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Electrolytes Flashcards

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1
Q

causes of hyponatremia

A

primary: water imbalance; euvolemic hyponatremia, hypovolemic hyponatremia d/t meds or loss of GI fluids, hypervolemic hyponatremia d/t renal failure or SIADH, excess water, head trauma

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2
Q

manifestations of hyponatremia

A

seizures, stupor (), lethargy, confusion, ABD cramps, poor appetite, overactive bowel sounds, muscle spasms, diminished tendon reflexes, orthostatic hypotension, shallow respirations

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3
Q

managing hyponatremia

A

assess the impacted systems, restrict/replace as needed: restrict water, replace sodium, adjust meds, monitor fluid balance: I/Os, daily weights, labs

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4
Q

causes of hypernatremia

A

increased sodium intake d/t GI feeds w/o supplemental water or hypertonic IV fluids, sodium excretion deficiency, fluid loss, lack of fluid intake, hyperventilation, hypercortisolism, aldosterone production increased

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5
Q

manifestations of hypernatremia

A

fatigue, restlessness, muscle twitching, seizures increased fluid retention, edema, decreased urine, extreme thirst, dry mouth

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6
Q

managing hypernatremia

A

assess for abnormal loss of water or low intake, monitor for CNS changes, gradually lower serum sodium, isotonic/hypotonic fluids slowly infused, restrict sodium intake

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7
Q

causes of hypokalemia

A

potassium loss (d/t meds, increased aldosterone, vomiting, diarrhea, NG tube prolonged suction, diaphoresis, impaired K reabsorption (kidney disease)), inadequate potassium intake, movement from ECF to ICF (alkalosis, hyperinsulinism), dilution of serum potassium (water intox., IVF with potassium deficient sol.)

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8
Q

manifestations of hypokalemia

A

weak irregular pulse, orthostatic hypotension, confusion, lethargy, coma, decreased motility (decreased bowels sounds), nausea, vomiting, skeletal muscle weakness, decreased deep tendon reflex, parasthesias, shallow resp., EKG changes

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9
Q

EKD changes d/t hypokalemia

A

ST depressions, shallow flat or inverted T wave, prominent U wave

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10
Q

managing hypokalemia

A

monitor heart rhythms (cardiac monitor, focused cardiac assess.), assess resp., GI, and renal (urine output, BUN, creatinine), monitor electrolytes, hold potassium-wasting meds, replenish potassium (potassium rich food)

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11
Q

replenishing potassium for hypokalemia

A

levels 2.5-3.5 supplement orally, less than 2.5 supplement IV

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12
Q

causes of hyperkalemia

A

excess K intake (food, meds, or IV sol.), decreased K excretion (K sparing meds, NSAIDs, ACEI, renal disease, adrenal insufficiency), movement for ICF to EXC (tissue damage, acidosis, hyperuricemia, hypercatabolism)

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13
Q

manifestations of hyperkalemia

A

slow irregular pulse, dysrhythmias, hypotension, weakened skeletal muscles, increased motility, hyperactive B.S., diarrhea, muscle spasms, cramping, paraesthesias, profound weakness and paralysis in extrem. at late and lethal levels

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14
Q

EKG changes of hyperkalemia

A

peaked T waves, flat P waves, widened QRS complex, Prolonged PR interval

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15
Q

managing hyperkalemia

A

limit/discontinue intake of K, increase excretion (potassium wasting diuretics, kayexalate for renal impairment, IV hypertonic glucose with insulin, IV calcium to prevent myocardial excitability, monitor K levels, assess cardiac function continuously

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16
Q

causes of hhypocalcemia

A

inadequate oral intake (alcoholism), malabsorption (lactose intol., celiac disease/crohns disease, inadequate vit. D intake, ESRD), increased excretion (renal disease, diarrhea, wound drainage-especially GI), decreased ionized fraction of calcium (chelate or binding meds, acute pancreatitis, hypophosphatemia, removal/drainage of parathyroid glands)

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17
Q

manifestations of hypocalcemia

A

bradycardia, hypotension, diminished pulses, irritable skeletal muscles (twitching, cramp, tetany, seizure), decreased resp., paresthesias, hyperctive deep tendon reflex, anxiety, irritability, increased GI motility, hyperactive BS, cramping, diarrhea, positive trosseau’s and chvosteks

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18
Q

EKG changes for hypocalcemia

A

prolonges SR and QT

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19
Q

trosseaus

A

carpal spasm induced byinflationg of BP cuff

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20
Q

Chvostek

A

contraction of facial muscles in response to light tap over facial nerve in front of ear

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21
Q

management of hypocalcemia

A

replenish Calcium (IV Slowly), increase vit. that increase absorption (vit D, aluminum hydroxide to reduce Phosph, have 10% cal. gluconate available for acute deficit), reduce environmental stim., seizure preacutions, monitor EKG for changes (especially w/ IV calcium), educate calcium rich foods

