Fluid and Electrolytes II

Question 1

excessive sodium in the blood; water rushes out of the cell into the blood and the cell shrinks (dehydrates)

Answer 1

hypernatremia

Question 2

135-145 mEq/L (blood test picks up on the amount of sodium outside of the cell)

Answer 2

normal sodium level

Question 3

electrolyte that helps water move from inside the cell and outside the cell. ____ and water love each other. wherever ____ goes water follows

Answer 3

Sodium

Question 4

causes of hypernatremia?

Answer 4

mnemonic device –> HIGH SALT
(HIGH) Hypercortisolism (hyper-ventilation), Increased sodium intake, GI feeding without adequate water supplement, Hypertonic solutions (ex: 3% solution)
(SALT) Sodium excretion decreased (ex: corticosteriods), Aldosterone problems (increased absorption of sodium), Loss of fluids, Thirst Impairment

Question 5

"NO FRIED FOODS FOR YOU"
F -fever flushed skin
R - restless, really agitated 
I - increased fluid retention
E - edema, extremely confused 
D - decreased urine output, dry mouth

Answer 5

signs and symptoms of hypernatremia

Question 6

• restrict NA+ intake (bacon, butter, canned foods, cheese, hot dogs, lunch meat, processed foods, etc)
• Patient safety: confused and agitated (call light in reach, fall risk)
• MD may order a isotonic or hypotonic IV solution (0.45% saline) give slowly (causes a shift of the fluid within the cell so watch out for cerebral edema)
• educate the client on proper diet and signs and symptoms of increased sodium level

Answer 6

nursing intervetions for hypernatremia

Question 7

low sodium in the blood ; the cell swells and could potentially burst. affects cells everywhere in the body and brain cells are particularly sensitive to this causing confusion for the patient.

Answer 7

hyponatremia

Question 8

“NO NA+”

• Na+ excretion is increased, renal problems, NG suction, vomiting, diuretics, sweating, diabetes insipidus, aldosterone sections
• Overload of fluids
• NA+ intake low through low salt diet or NPO status
• anti-diuretic hormone over secreted (SIADH)

Answer 8

causes of hyponatremia

Question 9

“SALT LOSS”
S - seizures and stupor
A - abdominal cramping and attitude changes (confusion)
L - lethargic
T - tendon reflexes diminshed, trouble concentrating
L - loss of urine and appetite
O - orthostatic hypotension, overactive bowel sounds
S - shallow respirations
S - spasms of the mucles

Answer 9

Signs and symptoms of hypnatremia

Question 10

• watch cardiac, respiratory, renal and GI status
• hypovolemic: administer IV solution to restore fluids and sodium (3% saline hypertonic solution)
• restrict fluids, some cases order diuretics
• declomyocin (tetracylcine) don’t give with food especially dairy and antacids (affects absorption)
• instruct the patient to indulge in sodium rich foods

Answer 10

nursing interventions for hypnatremia

Question 11

normal level is 3.5-5.1 anything over 7 is extremely dangerous

Answer 11

normal level of potassium

Question 12

high potassium in the blood ; ________ is responsible for nerve impulses and muscle contractions (loves to live inside the cell so potassium in this situation has mainly gravitated toward the outside of the cell)

Answer 12

hyperkalemia ; potassium

Question 13

“MURDER”
M - muscle weakness
U - urine production low or absent
R - respiratory failure
D - decreased cardiac contractility (weak pulse, low BP)
E - early signs of muscle twitching/cramps (late sign)
R - rhythm changes

Answer 13

signs and symptoms of hyperkalemia

Question 14

• monitor patient cardiac, respiratory, nueromusclant, and GI status
• hold PO supplements if ordered, stop IV potassium infusion
• initiate K+ restrictive diet (no potatoes, pork, fish, spinach, strawberries, tomatoes, oranges, mushrooms, cantaloupe
• prepare for dialysis
• may order lasix (potassium wasting drug)
• may order hypertonic solution of glucose and insulin

Answer 14

nursing intervention for hyperkalemia

Question 15

low potassium in the blood

Answer 15

hypokalemia

Question 16

"everything is slow and low" 
7 L's 
Lethargic
Low and slow respirations
Lethal cardiac S's
Loss of urine 
Leg cramps
Limp muscles
Low B/P and HR

Answer 16

signs and symptoms of hypkalemia

Question 17

never want to give ______ via IV push, subcutaneous injection or IM injection. Give slowly via IV

Answer 17

potassium

Question 18

Hold Lasiz, thiazides, and diagcin

Answer 18

these are potassium diuretics so no need to waste more potassium

Question 19

low calcium in the blood;

Answer 19

hypocalcemia

Question 20

plays a huge role in bone and teeth health, muscle and nerve function, cell function, and blood clotting

Answer 20

role of calcium

Question 21

normal 8.6-10.0 mg/dL

Answer 21

normal calcium level

Question 22

calcium is absorbed in the GI system, stored in the bone, excreted in the kidneys, _____ helps play in this role (calcium and phosphorus affect each other in opposite ways)

Answer 22

Vitamin D

Question 23

“CRAMPS”
C - confusion
R - reflexes hyperactive
A - Arrhythmias (prolonged QT interval & ST interval)
P- positive trousseaus’s sign (BP cuff upper arm inflate above stystolic and hold in place in 3 mins; patients hand open and closes (reflexes)
S- sign of onvastekis (masseter (lips or nose twitch toward jaw)

Answer 23

signs and symptoms of hypocalcemia

Question 24

• make sure safety precautions are in place and watch out for laryngeal spams
• monitor heart rhythm and watch any infiltration or phlebitis
• best to give through central line (10% Calcium glucoside)
• administer Vitamin D
• may order medicine like TUMS to decrease phosphorus level
• increased calcium intake (spinach, sardines, collard greens, milk, rhubarb, yogurt, cheese)

Answer 24

nursing interventions for hypocalcemia