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Med Surg Unit 1 NURS 241 > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Sodium

  1. What are normal levels of sodium?
  2. What is the role of sodium?
A
  1. Normal Level: 135-145
  2. The role of sodium is that it regulates water in and out of cells and vital for muscle contraction, cardiac contraction and nerve impulses
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2
Q

HYPOnatremia

How does HYPOnatremia happen?

A
  1. Occurs due to reduced excitable membrane depolarization and cellular swelling
  2. Osmolarity of ECF is lower than that of ICF resulting in water moving into the cell and causing it to swell
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3
Q

HYPOnatremia

What are causes of HYPOnatremia?

A
  1. Excessive diaphoresis
  2. Diuretics
  3. Wound Drainage
  4. Decreased secretion of aldosterone
  5. Hyperlipidemia
  6. Kidney Disease
  7. NPO
  8. Low-salt diet
  9. Cerebral salt-wasting syndrome
  10. Hyperglycemia
  11. Excessive ingestion of hypotonic fluids
  12. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
  13. Heart Failure
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4
Q

HYPOnatremia

What are signs and symptoms of HYPOnatremia?

A
  1. Cerebral Changes (acute or increased confusion); seizure, coma and death can occur if sodium becomes too low
  2. Neuromuscular changes:
    • general muscle weakness,
    • diminished deep tendon reflexes
  3. Intestinal Changes:
    • increased motility causing nausea, diarrhea and abdominal cramps. (hyperactive bowel sounds)
  4. Cardiovascular Changes
    • Rapid, weak thready pulse
    • BP is decreased (severe orthostatic hypotension; causing light-headness and dizziness)
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5
Q

HYPOnatremia

Interventions for HYPOnatremia

A
  1. Drug Therapy:
    • IV saline infusion
      o Severe hyponatremia is treated with hypertonic solutions (3% saline) or extreme hyponatremia (5% saline)
  2. Nutrition Therapy:
    o Oral sodium intake
    o Restricting Oral Fluid Intake
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6
Q

HYPERnatremia

How does HYPERnatremia happen?

A
  1. As sodium levels rise, a larger difference in sodium levels occur between the ECF and ICF
  2. More sodium is present to move rapidly across the cell membrane during depolarization, making excitable tissues more easily excited (irritable)
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7
Q

HYPERnatremia

What causes HYPERnatremia?

A
  1. Cushing Disease
  2. Corticosteroids
  3. Kidney Failure
  4. Excessive oral sodium intake
  5. Excessive administration of sodium containing IV fluids
  6. NPO
  7. Fever
  8. Watery Diarrhea
  9. Dehydration
  10. Hyperaldosteronism
  11. Infection
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8
Q

HYPERnatremia

What are signs and symptoms of HYPERnatremia?

A
  1. Nervous System:
    • Altered Cerebral Function (assess mental status; patient will be confused or agitated)
    • Patient may be lethargic, stuporous or comatose)
  2. Skeletal Muscle:
    • Muscle Twitching (early stage)
    • Deep tendon reflexes diminished or absent (later stage)
    • Assess muscle strength
  3. Cardiovascular:
    • Decreased contractility
    • Increased pulse
    • Hypotension
    • Bounding Pulses
    • Neck Veins Distended
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9
Q

HYPERnatremia

Interventions for HYPERnatremia

A
  1. Monitor response to therapy and ensure patient safety by preventing hyponatremia
  2. Drug Therapy:
    • Isotonic saline (0.9%) and dextrose 5% in 0.45% sodium chloride in hypertonic (becomes hypertonic once infused)
    • Diuretics (furosemide)
      o Assess the patient hourly for indications of excessive losses of fluid, sodium, or potassium
  3. Nutrition Therapy:
    • Adequate water intake
    • Sodium Restriction
    • Collaborate with dietitian to teach patient how to determine the sodium contents of food, beverages and drugs
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10
Q

Potassium

  1. What are normal levels of potassium?
  2. What is the role of potassium?
A
  1. Normal Levels: 3.5-5
  2. Role with muscle contractions and nerve impulse

Opposite relationship with sodium; found mainly IN cells

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11
Q

HYPOkalemia

How does HYPOkalemia occur?

A

When total body potassium levels are normal but potassium distrubtion between fluid spaces is abnormal or diluted by excess water

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12
Q

HYPOkalemia

What causes HYPOkalemia?

A
  1. Loop diuretics (furosemide), corticosteroids, too much insulin (moves potassium into cell)
  2. Increased secretion of aldosterone
  3. Cushing Syndrome
  4. Diarrhea
  5. Vomiting
  6. Wound Drainage (especially GI)
  7. NG suctioning
  8. Heat-induced excessive diaphoresis
  9. NPO
  10. Kidney disease impairing reabsorption of potassium
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13
Q

HYPOkalemia

What are signs and symptoms of HYPOkalemia?

