Electrolytes Keys Flashcards by Elizabeth Gausin

What two diseases can screw up electrolytes

Addison disease and Cushing

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Causes of hyperkalemia

CARED
Cellular movement (burns chemo agents, release k+)
Adrenal insufficiency (Addison disease)
Renal failure (#1 cause can’t filter out)
Excessive k+ intake (too many bananas)
Drugs (NSAIDS, beta blockers, ace inhibitors)

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S/s of hyperkalemia

MURDER
Muscle weakness
Urine production lil2nun
Respiratory failure
Decrease cardiac contraction Ty
Early signs of muscle twitching/cramps
Rhythm changes

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S/s of hypokalemia

Slow and low

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CA glucanite

Given during emergency treatment for hyperkalemia
Does not decrease potassium
It is given to protect the heart to allow other therapies to do their thing
Given IV and over 3 minutes
If given we need to stop calcium if bradycardia starts developing

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Hypertonic glucose and insulin

Emergency treatment for hyper kalemia

Insulin makes easy k+ movement into cells
Glucose helps prevent hypoglycemia
Rise and fall of BS does not allow pt to feel good so teach pt fall precautions and warn

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Insulin

Is thick in the IV so we want to make sure its patent andd you have a good IV 20-18 gauge

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Albuterol

Can be given with insulin and glucose and it helps shift potassium into cells
Teach that side effects is tachycardia and shakes

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Magnesium

Absorbed in the GI tract
Excreted in the kidneys

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Renal disease

Early stages cause hypokalemia but renal failure is #1 cause of hyperkalemia

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Foods rich in potassium

Bananas
Watermelon
White beans
Sweet potatoes
Avocados
Spinach

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Foods rich in magnesium

Dark chocolate
avocados
Milk nuts
Bananas
Peas
Peanut butter
Oranges

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Nursing intervention for magnesium

SIM
Safety w swallowing
(Small bites sitting up awake tilt chine down and swallow)
IV mg + sulfate (give slowly)
Monitor respiratory status and reflexes

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When giving potassium why is it better to do it in a central line rather a peripheal?

Faster, hurts less, less dangerous

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S/s of hypomagnesemia

BIG ONE Tight airway- strider, laryngospasm, difficulty swallowing
Neuromuscular- hyper FLEXIO- clonus, muscle twitching
GI - N,v,d
Neurological- increased brain activity - irritability, insomnia, confusion, seizure
Heart- increased bp, increased hr

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Causes of hypomagnesemia

Mg absorbed in the intestines

Renal loss

Malabsorption

Antibiotics

Chronic alcoholism (most common)

GI loss n,v,d

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Causes of hypomagnesemia

Mg absorbed in the intestine
Renal loss
Malabsorption (crohns,celiac disease
Antibiotics
Chronic alcoholism (most common)

GI loss (n,v,d)

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Three functions of calcium

Bone
Blood
Beats
(Necessary for clotting blood
Combines with phosphorous to form mineral salts in bone and teeth

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Which ages has more calcium in their bones than elderly?

Children

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Calcium and albumin low

Usually doctor will ignore calcium and replace albumin
Phosphorous is high when calcium is low so if albumin is low it gets ignored as well and albumin is treated??***

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Which calcium regulator pulls calcium and phosphorus from the bones and into the plasma?

Parathyroid gland releases PTH

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Which calcium regulator acts as an antagonist of PTH

Calcitonin
When ca is too high it keeps ca in the bone and prevents reabsorption.

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Why do celiac and crohn disease cause low calcium

Malabsorption

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What happens when someone takes corticosteroids for a long period of time?

Decreases the body ability to absorb Ca and increase how fast bone is broken down
Causes hypocalcemia
Hypernatremia
And hypokalemia

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Why does acute pancreatitis cause hypocalcemia

Effects PTH secretion

S/s of hypocalcemia often effect

Nerve transmission muscle and heart function

S/s of hypocalcemia

CRAMPS Confusion Reflexes hyperactive Arrythmias Muscle spasms Positive trousseau’s Signs of chvosteks

S/s hypocalcemia CATS

Convulsion Arrhythmias Tetany Spasm and Stridor

What are the first signs of hypocalcemia when it comes to muscle spasms

Tingling around mouth and finger tips

Infiltration of calcium can cause

Sloughing and necrosis so we need to Monitor

Acute symptomatic of hypocalcemia

Is a medical emergency and require admin of IV calcium

When a pt is present in early sings of hypocalcemia such as tingling around the mouth and the fingers what medical treatment can help?

