ELECTROLYTE BALANCE

Question 1

DEFINITION OF FLUID AND ELECTROLYTE BALANCE

Answer 1

Process of regulating the extra cellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes

Question 2

OSMOLALITY

Answer 2

Number of particles in a solution

Question 3

RISK FACTORS FOR ELECTROLYTE IMBALANCE

Answer 3

Very young- have more water content

Very old- do not eat or drink enough

Question 4

INDIVIDUAL RISK FACTORS

Answer 4

Renal failure- retain fluid
Burn victims- lose fluid and electrolytes
Excessive exercise- lose sodium and fluid
CHF- retain fluid
Surgery- retain fluid
Drinking too much water

Question 5

SODIUM (Na)

Answer 5

Extracellular
Important to nerve transmission
Vital for skeletal muscle and cardiac contraction
Important for volume of ECF

Normal 135-145

Question 6

HYPONATREMIA

Answer 6

Low sodium draws water into the cells and causes them to swell

Question 7

CAUSES OF HYPONATREMIA

Answer 7

Fluid dilution or loss of sodium (Na)
Renal disease
Fluid retention
CHF
Liver disease
Watery diarrhea
Sweat, diuretics

Question 8

TREATMENT OF HYPONATREMIA

Answer 8

Restrict fluid
Give diuretics
May give Na if due to large loss such as watery diarrhea

Question 9

POTASSIUM (K+)

Answer 9

Some control over intracellular osmolality and volume . Regulates protein synthesis, glucose, use and storage.

Normal 3.5-5.0

Question 10

HYPERNATREMIA

Answer 10

High sodium draws water out of the cells and causes them to shrink

Question 11

CAUSES OF HYPERNATREMIA

Answer 11

Dehydration

Question 12

SIGNS OF HYPERNATREMIA

Answer 12

Fluid volume deficit
Tachycardia
Weak pulse
Postural hypotension
High sodium level and elevated hematocrit

Question 13

TREATMENT OF HYPERNATREMIA

Answer 13

Replace fluids cautiously with 0.45 and 0.9 hypotonic fluids to isotonic
If fluid overload give lasting
Ensure adequate water intake

Question 14

HYPOKALEMIA

Answer 14

May be caused by the use of laxatives or diuretics

Low K+ and effects nerve transmission, interferes with contractility of the smooth, skeletal, and cardiac muscle

Question 15

SIGNS OF HYPOKALEMIA

Answer 15

May develop confusion, respiratory depression, lieu’s, and constipation. Keep close eye on surgery patients

Question 16

TREATMENT OF HYPOKALEMIA

Answer 16

May give K+ PO with breakfast or with food. Always give IV replacement on a pump. If given as a bolus, 10 mEq in 100 of normal saline infused over 1 hour.
NEVER DIRECT PUSH POTASSIUM!!!!!!!!

IF ON DIGOXIN YOU MUST BRING K+ LEVELS UP TO NORMAL OR RISK DIGOXIN TOXICITY

Question 17

HYPERKALEMIA

Answer 17

Too much potassium

>5

Question 18

CAUSES OF HYPERKALEMIA

Answer 18

May be caused by renal failure, too much intake or use of salt substitutes

Potassium has been the drug used in lethal injections to stop the heart

Question 19

TREATMENT OF HYPERKALEMIA

Answer 19

Drug therapy - Kayexalate and insulin ( drives K+ into the cell. Give 5% dextrose before giving

Encourage potassium rich foods

Question 20

MANIFESTATIONS OF IMBALANCES

Answer 20

HYPOKALEMIA- EKG changes, flattened or inverted T waves, skeletal muscle weakness

HYPERKALEMIA- cardiac arrest, parathesia, abdominal cramping

Question 21

CALCIUM

Answer 21

Normal level 9.0-10.5 mg/dL

Absorption requires active form of vitamin D
Stored in bones
Parathyroid asks the bones for calcium and thyroid tells bones to stop

Question 22

HYPOCALCEMIA

Answer 22

Calcium level < 9.0

Causes painful muscle spasms

Question 23

CAUSES OF HYPOCALCEMIA

Answer 23

Parathyroidectomy
Lactose intolerance
Alcohol abuse
Vitamin D deficiencies
No sun exposure

Question 24

TREATMENT OF HYPOCALCEMIA

Answer 24

Replace slow IV push
Teach about sources of calcium
Injury prevention- use a lift to move these patients to prevent fractures

Question 25

HYPERCALCEMIA

Answer 25

> 10.5

Question 26

CAUSES OF HYPERCALCEMIA

Answer 26

Overactive parathyroid Lung cancer Breast cancer Some cancers of the blood Results in blood clots and decreased peristalsis

Question 27

MAGNESIUM

Answer 27

Normal level 1.8-2.6 | Critical to skeletal muscle contraction, carb metabolism, ATP formation, vitamin activation, and growth

Question 28

HYPOMAGNESIUM

Answer 28

<1.8

Question 29

CAUSES OF HYPOMAGNESIUM

Answer 29

Alcoholism, burns over large part of the body, chronic diarrhea, fluid loss Excessive urination, such as from uncontrolled diabetes and in recovery from kidney failure, HYPOCALCEMIA

Question 30

SYMPTOMS OF HYPOMAGNESIUM

Answer 30

Chevoskek’s sign and trousseau’s sign, hyperactive reflexes, confusion and psychosis, abdominal issues

Question 31

TREATMENT OF HYPOMAGNESIUM

Answer 31

Oral supplements, IV magnesium sulfate Do not give too quickly, may cause hypotension

Question 32

HYPERMAGNESIUM

Answer 32

Caused by renal failure. | >2.6

Question 33

SYMPTOMS OF HYPERMAGNESIUM

Answer 33

Cardiac changes Reduced reflexes Lethargy Difficult breathing

Question 34

TREATMENT OF HYPERMAGNESIUM

Answer 34

Loop diuretic | Make sure patient only receives magnesium free drugs

Question 35

PRIMARY PREVENTION OF ELECTROLYTE IMBALANCE

Answer 35

Prevention designed to minimize risk factors and to manage the disease Patient teaching, dietary measures, oral supplements

Question 36

SECONDARY CLINICAL MANAGEMENT FOR ELECTROLYTE

Answer 36

No routine screening, monitoring serum levels may performed as part of disease management

Question 37

NURSING INTERVENTIONS OF ELECTROLYTE IMBALANCE

Answer 37

``` Daily weight ( most important) I/O Safety Comfort measures Oral hygiene Patient teaching( diet) ```