Fluid and Electrolyte Lecture 2 Flashcards
0
Q
Cardiac: weak, irregular heart rate, orthostatic hypotension, palpitations
This occurs in what fluid and electrolyte imbalance?
A
A: Hypokalemia
Study Tip:
Potassium = Cardiac
Hyper = Fast
Hypo = Slow
1
Q
What does MURDER mean when describing the signs and symptoms of HYPERKALEMIA?
A
Muscle Weakness Urine [Oliguria, Anuria] Respiratory distress Decreased Cardiac Contractility EKG charges Reflexes [Hyperreflexia or Areflexia(flaccid)]
2
Q
What does CATS mean when describing the signs and symptoms of HYPOCALCEMIA?
A
Convulsions
Arrhythmias
Tetany
Stridor and Spasms
3
Q
Urine specific gravity less than 1.010
What does this lab mean in relation to fluid and electrolyte balance?
A
A: Lab Tests: Hyponatremia
Study Tip: Low urine concentration because there is a lot of water in the blood which is diluting the salt or there is an excessive loss of salt.
3
Q
Oliguria
This occurs in what fluid and electrolyte imbalance?
A
A: Hyperkalemia
Study Tip: ^ K+ is caused by decreased urine production because potassium is excreted through the urine.
4
Q
What does FRIED SALT mean when describing the signs and symptoms of HYPERNATREMIA?
A
Flushed Skin and Fever [Low Grade]
Restless [Irritable, Anxious, and Confused]
Increased Blood Pressure and Fluid Retention
Edema [Peripheral and Pitting]
Decreased urine output and dry mouth
Skin flushed
Agitation
Low grade fever
Thirst
5
Q
What does A SIC WALT mean when describing the signs and symptoms of HYPOKALEMIA?
A
Alkalosis Shallow Respirations Irritability Confusion [Drowsiness] Weakness [Fatigue] Arrhythmias [Irregular Rate & Tachycardia] Lethargy Thready Pulse
also Decreased Intestinal Motility
[Nausea, Vomiting, and Ileus]
6
Q
Serum K less than 3.5 mEq/L
What does this lab mean in relation to fluid and electrolyte balance?
A
A: Lab Test: Hypokalemia
7
Q
Diuretics with fluids to increase sodium loss
What fluid imbalance is this treatment used to treat?
A
A: Treatment: Hypernatremia
9
Q
Neuromuscular nerve impulse transmission.
What electrolyte is this?
A
A: Potassium
9
Q
Major cation in teeth and bones.
This cation also binds highly to protein.
What electrolyte is this?
A
A: Calcium
Study Tip: Calcium binds with Phosphorus which causes them to have an inverse relationship. Calcium also binds with H+ ions to decrease acidosis.
10
Q
Diuretics, diabetic glycosuria, vomiting, diarrhea, excessive diaphoresis, burns, fever, aldosterone deficiency
This occurs in what fluid and electrolyte imbalance?
A
A: Hypovolemia
11
Q
Serum Na+ over 145 mEq/L
What does this lab mean in relation to fluid and electrolyte balance?
A
A: Hypernatremia
13
Q
Hyperosmolar Hyperglycemic NonKetoic Syndrome means the same thing as _________.
A
Diabetic Ketoacidosis
14
Q
What does MACHINE mean when describing the causes of HYPERKALEMIA?
A
Medications [ACE Inhibitors, NSAIDS] Acidosis [Respiratory or Metabolic] Cellular Destruction [Burns/Traumatic Injury] Hypoaldosteronism [Hemodialysis] Intake [Excessive] Nephrons [Renal Failure] Excretion [Impaired]
15
Q
Inability to ingest fluids.
This occurs in what fluid and electrolyte imbalance?
A
A: Hypernatremia
16
Q
EKG: flattened P wave, widened QRS, and a tented T wave,
What does this lab mean in relation to fluid and electrolyte balance?
A
A: Lab Test: Hyperkalemia
17
Q
Can irritate veins and cause chemical phlebitis
NEVER given IV push.
What fluid imbalance is this treatment used to treat?
A
A. Hypokalemia
Study Tip: K+ IS NEVER GIVEN IV PUSH/IM/SUBCU!
Do not put ice on a K+ IV site because it will constricts the blood vessels and cause more pain by allowing more of the vessels surface area to come in contact with the substance. RN can ask to have lidocaine added to the bag to decrease irritation.
18
Q
MAIN ECF cation, most abundant in body
Loss or gain usually coincides with water +/-
What electrolyte is this?
A
A: Sodium
19
Q
Serum Na+ over 145 mEq/L
What does this lab mean in relation to fluid and electrolyte balance?
A
A: Lab Tests: Hypernatremia
19
Q
K+ Dietary consultation
What fluid imbalance is this treatment used to treat?
A
A. Hypokalemia
19
Q
Poor Ca+ absorption
What fluid and electrolyte imbalance does this cause?
A
A: Hypocalcemia
Rationale: especially post menopause
21
Q
When calcium increases what happens to phosphorus levels?
A
Decrease
Study Tip: inverse relationship they bond together and are excreted as salts
22
Q
Oral fluid replacement, IV if necessary. Fluids given gradually over 48 hours.
What fluid imbalance is this treatment used to treat?
A
A: Treatment: Hypernatremia
23
This imbalance causes muscle weakness by inhibiting muscular excitability. increased ________ binds to the cell membrane and prevent cell membrane permeability closing the sodium channels to the cell.
