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HEHI Fall 2020 > Week 4 - ELectrolytes > Flashcards

Week 4 - ELectrolytes Flashcards

1
Q

What are some of the functions of electrolytes?

A
  1. water balance
  2. cellular growth and metabolism
  3. maintaining acid-base balance
  4. blood clotting
  5. cellular depolarization and repolarization
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2
Q

Range for Na+

A

135 - 145

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3
Q

What can happen in the body when there are changes in sodium?

A

Neurological issues (including seizures)

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4
Q

Why can Neurological issues (including seizures) happen when there are changes in sodium in the body?

A

Altered tonicity causing swelling of brain cells (hyponatremia) and shrinking of brain cells (hypernatremia)

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5
Q

Potassium normal range

A

3.5 - 5.0

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6
Q

What are changes in Na+ concentrations indicative of?

A

Generally - the body’s underlying fluid status rather than changes in the amount of Na+

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7
Q

Why is potassium important?

A

cell repolarization, especially cardiac repolarization

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8
Q

How do we recognize hyperkalemia?

A

tall peaked t-waves eventually progressing into cardiac arrest due to the inability to properly repolarize

FATAL

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9
Q

What happens with hypokalemia?

A

Heart becomes more irritable and prone to dysrhythmias (remember: lethal injections are a sedative + concentrated potassium).

This will initially manifest as Premature Ventricular Contractions. You may also see muscle cramps.

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10
Q

Magnesium normal range

A

1.7 - 2.2

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11
Q

Why is magnesium important?

A

It is usefl in inhibiting labor.

necessary to promote potassium absorption in the kidneys

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12
Q

What do elevated potassium levels do?

A

Stabilize cell membranes, making depolarization less likely

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13
Q

How do elevated magnesium levels present?

A

decreased or absent deep tendon reflexes

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14
Q

How do low levels of magnesium present?

A

hyperactive reflexes and muscle spasms

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15
Q

Ca++ normal range

A

8.5 - 10.5

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16
Q

What important functions does Ca++ support?

A

cardiac conduction
blood clotting
bone health

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17
Q

How does hypocalcemia present?

A

muscle irritability, specifically Trousseau’s and Chvostek’s sign

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18
Q

What are complications with hypocalcemia?

A

Increases risk of osteoporosis

Risk of bleeding due to impaired blood clotting

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19
Q

What are complications with hypercalcemia?

A

initially causes increaesd HR and BP

Prolonged hypercalcemia will cause cardiac arrest and increased risk of kdiney stones

risk of blood clots

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20
Q

Phosphate normal range

A

3.5 - 5.0

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21
Q

What is phosphate’s relationship with Ca+=?

A

Phosphate exists in the inverse proportion to Ca++

Hypophosphatemia will present like hypercalcemia

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22
Q

Why is phosphate important?

A

for ATP production, which is particularly affects the respiratory muscle function

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23
Q

What can CKD cause?

A

hyperkalemia, hypermagnesemia, hyperphosphatemia (and therefore hypocalcemia)

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24
Q

What do we do if potassium levels are high?

A

administer insulin to put the potassium IN cells

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25
Q

What does hyponatremia do?

A

brain cells expand b/c they are hypertonic –> cerebral edema

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26
Q

What does hypernatremia do?

A

brain cells shrink b/c the water in the cells will go towards the higher concentration of solutes (cells are hypotonic so water leaves them)

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27
Q

signs of hyper or hyponatremia?

A

altered mental status

Confusion
Headache
Lethargy (hyponatremia) / irritability (hypernatremia)
Coma
Seizures

Body more likely to handle chronic rather than acute hypo/hypernatremia

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28
Q

Treatment of hypernatremia

A

Replacement of fluid with hypotonic fluid (half NS)

NS (.9%) has 154 mEq, so it will cause hypernatremia

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29
Q

Causes of hypernatremia

A
  1. relative hypernatremia (more common)
    - dehydration
    - diabetes insipidus
  2. absolute hypernatremia: excessive sodium intake or disorders of sodium reabsorption
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30
Q

Signs and symptoms of hypernatremia

A

S&S of dehydration

Thirst, since osmoreceptors drive the thirst response

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31
Q

Causes of hyponatremia

A
  1. Intake of free water
    - overhydration with hypotonic IVF
    - psychogenic polydispisa
  2. fluid overload
    - CHF, renal failure
    - SIADH
  3. loss of salt due to diuretic use
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32
Q

Signs and symptoms of hypernatremia

A 
Neuro symptoms (swelling of brain cells)
S/sx of fluid overload (bounding pulses, elevated BP, etc.)
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33
Q

What is a risk of treatment of hyponatremia?

