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Fluids and Electrolytes > Electrolyte Imbalances > Flashcards

Electrolyte Imbalances Flashcards

1
Q

Sodium

Na

A

135 mEq/L-145 mEq/L
hyponatremia
hypernatremia

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2
Q

Potassium

K

A

3.5 mEq/L-5 mEq/L
hypokalemia
hyperkalemia

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3
Q

Calcium

Calcium

A

8.5 mg/dL-10.5 mg/dL
hypocalcemia
hypercalcemia

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4
Q

Magnesium

Mg

A

1.8 mg/dL-2.7 mg/dL
hypomagnesemia
hypermagnesemia

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5
Q

Phosphorus

P

A

2.5 mg/dL-4.5 mg/dL
hypophosphatemia
hyperphosphatemia

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6
Q

Chloride

Cl

A

96 mEq/L-108 mEq/L
hypochloremia
hyperchloremia

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7
Q

Hyponatremia

causes & manifestations

A
  • serum sodium < 135 mEq/L
  • causes: adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating, diuretics
  • manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased BP, nausea, abdominal cramping neurologic changes.
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8
Q

Hyponatremia

medical & nursing management

A

-medical: water restriction, sodium replacement.
-nursing: assessment and prevention, dietary sodium and fluid intake, identify and monitor at-risk patients, effects of medications (diuretics, lithium)
-replacement can be in form of isotonic solution
(lactated ringers, sodium chloride)

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9
Q

Hypernatremia

causes & manifestations

A
  • serum sodium >145 mEq/L
  • causes: excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions.
  • manifestations: thirst; elevated temperature; dry, swollen tongue; sticky mucosa; neurologic symptoms; restlessness; weakness.
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10
Q

Hypernatremia

medical & nursing management

A
  • medical: hypotonic electrolyte solution or D5W.
  • nursing: assessment and prevention, assess for OTC sources of sodium, offer and encourage fluids to meet patient needs, provide sufficient water with tube feedings.
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11
Q

Hypokalemia

causes & manifestations

A

below-normal serum potassium (<30 because it can cause cardiac dysrhythmias, which can be lethal.

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12
Q

Hypokalemia

medical & nursing management

A
  • medical: increased dietary potassium, potassium replacement, IV for severe deficit.
  • nursing: assessment, severe hypokalemia is life-threatening, monitor ECG and ABGs, dietary potassium, nursing care r/t IV potassium administration.
  • infusion pump used to ensure medication is not being given too quickly.
  • PO potassium is irritating drug–give with food to prevent gastric irritation.
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13
Q

Hyperkalemia

causes

A
  • serum potassium >5 mEq/L
  • causes: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis.
  • seen in patients w/ untreated renal failure or patients who have missed dialysis.
  • seen in patients w/ Addison’s disease because adrenal hormones lead to sodium loss–w/ sodium loss you get potassium retention.
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14
Q

Hyperkalemia

manifestations

A
  • cardiac changes and dysrhythmias
  • muscle weakness with potential respiratory impairment
  • paresthesias
  • anxiety
  • GI manifestations
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15
Q

Hyperkalemia

medical management

A
  • monitor ECG
  • limitation of dietary potassium
  • cation-exchange resin (Kayexalate)
  • IV sodium bicarbonate
  • IV calcium gluconate
  • regular insulin and hypertonic dextrose IV
  • beta-2 agonists
  • dialysis
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16
Q

Hyperkalemia

nursing management

A
  • assessment of serum potassium levels
  • mix IVs containing K+ well
  • monitor medication affects
  • dietary potassium restriction/dietary teaching for patients at risk
  • Hemolysis of blood specimen or drawing of blood above IV site may result in false lab result (sometimes when blood is hemolysized potassium is released)
  • salt substitutes, medications may contain potassium
  • potassium-sparing diuretics may cause elevation of potassium (should not be used in patients with renal dysfunction)
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17
Q

The ECG change that is specific to hyperkalemia is a peaked T wave.
TRUE or FALSE

A

TRUE

  • The ECG changes that are specific to hyperkalemia are peaked T wave; wide, flat P wave; and wide QRS complex.
  • The increased potassium slows down conduction.
  • ECG changes specific to hypokalemia are flattened T wave and the appearance of a U wave.
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18
Q

Hypocalcemia

causes

A

serum level <8.5 mg/dL–must be considered in conjunction with serum albumin level. (for every 1 g/dL drop in serum albumin there is a drop in calcium)
-causes: hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications, other.

