Electrolytes Flashcards
1
Q
What do electrolytes do to the body in general?
A
moves nutrients waste in and out of cells
maintain homeostasis
2
Q
What is another word for dehyration?
A
hypovolemia
3
Q
Why are older adults at increased risk of dehydration?
A
decreased ability to detect thrist and decreased body mass which includes water
4
Q
What are some ways that your body gets hypovolemic?
A
dehydration
imbalance of electrolytes
burns
trauma
blood loss
GI losses
shock
third spacing
fever
prolonged vomiting
severe diarrhea
profuse sweating
5
Q
What are clinical manifestations of fluid volume deficit?
A
Tachycardia
Low B/P
Orthostatic Blood Pressure
Low Central Venous Pressure (CVP)
Thready pulse
Dry mucus membranes
Dry furrowed tongue
Decreased skin turgor
Flat neck veins
sunken in eyeballs
6
Q
How does the body compensate for hypovolemia?
A
it needs to pump more blood to keep up cardiac output so the heart pumps faster as the the BP drops
7
Q
Blood urea nitrogen (BUN)
A
Kidney function
8
Q
What does ta complete metabolic panel have that a basic panel doesn’t?
A
In addition to those findings included in the BMP, the CMP also includes information regarding the body’s metabolism, including protein and liver function.
9
Q
Carbon dioxide (CO2)
A
Blood bicarbonate level
10
Q
Creatinine (CR)
A
Kidney function
11
Q
Glucose
A
Blood sugar level
12
Q
Chloride (Cl-–)
A
Blood chloride level
13
Q
Potassium (K+)
A
Blood potassium level
14
Q
Sodium (Na+)
A
Blood sodium level
15
Q
Calcium (Ca+)
A
Liver function
16
Q
Liver enzymes
Alkaline phosphate (ALP)
Alanine transaminase (ALT)
Aspartate aminotransferase (AST)
A
Liver function
17
Q
Bilirubin (total)
A
Liver function
18
Q
Protein (total)
A
Total blood protein
19
Q
Albumin
A
Liver function
20
Q
Electrolytes are responsible for the following functions within the body (5)
A
Maintaining the balance of water in the body
Balancing the blood pH (acid–base) level
Moving nutrients into the cells
Moving wastes out of the cells
Maintaining proper function of the body’s muscles, heart, nerves, and brain)
21
Q
What percentage of our body is what?
A
males: 60%
females: 54%
babies and young children: 70%
22
Q
What is the most frequently used laboratory indicator of the body’s fluid status
A
Serum osmolality
23
Q
expected reference range of serum osmolality
A
285 to 295 mOsm/kg
24
Q
Secondary way to measure osmolality, renal functtion, and hydration status
A
urine
25
expected reference range for urine osmolality
50 to 1,200 mOsm/kg
26
what holds 67% of the body’s water
intracellular space
27
As body water blank , the concentration of solutes blank. This, in turn, leads to blank in serum osmolality and indicates blank in hydration.
decreases
increases
increase
decrease
28
What receptors detect increased omotic pressure?
osmoreceptors
29
what detects decreased blood pressure? where are they?
baroreceptors in the aortic arch and carotid sinus
30
What does the amina terminalis detect?
decrease in body fluid volume
31
What doe ADH and vasopressin do?
A hormone excreted by the hypothalamus in the brain that maintains blood pressure and fluid volume
32
expected range of Potassium (K+)
3.5 to 5 mEq/L
33
expected range of Sodium (Na+)
136 to 145 mEq/L
34
expected range of Calcium (Ca2+)
9 to 10.5 mg/dL
35
expected range of Magnesium (Mg2+)
1.3 to 2.1 mEq/L
36
what is the movement of solutes, such as electrolytes, from an area of high concentration (such as within a cell) to an area of low concentration (such as the intravascular area)
diffusion
37
is diffusion passive or active?
passive
38
sodium–potassium pump is a type of what movement?
active transport
39
What is the body’s largest intracellular electrolyte?
potassium
40
potassium is used to:
support the transmission of electrical impulses of the body’s nerves and muscles
conduction of nerve cells within the heart
41
daily intake of potassium
3,400 mg for adult males and 2,600 mg for adult females
42
What organ is responsible for the primary excretion of potassium (90%)?
kidney
43
What are critical values for potassium?
less than 3 mEq/L for adults
less than 2.5 mEq/L for newborns.
