Electrolytes Flashcards
(134 cards)
1
Q
K+ normal range
A
3.5-5 mEq/L
2
Q
Na
A
136 to 145 mEq/L
3
Q
Calcium
A
9 to 10.5 mg/dl
4
Q
Mg
A
1.3 to 2.1 mEq/L
5
Q
Active transport
A
Solutes from low concentration to high concentration
6
Q
Ex of active transport
A
Sodium-potassium pump
7
Q
Potassium function in the body
A
- Largest intracellular electrolyte
- Supports transmission of electrical impulses of the body’s nerves and muscles
- Major role in conduction of nerves cells within heart
8
Q
How is K+ Excreted
A
Kidneys are primarily responsible (90%), sweat, digestive tract
9
Q
When administering K+ by IV how much should it be diluted
A
with 100 to 1000 mL of compatible solution, never directly from the vial
10
Q
The dose of potassium should never exceed _________ mEq/L unless ________ ________ is being treated
A
40, severe hypokalemia
11
Q
What rate is potassium normally set at
A
10 to 20 mEq/hour
12
Q
What should be continously monitored when giving potassium
A
ECG monitoring
13
Q
What is assessed during the assessment phase
A
14
Q
If there is a K+ imbalance, what is the most significant change that will be seen in the patient?
A
heart or electrical-related change
15
Q
Primary tubing for continuous infusion should be changed every _______
A
96 hours & when IV site is rotated
16
Q
Secondary tubing should be changed every ________
A
24 hours
17
Q
Infusions containing fat, glucose, or amino acids should be changed every _____
A
24 hours
18
Q
Blood and blood product administration sets should be changed every ______
A
4 hours
19
Q
What is the function of electrolytes in the body?
A
- Maintaining the balance of water
- Balancing pH level
- Moving nutrients into cells
- Moving water out of cells
- Maintaining the function of the body’s muscles, heart, nerves, and brain
20
Q
How do we assess electrolytes in the body?
A
measuring plasma values
21
Q
Where is sodium primarily found?
A
90% is found in extracellular fluid
22
Q
What is the function of sodium?
A
***1. Maintains fluid balance, concentration of EFC, osmotic pressure & blood volume
2. Helps control muscle contraction
3. Regulate nerve impulse transmission
23
Q
How is sodium excreted?
A
Urine, sweat, and feces (kidney is the major regulator)
24
Q
What usually accompanies the loss or gain of sodium?
A
water loss or gain
25
Hyponatremia is a serum level of?
less than 136
26
How is sodium lost?
excessive diaphoresis
overuse of diuretics
wound drainage
kidney disease/low sodium diets
NPO
V/D
Gastric suctioning
27
What is responsible for excessive water gain (overhydration), which lowers the ratio of sodium (dilution)?
Renal failure
Hyperglycemia
HF
excessive ingestion of hypotonic fluids
28
When do s/s of hyponatremia occur?
less than 125 mEq/L
29
The s/s of hyponatremia depend on?
They depend on how rapidly the changes in Na occur. An acute decrease has higher mortality rates than a slow loss.
30
What are s/s of hyponatremia with hypovolemia?
rapid, weak & thready pulse, peripheral pulses difficult to palpate & easy to block, flat neck veins, decreased BP--> dizziness
31
Hyponatremia with hypervolemia S/S
same as fluid overload: bounding pulse & difficult to block, crackles in lungs, pitting edema
32
Priority in NI for hyponatremia
Monitor patient response to therapy to prevent hypernatremia & fluid overload
33
Drug therapy for hyponatremia for fluid deficit
IV saline solutions
34
Drug therapy for fluid excess with hyponatremia
Vaprisol to promote excretion of water (rather than sodium)
35
NI for hyponatremia
Review labs
Assess I&O, mm, skin turgor, edema
Encourage intake of foods with high Na content
Fluid restriction 1000-1200 mL/24hrs
36
What causes hypernatremia?