A

Overlay rapid correction of hyponatremia will cause central pontine demyelination (can cause paralysis, dysphagia, AMS that is often permanent)

Should only correct by 10 mEq/24h

Overly rapid correction fo hypernatremia can cause a rebound cerebral edema

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34
Q

Who regulates potassium?

A

kidneys

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35
Q

What are causes of hyperkalemia?

A

CKD

Dietary: Intake of salt substitutes

Acidosis

Cell Lysis

  • crush injury
  • old RBCs

Pharm: antagonizing aldosterone (aldosterone increases Na+ retention and decreases K+ retention)

  • Aldactone (direct aldosterone antagonist)
  • ACE Inhibitors
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36
Q

S/sx of hyperkalemia?

A

TALL PEAKED T WAVES

Cardiac arrest (late sign)
Paresthesias (benign and nonspecific sign)
37
Q

Why do we use calcium gluconate as a treatment for hyperkalemia?

A

to stabilize cardiac cell membranes

38
Q

Why do we administer IV insulin to treat hyperkalemia?

A

to drive potassium into the cells

39
Q

What are some other treatments for hyperkalemia?

A

administer furosemide - we’re using a drug’s “side effect” as a therapeutic effect in this case!
- Of course, now the fluid loss becomes a side effect that we must monitor!!

Administer potassium binders (kayexalate) – but this takes time and causes diarrhea

Albuterol

Correct any underlying acidosis

Dialysis

40
Q

What leads to psudohyperkalemia?

A

Lysis of cells due to the trauma of the blood draw can cause a falsely elevated potassium

If you see a drastically elevated potassium in a patient who is asymptomatic and has no reason to be hyperkalemic, recheck

The lab will usually indicate “hemolysis” or “gross hemolysis” if they see lots of lysed RBCs

41
Q

Nursing interventions for a pt with hyperkalemia?

A

Recorgnize s/sx (assess)
- EKG monitoring
- Frequent BMPs - q6h, q8h, q12h
Recognize implications/side effects of treatment

42
Q

RN teaches a student nurse regarding the management of increased potassium levels in a client. Which action performed by the student nurse indicates effecive learning?
A. Administering sodium polystyrene sulfonate
B. Instructing a client to increase potassium and sodium intake
C. Monitoring glucose levels hourly
D. providing potassium sparing diuretics

A

A.

Hyperkalemia levels indicate hyperkalemia and are observed in clients with adrenal insufficiency. Administering potassium binding and excreting resin, such as sodium polystyrene sylforate, can reduce the potassium levels.

Potassium restriction should be initiated immediately to reduce the potassium levels.

Providing potassium-sparing diuretics may further lead to increase in potassium levels, and these diuretics should be avoided

43
Q

What lab tests indicate renal impairment?

A

Inreased serum creatinine concentration, BUN, and potassium ion concentration levels

Normal serum creatinine cont: .5 - 1.5 mg/dL)

A serum creatinine valure of 2.0 mg/dL indicates renal impairment.

Normal concentration fo potassium ions in serum 3.5 -5.0. A K+ ion conc of 5.9 indicates kidney dysfunction

Normal value of BUN lies between 7 and 20. A BUN value of 32 indicates renal impairment.

Normal range of albumin conc between 3.5 - 5.5

44
Q

What is oliguria a sign of?

A

Withholding IV potassium

Potassium chloride should not be given unless renal flow is adequate; otherwise, potassium chloride will accumulate in the body, causing hyperkalemia.

