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Module 2 (Skills) > Electrolytes & Fluids > Flashcards

Electrolytes & Fluids Flashcards

If it is **bolded** then highly important Review Intro to Fluids flashcards especially Hypo., Iso., and Hypertonic fluids

1
Q

Hydrostatic = _________ force

A

pushing

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2
Q

Hydrostatic pushes fluid out of

A

capillaries

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3
Q

Hydrostatic pressure is exerted by

A

pumping of heart

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4
Q

Oncotic is the __________ force

A

pulling

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5
Q

Oncotic pulls fluid out of

A

tissues and into capillaries

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6
Q

Oncotic pressure is exerted by

A

non-diffusible plasma proteins … albumin

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7
Q

Albumin def

A

protein that is soluble in water and coagulable by heat

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8
Q

What does the body use to maintain fluid balance in the body?

A
  • Kidneys
  • ADH
  • RAAS
  • Aldosterone
  • ANP
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9
Q

Kidneys

A

adjust urine volume and excrete electrolytes

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10
Q

ADH medication form and controls what?

A

vasopressin; controls retention

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11
Q

RAAS system hormone order

A

Renin
Angiotensinogen
Angiotensin 1
Angiotensin 2
Aldosterone

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12
Q

Aldosterone is a

A

water regulator

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13
Q

ANP _______ ________ volume.

A

reduces fluid

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14
Q

ANP stands for

A

Atrial natriuretic peptide

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15
Q

Kidneys are considered
Hint: Royal

A

King

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16
Q

ALWAYS check _____ __________ before med admin.
- What lab value do you check?

A

renal function
- creatinine

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17
Q

High BUN but low Creatinine

A

Dehydrated

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18
Q

High Creatinine and High BUN

A

renal failure

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19
Q

Calcium is related to what vitamin

A

D

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20
Q

What are the 7 functions of the kidneys?

A
  • control ACID-base balance
  • control WATER balance
  • maintaining ELECTROLYTE balance
  • removing TOXINS and waste products out
  • controlling BLOOD PRESSURE
  • producing ERYTHOPOIETIN
  • activating VITAMIN D
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21
Q

ADH medication

A

Vasopressin

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22
Q

Vasopressin controls

A

water retention

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23
Q

In the nephron, water is reabsorbed where

A

distal tubule

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24
Q

If the patient’s body is dehydrated, then what chain of events occurs?

A

RAAS

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25
Q

Where fluid flows

A

electrolytes go

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26
Q

What is the difference between ADH and aldosterone

A

ADH retains water
Aldosterone retains sodium and water

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27
Q

Aldosterone causes kidneys to

A

retain sodium and water

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28
Q

Aldosterone causes the body to excrete

A

potassium

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29
Q

Low aldosterone, potassium

A

high (hyperkalemia)

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30
Q

High aldosterone, potassium

A

low (hypokalemia)

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31
Q

Aldosterone increases

A

fluid volume (sodium and water)
BP

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32
Q

Ultimate goal of Aldosterone and RAAS

A

increases reabsorption of sodium and water
excretion of potassium

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33
Q

RAAS is activated by

A

low serum sodium
decreased cardiac output due to decreased ECF
ischemia in kidneys

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34
Q

Low sodium, decreased cardiac output, and kidney ischemia can cause what to be released

A

renin

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35
Q

RAAS system’s ultimate goal

A

bp elevation
increased fluid

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36
Q

Angiotensinogen is a

A

glycoprotein made in the liver

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37
Q

What converts Angiotensin 1 to Angiotensin 2?

A

an enzyme from the pulmonary bed

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38
Q

Angiotensin 2 is a powerful/POTENT

A

vasoconstrictor
- elevates BP through peripheral vasoconstriction
- Stimulation of aldosterone secretion

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39
Q

ACE inhibitors stop

A

Angiotensin 1 from converting Angiotensin 2 emzyme from working

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40
Q

Aldosterone is a

A

mineralocorticoid that helps control sodium utilization

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41
Q

Aldosterone is released by the

A

adrenal cortex

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42
Q

What does Aldosterone do?

A

reabsorbs water with sodium following
- increases plasma volume

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43
Q

ANP is produced and stored where?

A

in atria

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44
Q

BNP is released

A

when the heart can’t pump the way it should
- heart failure and severity ( > 100 )

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45
Q

BNP is what type of lab test?

A

blood test

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46
Q

ANP does what?

A
  • stops RAAS
  • decreases BP by vasodilation
  • reduces fluid volume by increasing the secretion of sodium and water
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47
Q

Hypovolemia vs Dehydration

A

Hypovolemia = loss of ECF including water and sodium
Dehydration = water loss alone

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48
Q

What is perfusion?