Hypercalcemia
| calcium
24
Isotonic IV fluids (NS), high sodium foods
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hyponatremia
25
Dialysate with NO Ca+
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
Study Tip: Dialysate using dialysis can be used if in renal failure but can't have calcium in it during hypercalcemia. Most dialysate has high levels of calcium in the fluid.
26
Regulates ECF volume, water distribution
| What electrolyte is this?
A: Sodium
27
Hypothalamic disorders. (brain’s thirst center)
| This occurs in what fluid and electrolyte imbalance?
A: Hypernatremia
29
Non-renal losses of potassium (laxative abuse, vomiting, diarrhea, prolonged NG suction, and wound drainage)
What fluid and electrolyte imbalance does this cause?
A: Hypokalemia
30
Dry, cracked mucous membranes
Weak, rapid pulse
Low blood pressure or orthostatic hypotension
What do these symptoms happen with related to hypovolemia?
A: Use of Diuretics, diabetic glycosuria, vomiting, diarrhea, excessive diaphoresis, pt has burns, fever, aldosterone deficiency
31
Poor skin turgor
Dry, cracked mucous membranes
Weak, rapid pulse
Low blood pressure or orthostatic hypotension
This occurs in what fluid and electrolyte imbalance?
A: Hypovlemia or hypernatremia
32
Hypovolemia causes what symptoms?
A: Dry, cracked mucous membranes
Weak, rapid pulse
Low blood pressure or orthostatic hypotension
33
Edema
Hypertension
Weight gain
Rapid, bounding pulse
This occurs in what fluid and electrolyte imbalance?
A: Hyponatremia or hypervolemia
34
Serum osmolality less than 280 (dilute blood)
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Tests: Hyponatremia
36
Edema
Hypertension
Weight gain
Rapid, bounding pulse
What do these symptoms happen with related to hyponatremia?
A: Happens with:
Heart failure, hepatic cirrhosis, renal failure, overhydration
Need to make another slide for this with ppt
37
Increased urine specific gravity and elevated urine Na in patients with SIADH
What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Tests: Hyponatremia
37
Elevated Hct and plasma protein
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Tests: Hyponatremia
Why?
37
S/sx Varies with cause and severity
Mild with hypervolemia.
This occurs in what fluid and electrolyte imbalance?
A: Hyponatremia
38
Exchanged for H+ ions when pH increases.
| What electrolyte is this?
A: Potassium
39
Restrict fluids to prevent fluid overload
Give patient oral Na+ supplements
What fluid imbalance is this treatment used to treat?
A: Treatment: Hyponatremia
40
ICU placement if swelling of brain cells occurs
| What fluid imbalance is this treatment used to treat?
A: Treatment: More severe Hyponatremia: Na+ < 120 mEq/L
40
Hypertonic IV solution ( ___% or ___% saline) if symptomatic
| What fluid imbalance is this treatment used to treat?
A: 3%-5%
Treatment: More severe Hyponatremia: Na+ < 120 mEq/L
41
To avoid fluid overload administer Na+ slowly and give diuretics (furosemide)
What fluid imbalance is this treatment used to treat?
A: Treatment: More severe Hyponatremia: Na+ < 120 mEq/L
42
Which is more common electrolyte imbalance seen in patients?
A: Hyponatremia
43
This is less common than hyponatremia?
A: Hypernatremia
44
This fluid and electrolyte imbalance if left untreated can lead to seizures, coma, and permanent neurological damage?
A: Hypernatremia
Study Tip: Hypernatremia can cause death.
45
What fluid and electrolyte imbalance has a mortality rate of >50%?
A: Hypernatremia
46
Serum Na+ less than 135 mEq/L
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Tests: Hyponatremia
47
Water deficit in the cells and interstitial space.
| This occurs in what fluid and electrolyte imbalance?
A: Hypernatremia
49
High protein feedings without adequate water.
| This can cause what fluid and electrolyte imbalance?
A: Hypernatremia
Feeding has high concentration of sodium glucose and potassium if patient is not given water imbalances can occur.
50
Skeletal and cardiac muscle contraction and electrical conductivity.
What electrolyte is this?
A: Potassium
51
Heart failure causes what fluid and electrolyte imbalance?
Increased fluid volume occurs because heart is not able to pump the large amount of fluid effectively. Which causes
Increased kidney excretion of urine.
52
Excessive sodium intake.
| What fluid and electrolyte imbalance does this cause?
A: Hypernatremia
53
Administration of Salt tablets to your patient.
| What fluid and electrolyte imbalance does this cause?
A: Hypernatremia
54
High sodium foods.
| What fluid and electrolyte imbalance does this cause?
A: Hypernatremia
55
Medications: Kayexalate
| What fluid and electrolyte imbalance does this medication cause?
A: Hypernatremia
Study Tip: Kayexalate exchanges Potassium from inside the cell for sodium in the bowels to stimulate diarrhea. This causes a release in Potassium and retention in Sodium.
56
Excessive IV administration of hypertonic solution
| What fluid and electrolyte imbalance does this cause?
A: Hypernatremia
57
Respiratory muscles may weaken causing tachypnea and tachycardia
This occurs in what fluid and electrolyte imbalance?
A: Hypokalemia
59
Restlessness/agitation, anorexia, nausea/vomiting.
| These are common early symptoms of what fluid and electrolyte imbalance?
