Electrolytes Flashcards
what electrolyte prefers living inside cells
potassium
what electrolyte prefers living outside the cell
sodium
Hyponatremia
sodium less than 135
sodium loss or water retention
less sodium to move across membranes, causes delayed polerization
fluid shifts into cells to follow higher concentration
causes of hyponatremia
excessive sweating w/o electrolyte addition
SIADH
too much hypotonic fluid
GI Losses
REnal losses
Skin losses
fasting diets
cirrhosis, heart failure, Primary hypoaldosteronism
Hyponatremia (ECFVD) manifestations
Lethargy, neuro changes, cold and clammy skin, dry mucous membranes, postural hypotension, decreased jugular venous filling, increased, thready pulse
Hyponatremia (ECFVE/normal)
CNS/neuro changes, nausea vomiting diarrhea, weight gain, increased BP/ bounding pulse
hyponatremia management/interventions
diuretics or sodium reintroduction, pushing food high in sodium
.9 sodium chloride, .4NaCl
fluid shifting back into vascular space
Seizure/fall precautions
Hypernatremia
Water loss/ Na gain
NA> 145
Increased NM excitability
fluid shift to ECf cauing cellular dehydration
causes of hypernatremia
Excessive diuretics, fluid loss from VOmiting/diarrhea, excessive sodium intake, inadequate water intake, insensible water loss, osmotic diuretic therapy, diabetes insipidus, uncontrolled diabetes, cushing syndrome
hypernatremia manifestations
neuromuscular excitability- twitching, cramps
tachycardiac sinus rhythm
dry cracked lips, seizures, hyperactivity increased BP edema, intense thirst
hypernatremia management/intervention
fluid to bring sodium down/ salt out
correct body osmolality
if dehydrated, hypotonic
if sodium excess, diuretics, hypotonic, sodium restriction
i/os, daily weightss, seizure precaution, food/water re-education
Hypokalemia
potassium less than 3.5
causes of hypokalemia
dialysis, diaphoresis, GI losses, renal losses (diuretics)
extreme insulin therapy
low potassium diet/ malnutrition
hypokalemia manifestations
constipation, nausea, paralytic ileus, fatigue, hyperglycemia, irregular, weak pulse, muscle weakness, decreased reflexes, shallow respirations
Presence of U wave
hypokalemia intervnetions/management
replacing k w/ pills/IV (cannot be given as a bolus)
Low K typically= low mg, give mg first
avocado, tomatoes, potatoes,
Hyperkalemia
potassium greater than 5
usually only w/ kidney failure and those not going to dilalysis
traumas, tumor pateint starting chemo
hyperkalemia causes
excess intake thrugh meds
acidosis, intense excersise, fever, crush injury, sepsis
Adrenal insufficiency, k-sparing diuretics, NSAIDS
Hyperkalemia manifestations
abdominal cramping, diahhreha, vomiting
confusion, fatigue, irregular pulse, muscle weakness/ cramps, loss of muscle tone, tall tented T-waves, asystole
Hyperkalemia management/interventions
Kaytyexalate, IV saline, wasting diuretics like lasix, push insulin to pusk K back into cells
remind importance of dialysis
kayexalate
medication that binds to K in the Gi tract, Treatment for hyperkalemia
The nurse is taking a history of a newly admitted 86-year old patient. Which factor may indicate that the client is at risk for developing hypernatremia?
The patient has been on a diet high in potassium.
The patient does not drink sufficient fluids.
The patient has been drinking excessive amounts of tap water.
The patient has had frequent urinary tract infections
The patient does not drink sufficient fluids.
In elderly patients, the thirst mechanism may be weakened. Inadequate water intake will lead to hypernatremia. From Harding text page. 312. Test taking strategy: Process of elimination, potassium is not directly correlated with sodium, drinking excessive amounts of water would lead to hyponatremia, and UTIs are not directly related to sodium balance.
which sodium imbalance present with lethargy and fatigue
hyponatremia
which sodium imbalance present with agitation
hypernatremia
which sodium imbalance present with increased ICP
hyponatrmia
fluid will go to area of high concentration- insdie cells, increasing ICP
which sodium imbalance present with decreased deep tendonm reflexes
hyponatremia
which sodium imbalance present with edema
hyponatremia
which sodium imbalance present with dry mucuos memebranes
hypernatremia
which potassium imbalance present with muscle cramps
hypokalemia
which potassium imbalance present with u-wave on EKG
hypokalemia
which potassium imbalance present with decreased GI mobility
hypokalemia
which potassium imbalance present with cardiac asystole
hyperkalemia
which potassium imbalance present with peak T_wave on EKG
hyperkalemia
which potassium imbalance present with Diarrhea
hyperkalemia
The patient with a history of renal failure develops hyperkalemia. The healthcare provider prescribes sodium polystyrene sulfonate (Kayexalate) to reduce serum potassium level. What is the action of this medication?
Shifts potassium into the cells.
Promotes renal excretion of potassium.
Pulls potassium into the bowel for excretion.
Binds potassium to albumin.
Pulls potassium into bowel for excretion
The patient is diagnosed with Clostridium Difficile associated diarrhea. Which laboratory data warrants immediate intervention by the nurse?
A serum sodium level of 137 mEq/L
Arterial blood gasses of pH 7.37, PaO2 95, PCO2 43, HCO3 24.
A serum potassium of 3.0 mEq/L.
A stool sample positive for Clostridium Difficile
serum potassium
GI losses lead to loss of potassium which can then lead to cardiac changes warranting immediate action.
