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N106 Fluids and Electrolytes > Electrolytes, Parenteral Management (IV's) and TPN > Flashcards

Electrolytes, Parenteral Management (IV's) and TPN Flashcards

1
Q

What is the difference between a cation and an anion?

Provide examples of electrolyte cations and anions.

A

A cation is an ion with a positive electrical charge and an anion is an ion with a negative electrical charge.
Examples of Cations:
Sodium (Na+); Potassium (K+); Calciun (Ca++); Magnesium (Mg++)
Examples of Anions:
Chloride (Cl-); Bicarbonate (HCO3-); Sulfate (SO4-); Hydrogen phosphate (HPO4-)

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2
Q

Which electrolyte cation is the most abundant electrolyte in the body?

A

Sodium (Na+)

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3
Q

What are the functions of sodium in the body?

A
  • Regulates water balance
  • Controls the extracellular fluid volume through osmotic pressure.
  • Increases cell membrane permeability
  • Stimulates conduction of nerve impulses and helps maintain neuromuscular irritability.
  • Controls contractility of muscles (esp heart)
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4
Q

What is the normal level of sodium concentration in the blood?

A

134 - 142 mEq/L

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5
Q

What is the term for less than normal concentration of sodium in the blood?
What is considered less than normal concentration?
What happens in the body during this condition?

A

Hyponatremia
<134 mEq/L
-Caused by water excess or loss of sodium
-The body decreases water excretion
-As sodium levels decrease in the extracellular fluid, water is pulled into the cells causing them to become edmatous
-As fluid moves into the cells, potassium is shifted out, causing potassium imbalance.

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6
Q

What are the most common signs & symptoms of hyponatremia?

A

Confusion, headache, fatigue, postural hypotension, N/V, abd cramps. **severe or prolonged deficit can cause seizures

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7
Q

What electrolyte pairs off AGAINST sodium? When sodium is conserved by the kidneys, this electrolyte is excreted?

A

Potassium

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8
Q

What is the sodium blood concentration level for hypernatremia?
What can cause hypernatremia?

A

> 145 mEq/L
Causes:
-Water loss, excess sodium
-Decreased Na excretion: renal failure; corticosteroids
-Increased Na intake: Oversalting; processed, frozen, canned, smoked foods; antacids containing sodium
-Increased water loss: sweating, fever, diarrhea

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9
Q

What happens in the body during hypernatremia?

A

-The body attempts to correct the imbalance by conserving water though renal reabsorption.
-Fluid Shifts from the cells to the interstitial spaces resulting in cellular dehydration.
.

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10
Q

What is the dominant intracellular cation?

A

Potassium

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11
Q

What are the functions of potassium in the body?

A
  • Regulation of water and electrolyte content within the cell.
  • Promotes transmission of nerve impulses and skeletal muscle function.
  • Assists in the cellular metabolism of carbohydrates and proteins
  • Controls the hydrogen ion concentration
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12
Q

How much potassium intake is required each day?

What is the normal extracellular level of potassium?

A

65 mEq

3.5 - 5 mEq/L

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13
Q

What is the main organ affected by potassium imbalances?

A

The heart

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14
Q

What is the main organ affected by sodium imbalances?

A

The brain

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15
Q

What are the main causes of hyperkalemia?

A
  • Renal Failure
  • Metabolic Acidosis
  • Use of salt or potassium supplements
  • Tissue trauma/damage (including from chemotherapy)
  • Infusion of blood nearing expiration
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16
Q

What medications can cause hyperkalemia?

A

Beta blockers (-lols), potassium-sparing diuretics, angiotensin-converting enzyme inhibitors (-prils), nonsteriodal antiinflammatory drugs, aminoglycosides (ie. gentamicin, streptomycin)

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17
Q

What are the main signs and symptoms of hyperkalemia?

A

N/V/D, Cardiac dysrhythmias, ECG changes (high T wave), Cardiac arrest

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18
Q

What is the potassium level that indicates hypokalemia?

What are the main causes?

A

< 3.5 mEq/L

  • NPO
  • Conditions causing very large urine output
  • Metabolic alkalosis
  • GI losses (vomiting, diarrhea, GI suctioning, Cushing’s syndrome)
  • Potassium-losing diuretics (thiazides, furosemide (lasix)); digitalis, corticosteroids
  • Excessive diaphoresis
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19
Q

What are the main signs and symptoms of hypokalemia?

A
  • Skeletal muscle weakness (leg cramps)
  • Cardiac dysrhythmias (weak, irregular pulse)
  • ECG Changes (flat T wave)
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20
Q

If potassium and sodium levels are both depleted, which one will the kidneys conserve by re-absorption and which one will be excreted?