44
What role do PN's have in determining lab values?
review, and if out of range, report the results to RN or provider
45
What are causes of hypokalemia? (10)
Medications
Certain cardiac conditions
Gastrointestinal losses
Metabolic alkalosis
Decreased oral intake of potassium
Excessive alcohol use
Chronic kidney disease
Diabetic ketoacidosis
Excessive sweating
Folic acid deficiency
46
The most common cause of hypokalemia is loss of potassium from what ?
kidneys or gastrointestinal tract
47
What medication type most commonly result in hypokalemia?
Potassium-wasting diuretics (loop, thiazide, and osmotic) because they get peed out
48
What are some medications can cause hypokalemia?
amphotericin B,
high doses of penicillin
theophylline
Potassium-wasting diuretics
49
What happens with hypokalemia less than 3 mEq/L ?
muscle weakness
cardiac arrhythmias
constipation
fatigue
50
What level is severe life-threatening hypokalemia?
potassium level less than 2.5 mEq/L,
51
What are s/s of hypokalemia? (6)
respiratory paralysis and failure
paralytic ileus
hypotension
tetany
rhabdomyolysis (muscle tissue breakdown)
life-threatening cardiac arrhythmias
52
Repeated episodes of hypokalemia can affect what?
renal function
53
What is a test to determine if the level of potassium? is affecting heart rhythm
ECG
54
Oral Potassium supplements can cause gastrointestinal distress, so what should they do?
they should be administered with or following a meal.
55
rhabdomyolysis
characterized by red-colored urine, low urine output, weakness, and muscle pain.
56
How should EV potassium be diluted?
100 to 1,000 mL of a compatible solution and never administered directly from the vial.
57
The dose of potassium should not exceed what unless what a is being treated
40 mEq/L
severe hypokalemia
58
What are some interventions if hypokalemia is the result of diuretic use,?
switch to potassium-sparing diuretic
routine oral potassium supplements
dietary consumption
59
What are some vegan options for raising potassium?
baked potato
prune juice
carot juice
white beans
sweet potato
banana
spinach
avocado
60
What foods in each food group have the highest concentration of potassium?
Baked potato—highest vegetable
Prune juice—highest fruit juice
Plain, nonfat yogurt—highest dairy product
Salmon—highest fish
Banana—highest fruit
61
What is the critical leel of hyperkalemia?
potassium value greater than 5 mEq/L.
62
Hyperkalemia can occur from several causes (10)
Renal failure
Dehydration
Diabetes mellitus
Medications
Trauma/burns
Excess intake of potassium
Transfusions of packed red blood cells
Acidosis
Sepsis
63
The most common cause of hyperkalemia is what?
renal failure
64
medications that most commonly result in hyperkalemia
Potassium-sparing diuretics
nonsteroidal anti-inflammatory medications (NSAIDs)
angiotnausea, vomiting, muscle aches and weakness, decreased deep tendon reflexes, paralysis, dysrhythmias or palpitationsensin-converting enzyme (ACE) inhibitors
65
hyperkalemia greater than 5 mEq/L can lead to
nausea, vomiting, muscle aches and weakness, decreased deep tendon reflexes, paralysis, dysrhythmias or palpitations
66
hyperkalemia level critical
potassium level greater than 5 mEq/L
67
severe life-threatening hyperkalemia, defined as:
potassium level greater than 7 mEq/L
68
hyperkalemia can lead to what s/s
paralysis
heart failure
death
69
what is a possible treatment option for someone with renal failure hyperkalemia?
hemodialysis
70
What are medications to treat hyperkalemia?
Calcium gluconate
calcium chloride
loop diuretics
thiazide diuretics
resin (sodium polystyrene sulfonate)
insulin
71
How do resins help hyperkalemia?
bind to the potassium in the body and are then excreted through the stool.