A

Oxygen to the bloodstream

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49
Q

Dehydration is common in the

A

elderly
- because they are less thirsty

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50
Q

S/S of Dehydration

A

red and dry mouth
Thirst
Oliguria
less and more concentrated urine
dizzy, confused
decreased skin turgor

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51
Q

Hypovolemia

A

ECF volume is reduced
- results in decreased tissue perfusion

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52
Q

Dehydration is

A

pure water loss from total body water
ECF 1/3

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53
Q

Dehydration is ALWAYS

A

hypernatremic

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54
Q

Treatment of dehydration

A

free water administration

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55
Q

Electrolytes are

A

separate into ions (changed particles) when dissolved in water

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56
Q

Electrolyte purposes

A
  • ions found in our body fluids
  • conduct electricity and energy
  • control body fluids
  • maintain homeostasis
  • communicate cell to cell, nerve to nerve, organ to organ
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57
Q

Cations are a ________ charge

A

positive

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58
Q

Anions are a ________ charge

A

negative

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59
Q

Cation electrolyte

A

Na+
K+
Ca++
Mg+

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60
Q

Potassium is more common in the

A

intracellular

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61
Q

Sodium is more common in

A

extracellular

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62
Q

Anion electrolytes

A

Cl
HCO3 (Bicarbonate)
Phosphate

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63
Q

Depletion of electrolytes

A

Vomiting
Peeing (urination)
Pooping (BM)
Sweating

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64
Q

Magnesium (Mg+) normal levels

A

1.5-2.5

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65
Q

Calcium and phosphorus have a/an __________ relationship

A

inverse

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66
Q

Phosphorus normal levels

A

2.4-4.5**

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67
Q

Potassium (K+) normal levels**

A

3.5-5.0

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68
Q

Calcium (Ca+) normal levels

A

8.5-10.5**

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69
Q

Chloride (Cl-) normal levels

A

95-105

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70
Q

Sodium (Na+)**

A

135-145

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71
Q

What foods are rich in Potassium?

A

fruits, green leafy vegetables, spinach, salt substitutes
- bananas and berry families

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72
Q

What foods are rich in Sodium?

A

table salt, cheese, spices, canned, processed foods (lunchmeat)

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73
Q

What foods are rich in Magnesium?

A

spinach, almonds, yogurt, green vegetables
Dark chocolate = excellent Mg+ source

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74
Q

What foods are rich in Calcium?

A

milk, cheese, green vegetables

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75
Q

What foods are rich in phosphorus?

A

dairy, meats and beans

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76
Q

What foods are rich in Chloride?

A

salty foods and salt substitutes, canned foods,
Vegetables such as tomatoes, lettuce, celery and olives

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77
Q

Sodium functions

A

maintain blood pressure
blood volume
pH balance (acid-base)
controlling nerve impulses
stimulating muscle contractions

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78
Q

Sodium key items

A

big impact on body’s fluid balance
major electrolyte in extracellular fluid
controls water balance
regulated by ADH & aldosterone, Na+ K+ pump

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79
Q

If the patient has a low or high sodium level, what assessment would you do? Possible intervention?

A

Neurological
Safety and fall bundle

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80
Q

With sodium think

A

Brain, Neuro checks, Safety

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81
Q

Hyponatremia Causes

A

dilution on sodium
- SIADH**
- water intoxication**
- psychogenic polydipsia
- hypotonic fluids**
- inadequate sodium intake
- increased Na diet

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82
Q

SIADH

A

impaired water excretion caused by an inability to suppress the secretion of ADH
water retention causes dilution sodium

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83
Q

Water intoxication

A

retaining fluid & sodium causing hemodilution of Na+

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84
Q

Psychogenic polydipsia

A

excessive fluid intake without physiologic stimuli

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85
Q

Hypotonic fluids

A

shifts solutes into the cells

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86
Q

Inadequate sodium intake types

A

fasting
NPO status
low Na+ diet

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87
Q

What is the 4 D’s

A

diarrhea
diuretics
drainage
diaphoresis (sweating)

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88
Q

What device is famous for depleting sodium and other electrolytes?

A

NG tube

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89
Q

Increased Na+ excretion

A

4D’s - diarrhea, diuretics, drainage, diaphoresis
Vomiting
Kidney disease
Hypoaldosteronism (Addison’s)
sodium loss and water retention

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90
Q

3 Flavors of Hyponatremia

A

Euvolemic
Hypovolemic
Hypervolemic

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91
Q

Euvolemic Hyponatremia

A

Low Na+ with (ECF) volume normal

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92
Q

Hypovolemic Hyponatremia

A

Na+ loss with ECF volume depletion

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93
Q

Hypervolemic Hyponatremia

A

Na+ loss with increased ECF volume

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94
Q

What is the mild S/S of hyponatremia?

