Final Exam Fluid And Electrolytes Topics 3-6 Questions Flashcards
Sodium value
135-145
- Signs and symptoms of hyponatremia (low conc. Of sodium in the body.)
< 136mEq/L - S/S of HYPERnatremia (causes hyperosmolality)
>145mEq/L - How are sodium and water balanced in the body? Which organ?
1. S/S weakness restlessness Delirium Confusion Tetany Thirst High temp, BP, ADH, and aldosterone
- Hyperosmolality causes water to move out of the cells to restore equilibrium, leading to cellular dehydration.
S/S of HYPERnatremia from water deficiency is often the result of an impaired level of consciousness.
EXCESS NA+ intake! Such as hypertonic NaCl, excess isotonic NaCl, IV sodium bicarbonate
Near drowning in salt water
Hypertonic feedings w/out water supplements
Inadequate water intake
Monitor pts. who are unconscious or cognitively impaired
Excess water loss due to high fever, heatstroke, prolonged hyperventilation, osmotic diuretic therapy, diarrhea
- The kidneys are our most important homeostatic control point. The balance happens in the kidneys with sensors from Various parts of the body providing feedback with the end goal bean preserving the plasma Osmololity Satinas tightly between 275 to 300 mOsm/kg and sodium levels between 135 to 145 mEq/L
Topic: Fluid and Electrolytes 3-6 questions
What are the 6 electrolytes?
Na+ K+ Cl- Ca+ Mg+ Phosphate Bicarbonate
How do each electrolyte function?
They play a role in conducting nervous impulses
Contracting muscles
Keeping you hydrated
Regulating your body’s pH levels.
K+
What will a nurse look for in a patient with HYPERkalemia
Muscle twitches Irritability and anxiety ⬇️ BP EKG Changes Dysrhythmias- irregular rhythm Abdominal cramping Diarrhea
The importance of K+ (critical mineral) 3.5-5.0
Normally, potassium helps The muscles to contract and expand, assisting the movement of your limbs. Potassium also helps absorb nutrients allowing for efficient communication of cells in the nervous system potassium is also especially important for proper cardiovascular function, helping to regulate blood pressure and heart rate.
What will a nurse look for in a patient with HYPOkalemia <3.5
One of the more common reasons for the condition of hypokalemia is that potassium is leaving the body through the digestive system.
Other common signs of potassium deficiency weakness is one of the first symptoms of potassium deficiency, weakness in the muscular system and limbs
fatigue, muscle cramps because the body relies on a delicate balance of electrolytes and minerals to keep the muscular system working efficiently
twitching,
constipation potassium also plays a critical role in managing the digestive system heart arrhythmia potassium plays a critical role in managing the cardiovascular system creating an irregular heartbeat or flutter
feeling thirsty potassium maintains hydration levels in the body however an increase in water intake may also lead to a depletion of sodium another critical electrolyte for managing optimal cell function if you notice yourself drinking more fluids drunk during the day and you may have a potassium deficiency
urination frequency
K+plays a role in managing kidney function
muscular paralysis, respiratory failure potassium again is critical for managing the muscular system and its interactions with CNS tiredness, muscular system weekends to potassium deficiency at risk of losing control of the cardiovascular function resulting in a loss of the ability to breathe
vomiting and diarrhea dehydration
again low blood pressure,
arrhythmia.
Which diseases are associated with HYPERnatremia?
Diabetes Insipidus
Primary hyperaldosteronism
Cushing syndrome
Uncontrolled diabetes
Manifestations HYPERnatremia
The nurse is going to see
Restlessness Agitation Lethargy Seizures Coma Intense thirst Dry swollen tongue STICKY mucous membranes Postural hypotension Weight loss ⬆️ pulse Weakness Muscle cramps
With normal or increased ECF volume
Peripheral and pulmonary edema
HYPOnatremia what occurs during excess sodium loss
G.I. losses; diarrhea, vomiting, fistulous, and NG suction
Renal losses: diuretics, adrenal insufficiency, sodium wasting renal disease
Skin Losses: Burns, wound drainage
Inadequate sodium intake
due to what?
