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NRS 105 Exam #1 > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Hypernatremia
Definition

A

Serum Sodium (Na) > 145 mEq/L
Excess of serum sodium due to:
* Water loss or sodium gain
* causes hyperosmolality leading to cellular dehydration (water moves from ICF ➡️ ECF)
* Primary protection is the thirst signal from the hypothalamus

More a water disorder than a sodium disorder. Too little water and/or too much salt

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2
Q

Hypernatremia
Clinical Manifestations

A
  • Thirst
  • ⬆️ HR
  • ⬆️ BP
  • ⬆️ Body Temperature
  • Swollen, dry tongue
  • Sticky mucous membranes
  • hallucinations
  • lethargy
  • restlessness, irritability
  • simple partial or tonic-clonic seizures
  • hyperreflexia
  • twitching
  • nausea, vomiting, anorexia
  • ⬇️ urine specific gravity and osmolality
  • ⬇️ urine sodium
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3
Q

Hypernatremia
Risk Factors

A
  • Very old
  • Very young
  • cognitively impaired
  • Can occur in normal fluid volume, FVD, and FVE
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4
Q

Hypernatremia
Causes

A
  • Excess sodium intake
  • High sodium diet
  • Hypertonic IVF
  • Fluid deprivation
  • Heat stroke
  • Diabetes Insipidus
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5
Q

Hypernatremia
Treatment

A
  • Gradual lowering of serum sodium with hypotonic IVF (0.45% NaCl) or isotonic nonsaline solution (D5W) 0.45% NaCl is safer
  • Diuretics
  • Reduce serum sodium no faster than 0.5 to 1 mEq/L/h
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6
Q

How does Sodium (Na) play a role in the body?

A
  • Plays a major role in ECF volume and osmolality
  • Generation and transmission of nerve impulses
  • Muscle contractility
  • Acid-base balance
  • Major cation in the ECF
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7
Q

Hyponatremia
Definition

A

Serum Sodium < 135 mEq/L
* Insufficient serum sodium
* Loss of more salt than water

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8
Q

Hyponatremia
Clinical Manifestations

A
  • Anorexia, nausea, vomiting
  • Headache
  • Lethargy
  • dizziness
  • confusion
  • muscle cramps/weaknesss/twitching
  • seizures
  • dry skin
  • weight gain
  • edema
  • ⬇️ Blood pressure
  • ⬆️ HR
  • ⬇️ urine specific gravity and osmolality
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9
Q

Hyponatremia
Risk Factors

A
  • Adrenal insufficiency
  • Heart failure
  • Hyperglycemia
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10
Q

Hyponatremia
Causes

A
  • SIADH
  • N/V/D
  • Adrenal Insufficiency
  • Acute: Fluid overload in surgical/sepsis patient
  • Exercising in extreme temps, excess water intake, prolonged exercise time
  • Medications: anticonvulsants, SSRIs, desmopressin acetate
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11
Q

Hyponatremia
Treatment

A
  • Replacement of sodium through mouth, ng tube, or parenteral routes
  • Lactated Ringers or 0.9% NaCl solutions (isotonic)
  • Water restriction (if normal or FVE)
  • Increase sodium no faster than 12mEq/L in 24 hours
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12
Q

How does Potassium play a role in the body?

A
  • Major ICF cation
  • Transmission and conduction of nerve and smooth muscle impulses
  • Cellular growth
  • Maintenance of cardiac rhythms
  • Acid-base balance
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13
Q

Hyperkalemia
Definition

A

Serum Potassium > 5mEq/L
* Excessive serum potassium

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14
Q

Hyperkalemia
Clinical Manifestations

A

Increased cell excitability:
* Changes in cardiac conduction (loss of P wave, prolonged PR Interval, widening of QRS)
* Tall peaked T waves
* Heart block, ventricular fibrillation, cardiac arrest

Muscle Weakness
Abdominal and/or leg cramps
Diarrhea

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15
Q

Hyperkalemia
Causes

A

Excess intake
* Salt substitutes
* Rapid parenteral administration

Internal Shift: K+ shifting out of cells
* Acidosis (DKA)
* Rhabdomyolysis, severe burns, crush injuries

Retention
* Renal injury or disease
* Medications: ARBs, ACE inhibitors, Beta Blockers, potassium sparing diuretics

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16
Q

Hyperkalemia
Treatment

A

Interventions based on severity!
* Monitor ECG, apical pulse
* Limit oral and parenteral K+ intake
* Increase elimination of K+: potassium wasting diuretics, sodium polystyrene sulfonate (Kalexate), dialysis (severe cases)
* Force K+ from ECF to ICF by IV insulin and glucose (severe cases: symptomatic or > 6.5)
* Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV

