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Module 2 > Unit 5- ELECTROLYTES > Flashcards

Unit 5- ELECTROLYTES Flashcards

1
Q

Hydrostatic Pressure is the __1__ force that ___2___ fluid ___3___ of capillaries?

A
  1. Pushing
  2. Push
  3. Out
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2
Q

How is hydrostatic pressure created?

A
  1. By the pumping of the heart
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3
Q

Oncotic pressure is the __1__ force that ___2___ fluids __3__ tissues into capillaries?

A
  1. Pulling
  2. Pulls
  3. Into
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4
Q

Oncotic pressure is exerted by?

A
  1. non-diffusible plasma proteins…. albumin
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5
Q

How do the kidneys maintain balance in the body? (simple answer)

A
  1. Adjust urine volume & excrete electrolytes
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6
Q

How does the Anit-diuretic hormone (ADH) maintain balance in the body (simple answer)

A
  1. Vasopressin; controls water retention
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7
Q

How does the Renin-Angiotensin-Aldosterone system (RAAS) maintain balance in the body? (simple answer)

A
  1. Release of Renin
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8
Q

How does Aldosterone maintain balance in the body (simple answer)?

A
  1. Water regulator
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9
Q

How does Atrial Natriuretic peptide (ANP) maintain balance in the body? (simple answer)

A
  1. Reduces fluid volume.
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10
Q

What are the 7 functions of the kidneys (remeber a wet bed)

A

A- controlling ACID-base balance

W-Controlling WATER balance
E- Controlling ELECTROLYTE balance
T- Removing TOXINS and waste products from the body

B-Controlling BLOOD pressure
E- Producing the hormone ERYTHROPOIETIN
D- Activating VITAMIN D

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11
Q

What is ADH also referred to as?

A

Vasopressin

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12
Q

What is the function of ADH? (simple anwser)

A
  1. Controls water retention.
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13
Q

What is the function of ALDOSTERONE? (simple anwser)

A
  1. Water regulator- regulates Na+ and water
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14
Q

How does ALDOSTERONE regulate NA+ and water? (simple anwser)

A
  1. ALDOSTERONE causes kidneys to retain Na+ and water & excrete K+
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15
Q

Low ALDOSTERONE = ____ K+?

A
  1. HIGH
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16
Q

High ALDOSTERONE = ____ K+?

A

LOW

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17
Q

When is ALDOSTERONE released? (simple answer)

A
  1. Released if Na+ is low and K+ is high
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18
Q

ALDOSTERONE increases the reabsorption of __1___ and the excretion of __2__?

A
  1. Reabsorption of Na+
  2. Excretion of K+

REMEMBER: where salt goes, water flows

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19
Q

Where are ATRIAL NATRIURETIC PEPTIDES stored?

A
  1. Produced and stored in the Atria
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20
Q

What is the function of ANP? (simple anwser)

A
  1. Stops the action of RAAS
  2. Decreases blood pressure by vasodilation
  3. Reduces fluid volume by increasing secretion of Na+ and water
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21
Q

What does ANP do to our blood pressure?

A
  1. Decreases blood pressure by vasodilation
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22
Q

What does ANP do to our fluid volume and how?

A
  1. Reduces fluid volume by increasing secretion of Na+ and water
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23
Q

What do we need to know about hypovolemia (when compared to dehydration)?

A
  1. Extracellular fluid volume is reduced, results in decreased tissue perfusion
  2. It can be produced by salt and water loss (e.g., with V/D, diuretics or 3rd spacing)
  3. Salt and water loss comes from extracellular fluid.
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24
Q

What doe we need to know about dehydration (when compared to hypovolemia)?

A
  1. Water loss alone is termed as dehydration
  2. Pure water loss comes from total body water, only about 1/3 is of ECF.
  3. Always hypernatremic
  4. Treatment: free water administration.
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25
Q

True or false: Electrolytes are ions found in our body fluids?

A
  1. True
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26
Q

True or false: Electrolytes do not conduct electricity or energy?

A

False

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27
Q

True or false: Electrolytes control body fluids?

A

True

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28
Q

True or false: Electrolytes help maintain homeostasis?

A

True

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29
Q

True or false: Electrolytes cannot communicate cell to cell or nerve to nerve or organ to organ?

A

False- they can

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30
Q

In general what do we need to know about electrolytes?

