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Critical Care Nursing > Electrolytes > Flashcards

Electrolytes Flashcards

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1
Q

HypoNAtremia

A

Na+ (sodium) level in the blood is <135

The concentration of sodium in the blood drops below normal

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2
Q

Causes of HypoNAtremia

A
  • Salt loss from the body is > water loss
    ex: diarrhea, NG suctioning, vomiting, sweating, salt-wasting diuretics
  • Body retains an excess amount of water compared to overall sodium level (dilution)
    ex: water intoxication, CHF, overuse of hypertonic solution
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3
Q

What do you observe with HypoNAtremia?

Increased Na+ Excretion vs Diluted Na+ level

A

Increased Na+: decreased skin turgor, dry mucous membranes, orthostatic HYPOtension, abdominal cramps

Diluted Na+: edema, crackles, distended JVD (chf)

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4
Q

If Na+ level continues to DECREASE?

A 
Headaches
Changes in LOC: 
-altered mental status
-extreme fatigue
-seizures
-coma
-death
***secondary to increased ICP and cerebral edema
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5
Q

How to treat HypoNAtremia

Increased Na+ excretion vs Diluted Na+ vs Extreme Neuro Symptoms

A

Increased Excretion:

  • fluid restriction
  • Sodium replacement
    • increased salt in diet, salt tabs,LR/ 0.9% NS

Diluted Na+:

  • Fluid restriction
  • Na+ restriction

Extreme Neuro Symptoms:
-Hypertonic IV Solution (3% NS)

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6
Q

HypERNAtremia

A

Na+ level in the blood is > 145

-The concentration of sodium in the blood is above normal

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7
Q

HypERNAtremia causes

A
  1. More salt than water is gained
    - excessive intake of Na+
    - fluid deprivation
    - Diabetes Insipidus (excessive ADH)
  2. More water than salt is lost
    - watery stools
    - Hyperventilation
    - Excessive diaphoresis
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8
Q

What to observe with HypERNAtremia

A 
*S.A.L.T.* 
S-skin flushed
A- agitation
L- low grade fever
T- thirst
-orthostatic hypotension 
-Weakness
-delusions/hallucinations
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9
Q

How to treat HypERNAtremia

A
  • Hypotonic Fluids ( D5W, 0.45% NS) or Isotonic
  • Salt wasting diuretics
  • Meds to suppress ADH (Desmopressin)
  • Increase fluid intake
  • Na+ restriction
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10
Q

NORMAL SODIUM LEVELS

A

135-145

-Helps to regulate fluid balance in the body

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11
Q

HypoKalemia

A

K+ level in the blood is < 3.5

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12
Q

NORMAL POTASSIUM LEVEL

A

3.5-5

Regulates a little of the fluid balance, but a lot of muscle contractions, and nerve signals

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13
Q

Causes of HypoKalemia

A
  • K* wasting diuretic (lasix)
  • Diarrhea/ Vomiting
  • NG suction
  • Inadequate intake (alcoholism, fasting/anorexia)
  • Chronic Kidney Disease
  • Excessive laxative use
  • Increased aldosterone
  • Diabetes-insulin causes shift
  • Metabolic Alkalosis
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14
Q

What to observe in HypoKalemia

A
  • *Levels below 3
  • Anorexia/ Fatigue
  • Muscle weakness/ cramping
  • N/V
  • Decreased bowl motility
  • Numbness/ tingling
  • Decreased deep tendon reflexes
  • Cardiac Arythmias (U wave)
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15
Q

How to treat HypoKalemia

Conservative vs Aggressive

A

Conservative:

  • Increased oral intake
  • K+ supplement

Aggressive:

  • IV replacement (K+ jumps)
  • **K+ can ONLY be given as IVPB
    • Peripheral Line= 20 mEq over 2 hrs
    • Central Line= 40 mEq over 2 hrs
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16
Q

HypERKalemia

A

Serum K+ level is > 5

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17
Q

Causes of HypERKalemia

A
  • increased K+ intake
  • K+ sparing diuretics
  • Dig-toxicity
  • Crush injuries /trauma/burns
  • Diabetes mellitis
  • Kidney failure
  • Decrease in aldosterone
  • rapid delivery/blood transfusions
  • metabolic acidosis
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18
Q

