Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 201 Week 6 > Fluids & Electrolytes Pt 2 > Flashcards

Fluids & Electrolytes Pt 2 Flashcards

1
Q

Sodium

  • Imbalances typically assoc w/parallel changes in osmolality
  • Plays a major role in
    > ECF volume & concentration
    > Generation & transmission of nerve impulses
    > Muscle contractility
    > Acid-base balance
A
  • Serum sodium reflects ratio of sodium to water
  • Changes in lvl may reflect a primary water imbalance, primary sodium imbalance, or combo
  • Na+ leaves body through urine, sweat, & feces; kidneys as primary regulator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

?

Elevated serum Na+ occurring w/water loss or Na+ gain

Causes hyperosmolality leading to ?

Primary protection is thirst from hypothalamus

A

Hypernatremia

cellular dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A deficiency in the synthesis of release of ___ from the posterior pituitary gland (central diabetes insipidus) or a decrease in kidney responsiveness to ___ (nephrogenic diabetes insipidus) can result in profound diuresis, producing a water deficit & hypernatremia

A

ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Manifestations
* Thirst, lethargy, agitation, seizures, & coma

  • Impaired LOC
  • Sx’s of fluid volume (deficit or excess ?)
A

deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If there’s an accompanying ECF volume deficit, manifestations like postural hypotension, weakness, & dec skin turgor occur

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Analyze Cues Prioritize Hypotheses

  • Risk for injury (! think of problems w/perfusion)
  • Risk for fluid volume deficit (d/t water loss)
  • Risk for electrolyte imbalance (d/t excessive intake of Na+)
  • Potential complication: seizures & coma leading to irreversible brain damage
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Planning & Implementation: Generate Solutions & Take Action

  • Treat underlying cause
  • Primary water deficit - replace fluid orally or IV w/isotonic or hypotonic fluids (D5W, 0.45% NaCl saline)
A
  • Excess sodium - dilute w/Na+-free IV fluids (D5W) & promote excretion w/diuretics
  • Monitor carefully
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

?

Results from loss of sodium-containing fluids &/or from water excess

Manifestations
> Confusion, irritability, HA, seizures, coma

A

Hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hyponatremia from loss of Na+-rich body fluids
- Profuse diaphoresis
- Draining wounds
- Excessive diarrhea or vomiting
- Trauma w/significant blood loss

A

Hyponatremia from water excess
- d/t inappropriate use of Na+-free or hypotonic IV fluids (>surgery, major trauma, fluid admin in renal failure pts)

! See CNS manifestations (cellular swelling)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nursing Management Nursing Diagnoses

  • Acute confusion
  • Risk for injury
  • Risk for electrolyte imbalance
  • Potential complications: severe neurologic changes/irreversible damage
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Generate Solutions & Take Action

  • Caused by water excess
    > Fluid restriction is needed
A
  • Severe sx’s (seizures)
    > Give small amts of IV hypertonic saline sol’n (3% NaCl)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • Abnormal fluid loss
    > Fluid replacement w/Na+-containing sol’n
A
  • Drugs that block vasopressin (ADH)
    > Conivaptan (Vaprisol)
    > Tolvaptan (Samsca)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

?

Is used to treat hyponatremia assoc w/HF, liver cirrhosis, & SIADH

A

Tolvaptan (Samsca)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

?

Results in inc urine output w/o loss of electrolytes like Na+ & K+
! Shouldn’t be used in pts w/hyponatremia from excess water loss

A

Conivaptan (Vaprisol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

?

  • Major ICF cation (98% being ICF)
  • Necessary for
    > Transmission & conduction of nerve & muscle impulses
    > Cellular growth
    > Maintenance of cardiac rhythms (neuromuscular & cardiac function)
    > Acid-base balance
A

Potassium

K+ conc in muscle cells is approx 140 mEq/L; in ECF 3.5 - 5.0 mEq/L

Needed for glycogen to be deposited in muscle & liver cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sources

  • Fruits & vegetables (bananas & oranges)
  • Salt substitutes
  • K+ rx’s (PO, IV) [K+ penicillin]
  • Stored blood
A
  • Regulated by kidneys
    > Eliminate 90% of K+ intake; rest lost in stool & sweat
  • Inverse relationship between Na+ & K+ reabsorption in kidneys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

?