NPO
Water loss
Fever/infection
Dehydration due to diabetes insipidus w/o adequate water intake
37
S/s of hypernatremia
Thirst, rough/red/dry/swollen tongue
Dry sticky mm
Diminished urine output
Irregular muscle contractions/weakness
Tachycardia, distended neck veins, increased BP
38
Priority NI for Hypernatremia
Monitoring response to Tx to prevent hyponatremia & dehydration
39
NI for hypernatremia
Assess pt hourly
Assess I&O, increase H20 intake, offer fluids
Monitor intake of foods & drugs high in Na
40
What is the treatment for hypernatremia caused by fluid loss?
Give a hypotonic IV solution so that blood serum is less concentrated and the kidneys can excrete excess sodium & water
41
What NI is performed when hypernatremia is caused by poor kidney excretion?
Give diuretics
42
What NI taken when a patient receiving tube feedings is hypernatremic
Give water with tube feedings
43
Where is K+ primarily found?
intracellular
44
What does K+ do in the body
Helps control intracellular fluid balance
Helps in the regulation of acid-base balance through H+ exchange
Support transmission of electrical impulses in nerves & muscles
45
What is the RDA, the recommended daily allowance for K+
3400 mg for men
2600 mg for female
46
What contributes to hypokalemia?
Excessive use of K+ wasting diuretics
V&D
Wound drainage
Prolonged NG suctioning
NPO or inadequate intake
Kidney disease
Laxative use
47
S/S of hypokalemia
A Sic Walt!:
Alkalosis
Shallow respirations
Irritability
Confusion, drowsiness
Weakness, fatigue
Arrhythmias, irregular rate/tachy
Lethargy
Thready pulse
!Decreased motility: N/V, Ileus
48
What is the effect of hypokalemia on digitalis medications?
It increases sensitivity to digitalis, potentiating its action
49
NI of hypokalemia
Assess VS, labs, I&O, Bowel sounds, handgrips, RR
Safety precaution--> risk for falls
Oral replacement
IV replacement (protocol)
50
What are the options for oral replacement to help with hypokalemia?
Salt substitutes (high in K+)
Foods: Baked potato, prune juice, carrot juice, salmon, banana
51
Precautions taken with IV K+ administration
It must never be given IV push
It should always be given slowly and diluted
Recheck labs when the dose is given (2h p)
52
What causes hyperkalemia?
Potassium excess through over ingestion & use of salt substitutes
Decreased excretion: Kidney failure, meds
Tissue damage, acidosis, and uncontrolled DM
53
What are some medications that can cause hyperkalemia?
K+ sparring diuretics, ACE inhibitors, NSAIDs
54
S/S of hyperkalemia
Muscle twitches-->cramps-->paresthesia
Irritability & anxiety
Decreased BP
Dysrhythmias -->Irregular rhythm
Abdominal cramping
Diarrhea
55
ECG changes related to hyperkalemia
peaked T waves, widened QRS complexes, prolonged PR intervals, and potentially disappearing P waves
56
ECG changes related to hypokalemia
flattened or inverted T-waves, ST segment depression, visible U-wave, potentially prolonged QT interval
57
What type of arrhythmias can hypokalemia lead to?
v-tach or v-fib
58
Priotiy NI for Hyperkalemia
Monitoring cardiac complications, patient safety, response to therapy, and patient education
59
Drug therapy for Hyperkalemia
Lasix
Patients with Renal disease: Kayaxalate or dialysis
IV insulin with glucose (hypertonic)
If acidotic, patients receive sodium bicarb
60
How does Lasix reduce K+ in the body?
promotes potassium excretion through the kidneys
61
How does sodium bicarb decrease potassium
It corrects metabolic acidosis & shifts potassium into cells
62
How does insulin reduce potassium?
Insulin stimulates glucose uptake, which also leads to potassium entering cells and leaving the bloodstream. Glucose is given to prevent hypoglycemia.
63
How does Kayexalate correct hyperkalemia?
exchanges sodium for potassium in the GI tract, leading to K+ elimination --> diarrhea
64
How is Kayexalate given?
orally or rectally administered resin
65
Hyperkalemia nursing interventions
Assess labs: electrolytes & renal function
Assess VS, bowel sounds, weakness
Assess for safety: Morse Fall
Collaborate with a Dietitian for Ed
66
If there is a sodium imbalance, what main indicator are we looking for?
volume-related changes
67
What is the main indicator of calcium abnormality?
neuromuscular responses or strength
68
Ionized calcium normal level
4.5 to 5.6 mg/dL
69
Where is most calcium found?
bones and teeth
70
What electrolyte should be corrected in the presence of decreased albumin level?