A

Mild = headache, nausea/vomiting, fatigue

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95
Q

What are the moderate S/S of hyponatremia?

A

lethargy, weakness, altered LOC

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96
Q

What are the severe S/S of hyponatremia? (Below 120)

A

seizures, respiratory arrest, death
brainstem herniation

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97
Q

What can a nurse do when suspecting Hyponatremia

A

Replace Sodium slowly
Stop Sodium Wasting Diuretics
Provide IV Fluids/medications

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98
Q

Every time you give an electrolyte, you give it

A

SLOWLY and recommended rate

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99
Q

Why do you Replace Sodium slowly

A

avoid fluid overload due to fluid shifting with sodium
can lead to neuro damage if given too rapidly
0.5 mEq/L per hour MAXIMUM
6 - 12 pts in a 24-hour period
Check Na+ levels every 2-4 hours

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100
Q

Stop Sodium Wasting Diuretics

A

loop diuretics; thiazides
may need to switch to spironolactone

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101
Q

Spironolactone is a

A

potassium sparing

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102
Q

The thiazide and loop diuretics need to have strict monitoring of

A

electrolytes

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103
Q

What fluid would you give to someone with mild to moderate hypovolemic hyponatremia?

A

0.9% Normal saline to correct fluid volume status & Na+

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104
Q

What fluid would you give to someone with severe
hypovolemic hyponatremia?

A

3% normal saline (hypertonic solution)
- give through a central line = highly caustic on veins
- gets rid of cell swelling away from the brain

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105
Q

What medication would you give to someone with hypervolemic hyponatremia?

A

give osmotic diuretics and fluid restriction
- Mannitol – excretes water but not Na+

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106
Q

What fluid would you use for SIADH?

A

EUVOLEMIC (normal volume with low Na)
- restrict fluid intake

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107
Q

Severe hyponatremia is

A

less than 120
- not increase by more than 6-12 mEq/L in first 24 hours

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108
Q

What is the order of interventions during severe hyponatremia?

A

administer 3% saline IV slowly - 6 to12 pts in a 24-hour period
Plan for CVAD
Insert indwelling catheter for strict I&Os
Perform neurologic checks every 2-4 hours
Keep on bedrest

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109
Q

What is key when dealing with cerebral involvement?

A

safety

110
Q

When administering 3% saline why go through a CVAD?

A

highly caustic to veins
- But can be given through peripheral veins

111
Q

If hyponatremia is overcorrected too quickly,

A

demyelination syndrome causing damage to nerve cells in the brain
- Locked-in syndrome

112
Q

SIADH full name

A

Syndrome of Inappropriate Anti-diuretic hormone

113
Q

SIADH-euvolemic hyponatremia

A

TOO MUCH ADH
high levels of ADH = retain water
upsets electrolytes, especially SODIUM
Increased water retention
Diluted sodium

114
Q

Mnemonic for SIADH

A

SIADH
- Soaked Inside
- Stop Urination

115
Q

Causes (3 Ss) of SIADH: Most common

A

Small cell lung cancer
Severe brain trauma
Sepsis infections of the brain

116
Q

ADH is created in

A

pituitary gland

117
Q

Mnemonic for ADH

A

Adds Da H2O

118
Q

What are the different types of Synthetic ADH?

A

Desmopressin, Vasopressin
** Pressin the BP up**

119
Q

ADH ________ urine output

A

decreases

120
Q

If SIADH or low Na, what is the priority problem?

A

Headaches
Low Na = seizures, DEATH

121
Q

What is the best/accurate way to monitor fluid changes?

A

Daily weight (I&Os, then BP)

122
Q

Treatment for SIADH

A

Fluid restriction = 800-1000 mL/day
Demeclocycline
Diuretics
Increase oral sodium intake
Daily weight
I&O

123
Q

Demeclocycline

A

blocks the effect of ADH resulting in more dilute urine

124
Q

T/F: caffeine is a diuretic used in the treatment of SIADH.

A

True

125
Q

Types of oral sodium intake

A

salt tablets
bacon
processed foods

126
Q

Causes of Hypernatremia

A

Decreased sodium excretion
- corticosteroids - retain sodium
- Cushing’s syndrome
- kidney disease
Increased sodium intake
Decrease Water intake
Increased water loss (hemoconcentration)

127
Q

If the patient had Hypernatremia what should the nurse be most concerned about?