High serum K+ caused by
> Impaired renal excretion
> Shift from ICF to ECF
> Massive intake

  • Most common in ?
A

Hyperkalemia

renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Factors

> Adrenal insufficiency w/a subseq aldosterone deficiency

> Acidosis, massive cell destruction (burn or crush inj, tumor lysis, severe infections) & exercise

> Digoxin-like rx’s & beta-adrenergic blocking drugs (propranolol)

A

> Potassium-sparing diuretics (amiloride), aldosterone receptor blockers (spironolactone)

> ACE-inhibitors (enalapril, vasopril)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hyperkalemia - Manifestations

  • Cramping leg pain
  • Weak or paralyzed skeletal muscles
  • Abdominal cramping or diarrhea (d/t hyperactivity of smooth muscles)
  • Cardiac dysrhythmias
A
  • Inc conc of K+ outside cell, altering ICF:ECF; = inc cellular excitability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ECG effects of hyperkalemia

  • P wave flattened; widening of QRS complex
  • QT shortening & T wave more narrowed & peaked
A
21
Q

Analysis: Analyze Cues

  • Risk for activity intolerance & injury (r/t lower extremity muscle weakness)
  • Risk for electrolyte imbalance
  • Potential complication: dysrhythmias
A
  • Eliminate oral & parenteral K intake
  • Increase elimination of K (diuretics, dialysis, Kayexalate [oral/rectal])
22
Q

Generate Solutions & Take Action

  • Force K from ECF to ICF by IV insulin or sodium bicarbonate (<if acidotic)
  • Reverse membrane effects of elevated ECF K+ by administering calcium gluconate IV
A
23
Q

?

Low serum K+ caused by

  • Inc loss of K+ via the kidneys or GI tract
  • Inc shift of K+ from ECF to ICF
  • Dietary K+ deficiency (rare)
  • ___ deficiency
  • Metabolic (acidosis or alkalosis ?)
A

Hypokalemia

Magnesium

alkalosis

24
Q

Hypokalemia - Manifestations

! Cardiac most serious
* Skeletal muscle weakness (legs)
* Weakness of respiratory muscles

A
  • Dec GI motility (= paralytic ileus or intestinal blockage)
  • Impaired regulation of arteriolar blood flow
  • Hyperglycemia (impairs insulin secretion)
25
Q

ECG effects of hypokalemia

  • T wave flattened; U wave emerging
  • Peak in P waves; QRS complex prolonged
A
26
Q

Analyze Cues

  • Risk for activity intolerance & injury r/t muscle weakness & hyporeflexia
  • Risk for electrolyte imbalance
  • Potential complication: dysrhythmias
A
27
Q

Generate Solutions & Take Action

  • KCl supplements orally or IV
  • Always dilute IV KCl
    ! NEVER give KCl via IVP or as a bolus
A
  • Should not exceed 10 mEq/hr
    > To prevent hyperkalemia & cardiac arrest
28
Q

Calcium

  • Formation of teeth & bone
  • Blood clotting
  • Transmission of nerve impulses
  • Myocardial contractions
  • Muscle contractions
A
  • Obtained from ingested foods (or made in skin in presence of sun)
  • Need vitamin D to absorb
  • Present in 3 forms: ionized calcium is biologically active
  • Changes in pH & serum albumin affect lvls
29
Q

Changes in serum pH will alter the level of ionized Ca+ w/o altering the total Ca+ lvl

A decreased plasma pH (___) decreases Ca+ binding to ___, leading to more ionized Ca+

A

acidosis

albumin

30
Q

An increased plasma pH (___) increases Ca+ binding, leading to decreased ionized Ca+

A

alkalosis

31
Q

Calcium balance controlled by: (negative feedback)

  • Parathyroid hormone
  • Calcitonin
A
32
Q

?

PTH is produced by the ____. Its production & release are stimulated by low serum Ca+ lvls

PTH increases bone resorption (movement of Ca+ out of bones), increases GI absorption of Ca+, & inc renal tubule reabsorption of Ca+

A

parathyroid gland

33
Q

?

Is produced by the thyroid gland & is stimulated by high serum Ca+ lvls

Opposes action of PTH & lowers lvl of serum Ca+ by dec GI absorption, inc Ca+ deposition into bone, & promoting renal excretion

A

Calcitonin

34
Q

?

