Fluid & Electrolytes Part 2 (B) Flashcards
Electrolytes are all-
Minerals / Salts
What are the positively charged electrolytes (Cations)?
Potassium, Sodium, Calcium, Magnesium
What can you monitor to identify any electrolyte imbalances with your pt’s?
Lab Values
What are the 3 age groups at a greater risk for electrolyte imbalances?
Infants
Children
Older Adults
What groups of people are at risk for electrolyte imbalances?
(Aside from age groups)
People with Cognitive Disorders or Chronic Illnesses
What does Calcium play an important role in?
Skeletal Mineralization
Muscle Contractions
Nerve Transmission of Impulses
Blood Clotting
Hormone Secretion
What is Skeletal Mineralization?
The process of the deposits of minerals on the bone matrix for the development of the bone itself
Calcium is predominantly what kind of electrolyte?
An Extracellular Cation
Hypocalcemia is a Total Blood Calcium Level of-
Less than 9
What are the risk factors for Hypocalcemia?
Increased calcium output
Poor intake or absorption of Calcium
Movement of Calcium into the bone from extracellular fluid
Shifting of calcium to an inactive form
What can cause increased calcium output to occur?
Chronic Diarrhea
Misuse of Laxatives
Steatorrhea
Poor Intake / Absorption of Calcium
Movement of Calcium into the bone from extracellular fluid
Shifting of calcium to an inactive form
What is Steatorrhea?
An increase in fat secretion in your stools or bowel movements
What can cause a poor Intake / Absorption of Calcium ?
Crohn’s Disease
Vitamin Deficiency (Caused by alcohol use disorders or Chronic Kidney Disease)
What are the clinical manifestations/ expected findings of a pt with Hypocalcemia?
Tetany
Cardiovascular Manifestations
GI Manifestations
CNS Manifestations
What is Tetany?
Muscle Twitches/spasms/involuntary muscle contractions
What are the expected findings of a pt diagnosed with Muscle Twitches / Tetany?
Numbness/tingling: fingers & circumoral
Muscle spasms occurring frequently at rest
Hyperactive deep tendon reflexes
Chvostek’s sign: Positive
Trousseau’s sign: Positive
Laryngospasms
This is a test where you tap on a person’s cheek in front of the ear to assess for any facial twitching =
Chvostek’s Sign
Hand finger spasms with sustained blood pressure cuff inflation =
Trousseau’s Sign
What are the cardiovascular manifestations of Hypocalcemia?
Weak Thready Pulse
Bradycardia or Tachycardia
Cardiac Dysrhythmias
What are the GI manifestations of Hypocalcemia?
Hyperactive Bowel Sounds
Diarrhea
Abdominal Cramping
What are the Central Nervous System manifestations of Hypocalcemia?
Seizures
What are the nursing actions for Hypocalcemia?
Calcium supplements (oral or IV) with Vitamin D supplements
Seizure precautions
Fall precautions
Keep emergency equipment on standby
High calcium foods
Include dairy products and dark green veggies
Padding side rails is a precaution for-
Seizures
Orange juice is a good source of-
Calcium
Hypercalcemia is a Total Blood Calcium Level of-
Over 10.5
What are the causes of Hypercalcemia?
Thiazide diuretics
Glucocorticoids (long term use)
Paget’s Disease
Hyperthyroidism
Hyperparathyroidism
Bone Cancer
What are the Neuromuscular manifestations of Hypercalcemia?
Decreased Reflexes
Bone Pain
What are the Cardiovascular manifestations of Hypercalcemia?
Dysrhythmias
Increased Risk for Blood Clots
What are the GI manifestations of Hypercalcemia?
Nausea & Vomiting
Constipation
Anorexia
What are the Genitourinary manifestations of Hypercalcemia?
Hypercalciuria
What are the CNS manifestations of Hypercalcemia?
Weakness
Lethargy
Confusion
Decreased LOC
Personality Changes
What are the nursing actions for Hypercalcemia?
Restrict Calcium
Increase Fluid Intake
Monitor for Pathological Fractures
What are Pathological Fractures?
Breaks in bones that are caused by an underlying disease and not from trauma
Magnesium is found mostly in your-
Bones
There is a small amount of magnesium in your-
Body Cells
Magnesium is an electrolyte that plays a key part of many body reactions that affect-
Cellular Function, Nerve Conduction, etc
What relies heavily on magnesium to do its job?