A: Hypernatremia
60
Weakness, lethargy, confusion, stupor, seizures, coma.
| These are common late symptoms of what fluid and electrolyte imbalance?
A: Hypernatremia
61
Laxative abuse
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
62
Low grade fever
Flushed skin
Intense thirst
These are symptoms of what fluid and electrolyte imbalance?
A: Hypernatremia
63
If sodium is gained during hypernatremia what symptoms does this cause?
A: Hypervolemia, increased BP, bounding pulse, dyspnea
64
If water is lost during hypernatremia what symptoms does this cause?
A: Hypovolemia, dry mucous membranes, oliguria, orthostatic hypotension
65
Urine specific gravity more than 1.030
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Tests: Hypernatremia
66
Serum osmolality more than 300
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Tests: Hypernatremia
66
Urine specific gravity more than 1.030 is normal. Normal is decreased in patients with Diabetes Insipidus. Why?
Because they are excreting large amounts of dilute urine because kidneys aren't properly concentrating urine.
67
Varies with cause
With fluid and electrolyte imbalances you must ALWAYS correct underlying disorder before you attempt to correct the symptoms.
What fluid imbalance is this treatment used to treat?
A: All Imbalances
68
Restrict sodium intake
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypernatremia
69
Diabetes Insipidus.
| What fluid and electrolyte imbalance does this cause?
A: Hypernatremia
Causes urination of large amounts of un concentrated urine causing the body to retain sodium.
70
IVs salt free: e.g D5W
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypernatremia
72
3.5 – 5.0 mEq/L
What does this lab mean in relation to fluid and electrolyte balance?
The MAIN intracellular fluid cation.
What electrolyte is this?
A: Potassium
Normal Serum Potassium
73
Maintains electrical neutrality and osmolality of cells.
| What electrolyte is this?
A: Potassium
74
Diet adjustment increase Ca+ intake
| What fluid imbalance is this treatment used to treat?
A: Treatment: Acute Hypocalcemia
75
Asymptomatic: treat underlying cause
| What fluid imbalance is this treatment used to treat?
A: Treatment: all imbalances
76
Function in the transmission of nerve impulses.
Instrumental in the production of energy and in blood clotting.
What controls these mechanisms?
A: Electrolytes
77
Decreased intake of potassium. Ex. Anorexia, fad diets NPO, fad diets, alcoholics, prolonged i.v. administration without potassium.
What fluid and electrolyte imbalance does this cause?
A: Hypokalemia
Study Tip: alcoholics have decreased intake
78
Transcellular Shift of potassium from the intracellular space to the extracellular space. (Ex. RBC transfusion due to new cells not being mobile and alkalosis)
What fluid and electrolyte imbalance does this cause?
A: Hypokalemia
79
Serum Na < 135 mEq/L
What does this lab mean in relation to fluid and electrolyte balance?
A: Hyponatremia
Study Tip: Hyponatremia can cause death.
80
```
Renal losses (Ex. decreased use of diuretics,potassium wasting diuretics excrete potassium causing high losses in the urine.)
What fluid and electrolyte imbalance does this cause?
```
A: Hypokalemia
81
Describe Potassium sparing diuretics?
A: doesn't excrete large amounts of potassium thus preventing losses.
82
Serum sodium decreases when extracellular fluid moves into the cell.
This occurs in what fluid and electrolyte imbalance?
A: Hyponatremia
83
Describe potassium wasting diuretics?
A: excrete potassium causing high losses in the urine.
84
Can be life threatening.
Watch closely if patient on digoxin.
Can potentiate action and cause toxicity.
This occurs in what fluid and electrolyte imbalance?
A: Hypokalemia
85
EKG: flat or inverted T Wave, and the presence of a U wave
This occurs in what fluid and electrolyte imbalance?
A: Hypokalemia
86
GI: decreased bowel sounds, constipation, ileus
| This occurs in what fluid and electrolyte imbalance?
A: Hypokalemia
87
Skeletal muscle weakness: especially in legs –parasthesias, leg cramps, decreased reflexes
This occurs in what fluid and electrolyte imbalance?
A: Hypokalemia
87
Slightly elevated blood glucose
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypokalemia
88
Elevated pH and bicarbonate levels
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypokalemia
90
_________ stimulates the osteoclasts in the bone which stimulate increased calcium reabsorption in the renal tubules.
parathyroid hormone
91
Twitching, hyperreflexia, ataxia, tremors. These are common neuromuscular symptoms of what fluid and electrolyte imbalance?
A: Hypernatremia
92
Decreased serum Mg
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypokalemia
A low level of magnesium in the blood can also cause hypokalemia. Magnesium is required for adequate processing of potassium. This may become evident when hypokalemia persists despite potassium supplementation. Direct Relationship.
93
Administer Oral K+ supplements to your pt.
| What fluid imbalance is this treatment used to treat?
A: Moderate to severe Hyperkalemia
Study Tip: this will not work if patient has malabsorption issues.
94
Affects concentration, excretion, and absorption of other electrolytes (especially Cl- and K+)
What electrolyte is this?
A: Sodium
95
Increased digoxin levels (if pt is taking this med)
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypokalemia
96
Major influence on ECF osmolality & osmolarity, water distribution
What electrolyte is this?
A: Sodium
97
EKG: flat or inverted T Wave, U wave,
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypokalemia
98
Restore normal balance
Treatment varies based on severity & cause
What fluid imbalance is this treatment used to treat?