72
What do Calcium gluconate or calcium chloride do to the body?
utilized to decrease the effect of excess potassium levels on the heart
73
What do Loop and thiazide diuretics cause the body to do?
excrete excess potassium through urination
74
People with hyperkalemia should have what kind of monitoring?
heart monitoring
blood glucose because they have increased risk of hypoglycemia
75
What does insulin do to potassium?
causes potassium to enter the cells
76
Why should people with hyperkalemia decrease use of salt substitutes?
they have potassium chloride that can increase the K+ levels
77
sodium is the most common electrolyte in what type of body fluid
body's most common extracellular electrolyte
78
function of sodium
supports proper neurologic and neuromuscular function
regulates the body’s fluid balance
helps maintain blood pressure
79
RDA for sodium is less than what?
2,300 mg per day, or approximately 1 teaspoon
80
expected reference range of sodium
136 to145 mEq/L
81
Critical value of hyponatremia
at less than 120 mEq/L.
82
factors that can place a client at risk for developing hyponatremia
Medications
Chronic or severe vomiting or diarrhea
Drinking excess amounts of water
Excess alcohol intake
Heart, kidney, and liver problems
Severe burns
83
What are the medications that most commonly result in hyponatremia, and how?
Thiazide diuretics through urinary loss
84
prolonged diarrhea or vomiting from hyponatremia can lead to what?
prolonged diarrhea or vomiting
85
How does heart failure and cirrhosis lead to hyponatremia?
lead to increased retention of fluid in the body, which dilutes sodium,
86
Moderate hyponatremia often manifests first with what?
lethargy and confusion. neurologic changes
headache, restlessness, and irritability
87
s/s of severe hyponetremia
muscle twitching
further decreases in level of consciousness
seizures
88
What are some education for hyponatremia? (4)
Drink water in moderation.
Check urine for a pale, yellow color to indicate adequate hydration.
Discuss with the provider the need to consume sports drinks with electrolytes when participating in demanding physical activities.
Use thirst as an indicator as to whether or not drinking water is necessary.
89
hy[pernatremia critical values occur at
levels greater than 160 mEq/L
90
Hypernatremia can occur from the following causes: (10)
Loss of body water
Medications
Gastroenteritis
Vomiting
Prolonged suction
Burns
Excessive sweating
Chronic kidney disease
Diabetes
Impaired thirst response
91
most common cause of hypernatremia
Loss of body water
92
High sodium levels result in manifestations like those seen in what?
hyponatremia
93
hypernatremia s/s
confusion,
lethargy
irritability
94
severe hypernatremia s/s
muscle twitching
ALOC with seizures
coma
95
plasma osmolality test for hypernatremia
above the expected reference level of 295 mOsm/kg.
96
Why is it important to decrease sodium level in hypernatremia slowly?
prevent cerebral edema
97
foods high in sodium
Roasted ham
shrimp
frozen pizza
canned soup
veggie juice
cottage cheese
instant/regular vanilla pudding
98
Calcium plays a role in what functions?
mineralization of bone
muscle contraction
nerve transmission
clotting of blood
hormone secretion
normal functioning of the hear
99
What is the most abundant mineral in the body?
Calcium
100
Where is most of Ca+ stored?
bones and teeth
101
Absorption of calcium by the intestines depends on an adequate supply of what vitamin?
vitamin D
102
RDA for vitamin D ?
600 international units (IU) for adults and 800 IU for older adults
around 1,300 mg for adolescents and 1,000 for adults. 1,200 mg for women over 50
103
What controls excretions of calcium?
action of parathyroid hormone
104
Why does an ionized CA+ level need to be analyzed?
CA+ is bound to protein so, the amount that is active or unbound needs to be identified
105
expected reference range for ionized calcium
for an adult is 4.5 to 5.6 mg/dL
106
Hypocalcemia critical values for serum and ionized
less than 6 mg/dL and less than 2.2 mg/dL, respectively.
107
A client’s ionized calcium level is generally estimated to be about what percent of their total calcium
50%
108
Hypocalcemia can occur from several causes (9)
Medications that decrease body’s absorption of calcium
Inadequate amount of vitamin D
Hormonal changes (menopause)
Hypoparathyroidism
Renal disease
Multiple blood transfusions
Electrolyte imbalances of magnesium or phosphate
Sepsis
Low albumin levels
109
Medications that can lead to hypocalcemia include stimulant laxatives
stimulant laxatives
long-term use of glucocorticoids
loop diuretics
Medications used to decrease the body’s gastric acid
110
stimulant laxatives do
decrease the absorption of calcium
111
hypocalcemia in long-term use of glucocorticoids can lead to
hich can deplete calcium stores by increasing a client’s risk of developing osteoporosis
112
loop diuretics in hypocalcemia
can lead to excess calcium excretion by the kidneys
113
Medications used to decrease the body’s gastric acid can affect hypocalcemia
by decreasing the breakdown of fat, a factor that is important for calcium absorption
114
How does PTH affect calcium levels?
they maintain the proper amount of calcium in the body
115
osteopenia, also known as low bone mass, and increase the risk what?
of bone fractures and osteoporosis.
116
Hypocalcemia can affect what body systems?
respiratory, cardiac, neurologic, sensory, neuromuscular, and integumentary system
117
Acute hypocalcemia can lead to what cardio problems? (4)
chest pain
dysrhythmias
heart failure
syncope
118
Acute hypocalcemia can lead to what neuromuscular problems? (3)
numbness and tingling of the fingers, toes, and the mouth
muscle cramping
spasms, particularly in the back and lower extremities
119
Acute hypocalcemia can lead to what neuro problems? (6)
confusion
depression
psychosis dementia
lethargy
seizures
personality changes
120
Acute hypocalcemia can lead to what respiratory problems? (5)
wheezing
spasms of the larynx and airway
dysphagia
changes to the voice
121
Acute hypocalcemia can lead to what integumentary problems? (5)
coarseness of the hair
hair loss (alopecia)
brittle nails
dry skin
itching
122
What happens to neonates and infants who ar born to mothers with diabetes, preeclampsia or hyperparathyroidism?
Neonates and infants are at greater risk for hypocalcemia
123
Two distinct findings can be elicited if hypocalcemia is suspected
Chvostek sign and the Trousseau sign
124
how to elicit a positive trousseau sign
place a blood pressure cuff on the client’s arm and inflate it 20 mm Hg above the client’s systolic blood pressure for 3 to 5 minutes
125
What sign is considered a more specific indicator of hypocalcemia than the what sign?
Trousseau
Chvostek
126
Limit calcium supplement intake to less than what mg per dose to promote absorption.
600
127
foods high in Calcium
american cheese
parmesan cheese
plain nonfat yogurt
almond milk
orange juice with ca fortified
soymilk
low-fat milk
cheddar
128
What level indicates hypercalcemia?
10.5 mg/dL and an ionized calcium level greater than 5.6 mg/dL.
129
hypercalcemia critical values occur at what level?
greater than 13 mg/dL and 7 mg/dL
130
Elevated serum calcium levels can lead to (5)
development of kidney stones
weakened bones
affect the function of the heart and brain.
131
Hypercalcemia is most commonly caused by (5)
Cancer
Hyperparathyroidism
Vitamin D toxicity
Medications
Renal failure
132
most common cause of hypercalcemia?
hyperparathyroidism
cancer
133
How does hyperparathyroidism lead to hypercalcemia?
it can secrete excessive amount of hormone PTH and then increased absorption of Ca+ by intestines and then increased reabsorption into kidneys.
excess levels of Ca+ in the blood
134
How does cancer lead to hypercalcemia?
bones are invaded, bone resorption occurs. As a result of this process, the cancer tumors release a hormone similar to PTH, which leads to increasing levels of calcium in the blood.
135
Hypercalcemia can be caused by toxicities of what medications
vitamin A and D
thiazide diuretics
prolonged bed rest
136
What are the first signs of mild hypercalcemia?
Gastrointestinal manifestations such as constipation and abdominal pain, nausea and vomiting, and anorexia
137
progressive levels of hypercalcemia s/s
GI manifestations
confusion and beharvioral changes
thirst, polyuria, bone pain, weakness
arrhythmias, delirium, coma
renal failure.
138
signs of severe hypercalcemia (4)
coma
arrhythmias
renal failure
delirium
139
Hypercalcemia Manifestations Mnemonic
Abdominal Moans
painful Bones
kidney Stones
Groans
neurologic overtones
140
what imaging tests, may also be prescribed to examine a client’s bones or lungs to diagnose hypercalcemia?
computed tomography (CT) scan or chest x-ray,
141
What is the body’s second most common intracellular electrolyte
magnesium
142
how much so magnesium is located in the bones
50-60%
143
Magnesium’s role in the body (5)
assist in the regulation of nerve and muscle function
maintain blood pressure
maintain serum glucose levels
support bone and teeth health
synthesize protein, DNA, and RNA.