A

cerebral hemorrhage

128
Q

Hypernatremia level

A

greater then 145

129
Q

Corticosteroids causes

A

kidneys to retain sodium

130
Q

Cushing’s syndrome

A

occurs due to prolonged exposure to glucocorticoids (prednisone) or a tumor producing excessive cortisol by adrenals

131
Q

Hyperaldosteronism

A

high sodium and water retention

132
Q

Severe hypernatremia level

A

greater then 160

133
Q

Hypernatremia Cause
Increased sodium intake

A

excessive oral sodium ingestion
too many processed foods
Hypertonic solutions (3% NS or 5%NS)
Alka seltzer, aspirin

134
Q

Decreased water intake due to

A

fasting; NPO status

135
Q

Hemoconcentration is caused by

A

dehydration
too much water loss & Na+ gain
Infection
Diabetes Insipidus

136
Q

Hypernatremia Interventions

A
  • Bring sodium levels down slowly
  • Provide IV/Meds of hypotonic solutions in case of fluid loss
  • Diuretics
  • Avoid high sodium meds
  • Restrict sodium and fluid intake as prescribed
  • Free water intake to help with hemodilution
  • pt safety: confused and agitated
  • Daily weight I&Os
  • Neurologic precautions (checks)
137
Q

Why do you bring a sodium level down slowly?

A

rapid correction can lead to seizures due to rapid
fluid shifts in the brain

138
Q

What solutions would you give a hypernatremic patient?

A

hypotonic
- 1/2 NS, D5W

139
Q

If inadequate renal excretion of sodium, administer

A

diuretics
-thiazides; loop diuretics

140
Q

Patient S/S of mild hypernatremia

A

faint feeling
muscle fatigue
weakness

141
Q

Patient S/S of moderate hypernatremia
(monitor closely)

A

confusion, irritability,
swollen and dry red tongue
hyperreflexia
muscle twitching
edema
thirst

142
Q

Patient S/S of severe hypernatremia

A

nausea & vomiting
increased muscle tone
seizures
coma

143
Q

Diabetes Inspidus =

A

hypernatremia

144
Q

Diabetes Insipidus is when the

A

the pituitary gland produces insufficient ADH (vasopressin)
- ADH deficiency

145
Q

S/S of diabetes insipidus

A

polydipsia
polyuria
dry inside = labs high
- increased sodium and diluted urine
**Dehydrated (DIE ADH)

146
Q

Causes of ADH

A

damage to brain
tumors
trauma

147
Q

Polydipsia

A

extreme thirst

148
Q

Polyuria

A

excrete dilute urine, greater than 200 mL

149
Q

If the patient is having their pitcher refilled every 15-20 mins and peeing constantly, what would you suspect and intervention?

A

Diabetes Insipidus
- record I&Os

150
Q

What are the differences between DI and SIADH

A

DI
-low AD and water in the body
- High UO, polyuria
- High sodium
- High H&H and osmolality from dehydration
- Risk of hypovolemic shock
- Tx: ADH

SIADH
- high ADH, water intoxication
- Low UO, oliguria
- low sodium (dilutional)
- low osmolality
- weight gain
- Risk: seizures
- Tx: hypertonic saline

151
Q

Potassium is the king of

A

hearts

152
Q

What is the major electrolyte in intracellular fluid?

A

Potassium

153
Q

Potassium purposes

A

Maintains heart & muscle contraction
Regulated by kidneys and aldosterone
Acid-Base balance
- Increased K+ in the cell——H+ moves out
- Increased H+ in the cell——K+ moves out
Diet is the main source of K+

154
Q

Hypokalemia

A

potassium loss
Inadequate potassium intake
Alkalosis, metabolic

155
Q

Potassium loss can occur from what

A

Diuretics - furosemide and digoxin
Corticosteroids
Inadequate intake of Potassium ( NPO, anorexia, nausea)
Increased secretion of aldosterone (Cushing’s)
GI loss
Excessive diaphoresis
Kidney disease

156
Q

Digoxin toxicity

A

– low K+ causes dig toxicity;
caution using diuretics with digoxin = increased risk for hypokalemia

157
Q

How do corticosteroids cause potassium loss?