A: All Imbalances
99
Hyperosmolar hyperglycemic non-ketoic syndrome. (severe water loss)
This occurs in what fluid and electrolyte imbalance?
A: Hypernatremia
A: Hypertonicity in the blood pulls fluid into the intravascular from the cells causing them to shrink and dehydrate.
100
High K+, Low Na+ diet
| What fluid imbalance is this treatment used to treat?
A. Hypokalemia
101
Oliguric renal failure
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
102
Supplements: po or IV
Never given IM or SQ
What fluid imbalance is this treatment used to treat?
A. Hypokalemia
103
Medication: NSAIDs
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
Study Tip: NSAIDS decrease blood flow to kidneys which decreases urine production which increases retention of potassium.
104
Multiple Blood transfusions
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
105
Too much K+ intake (oral or IV supplementation)
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
106
Excessive use of K+ based salt substitutes
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
107
Transcellular shifts ex. Rhabdomyolysis
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
108
Insulin deficiency with hyperglycemia
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
109
Drowsiness and confusion
| This occurs in what fluid and electrolyte imbalance?
A: Hyperkalemia
110
Tissue destruction: rhabdomyolysis, tumor lysis syndrome
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
Study Tip: when blood cells are lysed potassium is spilled into the ECF releasing K+ causing ^ in serum.
111
Muscle cramps, weakness, flaccid paralysis
| This occurs in what fluid and electrolyte imbalance?
A: Hyperkalemia
112
Chronic malabsorption syndrome
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
113
Low serum albumin level
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypocalcemia
114
EKG: flattened p wave, widened QRS, and tented T wave
| This occurs in what fluid and electrolyte imbalance?
A: Hyperkalemia
Study Tip: QRS measures ventricular firing which is required for a heartbeat. If the QRS occurs too rapidly it can turn into ventricular fibrillation which is fatal.
115
Assists in blood coagulation
| What electrolyte is this?
A: Calcium
116
NG tube placement
| What fluid imbalance is this treatment used to treat?
A: Moderate to severe Hyperkalemia
117
Serum Ca more than10.5 mg/dL
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypercalcemia
Study Tip: the medication calcitonin is a treatment used to decrease the blood serum calcium level. Calcitonin is also secreted by the thyroid gland.
118
K+ 5.1 – 6.0 mEq/L
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Mild Hyperkalemia
119
Serum Na decrease.
What does this lab mean in relation to fluid and electrolyte balance?
A: Extracellular and intravascular fluid moves into cells.
A: Hyponatremia
120
K+ 6.1 – 7.0 mEq/L
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Moderate Hyperkalemia
121
Decreased arterial pH while the patient is in acidosis
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hyperkalemia
Study Tip: Acidosis, which occurs in a number of diseases, is defined as an increase in the concentration of hydrogen ions in the bloodstream. In the body's attempt to correct the situation, hydrogen is taken up by muscle cells out of the blood in an exchange mechanism involving the transfer of potassium ions into the bloodstream. This can abnormally elevate the plasma's concentration of potassium ions. When acidosis is the cause of hyperkalemia, treating the patient for acidosis has two benefits: a reversal of both the acidosis and the hyperkalemia.
122
Primarily symptoms are neurological: Headache, irritability, disorientation, lethargy, confusion
This occurs in what fluid and electrolyte imbalance?
A: Hyponatremia
123
Monitor EKG for tented T wave, flattened p wave, widened QRS
What fluid imbalance is this treatment used to treat?
A: Hyperkalemia
124
K+ restricted diet
| What fluid imbalance is this treatment used to treat?
A: Hyperkalemia
125
_________ Inhibits calcium absorption in intestines
A: Phosphorus R/T Calcium Regulation
126
__________ promotes Ca+ absorption by intestines and kidneys, and resorption of Ca+ back into the bone.
A: Vitamin D R/T Calcium Regulation
127
Eliminate potassium sparing diuretics
| What fluid imbalance is this treatment used to treat?
A: Hyperkalemia
128
Eliminate potassium supplements
| What fluid imbalance is this treatment used to treat?
A: Hyperkalemia
129
Calcitonin is released in _______because it inhibits bone resorption of calcium which helps to excrete the calcium rapidly.
A: Hypercalcemia R/T Calcium Regulation
130
```
Loop diuretics (for mild) to increase excretion
What fluid imbalance is this treatment used to treat?
```
A: Hyperkalemia
131
Sodium polystyrene sulfonate (aka Kayexalate)
| What fluid imbalance is this treatment used to treat?
A: Moderate to severe Hyperkalemia
132
Evenly distributed and widely dispersed between ICF and ECF
| What electrolyte is this?
A: Calcium
133
Retention enema
Causes loose stools
What fluid imbalance is this treatment used to treat?
A: Moderate to severe Hyperkalemia
Rationale: Causes K+ to be lost through bowels
134
Dialysis used when other methods fail to balance levels
| What fluid imbalance is this treatment used to treat?
A: Moderate to severe Hyperkalemia
135
8.5 mg/dL – 10.5 mg/dL
| What does this lab mean in relation to fluid and electrolyte balance?
A: Normal Serum CaLcium
136
IV calcium gluconate, glucose and insulin
| What fluid imbalance is this treatment used to treat?
A: Moderate to severe Hyperkalemia in Emergency Situations
137
Helps cells to adhere to each other & maintain shape
| What electrolyte is this?
A: Calcium
138
Potassium affects what organ the most?