A
  1. Ions found in our body
  2. Conduct electricity, energy
  3. Control body fluids
  4. Maintain homeostasis
  5. Communicate cell to cell, nerve to nerve, organ to organ
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31
Q

What do electrolytes separate into when dissolved in water?

A
  1. Ions (charged particles)
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32
Q

Cations have what kind of charge and what are some examples?

A
    • positive charge
  2. Na+, K+, Ca++, Mg+
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33
Q

Anions have what kind of charge and what are some examples?

A
  1. -charge
  2. Cl-, HCO3-, phosphate
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34
Q

What can deplete our electrolytes?

A
  1. Vomiting
  2. Urination
  3. Bowel movement
  4. Sweating

Think fluid- where fluid flows…. electrolytes go

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35
Q

What are our 6 famous electrolytes?

A
  1. Magnesium (Mg+)
  2. Phosphorus (-)
  3. Potassium (K+)
  4. Calcium (Ca+)
  5. Chloride (Cl+)
  6. Sodium (Na+)
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36
Q

Normal Magnesium (Mg+) level?

A

1.5-2.5 mg/dl

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37
Q

Normal Phosphorus level?

A

2.4-4.5mg/L

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38
Q

Normal Potassium (K+) level?

A

3.5-5.0 mEq/L

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39
Q

Normal Calcium (Ca+) level?

A

8.5-10.5 mg/dL

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40
Q

Normal Chloride (Cl-) level?

A

95-105 mEq/L

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41
Q

Normal sodium (Na+) level?

A

135-145 mEq/L

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42
Q

What foods are rich in Potassium (K+)?

A
  1. Fruits,
    2.green leafy vegetables,
    3.spinach,
    4.salt substitutes
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43
Q

What foods are rich in Sodium (Na+)?

A
  1. Table salt
  2. Cheese
  3. Spices
  4. Canned/processed foods
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44
Q

What foods are rich in Magnesium (Mg+)?

A
  1. Spinach
  2. Almonds
  3. Yogurt
  4. Green Veggies
  5. Dark chocolate = excellent source of Mg+
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45
Q

What foods are rich in calcium (Ca+)?

A
  1. Milk
  2. Cheese,
  3. Green veggies
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46
Q

What foods are rich in phosphorous (P-)?

A
  1. Dairy
  2. meats
  3. Beans
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47
Q

What foods are rich in Chloride (Cl-) ?

A
  1. Salty foods and salt substitutes,
  2. Canned foods
  3. Veggies such as tomatoes, lettuce, celery and olvies
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48
Q

Anytime we think about sodium (Na+) levels what should come to mind….

A

Think Brain
Neuro Checks
Safety

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49
Q

What is the function of Sodium Na+ (135-145 mEq/L)?– list 5

A
  1. Maintain blood pressure
  2. Blood volume
  3. pH balance (acid base)
  4. Controlling nerve impulses
  5. Stimulating muscle contractions
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50
Q

True or false: Sodium Na+ has a big impact on the body’s fluid balance

A

True

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51
Q

Sodium Na+ is a major electrolyte in which….
1. Extracellular fluid
or
2. Intracellular fluid?

A
  1. Extracellular fluid
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52
Q

True or false: Sodium Na+ helps control water balance?

A

True

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53
Q

What regulates Sodium Na+?

A
  1. ADH & ALDOSTERONE, Na+ k+ pump
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54
Q

What level is considered Hyponatremic?

A
  1. <135 mEq/L
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55
Q

What causes Hyponatremia?

A
  1. Dilution of Sodium
  2. SIADH-
    A. Impaired water excretion caused by inability to suppress secretion of ADH; water retention causes dilutional hyponatremia
  3. Water Retention-
    A. Retaining fluid & sodium causing hemodilution of Na+
  4. Psychogenic polydipsia-
    A. excessive fluid intake without physiologic stimuli
  5. Hypotonic fluids-
    A. shift solutes into the cells
  6. Inadequate sodium intake
    A. Fasting; NPO status
    B. Low Na+ diet
  7. Increased Na+ excretion
    A. 4D’s- Diarrhea, diuretics, drainage, diaphoresis
    B. Vomiting
    C. Kidney Disease
    D. Hypoaldosteronism (Addisons’s)- sodium loss and water retention.
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56
Q

What are the “three flavors of hyponatremia?

A
  1. Euvolemic
    A. Low Na+ with ECF volume normal
  2. Hypovolemic
    A. Na+ loss with ECF volume depletion
  3. Hypervolemic
    A. Na+ loss with increased ECF volume
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57
Q

What s/s will a patient experiencing SEVERE hyponatremia have?

