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NRSG250 > Electrolyte balance > Flashcards

Electrolyte balance Flashcards

1
Q

electrolytes to focus on:

A

NA, K, CA, MG, P, CL

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2
Q

electrolytes in body fluids functions, diff of osmolarity/osmolality

A
  • Electrolytes function as a group
    • To promote neuromuscular irritability (how muscles move, how body functions)
    • Maintain body fluid volume and osmolality
      • Osmolality is the measure of the concentrating ability of the kidney (measure of fluid; solvent)
      • Osmolarity is the concentration of particles in the blood. An indication of hydration (275-295 mOsm/kg) (measure of particles; solutes)
    • help distribute body water between fluid compartments
    • regulate acid-base balance
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3
Q

electrolytes

A
  • Solutes are substances that are dissolved in body fluids
    • Nonelectrolytes
      • Do not separate into charged particles
      • Example: glucose
    • Electrolytes
      • Do separate into charged particle
        • Cations (+)
        • Anions (-)
      • Normally total number of+/- charges are equal on both sides of cell, not necessarily the same electrolytes, but the same charge.
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4
Q

regulation mechanisms for electrolytes

A 
Thirst 
Kidneys: Volume and osmolality 
RAA Mechanism: 
   -Responds to hypotension 
        -Vasoconstriction 
        -Na+ regulation 
   -ADH 
         -osmolality
         -blood volume
   -aldosterone
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5
Q

inside the cell is mostly what electrolyte? outside? their charges?

A

inside: mostly K
outside: mostly Na
both have pos charge. big big influencers on charge inside/outside cell

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6
Q

lost electrolytes thru?

A 
-Losses that override bodys homeostatic abilities, theres a problem. losses happen via 
•GI tract 
•Urinary tract 
•Sweat 
•Vomit 
•Nasogastric suctions 
•Wound drainage, hemorrhage
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7
Q

sodium functions

A
  • maintain ECF volume
  • regulate acid base balance with ions
  • conduct nerve impulses
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8
Q

sodium normal

A

135-145 meq/L

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9
Q

what regulates sodium

A

aldosterone, ADH, ANP

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10
Q

hypernatremia pt teaching

A

look in book for pt teaching and tx

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11
Q

hypernatremia definition, causes

A

> 145.
more water is lost than sodium.
causes: cushings syndrome, diabetes insipidus.

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12
Q

hypernatremia leads to?

A

cellular dehydration

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13
Q

hypernatremia s/s

A 
thirst
low grade fever
peripheral/pulmonary edema
postural hypotension
AMS
neuromuscular irritability
coma/seizures
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14
Q

hypernatremia tx

A

oral water replacement

cerebral edema risk if water replacement given too fast

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15
Q

hyponatremia, causes, effect on cells

A

(Low Serum Sodium)
• Water retention, loss or inadequate intake of sodium
• Diuretics
• Vomiting, diarrhea, GI suctioning
• Wound fluid loss
• Overuse of certain IV fluids ( too much 1/2 NS –> hyponatremic blood )
• Cells have reduced ability to depolarize

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16
Q

hyponatremia s/s

A
  • lethargy
  • headache
  • confusion
  • personality changes
  • apprehension
  • seizure, coma
  • brain damage is possible(SIADH)
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17
Q

what electrolyte has the most impt role for tonicity, fluid shifts

A

Sodium has THE most impt role with tonicity, fluid shifts when it comes to composition of blood/interstitial fluid/cells if we could measure them

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18
Q

hyponatremia tx

A

restrict water
intake sodium
oral unless very severe (risks with IV)
treat the underlying cause

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19
Q

potassium functions, normal

A

normal: 3.5-5.5 (narrow therapeutic range)
- intracellular osmolality
- cellular depolarization and repolarization
- cellular integrity
- neuromuscular impulses
- acid base balance
- carbs into energy
- amino acids into proteins
- cardiac contractions (the biggest concern!)

