TERM 3- MY NOTES FOUNDATIONS OF NURSING CH.22 "Fluids and Electrolytes " Flashcards
FLUIDS {WATER) _
,
Fluids and Electrolytes
,
Water has many functions. It provides an extracellular transportation route to deliver nutrients to the cells and carry waste products from the cells. Once inside the cells, it provides a medium in which chemical reactions, or metabolism, is able to occur.
A)true
B)false
A
Water also acts as a lubricant for tissues
A)true
B)false
A
Two other important functions of water are to aid in the maintenance of acid-base balance and to assist in heat regulation by evaporation.
A)true
B)false
A
Water constitutes the largest percentage of body weight. This percentage depends on several factors and varies with each individual. First, age affects the amount of water in the body.
A)true
B)false
A
A newborn’s body weight is comprised of 70% to 80% water. That percentage increases in a premature infant to as high as 90%. The infant begins to lose body fluid most rapidly in the first 6 months, and by 12 years the proportion approaches that of an adult.
A)true
B)false
A
Another important influence on the amount of water in the body is the amount of fat in the individual. There is a correlation between water content and fat content; fat contains relatively little water.
A)true
B)false
A
A woman has proportionately more body fat than a man, which means the woman has less body fluid than the man.
A)true
B)false
A
The more obese an individual, the smaller the percenttage of body water.
A)true
B)false
A
Both obese and older adults are at risk for complications of illness from dehydration or fluid shifts because they have less fluid reserve in their bodies .
A)true
B)false
A
Infants are also at risk for dehydration. More than half of an infant’s fluid is extracellular (outside the cells) .
A)true
B)false
A
Extracellular fluid is lost from the body more rapidly than intracellular (inside the cells) fluid
A)true
B)false
A
Very young, very old, and obese patients are at a higher risk for developing a deficient fluid volume.
A)true
B)false
A
A loss of 10% of body fluid is serious in an adult, and a 20% loss is fatal.
A)true
B)false
A
In an infant those figures are even more significant. A loss of 5% is serious, 10% is very serious, and 15% is fatal.
A)true
B)false
A
Life Span Considerations
Older Adults Dehydration
Older adults are at increased risk of dehydration because of
the following factors:
,
- Fat replaces lean muscle as aging progresses, leading to a decrease in total body fluid.
- The aging kidney is less able to concentrate urine, so more fluid is lost.
- Decreases in mobility and diminished sense of thirst often result in decreased fluid intake.
- Incontinent older individuals sometimes restrict fluid intake to reduce the frequency of urination.
- To compensate for changes in taste, older adults often oversalt their food, resulting in electrolyte and fluid imbalances.
- Physiologic changes in the skin and mucous membranes make them less reliable indicators of dehydration.
- Dehydration will sometimes first manifest as mild disorientation.
True
- Signs and symptoms of dehydration include thirst, dry mucous membranes, increased heart rate, decreased blood pressure, poor skin turgor, and flat neck veins.
- Dehydration increases the risk of orthostatic hypotension.
- Decreased fluid intake increases the likelihood of constipation.
- Because the aging kidney is less efficient at excretion, giving intravenous (IV) infusions or supplements containing sodium or potassium increases the risk of electrolyte imbalance.
- Monitor the complete blood count carefully to detect changes in the hematocrit as it relates to hemoglobin. Decreased plasma volume elevates the hematocrit, whereas the hemoglobin level remains constant.
True
FlUID COMPARTMENTS
,
The body has two primary fluid compartments: intracellular and extracellular
A)true
B)false
A
The fluid compartments are -as follows:
- Intracellular
- Extracellular
a. Interstitial
b. Intravascular
True
The intracellular fluid compartment is the larger of the two compartments, comprising 66% of the body’s fluid. It contains the fluid inside the billions of cells within the body.
A)true
B)false
A
The extracellular compartment contains any fluid outside the cells (34%). This compartment is further divided into the interstitial and the intravascular fluid comparhnents.
A)true
B)false
A
(Extracelluar compartment) Interstitial fluid is betvveen the cells, or in the tissues. It accounts for approximately 27% of the fluid in the patient’s body.
A)true
B)false
S
Examples of interstitial fluid include lymph, cerebrospinal fluid, and gastrointestinal (GI) secretions.
A)true
B)false
A
(Extracelluar comparment) Intravascular fluid is the plasma within the vessels. The cells of the blood are considered solid particles. After the cells are removed, the liquid that remains is the plasma. It makes up the remaining 7% of fluid volume
A)true
B)false
A
The intracellular and extracellular compartments are separated by a semipermeable membrane. This membrane allows for a constant back-and-forth flow as nutrients are taken into the cell and waste products are carried out.
A)true
B)false
A
BODY FLUID DISTRIBUTION
,
Intracellular means Fluid within cells
A)true
B)false
A
Extracellular means Fluid outside cells
A)true
B)false
A
Intravascular means Fluid within blood vessels; examples plasma
A)true
B)false
A
Interstitial means Fluid in tissues (between cells or in body spaces); Examples: interstitial fluid, lymph, cerebrospinal fluid, intraocular fluid, gastrointestinal (GI) secretions, urine, perspiration, exudates
A)true
B)false
A
Interstitial fluid (27%of total fluid in the body / 11.2L fluid volume) A)true B)false
A
Intravascular fluid (plasma) (7% of total body fluid/2.8L fluid volume in the body) A)true B)false
A
Intracellular fluid (66% of total fluid in the body/42L of fluid volume in the body) A)true B)false
A
INTAKE AND OUTPUT
,
Fluid leaves the body through the kidneys, the lungs, the skin, and the GI tract. To maintain homeostasis, the normal daily loss must be met by the normal daily intake
A)true
B)false
A
Homeostasis is a relative constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival. In order to maintain homeostasis, it is necessary that bodily fluids and electrolytes remain within the exact limits of normal
A)true
B)false
A
Daily water intake and output (I&0) is approximately 2500 mL
A)true
B)false
A
Water loss is replenished in two ways-first, by ingestion of liquids and food, and second, by metabolism, both of food and in body tissues.
