Electrolytes & Central Lines Flashcards
Exam 2
ELECTROLYTE DISORDERS
Hypernatremia/Hyponatremia
Hyperchloremia/Hychloremia
Hyperkalemia/Hypokalemia
Hypermagnesemia/Hypomagnesemia
Hypercalcemia/Hypocalcemia
Hyperphosphatemia/Hypophosphatemia
Sodium: Normal ranges
135-145 mEq/L
Sodium: Where is it located?
Extracellular
Sodium: What does it control?
Controls the distribution of water in the body
Sodium: What is it controlled by?
Controlled by thirst, ADH and the renin- angiotensin –aldosterone system
Sodium: What is it made up of?
Positively charged and chloride ions are negatively charged
Sodium: When is low sodium seen?
Low sodium in hyponatremia and is seen is people who have issues eliminating water.
Sodium: What is the primary result of sodium retention?
Edema is the primary result of retention
Sodium: What is hyponatremia?
Hyponatremia (less than 135)
Sodium: What are clinical manifestations of hyponatremia?
diarrhea,
vomiting,
perspiration,
hyperglycemia
polydipsia,
weight loss,
orthostatic hypotension
Headache,
confusion,
seizures,
lethergy
Hypernatremia: What are clinical manifestations?
-neuromuscular irritability
-restlessness
-Coma
-seizures
-signs of dehydration
What are signs of dehydration (Hypernatremia)
signs of dehydration
(tachycardia, dry mucus membranes, decrease urine output, flushed skin)
Hypernatremia:
What is the treatment for this?
Medical management 0.45 % NaCl or 5 % dextrose
Hypernatremia: Who is at risk of having high sodium?
-Diabetes Insipidus,
neoplasms,
hypercalcemia
-lithium,
SSRI
-hyperventilation,
Burns and exercise
Chloride: What are normal values?
97 to 107 mEq/L
What does chloride help with?
Maintaining pressure within the body
Maintain the osmotic pressure
How is chloride reabsorbed and excreted?
Excretion and reabsorption of chloride in the kidney
What are chloride levels parallel with?
Low sodium is low chloride ( parallel)
What is treatment for low chloride?
Treatment (Normal saline/ half NS)
What causes hypochloremia?
Hypochloremia –severe vomiting, burns , chronic respiratory acidosis, nasogastric suctioning and Addison’s disease
What are you monitoring for with hypochloremia?
Monitoring for changes in consciousness, respiratory efforts and muscle control
What are clinical manifestations of hyperchloremia?
-deep, rapid respirations
-tachypnea
-elevated blood pressure
-decreased cognitive ability
-lethargy
Hyperchloremia:
Nursing management: What needs to be monitored?
Changes in neurological
Cardiac changes
Respiratory status
Monitor hypertension
Hyperchloremia:
Nursing management: What actions need to be taken?
Adequate hydration
Education to avoid foods like cheese, eggs, canned vegs , processed meat and bananas
Potassium: What are normal values?
3.5 to 5.3 mEq/L
Potassium: What controls the movement of potassium?
Sodium-potassium pump controls the movement of potassium into and out of cells as needed for neuromuscular functions
What does potassium help with?
Protein synthesis
What is medical management of high or low potassium?
-oral or parental routes (cardiac monitoring )
What is normal about IV potassium?
It burns
How is potassium NEVER administered?
Never iv push
If someone needs to be on potassium for an extended period of time, what do you have to do?
Make sure they are on a cardiac monitor
What are signs and symptoms of low potassium?
-diarrhea,
vomiting,
anorexia,
bulimia
What can cause low potassium/sodium?
Medications (loop diuretics, thiazide, steroids, albuterol
excessive enema or laxatives, anorexia, bulimia
What are clinical manifestations of low potassium?
-weakness, constipation, nausea/vomiting, abdominal cramps, ST depressions, palpitations (PVC)
Severe hypokalemia can result in what?
sudden death results from ventricular fibrillation
What may cause hyperkalemia?
