Electrolytes

Question 1

Sodium levels

Answer 1

136-145

Question 2

Potassium levels

Answer 2

3.5-5.0

Question 3

Calcium levels

Answer 3

9.0-10.5

Question 4

Phosphate levels

Answer 4

3.0-4.5

Question 5

Magnesium levels

Answer 5

1.3-2.1

Question 6

Maintaining normal nerve and muscle function, regulation of acid-base balance

Answer 6

Sodium Role

Question 7

Imbalances for sodium

Answer 7

Hypernatremia

Hyopnatremia

Question 8

a. Increased free water loss or increased sodium gain
b. Causes hyperosmolality (shifts out of cell) leading to cellular dehydration
c. Body’s protection – thirst!

Answer 8

Hypernatremia

Question 9

a. Clinical Manifestations; hypernatremia

Answer 9

i. Excessive thirst
ii. Cognitive dysfunction
iii. Signs of volume depletion if there is volume deficit

Question 10

Nursing interventions/treatment: hypernatremia

Answer 10

i. Monitor VS, assessments, fluid status
ii. Treat the underlying cause!
1. Free water loss - IV Fluids (hypotonic or isotonic)
2. Abnormal sodium gain – Sodium-free IVF + diuretic
iii. Monitor sodium levels and response to treatment

Question 11

a. Results from excess water intake or abnormal sodium/water loss
b. Can be an isolated event or occur secondary to other illnesses

Answer 11

Hyponatremia Na <136

Question 12

Clinical manifestations: Hyponatremia

Answer 12

i. Mild to severe neurological symptoms

ii. Headache, irritability, confusion, lethargy, seizures, coma

Question 13

Treatment: hyponatremia
if excess water:
if abnormal fluid loss is cause;

Answer 13

i. Euvolemic - fluid restriction
ii. If excess water is cause – diuretics
iii. If abnormal fluid loss is cause – administer isotonic fluids, encourage fluid intake

Question 14

Excess water:

Answer 14

i. Fluid restriction may be only treatment
ii. Loop diuretics and demeclocycline
iii. Severe symptoms (seizures)
iv. Give small amount of IV hypertonic saline solution (3% NaCl)

Question 15

Abnormal fluid loss

Answer 15

i. Fluid replacement with isotonic sodium-containing solution
ii. Encouraging oral intake
iii. Withholding diuretics

Question 16

i. Promotes normal function of nerve and muscle cells, maintains normal electricity of the heart, aids in movement of nutrients and waste products, cellular growth, acid-base balance

Answer 16

Potassium

Question 17

Clinical manifestations: Hyperkalemia

Answer 17

i. Cardiac arrhythmias
ii. Fatigue, confusion
iii. Muscle cramps (tetany)
iv. Weak or paralyzed skeletal muscles
v. Abdominal cramping, diarrhea

Question 18

Meds for K excretion

Answer 18

diuretics, dialysis, Veltessa and/or Kayexalate (in stool)

calcium gluconate

Question 19

a. Results from increased loss of K+ via the kidneys or GI tract
i. Secondary to being overdiuresed or diarrhea/vomiting

Answer 19

Hypokalemia

Question 20

Manifestations: hypokalemia

Answer 20

i. Cardiac most serious
1. Cardiac arrythmias
ii. Skeletal and smoothe muscle weakness
iii. Decreased GI motility
iv. Hyperglycemia

Question 21

Administer KCl through

Answer 21

PO or IV NEVER PUSHING OR BOLUS

Question 22

i. Formation of teeth and bone
ii. Blood clotting
iii. Transmission of nerve impulses
iv. Myocardial contractions
v. Muscle contractions

Answer 22

Calcium

Question 23

Increases calcium deposition into bone, increases renal calcium excretion, and decreases GI absorption

Answer 23

Calcitonin

Question 24

Calcium balance controlled by:

Answer 24

Parathyroid hormone

Question 25

a. High levels of serum calcium caused by | i. Hyperparathyroidism (two-thirds of cases)

