Ch. 40 Electrolytes Flashcards
(90 cards)
1
Q
What are the names of the major electrolytes?
Hint: there are 7
A
Sodium Potassium Calcium Magnesium Chloride Bicarbonate Phosphate
2
Q
Main function of sodium?
A
controls of body fluids
3
Q
Main function of potassium?
A
cellular enzyme activity and water content and cardiac rhythm
4
Q
Main function of calcium?
A
Nerve impulse, blood clotting, muscle contraction
5
Q
Main function of magnesium?
A
metabolism of carbohydrates and proteins, vital actions involving enzymes. aids in dilating arteries and facilitating circulation, may prevent calcification of vessels, lowers total cholesterol, raises HDL cholesterol, inhibits platelet aggregation
6
Q
Main function of chloride?
A
maintains osmotic pressure in blood, produces hydrochloric acid
7
Q
Main function of bicarbonate?
A
body’s primary buffer system
8
Q
Main function of phosphate?
A
cell division, hereditary traits
9
Q
What is the normal range for sodium?
A
135-145 mEq/L
10
Q
What is the normal range for potassium?
A
3.5-5 mEq/L
11
Q
What is the normal range for calcium?
A
8.6-10.2 mg/dL
12
Q
What is the normal range for magnesium?
A
1.5-2.5
13
Q
What is the normal range for bicarbonate?
A
22-26
14
Q
What is the normal range for phosphate?
A
2.5-4.5
15
Q
Hypovolemia stands for ____ ____ ____
What symptoms can a patient experience if they have hypovolemia?
List 3-5 symptoms
A
Fluid Volume Deficit
dry mucous membranes urine output <30mL/hr postural hypotension weak, rapid pulse increased urine specific gravity Sunken eyes flat neck veins poor skin and tongue turgor thirst weight loss over short period
16
Q
What can cause hypovolemia? Risk factors
A
GI: Vomiting, diarrhea,
Hemorrhage
Excessive sweating
burns, draining wounds
Excessive laxative or diuretic use
Polyuria
17
Q
What are nursing interventions/assessments that are to be done with a patient with hypovolemia?
A
Assess for presence or worsening of FVD.
Administer oral fluids if indicated.
If patient unable to eat and drink, anticipate TPN or tube feedings to be ordered.
Monitor patient’s response to fluid intake, either oral or parenteral.
Be alert for signs of fluid overload.
Provide appropriate skin care
18
Q
Hypervolemia stands for ____ ___ _____
What symptoms/sign can you experience with hypervolemia?
list 3-5 symptoms/signs
A
Weight gain over short period Peripheral edema (may be pitting) Increased BP Shortness of breath Crackles and wheezes in lungs Full, bounding pulse Neck vein distention
Pulmonary edema
↓Urine specific gravity
19
Q
What can cause hypervolemia? risk factors
A
Compromised regulatory mechanisms: renal failure, CHF,
Excess IV fluids with sodium
Corticosteroid therapy
Excessive ingestion of sodium-containing substances in diet or sodium-containing medications
20
Q
Nursing interventions or assessment that can be done for a patient with hypervolemia
A
Assess for presence or worsening of FVE.
Encourage adherence to sodium-restricted and fluid-restricted diet, if ordered.
Encourage rest periods. Monitor patient’s response to diuretics. Teach self-monitoring of weight and intake and output. Attentive skin care. Monitor respiratory status
21
Q
T/F hyponatremia is due to increased amounts of sodium
A
FALSE. Due to loss of sodium
22
Q
What are symptoms of hyponatremia? List 3-5
A
Anorexia Nausea and vomiting Lethargy Confusion Muscle cramps Muscular twitching Seizures Coma Serum Na below 135 mEq/L Urine specific gravity <1.010
23
Q
What can cause hyponatremia? risk factors
A
Loss of sodium, as in: Loss of GI fluids Use of diuretics Water intoxication Disease states associated with SIADH (a form of hyponatremia)
SIADH- Syndrome of Inappropriate Antidirurectic Hormone
24
Q
Which patient is likely to be experiencing dehydration? Hypovolemia or hypervolemia?
