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5031 - Adult Med/Surg > Exam 1 - Electrolyte Balance > Flashcards

Exam 1 - Electrolyte Balance Flashcards

Exam 1

1
Q

Electrolytes are…

A

substances that become charged particles (ions) when they are in water

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2
Q

Na normal values

A

136-145 mEq/L

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3
Q

K normal values

A

3.5-5.0 mEq/L

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4
Q

Ca normal value

A

9.0-10.5 mg/dL

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5
Q

Mg normal value

A

1.3-2.1 mEq/L

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6
Q

_____ helps regulate intravascular volume

A

Sodium

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7
Q

What is the main role of Potassium?

A

Support the transmission of electrical impulses within the heart and muscles

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8
Q

90% of K is excreted through the ____.

A

Kidneys

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9
Q

Administration of insulin will increase cellular uptake of _____.

A

K

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10
Q

What are the roles of electrolytes?

A

(1) Balance body fluids
(2) Regulate heart rhythm
(3) Support nerve and muscle function
(4) Move nutrients and waste

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11
Q

Process of regulating plasma concentrations of electrolytes

A

Electrolyte balance

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12
Q

The main goal of electrolyte balance is what?

A

Intake matches output

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13
Q

Electrolyte balance is maintained by 3 physiological processes:

A

(1) Intake and absorption
(2) Distribution
(3) Output

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14
Q

Movement of electrolytes into various body fluid compartments

A

Distribution

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15
Q

Loss of electrolytes through normal and abnormal routes

A

Output

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16
Q

NG tubes and drains are high risk for ____

A

electrolyte imbalances

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17
Q

Name at least 3 risk factors for electrolyte imbalance (7)

A

(1) age
(2) neurological deficits
(3) disruption of phys processes
(4) changes in body fluid levels
(5) kidney disease
(6) endocrine disorders
(7) medications

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18
Q

Lisinopril is what type of medication?

A

ACE Inhibitors

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19
Q

Lisinopril is associated with what electrolyte imbalance?

A

Hyperkalemia

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20
Q

What are the two monitoring parameters for patients on lisinopril?

A

BP and K levels

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21
Q

NSAIDs are associated with what electrolyte imbalances?

A

Hyponatremia; hyperkalemia

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22
Q

Thiazide diuretics are associated with what electrolyte imbalances?

A

hyponatremia; hypokalemia

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23
Q

Laxatives can contain what electrolyte?

A

Mg

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24
Q

Location where specific electrolyte is in high amount is the…

A

electrolyte pool

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25
Q

Poor dietary intake and no access to water can both lead to _____ output and ____ intake

A

Normal output, not enough intake or absorption

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26
Q

Diarrhea, vomiting, and gastric suctioning can all lead to ____ output and ____ intake

A

Increased output, not enough intake or absorption

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27
Q

High doses of steroids can lead to ____ output and _____ intake

A

Increased output, not enough intake or absorption

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28
Q

Rapid infusion, too much water intake, and massive blood transfusion lead to ____ output and ____ intake

A

Normal output, excessive intake

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29
Q

Impaired kidney function and lack of aldosterone leads to ____ output and ____ intake.

A

Decreased output, normal intake

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30
Q

Rapid shift of K from ECF to ICF can lead to what type of imbalance?

A

Altered distribution

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31
Q

Mg and Ca imbalances impact the release of ____, which leads to _____

A

Ach; change in the speed of ions through nerve and muscle membranes

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32
Q

Imbalances of which electrolytes can lead to impaired perfusion and oxygenation?

A

K, Mg, Ca

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33
Q

Severe ___ can lead to cardiac arrest

A

hyperkalemia

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34
Q

Name at least 3 clinical manifestations of hypernatremia

A

(1) extreme thirst
(2) confusion, disorientation
(3) restlessness
(4) muscle twitching, weakness
(5) tachycardia, ortho hypo, hyperthermia

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35
Q

In hyponatremia with normal fluid volume, HR is ____

A

rapid

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36
Q

In hyponatremia with hypovolemia, HR is ___

A

thready, weak, rapid

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37
Q

In hyponatremia with hypervolemia, HR is ___-

A

rapid, bounding

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38
Q

Name at least 3 clinical manifestations of hypokalemia

A

(1) Muscle weakness
(2) dysrhythmias
(3) respiratory failure
(4) altered mental status
(5) abdominal distention
(6) constipation

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39
Q

During phase 1 of hyperkalemia, what are the clinical manifestations?

A

skeletal muscle twitching, tingling, burning sensation, numbness

40
Q

During phase 2 of hyperkalemia, what are the clinical manifestations?

A

Flaccid paralysis; can impact respiratory muscles

41
Q

In phase 2 of hyperkalemia, what is a common sign on the ECG?

A

very tall T wave

42
Q

Which type of calcium imbalance is more common?

A

Hypocalcemia

43
Q

the abnormal twitching of muscles that are activated by the facial nerve

A

Chvostek’s sign

44
Q

Chvostek’s sign is typically an indicator of what imbalance?

A

Hypocalcemia and hypomagnesemia

45
Q

Involuntary contractions of the muscles in the hand and wrist

A

Trousseau’s sign

46
Q

Trousseau’s sign is typically an indicator of what imbalance?

A

Hypocalcemia and hypomagnesemia

47
Q

Name the 4 key nursing interventions r/t electrolyte imbalances.