Heart
Study Tip: Cardiac Contractility
139
If Sodium falls to 110 mEq/L further deterioration (due to cerebral edema): stupor, delirium, ataxia, seizures, and coma.
This occurs in what fluid and electrolyte imbalance?
A: Hyponatremia
140
This cation is necessary for muscles to contract.
| What electrolyte is this?
A: Calcium
Study Tip: affects contraction of muscles can cause weakness and tetany.
Hypocalcemia will induce tetany. Too much sodium inside the cell because not enough calcium to close cell gates.
Hypercalcemia will induce weakness. Too little sodium because of closed gates.
141
Affects permeability and firing level of cells
| What electrolyte is this?
A: Calcium
142
_______ draws calcium from bones into the bloodstream when serum Calcium level is low and promotes increased kidney and intestinal reabsorption of calcium?
A: Parathyroid hormone (PTH) R/T Calcium Regulation
Study Tip: Calcium is also regulated by the parathyroid hormone. They work on a feedback mechanism. PTH pulls calcium out of the bone and promotes calcium retention in the bloodstream.
143
________ is a hormone produced by the thyroid which is a PTH antagonist which means it stops PTH from being released.
A: Calcitonin R/T Calcium Regulation
144
Low serum albumin
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
Rationale: This is THE MOST COMMON cause of Hypocalcemia!
Study Tip: Low serum albumin decreases total calcium because then calcium cannot bind to it which causes the calcium to be excreted in the urine.
It suggests there is a positive relationship.
Calcium in the blood is normally transported partly bound to plasma proteins (about 45%) notably albumin. When protein concentrations, and especially albumin concentrations, fluctuate substantially, total calcium levels may vary, whereas the ionized calcium may remain relatively stable. Thus dehydration or hemoconcentration may elevate serum albumin and a falsely elevated total serum calcium may be reported.
145
Neuromuscular: paresthesia of toes, fingers, face, twitching, muscle cramps, laryngo- and bronchospasm, tetany, positive Trousseau’s and Chvostek’s sign
This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
146
When _________ level goes up or retention increases, phosphorus level goes down or is then excreted. (and vice versa)
A: Calcium R/T Calcium Regulation
147
When Serum pH goes ________ less Ca+ binds and ionized Ca+ levels go up (Ca+ that is available in the blood) increases.
A: down (acidosis) R/T Calcium Regulation
148
Serum Ca less than 8.5 mg/dL
| What does this lab mean in relation to fluid and electrolyte balance?
A: Hypocalcemia
149
Cancer
| What fluid and electrolyte imbalance does this cause?
A: Hypercalcemia
Rationale: 2 MOST COMMON CAUSES includes
HYPERPARATHYROIDISM
150
Insufficient intake of Ca+
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
151
___________ suppresses the release of Parathyroid hormone (PTH)
A: Hypercalcemia R/T Calcium Regulation
152
Insufficient sunlight could mean low Vitamin D
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
153
Symptoms can vary from patient to patient from mild to moderate to severe.
Depends on rapidity of development.
This occurs in what fluid and electrolyte imbalance?
A: Hyponatremia
154
Elderly patients are at a high risk due to poor intake and decreased absorption.
What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
Study Tip: loss of mobility increases the release of Ca+ from bones which is then urinated out which results in Hypocalcemia.
155
Reduced activity, immobility, or inactivity
| What causes these symptoms?
A: Hypocalcemia
156
When Serum pH goes ________ Ca+ binds with protein and ionized Ca+ (Ca+ that is available in the blood) decreases.
A: up (alkalosis) R/T Calcium Regulation
157
______________ means muscle tissue breakdown.
Rhabdomyolysis
158
CV: V-fib, heart block
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
159
Fluid shifts have HUGE impact on brain cells.
| This is a common neurological symptom of what fluid and electrolyte imbalance?
A: Hypernatremia
160
```
Inadequate absorption (malabsorption) of Ca+
What fluid and electrolyte imbalance does this cause?
```
A: Hypocalcemia
161
Administer Oral K+ supplements
| What fluid imbalance is this treatment used to treat?
A. Hypokalemia
162
Renal patient takes TUMS to neutralize acid but they also contain a high concentration of calcium.
If your patient is taking TUMS to decrease their Phosphorus level by forcing it to bind with Ca+ do they take the medication with or without food?
Take it with a meal because you want the calcium to bind with the phosphorus. TUMS is made out of HCO3- and decreases stomach acid.
163
Increased GI motility (diarrhea)
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
164
_________ causes decreased absorption of Ca+ and enhanced secretion of Ca + by kidneys when serum calcium levels are high.
A: Calcitonin R/T Calcium Regulation
165
Lack of Vitamin D (sunlight)
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
Study Tip: sunscreen prevents patient from getting benefits of vitamin D from sun. Tell the patient did not wait 30 minutes before going out into the sun. When the patient goes into the sun they will get there vitamin D and in 15 minutes the sunscreen will begin to work.
166
What does ROME mean?
Respiratory Opposite Metabolic Equal
167
Anti-convulsants can interfere with Vitamin D metabolism
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
168
Decrease dietary intake of Ca+
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
169
Combines with other ions to maintain acid-base balance
ESSENTIAL for impulse transmission in nerve and muscle tissue
What electrolyte is this?
A: Sodium
170
PTH secretion reduced or eliminated
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
171
Hypovolemia and ___________ have an equal and inverse relationship.
