Lecture 4 management of electrolytes

Question 1

Whats Hyponatremia

Answer 1

soduim loss < 135 mmol/L
Severe=< 125 Meq/L

Question 2

Causes hyponatremia

Answer 2

1. Loss Na-containing fluid
2. Water excess

Question 3

What does Hyponatremia lower…

Answer 3

Plasma osmolality, shifting fluid into brain cells

Question 4

Symptoms hyponatremia:

Answer 4

-Neuro related
-Changes LOC

Question 5

ECF fluid volume symptoms for patient with hyponatremia

Answer 5

1. abnormal decrease in soduim loss (Hypovolemic hypontremia)

2.Abnormal increase in watter gain (hypervomeic hyponatremia)

Question 6

Treatement of hypoatremia

Answer 6

Iv’s, get soduim back

Question 7

What are severe symptoms of hypertonic saline/ what would you administer…

Answer 7

Seizures
administer (3% Nacl)

Question 8

A hypertonic saline solution causes water to shift ______cells

Answer 8

outside cell causing cell death

Question 9

Why must Iv hypertonic saline be administered with caution

Answer 9

Much higher concentrated salt, cell’s could collapse

Question 10

What’s the max rate of safe administration for hypertonic saline (3% Nacl)

Answer 10

100 ml/hr

Question 11

How is Hypertonic saline given

Answer 11

IV infusion pump

Question 12

What’s Hyperatremia

Answer 12

increase in soduim retention >145 mmol/L
life threatening at level >155 mmol/L
high mortality >180 mmol/L

Question 13

Hypernatremia prevalence seen more in….

Answer 13

Critically ill patients particularly with neuro condition

Question 14

1/5 of people with congestive heart failure experience….

Answer 14

Hypernatremia

Question 15

what are people with high protein tube feeding at risk for

Answer 15

Hypernatremia

Question 16

Causes Hypernatremia

Answer 16

water deficiency, and NA accumulation, usually just looks like a water definiency. FEVER, HEATSTROKE

Question 17

Does hypernatremia cause hyperosmolarity

Answer 17

YES! hyperosmolarity is a shift of water out of cells- cellular dehydration

Question 18

usually body does things to prevent hypernatremia

Answer 18

-stimulate thirst
-ADH release

Question 19

What’s hypothalamic disorder:

Answer 19

Lesion may cause disturbance of thirst mechanism but is rare

Question 20

Clinical manifestations of Hypernatremia:

Answer 20

-Change plasma osmolality
-Neurologic changes
-Nausea vomiting
-restlessness
-Thirst
-Body can tolerate high sodium levels

Question 21

Interventions for Hypernatremia:

Answer 21

-Remove sodium intake from diet
but if soduim go even lower give D5W IV

Question 22

Interventions for hyponatremia:

Answer 22

-Fluid restriction
But treatment associated with abnormal fluid loss give sodium containing solutions.

Question 23

Patient has sodium level 188 Meq/L and not drinking water: what is diagnosis..

Answer 23

Hypo(check)volemic Hypernatremia

Question 24

What is hypokalemia

Answer 24

Low levels of potassium in the ECF

Question 25

What are primary routes of potassium loss

Answer 25

Kidneys

Question 26

what would be a drop of 3.5 mmol/L in pottasium

Answer 26

Hypokalemia

Question 27

Slight decrease in potttasium has ….

Answer 27

Profound effects since it’s range is narrow

Question 28

Causes of Hypokalemia

Answer 28

-Low potassium diet
-starvation
-GI losses: vomiting, diarrrehea
-Renal losses: Diuretics, dialysis, magnesium depletion
-skin losses: diaphoresis

Question 29

Hypo and Hyper natremia major symptoms

Answer 29

NEURO

Question 30

Shifts of potassium into cell

Answer 30

-increase insulin
-alkalosis
-Tissue repair

Question 31

Diuretics…

Answer 31

remove excess fluid from body

Question 32

Potassium wasting diuretics vs sparing examples…

Answer 32

Wasting: Thiazides, loop diuretics

Sparing:
Spironolactone, amiloride hydrochloride

Question 33

Clinical manifestations of Hypokalemia

Answer 33

CARDIAC problems!!!!!!!
-alters resting membrane potential
-Fatigue
-leg cramps
-Fatigue
-nausea

Question 34

Nursing disgnosis for Hypokalemia

Answer 34

Electrolyte imbalance as evidence by low pottaosum levels and increased fluid loss

Question 35

What does potassium do in body:

Answer 35

-Cardiac
-muscle function
-Regulates soduim

Question 36

Hypokalemia interventions

Answer 36

KCL supplements added to Iv solution should never exceed 60 mmol/L

Question 37

Guidelines for IV potassium administration

Answer 37

• Should not exceed 10/20 mmol per hour
  -use infusion devices
  -Potassium could also be replaced with pottasium phosphate
  -Max 200 meq/L in 24 hours

Question 38

what should you monitor for patients

Answer 38

-TOXIC REACTION
- muscle weakness
- arrhythmias
-cardiac rhythm
-urine output

Question 39

What’s hyperkalemia

Answer 39

-high levels of potasium in blood
-above 5.5 mmol/L

Question 40

Causes of hyperkalemia

Answer 40

1. Excess potassium intake
2. Shifts of potassium out of cells (acidosis, tissue catabolism)
3. Failure to eliminate potassium
   -Renal disease
   -potassium sparing diuretics
   -ACE inhibitors
   -adrenal insuffinenecy

Question 41

Clinical manifestations of Hyperkalemia

Answer 41

-CARDIAC STANDSTILL
-anxiety
-Abdominal cramping
-muscle weakness
-irregular pulse

Question 42

Nursing diagnosis

Answer 42

evidence by <5.5 pottasium and decreased urine output
=Hyperkalemia

and this caused electrolyte balances, fever, sepsis…

Question 43

Treatment of hyperkalemia

Answer 43

-Elimination potassium intake
-Diurectics
-dialysis
-ion exchange resins (Force potassium from ECF to ICF)
-increase fluid intake
-Administer calcium gluconate (Reverse membrane effects of the elevated ECF)

Question 44

How would force potassium from ECF to ICF

Answer 44

-administer IV insulin (so patient does not become hypoglycemic)
-Administered Iv sodium bicarbonate (correct acidosis)

Question 45

Whats alkalosis

Answer 45

causes potassium move from ECF to ICF

Question 46

electrolytes have _____ limits

Answer 46

Narrow