Exam 1 - Electrolyte Balance Flashcards
Exam 1 (95 cards)
1
Q
Electrolytes are…
A
substances that become charged particles (ions) when they are in water
2
Q
Na normal values
A
136-145 mEq/L
3
Q
K normal values
A
3.5-5.0 mEq/L
4
Q
Ca normal value
A
9.0-10.5 mg/dL
5
Q
Mg normal value
A
1.3-2.1 mEq/L
6
Q
_____ helps regulate intravascular volume
A
Sodium
7
Q
What is the main role of Potassium?
A
Support the transmission of electrical impulses within the heart and muscles
8
Q
90% of K is excreted through the ____.
A
Kidneys
9
Q
Administration of insulin will increase cellular uptake of _____.
A
K
10
Q
What are the roles of electrolytes?
A
(1) Balance body fluids
(2) Regulate heart rhythm
(3) Support nerve and muscle function
(4) Move nutrients and waste
11
Q
Process of regulating plasma concentrations of electrolytes
A
Electrolyte balance
12
Q
The main goal of electrolyte balance is what?
A
Intake matches output
13
Q
Electrolyte balance is maintained by 3 physiological processes:
A
(1) Intake and absorption
(2) Distribution
(3) Output
14
Q
Movement of electrolytes into various body fluid compartments
A
Distribution
15
Q
Loss of electrolytes through normal and abnormal routes
A
Output
16
Q
NG tubes and drains are high risk for ____
A
electrolyte imbalances
17
Q
Name at least 3 risk factors for electrolyte imbalance (7)
A
(1) age
(2) neurological deficits
(3) disruption of phys processes
(4) changes in body fluid levels
(5) kidney disease
(6) endocrine disorders
(7) medications
18
Q
Lisinopril is what type of medication?
A
ACE Inhibitors
19
Q
Lisinopril is associated with what electrolyte imbalance?
A
Hyperkalemia
20
Q
What are the two monitoring parameters for patients on lisinopril?
A
BP and K levels
21
Q
NSAIDs are associated with what electrolyte imbalances?
A
Hyponatremia; hyperkalemia
22
Q
Thiazide diuretics are associated with what electrolyte imbalances?
A
hyponatremia; hypokalemia
23
Q
Laxatives can contain what electrolyte?
A
Mg
24
Q
Location where specific electrolyte is in high amount is the…
A
electrolyte pool
25
Poor dietary intake and no access to water can both lead to _____ output and ____ intake
Normal output, not enough intake or absorption
26
Diarrhea, vomiting, and gastric suctioning can all lead to ____ output and ____ intake
Increased output, not enough intake or absorption
27
High doses of steroids can lead to ____ output and _____ intake
Increased output, not enough intake or absorption
28
Rapid infusion, too much water intake, and massive blood transfusion lead to ____ output and ____ intake
Normal output, excessive intake
29
Impaired kidney function and lack of aldosterone leads to ____ output and ____ intake.
Decreased output, normal intake
30
Rapid shift of K from ECF to ICF can lead to what type of imbalance?
Altered distribution
31
Mg and Ca imbalances impact the release of ____, which leads to _____
Ach; change in the speed of ions through nerve and muscle membranes
32
Imbalances of which electrolytes can lead to impaired perfusion and oxygenation?
K, Mg, Ca
33
Severe ___ can lead to cardiac arrest
hyperkalemia
34
Name at least 3 clinical manifestations of hypernatremia
(1) extreme thirst
(2) confusion, disorientation
(3) restlessness
(4) muscle twitching, weakness
(5) tachycardia, ortho hypo, hyperthermia
35
In hyponatremia with normal fluid volume, HR is ____
rapid
36
In hyponatremia with hypovolemia, HR is ___
thready, weak, rapid
37
In hyponatremia with hypervolemia, HR is ___-
rapid, bounding
38
Name at least 3 clinical manifestations of hypokalemia
(1) Muscle weakness
(2) dysrhythmias
(3) respiratory failure
(4) altered mental status
(5) abdominal distention
(6) constipation
39
During phase 1 of hyperkalemia, what are the clinical manifestations?
skeletal muscle twitching, tingling, burning sensation, numbness
40
During phase 2 of hyperkalemia, what are the clinical manifestations?
Flaccid paralysis; can impact respiratory muscles
41
In phase 2 of hyperkalemia, what is a common sign on the ECG?
very tall T wave
42
Which type of calcium imbalance is more common?
Hypocalcemia
43
the abnormal twitching of muscles that are activated by the facial nerve
Chvostek's sign
44
Chvostek's sign is typically an indicator of what imbalance?
Hypocalcemia and hypomagnesemia
45
Involuntary contractions of the muscles in the hand and wrist
Trousseau's sign
46
Trousseau's sign is typically an indicator of what imbalance?
