Electrolytes Flashcards

Question

How is K+ regulated?

Answer 1

➢Regulated by the kidneys through excretion and aldosterone ➢Regulated by the Na-K pump

Answer 2

➢Mg++, Ca++ usually decreased with hypokalemia (Mg++ more than Ca++) ➢Mg++ acts as a modulator facilitating the movement of Na+ and K+ through the Na+-K+ pump inverse relationship with Na

Answer 3

➢The most abundant cation in the body stored in the bones and teeth ➢Calcium enters the body by dietary intake, absorbed through the intestinal tract, and stored in the bones. ➢ Two forms: Bound – attached to albumin Ionized – free, active form that must be kept within range. ➢Maintains bone strength and density ➢Activates enzymes Allows *skeletal and cardiac muscle contraction* ➢Controls *nerve impulse transmission* by regulating the movement of Na+ across membranes. *➢Membrane stabilizer (essential in stabilizing cardiac membrane)* ➢Allows blood clotting

Answer 4

➢Regulated by parathyroid hormones (increases) and thyrocalcitonin (decreases) ➢Vitamin D needed for absorption

Answer 5

➢Phos --inverse relationship ➢Mg++ - directly related ➢Bound Ca++ (which is commonly tested) is directly related to Protein

Answer 6

➢Mostly stored in bones and cartilage ➢It has a *vasodilatory effect on the cardiac system* ➢It has a *relaxing effect on the nerves* ➢Essential for cardiac function ➢Carbohydrate metabolism and Vitamin activation ➢ATP (energy) formation and cell growth ➢Regulates blood coagulation, skeletal muscle contractility, and smooth muscle relaxation *➢Required for Ca++ and Vit. B12 absorption*

Answer 7

Regulated by the kidneys and intestinal tract

Answer 8

➢Mg++, Ca++ usually decreased with hypokalemia (Mg++ more than Ca++) ➢Mg++ acts as a modulator facilitating the movement of Na+ and K+ through the Na+-K+ pump ➢Ca++ directly related

Answer 9

➢Major intracellular anion ➢Mostly found in the bones (80%) ➢Nearly present in all foods and absorbed efficiently in the jejunum ➢Activates vitamins and enzymes ➢Forms adenosine triphosphate (ATP) for energy supplies ➢Assists in bone mineralization and cell growth ➢Acid-base balance Calcium homeostasis ➢Regulation of nerve impulses, HR, muscle contraction

Answer 10

➢Regulated by parathyroid hormones ➢Regulated by renal excretion ➢Na+-mediated transport mechanism

Answer 11

Ca++ inverse relationship

Answer 12

➢ Major extracellular anion ➢ Enters the body through dietary intake ➢Regulates acid-base balance ➢Produces HCl acid ➢Regulates ECF balance ➢Acts as a buffer in O2-CO2 exchange ➢Maintains osmotic pressure

Answer 13

➢Regulated by the kidneys through aldosterone, antidiuretic hormone, and natriuretic peptide

Answer 14

➢Regulated by the kidneys through aldosterone, antidiuretic hormone, and natriuretic peptide

Answer 15

Na++ direct relationship HCO- inverse relationship

Answer 16

➢Dehydration or Hypovolemia

Answer 17

Overhydration or Hypervolemia

Answer 18

➢Patient safety: Monitor VS, mental status, muscle strength, and gait ➢Drug therapy: anti-diarrheal, antibiotic, anti- emetic, anti-pyretic ➢Fluid therapy: Oral hydration; IV fluid (see IV Fluid Management of FVD below). Monitor for fluid overload and IV site, weigh daily, I&O ➢Patient Education: Adequate hydration throughout the day, avoid falls/injuries, identify risks

Answer 19

➢Patient safety: Monitor VS, peripheral edema, skin breakdown, respiratory status, mental status, cardiac status ➢Drug therapy: diuretics, conivaptan, or tolvaptan. Monitor response to therapy, weigh daily, I&O ➢Nutrition therapy: Fluid and diet restrictions ➢Patient Education: Identify risks, appropriate diet choices, weight gain