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19
Q

Hypocalcemia

manifestation

A
  • tetany
  • circumoral numbness
  • parethesias
  • hyperactive DTRs
  • Trousseau’s sign
  • Chovstek’s sign
  • seizures
  • respiratory symptoms of dyspnea and laryngospasm
  • abnormal clotting
  • anxiety
  • ECG changes: may have a prolonged QT interval causes ventricular irritability–at high risk for ventricular tachycardia.
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20
Q

Trousseau’s sign

A

-patients fingers go into spasm because of low calcium

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21
Q

Chovstek’s sign

A

-gently touch side of face and patient will twitch

22
Q

Hypocalcemia

medical management

A
  • IV of calcium gluconate,
  • calcium and vitamin D supplements
  • diet
  • treatment includes supplementation–given PO if tolerated.
  • when mixing IV calcium gluconate mix w/ D5W (if mixed w/ normal saline it will precipitate out and patient will not receive it).
23
Q

Hypocalcemia

nursing management

A
  • assessment
  • severe hypocalcemia is life-threatening
  • weight-bearing exercises to decrease bone calcium loss
  • patient teaching r/t diet and medications
  • nursing care r/t IV calcium administration.
24
Q

Hypercalcemia

causes & manifestations

A

serum level >10.5 mg/dL

  • causes: malignancy and hyperparathyroidism, bone loss r/t immobility.
  • manifestations: muscle weakness, incoordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes, dysrhythmias.
  • the higher the Ca levels, the more the symptoms can occur.
25
Q

Hypercalcemia

medical management

A
  • treat underlying cause
  • fluids
  • furosemide (lasix–anything that will get rid of potassium)
  • phosphates
  • calcitonin
  • biphosphonates
26
Q

Hypercalcemia

nursing management

A
  • assessment (essential)
  • hypercalcemic crisis has high mortality
  • encourage ambulation
  • fluids of 3-4 L/d
  • provide fluids containing sodium unless contraindicated
  • fiber for constipation
  • ensure safety
27
Q

Hypomagnesemia

causes

A

serum level <1.8 mg/dL–evaluate in conjunction with serum albumin

  • causes: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood, contributing causes include diabetic ketoacidosis, sepsis, burns, hypothermia.
  • loss of Mg is usually through the GI tract (intestines through fistulas, the distal sm bowel)
28
Q

Hypomagnesemia

manifestations

A
  • neuromuscular irritability
  • muscle weakness
  • tremors
  • athetoid movements
  • ECG changes and dysrhythmias
  • alterations in mood and level of consciousness
29
Q

Hypomagnesemia

medical management

A
  • diet
  • oral magnesium
  • magnesium sulfate IV
  • check for Chovstek and Trousseau’s sign
  • increase in deep tendon reflexes
30
Q

Hypomagnesemia

nursing management

A
  • assessment
  • ensure safety
  • patient teaching r/t diet, medications, alcohol use
  • nursing care r/t IV magnesium sulfate (patient should be on cardiac monitor)
  • hypomagnesemia often accompanied by hypcalcemia–monitor urine output and potential for hypocalcemia
  • dysphasia common in magnesium-depleted patients–assess ability to swallow with water before administering food or medications.
  • vital signs checked q15 min
  • IV on pump
31
Q

Hypermagnesemia

causes

A

serum level >2.7 mg/dL

  • renal failure
  • diabetic ketoacidosis (because of catabolism that occurs and release of Mg)
  • excessive administration of magnesium
  • relatively uncommon
32
Q

Hypermagnesemia

manifestations

A
  • flushing
  • lowered BP
  • nausea
  • vomiting
  • hypoactive reflexes
  • drowsiness
  • muscle weakness
  • depressed respirations
  • ECG changes
  • dysrhythmias
33
Q

Hypermagnesemia

medical management

A
  • IV calcium gluconate
  • loop diuretics
  • IV NS of RL
  • hemodialysis
  • drugs can cause hypermagnesemia (antacids, laxatives)–give fluids and raise urine output to get rid of it.
  • elderly @ higher risk because of renal insufficiency
  • pregnant women preterm labor w/ hypertension @ high risk.
  • prevent by knowing what the patient is taking for medications
34
Q