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17
Q

Hypokalemia
Definition

A

Serum Potassium < 3.5 mEq/L
* Inadequate serum potassium

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18
Q

Hypokalemia
Causes

A
  • Increased loss of K+ via the kidneys (by loop or thiazide diuretics)
  • GI tract losses
  • Increased shift of K+ from the ECF to ICF
  • Magnesium deficiency
  • Metabolic alkalosis
  • Dietary K+ deficiency (anorexia, fasting)
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19
Q

Hypokalemia
Clinical Manifestations

A
  • Hyper-polarization of cells impairs muscle contraction
  • Cardiac (ST segment depression, prolonged QRS, Heart Blocks, ventricular dysrhythmias)
  • Skeletal muscle weakness (legs), cramps
  • Weakness of respiratory muscles
  • Decreased GI motility (constipation)
  • Impaired regulation of arteriolar blood flow
  • Hyperglycemia
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20
Q

Hypokalemia
Treatment and Nursing Interventions

A
  • Monitor ECG for changes
  • Check urine output before administering K+ (to make sure they are able to excrete normally)
  • KCl supplements orally or via IV
  • NEVER give KCl via IV Push or as a bolus
  • Always dilute IV KCl
  • Should not exceed 10mEq/hr to prevent hyperkalemia and cardiac arrest

`

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21
Q

How does calcium play a role in the body?

A
  • Formation of teeth and bones
  • Blood Clotting
  • Transmission of nerve impulses
  • Myocardial contractions
  • Muscle contractions
22
Q

What controls calcium balance in the body?

A

Parathyroid Hormone (PTH):
* production and release stimulated by LOW serum calcium levels
* Increases bone resorption (breaks down bone to release Ca)
* Increases GI absorption of Ca
* Increases renal reabsorption of Ca

Calcitonin
* produced by the thyroid in response to HIGH serum calcium levels
* opposes the action of PTH

23
Q

Hypocalcemia
Definition

A

Serum calcium < 8.8 mg/dL
* Inadequate calcium in the blood

24
Q

Hypocalcemia
Causes

A

Less calcium entering the blood
* Inadequate Vit. D, malnutrition (poor Ca intake)
* Decreased production of PTH (hypothyroidism, surgery)
* Chronic renal failure

Excess Excretion
* Renal insufficiency
* Burns, Rhabdo
* Pancreatitis, cirrhosis
* Diarrhea, laxative abuse