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22
Q

causes of hypercalcemia (dont need)

A

excessive oral intake (meds, food), increase absorption (excessive vit. D), decreased excretion (renal disease, thiazide diuretics), hemoconcentration (dehydration, lithium, adrenal insufficiency), increased bone resorption (hyperparathyroidism, hyperthyroidism, bone destruction from metastatic tumors, immobility, glucocorticoids)

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23
Q

manifestations of hypercalcemia (dont need)

A

tachycardia (early sign), brady cardia (late sign), HTN, bounding peripherl pulse, profound skeletal muscle weakness, diminished/absent deep tendon reflex, disorientation, lethargy, coma, decreased GI motility, hypoactive BS, anorexia, nausea, distention, constipation, EKG changes

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24
Q

hypercalcemia EKG changes (dont need)

A

shortened ST interval, widened T wave, heart block

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25
managing hypercalcemia (dont need)
limit/discontinue calcium intake (IV infusion, oral meds containing Vit D or calcium), replace thiazide diur. with those that excrete calcium), inhibit reabsorption (meds with phosphorus, calcitonin, or bisphosphonates), monitor for flank or ABD pain (kidney stones), educate pt to avoid calcium rich foods
26
causes of hypomagnesemia
insufficient intake (malnutrition, malabsorption, celia/crohns disease), increased excretion (diuretics, chronic alcoholism, vomiting, diarrhea), intracellular movement (hyperglycemia, insulin, sepsis)
27
manifestations of hypomagnesemia
tachycardia, HTN, shallow resp., twitching, parasthesias, + trosseaus and chvosteks, hyperreflexia, tetany, seizure, irritability/confusion, decreased motility, nausea, EKG changes
28
hypomagnesemia EKG changes
torsades de points : tall T waves, depressed ST segments
29
management of hypomagnesemia
restore mag and calcium (IV mag- initiate seizure precautions and monitor serum mag and assess for loss of deep tendon reflex), oral supps (may cause diarrhea and increased excretion), educate pt on mag rich foods
30
causes of hypermagnesemia (dont need)
increased intake, mag caontaining meds (laxatives, antacids, IV mag), decreased renal excretion d/t insufficiency
31
manifestations of hypermagnesemia (dont need)
bradycardia, disrhythmias, hypotension, skeletal muscle weakness, resp. insufficiency, (if skeletal muscles impacted), diminished/absent DTR, drowsiness, lethargy, coma, EKG changes
32
hypermagnesemia EKG changes
prolonged PR interval, widened QRS complex (dont need)
33
managing hypermagnesemia (dont need)
increase renal excretion w/ diuretics, IV calcium to reverse mag effects on cardiac muscle, educate pt on avoiding mag rich foods, educate pt on avoiding mag rich meds
34
causes of hypophosphatemia (dont need)
insufficient intake (malnutrition), increased excretion (hyperparathyroidism, malignancy, mag based or calcium based antacids, burns), intracellular shift (hyperglycemia, resp. alkalosis)
35
manifestations of hypophosphatemia (dont need)
decreased contractility and cardiac output, slowed peripheral pulses, shallow resp., neuromuscular weakness, decreased DTR, irritability, confusion, seizures, decreased bone density (can lead to bone deformity/FX), rhabdomylosis, decreased platelet aggregation/increased bleeding, immunosuppression
36
managing hypophosphatemia (dont need)
discontinue meds causing low PH, replenish phosphorus levels (oral supps with vit D, IV phosphorus if <1mg/dL, assess renal function prior to supplementing), monitor for signs of pathological FX, monitor serum phosphorus and calcium levels, educate pt on phosphorus rich foods
37
causes of hyperphosphatemia (dont need)
increased intake, decreased excretion, tumor lysis syndrome, hypoparathyroidism
38
manifestations of hyperphosphatemia (dont need)
signs/symptoms of hypocalcemia, bradycardia, hypotension, diminished pulses, irritable skeletal muscles (twitching, cramping, tetany, seizure), decreased resp., parasthesia, hyperactive DTR, anxiety/irritability, increased GI motility (hyperactive BS), cramping, diarrhea, positive trosseaus and chvoleks, EKG changes
39
EKG changes (dont need)
prolonged ST and QT intervals
40
management of hyperphosphatemia (dont need)
manage hypocalcemia (replenish calcium, reduce environment stimuli, initiate seizure precautions, monitor for signs of path. FX, monitor EKG changes (with IV calcium), educate on calcium rich food), admin. phosphate-binding meds (PhosLO), avoid phosphate containing meds (laxatives and enema), educate pt on phosphate rich food
41
causes of hypochloremia (dont need)
decreased intake (low sodium, admin of chloride deficient IV solutions), increased excretion (GI tube drainage, gastric suctioning, gastric surgery, severe vomiting/diarrhea, meds like corticosteroids, bicarb, excessive diuretics, laxatives, excessive sweating, burns), DKA, chronic resp. acidosis, massive blood transfusions, SIADH, increased aldosterone)