What to observe with HypERKalemia

A
  • Cardiac arythmias with EKG changes ( level > 6) ( T wave)
  • muscle weakness/ paralysis
  • nausea/ diarrhea

***Can lead to cardiac arrest (levels >8)

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19
Q

How to treat HypERKalemia

Conservative vs Aggressive

A

Conservative:

  • restrict K+ intake
  • Kayexalate (excretes K+ in stool)

Aggressive:

  • IV calcium gluconate (protects cardiac function)
  • IV insulin and dextrose solution
  • Dialysis w/ kidney failure
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20
Q

HypoCALCemia

A

Serum CA++ levels < 8.5

**Calcium level is opposite of phosphate levels

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21
Q

Causes of HypoCALCemia

A
  • limited CA++ in diet
  • Poor oral intake (malnutrition, alcoholism)
  • Hypoparathyroidism
  • Vitamin D deficiency
  • Medications (albumin based antacids)
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22
Q

What to observe with HypoCALCemia

A
  • **Levels < 4.4 (severe symptoms)
  • Tetany
  • Seizures
  • Trousseau Sign
  • Chvostek Sign
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23
Q

How to treat HypoCALCemia

A
  • increase oral intake of calcium
  • Vitamin D therapy
  • IV Calcium gluconate
  • IV calcium chloride
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24
Q

Nursing Management of HypoCALCemia

A
  • watch for patients w/ removed thyroid
  • osteoporosis
  • Seizure Precaution
  • Fall precaution
  • **Keep trach tray at bedside
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25
Q

HyperCALCemia

A

Serum CA++ levels > 10.2

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26
Q

What causes HyperCALCemia

A
  • malignancies
    • rapid and complete bone destruction
  • Hyperparathyroidism
  • **Can lead to CARDIAC ARREST
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27
Q

What to observe with HyperCALCemia

A

“Bones, stones, moans, groans”

  • bone pain, muscle weakness
  • Kidney stones
  • Anxiety, impaired memory, confusion, lethargy
  • GI pain, N/V, constipation, indigestion
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28
Q

How to treat HyperCALCemia

A
  • Treat the Cause
  • Chemotherapy
  • Partial Parathyroidectomy
  • Restrict CA++/ vitamin D intake
  • IV therapy- 0.9% NS to dilute CA++ levels and increase excretion
  • Ambulation
  • Calcitonin (intramuscularly)
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29
Q

NORMAL Magnesium Level

A
  1. 3-2.3
    - Aides in carbohydrate and protein metabolism
    - Important for neuromuscular function
    - Aides in vasodilation if cardiovascular system
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30
Q

HypOmagnesemia Causes

A

Low levels of magnesium

  • Alcohol withdrawal
  • NG suction
  • Diarrhea
  • IV glucose
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31
Q

HypERmagnesemia Causes

A
  • Kidney failure
  • Untreated DKA
  • Excessive use of: antacids, laxatives
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32
Q

HypOmagnesemia Symptoms

A
  • muscle twitches
  • weakness
  • tremors
  • Tetany
  • Trousseau’s Sign
  • Chvostek’s Sign
  • extreme agitation
  • torsadae’s de pointes
  • seizures
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33
Q

HypERmagnesemia Symptoms

A
  • HYPOtension
  • N/V
  • Lethargy
  • Trouble speaking
  • Paralysis
  • loss of DTRs
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34
Q

NORMAL Phosphorous

A
  1. 5-4.5
    - Helps with muscle and red blood cell function
    - Acid-base balance
    - Maintains nervous system
    - Provide strength for bones and teeth
    - Helps change food to energy
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35
Q

Hypophosphatemia Causes

A
  • Increase intake of carbs
  • Malnutrition
  • Alcoholism
  • Heat stroke
  • Liver failure
  • DKA
  • Low K+/Mg+ levels
  • hyperparathyroidism
  • immobile
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36
Q

HypERphosphatemia Causes

A
  • Kidney failure
  • Decreased urine output
  • Increased phosphorus intake
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37
Q

Hypophosphatemia Symptoms

A
  • irritable
  • fatigue
  • paresthesia
  • Difficult swallowing/speaking
  • Seizures
  • coma
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38
Q