Anti acids (tums) Milk Can be Normal for pt post op after

What type of arrhythmias can cause hypocalcemia

Tornadoes de pointes

Hypercalcemia s/s WEAK

Weakness of muscles EKG changes Absent reflexes absent minded (disoriented) ….abdominal distinction from constipation Kidney stone formation

What two electrolytes do we need to worry about digoxin

Hypercalcemia and potassium

What does lithium cause

Hypercalcemia and

What can hypercalcemia cause with arrhythmias

Cardiac arrest

Symptoms of digoxin toxcity

Confused irregular pulse and vision changes loss of apetite n,v,d

Where is calcium absorbed

Small intestine

What is a loop diuretic

LASIX /furosemide

Steroids

Inhibit intestinal reabsorption of calcium

Calcitonin is good for

Those patients who can’t tolerate large sodium loads such as renal and heart failure And admin IM

Why do we give phosphorus with vitamin d?

Reabsorption

When replacing phosphorus IV/PO

GIVE SLOW Fracture precautions

What is the opposite of calcium

Phosphate

What has an interrelationship with sodium

Water

Causes of hyponatremia

NONA Na excretion increase Overload of fluid Na intake low Antidiuretic hormone over secretion

S/s of hyponatremia

Salt loss Seizure and stupor Abdominal cramping, attitude ..changes (confusion) Lethargic Tendon reflexes diminished, confusion Loss of urine&apetite Orthostatic BP&overactive bowel sounds Shallow respirations spasms of muscles

What electrolyte does chloride follow?

Sodium

What happens when you increase sodium too fast in someone who is Hyponatremic

You can cause some permanent neurological damage

Rule of thumb for sodium in a 24 hour period

Not more than 12 meq/L

Hypernatremia causes

High salt Hyper cortisol is(cushingssyndromehyperventilation) Increased intake of sodium (oral or IV route GI feeding tube w/o adequate watersupplements Hypertonic solutions Sodium excretion decreased and corticosteriods Aldosteronism (hyper) Loss of fluids (infection, sweating, diarrhea, di Thirst impairment

Hypernatremia s/s

No fried foods for you Fever Restless, agitated Increased fluid retention Edema, extremely confused Decreased urine output dry mouth/skin

Osmolarity normal value

280-300

When a pt is hyponatremic and neurological symptoms are present

Give small amounts of hypertonic solution at a time

How long to increase sodium in a pt who is experiencing neurological symptoms

Until neurological issues start to diminish

If you have a pt that comes in and you ask if they are on lithium

They are automatically are at risk for hyponatremia

Colloids

Albumin(osmotically =to plasma) Dextran -plasma volume expander Hetastach-synthetic volume expander Mannitol -alcohol sugar

Colloid purpose

Large molecules that do not dissolve and can not pass through a membrane Used clinically for volume expansion Pull fluid into the blood

Desmopressin (DDAVP)

Given for hypernatremia Given to patients with DI

Hypokalemia causes

“Ditch” Drugs ( laxatives, diuretics or corticosteroids) Inadequate intake k+ Too much water intake (dilutes k) Cushing syndromes (increase na ) Heavy fluid loss (NG sunction, committing, diarrhea, wound drainage)

7 ls of hypokalemia

Lethargic Low shallow resp Lethal cardiac Loss of urine Leg cramps Limp muscles Low BP and hr

Always give potassium how?

Oral supplement with food below 2.5 give k+ as an infusion

If ur pt is on potassium sparring diuretics potassium supplements and salt substitutes should not be given to pt with

Renal issues

Sodium bicarbonate (emergency med treatment)

K shifts into cells

If your pt is on potassium sparring diuretics potassium supplements and salt substitutes should not be given to pt

With renal issues

Magnesium has a interrelationship with

Potassium

When your low in potassium

Youre giving magnesium as well In cardiac world potassium above 4 and magnesium above 2

Nursing interventions for hyper magnesium

Him Hemodialysis Iv calcium gluconate Monitor labs

Low magnesium resembles

Low calcium as well

Causes of hypermagnesemia

Antacids Renal failure Potassium excess

S/s of hypermagnesemia

Heart calm and quiet Lung -low and shallow resp GI- hypoactive bowel sounds Neuro-drowsiness lethargy Ms-weakness