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461 - Exam 4 > ATI - Electrolyte Imbalances - 58 > Flashcards

ATI - Electrolyte Imbalances - 58 Flashcards

(94 cards)

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1
Q

_____ is the major electrolyte found in ECF and is present in most body fluids or secretions.

A

sodium (Na+)

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2
Q

Sodium is essential for maintenance of ______ and fluid balance, active and passive transport mechanisms, and irritability and conduction of _____ and ______.

A

acid-base

nerve and muscle tissue

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3
Q

Expected serum sodium levels

A

136 - 145 mEq/L

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4
Q

_____ is a serum sodium level less than 136 mEq/L

A

Hyponatremia

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5
Q

Hyponatremia results from an excess of water in the ______ or loss of _____ rich fluids.

A

plasma

sodium

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6
Q

Hyponatremia delays and slows the ______ of membranes.

A

depolorization

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7
Q

With hyponatremia water moves from the _____ into the _____, which causes cells to swell (cerebral edema)

A

ECF to ICF

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8
Q

Serious complications can result from untreated acute hyponatremia such as coma, ______, and _______).

A

seizures

respiratory arrest

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9
Q

Risk Factors of Hyponatremia

A

Deficient ECF volume
Excessive GI losses: vomiting, nasogastric suctioning, diarrhea, tap water enemas
Renal losses: diuretics, kidney disease, adrenal insufficiency, excessive sweating
Skin losses: burns, wound drainage, gi obstruction, peripheral edema, ascites
Increased or normal ECF volume: excessive oral water intake, syndrome of inappropriate antiduretic hormone secretion (SIADH)
Edematous states: heart failure, cirrhosis, nephrotic syndrome
Excessive hyponotic IV fluids
Inadequate sodium intake (NPO status)
Hyperglycemia
Age-related risk factors: older adult clients are at greater risk due to an increased incidence of chronic illnesses, use of diuretic medications, and risk for insufficient sodium intake

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10
Q

Expected Findings with Hyponatremia - Vital Signs

A 
Hypothermia
Tachycardia
Rapid thready pulse
hypotension
orthostatic hypotension
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11
Q

Expected Findings with Hyponatremia - Physical Assessment Findings

A

vary with a normal decreased or increased ECF volume

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12
Q

Expected Findings with Hyponatremia - neuromusculoskeletal

A 
headahe
confusion
lethargy
muscle weakness with possible respiratory compromise
fatigue
decreased deep tendon reflexes (DTRs)
seizures
coma
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13
Q

Expected Findings with Hyponatremia - GI

A 
increased motility
hyperactive bowel sounds
abdominal cramping 
anorexia
nausea
vomiting
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14
Q

For hyponatremia the serum sodium lab test will be ______.

A

decreased: less than 136 mEq/L

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15
Q

For hyponatremia the urine specific gravity will be _____.

A

less than 1.010 (if not due to SIADH)

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16
Q

For hyponatremia the serum osmolarity is _______.

A

decreased: less than 280 mOsm/kg

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17
Q

p348 nursing care review

A

?

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18
Q

Hypernatremia is a serum sodium level _____.

A

greater than 145 mEq/L

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19
Q

With hypernatremia the serum osmolarity is ______ to ______.

A

increased: greater than 295 mOsm/kg

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20
Q

With Hypernatremia the urine specific gravity will be ______.

A

greater than 1.030

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21
Q

Patient Centered Care for Hypernatremia

A

Report lab finding outside of the expected reference range to the provider
Monitor level of consciousness and ensure safety
Provide oral hygiene and other comfort measures to decrease thirst
Monitor I&O, and alert the provider if urinary output is inadequate

Fluid Loss: Based on serum osmolarity. Administer hypotonic IV fluids (Q.225% sodium chloride)

Excess Sodium: 
Encourage water intake and discourage sodium intake.
Administer diuretics (loop diuretics)
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22
Q

______ is the major cation in ICF.

A

Potassium (K+)

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23
Q

Potassium plays a vital role in _______; transmission of nerve impulses; functioning of cardiac, lung, and muscle tissues; and acid-base balance.

A

cell metabolism

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24
Q

Potassium has reciprocal action with _____.

