Hyper vs Hypo Flashcards
Causes of Hypercalcemia
Hyperparathyroidism (key note: parathyroid regulates calcium)
Increased intake of calcium (Vitamin D)
Glucocorticoids (key: suppress the absorption of calcium)
Hyperthyroidism
Calcium excretion decreased with thiazide diuretics
Adrenal insufficiency (Addision’s Disease)
Lithium usage (affects parathyroid)
(Remember HIGHCAL)
S/S of Hypercalcemia
Weakness in muscles (Lethargy)
EKG changes (shorted QT interval)
Absent reflexes, Absent minded, Constipation
Kidney stone formation
Remember: body is too WEAK
Thiazide Diuretics
Increase calcium levels
Nursing Interventions for Hypercalcemia
Keep patient hydrated (decrease stone formation)
Safety (falls/injuries)
Monitor cardiac, GI, renal, and neuro status
Compliants of abdominal pain can mean kidney stone formation
Administer Calcitonin (calcium reabsorption inhibitor)
Dialysis
Calcium RICH foods
Yogurt
Sardines
Cheese
Spinach
Collard Greens
Tofu
Rhubarb
Milk
Remember: Young sally’s calicum serum continues to randomly mess up
Causes of Hypocalcemia
Low parathyroid hormone
Oral intake inadequate
Wound Drainage (GI system)
Celiac’s Disease/Crohn’s Disease
Acute Pancreatitis
Low Vitamin D intake
Chronic Kidney Disease (excessive excretion of Ca2+)
Increased Phosphorous levels
Using medications
Mobility issues
Remember: LOW CALCIUM
Electrolyte to monitor with neck surgery/removal of any neck surgery?
Calcium levels
watch for hypocalcemia
S/S of Hypocalemia
Confusion
Reflexes are hyperactive
Arrhythmias (PROLONGED QT INTERVAL)
Muscles spasms in calves/feet
Positive Trousseaus sign
Sign of Chvosteks sign
Remember: CRAMPS
Positive Trousseaus Sign
usually presents before Chvosteks sign
process: inflate BP cuff a bit higher than baseline systolic and hold for 3 minutes, it is positive when the hand involuntarily flexes
Sign of Chvosteks
hyperexcitability of the facial nerves
Process: tap on the jaw and on effected side the lips or nose will twitch towards the side that is being tested
Nursing Interventions for Hypocalcemia
Safety - risk for bone fractures
Watch for laryngeal spasms
Administer IV Calcium Gluconate - ADMINISTER SLOW - watch for digoxin, can cause toxicity
Administer Vitamin D to promote absorption
Causes for Hyperkalemia
Cellular movement of K+ from intracellular to extracellular (burns, tissue damage, ACIDOSIS)
Adrenal Insufficiency (Addison’s Disease)
Renal Failure
Excessive Potassium Intake
Drugs (Aldactens, ACE inhibitors, NSAIDS)
Remember: “Body CARED too much for K+)
What is potassium responsible for?
Potassium is responsible for nerve impulse conduction and muscle contraction
note: potassium rather be INTRACELLULAR
S/S of Hyperkalemia
Muscle weakness
Urine production is low or absent
Respiratory Failure
Decreased Cardiac Contractility (weak pulse, low BP)
Early signs of muscle twitching, cramps
Rhythm changes - TALL PEAKED T WAVE, FLAT P
Remember: Hyperkalemia is dangerous it may MURDER them
Nursing Interventions for Hyperkalemia
Monitor Cardiac, Respiratory, Neuromuscular & GI status
STOP IV potassium infusion or hold supplements if ordered
Initiate K+ restrictive diet
Prepare patient for dialysis
Order Lassie or other K+ wasting drugs
Potassium RICH foods
Potatoes
Oranges
Tomatoes
Avocados
Strawberries
Spinach
fIsh
Mushrooms
Causes for Hypokalemia
Drugs (Laxatives, Diuretics, Corticosteroids)
Inadequate intake K+ (NPO, anorexia)
Too much water intake (dilutes K+)
Cushing Syndrome
Heavy fluid loss (NG suction, wound drainages, diarrhea)
ALKALOSIS
Remember: Body is trying to DITCH K+
When a patient is connected to an NG tube, what do you need to watch out for?