A

(1) Seizure precautions
(2) Fall risk
(3) Oral care
(4) mobility

48
Q

Seizure precaution is particularly important for which imbalances?

A

Ca and Mg imbalances

49
Q

Fall risk is associated with what clinical manifestation?

A

Muscle weakness

50
Q

Pts with Ca imbalances may have painful spasms, which impair ____.

51
Q

Which electrolyte imbalances lead to increased excitability?

A

(1) hypernatremia
(2) hyperkalemia
(3) hypocalcemia
(4) hypomagnesemia

52
Q

5% Dextrose in Water (D5W)

53
Q

D10W

A

Hypertonic

54
Q

Ringer’s lactate

55
Q

5% dextrose in Ringer’s Lactate

A

hypertonic

56
Q

What are the most obvious problems of hyponatremia?

A

Cerebral changes

57
Q

If muscular weakness is present, what should the nurse assess next and why?

A

Respiratory effectiveness because ventilation depends on adequate strength of respiratory muscles

58
Q

What are the nursing priorities during interventions for imbalances?

A

(1) monitor pt response to therapy
(2) prevent opposite imbalance and fluid overload

59
Q

How do you treat hyponatremia with low fluid volume?

A

IV saline (isotonic)

60
Q

How do you treat hyponatremia with high fluid volume?

A

drugs that promote excretion of water and not sodium

61
Q

Severe hyponatremia should be treated with what?

A

3% saline (hypertonic)

62
Q

During hypernatremia, irritability can occur, which is what?

A

excitable tissues become more easily exicted; over-respond to stimuli

63
Q

Cushing syndrome and corticosteroids are associated with what imbalance?

A

Hypernatremia

64
Q

Hypernatremia with hypovolemia has what effect on HR and BP?

A

Increased HR, hypotension

65
Q

Hypernatremia with hypervolemia has what effect on HR and BP?

A

slow to normal HR; neck veins distended; high BP

66
Q

If you have hypernatremia due to lack of kidney excretion, what drug can you use?

A

Furosemide

67
Q

total body K levels are normal but K distribution b/w fluid spaces is abnormal or diluted by water

A

Relative hypokalemia

68
Q

Rapid infusions of ____ can lead to relative hypokalemia because of increased activity of the Na/K pump

69
Q

If Mg levels are low, ____ is often also present

A

hypokalemia

70
Q

What demographic tends to have increased K loss?

A

Older adults

71
Q

What should nurses assess every 2 hours in patients with hypokalemia and why?

A

Respiratory status b/c respiratory insufficiency and cardiac dysrhythmias are major cause of death

72
Q

Severe hypokalemia can cause the absence of ____ (GI)

A

Peristalsis

73
Q

Why is K never given IV Push or undiluted?

A

Can cause cardiac arrest

74
Q

Why is K never given IM or subQ?

A

K is a severe skin tissue irritant and can cause tissue necrosis

75
Q

If you give K via IV, what should check for?

A

Burning at the site; phlebitis

76
Q

If infiltration of a solution containing K occurs, what should you do?

A

Stop IV immediately
Remove venous access
Notify team
Document

77
Q

KCl can cause N/V so what is the best way to take it?

A

With food / meals

78
Q

How often should you perform respiratory monitoring for severe hypokalemia?

A

At least hourly

79
Q

Hypercapnia

A

Increased PaCO2

80
Q

The problems with hyperkalemia are related to what?

A

How rapidly ECF K levels increase

81
Q

What are the 3 main drugs to ask about during assessment for hyperkalemia?

A

Potassium-sparing diuretics, ARBs, ACEIs

82
Q

____ problems are the most severe problems from hyperkalemia and can lead to death

A

Cardiovascular

83
Q

What are life-threatening complications of severe hyperkalemia?

A

Complete heart block
Asystole
V fib

84
Q

How does late-stage hyperkalemia affects the neuromuscular system?

A

Flaccid paralysis

85
Q

_____ is an oral drug that binds with K in the GI tract and decreases absorption

86
Q

Why is insulin sometimes given for hyperkalemia?

A

It can help to move K from the ECF to the ICF b/c of increased activity of Na/K pump

87
Q

When should you notify the rapid response team with hyperkalemia?

A

(1) pt HR < 60 BPM
(2) T waves become spiked

88
Q

Steatorrhea is _____ in the stool

A

excessive fat

89
Q

What is one demographic that is especially at risk for hypocalcemia and why?

A

Postmenopausal females because of decrease in estrogen and decrease in weight-bearing exercises.

90
Q

Why is injury prevention important in someone with chronic hypocalcemia?

A

Brittle, fragile bones that fracture easily

91
Q

Why is IV normal saline 0.9% often given for hypercalcemia?

A

Because Na increases kidney excretion of Ca

92
Q

Use of loop or thiazide diuretics can cause which imbalance?

A

Hypomagnesemia

93
Q

What should you monitor for hourly when a patient is receiving IV MgSO4?

A

Deep tendon reflexes to monitor effectiveness and prevent hypermagnesemia.

94
Q

Patients with severe hypermagnesemia are at risk of what?

A

Cardiac arrest

95
Q

When cardiac problems are severe, giving ____ may reverse the cardiac effects of hypermagnesemia.

5031 - Adult Med/Surg (10 decks)

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