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
Calcium absorption requires?
The active form of Vitamin D
Vit D is obtained from foods or made in the skin by the action of sunlight on cholesterol
Bones contain about 99%
Other 1% in plasma and body cells.
Of the calcium in plasma, 50% is bound to plasma proteins primarily albumin, 40% in free or ionized form, the rest is found bound with phosphate, citrate, or carbonate.
A decreased plasma pH is what?
Acidosis!! This decreases Calcium binding to albumin, leading to more ionized calcium. And increase plasma pH equals alkalosis increases calcium binding, leading to decreased ionized calcium.
Total calcium values increase or decrease directly with which other serum?
Serum albumin levels
Parathyroid hormone (PTH) and calcitonin regulate what?
Calcium levels!
Since the bones serve as a readily available store of calcium the body can usually keep calcium levels normal by regulating the movement of calcium into or out of the bone.
Low serum calcium levels stimulate the parathyroid gland to make and release PTH. PTH increases bone resorption movement of calcium out of bones, increases G.I. absorption of calcium, and increases renal to bowl reabsorption of calcium high serum calcium levels stimulate the release of calcitonin from the thyroid gland calcitonin has the opposite effect of PTH it lowers the serum calcium level by increasing calcium deposition into bone, increasing renal calcium excretion and decreasing G.I. absorption.
Normal values of calcium?
9.0-10.5 mg/dL
Possible etiology of hypercalcemia?
Hyperthyroidism
Hyperaparathyroidism
Vit D intoxication
Multiple myeloma
Possible etiology of hypocalcemia
Pancreatitis Hypo parathyroidism, Malabsorption syndrome Renal failure Vit d deficiency
How does hypocalcemia occur?
Can result from any condition associated with PTH deficiency
How does hypocalcemia specifically occur?
Surgical removal of part of, or injury to, the parathyroid glands during thyroid or neck surgery or with neck radiation.
Hypocalcemia <9.0 other causes
The patient who receives multiple blood transfusions can develop hypocalcemia because citrate, used as an anticoagulant in blood banks, binds with calcium, decreasing ionized calcium levels. Sudden alkalosis may result in symptomatic hyper Kelsey Mia despite a normal total serum calcium level
No ionized calcium levels decrease the threshold for activating the sodium channels that cause cell membrane deep polarization this results in what?
Increased nerve excitability and sustain muscle contraction or tetani
Hypocalcemia <9.0
What are clinical signs of tetany?
Include Chvostek’s sign and Trousseau’s sign.
What is Chvostek’s sign? (Sign of hypocalcemia)
Is contraction of facial muscles in response to a tap over the facial nerve in front of the ear.
What is Trousseau’s sign?
Refers to carpal spasms induced by inflating blood pressure cuff on the arm when you inflate the cuff above the systolic pressure carpal spasms occur within three minutes if hypocalcemia is present.
Other manifestations of tetany are what? (Due to hypocalcemia <9.0)
Laryngeal stridor (Weakness of parts of the voicebox (larynx) that is present at birth this condition can cause a high-pitched sound called stridor her during inhalation.
Nursing diagnoses hypocalcemia
Electrolyte in balance, impaired breathing, activity intolerance, potential complications: fracture, respiratory arrest
Manifestations hypercalcemia >10.5
Lethargy, weakness, fatigue Decreased memory Depressed reflexes Increased BP Confusion, psychosis Anorexia, nausea, vomiting Bone pain, fractures Polyuria, dehydration Nephrolithiasis Seizures, coma
ECG changes in hypercalcemia > 10.5
Shortened ST segment and QT interval
Ventricular dysrhythmias
Increase digitalis effect
HYPERcalcemia is caused by?
>10.5
Hi serum calcium is caused by hyper parathyroidism in about 2/3 of persons cancers, especially hematologic, breast, and then cancers, cause the remaining third period cancers lead to hypercalcemia through tumor protecting factors that prompt osteoclastic activity and bone resorption.
Excess calcium acts like?
A sedative!
Leading to reduced excitability of muscles and nerves.
Neurologic manifestations do to hypercalcemia are what?
Fatigue, lethargy, weakness, and confusion and progress to hallucinations, seizures, and coma.