High levels of serum Ca+ caused by
> Hyperparathyroidism (2/3 cases)
> Malignancy (myeloma, kidney/lung/breast ca’s)
> Prolonged immobilization
> Rare - vit D overdose or inc’d antacid ingestion

A

Hypercalcemia

35
Q

Hypercalcemia - Manifestations

  • Lethargy, weakness, stupor, coma
  • Depressed reflexes
  • Decreased memory
  • Confusion, personality changes, psychosis
A
  • Anorexia, N/V
  • Bone pain, fx’s, nephrolithiasis
  • Polyuria -> dehydration
36
Q

Analyze Cues (! perfusion & safety)

  • Risk for activity intolerance, electrolyte imbalance (r/t generalized muscle weakness & neuromuscular & sensorium changes)
  • Risk for injury
A
  • Potential complication: dysrhythmias (d/t dec myocardial excitability)
37
Q

Generate Solutions & Take Action

  • Excretion of Ca+ w/loop diuretic [furosemide]
    > Drink 3000-4000 mL/day to excrete Ca+ & dec kidney stones forming
  • Hydration w/isotonic saline infusion
  • Low Ca+ diet
A
  • Mobilization
  • Synthetic calcitonin (give IM or subq)
  • Bi-phosphonates (Aredia, Zometa -> d/t malignancy; inhibit osteoclast activity)
38
Q

?

Low serum Ca+ lvls caused by

  • Dec production of PTH
  • Acute pancreatitis (lipolysis is a consequence)
  • Pts who receive many blood transfusions
  • Alkalosis
  • Inc Ca+ loss (i.e., from laxative abuse or malabsorption syndromes)
A

Hypocalcemia

39
Q

Hypocalcemia - Manifestations

  • Positive Trousseau’s or Chvostek’s sign
  • Laryngeal stridor
  • Dysphagia
A
  • Tingling around the mouth or in the extremities
  • Cardiac dysrhythmias (prolonged QT interval into a ventricular tachycardia)
40
Q

?

Is a carpal spasm induced by inflating a BP cuff above the systolic pressure for a few min

A

Trousseau’s sign

41
Q

?

Is contraction of facial muscles in response to a light tap over the facial nerve in front of the ear

A

Chvostek’s sign

42
Q

Analysis

  • Acute pain (r/t tetany, sustained muscle contractions)
  • Ineffective breathing pattern (d/t laryngospasms)
  • Risk for electrolyte imbalance
  • Risk for injury (d/t the tetany & seizures)
  • Potential complication: Fx or respiratory arrest
A
  • Treat cause
  • Oral or IV Ca+ supplements
    > Not IM to avoid local reactions
  • Rebreathe into paper bag (to promote CO2 retention)
  • Treat pain & anxiety to prevent hyperventilation-induced respiratory alkalosis
43
Q

?

  • Coenzyme in metabolism of protein & carbs
  • 2nd most abundant intracellular cation
  • Req’d for nucleic acid & protein synthesis
  • Helps maintain Ca+ & K+ balance
  • Necessary for Na-K pump
A

Magnesium

44
Q
  • Acts directly on myoneural junction
  • Important for normal cardiac function
  • 50-60% contained in bone; 2% in ECF, rest in cell
  • Absorbed in GI tract, excreted in kidneys
A
45
Q

?

High serum Mg caused by
> Increased intake or ingestion of products containing Mg when renal insufficiency or failure is present
> Excess IV Mg admin
- In the pregnant woman who receives mag sulfate for preeclampsia

A

Hypermagnesemia

46
Q

Hypermagnesemia - Manifestations

  • Lethargy
  • N/V
  • Impaired reflexes
  • Somnolence
  • Resp & cardiac arrest
A

Management

  • Prevent first - restrict Mg intake in high-risk pts
  • Emergency treatment
    > IV CaCl or calcium gluconate
  • Fluids & IV furosemide to promote urinary excretion
  • Dialysis
47
Q

?

Low serum Mg caused by
- Prolonged fasting or starvation
- Chronic alcoholism
- Fluid loss from GI tract
- Prolonged parenteral nutrition w/o supplementation
- Diuretics (inc risk of Mg loss through renal excretion)
- Hyperglycemic osmotic diuresis (uncontrolled DM inc renal excretion)

A

Hypomagnesemia

48
Q

Hypomagnesemia - Manifestations

  • Confusion / hyperactive DTRs
  • Muscle cramps, tremors, seizures
  • Cardiac dysrhythmias (PVC’s, v-fib)
  • Corresponding ___ and ___
A

hypocalcemia; hypokalemia

49
Q

Hypomagnesemia - Management

  • Treat underlying causes
  • Oral supplements
A
  • Inc dietary intake (green vegetables, nuts, bananas, oranges, PB, chocolate)
  • Parenteral IV or IM Mg when severe

NUR 201 Week 6 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions