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MedSurg > Lecture 6.1 - Electrolyte Imbalances > Flashcards

Lecture 6.1 - Electrolyte Imbalances Flashcards

1
Q

Which demographics are most vulnerable to dehydration from vomiting?

A

Older adults, children, and infants

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2
Q

What is the normal range for sodium in blood?

A

136-145 mEq/L

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3
Q

What cation is most common in ECF?

A

Na makes up 90% of ECF, being the main factor in determining ECF volume

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3
Q

changes in K effect the heart. What do changes in Na do?

A

Effect the brain

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4
Q

What can cause hypernatremia? What can it lead to and how does the body protect from it?

A

–> Excessive intake
–> Diabetes insopidus
–> Renal failure
–> Cushing Syndrome

Causes hyperosmolarity leading to cellular dehydration
Protected with thirst centre in hypothalamus

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5
Q

What are the manifestations for moderate and severe hypernatremia?

A

Moderate: Confusion, thirst, dry mucous membranes, low urinary output

Severe: HTN, tachycardia, flushed skin
–> Restlessness, agitation, confusion, seizures, coma
–> Hyper-reflexia, muscle twitching
Nausea, vomiting
–> Poor tissue turgor

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6
Q

How do we correct hypernatremia?

A

Fluids, diuretics to increase sodium output
–> Monitor daily weights, neuro deterioration, fluid imbalance

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7
Q

What are some nursing diagnoses associated with hypernatremia?

A

Electrolyte imbalance
Risk for injury: seizures

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8
Q

What is the normal potassium level?

A

3.5-5.1 mmol/L

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9
Q

What is the major ICF cation?

A

Potassium

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10
Q

Sodium is necessary for:

A

Maintaining fluid levels and regulating blood fluids to prevent low blood pressure.
Helps muscles contract, and sends nerve impulses throughout the body

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11
Q

Potassium is necessary for:

A

–> Transmission and conduction of nerve and muscle impulses
–> Cellular growth
–> Maintain cardiac rhythms (depolarizes and generates APs, low K is shown as a flat T wave in cardiac rhythm)
–> Regulates protein synthesis, and glucose storage and use.

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12
Q

K administration should never exceed what? Why?

A

20 mEq/hr
–> Prevents hyperK + cardiac arrest
–> Burns when infusing

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13
Q

What is the normal range for calcium? What is is necessary for?

A

2.10-2.75 mmol/L
–> Blood clotting
–> Muscle contraction (including myocardium)
–> Nerve function

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14
Q

What is the normal serum range for magnesium?

A

0.65-1.05 mml/L

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15
Q

What is the normal serum level for phosphorus? What does it do?

A

1.0-1.5 mmol/L
–> Activates vitamins and enzymes, forms ATP, and assists in cell growth and metabolism
–> Maintains acid-base balance
–> Maintains calcium homeostasis.

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16
Q

What are the different kinds of fluid spacing?

A

First Spacing
–> Normal distribution of ICF and ECF

Second Spacing
–> Abnormal accumulation on interstitial fluid (edema)

Third Spacing
–> Fluid accumulation in a part of the body not easily exchanged with ECF and in transcellular space
–> Fluid fills cavity and compresses soft structures, resulting in ascites, pleural effusions, pericardiac effusion or tamponade

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17
Q

We have to have a normal ____ before administering IV P-dye

A

Creatinine - verifies kidney function

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18
Q

What is pOSM?

A

Serum osmolarity by weight

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19
Q

What is an eGFR?

A

Creatinine clearance/24 hours to measure kidney function

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20
Q

What does ACTH do?

A

Triggers the release of aldosterone –> Sodium reapsorption

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21
Q

What does ADH do?

A

Signals for water reabsorption in the renal tubules/collecting ducts.

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22
Q

What does renin do?

A

Signals for Ang I (+ ACE) –> Vasoconstriction and aldosterone

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23
Q

What are some potential causes for hyponatremia?

A

Excessive loss through sweat, GI loss, or renal dysfunction.

Excessive H2O gain

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24
Q

What are the manifestations of hyponatremia?

A

HypoTN

Seizures, decreased muscle tone, twitching, tremors, weakness

V&D, cramping, anorexia

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25
Q

How can hyponatremia be treated?

A

Hypertonic IVF and fluid restriction
–> Consume salty food

Monitor for neuro and BP changes

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26
Q

What might cause hyperkalemia?

A

Massive cell destruction - such an in traumatic injury, severe infection, burns or anything that shifts ICF to ECF

Drugs: K-Sparing (Spironolactone, amiloride), ACE Inhibitors

Impaired renal excretion - renal failure most common

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27
Q

What are the manifestations of hyperkalemia?

A

Oliguria, renal failure

Addison’s disease, brady, arrhythmias

Cramping leg pain, abd cramps or dirrhea.

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28
Q

How is hyperkalemia treated?

A

Monitor: ECG

Hold K intake, use loop diuretics to excrete it.

Force K back into ECF with insulin or sodium bicarb

Calcium gluconate can reverse membrane effects of elevated ECF K.

Dialysis.

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29
Q

What are some causes of hypokalemia?

A

GI/renal losses

Mg deficiency

Metabolic alkalosis

30
Q

Manifestations of hypokalemia

A

Cardiac arrest/arrhythmias

Skeletal muscle weakness, oliguria

Decreased GI motility and impaired regulation of arteriolar blood flow.

31
Q

What treatment can be used for hypokalemia?