144
What supplements and medications can magnesium be obtained?
multivitamins, supplements, laxatives, and medications for gastrointestinal symptoms such as heartburn and indigestion
145
Where is magnesium excreted?
urine and feces
146
Critical values for hypomagnesium
Critical values occur at less than 0.5 mEq/L or greater than 3 mEq/L
147
Hypomagnesemia may be caused by
Critical values occur at less than 0.5 mEq/L or greater than 3 mEq/L
148
RDA for magnesium for women and men
Adult males require 400 to 420 mg/day and adult women need 310 to 320 mg/day
149
Hypomagnesemia Critical values occur at
less than 0.5 mEq/L or greater than 3 mEq/L.
150
Medications that can lead to magnesium loss include
loop or thiazide diuretics
certain antibiotics
proton-pump inhibitors
151
Why is it important to treat other concurrent electrolyte imbalances in potassium or calcium?
if they are present, as the magnesium imbalance is more difficult to correct in the ongoing presence of these imbalances
152
food high in Magnesium
Cooked spinach
pumpkin seeds
black beans
cooked soybeans
cashews
dark chocolate
avocados
tofu
salmon
banana
153
Symptoms of moderate hypomagnesemia
nausea
vomiting
decreased appetite
fatigue
weakness
154
severe hypomagnesemia s/s
neuromuscular changes such as muscle cramps and spasticity
numbness and tingling
seizures
tetany
personality changes
155
Why is IIV Magnesium a high-alert medication?
flushing, sweating, and potentially respiratory depression
Decreases in the client’s level of consciousness
CNS depressant medication
156
While hypomagnesemia is relatively common, what in the blood is a rare occurrence
excess magnesium
157
Hypermagnesemia can occur from
Kidney disease (acute and chronic)
Excessive intake
Medications
Trauma
Acidotic states
Hypothyroidism
Chronic alcohol use disorder
158
The most common cause of hypermagnesemia is
acute or chronic kidney disease,
159
How does acute or chronic kidney disease cause hypermag?
impaired kidneys fail to excrete enough magnesium through the urine
160
how can underlying bowel conditions cause hypermag?
decreased gastrointestinal motility and lead to increased magnesium absorption.
161
how do opioids or anticholinergics cause hypermag?
increase the dwell time of food boluses in the intestines, allowing for greater absorption of electrolytes such as magnesium
162
medications causing hypermag?
opioids
anticholinergics
laxatives
antacids
163
s/s when magnesium levels exceed 7 mg/dL
moderate neurologic manifestations may occur, confusion
sleepiness
blurred vision
headache. Decreasing reflexes, bladder paralysis, flushing, and constipation may also be present
164
Hypermagnesemia levels greater than 12 mg/dL s/s
muscle flaccid paralysis
decreased respiratory rate
hypotension
bradycardia
dysrhythmias
165
High magnesium levels (10 mEq/L or greater) cause (2)
so check for what?
muscle weakness and the loss of deep tendon reflexes, which together result in an absent patellar reflex
166
High magnesium levels (10 mEq/L or greater) cause (2)
muscle weakness and the loss of deep tendon reflexes, which together result in an absent patellar reflex
167
Why will decreasing magnesium serum levels will take more than 24 hour, longer than usual electrolytes?
Magnesium has a long half-life
168
What can suppress the manifestations of hypermagnesemia in the body?
intravenous calcium gluconate or calcium chloride to
169
Dehydration can occur from the following causes (5)
Lack of water intake
Gastrointestinal losses replaced with hypertonic fluids
Fever
Medications
Diabetic ketoacidosis
170
What medications can alter the body's thirst sensation?
benzodiazepines and selective serotonin-reuptake inhibitors (SSRIs)
171
Manifestations of moderate dehydration
altered cognitive and neuromuscular function
thirst
lethargy
dry mucosa
oliguria
172
Manifestations of severe dehydration
tachycardia
hypotension
lactic acidosis increasing the risk of shock
coma
seizure
173
What is the fluid of choice for treating dehydration, and why?
dextrose 5% in water (D5W)
contains no sodium and the glucose in the solution is quickly metabolized by the body
disperses to all fluid spaces
174
What is Third spacing, and what causes it?
fluids become sequestered in other body cavities, is an outcome of disorders such as cirrhosis and pancreatitis.