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20
Q

why is potassium important for the body

A

Also plays bigbig role because there’s lot of potassium in cell and also because it has huge impact on cardiac function: we worry if K is outisde normal, high or low, either one puts pt at risk for fatal dysrhythmia. It also has very narrow therapeutic range: 3.5-5.5 per the book

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21
Q

hyperkalemia causes

A

> 5.5

  • increased K intake
  • decreased urinary excretion
  • cellular damage, trauma (crush injuries and such) (Most common electrolyte in the cell: enough cells die from injury and insides of cell leak into bloodstream –> hyperkalemia)
  • inappropriate iv fluids
  • renal failure
  • potassium sparing diuretics
  • severe acidosis
  • sepsis
  • decrease in aldosterone, insulin
  • addison’s disease
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22
Q

hyperkalemia s/s

A
  • irregular pulse
  • irritability
  • ABD distension
  • cramping
  • muscle weakness (sometimes the first sign)
  • paresthesia, numbness
  • diarrhea
  • EKG changes
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23
Q

hyperkalemia ekg changes

A

The first change we will see with hyperkalemia is peaked T waves, but if it gets bad enough then it becomes a fatal dysrhythmia (severe hyperkalemia)

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24
Q

hyperkalemia tx

A

-treat underlying cause
-reduce K intake
-potassium reducing agents
In order from mild to severe tx:
1. loop diuretics (lasix PO) for potassium loss
2. kayexalate PO. Helps K exit body. Exits thru severe diarrhea. But better than having too much potassium. Let pt know, bathroom access.
3. calcium plus glucose (D50) plus insulin: IV calcium, glucose, and insulin. This draws K out of bloodstream because insulin helps open the door so glucose goes in, and K at same time comes out. Stays out. Decreases level very fast. However, it’s still in body unlike Kayexalate (also give them a loop diuretic) so it’ll very slowly go back into blood.
4. dialysis (very bad hyperkalemia)

25
Q

hypokalemia, causes

A

serum potassium <3.5

  • certain diuretics
  • hypomagnesemia
  • GI/renal disorders
  • cushing’s disease
  • elevated insulin
  • vomiting, diarrhea, nasogastric suction
26
Q

hypokalemia s/s

A
  • muscle weakness, cramps
  • n/v
  • paresthesias
  • weak, irregular pulse
  • ekg changes
27
Q

hypokalemia ekg changes

A

atrial and ventricular flat T’s

presence of U waves

28
Q

hypokalemia tx

A
  • treat underlying cause
  • foods high in potassium (it’d actually take like 10 bananas/day to equal the minimum dose of potassium, 10meq)
  • IV only if life-threatening (IV k: Don’t wanna run it any faster than 20meq/hr. Running pure K is very painful, causes site burning (assure pt the IV is fine, the K is just irritating to lining of veins. can ice the site to make the pain better, or slow it down, but better to ice it so pt is not in pain for longer)
  • PO potassium. Don’t wanna give more than 20meq PO at a time, sometimes will see orders for 40, but body won’t absorb it as well at that dose. Usually 20, 4 times a day.
29
Q

calcium functions, normal range

A 
normal: 9-11
helps with:
-neuromuscular transmission
-muscle contraction
-blood clotting
-bones and teeth
-cellular membranes
-energy conversions
30
Q

regulation mechanisms for calcium

A
  • Vitamin D
  • calcitonin
  • parathyroid hormone (One of the biggest diseases affecting Ca is a main pathology)
31
Q

hypercalcemia causes

A
  • primary hyperparathyroidism
  • bone malignancy
  • drug toxicity
  • other less common causes
32
Q

hypercalcemia s/s

A

bone weakness
bone demineralization
cardiac irregularities

33
Q

hypercalcemia tx

A

underlying cause
acute severe cases: furosemide
Drugs: bisphosphonates, glucocorticoids, calcitonin

34
Q

hypocalcemia causes

A
  • decreased PTH
  • elevated phosphorus
  • decreased mg
  • hypoalbuminemia
  • alkalosis
  • Vit D deficiency
  • renal failure
  • pancreatitis
35
Q

hypocalcemia s/s

A
  • dysrhythmia, bradycardia, hypotension
  • numbness of hands, hyperactive reflexes around mouth, bronchioles
  • confusion, hallucinations, anxiety, depression, psychosis
  • seizure
36
Q

hypocalcemia tx

A

oral/IV calcium
monitor phosphorus, Vitamin D
risk for cardiac arrest, hypotension