A

Diet - K rich foods

K supplementation
–> IV should not exceed 10-20 mEq/hr to prevent hyperK and CA, and to decrease pain

32
Q

What can cause hypercalcemia?

A

Hyperparathyroidism (most common)

Malignant bone disease (cancer)

Vit D overdose

Prolonged immobilization

Excessive supplements/antacids

33
Q

What are some manifestations of hypercalcemia?

A

Kidney stones, muscle weakness, decreased reflexes.

Decreased memory + Fatigue
Personality changes and disorientation

34
Q

How can hypercalcemia be treated?

A

Calcitonin, loop diuretics, mobilization, dialysis.

Oral fluids 3-4 liters a day or isotonic IV

35
Q

What causes hypocalcemia?

A

Renal failure, hypothyroidism

multiple blood transfusions

Alkalosis

36
Q

What are some manifestations of hypocalcemia?

A

Trousseau + Chvostek’s sign

Laryngeal stridor

Tingling around the mouth or extremities

Muscle numbness

37
Q

How can hypocalcemia be treated?

A

Calcium (not IM)

Diet rich in protein, calcium, vitamin D

Anticipate tracheostomy

38
Q

What is Trousseau’s sign?

A

When a BP cuff is inflated 220-230 mmHg and the forearm and hand flex

Indicative of hypocalcemia

39
Q

What is Chvostek’s Sign?

A

When tapping on the cheek results in muscle spasm

Indicative of hypocalcemia

40
Q

What are some causes of hypermagnemesia?

A

Increased intake w renal insufficiency + renal failure

Adrenal insufficiency

41
Q

What are some manifestations of hypermagnesemia?

A

Brady/hypo

Impaired reflexes

Somnolence

Respiratory + cardiac arrest

42
Q

How can hypermagnesemia be treated?

A

IV calcium gluconate/chloride

Fluids to promote excretion

43
Q

What can cause hypomagnesemia?

A

Chronic alcoholism

Prolonged fasting + Prolonged TPN w/o supplementation

GI loss + diuretics

DKA

44
Q

What are manifestations of hypomagnesemia?

A

Skeletal muscle weakness and hyperactive tendon reflexes. Painful contractions

Numbness + tingling

Decreased GI motility

45
Q

What treatment can help hypomagnesemia?

A

Supplementation and diet: nuts, peanut butter, bananas

Monitor vitals

IV but must be under 1g/h

46
Q

What rate must magnesium be administered IV?

A

1 g/h max

47
Q

What might cause hyperphosphatemia?

A

Excessive intake or renal failure

48
Q

What are the manifestations of hyperphophatemia?

A

Same as hypocalcemia
–> Muscle cramps, tingling, numbness
–> Joint and bone pain

Rash and pruritis

49
Q

How is hyperphosphatemia treated?

A

Diet low in phosphorus:
–> Pasta, bread, rice
–> Limited meat
–> Dairy substitutes

50
Q

What might cause hypophosphatemia?

A

Alcohol withdrawal

Recovery from DKA + glucose administration

Malabsorption syndrome + TPN

51
Q

What are the manifestations of hypophosphatemia?

A

Decreased cardiac output, weak peripheral pulses

Skeletal muscle weakness

52
Q

How is hypophosphatemia treated?

A

Diet high in phosphorus: meats, fish, nuts, beans, dairy products

Vit D supplements

Oral or IV calcium

Sodium phosphate

53
Q

What electrolyte imbalances can be caused by renal failure?

A

HyperNa, HyperMg, Hyperphosphatemia

HypoCa

54
Q

What electrolyte imbalances can be caused by TPN?

A

Hypo magnesium and phosphate with malabsorption syndrome

55
Q

Which electrolyte imbalances cause hyperreflexia?

A

Hyper: Na, Phosphate

Hypo Mg, Hypo Ca results in trousseau and Chvostek

56
Q

Which electrolyte imbalances cause muscle weakness?

A

Hypo: Na, K, Mg

57
Q

What is the normal bicarb range?

A

22-29 mEq/L

58
Q

What is the normal Hgb level?

A

120-180 g/L

59
Q

What is the normal WBC?

A

4.5-11.0 x 10^9/L

60
Q

ACE inhibitors can cause which electrolyte imbalance?

A

hyperkalemia

61
Q

What is the most common cause of renal failure?

A

Hyperkalemia

62
Q

Magnesium deficiency can cause which other electrolyte imbalance?

A

hypokalemia

63
Q

Alkalosis can cause which electrolyte imbalance?

A

HypoK, HypoCa

64
Q

Which drug can reverse membrane effects during hyperkalemia?

A

Calcium gluconate

65
Q

Which drugs can force potassium from the ECF to ICF?

A

Insulin and sodium bicarbonate

66
Q

Prolonged immobilization can lead to which electrolyte imbalance?

A

hyperCa

67
Q

Multiple blood transfusions can lead to which electrolyte imbalance?

A

HypoCa
–> Ca is necessary for clotting factors

68
Q

Which electrolyte imbalances can lead to tingling around the mouth or extremities?

A

HypoCa, Hyperphosphatemia, and hypoMg

69
Q

The symptoms of hyperphosphatemia look like what other imbalance?

A

Hypocalcemia

70
Q

Laryngeal stridor can occur with which electrolyte imbalance?

A

Hypocalcemia
–> Anticipate tracheostomy

71
Q

Chronic alcoholism can lead to which electrolyte imbalance?

A

Hypomagnesemia

72
Q

TPN without supplementation can lead to which deficiency?

A

Hypophosphatemia

MedSurg (14 decks)

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