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Hyper vs Hypo Flashcards

1
Q

Causes of Hypercalcemia

A

Hyperparathyroidism (key note: parathyroid regulates calcium)
Increased intake of calcium (Vitamin D)
Glucocorticoids (key: suppress the absorption of calcium)
Hyperthyroidism
Calcium excretion decreased with thiazide diuretics
Adrenal insufficiency (Addision’s Disease)
Lithium usage (affects parathyroid)

(Remember HIGHCAL)

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2
Q

S/S of Hypercalcemia

A

Weakness in muscles (Lethargy)
EKG changes (shorted QT interval)
Absent reflexes, Absent minded, Constipation
Kidney stone formation

Remember: body is too WEAK

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3
Q

Thiazide Diuretics

A

Increase calcium levels

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4
Q

Nursing Interventions for Hypercalcemia

A

Keep patient hydrated (decrease stone formation)
Safety (falls/injuries)
Monitor cardiac, GI, renal, and neuro status
Compliants of abdominal pain can mean kidney stone formation
Administer Calcitonin (calcium reabsorption inhibitor)
Dialysis

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5
Q

Calcium RICH foods

A

Yogurt
Sardines
Cheese
Spinach
Collard Greens
Tofu
Rhubarb
Milk

Remember: Young sally’s calicum serum continues to randomly mess up

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6
Q

Causes of Hypocalcemia

A

Low parathyroid hormone
Oral intake inadequate
Wound Drainage (GI system)
Celiac’s Disease/Crohn’s Disease
Acute Pancreatitis
Low Vitamin D intake
Chronic Kidney Disease (excessive excretion of Ca2+)
Increased Phosphorous levels
Using medications
Mobility issues

Remember: LOW CALCIUM

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7
Q

Electrolyte to monitor with neck surgery/removal of any neck surgery?

A

Calcium levels

watch for hypocalcemia

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8
Q

S/S of Hypocalemia

A

Confusion
Reflexes are hyperactive
Arrhythmias (PROLONGED QT INTERVAL)
Muscles spasms in calves/feet
Positive Trousseaus sign
Sign of Chvosteks sign

Remember: CRAMPS

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9
Q

Positive Trousseaus Sign

A

usually presents before Chvosteks sign

process: inflate BP cuff a bit higher than baseline systolic and hold for 3 minutes, it is positive when the hand involuntarily flexes

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10
Q

Sign of Chvosteks

A

hyperexcitability of the facial nerves

Process: tap on the jaw and on effected side the lips or nose will twitch towards the side that is being tested

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11
Q

Nursing Interventions for Hypocalcemia

A

Safety - risk for bone fractures
Watch for laryngeal spasms
Administer IV Calcium Gluconate - ADMINISTER SLOW - watch for digoxin, can cause toxicity
Administer Vitamin D to promote absorption

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12
Q

Causes for Hyperkalemia

A

Cellular movement of K+ from intracellular to extracellular (burns, tissue damage, ACIDOSIS)
Adrenal Insufficiency (Addison’s Disease)
Renal Failure
Excessive Potassium Intake
Drugs (Aldactens, ACE inhibitors, NSAIDS)

Remember: “Body CARED too much for K+)

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13
Q

What is potassium responsible for?

A

Potassium is responsible for nerve impulse conduction and muscle contraction

note: potassium rather be INTRACELLULAR

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14
Q

S/S of Hyperkalemia

A

Muscle weakness
Urine production is low or absent
Respiratory Failure
Decreased Cardiac Contractility (weak pulse, low BP)
Early signs of muscle twitching, cramps
Rhythm changes - TALL PEAKED T WAVE, FLAT P

Remember: Hyperkalemia is dangerous it may MURDER them

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15
Q

Nursing Interventions for Hyperkalemia

A

Monitor Cardiac, Respiratory, Neuromuscular & GI status
STOP IV potassium infusion or hold supplements if ordered
Initiate K+ restrictive diet
Prepare patient for dialysis
Order Lassie or other K+ wasting drugs

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16
Q

Potassium RICH foods

A

Potatoes
Oranges
Tomatoes
Avocados
Strawberries
Spinach
fIsh
Mushrooms

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17
Q

Causes for Hypokalemia

A

Drugs (Laxatives, Diuretics, Corticosteroids)
Inadequate intake K+ (NPO, anorexia)
Too much water intake (dilutes K+)
Cushing Syndrome
Heavy fluid loss (NG suction, wound drainages, diarrhea)
ALKALOSIS

Remember: Body is trying to DITCH K+

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18
Q

When a patient is connected to an NG tube, what do you need to watch out for?

A

HYPOkalemia
HYPOnatremia

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19
Q

S/S of Hypokalemia

A

EVERYTHING IS SLOW AND LOW

Weak pulse
Decreased bowel sounds
Confusion
Shallow respirations
EKG changes: depressed ST segment, U-wave

Remember 7 L’s:
Lethargic
Low, shallow respiratory
Lethal cardia A’s
low of urine
leg cramps
limp muscles
low BP and HR

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20
Q

Nursing Interventions for Hypokalemia

A

Watch Heart Rhythm, respiratory status, GI, and renal
Watch magnesium levels
levels >2.5 - start potassium INFUSION
Hold Lasix, Thiazides

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21
Q

Causes of Hyperatremia

A

Hypercortisolism (Cushing syndrome)
Increased Na2+ intake
GI feeding without adequate H2O supplement
Hypertonic solutions (ex: 3% saline)
Sodium excretion decreased (body is retaining sodium)
Aldosterone problems
Loss of fluids (dehydrated, fever, sweating)
Thirst impairment

Remember: HIGH SALT

22
Q

What is the role of sodium in the body?

A

Helps water move inside and outside of the cell

Wherever sodium goes, water follows.

23
Q

S/S of Hyperatremia

A

Fever, flushed, skin
Restless, really agitated
Increased fluid retention
Edema, extremely confused
Decreased urine output, dry mouth mouth/skin

Remember: “No FRIED foods for you”

24
Q

Nursing Interventions for Hyperatremia

A

Restrict Na2+ intake
- reduce foods such as bacon, butter, canned foods, cheese, hot dogs, lunch meat, processed foods, table salt
Patient safety
- confused and agitated
MD may order an isotonic/hypertonic IV solution (0.45 normal saline - Gove slowly)
Educate about diet

