Quiz 1 - Electrolyte imbalance

Question 1

Normal Range: 135-145

Answer 1

Sodium

Question 2

Kidneys chief regulator of fluid and electrolytes, exerts what kind of pressure?

Answer 2

Osmotic pressure

Question 3

______ Stimulates Na+ reabsorption (secreted by adrenal cortex under control of Angiotensin II) and K+ excretion

Answer 3

ALDOSTERONE: (hormone secreted by adrenal cortex in response to the renin-angiotensin aldosterone cycle and stimulates… )

Question 4

______: Hydrochlorothiazide (HCTZ) blocks Na+ reabsorption – does not retain sodium, exits in urine with excess fluid

Answer 4

Diuretics

Question 5

Estrogen ____ reabsorption of water and sodium

Answer 5

Increases

Question 6

Where does aldosterone cause sodium reabsorption?

Answer 6

Proximal Convoluted Tubule

Question 7

Aldosterone stimulate sodium reabsorption by….

Answer 7

when we need greater blood volume, we retain sodium which draws water in bloodstream which increase our blood volume that is circulating so in heart failure patient it’s not good bc not enough blood flow is being pumped from heart to kidneys so we have release of renin conversion of angio 1 to angio 2 and release of aldosterone and we reabsorb that sodium and water now that failing heart has more fluid and volume to pump

Question 8

____: Amount reabsorbed varies according to body’s need

Answer 8

Potassium

Question 9

Normal range: 3.5-5 mEq/L

Answer 9

Potassium

Question 10

Why must potassium be kept within normal range?

Answer 10

Disruption of cardiac conduction, Irritable cardiac cells, major life threatening dysrhythmias and lead to flat line

Question 11

What gets reabsorbed in proximal convoluted tubule? (potassium)

Answer 11

We will see that depending on serum potassium level, amount that is reabsorbed in PCT will vary so if we have high potassium then we might reabsorb less and get rid of more potassium. So if we have a low serum potassium, PCT will hang onto more potassium

Question 12

Foods high in potassium

Answer 12

Potato, potato skins, oranges, bananas, dried fruit, certain salt substitutes, cantaloupes, raisins, lentils

Question 13

Patients in in stage renal disease lose ability to balance of potassium. Chronic renal failure will have prob with _____ bc they take in a quite bit of potassium but not good urine output to secrete potassium out

Answer 13

Hyperkalemia

Question 14

______ are responsible for excreting more than 90% of the total daily K+ intake

Answer 14

Kidneys

Question 15

Hypokalemia EKG

Answer 15

T wave becomes flattened and we begin to see U wave

Question 16

Patient with a flat T wave, and a U wave. Patient states ”my legs are cramping” and then nurse has given a diuretic to get rid of fluid. Patient receiving diuretic may suffer _____

Answer 16

Hypokalemia

Question 17

Muscle cramping, weakness, nausea

Answer 17

Hypokalemia

Question 18

What will the nurse do with abnormal EKG waves and cramping?

Answer 18

Assess, documents, notify doctor, lab values, serum potassium, expect low potassium

Question 19

_____ should be administered only after adequate urine flow has been established

Answer 19

Potassium

Question 20

_____ is NEVER administered by IV push; IV K+ must be administered DILUTED using an INFUSION PUMP-

Answer 20

Potassium

Question 21

Why is potassium never administered by IV push?

Answer 21

Do not want to give patient too much potassium

Question 22

Never syringe or iv port, if so putting patient in cardiac arrest and they could die

Answer 22

TRUE

Question 23

False high potassium

Answer 23

pseudohyperkalemia

Question 24

Use of a tight tournequit around an exercising extremity while drawing blood

Answer 24

pseudohyperkalemia

Question 25

Drawing blood above a site where K+ is infusing or patient exercising that extremity

Answer 25

pseudohyperkalemia

Question 26

If patient receiving iv fluids with potassium in those IV fluids and draw blood in same extremity near site

Answer 26

pseudohyperkalemia

Question 27

Addison disease causes _____

Answer 27

Hyperkalemia

Question 28

Renal disease - Can't excrete potassium

Answer 28

Hyperkalemia

Question 29

Damage to cell/trauma, burn, lot of blood transfusion. antibiotic like PNC that has potassium, crushing injury

Answer 29

Hyperkalemia, potassium leaves cells and goes to the bloodstream

Question 30

_____ is the major intracellular electrolyte

Answer 30

Potassium

Question 31

How do we know patient has hyperkalemia?