HypERphosphatemia Symptoms

A
  • S/S of low Ca++
  • Anorexia
  • N/V
  • Bone/Joint pain
  • Hyperreflexia
  • Tachycardia
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39
Q

HypOphosphatemia Treatment

A
  • diet
  • Phosphorous supplements
  • Aggressive IV therapy (failing GI)
  • Alcohol cessation
  • Withdrawal protocols
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40
Q

HypERphosphatemia Treatment

A
  • Treat underlying cause
  • Kidney Failure
  • Respiratory/ Metabolic acidosis
  • diet
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41
Q

Why would a nurse give insulin and dextrose solution to a patient with HypERKalemia?

A

Because insulin opens up our cells for K+ to return to where it should be and the dextrose will balance out the increase in insulin

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42
Q

What does aldosterone do to sodium and potassium?

A

If sodium increases more potassium will be excreted

43
Q

Renin-Angiotensin-Aldosterone System

A

If sodium and potassium are increased or decreased kidneys stimulate aldosterone release

44
Q

Intracellular Space (ICS)

A

fluid inside the cells

45
Q

Extracellular Space (ECS)

A

fluid outside the cells

46
Q

The ECF is further divided into what?

A

intravascular
interstitial
transcellular

47
Q

What is the intravascular space?

A

fluid w/in the blood vessels

48
Q

The interstitial space contains what?

A

fluid b/t the cells, tissues, organs, and blood vessels

49
Q

What is an Interstitial Fluid Shift (Third Spacing)?

A

loss of ECF into a space that does not contribute to equilibrium b/t the ICF and ECF

50
Q

Early Evidence of Third Spacing

A

decrease in urine output despite adequate fluid intake

51
Q

What happens during Third Spacing?

A

Urine output decreases because fluid shifts out of the IVS; the kidneys receive less blood and try to compensate by decreasing urine output

52
Q

S/S of Third Spacing

A
  • increased HR
  • decreased BP
  • decreased CVP
  • edema
  • increased weight
  • imbalances in I/O’s
53
Q

What side effects are associated w/ Hyperkalemia?

A
  • cardiac arrhythmias/arrest
  • muscle weakness/damage
  • kidney failure
  • acidosis
54
Q

Normal movement of fluid through the capillary wall into the tissues is dependent on what two forces?

A
  • capillary hydrostatic pressure generated by cardiac contraction and exerted by plasma on walls of vessels
  • plasma oncotic pressure exerted by plasma proteins
55
Q

At the arterial end of the capillary bed fluids are filtered b/c of what?

A

Hydrostatic pressure exceeds oncotic pressure

56
Q

When do fluids re-enter the capillary?

A

Constant oncotic pressure exceeds hydrostatic pressure at the venous end of the capillary

57
Q

What is a normal osmotic pressure?

A

270-310

58
Q

What is Osmosis?

A

movement of water caused by a concentration gradient

59
Q

What determines the Osmolality of a solution?

A

the number of dissolved particles contained in a unit of fluid

60
Q

Tonicity

A

ability of all the solutes to cause an osmotic driving force that promotes water movement from one compartment to another

61
Q

Intravenous solutions are termed as what?

A
  • isotonic
  • hypotonic
  • hypertonic
62
Q

What does it mean if a solution is termed Isotonic?

A

it has the same effective osmolality as body fluids

63
Q

What is Osmotic diuresis?

A

increase in urine output

64
Q

What causes Osmotic diuresis?

A

excretion of substances such as Glucose, Mannitol, or contrast agents in the urine which exert an osmotic pull on water

65
Q

What happens when glucose is excreted in the urine?

A

It will bring water causing Polyuria w/ resulting FVD

66
Q

Diffusion

A

natural tendency of substance to move from an area of high concentration to one of low concentration

67
Q

Filtration

A

movement of water/solutes occurs from an area of high hydrostatic pressure to low hydrostatic pressure

68
Q

How does sodium tend to enter the cell?

A

Diffusion

69
Q

The Sodium-Potassium Pump moves sodium from the cell to where?

A

ECF

70
Q

Osmolality

A

the concentration of fluid that affects the movement of water b/t fluid compartments by osmosis

71
Q

Serum Osmolality primarily reflects the concentration of what?