A
  1. Seizures
  2. Brainstem herniation
  3. Respiratory arrest
  4. Death
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58
Q

What s/s will a patient experiencing MODERATE hyponatremia have?

A
  1. Lethargy
  2. Weakness
  3. Altered LOC
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59
Q

What s/s will a patient experiencing MILD hyponatremia have?

A
  1. Headache, N/V, Fatigue
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60
Q

What are some hyponatremia interventions? (mild-moderate)

A
  1. Replace sodium slowly
  2. Stop sodium wasting diuretics
  3. Provide IV fluids/medications
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61
Q

One intervention for hyponatremia is to replace sodium slowly. What else do we need to know about this intervention?

A
  1. Avoid fluid overload due to fluid shifting with sodium
    A. Can lead to neuro damage if given to QUICKLY
    B. 0.5 mEg/L per hour MAXIMUM
    C. 6-12 pts in 24-hour period
    D. Check Na+ levels every 2-4 hours
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62
Q

Stopping sodium wasting diuretics is a hyponatremia intervention. What else do we need to know about this intervention? (MAY NEED TO EDIT AFTER LECTURE)

A
  1. STOP Loop diuretics; Thiazides
  2. May need to switch to spironolactone
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63
Q

Providing IV fluids/Medications is an HYPOnatremia intervention. What else do we need to know about this intervention? (may need to change a little after lecture)

A
  1. Hypovolemic- 0.9% saline to correct fluid volume status & Na+
    A. 3% normal saline (hypertonic solution) used for extremely low Na+
    B. 3% normal saline is to be given though central line- highly caustic on veins
  2. Hypervolemic- Give osmotic diuretics and fluid restriction
    A. Mannitol- Excretes water but not Na+
  3. Euvolemia- SIADH
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64
Q

What are some interventions for SEVERE hyponatremia?

A
  1. Severe hyponatremia, less than 120 mEq/L- ADMINISTER 3% SALINE IV SLOWLY
    A. Not to increase by more than 6-12 mEq/L in first 24 hours
  2. Plan for CVAD (3% saline is highly CAUSTIC to veins)
  3. Insert indwelling catheter for strict I&O
  4. Perform neurologic checks every 2-4 hours and keep on bedrest
    A. Safety is key due to cerebral involvement
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65
Q

What happens if you overcorrect hyponatremia too quickly?

A
  1. Demyelination syndrome causing damage to nerve cells in the brain
  2. Locked in syndrome.
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66
Q

What happens to the sodium level during SIADH

A
  1. Decreases
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67
Q

What happens to water levels during SIADH?

A
  1. Increased water retention
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68
Q

True or false: With SIADH high levels of ADH retains water?

A

True

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69
Q

True or false: SIADH does not upset electrolytes?

A

False: Upsets electrolytes, especially sodium.

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70
Q

Trick to remember SIADH…. Take SI in SIADH and think what….

A
  1. Soaked inside… and stop urination
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71
Q

What are the causes of SIADH? (3- S’s)

A
  1. Small cell lung cancer
  2. Severe Brain Trauma
  3. Sepsis infections of brain
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72
Q

Where is ADH created?

A
  1. Pituitary gland
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73
Q

Adds DA H2o helps us remember what?

A

ADH and its funtion.

74
Q

Leaving blank to finish filling in slide 28 after lecture

A

3.

75
Q

Leaving blank to finish filling in slide 28 after lecture

A

2.

76
Q

Leaving blank to finish filling in slide 28 after lecture

A

1

77
Q

What is the treatment for SIADH?

A
  1. Fluid restriction - 800-100 mL/day
  2. Demeclocycline
    A. Blocks effect of ADH resulting in more dilute urine
  3. Diuretics
    A. medication/caffine
  4. Increase oral sodium intake
    A. Salt tablets, bacon, processed foods
  5. Daily weight & I&O
78
Q

What does SIADH stand for?

A

Syndrome of inappropriate Anti-Diuretic hormone.