A

sodium

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25
Expected serum potassium levels are ______.
3.5 mEq/L - 5.0 mEq/L
26
______ is a serum potassium level less than 3.5 mEq/L.
Hypokalemia
27
Hypokalemia is the result of an increased loss of potassium from the body, decreased intake and absorption of potassium, or movement of _____.
potassium into the cells.
28
Hypokalemia Risk Factors - general
Hyperaldosteronism Inadequate dietary intake (rare) Prolonged administration of non-electrolyte-containing IV solutions such as 5% dextrose in water
29
Hypokalemia Risk Factors - Excessive GI losses
vomiting nasogastric suctioning diarrhea excessive laxative use
30
Hypokalemia Risk Factors - renal losses
Excessive use of potassium-excreting diuretics | i.e. furosemide (lasix), corticosteroids
31
Hypokalemia Risk Factors - skin losses
diaphoresis | wound losses
32
Hypokalemia Risk Factors - ICF
metabolic alkalosis, after correction of acidosis (treatment of diabetic ketoacidosis), during periods of tissue repair (burns, trauma, starvation), total parental nutrition
33
Hypokalemia Expected Findings - Vital Signs
``` hyperthermia weak irregular pulse hypotension orthostatic hypotension respiratory distress ```
34
Hypokalemia Expected Findings - neuromusculoskeletal
ascending bilateral muscle weakness with respiratory collapse and paralysis muscle cramping decreased muscle tone and hypoactive reflexes paresthesias mental confusion
35
Hypokalemia Expected Findings - electrocardiogram (ecg)
``` premature ventricular contractions (PVCs) bradycardia blocks ventricular tachycardia flattening T waves ST depression ```
36
Hypokalemia Expected Findings - GI
``` decreased motility hypoactive bowel sounds abdominal distention constipation ileus (bowel obstruction in the ileum) nausea vomiting anorexia ```
37
Hypokalemia Expected Findings - other clinical findings
anxiety, which can progress to lethargy
38
Hypokalemia can be detected through what two laboratory tests?
serum potassium | arterial blood gases
39
Hypokalemia is reflected by serum potassium tests that have _______.
decreased to less than 3.5 mEq/L
40
Hypokalemia is reflected by arterial blood gases when the pH is _____.
greater than 7.45 (metabolic alkalosis)
41
Hypokalemia should be monitored by a ______ to monitor for dysrhythias, such as PVCs, ventricular tachycardia, flattening T waves, and ST depression.
ECG
42
Review patient centered care p 349
?
43
Hyperkalemia is a serum potassium level of ____.
greater than 5.0 mEq/L
44
Hyperkalemia is the result of an increased intake of potassium, movement of potassium out of the cell, or ________.
inadequate renal excretion
45
Hyperkalemia is uncommon in clients who have _______ function.
adequate kidney function
46
Hyperkalemia is potentially life-threatening due to the risk of ________ and _______.
cardiac arrhythmias | cardiac arrest
47
Hyperkalemia Risk Factors -
``` Increased total body potassium ECF shift Hypertonic States Decreased excretion of potassium Age ```
48
Hyperkalemia - Risk Factors - Increased Total Body Potassium
IV potassium administration salt substitutes blood transfusion
49
Hyperkalemia - Risk Factors - ECF Shift
``` Insufficient insulin acidosis (diabetic ketoacidosis) tissue catabolism (sepsis, trauma, surgery, fever, myocardial infarction) ```
50
Hyperkalemia - Risk Factors - Hypertonic States
uncontrolled diabetes mellitus
51
Hyperkalemia - Risk Factors - decreased excretion of potassium
``` kidney failure severe dehydration potassium-sparing diuretics ACE inhibitors adrenal insufficiency ```
52
Hyperkalemia - Risk Factors - Age
Older adult cleints are at greater risk due to decreased kidney function and medical conditions resulting in the use of salt substitutes angiotensin-converting enzyme inhibitors potassium-sparing diuretics
53
Hyperkalemia - Expected Findings - Vital signs
slow, irregular pulse | hypotension
54
Hyperkalemia - Expected Findings - neuromusculoskeletal
``` irritability confusion weakness with ascending flaccid paralysis paresthesias lack of reflexes ```
55
Hyperkalemia - Expected Findings - ECG
ventricular fibrillation peaked T waves widened QRS cardiac arrest
56
Hyperkalemia - Expected Findings - GI
increased motility diarrhea abdominal cramps hyperactive bowel sounds
57
Hyperkalemia will reflect _______ on a serum potassium test.
an increase, greater than 5 mEq/L
58
Hyperkalemia will reflect _____ on arterial blood gases.
metabolic acidosis; pH less than 7.35
59
With Hyperkalemia and ECG will show dysrhythmias
ventricular fibrilation peaked T waves widened QRS