A)true
B)false
A
Intake includes all fluids entering the body. Fluids are either liquids taken orally or those consumed in food, including foods that assume a liquid consistency at room temperature.
A)true
B)false
A
Additional intake includes tube feedings and parenteral intake such as intravenous (IV) fluids, blood components, and total parenteral nutrition (TPN).
A)true
B)false
A
Liquid output includes all fluids leaving the body, including those lost through perspiration and expiration.
A)true
B)false
A
Urine, diarrhea, vomitus, nasogastric suction, and chest tube drainage are examples of measurable outtput.
A)true
B)false
A
Drainage from surgical wounds and drainage collected in surgical receptacles such as the Jackson-Pratt, Davol, or Hemovac systems are also considered liquid output.
A)true
B)false
A
The determination of exact amounts of fluid loss and fluid replacement is not possible as part of nursing interventions, so you will use approximations.
A)true
B)false
A
Because it is possible to measure fluid I&O, the importance of accurate record keeping cannot be overemphasized when determining a patient’s fluid needs
A)true
B)false
A
The kidneys play an extremely important role in fluid balance. If the kidneys are not functioning properly, the body has great difficulty with regulating fluid balance.
A)true
B)false
A
The nephrons are the functioning units of the kidney.
A)true
B)false
A
The nephrons filter blood at a rate of 125 mL/min, or about 180 L/ day. This is called the glomerular filtration rate and leads to an output of 1 to 2 L (1000 to 2000 mL) of urine per day. The nephrons reabsorb the remaining 178 L or more of fluid.
A)true
B)false
A
If the body loses even 1% to 2% of its fluid, the kidneys conserve fluid by reabsorbing more water from the renal filtrate, which results in a more concentrated urine.
A)true
B)false
A
It is necessary for the kidneys to excrete a minimum of 30 mL/ hr of urine (720 mL/ 24 hr) to eliminate waste products from the body.
A)true
B)false
A
The kidneys react to fluid excesses by excreting a more dilute urine; this rids the body of excess fluid and conserves electrolytes.
A)true
B)false
A
A simple and accurate method of determining water balance is by weighing the patient under exact conditions, for example, same time of day, same amount of bed clothing, same type of gown, and same attached equipment, such as electrodes. Empty all drainage bags before weighing the patient
A)true
B)false
A
Because 1 L of fluid equals 2.2 pounds (1 kg), a weight change .of 2.2 pounds will reflect a loss or gain of 1 L of body fluid
A)true
B)false
A
To determine a patient’s hydration or dehydration levels, performance of urine specific measurements is appropriate. A urine specific gravity of more than 1.030 indicates concentrated urine (seen in conditions of dehydration), whereas a measurement of less than 1.010 indicates dilute urine (seen in conditions of hydration)
A)true
B)false
A
Specific Gravity-measures hydration of a patient
A)true
B)false
A
A urine specific gravity of more than 1.030 indicates concentrated urine (seen in conditions of dehydration), whereas a measurement of less than 1.010 indicates dilute urine (seen in conditions of hydration)
A)true
B)false
A
Normal Fluid Intake and Output in an Adult Eating 2500 Calories per Day (Approximate Figures)
,
Water in food
Gain:1000
Route:Skin
Loss:500
True
Water from oxidation
Gain:300
Route:Lungs
Loss:350
True
Water as liquid
Gain:1200
Route:Feces
Loss:150
True
Water as liquid
Gain:1200
Route:Kidney
Loss:1500
True
Total 2500mL
A)true
B)false
A
Measuring Intake and Output {1&0)
Nursing Action (Rationale),
Measure and record output in Foley drainage system, diarrhea stools, nasogastric suction, emesis, ileostomy, and output in surgical wound receptacles such as Davol, Jackson-Pratt, and Hemovac.
Measure and record output from chest tube drainage in water-sealed container by marking with felt-tip pen. (Ensures accurate mea. surement and proper disposal of output.)
A)true
B)false
A
MOVEMENT OF FLUID AND ELECTROLYTES
,
Substances entering the body begin their journey in the extracellular fluid. However, to carry out their functions, they have to cross the semipermeable membrane surrounding each body cell and enter the cell. The fat and protein molecules that make up the membrane are arranged so that some substances can enter the cells and others cannot.
A)true
B)false
A
A number of processes allow this mass movement of substances into and out of cells. These transport processes are classified under two general headings:
- Passive transport processes
- Active transport processes
True
active transport processes necessitate the expenditure of energy by the cell, and passive transport processes do not.
A)true
B)false
A
The energy required for active transport processes is obtained from an important chemical substance called adenosine triphosphate (ATP). ATP is produced in the mitochondria from nutrients and is capable of releasing energy that in turn enables the cell to work.
A)true
B)false
A
For active transport processes to occur, the breakdown of ATP and the use of the related energy are required.
A)true
B)false
A
The details of active and passive transport of substances across cell membranes is much easier to understand if you keep in mind the following two key facts:
,
1) in passive transport (the movement of small molecules by diffusion across a cell membrane) processes, no cellular energy is required to move substances from a high concentration to a low concentration;
A)true
B)false
A
(2) in active transport processes, cellular energy is required to move substances from a low concentration to a high concentration.