37
Q

magnesium functions, normal

A

enzymatic activities, neuromuscular interactions, neurotransmission, cardiac contraction, energy conversion, carbohydrate metabolism, protein synthesis

Normal: 1.8-3.0

38
Q

hypermagnesemia causes

A

Renal failure, adrenal insufficiency, IV Mg in obstetrical setting, DKA

39
Q

hypermagnesemia s/s

A
  • Hypotension, bradycardia, respiratory or cardiac arrest.
  • N/V
  • mental changes, respiratory depression, decreased deep tendon reflex
40
Q

hypermagnesemia tx

A

Treat underlying cause

Avoid Mg

Iv administration of supplements to decrease absorption, dialysis, diuretics

41
Q

hypomagnesemia causes

A 
Alcoholism
Diabetes
Loop diuretics
Malnutrition
Vomiting, diarrhea
Malabsorption syndromes
42
Q

hypomagnesemia s/s

A

severe deficiency:

  • Confusion, lethargy, seizures, tetany, deep tendon hyperreflexia, hallucinations
  • N/V
  • HTN, dysrhythmia (ST depression, prolonged QT, SVT)
  • death possibly
43
Q

hypomagnesemia tx

A

oral treatment

IV if severe and acute

44
Q

phosphorus functions, normal

A
  • carbohydrate, lipid, and protein metabolism
  • nerve/ muscle function
  • part of basic energy units
  • cellular and organelle membranes
  • RBCs

Normal: 2.5-4.5

45
Q

phosphorus regulators

A

calcitonin, PTH, vitamin D

46
Q

hyperphosphatemia causes

A

Renal disease, decreased excretion, excessive replacement, overuse of phosphate based enemas, acidosis, cellular destruction

47
Q

hyperphosphatemia s/s

A

deposition of calcium phosphate in soft tissues, dysrhythmias, occurs w/ hypocalcemia

48
Q

hyperphosphatemia tx

A

Phosphorus binding antacids

calcium based antacids

49
Q

hypophosphatemia causes

A

Vitamin D deficiency, bowel disorders, phosphate bind antacids, alcoholism, diabetic ketoacidosis, resp alkalosis

50
Q

hypophosphatemia s/s

A
  • Confusion, apathy, delirium, hallucinations
  • coma, seizure
  • peripheral neuropathy
  • ascending motor paralysis
  • dysrhythmias, hypoxia, heart block
  • resp failure
51
Q

chloride functions, normal

A

Chloride:
Electrical neutrality, Na reabsorption, hydrochloric acid for digestion, bicarbonate.
its main thing is acid-base balance.

Normal: 97-107

52
Q

hypophosphatemia tx

A

Treat underlying cause

High phosphate diet

Avoid phosphate binding antacids

IV for severe cases or bowel dysfunction

53
Q

hyperchloremia causes

A

Acidosis, hyperparathyroidism, dehydration, resp alkalosis

54
Q

hyperchloremia s/s

A

Increased depth and rate of respiration, lethargy, stupor, disorientation, coma

55
Q

hyperchloremia tx

A

look in book

56
Q

hypochloremia causes

A

Loss of GI fluid (vomiting, duodenal ulcer), DKA, bartter’s syndrome

57
Q

hypochloremia tx

A

look in book

58
Q

hypochloremia s/s

A

Hypochloremic alkalosis, paresthesia of face and extremities, muscle spasms and tetany, slow shallow respirations, dehydration

59
Q

main thing about chloride, what to suspect or look at when its abnormal

A

its main thing is acid-base balance. so it’s always hardest lab to address when abnormal. it’s usually very minorly out of range; look at things like dehydration, Parathyroid. mainly think about hydration status for abnormal chloride.

NRSG250 (11 decks)

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