- Acute/ chronic renal failure,
- medications or
- excessive intake of potassium
NSAIDs +renal insuffiency can cause
Hyperkalemia
What drugs can cause hyperkalemia?
NSAIDs
Digoxin
Beta blockers
What food have a lot of potassium?
Bananas, tomatoes oranges in patient with renal impairmentW
What are clinical manifestations of hyperkalemia?
-generalized fatigue,
muscle cramps,
paresthesia,
palpitations
What are clinical manifestations of hyperkalemia having to do with the heart?
-bradycardia, heart blocks
-ST depression and shortened QT interval
What is medical management of hyperkalemia?
-In end stage renal patient dialysis should be prompt
What is IV calcium used for in hyperkalemia?
IV calcium will not reduce potassium but reverse ECG changes
Hyperkalemia: If high potassium leads to metabolic acidosis, what should be given?
If the event result from metabolic acidosis IV insulin and NS can be used
Solutions Used in Infusion Therapy:
Crystalloid
Colloid
Isotonic, hypotonic, hypertonic
What are crystalloid solutions composed of?
crystalloid solutions are composed of electrolytes dissolved in water and includes dextrose solutions sodium chloride an alkaline or acidifying solution
What are colloid solutions composed of?
Colloidal solutions are composed of large molecules usually proteins are starch suspended in a fluid.
What are colloid solutions frequently referred to as?
frequently referred to as plasma volume expanders.
Isotonic solutions are similar to plasma why?
Isotonic solutions have the same or nearly the same osmolarity as plasma.
What kind of movement does isotonic solutions cause?
they cause no movement of fluid into or out of the cell
How do hypotonic solutions work?
hypotonic solutions have a lower solution concentrate than plasma and
cause fluid to move from the intravascular space into both the intracellular and interstitial spaces
What do hypotonic solutions cause to happen?
cause fluid to move from the intravascular space into both the intracellular and interstitial spaces
How are hypertonic solutions?
Hypertonic solutions have concentrations higher than plasma and
cause fluid to move from the cells into the intravascular space.
What do hypertonic solutions cause to happen?
cause fluid to move from the cells into the intravascular space.
What are crystalloids?
dextrose dissolved in water.
What are colloids?
Colloid- larger molecules with usually proteins that are suspended in the fluid
What are the types of Intravenous Access Devices
Peripheral
Central
INTRAVENOUS ACCESS DEVICE (IVAD) TYPES:
Central venous access device (CVAD):
What are the types?
Nontunneled percutaneous central catheters (jugular or subclavian)
Tunneled catheters (exit the skin from a site distal from where they enter)
Implanted ports (uppe chest wall)
Peripherally inserted central catheters (PICCs)
INTRAVENOUS ACCESS DEVICE (IVAD) TYPES (cont’d):
Central venous access device (CVAD)
Nontunneled percutaneous central catheters
jugular or subclavian)
INTRAVENOUS ACCESS DEVICE (IVAD) TYPES (cont’d):
Central venous access device (CVAD)
Tunneled catheters
(exit the skin from a site distal from where they enter)
INTRAVENOUS ACCESS DEVICE (IVAD) TYPES”:
Implanted ports
Implanted ports (upper chest wall)
NUTRITION AND TEACHING:
Administration of total parenteral nutrition (TPN)
When is it used?
Use only when oral or enteral routes are not possible
NUTRITION AND TEACHING:
Administration of total parenteral nutrition (TPN)
Why is it used carefully?
Increased risks to the patient and greater costs
NUTRITION AND TEACHING:
Administration of total parenteral nutrition (TPN):
What does it provide?
Provide the major macronutrients along with required micronutrients
NUTRITION AND TEACHING:
Patient teaching prior to IVAD insertion
What should patients understand?
Patient should understand why IVAD is required
Alternatives to the selected device
What to expect
