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sodium Flashcards

1
Q

sodium - found where?

A

MOST ABUNDANT CATION IN ECF
* ONLY SMALL AMT FOUND IN ICF

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2
Q

Na role (think contractions)

A

IMPORTANT ROLE IN GENERATION AND TRANSMISSION
OF IMPULSES IN NERVES AND MUSCLES
HELPS REGULATE ACID-BASE BALANCE

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3
Q

Na regulation (TAAA da - don’t forget the heart)

A
  • THIRST
  • ADH
  • ALDOSTERONE
  • ANP
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4
Q

hyponaturemia - most common what?

A
  • MOST COMMON ELECTROLYTE IMBALANCE SEEN IN HOSPITALIZED PATIENTS
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5
Q

Hyponaturemia - RISK FACTORS (SGS give me low salt)

A
  • SODIUM LOSS
  • GAIN OF WATER - hypotonic solution, rare but hypotonic solution for enteral feedings. Hazing. marathon runner.
  • SIADH - risk factor is pneumonia
    D5 creates a hypotonic situation - check this
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6
Q

brain cells most (overload the brain)

A

susceptible to fluid overload - cerebral edema

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7
Q

hyponatremia - clinical manifestations (think how you feel when you don’t have salt)

A

N/V, loss of energy, muscle weakness, seizures.

  • DEPENDENT ON RAPIDITY & SEVERITY OF HYPONATREMIA
  • MOST COMMON SX RELATED TO H2O SHIFT FROM VASCULAR SPACE INTO
    CELLS AND NA+ ROLE IN NERVE IMPULSE TRANSMISSION AND MUSCLE CTX
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8
Q

Hyponaturemia - NEUROLOGIC SYMPTOMS DON’T DEVELOP UNTIL NA+ VALUE APPROX (low salt brain at 120 min)

A

120-125
* SEIZURES OCCUR WHEN LEVELS REACH 115

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9
Q

hyponaturemia - LAB VALUES (think of normal values) and when Oz is low he makes a 280 degree)

A
  • NA+ LESS THAN 135MEQ/L
  • SERUM OSMOLALITY LESS THAN 280MOSM/KG
  • SG DECREASED (EXCEPT WITH SIADH)
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10
Q

INTERVENTIONS - hyponaturemia - assess what? (same stuff)

A
  • ASSESS AND DOCUMENT LOC,
    ORIENTATION, NEURO STATUS WITH
    VS
  • I & O DAILY WTS
  • MONITOR SERUM LEVELS
    CLOSELY
  • FREE FLUID RESTRICTION
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11
Q

hyponaturemia - DON’T CORRECT TOO
QUICKLY to prevent…(salt in the brain)

A

NEUROLOGIC DAMAGE
SECONDARY TO LYSIS OF
MYELIN

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12
Q

normal saline percent (saline is small)

A

.9%

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13
Q

hyponatermia - intervention - just one…and when it gets to what number?

A

ADMINISTER HYPERTONIC 3%
SALINE SOLUTION ONLY IF
DANGEROUSLY LOW (AT
LEAST 118 OR LOWER VALUE)

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14
Q

increased water

A

higher bp, if you have hyponateremia

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15
Q
  • GREATER THAN NORMAL CONCENTRATION OF NA+ IN ECF caused by..
A

EXCESS WATER LOSS OR OVERALL SODIUM EXCESS
* MAY OCCUR WITH WATER LOSS, WATER DEPRIVATION, OR NA+ GAIN

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16
Q

who is usually admitted for hypernaturemia?

A

elderly - don’t want to drink

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17
Q

hypernatermia - causes (hyper is anything without enough H20)

A
  • INCREASED SENSIBLE AND INSENSIBLE H2O LOSS
  • DIARRHEA (hypo AND hyper)
  • WATER DEPRIVATION/SODIUM GAIN
  • DIABETES INSIPIDUS (you aren’t absorbing water, so Na levels get too high)
  • EXCESS ALDOSTERONE SECRETION (gain of Na)
    free water prevents hyperosmolar state
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18
Q

hypernaturemia - CLINICAL MANIFESTATIONS related to…

A

WATER SHIFT FROM CELLS (CELLULAR DEHYDRATION) INTO
VASCULAR SPACE
* ALSO RELATED TO NA+ ROLE IN NERVE IMPULSE TRANSMISSION AND MUSCLE
CONTRACTION