A
Hypovolemia
25
Nursing interventions/assessments for hyponatremia?
Monitor fluid losses and gains.
Monitor for the presence of GI and CNS symptoms.
Monitor serum Na levels.
Check urine-specific gravity.
If able to eat, encourage foods and fluids with high sodium content.
Be aware of sodium content of common IV fluids.
Avoid giving large water supplements to patients receiving isotonic tube feedings.
Take seizure precautions when hyponatremia is severe.
26
What are symptoms of hypernatremia? list 3-5
```
Thirst
Elevated body temperature
Tongue dry and swollen, sticky mucous membranes
Severe hypernatremia
Disorientation
Hallucinations
Lethargy when undisturbed
Irritable and hyperactive
Focal or grand mal seizures
Coma
Serum Na above 145 mEq/L
Urine specific gravity >1.015
```
27
What can cause hypernatremia? risk factors
Water deprivation
Increased sensible and insensible water loss
Ingestion of large amount of salt
Excessive parenteral administration of sodium-containing solutions
Profuse sweating
Diabetes insipidus
28
Nursing interventions/assessments for Hypernatremia
Monitor fluid losses and gains.
Observe for excessive intake of high sodium foods.
Monitor sodium content of prescriptions and OTC drugs.
Monitor for changes in behavior such as restlessness, lethargy, and disorientation.
Look for excessive thirst and elevated body temperature.
Monitor serum Na levels.
Check urine specific gravity.
Give sufficient water with tube feedings to
29
```
Fatigue
Anorexia, nausea, and vomiting
Muscle weakness
Decreased bowel motility
Cardiac arrhythmias
Increased sensitivity to digitalis
Serum K below 3.5 mEq/L
ECG changes
Paresthesias or tender muscles
```
These are all symptoms of which electrolyte imbalance?
Hypokalemia
30
Diarrhea
Vomiting or gastric suction
Potassium-wasting diuretics
Steroid administration and certain antibiotics
Poor intake as in anorexia nervosa, alcoholism, potassium-free parenteral fluids
Polyuria
These are all causes/risk factors that can cause which electrolyte imbalance?
Hypokalemia
31
Nursing interventions/assessments for hypokalemia
Monitor for occurrence of hypokalemia.
Assess digitalized patients at risk for hypokalemia, which potentiates the action of digitalis
Prevent hypokalemia by:
Encouraging extra K intake if possible
Educating about abuse of laxatives and diuretics
Administer oral K supplements if ordered.
Be knowledgeable about danger of IV potassium administration.
32
Cardiac arrhythmias
Paresthesias of face, tongue, feet, and hands
Flaccid muscle paralysis
GI symptoms such as nausea, intermittent intestinal colic, or diarrhea may occur
Serum K >5.0 mEq/L
These are symptoms of which electrolyte imbalance?
Hyperkalemia
33
```
Decreased potassium excretion
Oliguric renal failure
Potassium-sparing diuretics
Hypoaldosteronism
High potassium intake
```
These are causes/risk factors for which electrolyte imbalance/
Hyperkalemia
34
Nursing interventions/assessments for Hyperkalemia
Monitor for hyperkalemia, which is life threatening.
Prevent hyperkalemia by:
Following rules for safe administration of K
Avoiding giving patients with renal insufficiency K-saving diuretics, K supplements, or salt substitutes
Cautioning about foods high in potassium content
35
```
Trousseau and Chvostek signs
Numbness and tingling of fingers and toes
Mental changes
Seizures
Spasm of laryngeal muscles
ECG changes
Cramps in muscles of extremities
Total serum calcium <8.6 mg/dL
```
These are symptoms of which electrolyte imbalance?