79
Q

What are the causes of hypernatremia >145 mEq/L

A

Decreased sodium excretion
1. Corticosteroids
A. Cause kidneys to retain sodium
2. Cushing’s syndrome
A. Occurs due to prolonged exposure to glucocorticosteroids (prednisone) or a tumor producing excessive cortisol by adrenals.
B. Hyperaldosteronism- high sodium and water renention
3. Kidney disease
4. Increased Sodium intake
A. excessive oral sodium ingestion– too many processed food
B. Hypertonic solutions (3% NS or 5%NS)
C. Alka Seltzer, asprin
5. Decrease water intake
A. Fasting: NPO status
6. Increased water loss (hemoconcentration)
A. Dehydration- too much water loss and Na+ gain
B. Diabetes insipidus

80
Q

Severe hypernatremia is defined as a sodium level of ?

A

> 160

81
Q

What are some hypernatremia interventions?

A
  1. Bring sodium levels down slowly
  2. Provide IV fluids/medication
  3. Diuretics
  4. Avoid medications that cause hypernatremia
  5. Restrict sodium & fluid intake as prescribed
  6. Free water intake to help hemodilution
  7. Patient safety- Confused & agitated
  8. Weigh daily
  9. I & O
  10. Neurologic precautions– Neuro checks
82
Q

Bringing sodium levels down slowly is a hypernatremia intervention. What else do we need to know about this intervention?

A
  1. Rapid correction can lead to seizures due to rapid fluid shifts in the brain
83
Q

Providing IV fluids and medications is a hypernatremia intervention. What else do we need to know about this intervention? (May need to edit after lecture)

A
  1. Administer IV infusion in case of fluid losses
  2. Hypotonic solutions
  3. 1/2 NS, D5W
84
Q

Diuretics is a hypernatremia intervention. What else do we need to know about this intervention?

A
  1. If inadequate renal excretion of sodium, administer diuretics (thiazides, loop diuretics)
85
Q

How would a patient with MILD hypernatremia present?

A
  1. Faint feeling
  2. Muscle fatigue
  3. Weakness
86
Q

How would a patient with MODERATE hypernatremia present?
(May need to add to after lecture)

A
  1. Confusion, irritability
  2. Swollen and dry red tongue***
  3. Hyperreflexia
  4. Muscle twitching
  5. Edema
  6. Thirst***
87
Q

How would a patient with SEVERE hypernatremia present (may need to add to after lecture)

A
  1. N/V
  2. Increased muscle tone
  3. Seizures
  4. Coma
88
Q

Diabetes Insipidus = Hyponatremia or Hypernatremia?

A

Hypernatremia- ADH (vasopressin) deficiency

89
Q

A trick to remember Diabetes Insipidus is… Take the first letter of each word… DI and think…..

A

DI dry inside
=Labs HIGH
Increased sodium and diluted urine

DI “dehydrated”
DIE ADH

90
Q

What are the causes of diabetes insipidus? (may need to add to after lecture)

A
  1. Damage to brain
  2. Tumors
  3. Trauma
91
Q

What is polydipsia?

A

Extreme thirst

92
Q

What is polyuria?

A
  1. Excrete dilute urine, >200 mL/hr
93
Q

For REVIEW: What should we remember about DI?
(ADD to after lecture)

A
  1. Low ADH, low water in body
  2. High UO, Polyuria
  3. High sodium
  4. High H&H and serum osmolality from dehydration
  5. RISK: hypovolemic shock
  6. TX: DDAVP (ADH)
94
Q

FOR REVIEW: What should we remember about SIADH?
(may need to add to after lecture)

A
  1. High ADH, water intoxication
  2. Low UO, Oliguria
  3. Low sodium (dilutional)
  4. Low serum osmolality
  5. Weight gain
  6. RISK: seizure
  7. TX: hypertonic saline.
95
Q

Potassium is a major electrolyte in the (intracellular or extracellular) fluid?

A

Intracellular

96
Q

What is the function of potassium in our body?

A
  1. Maintains heart and muscle contractions
  2. Acid-base balance
97
Q

What regulates our K+ levels?

A

Kidneys and aldosterone

98
Q

Increased K+ in the cell…… what happens to H+?

A

H+ moves out

99
Q

Increased H+ in cell…. what happens to K+

A

K+ moves out

100
Q

What is the main source of K+?

A

Diet

101
Q

True or false Potassium is the king of hearts?

A

True

102
Q

What are the causes of Hypokalemia?