Calcium
71
Function of calcium in the body?
Maintains bone strength & density
Regulates muscle contraction & relaxation
Role in blood clotting & coag
Nerve impulse transmission
72
What regulates calcium?
Parathyroid hormone & calcitonin
73
What does the absorption of calcium depend on?
An adequate supply of Vitamin D
74
What causes calcium deficiency leading to hypocalcemia?
Inadequate amount of vitamin D
Hormonal changes (menopause)
Hypoparathyroidism
Malabsorption syndromes (celiac & Crohn's)
Diarrhea
Kidney Failure
Wound drainage (especially GI)
75
What effects does hypocalcemia have on the body?
Dysrhythmias, CP, syncope
Numbness, tingling, and muscle cramps
confusion, lethargy, seizures
wheezing, laryngeal spasms
Brittle nails, hair loss, sry skin
76
Positive Chvostek's sign is an indicator of?
hypocalcemia
77
What is a positive Trousseau's sign
Blood pressure cuff inflated on the upper arm above the patient's systolic BP for 2-3 minutes, causing carpopedal spasm (flexion of wrist & thumb, fingers extended), indicating hypocalcemia
78
S/S of hypocalcemia
Loss of bone density, osteoporosis, vertebral compression (loss of height)
79
NI for hypocalcemia
-Drug therapy
-Nutritional therapy
-Quiet environment, low lighting, limited visitors
-Monitor the condition of the airway closely --> stridor can occur
-Seizure precautions
-Check pulse frequently
-Educated individuals at high risk of osteoporosis
80
Drug therapy for hypocalcemia
Oral & IV calcium replacement
Drugs that enhance calcium absorption (Vitamin D & aluminum hydroxide)
Oral meds before meals
81
Which foods are recommended for hypocalcemia
american chees, plain yogurt, almond milk
82
83
What causes hypercalcemia?
Actual excesses
Excessive intake of calcium or vitamin D
Kidney failure
Hyperparathyroidism
CA
Bed rest
84
S/S of hypercalcemia
Abdominal groans, painful bones, kidney stones, psychiatric moans, and fatigue overtones
85
Calcium has an inverse/reciprocal relationship with which electrolyte?
phosphorous
86
NI for hypercalcemia
-PO phosphate (blocks absorption of calcium)
-IV saline followed by diuretics
-Dialysis is used in severe cases
-Cardiac monitoring to identify dysrhythmias & decreased CO
-Mobilize pt
-Safety precautions--> risk for falls
87
Why does hypercalcemia require safety precautions?
Calcium is leached from bones, causing weakness
88
What effect does cranberry juice have on calcium?
CJ keeps urine acidic, which favors calcium solubility
89
What effect does forcing fluids have on calcium?
Eliminates calcium and prevents kidney stones
90
Normal phosphorus levels
2.5 - 4.5 mg/dL
91
Where is phosphorus found?
85% in bones & teeth
14% in soft tissues
92
Function of phosphorus in the body?
Helps maintain acid-base balance (H+ buffer)
Essential for energy production (ATP)
Role in bone & teeth formation, muscle & RBC function
93
What regulates phosphorus?
Parathyroid hormone and it is activated by vitamin D
94
What is the primary route of phosphorus excretion?
kidneys
95
Hypophosphatemia serum level
below 2.5 mg/dL
If phosphate is low, calcium is high
96
What causes hypophosphatemia?
malnutrition & starvation
Hypercalcemia/hyperparathyroidism
KF
Resp alkalosis
Uncontrolled DM
Chronic alcohol abuse
97
S/S of hypophosphosphatemia
Shallow respirations, low energy levels
Muscle weakness, bone pain or Fx
Irritability, confusion, seizures
98
NI for hypophosphatemia
-Stop the medication causing low P
-Drug therapy
-Nutritional therapy
99
Which medications contribute to low phosphate?
antacids, calcium supplements
100
What medications are given for low hypophosphatemia?