A)true
B)false
A
PASSIVE TRANSPORT
M
The primary passive transport processes that move substances through the cell membranes include the following:
• Diffusion
• Osmosis
• Filtration
True
DIFFUSION
,
Water is able to move freely from one compartment to another by diffusion. Diffusion is the movement of particles in all directions through a solution or gas.
A)true
B)false
A
ln diffusion, solutes move from an area of higher concentration to an area of lower concentration, which eventually results in an equal distribution of solutes within the two areas.
A)true
B)false
A
Diffusion occurs, for example, when ink is dropped into a glass of water. The ink will disperse in all directions until it is evenly distributed throughout the fluid. When diffusion occurs in the body, the molecules have the same action as the ink spreading through the water.
A)true
B)false
A
With each inhalation by the patient, oxygen enters the lungs and moves into the intravascular compartment and into the cells by diffusion. Gases, including oxygen, nitrogen, and carrbon dioxide, leave the capillaries and diffuse into the cell membrane and become distributed throughout the body .
A)true
B)false
A
OSMOSIS
,
Osmosis is the movement of water from an area of lower concentration to an area of higher concentration. Osmosis equalizes the concentration of ions or molecules on each side of the membrane. The flow of water will continue until the number of ions or molecules on both sides of the membrane is equal.
A)true
B)false
A
What happens when you boil a hot dog in water is an example of osmosis. The water passes through the hot dog skin, which is a semipermeable membrane, in an attempt to equalize the number of molecules on both sides of the membrane. Finally, when the hot dog is able to hold no more water, the skin, or semipermeable membrane, ruptures.
A)true
B)false
OSMOSIS
The red blood cells offer an example of the osmotic process in the body. If extracellular fluid is more concentrated than intracellular fluid, the fluid from inside the cell moves out to the extracellular fluid, causing the red blood cell to shrink.
If the fluid among the compartments is in equilibrium, fluid will enter and leave the cell at the same rate and the cell size will not change.
Another example is when extracellular fluid is less concentrated than the fluid in the red blood cells. Fluid moves into the cell, causing it to enlarge. The process will sometimes continue until the cell ruptures
Osmosis
True
Solutions are classified in the body as hypertonic, isotonic, or hypotonic according to the electrolyte concentration. The concentration of the solution will cause the cells of the body to react the same way the red blood cell does.
A)true
B)false
A
Hypertonic (a solution of higher osmotic pressure) solutions pull fluid from the cells; which makes them shrink
A)true
B)false
A
isotonic (a solution of same osmotic pressure) solutions expand the body’s fluid volume without causing a fluid shift from one compartment to another; equal
A)true
B)false
A osmosis
hypotonic (a solution of lower osmotic pressure) solutions move into the cells, causing them to enlarge. Each of these actions occurs through the mechanism of osmosis.
A)true
B)false
A
FILTRATION
,
Filtration is the transfer of water and dissolved substances from an area of higher pressure to an area of lower pressure. An example of filtration occurs at the capillary level of the circulation.
A)true
B)false
A
A force behind filtration is called hydrostatic pressure, which is the force of fluid pressing outward on a vessel wall. The pumping action of the heart is responsible for the amount of force, the hydrostatic pressure, that causes water and electrolytes to move from the capillaries to the interstitial fluid.
A)true
B)false
A
Passive Transport Processes
,
Diffusion
Movement of particles through a membrane from an area of high concentration to an area of low concentration-that is, down the concentration gradient
EXAMPLE;
Movement of carbon dioxide out of all cells; movement of sodium ions into nerve cells as they conduct an impulse
True
Osmosis
Diffusion of water through a selectively permeable membrane in the presence of at least one impermeable solute
EXAMPLE;
Diffusion of water molecules into and out of cells to correct imbalances in water concentration
True
Filtration
Movement of water and small solute particles, but not larger particles, through a filtration membrane; movement occurs from area of high pressure to area of low pressure
EXAMPLE;
In the kidney, water and small solutes move from blood vessels but blood proteins and blood cells do not, thus beginning the formation of urine
True
ACTIVE TRANSPORT
,
Active transport requires energy; it is a force that moves molecules into cells without regard for their positive or negative charge and against concentration factors that will prevent entry into the cell via diffusion.
A)true
B)false
A
Active transport moves fluid and electrolytes from an area of lower concentration to an area of higher concentration.
A)true
B)false
A
Substances actively transported through the cell membrane include sodium, potassium, calcium, iron, hydrogen, and amino acids.
A)true
B)false
A
The movement of glucose into the cells occurs through the process of active transport. Insulin provides the transport for glucose to leave the intravascular compartment and move into the cells, where the glucose can then be used for energy.
A)true
B)false
A
ELECTROLYTES
,
As water moves through the compartments of the body, it contains substances that are sometimes called minerals or salts but which are technically known as electrolytes
A)true
B)false
A
Electrolytes are substances that when in solution, separate (or dissociate) into electrically charged particles.
A)true
B)false
A
Electrolytes develop tiny electrical charges when they dissolve in water and break up into particles known as ions.
A)true
B)false
A
Ions develop either a positive or negative electrical charge. Ions with a positive charge are caLled cations. Ions with a negative charge . are called anions.
A)true
B)false
A
Ions with a positive charge are caLled cations.
A)true
B)false
A
Ions with a negative charge . are called anions.
A)true
B)false
A
The following are examples of cations: • Sodium (Na+) • Potassium (K+) • Calcium (Ca++) • Magnesium (Mg++)
True
The foLlowing are examples of anions: • Chloride (Cl-) - • Bicarbonate (HC03 - ) - • Sulfate (S04 -) 4 - • Hydrogen phosphate (HP04 - ) -
True
The princiipal electrolytes must be present in proper quantities for normal metabolism and function in the body. For this balance to occur, there must be a negatively charged anion for each positively charged cation.