Fasting diets
Hyponatremia Excess water gain (⬇️ sodium dilution)
Excess hypotonic IV fluids
Primary polydipsia
Hypotonic
Hypo: ”under/beneath”
Tonic: concentration of a solution
The cell has a low amount of solute extracellularly and it wants to shift inside the cell to get everything back to normal via osmosis. This will cause CELL SWELLING which can cause the cell to burst or lyses.
Hypotonic solutions 0.45% Saline (1/2 NS) 0.225% Saline (1/4 NS) 0.33% saline (1/3 NS) Hypotonic solutions are used when the cell is dehydrated and fluids need to be put back intracellularly. This happens when patients develop diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia.
Important: Watch out for depleting the circulatory system of fluid since you are trying to push
Primary polydipsia
Hyponatremia diseases
SIADH
Heart failure
Primary hypoaldosteronism
Cirrhosis
Manifestations of HYPOnatremia <136
With decreased ECF Volume
Irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, dry mucous membranes, postural hypotension, lower jugular venous feeling increased pulse thready pulse, cold and clammy skin
With normal or increased ECF volume you’re going to see headache, apathy, confusion, muscle spasms, seizures, nausea, vomiting, diarrhea, abdominal cramps, weight gain, increase blood pressure
Hyponatremia nursing implementation
Managing hyponatremia from fluid loss includes replacing fluid using ISOTONIC sodium containing solutions
encouraging oral intake
and withholding all diuretics.
In mild hyponatremia caused by water excess, fluid restriction may be the only treatment.
Loop diuretics and demeclocycline may be given.
If hyponatremia is acute or more serious small amounts of IV hypertonic saline solution parentheses 3% sodium chloride can restore the serum sodium level while the body is returning to a normal water balance.
What happens if a patient cannot tolerate fluid restrictions to treat hyponatremia?
Vasopressor receptor antagonist (drugs that block the activity of ADH) are used. These drugs include conivaptan (Vaprisol) and tolvaptan (Samsca)
Conivaptan is given IV to hospitalized patients with severe hyponatremia from water access until wrapped him is given orally to treat hyponatremia from Heart Failure or SIADH.
How should a nurse monitor a patient with HYPOnatremia?
Monitor serum sodium levels and the patient’s response to therapy.
Avoid rapid correction or overcorrection.
Caution: quickly increase in sodium levels can cause osmotic D myelination syndrome with permanent damage to nerve cells in the brain. An accurate urine output record is essential. The patient may need a urinary catheter placed if unable to help with monitoring output. If the patient has an altered sensorium or is having seizures, initiate seizure precautions.
The body is made up of
98% of the body potassium being in the cells
K+ concentration in ECF is
3.5-5.0 mEq/L
The sodium – potassium pump in cell membranes maintains this concentration difference by pumping potassium into the cell and sodium out. Insulin helps by stimulating the sodium potassium pump.
Diet is the main source for potassium. Patient may receive potassium from parenteral sources, including IV fluids, transfusions of stored hemolyzed blood, and certain medication such as potassium penicillin.
What is the primary route for potassium loss?
The kidneys are the primary route for potassium loss, eliminating about 90% of the daily potassium intake. Potassium expression depends on the serum potassium level, urine output, and renal function.
What happens with increased or decreased K+ excretion levels?
When serum potassium is high, urine potassium excretion increases, and when serum levels are low excretion decreases. Large urine output can cause excess potassium loss.
Impaired Kidney function causes what?
Potassium retention. There is an inverse relationship between sodium and potassium reabsorption in the kidneys.
What are factors that cause sodium retention?
Low blood volume,
hyponatremia,
aldosterone secretion cause potassium expression
Hyperkalemia (high serum potassium may result from what?
Impaired renal excretion
A Shift of potassium from ICF to ECF, a massive intake of potassium, or a combination of these factors. But the most common cause of hyperkalemia is renal failure. Adrenal insufficiency with subsequent aldosterone deficiency leads to potassium retention.
So what causes potassium to move from ICF to ECF?
This includes acidosis, massive cell destruction suggestion burn or crush injury, tumor lysis, severe infections, and intense exercise.
In metabolic acidosis, potassium ions shift from
ICF to ECF in exchange for hydrogen ions moving into the cell
Which drugs can impair entry of potassium into cells?
Digoxin-like drugs and B adrenergic blockers (i.e. propanolol) Can impair entry of potassium to cells resulting in higher ECF potassium concentrations.
Which Drugs can contribute to hyperkalemia by reducing the kidneys ability to excrete potassium?
NSAID’s
Potassium-sparing diuretics, angiotensin II receptor blockers (e.g. losartan) and ACE inhibitors (lisinopril) can contribute to hyperkalemia.
Which Clinical manifestations well the nurse be aware of in hyperkalemia?
This result in increase cell excitedability and changes in impulse transmission to the nerves and muscles. The most clinically significant problems are the changes in cardiac conduction with hyperkalemia. The initial finding is tall, Peaked T waves. As potassium increases, cardiac Depolarization decreases, leading to loss of P waves, a prolonged PR interval, ST segment depression, and widening QRS complex. Heart block, ventricular fibrillation, or cardiac standstill may occur
What patient manifestations will the nurse notice, in hyperkalemia?
The nurse will notice that the patient may have fatigue, confusion, tetany, muscle cramps, paresthesias, and weakness.
Therefore as potassium increases you’re going to see lots of muscle tone and weakness or paralysis of other skeletal muscles, including the respiratory muscles, can occur, leading to respiratory arrest.
Which G.I. manifestations will the nurse notice in a patient with hyperkalemia?
Abdominal cramping, vomiting, and diarrhea occur from hyper activity of G.I. smooth muscles
Nursing diagnoses hyperkalemia
Electrolyte imbalance
Activity intolerance
Impaired cardiac output
Potential complications: dysrhythmias
Reasons for potassium loss K+ <3.5
GI losses: diarrhea, vomiting,
Dialysis
Diaphoresis
Paresthesia
Unusual tingling, pricking, chilling, burning, numbness with no apparent physical cause.
Hypokalemia <3.5 S/S
Manifestations
Fatigue Muscle weakness Leg cramps Soft, flabby muscles Paresthesias Constipation, nausea, paralytic ileus Shallow respirations Weak, irregular pulse Hyperglycemia
ECG Changes HYPOkalemia
Flattened T wave Presence of U wave ST segment depression Prolonged QRS Peaked P wave Ventricular dysrhythmias 1st and 2nd degree heart block
ECG changes in HYPERkalemia >5.0
Tall, Peaked T wave “hyper T wave” Prolonged PR Interval ST segment depression Widening QRS Loss of P wave V-Fib V standstill
What is first and second degree heart block?
In first Degree AV blocks, there is a delay in electrical conduction from atria to ventricles. Second-degree heart block means that the electrical signals between your atria and ventricles can intermittently fail to conduct.
What is ventricular standstill?
It is a rare electrophysiological abnormality. Where the heart stops beating and stands perfectly still no blood is pumped and the results are the same as ventricular fibrillation.
How would a nurse manage HYPOkalemia?
Consists of oral or IV potassium chloride (KCL) supplements and ⬆️ dietary intake of potassium. Consuming potassium rich foods can usually correct mild hypokalemia fruits such as apricot avocado banana cantaloupe orange orange juice prunes raisins vegetables such as canned mushrooms greens except kale broccoli cooked carrots raw black beans spinach cooked tomatoes or yogurt salt free broth nuts and seeds granola chocolate bran or bran products
Digitalis (refresher)
Is used to treat congestive heart failure and heart rhythm problems such as atrial arrhythmias.
Digitalis can increase blood flow throughout your body and reduce swelling in your hands and ankles.
digitalis medicines strengthen the force of a heartbeat by increasing the amount of calcium in the heart cells.
Digitalis toxicity, nurse should monitor patient for?
Confusion Lethargy GI problems N/V Poor appetite Visual problems such as blurred vision Changes in color vision
What is the role of calcium in the body?
Calcium plays a role in the blood clotting, transmission of nerve impulses, myocardial contractions, and muscle contractions.
Major source for calcium is?
Dietary intake
