Electrolytes Keys Flashcards
What two diseases can screw up electrolytes
Addison disease and Cushing
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)
S/s of hyperkalemia
MURDER
Muscle weakness
Urine production lil2nun
Respiratory failure
Decrease cardiac contraction Ty
Early signs of muscle twitching/cramps
Rhythm changes
S/s of hypokalemia
Slow and low
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
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
Insulin
Is thick in the IV so we want to make sure its patent andd you have a good IV 20-18 gauge
Albuterol
Can be given with insulin and glucose and it helps shift potassium into cells
Teach that side effects is tachycardia and shakes
Magnesium
Absorbed in the GI tract
Excreted in the kidneys
Renal disease
Early stages cause hypokalemia but renal failure is #1 cause of hyperkalemia
Foods rich in potassium
Bananas
Watermelon
White beans
Sweet potatoes
Avocados
Spinach
Foods rich in magnesium
Dark chocolate
avocados
Milk nuts
Bananas
Peas
Peanut butter
Oranges
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
When giving potassium why is it better to do it in a central line rather a peripheal?
Faster, hurts less, less dangerous
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
Causes of hypomagnesemia
Mg absorbed in the intestines
Renal loss
Malabsorption
Antibiotics
Chronic alcoholism (most common)
GI loss n,v,d
Causes of hypomagnesemia
Mg absorbed in the intestine
Renal loss
Malabsorption (crohns,celiac disease
Antibiotics
Chronic alcoholism (most common)
GI loss (n,v,d)
Three functions of calcium
Bone
Blood
Beats
(Necessary for clotting blood
Combines with phosphorous to form mineral salts in bone and teeth
Which ages has more calcium in their bones than elderly?
Children
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??***
Which calcium regulator pulls calcium and phosphorus from the bones and into the plasma?
Parathyroid gland releases PTH
Which calcium regulator acts as an antagonist of PTH
Calcitonin
When ca is too high it keeps ca in the bone and prevents reabsorption.
Why do celiac and crohn disease cause low calcium
Malabsorption
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
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