A

water retention causing hemodilution

158
Q

Aldosterone causes potassium loss

A

K+ excretion through kidneys; higher levels of aldosterone cause more K+ excretion

159
Q

Ways of Potassium GI loss

A

Vomiting
diarrhea
prolonged NG suction

160
Q

Inadequate Potassium Intake causes

A

movement of K+ from ECF to ICF
excess insulin – moves K+ into the cell

161
Q

What happens during Metabolic Alkalosis

A

in alkalosis, there is less H+ in the blood—–causes H+ to shift out of cells and K+ to shift into cells
excess insulin – moves K+ into the cell

162
Q

Severe Potassium level

A

less than 2.5

163
Q

When remembering S/S of hypokalemia, what do you remember?

A

SLOW AND LOW

164
Q

Hypokalemia S/S Cardiovascular

A

torsades de pointes- twisting of points
irregular apical HR
lethal dysrhythmias
bradycardia

165
Q

Hypokalemia S/S Neuromuscular

A

confusion, lethargy
muscle weakness
diminished DTRs

166
Q

Hypokalemia S/S GI

A

Constipation - paralytic ileus

167
Q

If bowel sounds are absent, think

A

paralytic ileus – portion of bowel not moving and can lead to small bowel obstruction

168
Q

What other electrolyte should you check with hypokalemia? If low?

A

Magnesium
if Mg+ is low, it exacerbates K+ losses;
correct Mg+ first to correct K+

169
Q

torsades de pointes is also known as

A

Long QT Interval

170
Q

If the patient faints, then what do you think?

A

cardiac, and neurological

171
Q

Long QT Interval means

A

heart is taking longer to electrically charge for the next heartbeat

172
Q

Congenital Long QT Syndrome

A

born with altered DNA that causes long QT syndrome

173
Q

Why is Long QT syndrome bad?

A

This electrical glitch sets up the potential for something to catch the heart off guard and electrically trip it up, causing a spinning rhythm out of control

174
Q

acquired long QT syndrome

A

occur later in life due to some medical conditions, certain drugs, or mineral imbalances.

175
Q

Irregular QRS complexes

A

appearing to wrap around the EKG baseline

176
Q

Torsades de Pointes in hypokalemia Tx

A

IV Mg+ is treatment (slow 2G IVP)

177
Q

EKG in Hypokalemia

A

increased amplitude and width of P wave, T wave flattening and inversion, prominent U waves and apparent long QT intervals due to merging of the T and U wave.

178
Q

Comparison of Hypokalaemia and Hyperkalaemia EKG

A

Hypokalaemia: T wave inversion ST depression Prominent U wave
Hyperkalaemia: Peaked T waves, P wave flattening, PR prolongation, Wide QRS complex

179
Q

Hypokalemia Interventions

A

Monitor Cardiac and respiratory status
Administer K+ supplements orally or IV
administer K+ SLOWLY – can be lethal when given too fast
If patient in taking a diuretic may need to stop
Spironolactone (K+ sparing diuretic)
K+ rich foods
if taking orally, must take with food – never give
on an empty stomach
Monitor for digoxin toxicity

180
Q

Potassium is never administered IV push, potassium is always diluted
and administered using an infusion pump.
How do you give potassium?

A

IV, intramuscular, or subcutaneous routes, PO

181
Q

IV potassium is always diluted
and administered

A

using an infusion pump

182
Q

Causes of Hyperkalemia

A

Excess Potassium intake
Decreased Potassium secretion
Adrenal insufficiency
Renal failure - #1 cause
Traumatic burns
- Metabolic Acidosis

183
Q

ACE inhibitors drugs end in

A

pril

184
Q

What are the reasons for decreased potassium excretion?

A

K+ sparing diuretics (spironolactone)
Ace inhibitors
NSAIDs (decrease renal perfusion)

185
Q

Adrenal insufficiency causes

A
  • Addisons = low aldosterone = retention of K+
  • hypoaldosteronism causes large amounts of sodium excretion and retains K+ (Addison’s = destruction of adrenal gland)
186
Q

Metabolic Acidosis

A

there is more H+ in blood
causes H+ to shift into the cells and K+ to shift out in the cells
- Excretion of H+ ions by kidneys is accomplished by conserving bicarbonate, secretion of ammonia, and excretion of hydrogen in exchange for sodium.

187
Q

S/S of Hyperkalemia

A

Cardiovascular
bradycardia
dysrhythmias – V-fib and cardiac standstill

GI increased motility = hyperactive bowel sounds
diarrhea

Muscle weakness
can result in paralysis and respiratory arrest

188
Q

Severe potassium level high

A

greater than 6.5

189
Q

Lethal high level of potassium

A

greater than 8.5

190
Q

EKG and High Potassium

A

peaked narrow T wave,
ST segment depressed,
prolonged PR interval

191
Q

Mild Hyperkalemia Interventions

A

Monitor cardiac rhythm changes
Restrict K+ in diet
Diuretics
Cation exchange resins
sodium polystyrene sulfate (Kayexalate)
**PO or rectal = explosive diarrhea **
Stop medication causing an increase in K+
Dialysis for renal failure

192
Q

When do you stop Ca Gluconate 10% IV?

