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NURS 304 > Fluid and Electrolytes revisited > Flashcards

Fluid and Electrolytes revisited Flashcards

1
Q

Major Cations

A

sodium, potassium, calcium, magnesium, hydrogen

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2
Q

Major Anions

A

chloride, bicarb, phosphate, sulfate, proteinate

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3
Q

non electrolytes

A

BUN, Creatinine, Glucose

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4
Q

Major Electrolytes of ECF

A

Na+ (most important)
Cl- (important)
Ca 2+
HCO3- (important)

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5
Q

Major Electrolytes ICF

A 
K+ (most important)
Phosphate-
Sulphate-
Protein -
Mg+ (important)
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6
Q

Normal Sodium Plasma levels

A

135-145 mEq/L

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7
Q

Sodium balance

A

Sodium is most abundant ECF cation

Key to ECF volume

Diffuses between vascular and interstitial fluids (ECF)

Quickly transported OUT of cells by ATP-ase pump

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8
Q

Roles of Sodium

A

key to establishing transmembrane potential in all living cells

participates in action potential of excitable cells/tissues

critical to normal neuron, brain, muscle function

actively secreted in mucous and other secretions

comprises about 90% of osmotic forces

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9
Q

Sodium levels reflect…

A

WATER BALANCE

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10
Q

Serum sodium less than 135 mEq/L..?

A

Hyponatremia- TOO MUCH WATER

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11
Q

Causes of hyponatremia

A

losses from excessive sweating, vomiting, diarrhea, diuretic abuse

certain diuretic drugs combined with low salt diets

hormonal imbalances (insufficient aldosterone, adrenal insufficiency, excess ADH secretion/SIADH

excessive water intake

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12
Q

Effects and Clinical Manifestations of Hyponatremia

A

fluid imbalance in compartments –> fatigue, muscle cramps, abdominal discomfort, nausea, vomiting

Decreased osmotic pressure in ECF = cells swell

cerebal edema

neurological changes - headache, weakness, confusion, seizures, even coma and death

poor skin turgor, dry mucosa, decreased salivation

nausea, abdominal cramping

hypovolemia and decreased BP (all fluid going to CELLS)

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13
Q

Management of hyponatremia

A

treat underlying condition

medicate

assess: I + O, daily weight, lab values, CNS changes

encourage dietary sodium

evaluate effects of medications (diuretics, lithium)

maybe…:
replace sodium
restrict water
hypertonic saline

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14
Q

Serum sodium greater than 145 mEq/L

A

Hypernatremia = WATER DEFICIT

most affected are very old, very young, cognitively impaired

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15
Q

Potential causes of hypernatremia

A 
fluid deprivation
excess sodium administration
diabetes insipidus 
heat stroke
hypertonic IV solutions
insufficient ADH = dilute urine
loss of thirst mechanism
water diarrhea
prolonged rapid respiration without adequate fluids
large amt of sodium ingested w/o water
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16
Q

Effects and Clinical Manifestations of Hypernatremia

A

cells shrink

increased thirst
weakness,agitation
elevated temp
dry, rough mucous membranes
Edema (fluid moves into ecf)
increased BP (maybe)
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17
Q

Management of Hypernatremia

A

Gradual lowering of serum sodium level via infusion of hypotonic electrolyte solution
(oral fluids ok w/ alert pt and safe to swallow)

diuretics

assessment for abnormal loss of water and low water intake

assess for OTC sources of sodium

Monitor for CNS changes

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18
Q

Normal Potassium Serum Levels

A

3.5 - 5.5 mEq/L

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19
Q

Potassium balance

A

one of most imporant minerals in body

most abundant intracellular cation
30x higher in cell than out

Assessing K+ routinely done in INPATIENT settings

difficult to assess K+ levels since most are in cell

Blood potassium is often poorly indicative of tissue potassium stores

20
Q

Importance of Potassium

A

primary ion that establishes normal transmembrane potential in all living cells

participates in action potential

maintains normal electrical activity of excitable cells

critical to normal neuron, brain, and muscle function (including HEART, smooth muscle, skeletal muscle)

maintains ICF volume

critical to normal renal function

strong relationship with sodium

21
Q

Potassium serum level less than 3.5 mEq/L

A

Hypokalemia

may occur with alkalosis as serum potassium goes INTO cells and H+ goes OUT

22
Q

Causes of Hypokalemia

A

excessive potassium loss in urine due to prescription medications that increase urination (ie: loop diuretics)

poor dietary intake

alterations of acid-base balance

23
Q

Clinical Manifestations of hypokalemia

A

ECG changes

dysrhythmias

muscle weakness

decreased bowel motility

paresthesias

dilute urine

excessive thirst

fatigue

anorexia

24
Q

Management of Hypokalemia

A

Potassium replacement

Dietary or IV (if deficit severe)