175
Early manifestations of hypovolemia
thirst
dryness of mucous membranes
decreased skin turgor
decreased urine output
176
Why does blood tachycardia ocur with hypovolemia?
tachycardia
maintain circulating blood volume and perfuse vital organ
177
general signs of hypovolemia
confusion
tachypnea
chest pain with palpitations
diuresis
increasing hypotension
dry furrowed tongue
flat neck veins
thread pulse
178
clinical definition of hypovolemic shock
circulating volume lost is more than 20% of total volume
179
What tests are used to detect hypovolemia?
blood urea nitrogen (BUN) and creatinine (CR) levels ratio
180
A BUN/CR ratio of greater than 20:1 means what?
indicates a lack of blood flow to the kidneys
181
A complete blood count (CBC) may reveal what?
an elevated hematocrit level, indicating volume loss
182
if the hypovolemia is due to bleeding, what levels will be decreased.
the hematocrit and hemoglobin
183
What happens to urine specific gravity in hypovolemia?
urine specific gravity will be elevated, indicating concentrated urine from a lack of hydration.
184
What conditions can cause hypervolemia?
Heart failure
Kidney failure
Cirrhosis
Pregnancy
Excess IV fluid
185
How does cirrhosis cause hypervolemia?
can cause fluid retention and edema as fluid becomes sequestered in the abdomen
186
What medications can cause hypervolemia?
antihypertension medications
vasodilators and calcium channel blockers
glitazones used to treat type 2 diabetes
187
What is some info to obtain client's diet history to obtain education regarding electrolyte fluid imbalance?
diet history
info on prescribed medication
diuretics
188
s/s of hypervolemia
jugular vein distention
hypertension
bounding pulse
dyspnea, adventitious lung sounds
189
Age-related changes to the renal system make older clients more prone to what?.
hypervolemia
190
What are some age-related considerations
changes in the cardiovascular system
decrease in thirst sensation
Decreases in the renin–angiotensin system
frequently prescribed medications
191
Why are infants and young children are also at increased risk for fluid imbalances?
they have a higher rate of metabolism, higher body water content
higher ratio of surface area to volume
192
What is a common manifestation of hypervolemia in infants and young children?
vomiting and diarrhea
193
What type of solution are Lactated Ringers?
isontonic
194
When are Lactated Ringers usually used?
primarily used for replacing fluid and electrolytes lost due to burns or trauma
195
For a client receiving total parenteral nutrition, _____ _______ levels would be checked four times a day along with hourly urine output?
blood glucose
196
If hypovolemia goes untreated, serious symptoms may develop, including:
cyanosis
ALOC
Chest pain, tightness, Palpitations
anuria
Tachycardia & Tachypnea
Decreased blood pressure/ Weak pulse
197
Late signs of hypovolemia
blue discoloration of lips and nail beds
ALOC
palpitations
urin production
tachy x2
weak pulse
198
technical definition of hypovolemic shock
when the body has lost 20 percent or one-fifth of its blood or fluid supply
199
nursing care for hypovolemia
Check VS, labs, weight, and intake and output
Encourage fluid intake
IV administration of fluids or bolus
200
How can you take care of hypervolemic patients?
assess vitals
restrict fluids
ascultate for rales or crackles
diuretics
elevate legs to prevent edema
201
What electrolyte imbalance is all hight except for urin output and HR?
hyperpotassium
202
What cardiac irregularity is worse hyper or hypokalemia?
hypokalemia
203
What are typical signs of hypokalemia?
muscle weakness
leg cramps
fatigue
paresthesia
dysrhythmias
204
Functions of sodium are (3)
BP
BV
pH
205
Hyponatremia can cause what?
neuro-seizures and coma
tachycardia
weak thready pulses
respiratory arrest
206
hypocalcemia s/s
trousseaus
chvostek
diarrhea
circumoral tingling
risk for fractures
bleeding
cardiac dysrhthmias
207
hypercalcemia s/s
moans- constipation
groans- bone pain
stones- kidney stones
decreased DTR (opp)
208
reactions to blood transfusions
circulatory overload
anaphalaxis
tachycardia
fever/chills
back pain