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19
Q

DIAGNOSTIC TESTS - hypernaturemia - numbers (just think of normal range for Na - over is hyper) and osmolality above what? (os is 3 less than 300)

A
  • SODIUM GREATER THAN 145
  • SERUM OSMOLALITY ABOVE 297
  • SG INCREASED, EXCEPT WITH DIABETES INSIPIDUS
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20
Q

HYPERNATREMIA interventions (basically just water)

A
  • I&O
  • DAILY WTS
  • ASSESS AND DOCUMENT LOC, NEURO STATUS AND ORIENTATION WITH VS
  • IV OR ORAL H2O REPLACEMENT
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21
Q

INTERVENTIONS - hypernaturemia - how many days needed to correct hypernaturemia? and why? (salt needs 2 days)

A

(DESMOPRESSIN ACETATE)
* REORIENT PT AS NEEDED
* DECREASE DIETARY NA+ INTAKE
* CORRECT HYPERNATREMIA SLOWLY (to prevent cerebral edema), OVER 2 DAYS

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22
Q

chloride is ICF or ECF?

A
  • MOST ABUNDANT EXTRACELLULAR ANION AND MAKES UP FOR TWO THIRDS
    PLASMA ANIONS
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23
Q

chloride absorption, production, and excretion where?

A
  • REGULATION
  • GI - MOST ABSORBED IN INTESTINES. CHLORIDE PRODUCED MAINLY IN
    STOMACH AS HYDROCHLORIC ACID (run the risk of alkalosis with loss of hydrochloric acid)
  • KIDNEYS - EXCRETED AND REABSORBED IN KIDNEYS
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24
Q

headache characteristic of

A

hyponaturemia

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25
Q

treatment hyponaturemia - stop drinking

A

fluid restriction, stop low sodium diet. maybe change diuretic.

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26
Q

potassium - located where?

A
  • MAJOR CATION IN ICF
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27
Q

low potassium causes what heart problem?

A

dysrthmia

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28
Q

K+ regulation (Alden is a KID who regulates K+)

A
  • DIETARY INTAKE
  • KIDNEYS - PRIMARY REGULATORS
    OF K+ BALANCE
  • ALDOSTERONE
  • INSULIN
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29
Q

HYPOKALEMIA - common or not? (little Kalema is common)

A
  • ONE OF THE MOST COMMON ELECTROLYTE IMBALANCES
  • CHANGES IN SERUM K+ REFLECTIVE OF ECF VALUES NOT TOTAL BODY
    VALUES
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30
Q

hypokalemia - causes - eating? (can never eat enough potassium)

A

ETIOLOGY
* DUE TO LOSS FROM BODY OR MOVEMENT OF K+ INTO CELLS
* RARELY RESULT OF INADEQUATE INTAKE

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31
Q

which diuretic for hyperkalemia? (you know the one)

A

lasix and furosemide

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32
Q

CLINICAL MANIFESTATIONS of hypokalemia CLINICAL MANIFESTATIONS
RARELY DEVELOP UNLESS K+ DROPS below…(think of normal values)

A

3.0

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33
Q

hypokalemia - DIAGNOSTIC TESTS - what is decreased on blood test? (when kalema is low, she needs maggie and milk)

A
  • ECG: MAY SEE ST SEGMENT DEPRESSION, FLATTENED T
    WAVE, PRESENCE OF U WAVE & VENTRICULAR
    DYSRHYTHMIAS
  • DECREASED MG+ OR DECREASED CA++
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34
Q

if Mg is low, what else is usually low? (when maggie gets low, she needs milk and salt to pick her up)

A

Ca is and Na are usually low as well

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35
Q

INTERVENTIONS - hypokalemia - how much K+ supplement is usually ordered? (need vitamin K from 40 - 80)

A
  • ADMINISTER K+ SUPPLEMENT AS
    ORDERED
  • USUAL DOSE = 40-80MEQ
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36
Q

hypokalemia INTERVENTIONS - encourage foods…

A
  • ENCOURAGE FOODS HIGH IN K+
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37
Q

INTERVENTIONS - hypokalemia - monitor what vital signs?

A
  • MONITOR FOR IRREGULAR PULSE (monitor Apical pulse*****) tachycardia
    PULSE DEFICIT, BP, RESP STATUS
  • MONITOR ECG
  • MONITOR PTS RECEIVING DIG FOR
    SIGNS OF INCREASED DIG EFFECT
38
Q

digoxin (dig the extra sodium)

A

increases contraction. Stops Na to the cell, increases Ca in the cell so heart contraction is increased.

