Electrolytes & Imbalances

Question 1

Sodium (daily value, functions, sources)

Answer 1

• Recommended daily value: < 2,300 mg/day of sodium
• Sodium Functions:
  
  • Nerve impulse conduction & muscle contraction
  • Regulates fluid balance inside cells and fluid inside blood vessels, specifically the intracellular fluid (ICF) and extracellular fluid (ECF)
    
    • Osmolality & osmosis:
      
      • Sodium is one of main solutes in blood vessels ⇒ important solute in blood’s osmolality (solute concentration in blood)
      • Osmosis: movement of water from area of lower concentration of solutes to area of higher concentration of solutes
        Foods high in Na+/Sodium: table salt, milk, soy sauce, processed meats (sausage, bacon, ham) or luncheon/deli meats

Question 2

Hypernatremia Results in + S&S

Answer 2

• Results in: when water shift from intracellular space to blood vessels to dilute sodium in blood vessels ⇒ cells shrinks
• ↑ Thirst
• Muscle weakness
• Confusion
• ↓ LOC: sleepy, lethargic, coma
• Rapid ↑ in Na+ or Na+ is critically high ⇒ can lead to seizures

Question 3

Hyponatremia Causes + S&S

Answer 3

• Results in: less sodium in blood stream vs inside cells ⇒ so water in blood vessels will move into cells ⇒ cell swelling and lysis
• Muscle weakness
• Agitation/Confusion
• ↓ LOC: sleepy, lethargic, coma bc brain cells sensitive to fluid balance ⇒ neurological changes
• Rapid ↓ in Na+ or critically low Na+ lvls ⇒ can lead to seizures

Question 4

Hypernatremia Interventions

Answer 4

• Treat underlying cause !!!
  
  • Ie. treating diabetes insipidus by giving hypotonic fluids & vasopressin, bring down glucose via insulin, reduce stress, avoid simple carbs and eat complex carbs, bring fever down by removing covers/ice packs/acetaminophen, lowering RR by treating underlying cause like anxiety or fever
• Put pt on Low Sodium Diet: 1.5 - 2 g/day and eating food < 5% of DV
  
  • Substitute salt for other seasonings (no saltshaker)
  • Know that many salt substitutes contain potassium ⇒ monitor potassium lvls !!!
• Remove restraints q2h & offer hydration, esp if they’re not incline to drink on their own
• Have water/fluids within pt’s reach
• Evaluate enteral & parenteral feeding formula
• Educate older pts abt hydration importance regardless of thirst

Question 5

Hyponatremia Interventions

Answer 5

• Treat underlying cause of hyponatremia
• Fluid restriction for pts w/ SIADH, oliguric/anuric renal disease, HF
• Provide sodium replacement tablets
• Put pt on High Na+ Diet: > 20% DV of Na+ foods
• Let pt have liberal saltshaker use
• ↑ Na+ in IV fluids: consider 3% NaCl hypertonic solution
  
  • Avoid overuse of 0.45% NaCl hypotonic solution irrigating solutions, esp w/ G-tube flushes
• Limit tap water enemas to 3 max to prevent exacerbation of hyponatremia
• Control vomiting via ondansetron (anti-nausea medication)
• Control diarrhea via ↑ soluble fiber intake or treating C. diff
• REMINDER: Don’t ↑ Na+ too fast otherwise it’ll lead to cerebral swelling ⇒ seizures

Question 6

Potassium/K+ Recommended daily values, Functions, Sources

Answer 6

• Recommended daily value: 2,600 - 3,400 mg/day of potassium
• Potassium Functions:
  
  • Maintains resting cell membrane action potential in skeletal, smooth, cardiac muscles
  • Most K+ is inside cell
• Foods high in K+/Potassium: bananas, avocados, potatoes, salt substitutes, Brazil nuts

Question 7

Hyperkalemia Results in + S&S

Answer 7

• Results in: K+ lvls are higher in cells ⇒ cell lysis ⇒ K+ lvls shift from intracellular to bloodstream ⇒ K+ lvls goes up
• Dysrhythmias/Arrhythmias (terms used interchangeably): abnormal heartbeats and rhythm ⇒ can lead to cardiac arrest
• BIL quad muscle weakness
• Abd cramping
• Diarrhea

Question 8

Hyperkalemia Interventions

Answer 8

• Monitor pt’s apical HR and other pulses for 1 min
• Monitor cardiac/ECG
• If appropriate, rehydrate via starting IV fluids, ↑ PO intake
• Administer insulin bc insulin opens channels for glucose to enter into cells so K+ can slip into cell w/ glucose
• If glucose lvls aren’t alrdy high ⇒ give IV solution of 50% dextrose in water (D50) so that this can hide K+ in cell until pt can be dialyzed
• Urgent dialysis can be done to cleanse blood of that extra K+
• Advocate for K+ wasting diuretics like furosemide
• Advocate for Kayexalate (PO/enema) bc it pulls K+ into GI tract for excretion
• ↓ Salt substitutes use
• ↓ K+ rich foods (only eat foods w/ < 5% DV of K+)

Question 9

Hypokalemia S&S

Answer 9

• Dysrhythmias/Arrhythmias (terms used interchangeably): abnormal heartbeats and rhythm ⇒ can lead to cardiac arrest
• BIL quad muscle weakness
• ↓ Bowel sounds
• Abd distention
• Constipation

Question 10

Hypokalemia Interventions

Answer 10

• Advocate for K+ oral or IV replacement
• Stop K+ wasting diuretics
• Monitor pt apical HR and other pulses for 1 min
• Monitor cardiac/ECG
• ↑ K+ rich foods of > 20% DV K+

Question 11

Calcium/Ca+ Functions + Sources

Answer 11

• Calcium Function:
  
  • Stabilizes and excites nerve and cardiac/smooth muscle cells
  • Bone formation and stability
• Foods high in Ca+/Calcium: dairy products, broccoli, oranges

Question 12

Hypercalcemia S&S

Answer 12

• NV
• Constipation
• Fatigue/Weakness
• ↓ Deep tendon reflexes (DTRs)
• Confusion
• ↓ LOC: sleepy, lethargic, coma
• Dysrhythmias/Arrhythmias

Question 13

Hypercalcemia Interventions

Answer 13

• Monitor pt apical HR and other pulses for 1 min
• Monitor cardiac/ECG
• Advocate for IV fluids to dilute Ca+ (and may help w/ constipation)
• Also encourage soluble fiber if they’re constipated
• Tumor removal
• Calcitonin: hormone that tones down amt of Ca+ in bloodstream
• ↓ Ca+ rich foods and encourage eating < 5 % DV of Ca+
• Dialysis: short-term if Ca+ lvls are high and just aiming to clear blood of excess Ca+

Question 14

Hypocalcemia S&S

Answer 14

• Numbness and tingling of fingers, toes, circumoral (around mouth)
• ↑ DTRs
• Tetany: muscle twitching and cramping
  
  • • Chovstek’s sign: where you tap on pt’s cheek and it twitches bc they have hyperactive reflexes
  • • Trousseau sign: where you inflate BP cuff on pt’s arm and it’ll cause hand to contract and make duckbill shape
• Seizures
• OA/Pathological fractures that make bones weaker
• Dysrhythmias/Arrhythmias

Question 15

Hypocalcemia Interventions

Answer 15

• Monitor pt apical HR and other pulses for 1 min
• Monitor cardiac/ECG
• Advocate for Ca+ and Vit. D supplements
• Encourage eating foods high in Ca+ and Vit. D
• Encourage time under sun
• Advocate for phosphate binders if phosphorous is high
• Treat underlying cause of pancreatitis

Question 16

Magnesium/Mg+ Function + Sources

Answer 16

• Magnesium Functions: Stabilizes and excites nerve and cardiac/smooth muscle cells
• Foods high in Mg+/Magnesium: dark green leafy vegetables, whole grains, pumpkin seeds, almonds

Question 17

Hypermagnesemia S&S

Answer 17

• Lethargy
• ↓ DTRs
• Bradycardia
• Hypotension

Question 18

Hypermagnesemia Interventions

Answer 18

• Treat underlying cause
• Monitor HR and BP
• Put pt on cardiac monitor
• If appropriate, hydrate pt to dilute Mg
• Advocate for furosemide to ↑ Mg excretion
• Dialysis

Question 19

Hypomagnesemia S&S

Answer 19

• Insomnia
• Tetany: muscle twitching and cramping (bc cell membrane walls becomes unstable)
  
  • • Chovstek’s sign: where you tap on pt’s cheek and it twitches bc they have hyperactive reflexes
  • • Trousseau sign: where you inflate BP cuff on pt’s arm and it’ll cause hand to contract and make duckbill shape
• Tremors & Seizures
• HTN
• Dysrhythmias/Arrhythmias

Question 20

Hypomagnesemia Interventions

Answer 20

• Assess and monitor BP, Chovstek’s & Trousseau’s signs
• Put pt on cardiac monitor
• Advocate for Mg replacement via oral/IV
• Educate to avoid EtOH
• Alleviate diarrhea and educate on not overusing laxatives
• Advocate for Mg+ sparing diuretic like spironolactone

Question 21

Phosphate/PO Functions & Sources

Answer 21

• Phosphate Functions:
  
  • Part of ATP: main energy source for cells, helping them do work and carrying out processes
  • Works closely w/ Ca+ to form & maintain structural integrity of bones and health
  • PO & Ca+ have inverse relationship: if one goes down other goes up
• Foods high in PO/Phosphate: milk, yogurt, beer, cream soups, deli meat, hot dogs, bacon, sausage

Question 22

Hyperphosphatemia S&S

Answer 22

• S&S: same as hypocalcemia bc when there’s ↓ PO = ↑ Ca+
  
  • Numbness and tingling of fingers, toes, circumoral (around mouth)
  • ↑ DTRs
  • Tetany: muscle twitching and cramping
    
    • • Chovstek’s sign: where you tap on pt’s cheek and it twitches bc they have hyperactive reflexes
    • • Trousseau sign: where you inflate BP cuff on pt’s arm and it’ll cause hand to contract and make duckbill shape
  • Seizures
  • OA/Pathological fractures that make bones weaker
  • Dysrhythmias/Arrhythmias

Question 23

Hyperphosphatemia Interventions

Answer 23

• Low Phosphate Diet which is the Renal Diet: < 700 mg/day
• Phosphate binders taken w/ meals: Ca+ acetate or Ca+ carbonate sevelamer (Renvela)
  
  • Given w/ meals bc they bind w/ foods PO to prevent PO from being absorbed in GI tract
• Dialysis

Question 24

Hypophosphatemia S&S

Answer 24

• S&S: same as hypercalcemia bc when there’s ↑ PO = ↓ Ca+
• NV
• Constipation
• Fatigue/Weakness
• ↓ Deep tendon reflexes (DTRs)
• Confusion
• ↓ LOC: sleepy, lethargic, coma
• Dysrhythmias/Arrhythmias

Question 25

Hypophosphatemia Interventions

Answer 25

- Encourage eating foods ↑ in PO - Advocate for PO oral replacement