25
Cause of Hypoatremia
Na2+ excretion increased with renal problems, NG suction, vomiting, diuretics Overload of fluids (CHF, liver failure) Na2+ intake low through low salt diet or NPO status Antidiuretic hormone over secreted Remember: No Na2+
26
S/S of Hypoantremia
Seizures and Stupor Abdominal cramping and confusion Lethargic Tendon reflexes diminished, trouble concentrating Loss of urine and appetite Orthostatic hypotension, overactive bowels Shallow respirations Spasms of muscles Remember: SALT LOSS
27
Nursing Interventions for Hypoatremia
Watch cardiac, respiratory, GI and neurological stats\us Hypovolemic: administer IV solution to restore fluids (3% saline) Hypervolemic: restrict fluids, diuretic or dialysis
28
Causes of Hypermagnesemia
Magnesium containing antacids and laxatives Addisons Disease Glomerular filtration insufficiency (renal failure, kidneys are keeping too much mg) Remember: MAG - not very common
29
What is the role of magnesium
cell function such as transferring and storing energy, regulation of parathyroid hormone, metabolism of carbs, lipids, proteins, regulates blood pressure
30
S/S of Hypermagnesemia
Lethargy EKG changes (PR + QT prolonged intervals) Tendon reflexes are diminished/absent Hypotension Arrhythmias (bradycardia) Respiratory arrest GI issues Impaired breathing (skeletal weakness) Cardiac Arrest Remember: Lethargic - only in severe cases
31
Nursing Interventions for Hypermagnesemia
Monitor cardiac, resp, GI, and neuro Ensure safety due to Lethargic/drowsy Prevention: avoid giving pt in renal failure magnesium containing magnesium antacids/laxatives Renal failure prep dialysis IV Ca+ ordered to release side effects preferred in central line
32
Magnesium RICH foods
Avocado Green leafy vegetables Peanut butter, pork Oatmeal Fish Cauliflower Legumes Nuts Oranges Milk Remember: Always Get Plenty Of Foods Containing Large Numbers of Magnesium
33
Causes of Hypomagnesemia
Limited intake of magnesium (starvation) Other electrolyte issues cause decrease mg (hypokalemia, hypocalcemia) Wasting Mg+ via kidneys (Loop or Thiazide diuretics) Malabsorption issues (patient with history of Crohns, Celiac, diarrhea) Alcohol (poor dietary intake) Glycemic issues (DKA, insulin) Remember: LOW MAG
34
Where is magnesium absorbed
the small intestine note: excreted via the kidneys - any issues with these systems causes issues with mg levels
35
S/S of Hypomagnesemia
Trouessau's sign (low calcium levels) Weak respirations Irritability Torsades de pointes( abnormal heart rhythm - correlated to alcoholics), tetany Cardiac changes (flat T wave) Hypertension, hyper reflexes Involuntary movements Nausea GI Issues (decreased bowel sounds and movement) Remember: "Twitching"
36
Nursing Interventions for Hypomagnesemia
Monitor Cardiac, Respiratory, GI, and Neurological status Administer Magnesium Sulfate IV infusion - monitor Mg levels closely Checking deep tendon reflexes Place on seizure precautions
37
Causes of Hyperphosphatemia
Phosphosoda overuse: phosphate containing laxative and enemas Hypoparathyroidism Overuse of Vitamin D Syndrome of tumor lysis Habdomyolysis Insufficiency of kidneys Remember: PHOSHI
38
What is the role of phosphate?
builds bone and teeth and nerve and muscle function stored mainly in bones kidneys and parathyroid regulate
39
S/S of Hyperphosphatemia
Confusion Reflexes hyperactive Anorexia Muscles spasms in calves/feet Positive Trousseau's Sign Sign of Chvosteks -similar to hypocalcemia
40
Nursing Interventions for Hyperphosphatemia
Administer phosphate binding drugs - Phoslo No phosphate laxatives/enemas Restrict food rich in Photo Prepare for dialysis
41
Nursing Interventions for Hyperphosphatemia
Administer phosphate binding drugs - Phoslo No phosphate laxatives/enemas Restrict food rich in Photo Prepare for dialysis
42
Phosphate RICH foods
Fish Nuts Chicken Beef Organ meats Pork Whole Grains
43
Causes for Hypophosphatemia
Pharmacy: Aluminum, lack of vitamin D Hyperparathyroidism: too much secretion of hormone Oncogenic osteomalacia: kidneys wasting phosphate, bones soften Syndrome of referring Pulmonary Issues Hyperthyroidism Alcoholism Thermal burns: extreme burns all over the body Electrolyte imbalances: hypercalcemia, hypomagnesemia, hypokalemia Remember: PHOSPHATE
44
S/S of Hypophosphatemia
Breathing problems due to muscle weakness Rhabdomyolysis: caused by electrolyte disturances (Tea colored urine) Osteomalacia: bone function, deformity, softening of the bones Kills immune system (suppression) Extreme weakness Neuro changes (confusion, irritability, seizure precautions) Remember: BROKEN
45
Nursing Interventions for Hypophosphatemia
Administer oral phosphorus with Vitamin D Ensure patient safety - bone & confusion Encourage foods rich in phosphate Watch Ca2+ levels Make sure renal status is good
46
What is the role of chloride?
maintain the acid-base balance balances fluids with Na2+
47
Causes of Hypochloremia
GI related - vomiting, gastric juice, ileostomy Diuretics - Thiazides Burns Cystic Fibrosis Metabloc Alkalosis
48
S/S of Hypochloremia
same s/s as hypoatremia
49
Nursing Interventions for Hypochloremia
Look at the sodium level and assess for s/s of hypoatremia Other labs to monitor: HIGH bicarbonate & LOW potassium Saline (normal saline 0.9%) administration Sources of chloride rich food Remember: LOSS
50
Causes of Hyperchloremia
Increase Sodium intake No water drinking or loss too much water Decrease bicarbonate Cohn's Syndrome Corticosteroids Metabolic Acidosis
51
Nursing Interventions of Hyperchoremia
Hold sodium chloride infusions - follow low sodium/chloride rich foods Instead lactated Ringer - decrease chloride levels - lactate is turned into bicarb Collect I & O Labs to monitor - chloride, sodium, bicarb

NUR 240 (11 decks)

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