A

Sodium will be reabsorbed and potassium will be excreted.

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21
Q

What 4 hormones help to balance sodium (Na+) and chloride (Cl-)?

A

Aldosterone, Angiotensin II, ANP (Atrial natriuetic peptide), ADH (Antidiuretic hormone)

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22
Q

What is the main anion in interstitial and intravascular fluid?

A

Chloride

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23
Q

What is the normal range for Chloride?

A

96-105 mEq/L

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24
Q

Which 2 electrolytes does Chloride commonly combine with?

Which electrolyte is Chloride frequently paired with? (When this electrolyte is low, Chloride is also low)

A

Sodium (Sodium Chloride) and Potassium (Potassium Chloride)

Sodium.

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25
Q

Although rare, hyperchloremia is possible when levels of which electrolyte fall?

A

Bicarbonate (HCO3-)

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26
Q

What is the normal level of Calcium?

A

4.5 mEq/L -5.3 mEq/L

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27
Q

In addition to Vitamin D, what 2 hormones are necessary for the absorption and utilization of calcium?

A

Calcitonin and parathyroid hormone

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28
Q

What is the ratio of carbinic acid to bicarbonate for homeostasis?

A

1:20

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29
Q

What are the signs and symptoms of hypocalcemia?

What are the signs and symptoms of hypercalcemia?

A

HYPO - Neuromuscular irritation, increased excitability, and tetany.

HYPER- N/V, confusion, bizarre behavior, cardiac dysrhythmias, cardiac arrest, decreased deep tendon reflexes.

30
Q

What two tests are done to check for hypocalcemia?

A

Chvostek’s sign - contraction of facial muscles in response to a light tap over the facial nerve in front of the ear.
and
Trousseau’s sign - a carpal spasm induced by inflating a BP cuff above the systolic pressure for a few minutes.

31
Q

What can develop when the kidneys excrete high levels of calcium?

A

renal calculi (kidney stones)

32
Q

What is the normal level of phosphorus?

33
Q

Phosphorus has an inverse relationship with what electrolyte?

34
Q

What is necessary for the body to absorb calcium and phosphorus?

35
Q

What is the normal level of magnesium?

A

1.5-2.5 mEq/L

36
Q

A decreased level of this electrolyte often results in a decreased level of magnesium.

37
Q

What are the signs and symptoms of hypermagnesemia?

A

Sleepiness, slurred speech, slowed deep tendon reflexes.

38
Q

What are the three main causes of hypermagnesemia?

A
  • impaired renal function
  • Excess magnesium administration
  • Diabetic ketoacidosis when there is severe water loss
39
Q

Hypomagnesemia main signs and symptoms are?

A

Mental changes, paresthesias, increased neuromuscular irritability similar to those with hypocalcemia.

40
Q

What is the normal leval of bicarbonate?

A

22-24 mEq/L

41
Q

Is bicarbonate primarily an intracellular or extracellular electrolyte?
What is it’s main function?

A

extracellular

main function: regulation of the acid-base balance. It acts as a buffer to neutralize acids in the body.

42
Q

What are the three systems that work to keep the pH in the narrow range of normal?

A
  1. the blood buffers (works to neutralize hydrogen ions)
  2. the respiratory system (blows off or retains CO2)
  3. The kidneys (retains or excretes HCO3-)
43
Q

What types of Acid-Base imbalances are most frequently seen in children?

A

Respiratory alkalosis and Respiratory acidosis

44
Q

Which types of Acid-Base imbalances are most frequently seen in adults?

A

Metabolic alkalosis and Metabolic acidosis

45
Q

What Acid-Base imbalance is this?
pH > 7.45, PaCO2 (normal), HCO3 >28
What causes this imbalance?

A

Metabolic acidosis - loss of acid or increase in bicarbonate

Causes: vomitting, NG drainage, Excessive use of antacids, Fistulas, Steroids, Diuretics

46
Q

What Acid-Base imbalance is this?
pH>7.45, PaCO2 < 35, HCO3 (normal)
What causes this imbalance?

A

Respiratory Alkalosis - too much CO2 being excreted by lungs

Causes: Hyperventilation, Great pain

47
Q

What Acid-Base imbalance is this?
pH 45, HCO3 (normal)
What causes this imbalance?

A

Respiratory Acidosis: Acid buildup, R/T lungs not eliminating CO2
Causes: decreased respirations, Chronic respiratory disease, CNS depression, Narcotics, Barbiturates

48
Q

What Acid-Base imbalance is this?
pH<21
What causes this imbalance?

A

Metabolic Acidosis - too much acid in the body or loss of bicarbonate.
Causes: diarrhea, diabetic ketoacidosis, renal failure, Starvation, shock, heavy exercise

49
Q

Why would patient’s be put on TPN?

