NUR 240 electrolytes Flashcards
sodium
135-145
potassium
3.5-5.0
chloride
98-106
calcium
9-11
BUN
7-20
Creatinine
0.6-1.2
albumin
3.4-5.4
magnesium
1.5-2.5
Phosphorus
2.5-4.5
pH
7.35-7.45
PaCO2
35-45
PaO2
80-100
HCO3
22-26
ROME
respiratory opposite, metabolic equal
Furosemide (lasix) (loop diuretic) and hydrochlorothiazide (thiazide) have what effect on potassium?
potassium wasting diuretic
can lead to hypokalemia
Spironolactone has what effect on potassium?
potassium sparing diuretic
used to increase the amount of fluid passed from the body in urine, whilst also preventing too much potassium being lost with it
(widely prescribed for hypertension)
serous wound drainage
clear watery plasma
sanguineous
bright red blood
serosanguineous
pale, pink, watery; mixture of clear and red fluid
purulent
thick yellowish green, foul odor
types of hypertonic solution
5% saline
3% saline
5% dextrose in 0.9% saline (D5NS)
5% dextrose in 0.45% saline (D5 1/2 NS)
5% dextrose in LR (D5LR)
10% dextrose in water (D10W)
use hypertonic solution for
cerebral edema
hyponatremia
maintenance fluid
hypovolemia
what are hypErtonic solutions
“Enter the vessel from the cells”
more salt in the solution
less water in the solution
the vessels become more concentrated than the cells, water then leaves the cell, cell will shrink
types of Isotonic solution
0.9% sodium chloride (NS)
5% dextrose in water (D5W)
Lactated ringers (LR)
use isotonic solutions for
blood loss
dehydration
fluid maintenance
normal saline is the ONLY solution that is compatible to use with
blood products
what are isotonic solutions
“stays where I put it”
same osmolality as body fluids (equal water and particle ratio)
types of Hypotonic solutions
0.45% saline (1/2 NS)
0.33% saline (1/3 NS)
0.225 saline (1/4 NS)
5% dextrose in water (D5W)
use hypotonic solutions for
diabetic ketoacidosis (DKA)
helps kidneys excrete excess fluid
hypernatremia
hypervolemia
what are hypOtonic solutions?
“Out of the vessel, into the cell (cell swells)”
less salt
more water
the vessel becomes less concentrated the cell, water enters the cell, cells swell
when patient is on hypotonic fluids monitor for
fluid volume overload
NEVER use hypertonic fluids for
increased intracranial pressure, burns, or trauma
Causes of Metabolic alkalosis
vomiting (vomiting sounds like- ALKKKK-alosis)
NGT suction
hypokalemia
low K+= alKaLOWsis
compensation: slow and shallow breaths
Causes of metabolic acidosis
diarrhea- “if it comes out of your ASSidosis”
renal failure - “when the kidneys fall, acid prevails”
diabetic ketoACIDOSIS
lactic acidoSiS
- Shock- low perfusion
- Sepsis- severe infection
compensation: rapid deep respirations
hypoventilation
low and slow breathing = higher CO2
hyperventilation
fast breathing = lower CO2
respiratory alkalosis (fast RR) causes
panic attack
compensation: kidneys excrete less H+ and reabsorb less HCO3
Respiratory acidosis causes (low and slow RR)
sleep apnea
head trauma “knocked out”
post-operative
drugs (CNS depressants)
- opioid overdose
- alcohol intoxication
- benzodiazepines (Diazepam)
Pneumonia
COPD or asthma attack
compensation: kidneys excrete H+ (acid) and retain HCO3 (base)
key manifestations of respiratory alkalosis
Key manifestations= low PaO2, Low HCO3
key manifestations of respiratory acidosis
Key manifestations: mental status changes, high PaCO2, high HCO3
the nurse expects which client to be in respiratory acidosis ?
a. Morphine overdose
b. panic attack
c. sleep apnea
d. COPD
e. asthma attack
f. alcohol intoxication
a. Morphine overdose
c. sleep apnea
d. COPD
e. asthma attack
f. alcohol intoxication
how does the nurse expect the client to show compensation for the following ABG values?
pH= 7.20 PaO2= 82 PaCO2= 37 HCO3= 15
a. decreased RR
b. Increased RR
c. increased renal retention of H+
d. decreased renal excretion of HCO3
this is metabolic acidosis
patient will compensation with an increased respiratory rate (b)
hyperkalemia s/s
MURDER
Muscle cramps and weakness***
Urine abnormalities
Respiratory distress
Decreased cardiac contractility (decreased HR and BP)
ECG changes - tall peaked waves, widened QRS complex)
Reflexes (Increased DTR)
Management of hyperkalemia
monitor ECG
administer IV calcium glucante and IV sodium bicarb
discontinue IV and PO potassium
K restricted diet
hypokalemia s/s
thready weak irregular pulse
orthostatic hypotension
shadow respirations
anxiety
management of hypokalemia
potassium sparing diuretic
liquid potassium chloride
administration route for potassium
what do we never do
NEVER push potassium!!!!!!!
no IV pus, IM, or subQ
do: dilute iv potassium and administer with an infusion device
hyponatremia s/s
seizures, nausea, lethargy
hypernatremia s/s
changes in LOC, agitation, restlessness, edema
hypophosphatemia s/s
changes in LOC, numbness, weakening of the bones
hyperphosphatemia s/s
diarrhea, muscle weakness, decreased deep tendon reflex
hypocalcemia s/s
tetany, positive trousseaus sign, positive chvosteks sign
positive chvosteks sign
positive trousseaus sign
hypercalcemia s/s
bone pain, kidney stones, muscle weakness
hypomagnesemia s/s
increased everything (BP, HR, RR, DTR)
hypermagnesemia s/s
decreased everything aka SEDATED ((BP, HR, RR, DTR, energy)
calcium and phosphorus relationship
inverse
increase Ca+ = decrease PO4
magnesium and calcium relationship
same
increase in mag = increase in Ca+
Potassium and sodium relationship
inverse
increase K = decreased in Na
osmosis
when solute moves from a HIGHER concentration to a LOWER concentration
recommended amount of fluids per day
2,500 mL/day of fluid.
over use of antacids can lead to
metabolic alkalosis
primary extracellular electrolytes are
sodium, chloride and bicarb
Which IV solutions would the nurse expect to be ordered for a client who has hypovolemia? Select all that apply.
0.9% NaCl (normal saline)
Lactated Ringer’s solution
5% dextrose in 0.9% NaCl
lab data indicating infection
elevated WBC count- norm is 5,000-10,000
increased lymphocytes and neutrophil levels
increase eosinophils= allergic response or parasitic infection
elevated ESR= inflammation is present