Hypocalcemia
36
```
Surgical hypoparathyroidism
Malabsorption
Vitamin D deficiency
Acute pancreatitis
Excessive administration of citrated blood
```
These are causes/risk factors for which electrolyte imbalance?
Hypocalcemia
37
Nursing interventions/assessments for hypocalcemia
Take seizure precautions when hypocalcemia is severe.
Monitor condition of airway.
Take safety precautions if confusion is present.
Educate people at risk for osteoporosis about the need for dietary calcium intake.
Discuss calcium-losing aspects of nicotine and alcohol use.
38
What symptoms for hypercalcemia?
```
Muscular weakness
Tiredness, lethargy
Constipation
Anorexia, nausea, and vomiting
Decreased memory and attention span
Polyuria and polydipsia
Renal stones
Neurotic behavior
Cardiac arrest
Serum calcium >10.5 mg/dL
```
39
What are causes for hypercalcemia? risk factors
Hyperparathyroidism
Prolonged immobilization
Large doses of vitamin D
Overuse of calcium supplements
40
Increase mobilization when feasible.
Encourage sufficient oral intake.
Discourage excessive consumption of milk products.
Encourage bulk in the diet.
Take safety precautions if confusion is present.
Be alert for signs of digitalis toxicity
Force fluids to prevent formation of renal stones.
These are nursing interventions/assessments you would do as a nurse for which electrolyte imbalance?
Hypercalcemia
41
What are symptoms of hypomagnesemia?
```
Cardiac manifestations
Tachyarrhythmias
Increased susceptibility to digitalis toxicity
Mental changes
Disorientation
Mood changes
Serum magnesium <1.3 mEq/L
```
42
What are causes for hypomagnesemia? risk factors
```
Chronic alcoholism
Intestinal malabsorption
Diarrhea
Drugs
Thiazide diuretics
Aminoglycoside antibiotics
```
43
Assess for magnesium deficit because it predisposes patient to digitalis toxicity.
Take seizure precautions if necessary.
Monitor condition of airway because laryngeal stridor can occur.
Educate the patient if abuse of diuretics or laxatives is a problem.
Educate about intake of foods rich in magnesium
These are nursing interventions/assessments done as a nurse for which electrolyte imbalance?
Hypomagnesemia
44
Renal failure
Adrenal insufficiency
Excessive magnesium administration during treatment of eclampsia
Hemodialysis with hard water or dialysate high in magnesium content
```
these are causes/risk factors for which electrolyte imbalance?
Hypomagnesemia
Hypermagnesemia
Hypovolemia
Hyperkalemia
```
Hypermagnesemia
45
What symptoms of hypermagnesemia?
Early sign is serum magnesium level of 3–5 mEq/L
Flushing and sense of skin warmth
Hypotension
Depressed respirations
Drowsiness, hypoactive reflexes, and muscular weakness
Cardiac abnormalities
46
If _______is present, be alert for low BP and shallow respirations, lethargy, drowsiness, and coma.
Do not give magnesium-containing medications to patient with renal failure or compromised renal function.
Be cautious of OTC drugs.
Check deep tendon reflexes frequently.
These are nursing interventions/assessment for which electrolyte imbalance?
Hypermagnesemia
47
```
Cardiomyopathy
Acute respiratory failure
Seizures
Decreased tissue oxygenation
Joint stiffness
Serum phosphate <2.5 mg/dL
```
These are symptoms of which electrolyte imbalance?
Hypophosphatemia
48
Parenteral nutrition
Alcohol withdrawal
Diabetic ketoacidosis
Respiratory alkalosis
These are risk factors/causes for which electrolyte imbalance?
Hypophosphatemia
49
Nursing interventions/assessments for hypophosphatemia
Be aware that severely hypophosphatemia patients are at greater risk for infection.
Administer IV phosphate products cautiously.
Introduce parenteral nutrition cautiously in patients who are malnourished.
Monitor for diarrhea when taking oral supplements.
Sudden increase in serum phosphate level can cause hypocalcemia.