Hypernatremia
172
Thyroid surgery, removal of parathyroid tumor, parathyroid disease
What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
Study Tip: during thyroid surgery they can accidentally remove some parathyroid gland which can decrease secretion of calcium.
173
Less sodium to move across excitable membranes causes ?
| This occurs in what fluid and electrolyte imbalance?
A: Delayed membrane depolarization
A: Hyponatremia
174
When calcium is retained by kidneys, ______ is then excreted because they have an inverse relationship.
A: Phosphorus R/T Calcium Regulation
175
Medication: Calcitonin
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
Rationale: reduce calcium resorption from bone
176
Hyperphosphatemia occurs when phosphorus combines with Ca+ to form salts
What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
Study Tip: calcium binds with the phosphorus which creates salts which are than urinated out.
177
Alkalosis can cause Ca+ to bind to albumin which decreases ionized Ca+
What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
178
Patients with Burns
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
Study Tip: calcium gets trapped in the damaged tissue causing hypocalcemia
179
Patients with Infections
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
180
Abnormal Nerve transmission, muscle and heart function
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
Rationale: MOST COMMON SYMPTOMS
181
Neuro: anxiety, confusion, irritability, seizures
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
182
GI: diarrhea
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
183
Chvostek’s and Trousseau’s Signs
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
184
Diminished response to digoxin
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
185
Decreased cardiac output
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
186
EKG:
Lengthened QT interval (at risk for torsades de pointes)
Prolonged ST segment
This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
187
Hypervolemia and ____________ mean the same thing.
Hyponatremia
188
Decreased myocardial contractility leading to:
Angina, bradycardia, hypotension, and heart failure
This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
189
Dehydration means the same thing as both?
Hypernatemia and hypovolemia
190
Excessive Vitamin D ingestion
| What fluid and electrolyte imbalance does this cause?
A: Hypercalcemia
191
Torsades de pointes
| This occurs in what fluid and electrolyte imbalance?
A: Hypocalcemia
192
EKG
Prolonged ST segment
Lengthened QT interval
What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypocalcemia
193
Abdominal cramping, diarrhea
| This occurs in what fluid and electrolyte imbalance?
A: Hyperkalemia
193
Total serum Ca less than 8.5 mg/dL
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypocalcemia
193
IV Calcium Gluconate
| What fluid imbalance is this treatment used to treat?
A: Treatment: Acute Hypocalcemia
Rationale: MOST COMMON TREATMENT
193
Calcium Chloride
| What fluid imbalance is this treatment used to treat?
A: Treatment: Acute Hypocalcemia
Rationale: GIVEN FOR CARDIAC ARREST
Study Tip: Calcium chloride has a higher concentration of calcium and is only used during cardiac arrest because of adverse effects and irritation of the blood vessels.
194
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Digoxin toxicity (if patient is on digoxin)
What does this lab mean in relation to fluid and electrolyte balance?
```
A: Lab Test: Hypercalcemia
195
Magnesium replacement may also be needed for desired response
What fluid imbalance is this treatment used to treat?
A: Treatment: Acute Hypocalcemia
196
If deficiency is severe or if the patient can’t take oral supplements : IV replacement
What fluid imbalance is this treatment used to treat?
A. Hypokalemia
197
Increased intestinal absorption of Ca+ and decreased excretion of Ca+ by kidneys
What fluid and electrolyte imbalance does this cause?
A: hypercalcemia
Study Tip: parathyroid hormone stimulates the osteoclasts in the bone which stimulate increased calcium reabsorption in the renal tubules. Parathyroid hormone can also decrease the reabsorption of phosphorus excreting it in the urine.
198
Pancreatic insufficiency: leads to intestinal loss
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
Rationale: Decreased absorption
199
Antacid abuse
| What fluid and electrolyte imbalance does this cause?
A: Hypercalcemia
200
Hypervolemia and ________ have an equal inverse relationship.
Hyponatremia
201
Muscle weakness, hyporeflexia, loss of muscle tone
| This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
Study Tip: this occurs because in hypercalcemia everything slows down and in hypocalcemia everything speeds up.
202
Usually caused by resorption of Ca from bone
| What fluid and electrolyte imbalance does this cause?
A: Hypercalcemia
203
Address underlying cause
Correct imbalance quickly and safely
What fluid imbalance is this treatment used to treat?
A: All imbalances
204
The MAIN intracellular fluid cation.
| What electrolyte is this?
A: Potassium
205
Bradycardia, cardiac arrest
| This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
Study Tip: this occurs because in hypercalcemia everything slows down and in hypocalcemia everything speeds up.
209
Medication: Potassium sparing diuretics
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
Study Tip:
210
Vitamin D supplements if chronic
| What fluid imbalance is this treatment used to treat?
A: Treatment: Acute Hypocalcemia
211
Hyperparathyroidism
| What fluid and electrolyte imbalance does this cause?
A: Hypercalcemia
Rationale: 2 MOST COMMON CAUSES includes
CANCER
212
Calcium Gluconate given with Insulin
| What is this treatment used to treat?
Hyperkalemia
Study Tip: this treatment works because the glucose goes into the cells and forces K+ to go out of the cells into the blood stream and the insulin in the bloodstream forces the K+ out of the blood stream through excretion in the urinh.
213
Fatigue or weakness
| This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
214
Acidosis
| What fluid and electrolyte imbalance does this cause?