Laboratory Assessment:
 Hypokalemia causes ECG changes in the heart (ST-segment depression, flat or inverted T-waves and increased U waves)
 Dysrhythmias can lead to death, especially in older adults who are taking digoxin

A
  1. Respiratory
    • Shallow respirations due to respiratory muscle weakness
      o Assess breath sounds, ease of respiratory effort, color of nail beds and mucous membranes and rate of depth of respiration
  2. Musculoskeletal:
    • Skeletal muscle weakness
    • Hand grasps are weak
    • Deep tendon reflexes are reduced
      o Assess muscle weakness and the patient’s ability to perform ADLs
  3. Cardiovascular:
    * Thready and weak pulse
    * Irregular heartbeat (dysrhythmias)
    * Low blood pressure
  4. Neurologic:
    • Altered Mental Status (lethargic)
    • Short-term irritability and anxiety
  5. Intestinal Changes:
    • Decreased peristalsis
    • Bowel sounds hypoactive
    • Nausea
    • Vomiting
    • Abdominal Distention
      o Observe for bowel distention and auscultate for bowel sounds (severe hypokalemia can cause the absence of peristalsis (paralytic ileus)
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14
Q

HYPOkalemia

Interventions for HYPOkalemia

A
  1. Drug Therapy:
    • Additional potassium and drugs to prevent potassium loss(potassium chloride, potassium gluconate or potassium citrate)
      o Give oral potassium (liquid or solids) during or after a meal and advise patients to not take on a empty stomach
      * Potassium is given IV for severe hypokalemia
      o NEVER GIVE POTASSIUM IM or SUBCUTANEOUS INJECTION (potassium is a severe tissue irritant and tissues will become necrotic)
      o Assess the IV site hourly and ask the patient if they feel burning or pain at the site
      * A potassium-sparing diuretic (spironolactone) may be prescribed to increase urine output without increasing potassium loss
  2. Nutrition Therapy:
    * Eats foods rich in potassium (banana, citrus juices, raisin and meat)
  3. Implement Safety:
    • Patient is at risk for falls
      o Put in fall precautions
      o Use gait belt when ambulating with assistance
  4. Respiratory Monitoring:
    • Check oxygen saturation with pulse ox
    • Assess respiratory muscle effectiveness by checking the patient’s ability to cough
    • Assess face, oral mucous and nail beds for pallor or cyanosis
    • Obtain ABGs
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15
Q

HYPERkalemia

What causes HYPERkalemia?

A
  1. Over ingestion of potassium-containing food or medications
    • Salt substitutes
    • Potassium Chloride
  2. Rapid infusion of potassium-containing IV solutions
  3. Kidney Failure
  4. Potassium-Sparing Diuretics
  5. Angiotensin-Converting Enzyme Inhibitors
  6. Tissue Damage
  7. Uncontrolled Diabetes Mellitus
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16
Q

HYPERkalemia

History Assessment of HYPERkalemia

A
  • Ask about kidney disease, diabetes mellitus, recent medical or surgical treatment, and urine output including frequency and amount of voiding
  • Obtain nutrition history to determine intake of potassium-rich foods and the use of salt substitutes
17
Q

HYPERkalemia

What are signs and symptoms of HYPERkalemia?

A
  1. Cardiovascular:
    o MOST SEVERE PROBLEM
    o Bradycardia
    o Hypotension
    o ECG changes (tall, peak T-waves, prolonged PR intervals, flat or absent P waves and wide QRS complexes)
    o Complete heart block, v-fib and asystole
  2. Neuromuscular:
    o Muscle twitching
    o Tingling and Burning sensation followed by numbness in hands and feet and around the mouth (paresthesia)
  3. Intestinal:
    o Increased motility with diarrhea
    o Hyperactive Bowel Sounds
    o Frequent bowel movements that are watery

Laboratory Assessment:
* If caused by dehydration:
o Elevated electrolytes, hematocrit, hemoglobin
* If caused by kidney failure:
o Elevated BUN/Cr, decreased blood pH, normal or low hematocrit and hemoglobin levels

18
Q

HYPERkalemia

Interventions for HYPERkalemia

A
  1. Drug Therapy:
    o Enhance potassium excretion and promote the movement of potassium from ECF into the cells
    o Stop potassium-containing infusions
    o Withhold oral potassium supplements
    o Teach patient to select foods low in potassium
    o Potassium-excreting diuretics
    o Insulin increases the activity of the sodium-potassium pumps, which moves potassium from the ECF into the cell
    o IV fluids containing glucose and insulin are prescribed to decrease potassium (hypertonic)
     Observe for hypokalemia and hypoglycemia during this therapy
  2. Cardiac Monitoring:
    o Allows for the early recognition of dysrhythmias and other symptoms of hyperkalemia on cardiac muscle
  3. Patient Teaching:
    o Teach which foods to avoid and instruct them to read labels on drugs and food packages
    o Avoid salt substitute
19
Q

Calcium

  1. What are normal levels of calcium?
  2. What does calcium do?
A
  1. Normal Levels: 8.5-10.5
  2. Plays a role in the health of our bones and teeth, muscle and nerve conduction and clotting
20
Q

HYPOcalcemia

What causes HYPOcalcemia?