50
Hyperphosphatemia can cause what type of symptoms?
| list 3-5
Short-term consequences:
Symptoms of tetany, such as tingling of the fingertips and around the mouth, numbness, and muscle spasms
Serum phosphate >4.5 mg/dL
51
What are causes for hyperphosphatemia? riskf actors
Large intake of milk
Excessive intake of phosphate-containing laxatives (Fleet phosphosoda)
Large vitamin D intake
Hyperthyroidism
52
What are nursing interventions/assessments as a nurse for patients with hyperphosphatemia?
Monitor for signs of tetany.
Be aware that soft tissue calcification can be a long-term complication of chronically elevated serum phosphate levels.
Instruct patients that use of phosphate-containing laxatives can result in hyperphosphatemia.
Avoid foods high in phosphorus content.
53
Respiratory acidosis occurs when there is a primary excess/deficit of carbonic acid/bicarbonate in ECF
"circle" your answer
Respiratory acidosis occurs when there is a primary excess of carbonic acid in ECF
54
Respiratory alkalosis occurs when there is a primary excess/deficit of carbonic acid/bicarbonate in ECF
"circle" your answer
Respiratory alkalosis occurs when there is a primary deficit of carbonic acid in ECF
55
Metabolic acidosis occurs when there is a proportionate excess/deficit of carbonic acid/bicarbonate in ECF
"circle" your answer
Metabolic acidosis occurs when there is a proportionate deficit of bicarbonate in ECF
56
Metabolic alkalosis occurs when there is a primary excess/deficit of carbonic acid/bicarbonate in ECF
"circle" your answer
Metabolic alkalosis occurs when there is a primary excess of bicarbonate in ECF
57
What is a normal pH range?
7. 45-7.55
7. 35-7.40
7. 35-7.45
7. 25-7.35
Normal: 7.35-7.45
58
T/F anything below 7.35 is a base and anything above 7.45 is acidic for pH?
FALSE
| anything below 7.35 is ACIDIC and anything above 7.45 is BASE
59
What is a normal range for PaCO2 (mm Hg) ?
(partial pressure of carbon dioxide)
35-45
30-40
32-42
25-35
35-45- Normal
60
What is considered acidic and base for PaCO2
Acidic: >45
Base: <35
61
What is a normal range for HCO3 (mEq/L) ?
(hydrogen carbonate)
20-30
25-35
22-32
22-26
22-26
62
T/F an acidic hydrogen carbonate (HCO3) is anything less than 22 mEq/L
TRUE
63
What is a base for HCO3?
>26
64
```
FIB:
Respiratory acidosis has a
______ pH
______ PaCO2
______ HCO3
```
hint: think of what increases, what decreases, and what stays in the normal range
Decreased pH (<7.35)
Increased PaCO2
Normal HCO3
65
```
FIB:
Respiratory alkalosis is
_____ HCO3
_____ pH
_____ PaCO2
```
hint: think of what increases, what decreases, and what stays in the normal range
Normal HCO3
Increased pH (>7.45)
Decreased PaCO2
66
Which acid-based imbalance has a decreased pH level, decreased HCO3 level, and normal PaCO2 level ?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Metabolic acidosis
67
Which acid-based imbalance has an increased pH, increased HCO3, and normal PaCO2?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Metabolic alkalosis
68
pH: 7.42
PaCO2: 38 mm Hg
HCO3: 24 mEq/L
This is an example of ?
```
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
This is a normal acid-base balance
```
This is a normal acid-base balance
69
pH: 7.34
PaCO2: 43 mm Hg
HCO3: 21 mEq/L
This is an example of ?
```
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
This is a normal acid-base balance
```
Metabolic acidosis
70
pH: 7.47
PaCO2: 32 mm Hg
HCO3: 24 mEq/ L
This is an example of ?
```
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
This is a normal acid-base balance
```
Respiratory alkalosis
71
pH: 7.33
PaCO2: 47 mm Hg
HCO3: 25 mEq/L
This is an example of ?