A: Hypercalcemia
Rationale: Increases calcium ionization
214
Calcium affects what organ the most?
Muscle
Study Tip: weakness and tetany
215
Anorexia, Nausea, Vomiting, and constipation
| This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
Rationale: GI: may be first indications noted by patient
Study Tip: this occurs because in hypercalcemia everything slows down including peristalsis which causes food to back up in the intestines causing anorexia, constipation, nausea, and vomiting.
216
Decreased bowel sounds
| This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
Study Tip: this occurs because in hypercalcemia everything slows down and in hypocalcemia everything speeds up.
218
Hyponatremia and __________ mean the same thing.
Hypervolemia
219
This is considered a Metabolic emergency.
| This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
219
Pathological fractures
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypercalcemia
Study Tip: fractures occur easier in Hypercalcemia because the calcium is being pulled out from inside of the bone causing the bone to become weak.
220
Kidneys work overtime- may lead to renal failure
| This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
Study Tip: this occurs because the kidney has to work really hard to excrete all of the extra calcium to maintain balance.
221
Alcoholics
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
Rationale: poor intake and low Mg (decrease PTH)
223
Breast fed infants if mom has poor intake
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia
224
Close monitoring of K+ level
| What fluid imbalance is this treatment used to treat?
A. Hypokalemia
225
Heart block
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Hypercalcemia
226
Aids in maintenance of acid-base balance
Activates nerve and muscle cells
What electrolyte is this?
A: Sodium
Study Tip: Why? Sodium helps control acid/base imbalance by combining with chloride and bicarbonate to maintain acid/base balance.
226
Stop taking meds containing Ca+
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
226
Hydrate
If symptomatic or in presence of renal failure
What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
227
Monitor electrolyte levels
| What fluid imbalance is this treatment used to treat?
A: Hyperkalemia
228
Changes in pH and increased serum calcium levels can cause what complication of renal failure?
Kidney stones
229
Cushing’s syndrome (excessive adrenocortical hormone).
| What fluid and electrolyte imbalance does this cause?
A: Hypernatremia
230
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EKG:
Prolonged PR interval
Shortened QT interval
Flattened T waves
What does this lab mean in relation to fluid and electrolyte balance?
```
A: Lab Test: Hypercalemia
Study Tip: Short QT likes long PR with a flat T op
230
IV corticosteroids
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
Rationale: Block bone resorption of Ca+ and decrease GI absorption of Ca+ helps to excrete
231
Hypovolemia and Hyponatremia ______ occur at the same.
CAN
Study Tip: When this occurs with the use of diuretics this gets rid of sodium.
*Hypovolemia = low vascular volume = low BP
232
Central nervous system cells most vulnerable to what condition?
A: Hyponatremia
Study Tip: this is why you give fluids gradually. You do not want to cause trauma to the cells or cause them to burst.
234
Get Ca+ Back to the Bones
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
235
Medication: Biphosphanates
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
Rationale: prevent bone loss of Ca+ helps to retain ca+ in the bone
236
Calcium also binds with magnesium?
Why?
237
Medication: Mithramycin
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
Rationale: Anti-neoplastic used when caused by malignancy. Inhibits bone resorption, short lived effects
238
```
Hepatic disease
Hyperaldosteronism
Acute alcoholism
Heart failure
Malabsorption
Nephritis
Acute leukemias
What causes these symptoms?
```
Study Tip: Hypokalemia
239
Loss or Gain usually coincides with water loss and gain. What electrolyte is this?
Sodium
Study Tip: If serum Sodium decreases then the size of the cell increases. Decreased serum sodium means that the blood is hypotonic. This means that there is more fluid in the blood than there is Solutes. Which makes the concentration in the cell and in the interstitial higher than the intravascular. Fluid goes to the are with the higher concentration leaving the vascular and causing the cells to swell.
239
Decreased serum sodium causes ______.
Confusion
Study Tip:
Decreased serum sodium means that the blood is hypotonic. This means that there is more fluid in the blood than there is Solutes. Which makes the concentration in the cell and in the interstitial higher than the intravascular. Fluid goes to the are with the higher concentration leaving the vascular and causing the cells to swell. The faster the decrease in sodium the more rapidly the increase in severity of symptoms.
241
Hemodialysis or peritioneal dialysis
| What fluid imbalance is this treatment used to treat?
A: Treatment: Hypercalcemia
Why?
242
Increased blood sugar means increased __________.
Dehydration
Study Tip: Glucose has its own pulling power and pulls fluid from the cells and interstitial which shrinks cells sucking them dry of fluid dehydrating them.
243
Isotonic IV fluid is what percentage salt?
| Hypertonic Solution IV fluid is what percentage salt?
Isotonic IV fluid is? 0.9% saline
Hypertonic Solution IV fluid is? 3% - 5% saline
.9% salt with the rest saline very low salt content
3-5% salt with the rest saline high salt content
243
When does aldosterone refrain from telling kidneys to hold onto sodium and water?
Why? When the patient has Hypovolemia and Hyponatremia.
244
Confusion, altered mental status, depression, personality changes, lethargy to coma
This occurs in what fluid and electrolyte imbalance?
A: Hypercalcemia
245
Sodium affects what organ the most?
Brain - Neurological
246
alKAlosis does what to the pH?
aciDosis does what to the pH?
Kicks the pH ^^UP^^^
| Slides the pH DOWN
247
In acidosis what is Hydrogen exchanged for inside the cell?