Answer 20

RESUSCITATE FIRST, then MAINTAIN. REPLACE or REDISTRIBUTE as appropriate. ASSESS always! If there are signs of hypotension and tissue hypoperfusion (SBP \<100, HR \>90, RR \>20, capillary refill \> 2 seconds, peripheries cold to touch, altered mental status) → give isotonic solutions ***Note: Isotonic solutions do not shift between the compartments, which effectively expands intravascular (EFC) volume and improve BP.*** Once BP has stabilized→maintain, replace, or redistribute to sustain cellular needs • If hypernatremic, give hypotonic solutions or dextrose- containing crystalloids ***Note: Hypotonic solutions hydrate the cells because they shift from EFC to IFC – watch for cerebral edema. Initially considered hypertonic, dextrose-containing solutions become isotonic or hypotonic once the dextrose is metabolized. For example, D5NS becomes isotonic, and D51/2NS becomes hypotonic.*** If hyponatremic, give isotonic solutions In symptomatic hyponatremia - give hypertonic solutions (3-5% Normal Saline) slowly to prevent Central Pontine Myelinolysis (also known as Osmotic Demyelination Syndrome). Patients with chronic hyponatremia (occurring \> 48 hours) are more prone to this condition with rapid correction than those with acute hyponatremia. ***Note: Hypertonic solutions are used to treat symptomatic hyponatremia, volume resuscitation in critical care, and prevention of cerebral edema in Traumatic Brain Injury (TBI).***

Answer 21

1. Hypotonic solutions: 1. \< 270 mOsm/L 2. Isotonic solutions 1. 270-300 mOsm/L 3. Hypertonic solutions 1. \> 300 mOsm/L

Answer 22

Crystalloid: 0.45% NaCl (½ normal saline)

Answer 23

1. Crystalloid: 0.9% NaCl (normal saline/ NS) 2. Balanced solution: Lactated Ringers (LR) 3. *Electrolyte-free (Dextrose) solutions: 5% Dextrose (D5W)* \*\*\* once dextrose is metabolized, it becomes hypotnic\*\*\*\*

Answer 24

1. Crystalloids: 3-5% NaCl 2. Crystalloid containing Dextrose solutions: 1. 10% Dextrose (D10W) 2. 5% Dextrose in 0.9% sodium chloride (D5NS) 3. 5% Dextrose in 0.45% NaCL (D5½NS) 4. 5% Dextrose in lactated ringers (D5LR) \*\*Once dextrose is metabolized, the remaining crystalloid portion determines tonicity\*\*

Answer 25

Sodium imbalances occur with fluid imbalances because the same hormones regulate both sodium and water balance. * Hyponatremia can occur in the setting of FVD or FVE.* * Hypernatremia can occur in the setting of FVD or FVE.* Cerebral changes are mainly seen in hyponatremia due to cerebral edema and increased intracranial pressure. Muscle weakness, spasms, and twitching occur due to a compromised transmission of nerve impulses. Assess respiratory status if muscle weakness is present.

Answer 26

* Patient safety: Monitor response to therapy; Skin protection; Seizure precaution if severe; Monitor for hypernatremia, fluid overload, neuro status, VS, and I&O * Nutrition therapy: High Na+ intake; Restrict fluid intake (if ass. with hypervolemia); Adequate fluid intake (if ass. with hypovolemia)

Answer 27

* reduce diuretic doses * w/ hypervolemia: (dilutional hyponatremia) * Tolvaptan or conivaptan (removes water but keeps Na+) * w/hypovolemia: normal saline * with hypovolemia + neuro symptoms: hypertonic solution (3-5% normal saline)

Answer 28

Patient Education: Identify risks; Appropriate diet choices; Monitor weight

Answer 29

Patient safety: Monitor response to therapy; Skin protection; Seizure precaution if severe; Monitor for hyponatremia, dehydration, neuro status, VS, and I&O Nutrition therapy: Na+ restriction; Restrict fluid intake (if ass. with hypervolemia); Adequate fluid intake (if ass. with hypovolemia)