A

 Inadequate oral intake of calcium
 Lactose intolerance
 Malabsorption Syndromes:
* Celiac disease
* Crohn’s
 Inadequate intake of vitamin D
 End-stage kidney disease
 Diarrhea
 Steatorrhea
 Wound Drainage

21
Q

HYPOcalcemia

What are signs and symptoms of HYPOcalemia?

A
  1. Neuromuscular:
    o Occurs first in the hands and feet
    o Paresthesia (tingling and numbness)
    o Muscle twitching, painful cramps
    o Positive Trousseau’s and Chvostek Sign
  2. Cardiovascular:
    o Weak, thready pulse
    o Hypotension
    o ECG changes (prolonged ST and QT intervals)
  3. Intestinal:
    o Increased peristaltic activity
     Assess the abdomen for hyperactive bowel sounds
     Patient may report painful, abdominal cramping
  4. Skeletal:
    o Osteoporosis
    o Bones are brittle, less dense, and fragile and may break easily
    o Vertebrae become more compact and the spine to bend forward
     Observe for spinal curvatures and any unusual bumps or protrusions in bones
21
Q

HYPOcalcemia

History Assessment of HYPOcalemia

A
  • Assess intake of dairy products and if they take calcium supplements regularly
  • Ask about history of orthopedic surgery or bone healing, thyroid surgery, therapeutic irradiation of upper middle chest and neck area
  • Reports of frequent painful muscles spasms (charley horse) usually in the thigh, calf or foot during sleep or rest.
22
Q

HYPOcalcemia

Interventions for HYPOcalemia

A
  1. Drug Therapy:
    o Calcium Replacement (oral or IV) and drugs that enhance the absorption of calcium such as vitamin D
  2. Nutrition Therapy:
    o Calcium-rich diet
  3. Environmental Management:
    o Keep the room quiet
    o Limit visitors
    o Adjust lighting
    o Use soft voice
  4. Injury Prevention Strategies:
    o Use lift sheet rather than pulling the patient
    o Observe for normal range of joint motion and any unusual surface bumps or depression over bony areas
23
Q

HYPERcalcemia

What causes HYPERcalcemia?

A
  • Excessive oral intake of calcium
  • Excessive oral intake of vitamin D
  • Kidney failure
  • Use of thiazide diuretics
  • Hyperparathyroidism
  • Malignancy
  • Hyperthyroidism
  • Immobility
  • Use of glucocorticoids
  • Dehydration
24
Q

HYPERcalcemia

What are signs and symptoms of HYPERcalcemia?

A
  1. Cardiovascular:
    o Increased heart rate and blood pressure (mild)
    o Depressed electrical conduction (severe)
    o Assess pulse and BP for poor perfusion
    o Hypercalcemia allows blood clots to form more easily whenever blood flow is slow or impaired
     Occurs in the lower legs, pelvic region
  2. Neuromuscular:
    o Severe muscle weakness
    o Decreased deep tendon reflexes without paresthesia
    o Confusion and Lethargic
  3. Intestinal:
    o Decreased peristalsis
    o Constipation
    o Anorexia
    o Nausea/Vomiting
    o Abdominal distention
    o Bowel sounds are HYPOACTIVE
25
Q

HYPERcalcemia

Interventions for HYPERcalcemia

A
  1. Drug Therapy:
    o STOP IV fluids containing calcium (LR) and oral drugs containing calcium or vitamin D
    o IV fluids- 0.9% NS (helps kidneys to excrete calcium)
    o Thiazide diuretics are discontinued and replaced with diuretics that increase the excretion of calcium (furosemide)
    o Drugs that inhibit calcium reabsorption (phosphorus, calcitonin, bisphosphonates and prostaglandin synthesis inhibitors (aspirin, NSAIDS)
  2. Cardiac Monitoring:
    o Identify dysrhythmias
    o Compare ECG with patient’s baseline
    o Look for changes in T waves and QT interval and changes in rate and rhythm

Med Surg Unit 1 NURS 241 (6 decks)

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