A)true
B)false
A
A sample of plasma is taken to measure the electrolytes. The measurement is expressed in milliequivalents (mEq). Rather than electrolytes being measured by their weights, they are measured by their electrical activity.
A)true
B) false
A
A milliequivalent (mEq) is a measure of the chemical activity or chemical combining power of an ion. The chemical activity of an electrolyte is compared with the chemical activity of hydrogen. One milliequivalent of any electrolyte has the same chemical combining power as 1 mEq of hydrogen. In each fluid compartment in the body, the cations and anions balance each other with their chemical combining power to maintain electrical neutrality, which again keeps the body in homeostasis. A)true B)false
A
The location and the function of each electrolyte become important in Understanding disease processes. The healthy body maintains homeostasis by correcting any excesses or deficiencies of the electrolytes.
A)true
B)false
A
Sodium (cation)
,
The normal blood level of sodium (Na+), a cation and the most abUndant electrolyte in the body, is 134 to 142 mEq/ L.
A)true
B)false
A
It is the major extracellular electrolyte, and because the plasma sample used to measure electrolyte levels comes from the extraceLlular fluid, the level is high. In contrast, the intracellular level of sodium is approximately 10 mEq.
A)sodium
B)potassium
A
The major source of sodium comes from the diet. That is true of all the electrolytes.
A)true
B)false
A
However, unlike the other electrolytes, sodium is a substance that it is frequently necessary to limit in the diet rather than encourage.
A)true
B)false
A
The kidneys are the primary excretion route for sodium. It is important to know that many electrolytes, such as sodium, not only pass into and out of the body, but also move back and forth between a number of body fluids during each 24-hour period.
A)true
B)false
A
During a 24-hour period, more than 8 L of fluid containing 1000 to 1300 mEq of sodium are poured into the digestive system. This sodium, along with most of that contained in the diet, is almost completely reabsorbed.
A)true
B) false
A
Some major dietary sources of sodium are cheese, table salt, seafood, processed meat, caru1ed vegetables, canned soups, ketchup, and snack foods, such as pretzels and potato chips. Precise regulation and control of sodium levels is required for survival.
A)true
B)false
A
The functions of sodium include regulation of the water balance.
A)true
B)false
A
Sodium controls the extracellular fluid volume mainly through osmotic pressure, because water follows the sodium in the body (where sodium is, water will follow). It also increases cell membrane permeability.
A)true
B)false
A
Sodium stimulates conduction of nerve impulses and helps maintain neuromuscular irritability. Sodium is important in controlling contractility of muscles, especially the heart.
A)true
B)false
A
Hyponatremia
,
A less-than-normal concentration of sodium in the blood is called hyponatremia. This is possible when there is a sodium loss or a water excess.
A)true
B)false
A
Hyponatremia occurs when the sodium drops to less than 134 mEq/ L in the extracellular fluid.
A)true
B)false
A
When a deficiency results from sodium loss, the body attempts to compensate by decreasing water excretion.
A)true
B)false
A
Hyponatremia occurs because water is being retained in the body, which has a diluting effect on all of the blood components
A)true
B)false
A
The signs and symptoms of hyponatremia depend on the cause and also on how rapid and severe the sodium loss is.
A)true
B)false
A
As sodium levels decrease in the extracellular fluid, water is pulled into the cells, causing them to become edematous, and as the fluid moves into the cells, potassium is shifted out; therefore the patient is likely to also have a potassium imbalance.
A)true
B)false
A
Hyponatremia: Causes, Signs and Symptoms, and Nursing Interventions
,
CAUSES • Inadequate sodium intake • Loss of Gl fluids • Vomiting • Diarrhea • Gl or biliary drainage via nasogastric tube or T-tube • Fistulas • Loss through skin • Diaphoresis • Large open lesions (burns) • Shifting of body fluids • Massive edema • Ascites • Burns • Small bowel obstruction • Lengthy hydrotherapy
True hyponatremia
SIGNS AND SYMPTOMS • Headache* • Irritability • Muscle weakness, muscle twitching, tremors • Fatigue· • Apathy • Postural hypotension· • Nausea and vomiting • Abdominal cramps • Apprehension
True hyponatremia
Severe or Prolonged Deficit
• Shock
• Altered level of consciousness {lethargy, confusion)
• Seizures
• Coma
• Altered level of consciousness usually accompanies a serum sodium level less than 125 mEq/L and indicates that the patient’s condition is deteriorating
True hyponatremia
NURSING INTERVENTIONS
- Monitor 1&0 of patients receiving diuretic medications
- Monitor and record vital signs, especially blood pressure and pulse
- Monitor neurologic status frequently; report any change in level of consciousness
- Weigh patient daily
- Monitor skin turgor at least every 8 hours
- Restrict fluid intake as ordered, because this is primary treatment for dilutional hyponatremia; post a sign about fluid restriction in the patient’s room
- Observe for abnormal Gl, renal, or skin losses
- Replace fluid loss with fluids containing sodium, not plain water
True hyponatremia
Hypernatremia
,
Hypernatremia is a greater-than-normal concentration -of sodium. The sodium level exceeds 145 mEq/ L. It is caused by an excess of sodium or a decrease in body water. The body attempts to correct the imbalance by conserving water through renal reabsorption.
A)true
B)false
A
Hypernatremia causes fluid to shift from the cells to the interstitial spaces, resulting in cellular dehydration and an interruption in cellular processes. Again, a potassium imbalance frequently occurs. In sodium retention, potassium is excreted.