A

bradycardia

193
Q

Ca+ Gluconate 10% IV
Purpose?
Monitor?

A

protects heart from myocardial irritability
= DOES NOT LOWER potassium
- dysrhythmias, BP and HR

194
Q

If the patient has a potassium level of 6.5 or higher, what emergency medical tx would occur

A

Ca+ Gluconate 10% IV - must be given over 3-5 minutes
Hypertonic glucose & insulin = Moves excess K+ into the cells
NaHCO3 if acidosis = K+ shifts into the cell and raises pH

195
Q

What is the most abundant cation in the body?

A

Calcium

196
Q

Calcium and Magnesium levels are

A

best friends (One goes up the other follows

197
Q

Calcium functions

A

Calcium will help with function of Mg+ when Mg+ is low
Keeps the 3 B’s strong
= Bone – 90% of body’s calcium - fractures
= Blood clotting - bleeding
= Beat (heart rate) myocardial contraction

198
Q

What 3 hormones regulate Calcium?

A

Parathyroid
Calcitonin
Calcitrol

199
Q

Parathyroid hormone and Calcium relationship

A

the parathyroid gland makes it
- releases when Ca+ levels are low
- stops if Calcium is too high

200
Q

Where are the parathyroid and thyroid glands located?

A

Neck

201
Q

Calcitonin and Calcium relationship

A

– regulated by thyroid;
released when Ca+ levels are high to lower Ca+ and put back into the bone

202
Q

____ increases blood calcium levels; __________ decreases blood calcium levels

A

PTH; Calcitonin

203
Q

calcitriol

A

– Vitamin D analog; controls blood calcium by suppressing the release of PTH

204
Q

Calcium normal levels

A

8.5-10.5

205
Q

Ionized Calcium
NOT TESTED

A

Calcium in blood not attached to proteins (free calcium)
Most accurate test for assessing true calcium status
Important if abnormal levels of proteins
May be drawn if signs of bone, kidney, liver, or parathyroid disease

206
Q

Ionized Calcium normal levels
NOT TESTED

A

4.8-5.6

207
Q

Calcium and phosphorus relationship

A

inverse

208
Q

Hypocalcemia Causes

A

Vitamin D deficiency - required for the absorption of Ca+
Long-term corticosteroids
Hypoparathyroidism - decrease in parathyroid hormone, removal of parathyroid glands
Renal disease
Massive diarrhea
Hyperphosphatemia – inverse relationship with calcium
Medications – diuretics; laxatives; corticosteroids (contribute to bone loss)
Thyroidectomy or any neck surgery can inadvertently irritate or remove
parathyroid glands

209
Q

S/S of hypocalcemia

A

Cardiovascular
hypotension
dysrhythmias (V Tach)
decreased HR
Neuromuscular
irritable skeletal muscles – twitching, cramps, tetany, seizures, paresthesias
painful muscle spasms in calf or foot
positive Trousseau’s and Chvostek’s signs
hyperactive deep tendon reflexes (DTRs)
osteoporosis – body trying to get more calcium
GI
hyperactive bowel sounds
diarrhea

210
Q

Chvostek and Trouseau Signs hypocalcemia

A

ouch the face near the ear and if they flinch then positive
contraction of hand after bp

211
Q

Hypocalcemia Interventions

A

Replace Calcium (IV or PO)
IV calcium gluconate 10% over 10 – 20 minutes
monitor BP, HR & place patient on heart monitor
Vitamin D if giving PO
Aluminum hydroxide (Tums) calcium supplements
Initiate seizure precautions & bleeding precautions
Move patient carefully
Educate on calcium-rich foods
dairy, cheese, milk, yogurt
collard greens, broccoli

212
Q

Hypercalcemia Causes

A

Hyperparathyroidism
Antacids
Excessive oral intake of calcium & vitamin D
Malignancies – of the bone; bone destruction = calcium is released into the bloodstream
Renal disease – inability to excrete

213
Q

What gland abnormality causes the following?
Kidney stones, painful bones, moans
from constipation, nausea & vomiting

A

Parathyroid

214
Q

S/S of Hypercalcemia

A
  • Neuromuscular
    muscle weakness
    diminished or absent DTRs
  • GI
    hypoactive bowel sounds (constipation)
  • Renal
    kidney stones
    -Stones, bones, abdominal moans
215
Q