Hypocalcemia and hypomagnesemia
47
Name the 4 key nursing interventions r/t electrolyte imbalances.
(1) Seizure precautions
(2) Fall risk
(3) Oral care
(4) mobility
48
Seizure precaution is particularly important for which imbalances?
Ca and Mg imbalances
49
Fall risk is associated with what clinical manifestation?
Muscle weakness
50
Pts with Ca imbalances may have painful spasms, which impair ____.
mobility
51
Which electrolyte imbalances lead to increased excitability?
(1) hypernatremia
(2) hyperkalemia
(3) hypocalcemia
(4) hypomagnesemia
52
5% Dextrose in Water (D5W)
isotonic
53
D10W
Hypertonic
54
Ringer’s lactate
isotonic
55
5% dextrose in Ringer’s Lactate
hypertonic
56
What are the most obvious problems of hyponatremia?
Cerebral changes
57
If muscular weakness is present, what should the nurse assess next and why?
Respiratory effectiveness because ventilation depends on adequate strength of respiratory muscles
58
What are the nursing priorities during interventions for imbalances?
(1) monitor pt response to therapy
(2) prevent opposite imbalance and fluid overload
59
How do you treat hyponatremia with low fluid volume?
IV saline (isotonic)
60
How do you treat hyponatremia with high fluid volume?
drugs that promote excretion of water and not sodium
61
Severe hyponatremia should be treated with what?
3% saline (hypertonic)
62
During hypernatremia, irritability can occur, which is what?
excitable tissues become more easily exicted; over-respond to stimuli
63
Cushing syndrome and corticosteroids are associated with what imbalance?
Hypernatremia
64
Hypernatremia with hypovolemia has what effect on HR and BP?
Increased HR, hypotension
65
Hypernatremia with hypervolemia has what effect on HR and BP?
slow to normal HR; neck veins distended; high BP
66
If you have hypernatremia due to lack of kidney excretion, what drug can you use?
Furosemide
67
total body K levels are normal but K distribution b/w fluid spaces is abnormal or diluted by water
Relative hypokalemia
68
Rapid infusions of ____ can lead to relative hypokalemia because of increased activity of the Na/K pump
Insulin
69
If Mg levels are low, ____ is often also present
hypokalemia
70
What demographic tends to have increased K loss?
Older adults
71
What should nurses assess every 2 hours in patients with hypokalemia and why?
Respiratory status b/c respiratory insufficiency and cardiac dysrhythmias are major cause of death
72
Severe hypokalemia can cause the absence of ____ (GI)
Peristalsis
73
Why is K never given IV Push or undiluted?
Can cause cardiac arrest
74
Why is K never given IM or subQ?
K is a severe skin tissue irritant and can cause tissue necrosis
75
If you give K via IV, what should check for?
Burning at the site; phlebitis
76
If infiltration of a solution containing K occurs, what should you do?
Stop IV immediately
Remove venous access
Notify team
Document
77
KCl can cause N/V so what is the best way to take it?
With food / meals
78
How often should you perform respiratory monitoring for severe hypokalemia?
At least hourly
79
Hypercapnia
Increased PaCO2
80
The problems with hyperkalemia are related to what?
How rapidly ECF K levels increase
81
What are the 3 main drugs to ask about during assessment for hyperkalemia?
Potassium-sparing diuretics, ARBs, ACEIs
82
____ problems are the most severe problems from hyperkalemia and can lead to death
Cardiovascular
83
What are life-threatening complications of severe hyperkalemia?
Complete heart block
Asystole
V fib
84
How does late-stage hyperkalemia affects the neuromuscular system?
Flaccid paralysis
85
_____ is an oral drug that binds with K in the GI tract and decreases absorption
Patiromer
86
Why is insulin sometimes given for hyperkalemia?
It can help to move K from the ECF to the ICF b/c of increased activity of Na/K pump
87
When should you notify the rapid response team with hyperkalemia?
(1) pt HR < 60 BPM
(2) T waves become spiked
88
Steatorrhea is _____ in the stool
excessive fat
89
What is one demographic that is especially at risk for hypocalcemia and why?
Postmenopausal females because of decrease in estrogen and decrease in weight-bearing exercises.
90
Why is injury prevention important in someone with chronic hypocalcemia?
Brittle, fragile bones that fracture easily
91
Why is IV normal saline 0.9% often given for hypercalcemia?
Because Na increases kidney excretion of Ca
92
Use of loop or thiazide diuretics can cause which imbalance?
Hypomagnesemia
93
What should you monitor for hourly when a patient is receiving IV MgSO4?
Deep tendon reflexes to monitor effectiveness and prevent hypermagnesemia.
94
Patients with severe hypermagnesemia are at risk of what?
Cardiac arrest
95
When cardiac problems are severe, giving ____ may reverse the cardiac effects of hypermagnesemia.
Calcium