42
manifestations of hypochloremia (dont need)
may include hyponatremia and assoc. signs/symptoms, agitation/irritability, tremors, cramps, hyperactive DTR, tetany, seizures, slow/shallow resp, arrhythmias
43
managing hypochloremia (dont need)
monitor ABG and electrolytes, assess LOC and muscle strength and vital signs an resp status often, correct underlying cause and acid-base balance, replenish chloride with NS or half NS, ammonium chloride IV (acidifying agent) or treat metabolic acidosis, educate pt on chloride rich foods and avoid drinking free water
44
causes of hyperchloremia (dont need)
iatrogenic hyperchloremic metabolic acidosis, increase water loss, excess adrenocortical hormone secretion, decreased glomerular filtration rate
45
manifestations of hyperchloremia (dont need)
hypervolemia, HTN, tachypnea, hypernatremia, weakness, lethargy, decreased cognitive ability, severe = decreased CO and arrythmias and coma
46
types of fluid
hypotonic, isotonic, hypertonic
47
isotonic fluids
increases extracellular fluid volume d/t blood loss, volume deficit, dehydration (ex. 0.9% NS, D5W, LR)
48
hypotonic fluids
more dilute solutions; movement of water into the dehydrated space (cells swell); lower sodium concentration so water moves out to higher sodium concen.; treatment for hypernatremia (ex. 1/2 NS)
49
Hypertonic fluids
more concentrated solution; movement of water out of cells (cells shrink); given slowly due to risk for cerebral edema and pulmonary edema (ex. 3% NS); given for hyponatremia
50
colloids
plasma expanders; pull fluid from interstitial compartment into vascular component too increase vascular volume quickly; given for shock or if pt cannot tolerate large volume (e. albumin, fresh frozen plasma)
51
fluid shift: second spacing (edema)
excess accumulation of fluid into the interstitial space; localized d/t traumatic injury, local inflammatory process, burns; generalized d/t cardiac renal or liver failure
52
causes of second spacing
elevated hydrostatic pressure forccing fluid into the tissue space, decrease in plasma oncotic pressure (less proteins to pull water back in), elevated interstitial oncotic pressure, obstruction of lymphatic flow (decreasing removal of interstitial fluid
53
fluid shift: third space
accumulation of trapped extracellular fluid into body space that does not usually hold fluid; representative of volume loss; d/t surgery, trauma, inflammation, infection
54
common spaces of third space fluid shift
pericardium, pleural, peritoneal, abdomen
55
isotonic dehydration
equal loss of water adn electrolytes; decreased circulating blood causing inadequate tissue perfusion
56
hypertonic dehydration
water loss > electrolyte loss (causing hypernatremia); fluid moves from intracellular into plasma (cells shrink) d/t alterations in plasma electrolytes
57
hypotonic dehydration
electrolyte loss > water loss (causing hyponatremia); fluid moves from plasma and interstitial space into cells (cells swell) d/t fluid shifting between compartments and decreasing plasma volume
58
fluid volume deficit clinical manifestations : lab findings
increased serum osmolarity, increased hematocrit, increased BUN, increased serum sodium, increases urine Specific gravity
59
fluid volume deficit clinical manifestations: assessment findings
weak/thready/diminished pulse, decreased BP/ortho., flat neck veins, decreased RR/dyspnea, lethargy/coma, muscle weakness, fever, decreased urine output, decreased skin turgor, dry mouth, diminished bowel sounds, constipation, thirst
60
fluid volume deficit management
oral rehydration/ IV: isotonic dehydration rehydrate with isotonic fluids, hypertonic dehydration with hypotonic, hypotonic dehydration with hypertonic
61
fluid volume overload clinical manifestation: lab findings
decreased serum osmolality, decreased hematocrit, decreased BUN, decreased serum sodium, decreased urine specific gravity
62
fluid volume overload clinical manifestations: assessment findings
bounding pulse, elevated BP. JVD, increased RR/crackles/SOB, altered LOC, weakness, increased UO, edema, diarrhea, liver enlargement, ascites
63
management of fluid overload
diuretics, prevent fluid intake, prepare for dialysis, monitor electrolytes
64
Na electrolyte purpose
Na- water distribution, muscle contraction, nerve impulse
65
K electrolyte purpose
skeletal and cardiac muscle activity
66
Ca electrolyte purpose
bone/teeth structure, nerve impulse, muscle contraction/relaxation
67
MG electrolyte purpose
vasodilate and decrease peripheral vascular resistance to control muscle excitability
68
Ph electrolyte purpose
muscle function, structure for cell and bone
69
Cl electrolyte purpose
maintain acid-base balance, exerts osmotic pressure (with Na), inverse relationship with bicarb

Adults 1 (10 decks)

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