Hypermagnesemia

nursing management

A
  • assessment
  • DO NOT administer medications containing magnesium
  • patient teaching regarding magnesium containing OTC medications
35
Q 
Patient with Crohn's disease develops tremors while receving total parental nutrition.  Suspecting she may have hypomagnesemia, you assess her neuromuscular system.  You expect to see:
    A. non reactive pupil response
    B. Trousseau's sign
    C. decreased reflexes
    D. lethargy
A

B. Trousseau’s sign

  • patients who have low Mg also have low Ca and would have the same symptoms–positive Trousseau’s sign
  • they have hyper reflexes
36
Q

Hypophosphatemia

causes

A

serum level <2.5 mg/dL

  • alcoholism
  • refeeding of patients after starvation (when P as supplementation is not sufficient enough, P shifts into the cells–usually occurs 3+ days after feeding begins)
  • pain
  • heat stroke
  • respiratory alkalosis
  • hyperventilation
  • diabetic ketoacidosis
  • hepatic encephalopathy
  • major burns
  • hyperparathyroidism
  • low Mg
  • low K
  • diarrhea
  • vitamin D deficiency
  • use of diuretic and antacids
  • inverse relationship between Ca and P–increased Ca/decreased P.
37
Q

Hypophosphatemia

manifestations

A
  • neurologic symptoms
  • confusion
  • muscle weakness
  • tissue hypoxia
  • muscle and bone pain
  • increased susceptibility to infection and respiratory symptoms
38
Q

Hypophosphatemia

medical management

A
  • oral or IV phosphorus replacement

* mild-moderate is treated with diet–eggs, nuts, whole grain, meat, fish, poultry, milk

39
Q

Hypophosphatemia

nursing management

A
  • assessment
  • encourage foods high in phosphorus (eggs, nuts, whole grain, meat, fish, poultry, milk)
  • gradually introduce calories for malnourished patients receiving parenteral nutrition
40
Q

Hyperphosphatemia

causes

A

serum level >4.5 mg/dL

  • severe when >6.0 mg/dL
  • renal failure
  • excess phosphorus
  • excess vitamin D
  • acidosis
  • hypoparathyroidism
  • chemotherapy
  • anything that causes cellular destruction also causes an increase in the release of phosphorus
41
Q

Hyperphosphatemia

manifestations

A
  • few symptoms
  • soft-tissue calcifications
  • symptoms occur due to associated hypocalcemia
42
Q

Hyperphosphatemia

medical management

A
  • treat underlying disorder
  • vitamin D preparations
  • calcium binding antacids
  • phosphate binding gels or antacids
  • loop diuretics
  • NS IV
  • dialysis
43
Q

Hyperphosphatemia

nursing management

A
  • assessment (I&Os, vital signs, fluid&electrolytes)
  • avoid high-phosphorus foods
  • patient teaching r/t diet, phosphate-containing substances, signs of hypocalcemia
44
Q

Hypochloremia

causes

A

serum level s disease

  • reduced chloride intake
  • GI loss
  • diabetic ketoacidosis
  • excessive sweating
  • fever
  • burns
  • medications
  • metabolic alkalosis
  • loss of chloride occurs w/ loss of other electrolytes: potassium, sodium
45
Q

Hypochloremia

manifestations

A
  • agitation
  • irritability
  • weakness
  • hyperexcitability of muscles
  • dysrhythmias
  • seizures
  • coma
  • most common presentation–acid-base imbalance (usually metabolic alkalosis
46
Q

Hypochloremia

medical management

A
  • replace chloride

- IV NS or 0.45% NS

47
Q

Hypochloremia

nursing management

A
  • assessment
  • avoid free water (shouldn’t drink excess amount of water because it will dilute the chloride)
  • encourage high-chloride foods
  • patient teaching r/t high chloride
48
Q

Hyperchloremia

causes

A

serum level >108 mEq/L

  • excess sodium chloride infusions w/ water loss
  • head injury
  • hypernatremia
  • dehydration
  • severe diarrhea
  • respiratory alkalosis
  • metabolic acidosis
  • hyperparathyroidism
  • medications
  • typically occurs when there is excessive ingestion of aluminum chloride
49
Q

Hyperchloremia

manifestations

A
  • tachypnea
  • lethargy
  • weakness
  • rapid, deep respirations
  • hypertension
  • cognitive changes
50
Q

Hyperchloremia

medical management

A
  • restore electrolyte and fluid balance
  • Lactaed Ringers
  • sodium bicarbonate
  • diuretics
51
Q

Hyperchloremia

nursing management

A
  • assessment

- patient teaching r/t diet and hydration

Fluids and Electrolytes (1 decks)

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