Answer 31

Complain of paraesthesia, irritability, diarrhea, muscle weakness, peaked peaked T waves, shortened Q T intervals

Question 32

- Dialysis (draw off high potassium from blood), - IV glucose amp D50 followed by regular insulin. - insulin will carry glucose into the cells and also grabs potassium and carries it into the cells

Answer 32

Lowering Potassium

Question 33

Does not really lower the potassium but it stabilizes the heart and keeps it contracted regularly because the high potassium can decrease activity of the heart. This medicine protects the heart.

Answer 33

Calcium Gluconate

Question 34

As potassium levels go up, patients tend to go through _____ acidosis

Answer 34

Metabolic

Question 35

Treatment for metabolic acidosis and hyperkalemia?

Answer 35

Sodium Bicarbonate

Question 36

High potassium can result due to increase use of diuretic, = causes to get rid of excess fluid and cause potassium fluids go up

Answer 36

Potassium spearing diuretic (Aldactone-spironolactim)

Question 37

Digoxin toxicity may have issues with potassium, either high or low

Answer 37

True

Question 38

NSAID (ibuprofen, advil) cause _____

Answer 38

Hyperkalemia

Question 39

ACE inhibitors (captopril, lisinopril) cause ____

Answer 39

Hyperkalemia

Question 40

K+ sparing diuretics (spironolactone) cause ____

Answer 40

Hyperkalemia

Question 41

Normal Range: 8.5-10.2

Answer 41

Calcium

Question 42

Exerts sedative action on nerve cells Keep nerve cells quiet so they can do their job If not enough calcium, nerves become irritable

Answer 42

Calcium

Question 43

Plays key role in transmission of nerve impulses

Answer 43

Calcium

Question 44

Regulates muscle contraction, and relaxation of heart rhythm

Answer 44

Calcium

Question 45

Necessary for blood coagulation

Answer 45

Calcium So if not enough calcium, then you may issues with clotting and bleeding

Question 46

Dairy products, green leafy vegetables –kale, spinach, salmon, sardines, broccoli

Answer 46

Foods high in calcium

Question 47

Common in Renal patients due to elevated phosphorous = can’t excrete phosphorus… so...

Answer 47

Hypocaclemia

Question 48

Ca+ and Phosphorous have an INVERSE relation | As phosphorous goes up, calcium goes down

Answer 48

True

Question 49

Tetany- increased neural excitability (twitching), tingling (lips, side of face) all the way to SEIZURES

Answer 49

S/S of Hypocalcemia

Question 50

+ CHVOSTEK’S & + TROUSSEAU’S

Answer 50

Hypocalcemia

Question 51

Cardiac dysrhythmias

Answer 51

Hypocalcemia

Question 52

______ glands watch calcium levels in the blood and when calcium levels drop

Answer 52

Parathyroid

Question 53

______ gland is on alert && says “woah there’s not enough calcium in the blood, we have a problem, our patient has tetany then it says we gotta get calcium from somewhere-bone" (Hypocalcemia)

Answer 53

Parathryroid

Question 54

Parathryoid gland release _____ hormone and it causes calcium to be pulled from the bone (Hypocalcemia)

Answer 54

Paratharmone

Question 55

When calcium levels drop in renal patients due to phosphorous being too high, patients in renal failure can’t secrete phosphours

Answer 55

True

Question 56

When you tap on the trigeminal nerve (5), the mouth will pull up toward where you are tapping, tapping of nerve moves mouth up (Hypocalcemia)

Answer 56

Positive Chvostek’s

Question 57

When blood cuff is put on arm and the hand draws up into a claw like because we have exerted pressure on nerves that are already excitable, twitching and drawing up of the hand (Hypocalcemia)

Answer 57

Positive Trousseaus’s

Question 58

Correlate serum Ca+ with serum albumin

Answer 58

True

Question 59

Medical emergency requiring IV calcium | -Give slowly to avoid bradycardia that could lead to cardiac arrest

Answer 59

Treatment of Hypocalcemia

Question 60

Monitor for seizures/ provide safe environment | Neurological damage

Answer 60

Treatment of Hypocalcemia

Question 61

Airway management

Answer 61

Treatment of Hypocalcemia

Question 62

______ are major route for phosphorous excretion

Answer 62

Kidneys

Question 63

Normal level: 2.5-4.5mg/dl

Answer 63

Phosphorous

Question 64

Necessary for muscle function, RBC production, nerve conduction, metabolism of carbohydrates, protein, and fat

Answer 64

Phosphorous

Question 65

Too high level of phosphorous

Answer 65

Hyperphosphatemia

Question 66

What causes hypocalcemia?

Answer 66

Hyperphosphatemia & Low Active Vitamin D

Question 67

Renal function help activate and metabolize vitamin D therefore patient with renal failure will not have active vitamin D

Answer 67

True

Question 68

What happens to a patient with hypocalcemia?