39
Q

K+ slight increase can have…and is hyper or hypo worse?

A

SLIGHT INCREASE CAN HAVE PROFOUND CONSEQUENCES
* LESS COMMON THAN HYPOKALEMIA, BUT MORE SERIOUS.

40
Q

hyperkalemia etiology/causes (kalema gets hyper and lyses when she doesn’t have insulin

A
  • INCREASED INTAKE OF POTASSIUM
  • SHIFT OF K+ FROM ICF
  • INSULIN DEFICIENCY
  • DECREASED RENAL EXCRETION (renal failure at risk for hyperkalemia)
  • CELL TRAUMA (and K+ spills out)
41
Q

hyper is (my plasma is hyper)

A

plasma

42
Q

crush injury and tumor lysis syndrome

A

hyperkalemia

43
Q

hyperkalemia - usually only apparent with…

A

EXTREME ELEVATIONS
* INCREASED K+ MUSCLE CELLS MORE EXCITABLE
* DIFFICULT TO DIFFERENTIATE K+ IMBALANCE BY SX ALONE

44
Q

hyperkalemia DIAGNOSTIC TESTS - numbers (hyper kalema diagnosed at 5)

A
  • SERUM K+ GREATER THAN 5MEQ/L
  • BE CAREFUL NOT TO LEAVE TOURNIQUET ON TOO LONG
  • ABGS: MAY SEE ACIDOSIS
  • ECG: TALL THIN T WAVES, PROLONGED PR INTERVAL, ST
    DEPRESSION, WIDENED QRS & LOSS OF P WAVE
45
Q

K+ excreted via

A

kidneys, need to check I & O

46
Q

kayexalate (kay needs to poop potassium)

A

reduction of K+ levels. increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract.

47
Q

correct imbalance - hyperkalemia (when kalema is hyper, giver her insulin)

A

with inuslin and glucose, and last resort dialysis

48
Q

hyperkalemia - INTERVENTIONS - monitor the usual and increase what?

A

INTERVENTIONS
* I&O
* LOW K+ DIET
* INCREASE URINE OUTPUT (K+
WASTING DIURETICS)
* MONITOR ECG IF INDICATED

49
Q

hyperkalemia - how to correct? (antagonist forcing me to eliminate hyper)

A
  • ANTAGONIZE EFFECT OF POTASSIUM ON CELL MEMBRANE
  • FORCE POTASSIUM INTO CELL
  • ELIMINATE FROM BODY
  • CORRECT CAUSE
50
Q

hold

A

lisinipro

51
Q

ASSESSMENT BEFORE AND DURING K+ INFUSION (vesicant)

A

check labs, HR, urine output, monitor for hyperkalemia. K+ is a vesicant drug so monitor insertion site.

52
Q

Na value range (went to Na at age 35)

A
  • NORMAL SERUM VALUE 135-145 MEQ/L
53
Q

Na+ where is it absorbed and eliminated? (where everything is)

A
  • ABSORBED VIA GI AND ELIMINATED THROUGH URINE
54
Q

Na - most important for what?

A
  • MOST IMPORTANT ELECTROLYTE REGULATING OSMOLALITY
55
Q

hyponaturemia * TYPICALLY ASSOCIATED WITH ecf or icf imbalances?

A

ECF IMBALANCES
* INADEQUATE SODIUM INTAKE
* INCREASED EXCRETION - (kidney problems, diarrhea)
* DILUTIONAL (WATER EXCESS, USUALLY ASSOC WITH HYPERVOLEMIA)

56
Q

hyponaturemia - clinical problems are largely from intra or extracellular shifts? (low sodium in the cell is the problem)

A

INTRACELLULAR SHIFT OF WATER

57
Q

chloride - where is it located and what percent?

A
  • 80% TOTAL BODY CHLORIDE FOUND IN ECF
58
Q

role of chloride?