A)true
B)false
A
Hypernatremia: Causes, Signs and Symptoms, and Nursing Interventions
,
CAUSES • More water than sodium is lost from the body • Abnormally large intake of sodium -Taking too many salt tablets -Overuse of table salt -IV saline infused too rapidly -Prepared foods: frozen, canned, smoked -Dairy products in large amounts -Consumption of antacids containing sodium
True hypernatremia
SIGNS AND SYMPTOMS • Dry, tenacious mucous membranes • Low urinary output • Firm, rubbery tissue turgor • Restlessness, agitation, confusion, flushed skin
True hypernatermia
Severe or Prolonged Excess
• Manic excitement
• Tachycardia
• Death
True hypernatermia
NURSING INTERVENTIONS
• Monitor and record vital signs, especially blood pressure and pulse
• Provide a safe environment for confused or agitated patient
• Monitor 1&0
• Weigh daily to check for body fluid loss
• Decrease sodium intake in diet
• Monitor water loss from fever, infection, increased respiratory rate
• Monitor serum sodium level
True
Hypernatermia
Potassium (cation)
,
The routes of potassium excretion are the kidneys (80% to 90%) and in the feces and perspiration (10% to 20%).
A)true
B)false .
A
The kidneys control the excretion of potassium
A)true
B)false
A
Sodium and potassium seem to pair off against each other, and the kidneys prefer to conserve sodium, even when both electrolytes are depleted. In both normal and abnormal situations, sodium will be reabsorbed and potassium will be excreted
A)true
B)false
A
Because the major route of excretion of potassium is the kidneys, any condition that causes a decrease in urine output also causes potassium retention.
A)true
B)false
A
Serum potassium levels increase in kidney failure. A rise in potassium necessitates continuous monitoring. An important consideration in homeostasis is that kidney function will determine the potassium level in the body.
A)true
B)false
A
Too little or too much potassium affects the heart muscle and has potential to result in a life-threatening -disturbance in cardiac rhythm (dysrhythmia).
A)true
B)false
A
The main function of potassium is regulation of water and electrolyte content within the cell. With sodium and calcium, it promotes transmission of nerve impulses and also skeletal muscle hmction.
A)true
B) false
A
Potassium assists in the cellular metabolism of carbohydrates and proteins.
A)true
B)false
A
Another function of potassium is to control the hydrogen ion concentration. When potassium moves out of the cell, sodium and hydrogen ions move in. The result is the regulation of acid-base balance.
A)true
B)false
A
Hypokalemia
,
A decrease in the body’s potassium to a level less than 3.5 mEq/L is known as hypokalemia. Because the normal range for a serum potassium level is narrow (3.5 to 5 mEq/ L), a slight decrease has profound consequences.
A)true
B)false
A
The major cause of potassium Loss is renal excretion.
A)true
B)false
A
The kidneys do not conserve potassium and excrete it even when the body needs the potassium.
A)true
B)false
A
Intestinal fluids contain large amounts of potassium.
A)true
B)false
A
In excessive GI losses from gastric suctioning or prolonged vomiting, potassium tends to become depleted.
A)true
B)false
A
Severe diarrhea, fistulas, ileostomy, villous adenoma (tumor of the intestine that produces potassium-containing mucus), and excessive diaphoresis will also sometimes result in potassium loss.
A)true
B)false
A
The use of diuretics, such as thiazides or furosemide (Lasix), promotes hypokalemia
A)true
B)false
A
Conditions that cause injury to the cells in turn cause the release of potasium from the cells to the interstitial spaces and ultimately to the kidneys.
A)true
B)false
A
If renal function is normal, the potassium will be excreted. Because the normal amounts of potassium are so small, fluctuations have the potential to develop into serious problems.
A)true
B)false
A
Hypokalemia has the capacity to affect skeletal and cardiac function. The resulting muscle weakness causes lifethreatening cardiac conduction abnormalities.
A)true
B)false
A
Foods Rich in Potassium
,
FRUITS (INCLUDING JUICES) • Apricots • Bananas • Grapefruit • Melon • Cantaloupe • Honeydew • Dried fruits, figs, dates, raisins • Oranges
Potassium
PROTEIN FOODS • Beef • Chicken • Liver • Pork • Veal • Turkey • Milk • Nuts, peanut butter
Potassium
VEGETABLES • Asparagus • Dried beans • Broccoli • Cabbage • Carrots • Celery • Mushrooms • Dried peas • Potatoes (especially skins): white, sweet • Spinach • Squash • Tomatoes
Potassium
BEVERAGES
• Cocoa
• Cola drinks
• Instant tea and coffee
Potassium
Hypokalemia: Causes, Signs and Symptoms, and Nursing Interventions
,
CAUSES
• Decreased potassium intake
• Increased potassium loss
- Increased aldosterone activity
-GI losses (vomiting, diarrhea, Gl suctioning)
-Ileostomy
-Potassium
-losing diuretics
-Loss from cells, as in trauma, burns, fistulas
- Skin losses, diaphoresis
• Conditions causing very large urine output
• Potassium shift into cells
-Treatment of acidosis -Metabolic alkalosis
- Villous adenoma (tumor of the intestine that produces potassium-containing mucus)
True hypokalemia
SIGNS AND SYMPTOMS
• Skeletal muscle weakness (especially in lower extremities), leg cramps*
• Paresthesias, hyporeflexia
• Decreased bowel sounds, cramps, and constipation, anorexia, nausea, vomiting•
• Diminished deep tendon reflexes, lethargy, confusion; paralysis involving the respiratory muscles; coma
• Orthostatic hypotension
• Cardiac dysrhythmias; weak, irregular pulse
• ECG changes
• Polyuria
True hypokalemia
Severe or Prolonged Deficit • Flaccid paralysis • Kidney damage • Paralytic ileus • Cardiac or respiratory arrest
True
Hypokalemia
NURSING INTERVENTIONS
• Carefully assess patients taking digitalis glycosides, especially if also taking a diuretic, for hypoglycemia, which has capacity to potentiate the action of the digitalis glycoside medication and cause toxicity
• Administer potassium chloride (KCI) supplement as prescribed by the physician (oral or IV)
• Whether through a peripheral or central catheter, it is necessary to administer IV potassium with care to prevent serious complications
• IV potassium is always diluted and delivered using an infusion controller
• Encourage increased intake of foods high in potassium
• Monitor bowel sounds
• Monitor serum potassium level
• Monitor 1&0 (about 40 mEq of potassium is lost in each liter of urine; diuresis has potential to put the patient at a risk for potassium loss)
• During treatment with potassium, it is necessary for the patient’s urinary output to be at least 600 mL/day. If urinary output is less than 20 mL/hr for 2 consecutive hours, interrupt the infusion and immediately notify the physician. If renal function is impaired, there is a significant risk of hyperkalemia.
