorexia, nausea, vomiting
• cardiac arrhythmias (ST depression, flattened T wave with a U wave)

Question 18

Treatment of hypokalemia

Answer 18

• change the diuretic to a potassium-sparring one
• increasing oral intake
• administer potassium replacement
• administer IV KCl

Question 19

Hyperkalemia

Answer 19

excessive blood potassium levels

Question 20

Causes of hyperkalemia

Answer 20

• renal failure because kidneys cannot excrete potassium
• severe burns
• potassium-sparring diuretics
• overuse of potassium supplements
• salt substitutes, diet soda, potassium-rich foods
• crushing injuries
• Addison’s disease
• rapid administration of parenteral potassium

Question 21

Signs & symptoms of hyperkalemia

Answer 21

• diarrhea, nausea
• muscle weakness
• paresthesia
• cardiac arrhythmias (prolonged PR interval, widened QRS, ST segment depression, peaked T wave)

Question 22

Treatment of hyperkalemia

Answer 22

• decreasing oral potassium intake
• administering regular insulin & glucose to shift potassium into cells
• peritoneal dialysis or hemodialysis

Question 23

Nursing management for hypo- & hyper- kalemia

Answer 23

• assess for signs and symptoms
• monitor labs
• administer medications to restore potassium balance
• consult with physician when the client receives long-term IV fluid therapy without potassium
• dilute IV potassium in IV solution & administer at a rate < 10mEq/h

Question 24

Pharmacological considerations for potassium

Answer 24

• never administer to a client with insufficient kidney function
• potassium depresses heart contractions when given in a bolus - causes bradycardia & cardiac arrest
• may experience burning along the vein with IV potassium infusion

Question 25

Which gland(s) regulates serum calcium levels?

Answer 25

Parathyroid glands

Question 26

What are the functions of calcium

Answer 26

• necessary for blood clotting
• assist with the function of smooth, skeletal & cardiac muscles
• transmit nerve impulses

Question 27

Normal levels for calcium

Answer 27

9-11mg/dL (serum)
4.4-5.4mg/dL (ionized)

Question 28

Causes of hypocalcemia

Answer 28

• vitamin D deficiency
• hypoparathyroidism
• severe burns
• acute pancreatitis
• corticosteroid use
• rapid administration of blood containing anti-calcium additive
• intestinal malabsorption
• accidental surgical removal of parathyroid glands

Question 29

Signs & symptoms of hypocalcemia

Answer 29

• paresthesia & oral paresthesia
• muscle & abdominal cramps
• positive Chvostek sign (spasm of the facial muscle when the facial nerve is tapped)
• Trousseau sign (spasm of fingers, hand, wrist when BP cuff is inflated for 3 min)
• mental changes
• laryngeal spasms with airway obstruction
• tetany
• seizures
• bleeding
• cardiac arrhythmias

Question 30

Treatment for hypocalcemia

Answer 30

• oral calcium & vitamin D
• IV calcium gluconate

Question 31

Causes of hypercalcemia

Answer 31

• parathyroid gland tumors
• multiple fractures
• Paget disease
• hyperparathyroidism
• excessive vitamin D supplement
• prolonged immobilization
• some chemotherapy agents
• some cancers (multiple myeloma, acute leukemia, lymphomas)

Question 32

Signs & symptoms of hypercalcemia

Answer 32

• deep bone pain
• constipation
• anorexia, nausea, vomiting
• polyuria
• thirst
• pathologic fractures
• mental changes (decreased memory & attention)
• kidney stones