A
  • NPO > 7 days (ie. pancreatitis)
  • Inflammatory disease (ie. ulcerative colitis)
  • GI absorption of protein impaired (ie. sm bowel obstruction)
  • bowel rest needed (ie. post bowel surgery)
  • normal enteral feeding is not possible or is inadequate
  • Tube feeding alone cannot provide adequate nutrition
50
Q

What conditiond can occur if infusion of TPN is infused too rapidly?

A

Hyperglycemia, glycosuria, mental confusion, loss of consciousness

51
Q

What main considerations should be made regarding administering potassium via IV?

A
  • Cannot administer through IV push. This may cause cardiac arrest.
  • Should never be administered undiluted, always diluted in 500 - 1000 mL of an IV solution.
52
Q

What should be assessed prior to administering magnesium?

A

Deep tendon reflexes (knee-jerk reaction). If reflex is absent or a slow response is obtained, the nurse should withhold the dosage and notify physician.

53
Q

For what conditions are plasma expanders contraindicated?

A
  • Patient’s with hypersensitivity of any component of the solution (hespan or dextran)
  • Those with severe bleeding disorders
  • Severe cardiac failure
  • Renal failure with oliguria or anuria
54
Q

Plasma expanders should be used cautiously for what conditions?

A
  • Renal disease-
  • Heart Failure
  • Pulmonary edema
  • Bleeding disorders
55
Q

What are the signs and symptoms of fluid overload?

A
  • HA
  • Weakness
  • Blurred weakness
  • Behavioral changes (confusion, disorientation, delirium, drowsiness)
  • Weight gain
  • Isolated muscle twitching
  • Hyponatremia
  • Rapid breathing
  • Wheezing
  • Coughing
  • Rise in blood pressure
  • Distended neck veins
  • Elevated central venous pressure
  • Convulsions
56
Q

How does fluid overload occur?

A

When the body’s fluid requirements are met and the administration of fluid occurs at a rate that is greater than the rate at which the body can use or eliminate the fluid.

57
Q

Why would Parenteral (IV replacement) replacement solutions be used?

A
  • To replace electrolytes, calories or water for hydration.
  • To facilitate nutrition and maintain electrolyte balance when the patient cannot eat
  • As a method to deliver drugs when a less invasive method is not suitable due to drug pharnacokinetics or patient status
58
Q

What are some possible complications from parenteral fluid administration?

A 
Fluid overload
Infiltration
Extravasation
Hyperglycemia
Hypoglycemia
Electrolyte imbalance
59
Q

What is the definition of infiltration and what are the signs and symptoms?

A

Definition - Collection of fluid into tissue
Signs/Symptoms: Swollen IV site, Leaking IV site,
Cold hand or extremity
Pain
Edema

60
Q

What is the definition of extravasation and what are the signs and symptoms?

A

Definition: Escape of fluid from a blood vessel into the surrounding tissue
Signs/Symptoms: Pain, stinging, burning, induration, erythema, venous discoloration or swelling

61
Q 
A nurse is preparing to administer an electrolyte that is a major component of extracellular fluid.  Which of the following would most likely be administeres?
Potassium
Sodium
Phosphate
Magnesium
62
Q 
A nurse is preparing to administer prescribed plasma protein fraction to a patient.  The nurse understands that this drug is used to treat which of the following?
Proteinuria
Anemia
Hypovolemic shock
Protein C deficiency
A

Hypovolemic shock

63
Q 
The nurse would assess a patient receiving which of the following for signs and symptoms of hypokalemia?
Furosemide (Lasix)
Lisinopril (Prinivil)
Digoxin (Lanoxin)
Spironolactone (Aldactone)
A

Furosemide (Lasix)

64
Q

Normal saline contains what percentage of sodium chloride?

65
Q

What alkalinizing drug is used to treat metabolic acidosis, increasing blood pH?

A

Bicarbonate (HC03-)

66
Q

What adverse reactions may occur after administering bicarbonate?

A

N/V, Indigestion, gas, systemic alkalosis

67
Q

What acidifying drug is used to treat metabolic alkalosis, lowering pH?

A

Ammoniium chloride

68
Q

What adverse reactions may occur after administering ammonium chloride?

A

Metabolic acidosis, loss of potassium

69
Q

For what conditions is bicarbonate contraindicated?

A
  • patients losing chloride
  • patients with metabolic or respiratory alkalosis
  • hypocalcemia
  • renal failure
  • abdominal pain
  • sodium-restricted diet
70
Q

What types of fluids are compatible with blood products?

A

Only 0.9% normal saline

N106 Fluids and Electrolytes (2 decks)

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