Hypercalcemia Interventions

A

Administer IV fluids = 0.9% saline to get the kidneys to excrete calcium
D/C calcium
discontinue oral meds with calcium & vitamin
Loop diuretics
furosemide
Medications
phosphorous
inverse relationship with calcium
calcitonin
bisphosphonates
Dialysis if medications fail
Educate on avoiding calcium-rich foods

216
Q

Less severe hypercalcemia interventions

A

IV NS
and loop diuretics

217
Q

Magnesium normal levels

A

1.5-2.5

218
Q

Magnesium functions

A

Support muscle and nerve function & energy production
- Direct relationship with calcium
- Inverse relationship with phosphorous
Helps to maintain
- blood glucose control
- blood pressure
- skeletal muscle contraction
- neurologic function
- ATP formation
- Immune system – fights inflammation

219
Q

Causes of hypomagnesemia

A

Chronic alcohol use - #1 cause
- poor diet/malnutrition; starvation
- malabsorption due to the effects of alcohol on the GI tract
Renal loss – overuse of alcohol increases excretion of Mg
GI loss – NG, diarrhea, vomiting
Diuretics

220
Q

If the patient is unable to maintain order; everything goes crazy.
What condition is this?
Hint: Magnum PI

A

hypomagnesemia

221
Q

S/S Hypomagnesemia

A

Neuromuscular
tetany, twitches, paresthesias
positive Trousseau’s & Chvostek’s signs
- due to direct relationship with Ca+
Increased DTRs
Laryngeal stridor: can’t breath
Tachycardia

222
Q

What electrolytes are best friends

A

Calcium and Magnesium

223
Q

Hypomagnesemia Interventions

A

replace Mg+ and Ca+ (IV or PO)
when replacing Mg+ IV give slowly (can slow HR)
seizure precautions
monitor DTRs – if diminished or absent = hypermagnesemia
discontinue medications that cause Mg+ loss
Monitor K+ if magnesium is low
Secondary K+ depletion

224
Q

Hypocalcemia accompanies ________________; interventions
aim to restore ________ levels

A

hypomagnesemia; calcium

225
Q

Treat _____________ prior to ____________;
when the body is in a state of low Mg+, it is unable to process & absorb K+

A

hypomagnesemia; hypokalemia

226
Q

Causes of Hypermagnesemia

A

Increased Mg+ intake (OTC and meds contraindicated - laxatives)
Decreased renal excretion of Mg+
Calm and Slow

227
Q

Hypermagnesemia S/S

A
  • Heart – calm & quiet
    respirations low and shallow
    bradycardia
    hypotension
  • Lung
    respirations low and shallow
  • GI
    hypoactive bowel sounds
    Neurological
    drowsiness, lethargy
  • MS
    Diminished or absent DTR’s
228
Q

What is the antidote of a magnesium overdose?

A

Calcium Gluconate

229
Q

Hypermagnesemia Interventions

A

Calcium Gluconate for magnesium overdose
Diuretics for Mg+ excretion

230
Q

Phosphorus normal levels

A

2.4-4.5

231
Q

Phosphorus Main functions

A

Regulated by parathyroid and calcitriol
Helps regulate calcium
inverse relationship with calcium and magnesium
Cellular metabolism and energy production through ATP (Adenosine Triphosphate)
Essential for bone and teeth

232
Q

Hypophosphatemia Causes

A
  • Insufficient phosphorous intake
    malnutrition
    starvation
    ‘Refeeding Syndrome’ – fatal shift of fluids &
    electrolytes that may occur in malnourished patients
  • Increased phosphorous excretion
    hyperparathyroidism – calcium rises; phosphorous drops
    malignancy
    diuretics and diarrhea
    use of magnesium-based or aluminum-based antacids
    increased Ca+ depletes phosphorous
233
Q

S/S of Hypophophatemia

A

Cardiovascular
decreased BP, HR
GI – hypoactive bowel sounds
GU – kidney stones
Neurological–altered LOC decreased DTR
Musculoskeletal – severe muscle weakness
Bone pain & fractures
MOANS GROANS AND STONES

234
Q

Hypophosphatemia Interventions

A

Replace phosphorous IV or PO slow
phosphorous slow if severely low
administer oral phosphorous with Vitamin D
Fracture precautions

235
Q

Hyperphosphatemia Causes

A

Increased phosphorous intake
Overuse of laxative and enemas with phosphorous
Decreased excretion of P- due to renal insufficiency
Hyperparathyroidism
Hypocalcemia