Answer 68

Phosphorous levels will increase, calcium level will decrease. Parathyroid gland will produce parathormone which will cause bone to release calcium and phosphate but most important calcium, calcium will be released to the blood.

Question 69

In a hypocalcemia patient, Kidney will also try to reabsorb calcium but remember renal failure patient’s can’t reabsorb so we don’t see that happening much

Answer 69

True

Question 70

If calcium is being pulled out the bone, patients will have _____

Answer 70

osteoporosis

Question 71

Renal Osteodystrophy/Osteoporosis: Patients with chronic renal failure will not have have stable bones

Answer 71

Hyperphosphatemia

Question 72

Very susceptible to fracture

Answer 72

Hyperphosphatemia

Question 73

Rare painful syndrome of calcification of the small blood vessels located within the fatty tissue and deeper layers of the skin, blood clots, and the death of skin cells due to too little blood flow. (Hyperphosphatemia)

Answer 73

Calciphylaxis

Question 74

Calcium deposited in sites throughout body where you normally wouldn't have calcium is called _____

Answer 74

Calciphylaxis

Question 75

High phosphorous levels will have inverse relationship = low calcium = parahtryoid will secrete parathormone will get calcium out of bone and cause bones to be weak and more likely to have fractures, will have hard things under skin like pebbles and skin will become irritated and sores will develop due to calcium rupturing through the skin (Calciphylaxis)

Answer 75

True

Question 76

Overtime bc patients have poor reabsorption of calcium in bones, you will actually see the bones in the digits of the hand become harder to define, less calcium in the bones, bones are thinning, areas where you will see almost nothing due to ___

Answer 76

Lack of reabsorption of calcium in the bone bc its going out into the bloodsteam

Question 77

Horrible sores back of legs, inner thigh, bellys, wounds are hard to treat, can become infected, patients often do not survive

Answer 77

Calciphylaxis

Question 78

Hyperphosphatemia: too high of a phosphorous bc can’t be excreted, patient not having good renal function, no urine output so can’t get rid of phosphorous

Answer 78

True

Question 79

Parathyroidectomy

Answer 79

Remove parathyroid gland because that will stop the pulling of calcium out of the bone

Question 80

Phosphate binders: Ex. Phoslo

Answer 80

w/ every meal patient will take a phosphate binder, these are big chalky like capsules. Phoslo binds the phosphorous in the gut and prevents phosphorous from being absorbed into the blood stream, binds high phosphorous foods in the GI tract and excrete via stool

Question 81

Foods high in phosphorous

Answer 81

Hard cheeses, nuts, whole grains, dried fruits & vegetables, dairy products

Question 82

Parahyroidectomy, phosphate binders, limit foods high in phosphorous

Answer 82

Treatments of hyperphosphatemia

Question 83

Renal excretion of _____ keeps body’s level in check

Answer 83

Magnesium

Question 84

Necessary for intracellular enzyme activity, carbohydrate & protein metabolism, neuromuscular function (nerve conduction and muscle contraction) particularly the heart

Answer 84

Magnesium

Question 85

After MI may have irritability and dysrhythmias so will give patients _____

Answer 85

Magnesium

Question 86

Diminished excitability of muscle cells- sluggish

Answer 86

Increase in magneisum

Question 87

Increased neuromuscular irritability

Answer 87

Decreased magnesium

Question 88

Magnesium and potassium are like sisters

Answer 88

True

Question 89

Cardiac patients – If can’t get serum potassium levels up, magnesium will be given so if you have magnesium up then potassium will go up as well, they like sisters, same effects, too much magnesium will shut down the heart, too much potassium will shut down the heart, too little magneisum will cause heart to be irritable and dysrhythmia, too little potassium dysrhythmia as well

Answer 89

True

Question 90

Most common cause of hypermagnasemia

Answer 90

Renal failure

Question 91

Why is renal failure the most common cause of hypermangasemia?

Answer 91

Bc can’t excrete cus they got no urine output so hang up to magnesium

Question 92

Hypermagnasemia patients need to avoid medication high in magnesium such as ___ __ _____

Answer 92

Milk of magnesia

Question 93

Muscle weakness, lethargy, drowsiness, loss of reflexes-tapping of the knee-nothing happens, facial flushing, decreased blood pressure due to peripheral vasodilation

Answer 93

S/S of hypermagnasemia

Question 94

Hemodialysis: draw off the magnesium IV calcium/ magnesium: protect heart Avoid OTC medications Ventilatory support

Answer 94

Treatment for hypermagnasemia

Question 95

90% of Na+ in filtrate (what goes into bowmans capsule, through tuft capillaries into proximal convoluted tubule) is reabsorbed

Answer 95

True

Question 96

Heparin causes ___

Answer 96

Hyperkalemia