```
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
This is a normal acid-base balance
```
Respiratory acidosis
72
When a patient is on fluid restrictions, how many cups of fluid TOTAL can they receive in a day?
2
4
6
8
4 cups total
73
T/F You cannot give patients salty foods or high in sugar snacks when on fluid restrictions?
TRUE
74
What are foods that are recommended to patients who are hypovolemic?
Foods with high water content
citrus fruit
melons
celery
75
What are foods recommended to patients who are hypokalemic?
Increase foods with high potassium
| bananas, citrus fruits, apricots, melons, broccoli, potatoes, raisins, lima beans
76
What foods are recommended to avoid for hypernatremia patients?
avoid foods high in sodium
processed cheese, lunch meats, canned soups and vegetables, salted snack foods
also eliminate table salt
77
Leading food sources: fruits and vegetables, dried peas and beans, whole grains, milk, meats
are an example of where which electrolyte can be found?
Potassium
78
Sources include milk and milk products; dried beans; green, leafy vegetables; small fish with bones; and dried peas and beans
are an example of where which electrolyte can be found?
Calcium
79
Sources include green, leafy vegetables; nuts; seafood; whole grains; dried peas and beans; cocoa
are an example of where which electrolyte can be found?
Magnesium
80
Almost all ______ in the diet comes from salt
Found in foods high in sodium, processed foods
chloride
81
Sources include all animal products (meat, poultry, eggs, milk, bread, ready-to-eat cereal)
for which electrolyte?
Phosphate
82
What are assessments/symptoms you can see in a patient who has a respiratory acidosis disturbance?
```
Acute respiratory acidosis
Mental cloudiness
Dizziness
Muscular twitching
Unconsciousness
ABGs
pH <7.35
PaCO2 >45 mm Hg (primary)
HCO3− normal or only slightly elevated
Chronic respiratory acidosis
Weakness
Dull headache
ABGs
pH <7.35 or low N
PaCO2 >45 mm Hg (primary)
HCO3− >26 mEq/L (compensatory)
```
83
What are assessments/symptoms you can see in a patient who has a respiratory alkalosis disturbance?
Lightheadedness
Inability to concentrate
Hyperventilation syndrome
Tinnitus
Palpitations
Sweating
Dry mouth
Tremulousness
Convulsions and loss of consciousness
ABGs
pH >7.45
PaCO2 <35 mm Hg (primary)
HCO3− <22 mEq/L (compensatory)
84
What are assessments/symptoms you can see in a patient who has a metabolic acidosis disturbance?
Headache
Confusion
Drowsiness
Increased respiratory rate and depth
Nausea and vomiting
Peripheral vasodilation
ABGs
pH <7.35
HCO3− <22 mEq/L (primary)
PaCO2 <35 mm Hg
Hyperkalemia frequently present
85
What are assessments/symptoms you can see in a patient who has a metabolic alkalosis disturbance?
Dizziness
Tingling of fingers and toes
Hypertonic muscles
Depressed respirations (compensatory)
ABGs
pH >7.45
HCO3− >26 mEq/L (primary)
PaCO2 >45 mm Hg (compensatory)
Hypokalemia may be present
86
What percentage of NaCl (normal saline) would you give for isotonic solutions?
0.9 % NaCl (normal saline)
87
What percentage of NaCl (normal saline) would you give for hypotonic solutions?
0. 33 % NaCl (1/3- strength of normal saline)
| 0. 45 % (1/2- strength of normal saline)
88
What percentage of NaCl (normal saline)/ dextrose would you give for hypertonic solutions?
5% dextrose in Lactated Ringer's solution
5% dextrose in 0.9 % NaCl
89
What are the major cations in body fluid?
sodium, potassium, calcium, hydrogen, and magnesium.
90
What are the major anions in body fluid?
chloride, bicarbonate, and phosphate.
