E3 (F&E, Acid/Base)

Question 1

4 functions of electrolytes

Answer 1

Promote neuromuscular irritability, maintain body fluid osmolality, regulate acid/base balance, regulate distribution of body fluids among body fluid compartments.

Question 2

Na normal range

Answer 2

135-145mEq/L

Question 3

Na functions

Answer 3

Control water distribution, determine ECF volume & concentration, electrochemical state for proper muscle and nerve function.

Question 4

Hyponatremia causes

Answer 4

Excessive Na loss (loss of GI fluids or secretions, sweating, Rx, Addison’s), excessive water gain (excessive IVF, SIADH, continuous bladder irrigation, polydipsia).

Question 5

Hyponatremia S/S

Answer 5

Poor skin turgor, dry mucosa, HA, Orthostatic fall in BP, N, abd cramping, neuro changes, anorexia, muscle cramps, lethargy.

Question 6

Hyponatremia lab

Answer 6

Serum Na:

Question 7

Hyponatremia Tx

Answer 7

• Replace Na by mouth, IV, NGT
• do not increase serum Na by more than 12 mEq/L in 24 hrs.
• If water gain: Restrict water, loop diuretics

Question 8

Hyponatremia Nrsg

Answer 8

*monitor for neuro changes, oral hygiene

Question 9

SIADH

Answer 9

Hypothalmus secretes too much ADH, causes water retention and lowers serum Na.

Question 10

SIADH S/S

Answer 10

Fingerprinting ( when finger is pressed over bony prominence)

Question 11

SIADH lab

Answer 11

Low BUN & creatinine due to overhydration

Question 12

SIADH Tx

Answer 12

Tx underyling cause, hypertonic saline cannot be used alone b/c it would be rapidly excreted in urine.

Question 13

SIADH Nrsg

Answer 13

I/O, daily weight, neuro symptoms,

Question 14

Hypernatremia causes

Answer 14

decreased water intake, hypertonic tube feeding, IVF with increased Na, Water loss (Gi, burns, heat), CAPD, DI.

Question 15

Hypernatremia S/S

Answer 15

Skin is flushed
Agitation
Low grade fever
Thirst

Question 16

Hypernatremia lab

Answer 16

Serum Na: > 145
Serum Osmo: > 300
Specific Gravity: > 1.015

Question 17

Hypernatremia Tx

Answer 17

Decrease serum Na gradually (0.5-1 mEq/L/hr over 48 hours), neuro chagnes & cerebral edema, hypotonic solution (D5W or half NS).

Question 18

Hypernatremia Nsg

Answer 18

monitor fluid loss/gain, neuro changes, offer fluids, monitor Na intake.

Question 19

Hypokalemia normal range

Answer 19

3.5 - 5.0

Question 20

Hypokalemia causes

Answer 20

GI suction, V/D, TPN or IVF w/o K replacement, Trauma, DM (uncontrolled), Rx (diuretics, lax, insulin)

Question 21

Hypokalemia S/S

Answer 21

Skeletal muscle weakness
U-wave (EKG)
Constipation and ileus
Toxicity of Digoxin
Irregular weak pulse
Orthostatic hypoTN
Numbness

Question 22

Hypokalemia lab

Answer 22

K

Question 23

Hypokalemia Tx

Answer 23

Replace K (PO or IV)
Diet - bananas, fruits & vegs, legumes, milk, & meat.
Tx underlying cause (Mg)

Question 24

IV K supplement

Answer 24

*Must use IV pump, must be diluted, monitor IV site and kidney output. *K is an irritant to vein.

Question 25

Hypokalemia Nrsg

Answer 25

Contractile force decreased, myocardium irritability, pt ed (diuretics and lax)

Question 26

Hyperkalemia Causes

Answer 26

*Renal Failure, Acidosis, Addison’ss, K sparing diuretics.

Question 27

Hyperkalemia S/S

Answer 27

Cardiac fx (Brady), muscle weakness & paralysis, GI hyperactivity, flaccid muscle paralysis (legs, trunk, arms, resp).

Question 28

Hyperkalemia lab

Answer 28

Serum K: >5.0
ECG abnormalities
ABG: low pH

Question 29

Hyperkalemia Tx

Answer 29

K restricted diet, monitor Dig levels, dialysis.

Question 30

Hyperkalemia Emergency Tx

Answer 30

Ca Gluconate IV (does not lower K, just antagonizes k action on heart)