slow rate of K+ administration, no faster than maximal rate

Slowly w/ infusion pump and only have adequate urine output has been established

25
Q

What to monitor for when treating hypokalemia

A

ECG for changes

ABGs

Receiving digitalis for toxicity

early signs and symptoms

26
Q

Serum potassium greater than 5.0 mEq/L

A

Hyperkalemia

seldom occurs in pts with normal renal function

increased risk in older adults

CARDIAC ARREST is frequenly associated

27
Q

Causes of hyperkalemia

A

Impaired renal function

MED ERROR: too rapid admin of K+

HYPOaldosteronism: aldosterone functions to move K+ into cells of kidneys to be excreted. low aldosterone activity = increased K+ levels

meds, tissue trauma, tumor lysis syndrome, acidosis (H+ enters cell, K+ leaves)

28
Q

Clinical Manifestations of hyperkalemia

A

Cardiac changes

dysrhythmias

muscle weakness

paresthesias

anxiety

GI problems

29
Q

Management of Hyperkalemia

A

Monitor ECG

assess labs

monitor I+O

obtain apical pulse (rhythm and rate)

Limit dietary potassium

Administration of cation exchange resins (Kayexalate)

30
Q

Emergent care of Hyperkalemia

A

IV calcium gluconate

IV sodium bicarb

IV regular insulin and hypertonic dextrose IV

beta 2 agonists

dialysis

administer IV slowly and w/ infusion pump

31
Q

Normal Serum Levels of Calcium

A

8.8-10.5 mg/dL

32
Q

Calcium balance

A

most abundant mineral in whole body

serum calcium is very tightly regulated and does NOT fluctuate with changes in dietary intakes

bone tissue used as reservoir for calcium to store it and maintain constant concentrations in blood, muscle and ICF

33
Q

Importance of calcium

A

normal neuron signaling

MUSCLE CONTRACTION

used as intracellular second messenger

essential for neurotransmitter secretion; ALL muscle contractions (heartbeat, vasoconstriction and dilation, skeletal and smooth muscle)

hormonal secretion

intracellular signaling

hemostasis

a SMALL AMT. of calcium is needed to support these metabolic functions

34
Q

Calcium and bone

A

remaining 99% of calcium supply stored in bones and teeth where it supports structure and function

bone goes under constant resorption and deposition of calcium throughout life
more deposition in youth, even in adults, more bone breakdown in older adults

35
Q

Serum calcium level controlled by…

A

Parathyroid hormone
raises serum calcium levels –> activates osteoclasts –> increasing reabsorption from intestines and renal tubules

lowers serum calcium levels –> inhibits osteoclast activities –> inhibits reabsorption of calcium from renal tubules

calcitonin

36
Q

Calcium serum level less than 8.6 mg/dL

A

Hypocalcemia

must be considered in conjunction with serum albumin level

why?: calcium ion highly bound to proteins, cannot be interpreted w/o total protein/albumin level

37
Q

Causes of hypocalcemia

A

hypoparathyroidism

malabsorption

osteoporosis

pancreatitis

alkalosis

transfusion of citrated blood

kidney injury

medications

38
Q

Clinical manifestations of hypocalcemia

A

tetany

circumoral numbness

paresthesias

hyperactive deep tendon reflexes

Trosseau sign

Chovostek sign

seizures

respiratory symptoms (dyspnea and laryngospasm)
abnormal clotting

anxiety

39
Q

Management of hypocalcemia

A

IV calcium gluconate (emergent situations)

Seizure precautions

oral calcium and vitamin D supplements

exercises to decrease bone calcium loss

patient teaching for diet and meds

40
Q

Chvosteks Sign

A

signs of tetany

abnormal rxn of facial nerve

tap at angle of jaw (masseter muscle) –> muscles of face will twitch momentarily due to hyper excitability of nerves

41
Q

Trosseau Sign

A

cramping of hands w/ BP cuff on

42
Q

Calcium serum level greater than 10.2 mg/dL

A

Hypercalcemia

high mortality

43
Q

Causes of Hypercalcemia

A

malignancy

hyperparathyroidism

bone loss related to immobility

diuretics

44
Q

Clinical Manifestations of Hypercalcemia

A

polyuria

thirst

muscle weakness

intractable nausea

abdominal cramps

severe constipation

diarrhea

peptic uler

bone pain

ECG changes

dysrhythmias

45
Q

Management of hypercalcemia

A

treat underlying cause

administer IV fluids (furosemide, phosphates, calcitonin, bisphosphates)

increase mobility

encourage fluids

dietary teaching

fiber (for constipation)

ensure safety

NURS 304 (4 decks)

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