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NURS232 > Lyte Imbalance > Flashcards

Lyte Imbalance Flashcards

(45 cards)

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1
Q

Extended chemistry Panel includes

A

Calcium, phosphate Mg, in addition to usual chemistry panel

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2
Q

Hypernatremia

A

Occurring bc of water loss or Na Gain

Causes hyperosmolality leading to cellular dehydration
Primary protection is THIRST from hypothalamus

Does not normally occur in pts with norma LOC who can sense thirst and swallow

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3
Q

Manifestations of Hypernatremia

A

Intense thirst
Lethargy
Agitation
Progressing to Seizures (maybe)
Coma

Due to Dehydration of the neurons

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4
Q

Treating hyernatremia

A

Treat the cause
- treating reason for dehydration
- Giving drink OR isotonic solution to dillute sodium

Primary water deficit? PO or IV 0.9% NaCl
Primary sodium excess? Dilute w/ salt-free IV fluids (ie D5W) & excrete Na+ w/ diuretics

Serum sodium levels must be reduced gradually to avoid cerebral edema IMPORTANT

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5
Q

Hyponatremia causes

A

Occuring due to water gain, or sodium loss or both

Inappropriate use of sodium-free or hypotonic IV fluids
SIADH (Syndrome of Inappropriate ADH) - dilutional hypoH connected to water retention
Losses of sodium-rich body fluids from the GI tract, kidneys and skin (ie sweat)

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6
Q

Manifestation of hypoNa

A

Due to cellular swelling in CNS

Altered CNS:
Headache
irritability
confusion/conc difficulty
Seizure
coma

Likely Progressive

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7
Q

Treatment of hypoNA

A

Fluid restriction
Increases conc of Na in blood

Hypertonic saline VERY extreme - pt would have REALLY altered LOC, potentially comatos

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8
Q

Severe K+ deficit or excess we are most worried abt

A

Myocardial contractility
- Can lead to SIGNIFICANT dysrythmias

Less than 3, greater than 6.5-7

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9
Q

K+ is necceassry for

A

Transmission and conduction of nerve impulses
Maintenance of cardiac rhythms ***
Skeletal & smooth muscle contraction
Acid–base balance

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10
Q

Factors that cause Na retention cause Potassium _____

A

Depletion/loss
e.g. low blood volume, increased aldosterone)

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11
Q

Primary organ dealing with K+ balance

A

Kidneys 90% responsible

CKD can result in HyperK

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12
Q

Causes of hyper K

A

Massive intake
Renal failure
Shift from intercellular fluid to extracellular fluid (acidosis)
Massive cell destruction (crushing, ischemia, burns)
Catabolic states
Transfusion of aged blood

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13
Q

Acidosis and hyper K

A

Too much K in cells means that H+ is pulled into bloodstream

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14
Q

Manifestations of hyperK

A

Weak or paralyzed skeletal muscles
May experience cramping leg pain
Ventricular fibrillation or cardiac standstill
Abdominal cramping or diarrhea

Normal K is high intercellular and low extracelular causing negative electrical membrane - increase K = decrease excitablilty

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15
Q

Nursing management of hyperKalemia

A

C - Calcium Gluconate (stablize myocardium)
B - Beta2 Adrenergic Agonist (Salbutamol) - bronchodilator
I - Insulin - Moves glucose into cells AND K+ into cells
G - Glucose
K - Kayxalate - Binding Resin working in GI tract, sustain lower level
Drop - Diuretics (Loop or Thirazide)
- Require functional kidneys
- Dialysis

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16
Q

If pt levels of K are below 3 and over 7 nursing interventino

A

Cardiac monitering

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17
Q

Causes of HypoK

A

Abnormal Losses of K by kidneys or GI tract
Shift from extracellular to intercellular
Inadequate intake (rare)
Diuretic use
*Magnesium deficiency**
- Mg and K are correlated
Metabolic alkalosis

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18
Q

Hypokalemia Manifestations

A

Most serious are cardiac
(Depolarization of cell membranes)
Skeletal muscle weakness & paralysis
Muscle cramping & muscle cell breakdown

Not important

Decreased GI motility (paralytic ileus)
Diuresis
Hyperglycemia

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19
Q

Hypokalemia management

Study These Flashcards
A

Supplements given PO or IV (IV if needing rapid), but PO is still quickly absorbed

Should not exceed 10-20mmol/hr of replacement

IV K+ must always be dilluted in IV fluid

20
Q

Calcium obtained by

Study These Flashcards
A

Ingested foods
More than 99% combined with phosphorus and concentrated in skeletal system

20
Q

Ca and Phospherus relationship

21
Q

Primary storage of Ca

Study These Flashcards
A

Bones - therefore, in dficiencies, bones and teeth are demineralized to increase serum levels

