Lecture 4 management of electrolytes Flashcards
Whats Hyponatremia
soduim loss < 135 mmol/L
Severe=< 125 Meq/L
Causes hyponatremia
- Loss Na-containing fluid
- Water excess
What does Hyponatremia lower…
Plasma osmolality, shifting fluid into brain cells
Symptoms hyponatremia:
-Neuro related
-Changes LOC
ECF fluid volume symptoms for patient with hyponatremia
- abnormal decrease in soduim loss (Hypovolemic hypontremia)
2.Abnormal increase in watter gain (hypervomeic hyponatremia)
Treatement of hypoatremia
Iv’s, get soduim back
What are severe symptoms of hypertonic saline/ what would you administer…
Seizures
administer (3% Nacl)
A hypertonic saline solution causes water to shift ______cells
outside cell causing cell death
Why must Iv hypertonic saline be administered with caution
Much higher concentrated salt, cell’s could collapse
What’s the max rate of safe administration for hypertonic saline (3% Nacl)
100 ml/hr
How is Hypertonic saline given
IV infusion pump
What’s Hyperatremia
increase in soduim retention >145 mmol/L
life threatening at level >155 mmol/L
high mortality >180 mmol/L
Hypernatremia prevalence seen more in….
Critically ill patients particularly with neuro condition
1/5 of people with congestive heart failure experience….
Hypernatremia
what are people with high protein tube feeding at risk for
Hypernatremia
Causes Hypernatremia
water deficiency, and NA accumulation, usually just looks like a water definiency. FEVER, HEATSTROKE
Does hypernatremia cause hyperosmolarity
YES! hyperosmolarity is a shift of water out of cells- cellular dehydration
usually body does things to prevent hypernatremia
-stimulate thirst
-ADH release
What’s hypothalamic disorder:
Lesion may cause disturbance of thirst mechanism but is rare
Clinical manifestations of Hypernatremia:
-Change plasma osmolality
-Neurologic changes
-Nausea vomiting
-restlessness
-Thirst
-Body can tolerate high sodium levels
Interventions for Hypernatremia:
-Remove sodium intake from diet
but if soduim go even lower give D5W IV
Interventions for hyponatremia:
-Fluid restriction
But treatment associated with abnormal fluid loss give sodium containing solutions.
Patient has sodium level 188 Meq/L and not drinking water: what is diagnosis..
Hypo(check)volemic Hypernatremia
What is hypokalemia
Low levels of potassium in the ECF
What are primary routes of potassium loss
Kidneys
what would be a drop of 3.5 mmol/L in pottasium
Hypokalemia
Slight decrease in potttasium has ….
Profound effects since it’s range is narrow
Causes of Hypokalemia
-Low potassium diet
-starvation
-GI losses: vomiting, diarrrehea
-Renal losses: Diuretics, dialysis, magnesium depletion
-skin losses: diaphoresis
Hypo and Hyper natremia major symptoms
NEURO
Shifts of potassium into cell
-increase insulin
-alkalosis
-Tissue repair
Diuretics…
remove excess fluid from body
Potassium wasting diuretics vs sparing examples…
Wasting: Thiazides, loop diuretics
Sparing:
Spironolactone, amiloride hydrochloride
Clinical manifestations of Hypokalemia
CARDIAC problems!!!!!!!
-alters resting membrane potential
-Fatigue
-leg cramps
-Fatigue
-nausea
Nursing disgnosis for Hypokalemia
Electrolyte imbalance as evidence by low pottaosum levels and increased fluid loss
What does potassium do in body:
-Cardiac
-muscle function
-Regulates soduim
Hypokalemia interventions
KCL supplements added to Iv solution should never exceed 60 mmol/L
Guidelines for IV potassium administration
- Should not exceed 10/20 mmol per hour
-use infusion devices
-Potassium could also be replaced with pottasium phosphate
-Max 200 meq/L in 24 hours
what should you monitor for patients
-TOXIC REACTION
- muscle weakness
- arrhythmias
-cardiac rhythm
-urine output
What’s hyperkalemia
-high levels of potasium in blood
-above 5.5 mmol/L
Causes of hyperkalemia
- Excess potassium intake
- Shifts of potassium out of cells (acidosis, tissue catabolism)
- Failure to eliminate potassium
-Renal disease
-potassium sparing diuretics
-ACE inhibitors
-adrenal insuffinenecy
Clinical manifestations of Hyperkalemia
-CARDIAC STANDSTILL
-anxiety
-Abdominal cramping
-muscle weakness
-irregular pulse
Nursing diagnosis
evidence by <5.5 pottasium and decreased urine output
=Hyperkalemia
and this caused electrolyte balances, fever, sepsis…
Treatment of hyperkalemia
-Elimination potassium intake
-Diurectics
-dialysis
-ion exchange resins (Force potassium from ECF to ICF)
-increase fluid intake
-Administer calcium gluconate (Reverse membrane effects of the elevated ECF)
How would force potassium from ECF to ICF
-administer IV insulin (so patient does not become hypoglycemic)
-Administered Iv sodium bicarbonate (correct acidosis)
Whats alkalosis
causes potassium move from ECF to ICF
electrolytes have _____ limits
Narrow