Potassium
Study Tip: this occurs because they are both positive ions. K+ goes into ECF which ALWAYS causes hyperkalemia because it goes into the intravascular.
248
Medication: Mithramycin
| What fluid and electrolyte imbalance does this cause?
A: Hypocalcemia (excessive loss of Ca+)
Rationale: reduce calcium resorption from bone
249
When a patient comes in with diabetic Ketoacidosis what is the priority?
Why? Can be liters of fluids down because they did not know about it and need lots of IV fluid replacement. Patient will be dehydrated due to high concentration of Solutes in the blood pulling fluid from the cells causing them to shrink.
250
Hyperaldosteronism affects the kidneys causing what two effects of fluid and electrolyte imbalance.
Increased sodium retention due to retaining sodium and water.
Increased potassium excretion through the urine.
251
Weak Heart and Decreased GI motility is caused by what fluid/electrolyte imbalance?
Hypokalemia
252
Hypernatremia occur what two ways?
When serum Sodium is increased without a change in fluid volume. Increased tonicity.
If fluid volume decreases in relation to sodium concentration. Increased tonicity.
253
K+ more than 7.0 mEq/L
| What does this lab mean in relation to fluid and electrolyte balance?
A: Lab Test: Severe Hyperkalemia
254
Patient with ________ will say hypokalemia feels very similar due to the effects on the heart.
atrial fibrillation
255
This is not palatable.
The generic name is sodium polystyrene sulfonate.
It can be given through the NG tube, enema, and oral route.
What is this treatment used to treat?
Hyperkalemia
Study Tip: It does not reabsorb K+ in the bowels so it is lost in diarrhea. Sodium is gained in exchange for K+ lost. Monitor the sodium level of patients using this treatment very closely.
256
_________ is secreted by the thyroid gland to decrease serum calcium level.
_________ is secreted by the parathyroid gland to increase serum calcium level.
Calcitonin
| Parathyroid Hormone
258
What vitamin helps the body absorb calcium?
Vitamin D
259
_______ inhibits (stops) the absorption of Calcium in the intestines.
Phosphorus
260
Renal patient takes TUMS to neutralize acid but they also contain a high concentration of calcium.
If your patient is taking TUMS to increase their Ca+ level do they take the medication with or without food?
Take it without a meal so the calcium will not bind with the phosphorus in the food.
261
When phosphorus levels increase what happens to calcium levels?
Decrease
Study Tip: inverse relationship
262
When your patient is on Digoxin what lab value is the priority?
Calcium levels
Study Tip: when a patient has angina the heart muscle is not getting enough oxygen due to decreased contractility which is seen in Hypocalcemia so as a nurse you would give Digixin to increase myocardial contractility.
263
What is a nursing independent intervention to decrease serum calcium level?
Hydrate the patient to dilute the blood.
265
Hypercalcemia is caused by Ca+ getting out of the bone into the blood. _________ is caused by the increased Ca+ binding with Phosphorus which decreases HCO3- increasing acidity.
Acidosis
Study Tip: why?
266
__________ can also decrease the reabsorption of phosphorus excreting it in the urine.
Parathyroid hormone
267
If Sodium falls to 110 mEq/L further deterioration (due to cerebral edema) symptoms of severe hyponatremia include?
A: stupor, delirium, ataxia, seizures, and coma.
268
Regulate fluid distribution.
Govern acid-base balance.
What controls these mechanisms?
A: Electrolytes
270
Primarily neurological symptoms for hyponatremia include?
A: Headache, irritability, disorientation, lethargy, confusion
271
Transcellular shifts ex. Metabolic Acidosis
| What fluid and electrolyte imbalance does this cause?
A: Hyperkalemia
272
This imbalance causes muscle tetany. There's not enough ________ to close sodium channels which causes muscular excitability. Channels are left open. If they are left open long enough this can lead to _________.
calcium
hypernatremia
273
Potassium and Glucose have a relationship involving insulin.
insulin is the first-line defense against hyperkalemia. a rise in plasma k+ stimulates insulin release by the pancreatic beta cell. insulin, in turn, enhances cellular potassium uptake, returning plasma k+ towards normal. the enhanced cellular uptake of k+ that results from increased insulin levels is thought to be largely due to the ability of insulin to stimulate activity of the sodium potassium atpase located in cell plasma membranes. the insulin induced cellular uptake of potassium is not dependent on the uptake of glucose caused by insulin. insulin deficiency allows a mild rise in plasma k+ chronically and makes the subject liabel to severe hyperkalemia if a potassium load is given. conversely, potassium deficiency may cause decreased insulin release. thus plasma potassium and insulin participate in a feedback control mechanism.
274
heart block, ventricular arrhythmias, asystole
| This occurs in what fluid and electrolyte imbalance?
A: Hypermalemia
275
ventricular arrhythmias, cardiac arrest
| This occurs in what fluid and electrolyte imbalance?
A: Hypokalemia
276
_________ is usually accompanied with low blood potassium level, causing, e.g., muscular weakness, muscle pain, and muscle cramps (from disturbed function of the skeletal muscles), and muscle spasms (from disturbed function of smooth muscles).
A: Metabolic alkalosis
277
__________ may also cause low blood calcium levels. As the blood pH increases, blood transport proteins, such as albumin, become more ionized into anions. This causes the free calcium present in blood to bind more strongly with albumin. Causing hypocalcemia. If severe, it may cause tetany.
A: Metabolic alkalosis