A
  1. Diuretics
    A. Digoxin toxicity- low K+ causes dig toxicity; caution using diuretics with digoxin = increased risk for hypokalemia
  2. Corticosteroids (water retention causing hemodilution)
  3. Increased secretion of aldosterone (crushing’s)
    A. Aldosterone = k+ excretion through kidneys; higher levels of aldosterone cause more K+ excretion
  4. GI loss
    A. Vomiting/diarrhea/prolonged NG suction
  5. Excessive diaphoresis
  6. Kidney disease
  7. Inadequate K+ intake
    A. Movement of K+ from ECF to ICF
    B. excess insulin- moves K+ into the cell
  8. Alkalosis, Metabolic
    A. H+ and K+ located inside the cell
    B. In alkalosis, there is less H+ in blood which causes H+ to shift out of the cells and K+ to shift into cells
    C. Excess insulin - moves K+ into the cell
103
Q

What is considered a severe hypokalemia level?

A
  1. less than or equal to 2.5
104
Q

A patient experiencing hypokalemia might present with what cardiovascular symptoms?

A
  1. Torsades De pointes
  2. Irregular apical HR
  3. Lethal dysrhythmias
  4. Bradycardia
105
Q

A patient experiencing hypokalemia might present with what neuromuscular symptoms?

A
  1. Confusion, lethargy
  2. Muscle weakness
  3. Diminished DTRs
106
Q

A patient experiencing hypokalemia migh present with what GI symptoms?

A
  1. Constipation
    A. If bowel sounds are absent, THINK– paralytic ileus- portion of bowel not moving can lead to small bowel obstruction.
107
Q

What other level should we check with hypokalemia?

A
  1. Should check Mg+ level. If Mg+ is low, it exacerbates K+ losses; correct Mg+ first to correct K+
108
Q

If your patient is experiencing hypokalemia and you check there electrolyte levels and notice that your patient has a low Mg+ level…. should you treat the Mg+ level first or K+ level first?

A

Mg+

109
Q

What does a long QT interval mean?

A

It means the heart is taking longer to electrically charge for the next heartbeat..

110
Q

What is a common symptom of a patient who is experiencing long QT’s?

A

Syncope

111
Q

Review EKG slides 43-44

A

Review EKG slides 43-44

112
Q

What might we see in a EKG for hypokalemia?

A
  1. Increased amplitude and width of P wave, T wave flattening and inversion, Prominent U waves and apparent long QT intervals due to merging of the T and U wave
113
Q

FOR REVIEW: Hypokalemia vs. Hyperkalemia EKG’s

A
  1. Hypokalemia- T wave inversion, ST depression, prominent U wave
  2. Hyperkalemia- peaked T waves, P wave flattening, PR prolongation, Wide QRS complex
114
Q

What are some hypokalemia interventions?

A
  1. Monitor cardiac and respiratory status
  2. Administer K+ supplements orally or IV
    A. administer K+ SLOWLY- can be lethal when given too fast
  3. If patient is taking a diuretic, may need to stop
    A. Spironolactone (K+ sparing diuretic)
  4. K+rich foods
    A. If taking orally, must take with food- never give on an empty stomach
    B. Monitor for digoxin toxicity
115
Q

Potassium is NEVER administered how?

A
  1. IV push
  2. IM
  3. SQ

IV POTASSIUM IS ALWAYS DILUTED AND ADMINISTERED USING AN INFUSION PUMP

116
Q

True or false: IV potassium is ALWAYS administered using an infusion pump?

A

True– can be deadly otherwise

117
Q

What are the causes of hyperkalemia ( >5.0 mEq/L)

A
  1. Excess K+ intake
  2. Decreased K+ excretion
    A. K+ sparing diuretics (spironolactone)
    B. Ace inhibitors
    C. NSAIDs (decrease renal perfusion)
  3. Adrenal insufficiency
    A. Addisons = low aldosterone = retention of K+
    B. Hypoaldosteronism causes large amounts of sodium excretion and retain K+ (Addison’s = destruction of adrenal gland)
  4. Kidney disease
    A. #1 cause; decrease in urine and increase in K+
  5. Traumatic burns
  6. Acidosis, metabolic
    A. H+ and K+ located inside the cell
    B. in acidosis, there is more H+ in blood— Causes H+ to shift into the cells and K+ to shift out in the cells.
118
Q

What is the number one cause of hyperkalemia?

A
  1. Kidney disease
119
Q

What hyperkalemia level is considered severe??

A
  1. Severe > greater than or equal to 6.5 mEq/L
120
Q

What hyperkalemia level is considered LEATHAL?

A
  1. LEATHAL > greater than or equal to 8.5 mEq/L
121
Q

A patient with hyperkalemia might present with what cardiovascular s/s?