Brain, Heart, Muscles
Magnesium has a direct effect on-
The balance of other electrolytes (Sodium, Calcium, Potassium)
There is a very small amount of magnesium in the-
Extracellular Fluid
Hypomagnesemia often occurs along side -
Hypocalcemia & Hypokalemia
These organs are responsible for retaining normal magnesium levels:
Small & Large Intestines
Bones
Kidneys
How do the Small & Large Intestines help retain normal magnesium levels?
Absorb magnesium from the food you eat
How do the Bones help retain normal magnesium levels?
Storage system for magnesium
How do the Kidneys help retain normal magnesium levels?
Excretion or release of magnesium via the urine
A problem with the Small & Large Intestines, Bones, or Kidneys can all leave you at a high risk of acquiring-
Hypomagnesemia
Hypomagnesemia is magnesium level of -
Lower than 1.3
Hypermagnesemia is magnesium level of -
Higher than 2.1
What are the risk factors of Hypomagnesemia?
Increased Magnesium Output
Shift to an inactive form
Inadequate magnesium intake
Inadequate magnesium absorption
What can cause increased magnesium output?
Increased GI losses (Diarrhea or NG Tube set to suction)
Thiazides
Loop Diuretics
Can be associated with Hypocalcemia
What can cause magnesium to shift to an inactive form?
A rapid infusion of citrated blood
What can cause an inadequate magnesium intake and absorption?
Malnutrition, Alcohol Use Disorder, Misuse of Laxatives
What are the Neuromuscular manifestations of Hypomagnesemia?
Increased Nerve Impulse Transmission:
Hyperactive Deep Tendon Reflexes, Paresthesia, Tetany, Positive Chvostek’s Sign, Positive Trousseau’s Sign, Insomnia, Seizures
What are the GI manifestations of Hypomagnesemia?
Hypoactive Bowel Sounds
Constipation
Distended Abdomen
Paralytic Ileus
Hypomagnesemia mainly effects your-
Neuromuscular System + Heart
What are the Cardiovascular manifestations of Hypomagnesemia?
Dysrhythmias
Tachycardia
Hypertension
Premature Ventricular Contractions
ECG Waveform Changes
What are the nursing actions for Hypomagnesemia?
Stop any meds that waste magnesium
Magnesium replacement: oral for mild manifestations and IV for severe
Oral replacement can potentially cause diarrhea making the depletion worse
High magnesium foods (include whole grains and dark green veggies)
What are some foods that are high in Magnesium?
Pumpkin Seeds, Dry Roasted Almonds, Boiled Spinach, Dry Roasted Cashews, Pumpkin Seeds (In Shell), Oil Roasted Peanuts, Cereal (Shredded Wheat), Plain / Vanilla Soy Milk, Cooked Black Beans, Dark Chocolate (60-90% Cocoa), Smooth Peanut Butter, Bread (Whole Wheat), Avocado, Baked Potato (with Skin), Cooked Brown Rice, Plain Low-Fat Yogurt, Fortified Breakfast Cereals, Instant Oatmeal, Canned Kidney Beans, Bananas, Unsweetened Cocoa Powder, Farmed Atlantic Salmon, Milk, Cooked Halibut, Raisins, Roasted Chicken Breast, 90% Lean Ground Beef, Chopped & Cooked Broccoli, Apples, Cooked White Rice, Raw Carrots
Causes of Hypermagnesemia =
Kidney impairment
Adrenal impairment
Increased intake of medications containing magnesium
What meds contain magnesium?
Laxatives & Antacids
What are the Neuromuscular Manifestations of Hypermagnesemia?
Muscle Paralysis
Shallow Respirations
Bradypnea
Diminished DTR’s (deep tendon reflexes)
What are the Cardiovascular Manifestations of Hypermagnesemia?
Bradycardia
Hypotension
Cardiac Arrest
Dysrhythmias
ECG changes
What are the CNS Manifestations of Hypermagnesemia?
Lethargy
What are the nursing actions for Hypermagnesemia?
Assess vital signs, LOC, & reflexes frequently
Notify HCP if there are changes or absent reflexes
Loop diuretics and magnesium free fluids if kidney function is adequate
Calcium gluconate for severe cardiac changes
How can you diagnose Hypermagnesemia?
ECG (prolonged PR interval and wide QRS)