22
Q

What does Ca do

Study These Flashcards
A

Blocks sodium transport and stabilizes cell membrane
Ionized form is biologically active

23
Q

3 ways in which the blood carries Ca (Not super important)

Study These Flashcards
A

Free or ionized form (Biologically active)
- Availble to do the work, not stored

Bound to protein (Albumin mainly)
- Low levels of albumin causes issues

Complexed with phosphate citrate or carbonate

24
Changes in serum pH affect on Ca
Acidosis decrease Ca binding to albumin = increase Ca levles Alkolosis is opposite
25
Calcium functions
Transmission ofnerve impulses Myocardial contractions Blood Clotting Formation of teeth and bones Involved in muscle contractions (controlled by PTH INCREASES resorption and calcitonin decreases RESORPTION)
26
Calcitonin
Produced by thyroid gland Stimulated by high serum hormones Lowers CA lelve by deceasing GI absorption, promoting rneal excretion and resorption into bones
27
HyperCa caused by
Hyperparathyroidism Malignancy in the bone (seconadary to breast and lung cancer) Not important Prolonged immobilization
28
Manifestations of Hyper Ca
Cardiac dysrythmias Neuro alterations Not important Mood changes Neuron death Decreased memory Alterations in mental function/confusion/disorientation Fatigue Bone Pain Renal Calculi (Kidney stones)
29
Nursing implications for HyperCa
Promote excretion of Ca in the urine - Drink 3-4L a day - IV saline bolus (More immediate) - Loop diuretic Sustaining w/ Synthetic calcitonin (Nasal spray, injection) Sustaining with low Ca diet Mobilization - wt bearing activities IV Pamidronate (In malignancy) - Reverse levels quickly
30
HypoCa Caused by
Hypoparathyroidism Chronic alcoholism or hypoalbuminemia (liver disease) Acute pancreatitis Malabsorption syndromes & diarrhea (e.g. Crohn’s disease) Multiple blood transfusions Inadequate dietary intake Low Ca or Vit. D intake Medications Steroids Loop diuretics (e.g. Lasix) Laxative abuse
31
Manifestations of hypoCa
Depression, anxiety, confusion Tetany Numbness & tingling in extremities & region around mouth Positive Chvostek’s or Trousseau’s sign Dysphagia Laryngeal stridor Hyperreflexia, muscle cramps Seizures ECG changes
32
Positive Chvostek’s or Trousseau’s sign
Arm contraction during BP (Trousseaus) Twinging front of ear causing a facial twitch (Chvostek)
33
Nursing management of HypoCa
Treat cause PO/IV supplements Ca Rich Diet/ Vot D supplements
34
Phosphate
Primary anion in the ICF (along with K+) Essential to the function of: Muscle RBCs Nervous system Involved in: acid-base buffering system Mitochondrial energy production of ATP Cellular uptake and use of glucose Metabolism of carbohydrates, proteins and fats (as an intermediary in) Inverse relationship between PO4 and Ca2+ Renal function must be adequate to maintain normal levels of PO4
35
Hyperphosphatemia
Acute or chronic renal faiulre ** chemotherapy Excessive ingenestion of milk or phosphjate containing laxatives ----
36
Manifestations of hyperPhosph
Hypocalcemia Muscle problems / tetany Deposition of calcium-phosphate precipitates in skin, soft tissue, corneas, viscera, blood vessels
37
Management of hyperPhosph
W/ renal funciton Don't eat too much phospherus Ensure adequate hydration and correction of hypoCa conditions W/ Renal Failure Dietary phosphate restrictions -- --
38
Hypophosp manifestations
Changes in mental status CNS depression Confusion Muscle weakness Pain Dysrythmias
39
Nursing management of Hyophosph
Mild- oral supplementation Severe - IV supplementation (Rare) - Dangerous with causing precipitate in BV
40
Mg Important for
Second most abundat intracellular Cationafter K+ Required for production of ATP Muscle contration and relaxation - Less critical for cardiac, but more involved in mental and cog chagnes and skeletal muscles Factors that regulate calcium (ie PTH) seem to influence magnesium as well Because magnesium balance is related to K+ and Ca2+, they should be assessed together
41
Know Phosphate AS it pertains to CA (KNOW Ca first)
42
Mg is related to
Ca
43
HyperMg
Increased intake Renal insuffeciency Combo of both Pts on Lithium
44
Manifestations of hypermg
Nerve and muscle function impairment HOTN Facial flushing Lethargy urinary retention As it progresses Deep tendon reflexes loss Muscle paralyis Coma Resp depression

NURS232 (27 decks)

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