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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
What to monitor for when treating hypokalemia
ECG for changes ABGs Receiving digitalis for toxicity early signs and symptoms
26
Serum potassium greater than 5.0 mEq/L
Hyperkalemia seldom occurs in pts with normal renal function increased risk in older adults CARDIAC ARREST is frequenly associated
27
Causes of hyperkalemia
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
Clinical Manifestations of hyperkalemia
Cardiac changes dysrhythmias muscle weakness paresthesias anxiety GI problems
29
Management of Hyperkalemia
Monitor ECG assess labs monitor I+O obtain apical pulse (rhythm and rate) Limit dietary potassium Administration of cation exchange resins (Kayexalate)
30
Emergent care of Hyperkalemia
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
Normal Serum Levels of Calcium
8.8-10.5 mg/dL
32
Calcium balance
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
Importance of calcium
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
Calcium and bone
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
Serum calcium level controlled by...
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
Calcium serum level less than 8.6 mg/dL
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
Causes of hypocalcemia
hypoparathyroidism malabsorption osteoporosis pancreatitis alkalosis transfusion of citrated blood kidney injury medications
38
Clinical manifestations of hypocalcemia
tetany circumoral numbness paresthesias hyperactive deep tendon reflexes Trosseau sign Chovostek sign seizures ``` respiratory symptoms (dyspnea and laryngospasm) abnormal clotting ``` anxiety
39
Management of hypocalcemia
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
Chvosteks Sign
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
Trosseau Sign
cramping of hands w/ BP cuff on
42
Calcium serum level greater than 10.2 mg/dL
Hypercalcemia high mortality
43
Causes of Hypercalcemia
malignancy hyperparathyroidism bone loss related to immobility diuretics
44
Clinical Manifestations of Hypercalcemia
polyuria thirst muscle weakness intractable nausea abdominal cramps severe constipation diarrhea peptic uler bone pain ECG changes dysrhythmias
45
Management of hypercalcemia
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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