HYPOkalemia
HYPOnatremia
S/S of Hypokalemia
EVERYTHING IS SLOW AND LOW
Weak pulse
Decreased bowel sounds
Confusion
Shallow respirations
EKG changes: depressed ST segment, U-wave
Remember 7 L’s:
Lethargic
Low, shallow respiratory
Lethal cardia A’s
low of urine
leg cramps
limp muscles
low BP and HR
Nursing Interventions for Hypokalemia
Watch Heart Rhythm, respiratory status, GI, and renal
Watch magnesium levels
levels >2.5 - start potassium INFUSION
Hold Lasix, Thiazides
Causes of Hyperatremia
Hypercortisolism (Cushing syndrome)
Increased Na2+ intake
GI feeding without adequate H2O supplement
Hypertonic solutions (ex: 3% saline)
Sodium excretion decreased (body is retaining sodium)
Aldosterone problems
Loss of fluids (dehydrated, fever, sweating)
Thirst impairment
Remember: HIGH SALT
What is the role of sodium in the body?
Helps water move inside and outside of the cell
Wherever sodium goes, water follows.
S/S of Hyperatremia
Fever, flushed, skin
Restless, really agitated
Increased fluid retention
Edema, extremely confused
Decreased urine output, dry mouth mouth/skin
Remember: “No FRIED foods for you”
Nursing Interventions for Hyperatremia
Restrict Na2+ intake
- reduce foods such as bacon, butter, canned foods, cheese, hot dogs, lunch meat, processed foods, table salt
Patient safety
- confused and agitated
MD may order an isotonic/hypertonic IV solution (0.45 normal saline - Gove slowly)
Educate about diet
Cause of Hypoatremia
Na2+ excretion increased with renal problems, NG suction, vomiting, diuretics
Overload of fluids (CHF, liver failure)
Na2+ intake low through low salt diet or NPO status
Antidiuretic hormone over secreted
Remember: No Na2+
S/S of Hypoantremia
Seizures and Stupor
Abdominal cramping and confusion
Lethargic
Tendon reflexes diminished, trouble concentrating
Loss of urine and appetite
Orthostatic hypotension, overactive bowels
Shallow respirations
Spasms of muscles
Remember: SALT LOSS
Nursing Interventions for Hypoatremia
Watch cardiac, respiratory, GI and neurological stats\us
Hypovolemic: administer IV solution to restore fluids (3% saline)
Hypervolemic: restrict fluids, diuretic or dialysis
Causes of Hypermagnesemia
Magnesium containing antacids and laxatives
Addisons Disease
Glomerular filtration insufficiency (renal failure, kidneys are keeping too much mg)
Remember: MAG
- not very common
What is the role of magnesium
cell function such as transferring and storing energy, regulation of parathyroid hormone, metabolism of carbs, lipids, proteins, regulates blood pressure
S/S of Hypermagnesemia
Lethargy
EKG changes (PR + QT prolonged intervals)
Tendon reflexes are diminished/absent
Hypotension
Arrhythmias (bradycardia)
Respiratory arrest
GI issues
Impaired breathing (skeletal weakness)
Cardiac Arrest
Remember: Lethargic
- only in severe cases
Nursing Interventions for Hypermagnesemia
Monitor cardiac, resp, GI, and neuro
Ensure safety due to Lethargic/drowsy
Prevention: avoid giving pt in renal failure magnesium containing magnesium antacids/laxatives
Renal failure prep dialysis
IV Ca+ ordered to release side effects
preferred in central line
Magnesium RICH foods
Avocado
Green leafy vegetables
Peanut butter, pork
Oatmeal
Fish
Cauliflower
Legumes
Nuts
Oranges
Milk
Remember: Always Get Plenty Of Foods Containing Large Numbers of Magnesium
Causes of Hypomagnesemia
Limited intake of magnesium (starvation)
Other electrolyte issues cause decrease mg (hypokalemia, hypocalcemia)
Wasting Mg+ via kidneys (Loop or Thiazide diuretics)
Malabsorption issues (patient with history of Crohns, Celiac, diarrhea)
Alcohol (poor dietary intake)
Glycemic issues (DKA, insulin)
Remember: LOW MAG
Where is magnesium absorbed
the small intestine
note: excreted via the kidneys
- any issues with these systems causes issues with mg levels
S/S of Hypomagnesemia
Trouessau’s sign (low calcium levels)
Weak respirations
Irritability
Torsades de pointes( abnormal heart rhythm - correlated to alcoholics), tetany
Cardiac changes (flat T wave)
Hypertension, hyper reflexes
Involuntary movements
Nausea
GI Issues (decreased bowel sounds and movement)
Remember: “Twitching”
Nursing Interventions for Hypomagnesemia
Monitor Cardiac, Respiratory, GI, and Neurological status
Administer Magnesium Sulfate IV infusion - monitor Mg levels closely
Checking deep tendon reflexes
Place on seizure precautions
Causes of Hyperphosphatemia
Phosphosoda overuse: phosphate containing laxative and enemas
Hypoparathyroidism
Overuse of Vitamin D
Syndrome of tumor lysis
Habdomyolysis
Insufficiency of kidneys
Remember: PHOSHI
What is the role of phosphate?