A

Sodium

72
Q

What is the most reliable indicator of the concentrating abilities of the kidneys?

A

Serum osmolality measured w/ urine osmolality

73
Q

When concerned about renal concentrating ability what will be obtained at the same time?

A

Serum and urine osmolality test

74
Q

What is the normal ratio of urine and serum?

A

3:1

75
Q

The specific gravity of urine measures what?

A

the kidney’s ability to excrete or conserve water

76
Q

What is the normal range of urine specific gravity?

A

1.010 to 1.025

77
Q

Why is specific gravity a less reliable indicator of concentration than urine osmolality?

A

B/c it is influenced by both the number and size of particles in the urine

78
Q

What is a normal BUN level?

A

10-20

79
Q

Factors that increase BUN levels are?

A
  • decreased kidney function
  • GI bleeding
  • dehydration
  • increased protein
  • fever/sepsis
80
Q

Factors that decrease BUN are?

A
  • end stage liver disease
  • low protein diet
  • starvation
  • SIADH
  • expanded fluid volume (pregnancy)
81
Q

What is a better indicator of kidney function than BUN?

A

Creatinine

82
Q

Why is creatinine better than a BUN?

A

B/c it does not vary w/ protein intake and metabolic state

83
Q

Normal Serum Creatinine

A

0.6-1.4

84
Q

FVD or Hypovolemia

A

loss of ECF volume exceeds the intake of fluid

85
Q

When does Hypovolemia occur?

A

when water AND electrolytes are lost in the same proportion as they exist in normal fluids

86
Q

Dehydration

A

loss of water ALONE with increased serum sodium levels

87
Q

Causes of FVD

A
  • vomiting
  • diarrhea
  • GI suctioning
  • fever
  • sweating
  • burns
  • diabetes insipidus
  • diuretics
  • hemorrhage
88
Q

S/S of Hypovolemia

A
  • weight loss
  • decreased skin turgor
  • oliguria
  • postural hypotension
  • weak rapid HR
  • decreased CVP
  • cool, clammy skin
89
Q

Lab Results for patient w/ Hypovolemia/Dehydration

A
  • elevated BUN
  • elevated hematocrit/hemoglobin
  • elevated serum osmolarity
  • elevated glucose
  • elevated protein
  • hemoconcentration
90
Q

What is frequently used to treat hypotensive patients w/ FVD?

A

Isotonic Electrolyte Solutions (Lactate Ringer, 0.9% sodium chloride) b/c they expand plasma volume

91
Q

Weight loss is common w/ FVD, but if the patient is edematous or third spacing the nurse may see what?

A

Weight gain

92
Q

FVD or Hypervolemia

A

abnormal retention of water secondary to an increase in overall sodium content

93
Q

Hypervolemic Hyponatremia

A

increased volume that decreased sodium related to dilution

94
Q

S/S of FVE

A
  • edema
  • JVD
  • crackles
  • tachycardia/bounding pulse
  • increased BP/pulse pressure/CVP
  • increased urine output
  • dyspnea
95
Q

Lab Values for Hypervolemia due to hemodilation

A
  • decreased BUN
  • decreased HCT
  • azotemia
96
Q

Management for Hypervolemia

A
  • fluid and Na+ restriction
  • diuretic therapy
  • hourly I/O’s
  • hemodialysis w/ impaired kidney failure
  • monitor ABG’s/labs
97
Q

Causes of Edema

A
  • increased venous pressure/DVT
  • lymphatic drainage system
  • decreased plasma albumin
  • increased capillary leakage
  • infections
98
Q

Acidosis leads to what?

A

Hyperkalemia

99
Q

Alkalosis leads to what?

A

Hypokalemia

100
Q

Oral potassium can produce what?

A

Small-bowel lesions

101
Q

Patients taking oral potassium must be cautioned and assessed for what?

A

abdominal distention
pain
GI bleed

102
Q

Potassium should only be administered after what has been established?

A

Adequate urine flow

103
Q

What is an indication to stop a potassium infision?

A

urine volume less than 20 mL/hr for 2 consecutive hours

104
Q

Potassium should never be administered how?

A

IV push or IM

W/o an infusion pump

Critical Care Nursing (14 decks)

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