45
Q

What are paresthesis and tetany signs of?

A

Hypocalcemia

46
Q

What are muscle weakness and cardiac dysrhythmias a sign of?

A

potassium depletion in the skeletal and cardiac muscles:

the sodium-potassium pump facilitates conduction fo nerve impulses and muscle activity.

47
Q

What can numbness around the mouth be a sign of?

A

Hypocalcemia

48
Q

why do we use NS for hypovolemia?

A

B/c we don’t want to add more Na+ to a hypertonic environment

49
Q

How does ADH influence sodium concentration?

A

By changing the amount of water in the body

50
Q

What is Aldosterone’s role in sodium management?

A

Aldosterone is responsible for managing sodium levels (and decreasing potassium levels)

too much can cause you to lose K+ and retain Na+

51
Q

How are relative and absolute hyp*natremia different?

A

Relative hyp*natremia - the amount of water in body has changed. Na+ level is the same, but concentration has changed.

vs.

Absolute hyp*natremia - water levels are the same, but the Na+ level has changed.

52
Q

How do we treat relative hyp*natremia?

A

hydration or treatment of underlying cause of hyp*natremia

53
Q

How do we treat absolute hyp*natremia?

A

We add or subtract salt from the diet/IV fluids or eliminate any drugs that cause salt loss.

54
Q

How do we treat absolute hyp*natremia?

A

We add or subtract salt from the diet/IV fluids or eliminate any drugs that cause salt loss.

55
Q

What are some causes of hypernatremia?

A
  1. dehydration (relative hypernatremia)
  2. diabetes insipidus (the body does not produce enough ADH –> overproduction of very dilute urine)
  3. Hyperaldosteronism - in cases of heart failure, baroreceptors detect low CO and assume prob is dehydration –> activation of RAAS and body holds on to salt.
56
Q

S/sx of hypernatremia

A
  1. neurological changes (due to shrinking brain cells), especially restless, confusion, irritability + increased muscle spasticity and DTRs
  2. Seizures - big risk
  3. if loss of fluid has caused relative hypernatremia, then you would expect to see signs of fluid loss (thirst, dry mouth, skin tenting, hypotension)
57
Q

Treatment of hypernatremia

A

Fluid replacement (ideally with IV fluids that are hypotonic - you don’t want to add more salt to the problem)

Treat underlying condition causing dehydration

58
Q

Causes of hyponatremia

A

Intake of free water

  • overhydration with hypotonic IVF
  • psychogenic polydipsia

Fluid overload

  • CHF renal failure
  • SIADH (syndrome of inappropriate antidiuretic hormone)

salt losses (hard to lose salt form the body w/out losing fluid as well; but some conditions like burns or certain meds/diuretics can cause this)

Inadequate salt intake

59
Q

S/sx of Hyponatremia

A

Neurologic symptoms (typically headaches and confusion) this time due to neuronal swelling) again, seizures are a big risk)

60
Q

Treatment of hyponatremia

A

Asymptomatic: fluid restrictions, salt tabs, diuresis

symptomatic: hypertonic IV fluids solutions (3% saline)

often, b/c hyponatremia due to hemodilation, don’t want to give fluids b/c –> fluid overload

61
Q

Causes of hyperkalemia

A

Kidney disease (acute or chronic)

cellular destruction (lysis of cells)

  • pseudohyperkalemia (lysis or RBCs during collection of blood
  • old blood transfusion

Acidosis (cells trade K+ ions for H+, leading to lots of K+ in the blood, even though total body K+ hasn’t changed)

Dietary

Pseudohyperkalemia

62
Q

S/sx of hyperkalemia

A

tall peaked t waves

63
Q

treatment for hyperkalemia

A

place pt on cardiac monitor

calcium gluconate to stabilize cardiac cell membranes and prevent cardiac sequelae

kayexalate

insulin with “push” K= into the cells (but you must give dextrose with it or your pt’s blood sugar will drop)

B2 agonists like albuterol will also push K+ into cells

dialysis

64
Q

Causes of hypokalemia

A

Removal of GI contents

  • Vomiting
  • NG suction

Diuretic therapy - especially loop diuretics like furosemide

hyperaldosteronism

inadequate magnesium (magnesium is required for kidney to uptake potassium)