Answer 30

* with hypervolemia: loop diuretics * with hypovolemia: isotonic solution to resuscitate * Once BP is stable, hypotonic or D5W

Answer 31

Identify risks; Appropriate diet choices; Monitor weight

Answer 32

K+ imbalances are life-threatening as K+ affects all body systems, particularly the heart. *Cardiac monitoring for dysrhythmias is critical*: PVCs, conduction delays, ventricular fibrillation, and heart blocks. Tall T waves (hyperkalemia) or presence of U wave (hypokalemia) on ECG. In symptomatic hyperkalemia, giving calcium stabilizes the cardiac membrane to prevent lethal dysrhythmias. Patients at the highest risk for hyperkalemia include those with renal dysfunction, chronically ill, debilitated patients, and older adults. Patients at the highest risk for hypokalemia include those with CHF and on diuretics. In hypokalemia, o Assess respiratory status if muscle weakness is present. o Monitor for common clinical complaints of leg cramps and constipation. o Watch for digoxin toxicity.

Answer 33

Patient safety: Adequate oxygenation; Fall prevention; Injury prevention from K+ administration; Monitor response to therapy; Monitor for hyperkalemia, metabolic alkalosis, cardiac status, respiratory status, muscle weakness, constipation, and VS Drug therapy: K+ oral supplements; K+ IV infusion (essential to know proper administration); Discontinue medications causing the imbalance Nutrition therapy: High K+ diet Patient Education: Identify risk; Appropriate food choices; Early detection of complications

Answer 34

Do not give intravenous potassium at a rate higher than 20 mEq per hour. Never give potassium supplements by the intramuscular, subcutaneous, or IV push routes. Use a pump or controller when giving intravenous potassium-containing solutions. Assess the IV site hourly – stop infusion if infiltration or phlebitis is suspected. Give oral potassium during or after a meal to avoid nausea and vomiting

Answer 35

Patient safety: Cardiac complications; Fall prevention; Monitor response to therapy; Monitor for hypokalemia, metabolic acidosis, cardiac status, and VS Drug therapy: Discontinue medications causing the imbalance; IV Calcium (if cardiac symptoms are present); IV glucose and insulin; IV HCO3; Sodium Polystyrene Sulfonate; Loop Diuretics; Patiromer (a new drug that decreases absorption of K+ in the GI tract); Sodium Zirconium Cyclosilicate (a new drug that works on the GI tract to lower K+) Hemodialysis Nutrition therapy: Low K+ diet Patient Education: Identify risks; Appropriate food choices; Early detection of complications

Answer 36

• Neuromuscular changes (paresthesia, tingling, numbness, and tetany) occur, particularly in hypocalcemia. These tests are also used in hypomagnesemia. o Trousseau sign - carpopedal spasm when BP cuff inflated (Fig. 11.13) p. 180 o Chvostek's sign – facial twitching when facial nerve tapped (Fig. 11.14) p. 180 • Hypocalcemia may cause laryngospasms – watch respiratory status. • Hypercalcemia o Cardiac dysrhythmias can occur – cardiac monitoring is essential. o May further increase the risk of clotting in those who are predisposed to blood clots. Patients with chronic renal failure will most likely have hypocalcemia due to hyperphosphatemia. Hyperphosphatemia must be treated with hypocalcemia.

Answer 37

o Postmenopausal women are at risk for chronic calcium loss due to reduced weight-bearing activities and decreased estrogen levels. o Patients with chronic hypocalcemia will have brittle, fragile bones – use lift sheets when repositioning to prevent fractures. o Chronic hypocalcemia may further increase the risk of bleeding related to delayed clotting.