A
  1. Low blood pressure
  2. Dysrhythmias- V fib and cardiac standstill
122
Q

A patient with hyperkalemia might present with what GI s/s?

A
  1. Increased motility = hyperactive bowel sounds
  2. Diarrhea
123
Q

A patient with hyperkalemia might present with what muscle weakness s/s?

A
  1. Can result in paralysis and respiratory arrest.
124
Q

Review slide 50 EKG

A

Review Slide 50 EKG

125
Q

What are some interventions for mild hyperkalemia?

A
  1. Monitor cardiac rhythm changes
  2. restrict K+ in diet
  3. Diuretics
  4. Cation exchange resins
    A. Sodium polystyrene sulfate ( kayexalate)
    B. PO or Rectal* = explosive diarrhea
  5. Stop medication causing increase in K+
  6. Dialysis
126
Q

What are some emergency medical interventions for severe hyperkalemia?

A
  1. Ca+ gluconate 10% IV
    A. Protects heart from myocardial irritability
    B. It DOES NOT LOWER K+
    C. Must be given over 3-5 mins
    D. place on monitor for dysrhythmias, monitor BP and HR
  2. Hypertonic glucose & insulin
    A. Moves excess K+ into the cells
  3. Na0HCO2
    A. K+ shifts into the cell and raises pH
127
Q

True or false: Calcium will help with function of Mg+ when Mg+ is low?

A

True

128
Q

True or false: Ca+ and Mg+ are bet friends- when one goes up, the other will follow?

A

True

129
Q

What is calcium’s 3 functions? (Thnk 3b’s)

A
  1. Bone- 90% of body’s calcium
  2. Blood clotting
  3. Beat (heart rate) myocardial contractions
130
Q

What 3 hormones regulate Calcium?

A
  1. Parathyroid hormone- parathyroid gland makes and releases when Ca+ levels are low
  2. Calcitonin- regulated by thyroid: is released when Ca+ levels are high to lower Ca+ and put back into bone
  3. Calcitriol- Vitamin D analog; controls blood calcium by suppressing release of PTH
131
Q

True or false: PTH decreases blood calcium levels; calcitonin increases blood calcium levels?

A

False- PTH increases blood calcium levels; calcitonin decreases blood calcium levels

132
Q

What is the normal levels of Ionized calcium?

A

4.8-5.6 mg/DL

133
Q

What do we need to know about Ionized calcium
(may need to add to or edit after lecture)

A
  1. Calcium in blood not attached to proteins (free calcium)
  2. Most accurate test for assessing true calcium status
  3. Important if abnormal levels of proteins
  4. May be drawn if signs of bone, kidney, lever or parathyroid disease
134
Q

What are the causes of hypocalcemia <8.5 mg/DL

A
  1. Vitamin D Deficiency
    A. Required for absorption of Ca+
  2. Long-term corticosteroids
  3. Hypoparathyroidism
    A. decrease in parathyroid hormone
    B. Removal of parathyroid gland
  4. Renal disease
  5. Massive diarrhea
  6. Hyperphosphatemia- inverse relationship with calcium
  7. Medications
    A. Diuretics; laxatives; corticosteroids (contribute to bone loss)
  8. Thyroidectomy or any neck surgeries can inadvertently irritate or remove parathyroid gland
135
Q

A patient with hypocalcemia may present with what cardiovascular s/s?

A
  1. Hypotension
  2. Dysrhythmias
    3 decreased heart rate
136
Q

A patient with hypocalcemia may present with what neuromuscular s/s?

A
  1. Irritable skeletal muscles- twitching, cramps, tetany, seizures, paresthesia’s
  2. Painful muscle spasms in calf or food
  3. Positive Trousseau’s and Chvostek’s signs
  4. Hyperactive deep tendon reflexes (DTRs)
  5. Osteoporosis- Body trying to get more calcium
137
Q

A patient with hypocalcemia may present with what GI s/s?

A
  1. Hyperactive bowel sounds
  2. Diarrhea
138
Q

What are some interventions for hypocalcemia?