65
Q

S/sx of hypokalemia

A

muscle cramps and spasms

irritable heart muscle - premature ventricular contractions and other dysrhythmias

66
Q

Treatment of hypokalemia

A

Replacement - consider replacing magnesium too

  • IV vs. PO replacement
  • PO risks: GI upset
  • IV risk:
    • Cardiac arrhythmias (lethal injection). Never give quicker than 20 mEq/hr
    • phlebitis/burning - slow down rate, use central line

aldosterone-antagonist medications (aka ‘potassium sparing diuretics’ like spironolactone) - retain K+

Dietary supplementation

67
Q

Why is calcium important?

A

plays an important role in cardiac conduction, bone health, and clotting

in the sarcoplasmic reticulum in cardiac myocytes

68
Q

What regulates calcium levels?

A

Parathyroid Gland

Thyroid Gland

Vitamin D levels

Phosphate levels

69
Q

Causes of hypercalcemia

A

Parathyroid disorders (too much PTH)

Corticosteroids

Excessive oral intake

70
Q

S/sx of hypercalcemia

A

Even though calcium can generally be understood as a “cell membrane stabilizing” electrolyte, the influence of Ca++ on heart tissue means you will initially see tachycardia and hypertension due to calcium’s role in the sarcoplasmic reticulum

Prolonged hypercalcemia eventually “wears out” the heart –> bradycardia

Increased BP

Bounding pulses

Hypercoagulability

Kidney Stones

71
Q

Treatment of hypercalcemia

A

Ca++ binders

Monitor EKG

Loop diuretics

72
Q

Causes of hypocalcemia

A

Parathyroid disorders

Low calcium intake

High phosphate levels

Low Vitamin D

73
Q

S/sx of hypocalcemia

A

Trousseau’s and Chvostek’s Signs

Muscle spasms

Hypotension and non-specific EKG changes

74
Q

Treatment for hypocalcemia

A

Monitor for osteoporosis: DEXA scan; fall precautions if (+) osteoporosis

Give calcium

Give vitamin D

75
Q

Why is phosphorous important?

A

Needed for muscle function –> diaphragm

76
Q

Hyperphosphatemia

A

See hypocalcemia since this is where the problems tend to arise

77
Q

Hypophosphatemia

A

respiratory issues/muscle weakness

78
Q

what are patients on furosemide at risk for and why?

A

hypokalemia b/c furosemide is a loop diuretic and causes loss of K+

79
Q

What is Na+ responsible for?

A
  1. Maintaining fluid balance in the body

2. Maintaining electrical charge (as the primary cation in the ECF)

80
Q

What is Na+ regulated by?

A

Aldosterone (RAAS) (controls Na+)

ADH (controls amt of water in body)

81
Q

What type of hypernatremia is more common?

A

relative - dehydration

82
Q

beer potomania

A

gallons of beer a day

beer is hypotonic –> hyponatremia

not as at risk for seizures, but definitely still at risk

hypomagnesia

anemia (not adequate folic acid and B12)

fall risk

83
Q

How does central pontine demyelination happen and what are the risks?

A

Over treatment of hyponatremia

The risks or dysphagia, paralysis, and AMS - often permanent

84
Q

How do we avoid central pontine demyelination?

A

Don’t increase pt’s fluids quicker than 10mEq/24h

85
Q

What can giving fluids too quickly do to someone with hypernatremia?

A

Can cause cerebral edema

You should not give fluids to a hypernatremic pt faster that 12mEq/24h

86
Q

Why will you have hyperkalemia when you are acidotic?

A

Acidosis causes hyperkalemia

H+ and K+

cells will take on H+ to compensate for acidosis –> excess H+ in cell –> have to trade out K+ to maintain electric neutrality

relative hyperkalemia

87
Q

hyponatremia

A

swelling of the brain cells

88
Q

hypernatremia

A

shrinking of the brain cells

HEHI Fall 2020 (6 decks)

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