60
Nursing Care p 350
?
61
When do you use loop diuretics?
to increase potassium excretion from the renal system, if kidney function is adequate. used with Hyperkalemia
62
When you have hyperkalemia one medication that can be used is sodium polystyrene sulfonate either ______ or as an _____.
orally | enema
63
Sodium polystyrene sulfonate increases the excretion of potassium from the _______.
gi system
64
_______ is found in the body's cells, bones, teeth.
calcium
65
The expected calcium level is _____ to ____.
9.0 to 10.5 mg/dL
66
Calcium balance is essential for proper functioning of the cardiovascular, neuromuscular, and ______ systems, as well as blood clotting and bone and teeth formation.
endocrine
67
Hypocalcemia is a total serum calcium level less than _____.
9.0 mg/dL
68
Risk Factors for hypocalcemia
increased calcium output inadequate calcium intake or absorption calcium shift from ECF into bone or to an inactive form
69
With hypocalcemia increased calcium output can result from chronic diarrhea or _______.
steatorrhea as with pancreatits (binding of calcium to undigested fat)
70
With hypocalcemia inadequate calcium intake or absorption occurs with _____ syndromes, such as Crohn's disease or _____ deficiency (alcohol use disorder, chronic kidney disease)
malabsorptin syndromes | vitamin D deficiency
71
With hypocalcemia, calcium shift from ECF into bone or to an inactive form due to rapid infusion of blood transfusion, post-throidectomy, and ______.
hypoparathyroidism
72
Hypocalcemia - Expected Findings - Muscle Twitches/Tetany
Numbness and tingling (fingers and around mouth) Frequent, painful muscle spasms at rest that can progress to tetany hyperactive DTRs Positive Chvostek's sign (tapping on the facial nerve triggering facial twitching) Positive Trousseau's sign (hand/finger spasms with sustained bp cuff inflation) laryngospasms
73
Hypocalcemia - Expected Findings - Cardiovascular
weak, thready pulse, tachycardia or bradycardia | cardiac dysrhythmias: prolonged QT interval and ST segments
74
Hypocalcemia - Expected Findings - GI
hyperactive bowel sounds diarrhea abdominal cramping
75
Hypocalcemia - Expected Findings - Central Nervous System
seizures due to overstimulation of the CNS
76
A calcium diagnostic test.
ECG
77
Nursing care for hypocalcemia
Administer oral or IV calcium supplements (carefully monitor respiratory and cardiovascular status) Initiate seizure precautions Keep emergency equipment on standby Encourage foods high in calcium, including dairy products and dark green veggies.
78
Hypercalcemia is a total serum calcium level _______.
greater than 10.5 mg/dL
79
Hypercalcemia Risk Factors
Decreased calcium output Increased calcium intake and absorption Calcium shift from bone to ECF
80
With hypercalcemia, decreased calcium output can be caused by ______.
thiazide diuretics
81
With hypercalcemia, calcium shift from bone to ECF can be caused by:
``` Hyperparathyroidism Bone cancer Paget's disease Chronic immobility Long-term glucocorticoid use Hyperthyroidism ```
82
Hypercalcemia - Expected Findings - neuromuscular
decreased reflexes bone pain flank pain if renal calculi develop
83
Hypercalcemia - Expected Findings - Cardiovascular
dysrhythmias | increased risk for blood clot
84
Hypercalcemia - Expected Findings - GI
anorexia nausea vomiting constipation
85
Hypercalcemia - Expected Findings - CNS
weakness, lethargy | confusion, decreased level of consciousness
86
Hypercalcemia Diagnostic procedures
ECG - Shortened QT interval
87
Nursing Care - Hypercalcemia
increase the client's activity level limit dietary calcium encourage fluids to promote urinary excretion encourage fiber to promote bowel elimination implement safety precautions if client is confused monitor for pathologic fractures encourage fluid intake to decrease the risk for renal calcium stone formation monitor for blood clots, measure calf circumference
88
Most of the body's magnesium is found in the ____.
bones
89
Magnesium in smaller amounts is found within the body ____.
cells
90
A very small amount of magnesium is found in ____.
ECF
91
The expected magnesium level range is _____.
1.3 to 2.1 mEq/L
92
Hypomagnesemia is a serum magnesium level less than ____.
1.3 mEq/L
93
Hypomagnesemia Risk Factors
Increased Magnesium Output | Inadquate Magnesium intake or absorption
94
Increased magnesium output associated with hypomagnesemia can be caused by
GI losses (diarrhea, nasogastric suction) Thiazide or loop diurectics often associated with hypocalcemia

461 - Exam 4 (6 decks)

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