Answer 38

Patient safety: Reduce environmental stimuli; Prevent injury – fractures from chronic hypocalcemia; Seizure precaution if severe; Monitor for hypercalcemia, K+, Mg++, Vit D, PTH levels, cardiac status, respiratory status, neuromuscular status, VS, skeletal – for chronic hypocalcemia, and delayed clotting Drug therapy: Ca++ oral/IV replacements; Vit D supplement Aluminum hydroxide Nutrition therapy: High calcium diet; Low phosphate diet Patient Education: Identify risks; Appropriate food choices

Answer 39

Patient safety: Cardiac complications; Monitor for hypocalcemia, cardiac status, neuro status, intestinal status, VS, and blood clotting Drug therapy: Discontinue medications causing the imbalance (lactated ringers, thiazide diuretics, Vit. D); Loop diuretics; Bisphosphonates (pamidronate) – for malignancy-associated hypercalcemia; Calcitonin – to inhibit bone resorption; IV fluid therapy Hemodialysis Nutrition therapy: Low Ca++ diet; High phosphate diet Patient Education: Identify risks; Appropriate food choices

Answer 40

• Imbalances have a *sedating effect on the nerves and a vasodilatory effect on the cardiac muscle*. o Hypo – neuromuscular Irritability o Hyper – neuromuscular depression The key characteristic of hypermagnesemia is severe hypotension with nausea and sometimes vomiting. With symptomatic hypermagnesemia, giving calcium stabilizes the cardiac membrane to prevent lethal dysrhythmias. Hypomagnesemia is common in the critically ill and is associated with hypokalemia and hypocalcemia - treat all imbalances Oral Mg++ can cause diarrhea and thereby increases Mg++ loss. Avoid administering magnesium sulfate by the intramuscular route – it causes pain and tissue damage. Assess for depressed DTR, neuro status, and hypotension during the administration of IV Mg++.

Answer 41

Patient safety: Reducing environmental stimuli; Preventing injury; Seizure precaution if severe; Monitor for hypermagnesemia, K+, Ca++ levels, cardiac (torsades), neuromuscular status, intestinal status, and VS • Drug therapy: Discontinue medications causing the imbalance; Oral Mg++ supplements (watch for diarrhea); IV MgSO4 (if severe); Ca++ replacement (if accompanied by hypocalcemia); K+ replacement (if accompanied by hypokalemia) • Nutrition therapy: High Mg++ diet • Patient Education: Identify risks, appropriate food choices

Answer 42

Patient safety: Cardiac complications; Monitor for hypomagnesemia, cardiac (bradycardia, hypotension), mental status, neuromuscular status, intestinal status, and VS Drug therapy: Discontinue medications causing the imbalance; Loop Diuretics; IV fluid therapy Hemodialysis Nutrition therapy: Low Mg++ diet Patient Education: Identify risks, appropriate food choices

Answer 43

Body functions are not usually affected by an acute imbalance. Chronic hypophosphatemia is commonly seen in musculoskeletal changes Issues associated with Phosphate imbalances are r/t Ca++ imbalances. Management of one imbalance entails the management of the other.

Answer 44

Malnutrition Starvation Use of aluminum hydroxide-based antacids Use of magnesium-based antacids Hyperparathyroidism Hypercalcemia Kidney failure Malignancy Hyperglycemia Hyperaliminetaion Respiratory alkalosis Uncontrolled DM Alcohol abuse

Answer 45

Cardiac: Weak contractility, decreased stroke volume, decreased cardiac output, weak peripheral pulses Musculoskeletal: weakness leading to rhabdomyolysis, respiratory failure Neuro status: Irritability and seizure (only if severe)

Answer 46

Nutrition therapy: High phosphate diet; Low Ca++ diet Patient Education: Identify risk, Appropriate food choices * Patient safety: Fall precaution; Monitor for hyperphosphatemia, hypocalcemia, neuro status, cardiac status, musculoskeletal, and VS * Drug therapy: Treat cause; Discontinue medications causing the imbalance; Oral phosphate with Vit D supplement; IV phosphates (for Phos \< 1mg/dL); Cinacalcet

Answer 47

* Decreased kidney excretion resulting from kidney disease * Tumor lysis syndrome * Increased intake of phosphorus * Hypoparathyroidism