Changes in cardiac conduction due to hypercalcemia can lead to what?
DYSRHYTHMIAS
Including heart block and ventricular tachycardia
Hypocalcemia <9.0 CAUSES
Primary hypo parathyroidism Renal insufficiency Acute pancreatitis High phosphate level Vit D deficiency Loop diuretics Diarrhea Low serum albumin Chronic alcohol use Low magnesium levels Tumor lysis syndrome
Hypocalcemia ECG changes <9.0
Elongation of ST segment
Prolonged QT interval
Ventricular tachycardia
How would the nurse help manage hypocalcemia?
Treating miles or a symptomatic hypocalcemia involved a diet high in calcium Ridge foods and calcium and vitamin D sublimation. Symptomatic hypocalcemia is treated with IV calcium gluconate. Measures to promote CO2 retention, such as breathing into a paper bag or sedating the patient, can control muscle spasm another symptoms of tetany until the calcium level is corrected. Patient’s taking loop diuretics may need to change to thiazide diuretics to decrease urinary calcium excretion.
Hypocalcemia, closely assess any patient who had what type of surgery?
Thyroid or neck surgery in the immediate postoperative period. BC of the proximity of the sx to the parathyroid glands.
What can precipitate hypocalcemic symptoms?
Adequately treat pain and anxiety bc hyperventilation induced respiratory alkalosis can precipitate hypocalcemic symptoms.
Phosphorus is the
Primary anion in ECF and the second most abundant element in the body after calcium.
Most phosphorus is found where?
Bones and teeth ac calcium phosphate. The rest is metabolically active in the form of phosphate salts.
Why is phosphorus essential?
It is essential to the function of muscle, red blood cells, and the Nervous system.
How is phosphorus involved in the body?
In the acid-base buffering system; the mitochondrial formation of ATP; cellular uptake and use of glucose; and carbohydrate, protein, and fat metabolism.
What maintains serum phosphate levels and balance?
PTH
Proper phosphate balance requires adequate renal functioning because the kidneys are the major route of phosphate excretion. When the phosphate level in the glomerular filtrate falls below normal or PTH levels are low the kidneys re-absorb more phosphate a reciprocal relationship exist between phosphate and calcium. This means a low serum calcium level will result in a high phosphate level and vice versa
Phosphorus (phosphate) 3.0-4.5 High levels >4.5 etiology
Bone cancer Hypo parathyroidism, renal disease, vitamin D intoxication, hypocalcemia Hyperthermia Sickle cell anemia, hemolytic anemia Thyrotoxicosis Rhabdo Tumor lysis syndrome
Phosphorus (phosphate) 3.0-4.5
Low levels <3.0 etiology
Diabetes, hyperparathyroidism, vitamin D deficiency
Which manifestations with the nurse expect to see in a patient with hyperphosphatemia?
The patient will present with hypocalcemia, numbness and tingling in extremities and region around mouth, hyperreflexia, muscle cramps, tetany, seizures, calcium phosphate precipitate in skin, soft tissue, cornea, viscera, blood vessels
Severe hypo phosphatemia may be fatal because of what?
Decreased cellular function
Acute manifestations include CNS depression, muscle weakness and pain, respiratory failure, and heart failure. Chronic hypophosphatemia alters bone metabolism, resulting in rickets and osteomalacia.
How would a nurse manage phosphate imbalances?
Managing mild phosphate deficiency involves increasing oral intake with dairy products or phosphate supplements. Dairy products are better tolerated because phosphate supplements are often associated with adversity effects, including diarrhea and bloating. Symptomatic hypophosphatemia can be fatal and usually requires IV administration of sodium phosphate or potassium phosphate during IV replacement make sure to monitor the serum calcium and phosphate levels every 6 to 12 hours per form frequent assessment during IV therapy as complications including hypocalcemia, hyperkalemia, hypertension, and dysrhythmias.
Magnesium levels
1.3-2.1 mEq/L
High magnesium etiology
Addison’s disease, hypothyroidism, renal failure
Low magnesium etiology
Chronic alcoholism
Severe malabsorption
Role of magnesium in the body?