builds bone and teeth and nerve and muscle function
stored mainly in bones
kidneys and parathyroid regulate
S/S of Hyperphosphatemia
Confusion
Reflexes hyperactive
Anorexia
Muscles spasms in calves/feet
Positive Trousseau’s Sign
Sign of Chvosteks
-similar to hypocalcemia
Nursing Interventions for Hyperphosphatemia
Administer phosphate binding drugs - Phoslo
No phosphate laxatives/enemas
Restrict food rich in Photo
Prepare for dialysis
Nursing Interventions for Hyperphosphatemia
Administer phosphate binding drugs - Phoslo
No phosphate laxatives/enemas
Restrict food rich in Photo
Prepare for dialysis
Phosphate RICH foods
Fish
Nuts
Chicken
Beef
Organ meats
Pork
Whole Grains
Causes for Hypophosphatemia
Pharmacy: Aluminum, lack of vitamin D
Hyperparathyroidism: too much secretion of hormone
Oncogenic osteomalacia: kidneys wasting phosphate, bones soften
Syndrome of referring
Pulmonary Issues
Hyperthyroidism
Alcoholism
Thermal burns: extreme burns all over the body
Electrolyte imbalances: hypercalcemia, hypomagnesemia, hypokalemia
Remember: PHOSPHATE
S/S of Hypophosphatemia
Breathing problems due to muscle weakness
Rhabdomyolysis: caused by electrolyte disturances (Tea colored urine)
Osteomalacia: bone function, deformity, softening of the bones
Kills immune system (suppression)
Extreme weakness
Neuro changes (confusion, irritability, seizure precautions)
Remember: BROKEN
Nursing Interventions for Hypophosphatemia
Administer oral phosphorus with Vitamin D
Ensure patient safety - bone & confusion
Encourage foods rich in phosphate
Watch Ca2+ levels
Make sure renal status is good
What is the role of chloride?
maintain the acid-base balance
balances fluids with Na2+
Causes of Hypochloremia
GI related - vomiting, gastric juice, ileostomy
Diuretics - Thiazides
Burns
Cystic Fibrosis
Metabloc Alkalosis
S/S of Hypochloremia
same s/s as hypoatremia
Nursing Interventions for Hypochloremia
Look at the sodium level and assess for s/s of hypoatremia
Other labs to monitor: HIGH bicarbonate & LOW potassium
Saline (normal saline 0.9%) administration
Sources of chloride rich food
Remember: LOSS
Causes of Hyperchloremia
Increase Sodium intake
No water drinking or loss too much water
Decrease bicarbonate
Cohn’s Syndrome
Corticosteroids
Metabolic Acidosis
Nursing Interventions of Hyperchoremia
Hold sodium chloride infusions - follow low sodium/chloride rich foods
Instead lactated Ringer - decrease chloride levels - lactate is turned into bicarb
Collect I & O
Labs to monitor - chloride, sodium, bicarb