Answer 48

• Consistent with the manifestations of hypocalcemia

Answer 49

Patient safety: Reduce environmental stimuli; prevent injury – fractures from chronic hypocalcemia; Seizure precaution if severe; monitor for hypercalcemia, K+, Mg++, Vit D, PTH levels, cardiac status, respiratory status, neuromuscular status, VS, skeletal – for chronic hypocalcemia, and delayed clotting Drug therapy: Treat cause; Phosphate binders (sevelamer) – must be given with food; Ca++ oral/IV replacements; Vit D supplement; Aluminum hydroxide; IV fluid therapy; Loop diuretic or acetazolamide Hemodialysis Nutrition therapy: Low phosphate diet; High Ca++ diet Patient Education: Identify risks; Appropriate food choices

Answer 50

Imbalances usually occur as a result of other electrolyte imbalances – correct other electrolyte or acid-base problems. Hyperchloremia is associated with metabolic acidosis Hypochloremia is associated with metabolic alkalosis

Answer 51

Vomiting Diarrhea Gastrointestinal suction Renal failure combined with salt deprivation Overtreatment with diuretics Chronic respiratory acidosis Diabetic ketoacidosis Excessive sweating SIADH excretion Salt-losing nephropathy Acute intermittent porphyria Water intoxication Expansion of extracellular fluid volume Adrenal insufficiency Hyperaldosteronism Metabolic alkalosis Use of certain drugs like chronic laxative or bicarbonate ingestion, corticosteroids, and diuretics

Answer 52

• Hyperirritability Tetany or muscular excitability Slowed respiration Hypotension secondary to fluid loss

Answer 53

Renal failure Nephrotic syndrome Dehydration Overtreatment with normal saline Hyperthyroidism Diabetes insipidus Metabolic acidosis from diarrhea (loss of HCO3–) Respiratory alkalosis Hyperadrenocorticism Use of certain drugs - acetazolamide (hyperchloremic acidosis), androgens, hydrochlorothiazide, salicylates (intoxication)

Answer 54

Weakness • Lethargy Unconsciousness (usually a late sign) Kussmaul respirations

Answer 55

➢ Assure patient safety. ➢ Use a gait belt when assisting a patient with muscle weakness to walk or transfer. ➢ Assess patient respiratory status if muscle weakness is present. ➢ Do not give oral fluids to an unconscious patient. ➢ Schedule offerings of feedings throughout the day if the patient has cognitive impairments or limited mobility. ➢ Offer or perform oral care at least every 4 hours. ➢ Use a pump or controller to deliver intravenous fluids to patients with fluid overload.

Answer 56

➢ Maintain adequate fluid intake (at least 2-3 L/day unless contraindicated). ➢ Increase fluid intake when exercising, in hot or dry environments, or during conditions that increase metabolism, such as fever. ➢ Take daily weights on the same scale, close to the same time each day, and with about the same amount of clothing each time - monitor for changes or trends. ➢ Caffeine and alcohol can cause dehydration. ➢ Read food labels to determine the electrolyte content of processed foods. ➢ Consider the patient's food preferences/dislikes and the person preparing the food when planning an electrolyte-restricted diet. ➢ Follow dietary restrictions and recommendations. ➢ Report changes in symptoms

Answer 57

Worcestershire sauce, soy sauce, onion salt, garlic salt, bouillon cubes, processed meats like bacon, sausage, and ham, canned soups, canned vegetables, fast foods

Answer 58

All meats (red meat and chicken) and fish, such as salmon, cod, flounder, sardines, soy products, veggie burgers., broccoli, peas, lima beans, tomatoes, potatoes (particularly their skins), sweet potatoes, winter squash, citrus fruits, cantaloupe, bananas, kiwi, prunes, and apricots, milk, yogurt, and nuts

Answer 59

Yogurt, most cheeses, buttermilk, milk, green leafy vegetables such as broccoli, collards, kale, mustard greens, turnip greens, Chinese cabbage, salmon, and sardines canned with their soft bones, almonds, Brazil nuts, sunflower seeds, tahini, dried beans, blackstrap molasses, orange juice, soy milk, tofu, ready-to-eat cereals, and bread.

Answer 60

Meat, milk, processed foods that contain sodium phosphate, whole-grain bread, cereals

Answer 61

Bananas, dried apricots, avocados, nuts, peas, beans, seeds, soy products, whole grains, milk

Electrolytes Flashcards

(93 cards)