Answer 25

Hypercalcemia

Question 26

Manifestations; Hypercalcemia

Answer 26

i. Fatigue, lethargy, weakness, confusion ii. Hallucinations, seizures, coma iii. Dysrhythmias iv. Bone pain, fractures, nephrolithiasis (kidney stones) v. Polyuria, dehydration

Question 27

Implementation; hypercalcemia

Answer 27

1. Low calcium diet 2. Increased weight-bearing activity 3. Increased fluid intake (3k-4k L) 4. Hydration with isotonic saline infusion 5. Bisphosphonates—gold standard 6. Calcitonin a. Immediate effect

Question 28

a. Low serum Ca levels caused by i. Decreased production of PTH (parathyroid hormone) ii. Multiple blood transfusions iii. Alkalosis iv. Increased calcium loss

Answer 28

Hyopcalcemia

Question 29

Manifestations hypocalcemia

Answer 29

i. Positive Trousseau’s or Chvostek’s sign 1. Trousseau’s: BP on cuff, inflate for a few minutes-will have carpal spasms 2. Chvostek’s: Tap on facial nerve, facial twitching ii. Laryngeal stridor 1. Noisy respirations iii. Dysphagia iv. Numbness and tingling around the mouth or in the extremities v. Dysrhythmias

Question 30

treatment of hypocalcemia

Answer 30

i. Treat cause ii. Calcium and Vitamin D supplements iii. IV calcium gluconate iv. Rebreathe into paper bag v. Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis

Question 31

b. Essential to function of muscle, red blood cells, and nervous system d. Serum levels controlled by parathyroid hormone e. Maintenance requires adequate renal functioning

Answer 31

Phosphate (anion) in ICF

Question 32

Hyperphosphatemia Phos caused by:

Answer 32

i. Acute kidney injury or chronic kidney disease ii. Excess intake of phosphate or vitamin D iii. Hypoparathyroidism

Question 33

Hyperphosphatemia manifestations

Answer 33

i. Tetany, muscle cramps, paresthesias, hypotension, dysrhythmias, seizures (hypocalcemia) ii. Calcified deposition in soft tissue such as joints, arteries, skin, kidneys, and corneas (cause organ dysfunction)

Question 34

V. Hyperphosphatemia management

Answer 34

i. Identify and treat underlying cause ii. Restrict intake of foods and fluids containing phosphorus 1. Milk, beans iii. Oral phosphate-binding agents 1. Calcium carbonate iv. Hemodialysis v. Volume expansion and forced diuresis vi. Correct any hypocalcemia

Question 35

a. Cofactor in enzyme for metabolism of carbohydrates b. Required for DNA and protein synthesis c. Blood glucose control d. BP regulation

Answer 35

Magnesium

Question 36

i. Increased intake of products containing magnesium when renal insufficiency or failure is present ii. Excess IV magnesium administration

Answer 36

hypermagnesmia

Question 37

hypermagnesmia manifestations

Answer 37

i. Hypotension, facial flushing ii. Lethargy iii. Nausea and vomiting iv. Impaired deep tendon reflexes v. Muscle paralysis vi. Respiratory and cardiac arrest—can lead to coma

Question 38

i. Prolonged fasting or starvation ii. Chronic alcoholism iii. Fluid loss from GI tract iv. Prolonged parenteral nutrition without supplementation v. Diuretics, proton-pump inhibitors vi. Hyperglycemic osmotic diuresis

Answer 38

Hypomagnesemia

Question 39

Manifestations; hyopmagnesemia

Answer 39

i. Resembles hypocalcemia 1. Muscle cramps, tremors 2. Hyperactive deep tendon reflexes 3. Chvostek’s and Trousseau’s signs 4. Confusion, vertigo, seizures

Question 40

Hypophosphatemia causes

Answer 40

Malnurishment/malabsorption diarrhea use of phosphate-binding antacids inadequate replacement during parenteral nutrition

Question 41

Hypophosphatemia Manifestations

Answer 41

CNS depression Muscle weakness/p! Rickets (bow legged) & osteomalacia (softening of bones)