Multiple Blood Transfusions
* from added citrate in blood packages

25
**Hypocalcemia** Clinical Manifestations
* **Tetany** (Positive Trousseau's or Chvostek's sign) * Laryngeal stridor * Dysphagia * Perioral (or lips/fingertips/toes) tingling * Cardiac dysrhythmias
26
**Hypocalcemia** Treatment/Nursing Interventions
* Treat underlying cause * **Oral calcium** and **vitamin D** supplements * IV **calcium gluconate** * **seizure precautions** * Weight-bearing **exercise** to decrease bone calcium loss * Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
27
**Hypercalcemia** Definition
**Serum Calcium > 10.5mg/dL** * Excessive calcium in the blood
28
**Hypercalcemia** Causes
* **Hyperparathyroidism** *(2/3 of cases)* * Malignancy *(1/3 of cases)* * RARE: excessive intake, prolonged immobilization, excess Vit. D
29
**Hypercalcemia** Clinical Manifestations
* **Neuro:** fatigue, lethargy, muscle weakness, stupor, coma, depressed reflexes, decreased memory, confusion, personality changes, psychosis * **ECG Changes** * Anorexia, nausea, vomiting * **Bone pain**, fractures * Flank pain from nephrolithiasis (kidney stones) * Polyuria, dehydration
30
**Hypercalcemia** Treatment/Nursing Interventions
* Increase fluid intake & calcium excretion with loop diuretics * Hydration with isotonic saline infusion * Low calcium diet * Mobilization * Synthetic calcitonin * Bisphosphonates (in cases of malignancy)
31
What role does Phosphate play in the body?
* Primary **anion** in the **ICF** * Located primarily in bones and teeth * Essential to muscle function * Essential for Red Blood Cells * Essential for nervous system * Involved in: Acid-base buffering, ATP production, cellular uptake of glucose, metabolism of carbohydrates, proteins, and fats
32
How is Phosphate controlled in the body?
* Serum levels controlled by Parathyroid Hormone * Requires adequate renal functioning * **Reciprocal relationship with Calcium**
33
**Hyperphosphatemia** Definition
**Serum Phosphate > 4.5mg/dL** Excessive phosphate in the blood
34
**Hyperphosphatemia** Causes
* AKI or CKD *(Acute Kidney Insufficiency/Chronic Kidney Disease)* * Chemotherapy * Hypoparathyroidism (Increases phosphate reabsorption) * Tumor lysis, rhabdo * Excessive intake of phosphate or Vitamin D (laxatives and dairy products)
35
**Hyperphosphatemia** Clinical Manifestations
* Often **asymptomatic** *(unless calcium binds to phosphate... hypocalcemia)* * Neuromuscular irritability and tetany *(hypocalcemia)* * Long term increase results in calcified deposits in soft tissue *(joints, arteries, skin, kidneys, corneas)*
36
**Hyperphosphatemia** Treatment/Nursing Interventions
* Identify and treat underlying cause * Restrict foods and fluids containing phosphorous * Calcium binding agents *(Calcium carbonate)* * Adequate hydration and correction of hypocalcemic conditions * Normal Saline IV with loop diuretics * Hemodialysis *(if severe/symptomatic)*
37
Foods high in Phosphorous
* Dairy products * Chicken, turkey, pork * Seafood * Lima beans, green peas
38
**Hypophosphatemia** Definition
**Serum phosphate < 2.7 mg/dL** LOW phosphorous in the blood
39
**Hypophosphatemia** Causes
* Malnourishment/malabsorption * Diarrhea * (ETOH) Alcohol abuse * Use of phosphate binding antacids *(Tums)* * During parenteral nutrition with inadequate replacement
40
**Hypophosphatemia** Clinical manifestations
* Mild to moderate *(often asymptomatic)* **Extreme/Rare:** * CNS depression, confusion * Cardiomyopathy * Respiratory failure
41
**Hypophosphatemia** Treatment/Nursing Intervention
* Ingestion of foods high in phosphorous * Oral phosphate supplements *(Powder diluted in water)*: sodium or potassium phosphate * IV administration of sodium or potassium phosphate if severe
42
How does Magnesium play a role in the body?
* Required for **DNA** and **protein** synthesis * Necessary for the **sodium-potassium pump** * Important for normal **cardiac** function **Absorbed in the GI tract** **Excreted primarily through the kidneys (and stool)** **50%-60% contained in bone**
43
**Hypermagnesemia** Definition
**Serum magnesium > 2.6mg/dL** Excessive magnesium in the blood
44
**Hypermagnesemia** Causes
* Increased intake of products containing magnesium combined with renal insufficiency *(Maalox, Milk of Mag.)* * Treatment of migraines or menstrual cramps * Excess intravenous magnesium administration *(Tx for eclampsia)* * Decreased output *(End Stage Renal Disease, Acute Kidney Insufficiency, Adrenal Insufficiency)*
45
**Hypermagnesemia** Clinical Manifestations
* Acts as a sedative * ECG changes * Hypotension * Lethargy/Somnolence * Nausea/vomiting * Impaired Reflexes * Respiratory and cardiac arrest
46
**Hypermagnesemia** Treatment/Nursing Interventions
**Prevention first!** **Emergency treatment for symptomatic pts:** * IV Calcium gluconate (to antagonize the effects on the membrane) * 1-2 g. IV (max 0.5-2mL/min) * May repeat as needed * Fluids and IV furosemide to promote urinary excretion * Dialysis if renal function is impaired
47
**Hypomagnesemia** Definition
**Serum magnesium level < 1.8mg/dL** Low magnesium in the blood
48
**Hypomagnesemia** Causes
* Prolonged fasting/starvation * Chronic alcoholism * Fluid loss from GI tract * Prolonged parenteral nutrition without supplementation * Diuretics * Large Blood transfusion
49
**Hypomagnesemia** Clinical Manifestations
* Hyperactive deep tendon reflexes * Muscle cramps * Tremors * Seizures * Cardiac dysrhythmias *(Torsade de pointes, Vfib)* * Corresponding hypocalcemia and hypokalemia
50
**Hypomagnesemia** Treatment/Nursing Interventions
* Treat underlying condition * Monitor ECG * Seizure precautions * Oral supplements * Increase dietary intake of magnesium containing foods * IV magnesium when severe
51
Foods high in Magnesium
* Green vegetables * Nuts * Bananas * Oranges * Peanut Butter * Chocolate
52
Foods high in Potassium
* Spinach * Bananas * Potatoes * Avocado * Sweet Potatoes * Tomatoes * Oranges

NRS 105 Exam #1 (6 decks)

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