• Monitor telemetry
True hypokalemia
Hyperkalemia
,
An increase in the body’s serum potassium level greater than 5 mEq/ L is known as hyperkalemia. Because the normal range for a serum potassium level is narrow (3.5 to 5 mEg/ L), a slight increase poses the risk of serious consequences.
A)true
B)false
A
Potassium is gained through intake and lost by excretion. This condition is not as common as hypokalemia as long as renal function is normal. The major cause of potassium excess is renal disease, in which potassium is not excreted adequately.
A)true
B)false
A
When severe tissue damage occurs, potassium is released from the cells. Shock often accompanies this damage, resulting in reduced kidney output. The result is an elevated potassium level.
A)true
B)false
A hyperkalemia
Excessive intake of foods high in potassium, espeecially with decreased urine output, may cause an increased serum potassium level.
A)true
B)false
A
Other causes of hyperrkalemia include
(1) excessive use of salt substitutes (most of which use potassium as a substitute for sodium);
(2) potassium supplements (oral or IV);
(3) infusion of a large volume of blood nearing its expiration date (serum concentration increases the longer donated blood is stored);
(4) drugs such as beta blockers, which inhibit potassium shifts into cells;
(5) potassium-sparing diuretics such as spironolactone;
(6) chemotherapy, which causes cell death or lysis with release of high levels of intracellular potassium into the blood;
(7) angiotensin converting enzyme inhibitors;
(8) nonsteroidal antiinflammatory drugs;
(9) aminoglycosides.
True
Although hyperkalemia is less common than hypokalemia, it is often more dangerous because of cardiac arrest, which is caused by overstimulation of the carrdiac muscle. A serum potassium level of 7 mEq/ L or greater risks serious cardiac dysrhythmias.
A)true
B)false
A
Hyperkalemia: Causes, Signs and Symptoms, and Nursing Interventions
,
CAUSES
NoTE: Hyperkalemia may be the most dangerous of the electrolyte disorders.
- Potassium intake (parenteral or oral) in excess of kidney’s ability to excrete
- Excessive use of salt substitutes
- Renal failure
- Adrenal insufficiency
- Potassium enters the bloodstream from injured cells with extensive trauma (shift of potassium out of the cells into extracellular fluid)
- Metabolic acidosis
- Infusion of large volume of blood nearing expiration date
- Beta blockers
- Potassium-sparing diuretics
- Tumor lysis syndrome after chemotherapy
- Angiotensin-converting enzyme inhibitors
- Nonsteroidal antiinflammatory drugs
- Aminoglycosides
True hyperkalemia
SIGNS AND SYMPTOMS* • Signs and symptoms are often nonspecific; serum potassium level and electrocardiogram (ECG) tracings are often the best clinical indicators • Irritability • Nausea, vomiting • Diarrhea, colic • Cardiac dysrhythmias • ECG changes • Irregular pulse rate • Hypotension • Numbness, tingling
True hyperkalemia
Severe or Prolonged Excess
• Flaccid paralysis
• Cardiac arrestt (serious dysrhythmias become especially dangerous when the serum potassium level reaches 7 mEq/L or more [normal serum potassium level ranges from 3.5 to 5 mEq/L])
• Anuria
True hyperkalemia
NURSING INTERVENTIONS
• Decrease intake of foods high in potassium
• Administer Kayexalate (sodium polystyrene sulfonate) as prescribed by the physician (Kayexalate is possible to give orally, through a nasogastric tube, or as a retention enema); keep in mind when giving Kayexalate that serum sodium level will sometimes rise-watch for congestive heart failure
• Loop diuretics
• Decrease or stop medications associated with high potassium level
• Monitor underlying disorders leading to high potassium level
• Assess vital signs
• Monitor telemetry to detect dysrhythmias
• Monitor 1&0 (report an output of less than 30 ml/hr; an inability to excrete potassium in the urine will potentially lead to dangerously high potassium level)
• Hemodialysis in acute symptomatic hyperkalemia
• Monitor bowel sounds and number and character of bowel movements
• Monitor serum potassium level
True hyperkalemia
Chloride (anion)
,
The normal blood level of chloride (CI-), an extracellular anion, is 96 to 105 mEg/L. It is the chief anion in interstitial and intravascular fluid. Even though chloride accounts for more than two thirds of the anions in the body, it is usually not considered alone.
A)true
B)false
A
Chloride has the ability to diffuse quickly between the intracellular and extracellular compartments and combines easily with sodium to form sodium chloride or with potassium to form potassium chloride. It is more often linked with sodium.