-Mix oral powder replacement of phosphorus supplement with chilled or ice H20 (tastes better) and give with Vitamin D
-IV phosphorus is given slowly
101
What foods are high in phosphorus?
fish, beef, chicken, pork, nuts, whole grain breads & cereals
102
What causes hyperphosphatemia?
Decreased excretion r/t renal insufficiency
Increased intake of phosphorus
Hypocalcemia (Hypoparathyroidism)
103
S/S of hyperphosphatemia
Same as with hypocalcemia:
-muscle cramps & weakness
Positive Trousseau's & Chvostek's signs
decreased mental status
hyperreflexia
long-term deficits -->soft tissue calcification
104
NI for hyperphosphatemia
Drug therapy
Safety precautions--> seizure precautions
Quiet environment, low lighting, limit visitors
105
Drug therapy for hyperphosphatemia
oral & IV calcium replacement
Meds that enhance calcium absorption: Vit D & aluminum hydroxide
106
Where is the majority of Mg found?
bones
107
Function of magnesium
-Important for metabolizing carbs & proteins
-Assist in the regulation of nerve & muscle function
-Regulates blood pressure, blood sugar levels, and bone health
108
What are the causes of Hypomagnesemia
-Inadequate intake: malnutrition, starvation, diarrhea, malabsorption disease (Crohn's, Celiac)
-Chronic alcoholism is the most common cause**
-Medications
109
What medications cause hypomagnesemia
diuretics, certain antibiotics, proton pump inhibitors
110
Examples of PPIs
Prilosec (Omeprazole), Protonix (Pantoprazole), the -"zoles_
111
S/S of hypomagnesemia
EKG changes, dysrhythmias
weakness, tetany, seizures
N/V, fatigue
Shallow respirations
Numbness & tingling, cramps
Irritability, confusion, psychosis
112
NI for hypomagnesemia
Restoring mag & other electrolytes by IV or PO
Nutritional therapy
113
Foods containing Magnesium
Fish, artichokes, spinach, black or navy beans, nuts, pumpkin seeds, barley & wheat
114
What are the causes of Hypermagnesemia?
Increased magnesium-containing antacids & laxatives (MOM)
Decreased excretion r/t kidney failure
115
S/S of hypermagnesemia
Bradycardia, hypotension, dysrhythmias
Decreased reflexes
If it is a severe: seizure, coma, or cardiac arrest
116
Chloride normal range
98 to 106 mEq/L
117
NI of hypermagnesemia
Dialysis for the patient with renal failure
Loop diuretics
Stop use of antacids/laxatives
IV calcium to suppress manifestations of hypermagnesemia
118
normal chloride serum level
98-106 mEq/L
119
Where is the greatest concentration of Cl
80% in ECF, with the majority in lymph & interstitial fluids
120
Function of Cl in the body
Role in acid-base balance in combining H+ ==> hydrochloric acid
Maintains osmotic pressure & fluid balance with Na
121
Where is Cl primarily obtained from?
diet as table salt
122
What causes hypochloremia
V/D, profuse sweating, GI suctioning, Diuretics, decreased intake
123
S/S of hypochloremia
Muscle spasms, SOB, hypotension
124
NI for hypochloremia
-Assess labs
-Encourage high-sodium foods
-Meds: Antiemetics & anti-diuretic, DC use of diuretics
125
Hyperchloremia causes
Very rare
May occur with dehydration, hypernatremia, and metabolic acidosis
126
S/S of hyperchloremia
HTN, weakness, confusion
127
Interventions for Hyperchloremia
correct fluid balance & underlying cause
Administer IV hydration
Continually monitor LOC
Assess labs
128
Mg abnormalities will show up as..
electrical activity ==> nerve conduction--> nervous system, cardiovascular, muscle function
129
Which electrolytes are directly affected along with Mg?
Mg, Ca, K
130
Phosphorus will affect...
Energy/ATP
131
What is 2nd most abundant electrolyte in cell?
Mg
132
133
What electrolyte does Mg regulate
Calcium in the smooth muscle (Mg is a Ca antagonist)
134
Alcohol inhibits the absorption of which electrolyte
Inhibits absorption of Mg in the GI tract and gets excreted through the kidneys ( can also cause pancreatitis, which decreases Mg)