A
  1. Replace Calcium (IV or PO)
    A. IV calcium gluconate 10% over 10-20 mins— monitor BP, HR and place on patient on heart monitor
    B. Vitamin D if giving PO
    C. Aluminum hydroxide (TUMS) calcium supplements
  2. Initiate seizure precautions & bleeding precautions
  3. Move patient carefully
  4. Educate on calcium rich foods
    A. Dairy, cheese, milk, yogurt,
    B. Collard greens, broccoli
139
Q

What are the causes of Hypercalcemia >10.5 mg/dL

A
  1. Hyperparathyroidism
  2. Antacids
    A. excessive oral intake of calcium & vitamin D.
  3. Malignancies- of the bone; bone destructions calcium is released into the bloodstream
  4. Renal disease – inability to excrete
140
Q

A patient with hypercalcemia would present with what neuromuscular s/s?

A
  1. Muscle weakness
  2. Diminished or absent DTR’s
141
Q

A patient with hypercalcemia would present with what GI s/s?

A
  1. Hypoactive bowel sounds
  2. Constipation
142
Q

A patient with Hypercalcemia would present with what Renal s/s?

A
  1. Kidney stones
143
Q

Stones, bones and abdominal moan
Think: Kidney stones, painful bones, moans from constipation and N/V help you remember what? (Might need to add after lecture)

A
  1. Hypercalcemia patient presentation
144
Q

What are some interventions for hypercalcemia

A
  1. Administer IV fluids
  2. Discontinue Calcium
  3. Loop diuretics
  4. Medications
  5. Dialysis
  6. Educate on avoiding calcium rich foods
  7. IV NS and loop diuretics = less severe
145
Q

Administering IV fluids is an interventions for hypercalcemia. What else should we know about this intervention?

A
  1. 0.9% saline to get the kidneys to excrete calcium
146
Q

Discontinue calcium is an intervention for hypercalcemia. What else should we know about this intervention?

A
  1. Discontinue oral meds with calcium and vitamin D (double check)
147
Q

SLIDE 61— finish after lecture

A

Leaving blank

148
Q

Slide 61– Leaving blank until after lecture

A
149
Q

Silde 61 leaving blank until after lecture

A
150
Q

What is Mg+ function?

A
  1. Support muscle and nerve function and energy production
151
Q

What electrolyte is Mg+ best friend?

A

Ca+

152
Q

Mg+ has an inverse relationship with which electrolyte?

A
  1. Phosphorous
153
Q

Mg+ helps maintain what?

A
  1. Blood glucose control
  2. Blood pressure
  3. Skeletal muscle contraction
  4. Neurologic function
  5. ATP formation
  6. Immune system- fights inflammation
154
Q

What are the causes of hypomagnesemia ( <1.5mg/dL)

A
  1. Chronic alcohol use- # 1 cause
    A. Poor diet/malnutrition; starvation, malabsorption due to effects of alcohol on GI tract
  2. Renal loss- overuse of alcohol increases excretion of Mg
  3. GI loss- NG, diarrhea
  4. Diuretics
155
Q

A patient with hypomagnesemia might present with what neuromuscular s/s?

A
  1. Tetany, twitches, paresthesias
  2. Positive Trousseau’s & Chvostek’s signs
    A. Due to direct relationship with Ca+
  3. Increased DTRs
  4. Laryngeal stridor
  5. Tachycardia

Unable to maintain order; everything goes crazy

156
Q

What are some interventions for hypomagnesemia?

A
  1. Replace Mg+ and Ca+ (IV or PO)
  2. When replacing Mg+ IV give slowly ( can slow HR)
  3. Seizure precautions
  4. Monitor DTRs- if diminished or absent = hypermagnesemia
  5. Discontinue medications that cause Mg+ loss
  6. monitor K+ if magnesium is low
    A. secondary to K+ depletion
157
Q

True or false: Hypocalcemia companies hypomagnesemia; Interventions aim to restore calcium levels?

A

True

158
Q

True or false: Treat Hypokalemia prior to hypomagnesemia?

A

False- Treat hypomagnesemia prior to hyperkalemia; when the body is in a state of low M+, it is unable to process & absorb K+

159
Q

What are the causes of Hypermagnesemis? ( > 2.5mg/dL)

A
  1. Increased Mg+ intake
  2. Decreased renal excretion of Mg+
160
Q

A patient with hypermagnesemia might present with what cardiovascular s/s?

A
  1. Heart- Calm & Quiet
    A. Respirations low and shallow
    B. Bradycardia
    C. Hypotension
161
Q

A patient with hypermagnesemia might present with what respiratory s/s?

A
  1. Respiration low and shallow
162
Q

A patient with hypermagnesemia might present with what GI s/s?