A)true
B)false
A
The daily requirement of chloride is equal to that of sodium (3.65 to 10.85 g/ day). Foods containing sodium also contain chloride. The main route of excretion is through the kidneys.
A)true
B)false
A
Chloride is necessary for the formation of hydrochloric acid in gastric juice. It is also a valuable electrolyte in regulating the osmotic pressure between the compartments and assisting in the regulation of acid-base balance.
A)true
B)false
A
Hypochloremia
,
Hypochloremia usually occurs when sodium is lost, because sodium and chloride are frequently paired.
A)true
B)false
A
The most common causes of hypochloremia are vomitting and prolonged nasogastric or fistula drainage.
A)true
B)false
A
Hyperchloremia
,
Hyperchloremia rarely occurs but is possible when biicarbonate levels fall. The increase in chloride anions represents all attempt to compensate and maintain equal numbers with the cations in the body fluid. Because chloride imbalances rarely occur independently of other electrolytes, there are no specific signs and symptoms to identify a chloride imbalance.
A)true
B)false
A
Calcium (cation)
,
The normal blood level of calcium (Ca++), a positively charged ion, is approximately 4.5 mEq/ L. Of the 1200 g of calcium in the body, 99% is concentrated in the bones and the teeth, where it is physiologically inactive. The remaining 1% is found in the soft tissue and the extracellular fluid.
A)true
B)false
A
Calcium is deposited in the bones and mobilized as needed to keep the blood level constant during any period of insufficient intake.
A)true
B)false
A
Three considerations are important in the blood calcium level:
- Deposition and resorption of bone
- Absorption of calcium from the GI tract
- Excretion of calcium in urine and feces
True
Vitamin D, calcitonin, and parathyroid hormone (parathormone) are necessary for the absorption and utilization of calcium.
A)true
B)false
A
The best food sources of calcium are milk and cheese. Other sources include beans, nuts, cauliflower, lettuce, and egg yolks.
A)true
B)false
A
The average daily intake for calcium is 200 to 2500 mg.
a)TURE
B)false
A
CALCIUM
The dietary reference intakes (DRis) vary from -360 mg for infants
-1200 mg for females 15 to 18 years of age.
-During pregnancy and lactation, 1300 mg is required.
True
Prevention of osteoporosis focuses on adequate calcium intake (1000 mg/ day in premenopausal women and postmenopausal women taking estrogen and 1500 mg/day in postmenopausal women who are not receiving supplemental estrogen).
A)true
B)false
A
Calcium is removed from the body via the urine and feces.
A)true
B)false
A
Calcium is required for the formation and maintenance of strong bones and teeth. It is also necessary for normal blood clotting.
A)true
B)false
A
Calcium has a depressing or sedative effect on neuromuscular irritability and thus promotes normal transmission of nerve impulses; it also helps regulate normal muscle contraction and relaxation. It helps bold body cells together by establishing the thickness and strength of cell membranes.
A)true
B) false
A
One of its most important functions of calcium is to act as an enzyme activator for chemical reactions in the body.
A)true
B)false
A
Hypocalcemia
,
Hypocalcemia develops when the serum level is less than 4.5 mEq/L. Possible deficiencies arise from a variety of problems:
• Infusion of excess amounts of citrated blood (cittrates bind to the calcium)
• Excessive loss through diarrhea
• Inadequate dietary intake of calcium or vitamin D
• Surgical removal of parathyroid glands
• Decreased parathyroid function
• Pancreatic disease
• Small bowel disease
True
The signs and symptoms of hypocalcemia are neuromuscular irritation and increased excitability. As neuromuscular signs and symptoms increase, tetany is possible.
A)true
B)false
A
Tetany is a condition characterized by excessive muscle cramps, laryngeal spasms, stridor, carpal spasms (Trousseau’s sign), pedal spasms, and contraction of facial muscles
A)true
B)false
A
Tests for hypocalcemia.
A, Chvostek’s sign is a contraction of facial muscles in response to a light tap over the facial nerve in front of the ear.
B, Trousseau’s sign is a carpal spasm induced by C, inflating a blood pressure cuff above the systolic pressure for a few minutes.
True
Hypocalcemia: Causes, Signs and Symptoms, and Nursing Interventions
,
CAUSES
• Excess binding of calcium ions
• Large amount of citrated blood
• Excess alcohol
• Alkalosis
• Dietary deficiency of calcium and vitamin D
• Chronic renal failure
• Pancreatic disease
• Disease of small bowel; malabsorption
• Severe diarrhea
• Anticonvulsants, such as phenobarbital and phenytoin (Dilantin)
• Diuretics (Lasix, Edecrin)
• Draining intestinal fistulas
• Deficiency of parathyroid hormone or vitamin D
• Increased magnesium
• Thyroid surgery (surgical removal of parathyroid glands, removal of parathyroid tumor)
• Injury or disease of parathyroid gland
• Severe burns
• Low serum albumin levels
True hypocalcemia
SIGNS AND SYMPTOMS • Anxiety, confusion, irritability • Osteoporosis, pathologic fractures • Tingling around nose, mouth, ears, fingers, toes* • Twitching • Muscle spasm of feet and hands* • Tetany (note positive Trousseau's or Chvostek's sign) • Laryngeal spasms • Nausea, vomiting* • Hyperactive deep tendon reflexes • Diarrhea• • Cardiac dysrhythmias, cardiac arrest • Calcium deposits in body tissues • Diminished response to digitalis glycosides
True hypocalemia
NURSING INTERVENTIONS
• Monitor vital signs; monitor respiratory status, including rate, depth, and rhythm; be alert for stridor, dyspnea, or crowing (laryngeal spasms)
• Monitor pertinent laboratory values including calcium, albumin, and magnesium
• Encourage intake of a diet high in calcium-rich foods, vitaminD, and protein
• Administer calcium and vitamin D as prescribed by the physician
• Monitor treatment of underlying causes
• Acute hypocalcemia necessitates either IV calcium gluconate or calcium chloride
• For acute hypocalcemia, keep a tracheotomy tray and resuscitation bag at bedside in case of laryngeal spasms
• Monitor telemetry
• Monitor serum calcium, albumin, and magnesium levels
• Monitor 1&0
True hypocalemia
Hypercalcemia
,
Hypercalcemia occurs when calcimn levels exceed 5.8 mEq/L. It may occur when calcium stored in the bone enters the circulation, for example, in patients who are immobilized.