236
Q

hyperphosphatemia S/S

A

*Neuromuscular
irritable skeletal muscles – twitching, cramps, tetany, seizures, paresthesias
painful muscle spasms in calf or foot
positive Trousseau’s and Chvostek’s signs
hyperactive deep tendon reflexes (DTRs)
osteoporosis – body trying to get more calcium
-GI
hyperactive bowel sounds
diarrhea

237
Q

Hyperphosphatemia Interventions

A

Same interventions as hypocalcemia

Replace Calcium (IV or PO)
IV calcium gluconate 10%
monitor BP, HR & place patient on heart
Vitamin D if giving PO
Aluminum hydroxide (Tums) calcium supplements
Initiate seizure precautions & bleeding precautions
Move patient carefully
Educate on calcium rich foods
dairy, cheese, milk, yogurt
collard greens, broccoli

238
Q

Chloride functions

A

Major anion of ECF
Sodium is major cation of ECF
Moves in and out of the cell with sodium
Involved in regulating acid base balance
chloride likes sodium; if Na+ loss = Cl- loss

239
Q

What is the major anion of the ECF?

A

Chloride

240
Q

Chloride normal levels

A

95-105

241
Q

Corticosteroids

A

bone loss; increased blood glucose; Na+ retention
- low potassium

242
Q

Ace Inhibitors, Spironolactone (Aldactone), ARBs

A

hold on to K+
- low sodium

243
Q

Insulin

A

move K+ into the cell

244
Q

Furosemide

A

potent diuretic; should monitor all electrolytes
Laxatives (Mg)

245
Q

NSAIDs (Ibuprofen)

A

decrease renal perfusion

246
Q

Potassium normally lives in what fluid

A

Intracelular

247
Q

Potassium is responsible for

A

Nerve impulse induction and muscle contraction

248
Q

Medications to avoid renal failure

A

Ace inhibitors
steroids (hold)
furosemide (hold)
give this instead = spironolactone (Aldactone)
ARBs
NSAIDs

249
Q

If a patient with renal failure needs NSAIDs, what is a safer alternative?

A

Tylenol

250
Q

What is the best/accurate way to monitor fluid changes?

A

Daily weight

251
Q

ARBs

A

Angiotensin Resistant Blockers

252
Q

What do you hold when the patient is in renal failure or high potassium?

A

ACEs and ARBs

253
Q

Laxatives contain what if in renal failure?

A

Mg

254
Q

Lisionopril is a

A

ACE inhibitor

255
Q

Spirinolactone is a

A

potassium sparing diuretic

256
Q

ARBs end in

A

sartans (valsartan)

257
Q

If the patient is in post-cardiac arrest, what is the organ that was affected besides the heart?

A

kidney acute failure

258
Q

If there is a sudden change in LOC, then what do you think might be the cause?

A

Hypoxia (low O2)

259
Q

With Lasix, what do you monitor? How slow do you give it?

A

BP; 2-4 mins
If you don’t v-fib, hearing loss, hypotension, lethal dysrhythmia

260
Q

If you do not give Lasix at 2-4 mins, then what can occur

A

v-fib, hearing loss, hypotension, lethal dysrhythmia

261
Q

What patient might have Furosemide?

A

heart failure
, liver, renal

262
Q

calcium is high, phosphorous

A

low

263
Q

If you have lupus and have a high-dose steroid, what ELECTROLYTE IMBALANCES might occur?

A

osteoporosis
- hypocalcemia
hypernatremia
hypokalemia
increases blood glucose
suppresses immune system

264
Q

If magnesium is out of order, then

A

chaos and not order of electrolytes

265
Q

Why is magnesium needed?

A

help nerve function
controls glucose
immune system stronger
helps calcium
sleep and focused

266
Q

If you have heart failure and have high doses of furosemide, then what lab would you need to know?

A

Potassium (worry about hypokalemia)
Magnesium (if not normal take care of first)

267
Q

If you have a low potassium level, then check

A

magnesium level

268
Q

Why should you never give potassium on an empty stomach?

A

GI upset

269
Q

What should also be given if you send home a patient on a diuretic?
What should you stop if you run out of diuretics?

A

Potassium, yes

270
Q

What is given if the patient has hypokalemia

A

Kayexssolate Insulin

271
Q

If I over-treat a diabetes inspidus patient, what will happen?

A

water intoxication (HA, altered LOC)

272
Q

When monitoring a client for hyponatremia, which assessment findings would the nurse consider significant? Select all that apply.
- Thirst
- Seizures
- Erythema
- Confusion
- Constipation

A

Seizures
Confusion

Module 2 (Skills) (12 decks)

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