A
  1. Hypoactive bowel sounds
163
Q

A patient with hypermagnesemia might present with what MS s/s?

A
  1. Diminished or absent DTR’s
164
Q

What are some interventions for hypermagnesemia?

A
  1. Calcium gluconate is antidote for Mg+ overdose
  2. Diuretics for Mg+ excretion
165
Q

What are the main functions of phosphorus (P-)

A
  1. Helps regulate calcium
  2. Cellular metabolism and energy production through ATP (Adenosine triphosphate)
  3. Essential for bone and teeth
166
Q

What regulates phosphorus?

A
  1. Parathyroid and calcitriol
167
Q

Phosphorus has an inverse relationship with which electrolytes?

A
  1. Calcium and magnesium
168
Q

What are the causes of hypophosphatemia <2.4mg/dL

A
  1. Insufficient phosphorus intake
    A. Malnutrition
    B. Starvation- “Refeeding syndrome”- fatal shift of fluids & electrolytes that may occur in a malnourished pt.
  2. Increased phosphorus excretion
    A. Hyperparathyroidism- calcium rises; phosphorous drops
    B. Malignancy
    C. Diuretics and diarrhea
    D. Use of magnesium-based or aluminum-based antacids — increased Ca+ depletes phosphorus
169
Q

A patient with hypophosphatemia might present with what cardiovascular s/s?

A
  1. Decreased BP, HR
170
Q

A patient with hypophosphatemia might present with what GI s/s?

A
  1. Hyperactive bowel sounds
171
Q

A patient with hypophosphatemia might present with what Neuro s/s

A
  1. Altered LOC and Decreased DTR
172
Q

A patient with hypophosphatemia might present with what musculoskeletal s/s?

A
  1. Severe muscle weakness, bone pain & fractures
173
Q

What are some interventions for hypophosphatemia?

A
  1. Replace phosphorus IV or PO
    A. Phosphorus slowly if severely low
    B. Administer oral phosphorous with Vitamin D
  2. Fracture precautions
174
Q

What are the causes of hyperphosphatemia? >4.5 mg/dL

A
  1. Increased phosphorus intake
  2. Overuse of laxatives and enemas w/phosphorus
  3. Decreased excretion of P- due to renal insufficiency
  4. Hyperparathyroidism
  5. Hypocalcemia
175
Q

A patient with hyperphosphatemia might present with what neuromuscular s/s? (double check after lecture)

A
  1. Irritable skeletal muscles- twitching, cramps, tetany, seizures, paresthesia
  2. Painful muscle spasms in calf or foot
  3. Positive Trousseau’s and Chvostek’s signs
  4. Hyperactive deep tendon reflexes (DTRs)
  5. Osteoporosis- body trying to get more calcium
176
Q

A patient with hyperphosphatemia might present with what GI s/s? (double check after lecture)

A
  1. Hyperactive bowel sounds
  2. Diarrhea
177
Q

What are some interventions for hyperphosphatemia? (double check after lecture)

A
  1. Replace calcium (IV or PO)
    A. IV calcium gluconate 10%- monitor BP, HR and place pt on heart monitor
    B. Vitamin D if giving on PO
    C. Aluminum hydroxide (TUMS) calcium supplements
  2. Initiate seizure precautions & bleeding precautions
  3. Move patient carefully
  4. Educate on calcium Rich foods
    A. Dairy, cheese, milk, yogurt
    B. Collard greens, broccoli

SAME INTERVENTIONS AS HYPOCALCEMIA

178
Q

Chloride is a major _____ of ECF? (Anion or Cation)

A

Anion

179
Q

Sodium is a major ____ of ECF (Anion or cation)

A
  1. Cation
180
Q

What is the function of chloride?

A
  1. Moves in and out of the cell with sodium
  2. Involved in regulating acid base balance
181
Q

True or False: Chloride likes sodium; if Na+ loss =Cl - loss

A

true

182
Q

What are some medications that affect electrolytes?

A
  1. Corticosteroids- bone loss; increased blood glucose; NA+ retention
  2. ACE inhibitors- hold on to K+
  3. Spironolactone (Aldactone)- hold on to K+
  4. ARBs- Hold on to K+
  5. Insulin- move K+ into cells
  6. Furosemide- Potent diuretic; should monitor all electrolytes
  7. Laxatives- Mg
  8. NSAIDs- decreases renal perfusion.

Module 2 (14 decks)

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