A)true
B)false
A
An increased intake of calcium or vitamin D also causes hypercalcemia.
A)true
B)false
A
Hypercalcemia: Causes, Signs and Symptoms, and Nursing Interventions
,
CAUSES • Loss from bone • Immobilization • Metastatic bone cancer • Multiple myeloma • Excess intake • Dietary • Antacids containing calcium • Increased absorption • Increased parathyroid hormone • Increased vitamin D
True hypercalemia
SIGNS AND SYMPTOMS • Anorexia, nausea, vomiting • Behavioral changes, including confusion • Thirst, polyuria* • Renal calculi • Decreased deep tendon reflexes • Constipation • Paralytic ileus • Lethargy, coma • Cardiac dysrhythmias, cardiac arrest • Hypertension • Decreased muscle tone* • Decreased Gl motility • Bone pain
True hypercalemia
NURSING INTERVENTIONS
• Assist in the promotion of excretion of calcium in the urine
• Administer diuretics as ordered by the physician
• Encourage drinking 3000 to 4000 L of fluids per day
• Monitor 1&0
• Be aware that in life-threatening hypercalcemia, measures to increase calcium secretion will sometimes include hemodialysis or peritoneal dialysis
True hypercalemia
Phosphorus (anions)
,
The normal blood level of phosphorus, chiefly present as hydrogen phosphate (HP04 -), an intracellular anion, -is approximately 4 mEq/ L.
A)true
B)false
A
Phosphorus and calcium have an inverse relationship in the body: An increase in one causes a decrease in the other. As blood calcium levels increase, a decrease in phosphorus levels is necessary, and vice versa.
A)true
B)false
A
The majority (70% to 80%) of phosphorus is found combined with calcium in an individual's bones and teeth, 10% is in an individual's muscle, and the remaining 10% is in the nerve tissue of the body. A)true B)false
A
Dietary intake of phosphorus is usually 800 to 1500 mg/ day.
A)true
B)false
A
The minimum daily requirement of phosphorus is 800 mg.
A)true
B)false
A
Higher intake of phosphors during pregnancy and lactation is needed. An adequate intake of vitamin D is necessary for the absorption of both calcium and phosphorus.
A)true
B)false
A
Because a generous amount of phosphorus is present in many foods, a deficiency seldom(rarely) occurs. Foods especially high in phosphorus include beef, pork, fish, poultry, milk products, and legumes.
A)true
B)false
A
The kidneys are responsible for approximately 90% of the excretion of phosphorus. The remainder is excreted in the feces.
A)true
B)false
A
With calcium, phosphorus contributes to the support and maintenance of bones and teeth.
A)true
B)false
A
Phosphors important in many chemical reactions and acts as a buffer to regulate the body’s acid-base balance. It promotes the -effectiveness of many of the B vitamins, assists in norrmal nerve and muscle activity, and participates in carbohydrate metabolism.
A)true
B)false
A
Hypophosphatemia
,
Hypophosphatemia is possible as a result of a dietary insufficiency, impaired kidney function, or maldistribution of phosphate. Muscle weakness, especially affecting the respiratory muscles, sometimes occurs.
A)true
B)false
A
Hyperphosphatemia
,
Hyperphosphatemia most commonly occurs as a result of renal insufficiency. Another cause is increased intake of phosphate or vitamin D. Signs and symptoms of tetany, numbness and tingling around the mouth, and muscle spasms develop
A)true
B)false
A
Magnesium (cation)
,
The normal blood level of magnesium (Mg++), the second most abundant cation in the intracellular fluid, is 1.5 to 2.4 mEq/ L. Although only small amounts of magnesium are in the blood, it is important in maintaining normal body function.
A)true
B)false
A
The majority of Magnesium (60%) is found in the bone, 39% in the muscle and the soft tissue, and 1% in the extracellular fluid, most of which is in the cerebrospinal fluid.
A)true
B)false
A
Magnesium Dietary intake is usually 200 to 400 mg daily.
A)true
B)false
A
The minimum magnesium daily requirement is 250 mg for the average adult, 150 mg for an infant, and 400 mg for a female during pregnancy and lactation.
A)true
B)false
A
Magnesium is annother electrolyte commonly distributed in foods. Whole grains, fruits, vegetables, meat, fish, legumes, and dairy products are dietary sources.
A)true
B)false
A
The major route of magnesium excretion is the kidneys. There is a correlation between the amount of magnesium and the amount of potassium excreted. The kidneys do not conserve potassium, but they do conserve magnesium; therefore if a magnesium deficiency develops, the body will conserve magnesium at the expense of excreting potassium.
A)true
B)false
A
Magnesium is now linked as a cofactor in the activation of many enzymes. It also promotes regulation of serum calcium, phosphate, and potassium levels and is essential for integrity of nervous tissue, skeletal muscle, and cardiac functioning
A)true
B)false
A