A

REGULATION OF OSMOTIC PRESSURE AND WATER BALANCE (ALONG
WITH NA)

59
Q

chloride normal values (chloride for the pool is $100)

A
  • NORMAL SERUM VALUES 100-106MEQ/L
60
Q

K+ - normal values

A
  • NORMAL VALUE IS 3.5-5.0
61
Q

K+ regulates (K+ regulates the conductions in my heart and muscle)

A

METABOLIC ACTIVITIES
* ESSENTIAL FOR TRANSMISSION AND CONDUCTION OF
NERVE IMPULSES, NORMAL CARDIAC RHYTHMS, AND
SKELETAL AND SMOOTH MUSCLE CTX

62
Q
  • WHEN SEVERE, HYPOKALEMIA CAN AFFECT
A

CARDIAC CONDUCTION

63
Q
  • PRIMARY PROTECTION AGAINST DEVELOPMENT OF HYPEROSMOLALITY AND
    HYPERNATREMIA is (what you have alllll daaay long)
A

THIRST

64
Q

hypokalemia - how fast to administer? (K+ is 10, 20, 30, 40)

A
  • SHOULD NOT ADMINISTER K+ FASTER
    THAN 10-20MEQ/HR OR IN
    CONCENTRATION HIGHER THAN 30-
    40MEQ IN DEXTROSE FREE IV
  • IF GIVING MORE THAN (don’t give faster than) 10MEQ/HR = CARDIAC MONITOR. If more than 10MEQ/HR, need to be on a cardiac monitor.
65
Q

never give K+ how?***

A
  • NEVER GIVE IV PUSH OR IM!!!! You will kill them.
66
Q

hypokalemia - monitor what? And when to hold?

A
  • I&O. * MONITOR URINE OUTPUT
    if no urine output, HOLD potassium
67
Q

hypokalemia - how much to administer for lost urine? (40 yrs. of urine)

A

40MEQ OF K+ LOST/ L OF URINE

68
Q

hyponaturemia - encourage foods…and what meds to take? (Demi need salt)

A
  • ENCOURAGE FOODS HIGH IN
    NA+ (cheese, look at the LIST of food - you need to memorize it)
  • MEDICATIONS I.E.
    DEMECLOCYCLINE, SALT
    TABS (works on kidneys)
69
Q
  • SODIUM-POTASSIUM PUMP CRITICAL TO MAINTAINING
    BALANCE BETWEEN
A

INTRACELLULAR & EXTRACELLULAR
K+

70
Q

PRIMARY PROTECTION AGAINST DEVELOPMENT OF HYPEROSMOLALITY AND HYPERNATREMIA

A

THIRST

71
Q

tx for diabetes insipidious (hypernatremia) - (desmosomes are insipidous)

A

TX DIABETES INSIPIDUS (DESMOPRESSIN ACETATE)

72
Q

which one can have profound consequences with a slight increase? (mina)

A

hyperkalemia

73
Q

with sodium, think…
potassium, think..

A

water and neuro changes.
K = cardiac

74
Q

most important in regulating osmolality?

A

sodium

75
Q

the more sodium, the more..

A

solute

76
Q

diarrhea can cause

A

hyponaturemia

77
Q

SIADH - serum gravity will

A

not be decreased bc the patient is holding onto water and putting out concentrated urine

78
Q

free fluid restrictions for what patients?

A

hypontremia

79
Q

3% saline is hypo or hyper?

A

hypertonic.

80
Q

what prevents hyperosmolar (condition in which the blood has a high concentration of salt (sodium), glucose, etc) state?

A

free water

81
Q

hypernatremia - hypo or hypertonic solution?

A

hypo - but be very very careful.

82
Q

ECG hyper and hypokalemia

A

just know that there are changes

83
Q

don’t ever crush what type of tablet?

A

potassium

84
Q

calcium gluconate for what? (kalema needs glue also)

A

quiets cardiac muscle if pt has hyperkalemia

85
Q

hyperkalemia - kalema is so hyper she actually slows down

A

bradycardia

86
Q

hypermagnesium (big guns)

A

heart is calm and quiet

87
Q

hypercalcemia (hyper california is still slow)

A

everything is slow

88
Q

hyperphosphatemia

A

french also

89
Q

DTR (kalema and floss are high, ca and maggie are slow)

A

hyperkalemia (tight) - high
hypermagnesia - slow (sheriff)
hypercalcemia - slow
hyperphosphatemia - high

90
Q

hyperkalemia - tight

A

slow heart HR, diarrhea, and paralysis

91
Q

hypernatremia and high calcium (sister) same symptoms - big and slow

A

bloated, N/V

92
Q

intracellular shift

A

something moving into the intracellular space

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