It is a cool factor in many enzyme systems, including those responsible for carbohydrate metabolism, DNA and protein synthesis, blood glucose control, and blood pressure regulation, magnesium as needed for the production and use of ATP, the energy source for the sodium potassium pump.
What other important function does magnesium play?
Muscle contraction and relaxation, normal neurologic function, and neurotransmitter release depend on magnesium.
Which organs regulate serum magnesium in the body?
The kidneys and G.I. system regulate serum magnesium by controlling the amount of magnesium reabsorbed in the ascending loop of Henley and distal tubules and absorption in the small intestine G.I. absorption and Reno reabsorption increase when magnesium levels are low.
Causes of hypermagnesemia >2.1mEq/L
Renal failure, IV administration of magnesium, especially for treatment of eclampsia, tumor lysis syndrome, hypothyroidism, metastatic bone disease, adrenal insufficiency, antacids and laxatives
Manifestations that a nurse would expect to see in a patient with HYPERmagnesemia >2.1
G, drowsiness, muscle weakness, urinary retention, nausea, vomiting, diminished deep tendon reflexes, flushed warm skin especially facial decrease Paul’s decrease blood pressure
What causes hypomagnesemia >1.3 mEq/L
G.I. tracked fluid losses example diarrhea, NG suction, chronic alcohol use, malabsorption syndromes, prolonged malnutrition, acute pancreatitis, increased urine output, hyperglycemia, proton pump inhibitor therapy
Which clinical manifestations with a nurse expect to see with a patient with hypomagnesemia <1.3mEq/L
The nurse should expect to see a patient who presents with confusion, muscle cramps, tremors, seizures, vertigo, hyper active deep tendon reflexes, Chvostek’s and trousseau’s sign, increase pulse, increase blood pressure, dysrhythmias
Hypermagnesmia high serum magnesium level usually occurs?
Only with increased magnesium intake accompanied by renal insufficiency or failure
A patient with chronic kidney disease who ingest products containing magnesium such as Maalox or milk of magnesia will have a problem with excess magnesium.
Best objective way to assess fluid balance?
Look for edema in the patient
How do you treat HYPERnatremia?
Hypotonic solution
D5W (3%)
You can also give the pt. a diuretic but be sure to monitor for too much volume loss.
Excess sodium: dilute with sodium free IV fluids and give diuretic to promote excretion
How do you treat serious hyponatremia?
Replacing fluid using IV hypertonic saline solution 3%
Should fall precautions be implemented for HYPERnatremia?
Yes!
What is a severe complication to watch out for in both hypo and HYPERnatremia?
Seizures and coma
What can cause serum sodium levels to fall?
Drinking too much water
The nurse is administering 3% saline solution IV to a patient with severe hyponatremia. It is most important for the nurse to observe for what?
Shortness of breath and increased respiratory rate
Why? Because this may cause dangerous intravascular volume overload and pulmonary edema
Which electrolyte maintains cardiac rhythms and acid base balance?
Potassium
Which condition will present in Renal failure?
Hyperkalemia
What does a nurse have to look out for in patients with hyperkalemia?
Dysrhythmias
How does a nurse manage hyperkalemia?
Administer diuretics through dialysis and illuminate oral and parenteral potassium intake
How are the nurse reverse membrane effects of elevated ECF potassium?
Buy administrating calcium gluconate IV
If a patient doubles up on their furosemide (Lasix)
What will this result in?
HYPOkalemia
Hypo kalemia increases what in the body?
Blood sugar patients can present with hyperglycemia
How would a patient present with HYPOkalemia?
Heart rate would be up and irregular, respiratory rate would also be up
Treating HYPOkalemia
KCI supplements given orally or IV Always dilute IV KCl Never give KCl via IV push or as a bolus Should not exceed 10 MEQ/hr Use an infusion pump
What should the nurse teach a patient about HYPOkalemia when they are discharging the patient?
Teach patient ways to prevent hypokalemia patients at risk should have regular monitoring of serum potassium levels. Teach the patient taking digitalis to report signs and symptoms of digoxin toxicity at ones to their healthcare provider
A patient is admitted with renal failure and an arterial blood pH level of 7.29. Which lab results should the nurse expect?
Serum potassium 5.9
Hyperkalemia
