Treatments only, exam 1

Question 1

hyponatremia

Answer 1

Mild/moderate: fluid restriction, oral sodium supplements.

Severe/symptomatic: Hypertonic saline (3% or 5% NaCl) may be administered at 1–2 mL/kg/hr if seizures or signs of herniation occur rescue boat with brokan oar slowing it down, and alarm showing treats severe symptoms only

Administer slowly and cautiously to avoid fluid volume overload
Avoid overcorrection (>8–12 mEq/L in 24 hr) to prevent osmotic demyelination

Correct Na⁺ slowly (no more than 0.5 mEq/L/hr) to prevent osmotic demyelination.

Daily increase target: 8–12 mEq/L.

Assessment focus:

Early signs: confusion, tremors, twitching, seizure risk

Monitor I&O, daily weight, neurological status especially in older adults, alcohol users, those on diuretics or with burns/malnutrition, monitor serum sodium

Question 2

Hypernatremia

Answer 2

Treatment
Gradual fluid replacement with hypotonic solutions (0.45% NaCl or D5W)

Must be infused slowly to prevent cerebral edema

Monitor neuro status closely
Monitor serum sodium, urine specific gravity, daily weights
Use of loop diuretics or sodium bicarbonate in some cases

⚠️ Safety Warnings
Rapid correction of sodium → cerebral edema (hyponatremia) or osmotic demyelination (hypernatremia)

Free water deficit calculations are critical for managing severe hypernatremia.

Total Body Water (TBW):

Men: 0.6 × weight (kg)

Women: 0.5 × weight (kg)

Elderly: 0.45–0.5 × weight (kg)

Water Deficit = TBW × [(Serum Na / 140) − 1]

Question 3

Hypokalemia

Answer 3

Goal: Restore potassium balance
If dietary intake is insufficient:

Use oral potassium supplements
Orange juice, bananas, dried fruits, meats

IV replacement if symptomatic or severe

Never give IVP (IV push) potassium → fatal arrhythmia risk

routine rate: 10 mEq/hr peripheral, up to 20 mEq/hr central line; 60 max daily for routine and NOT a bolus
NUR 213 - Emergency max dose: 40 mEq through central line only
Max 24-hour dose: 150 mEq

Treat underlying cause (e.g., change diuretics, correct alkalosis)

Monitor serum K⁺ levels and ECG
Nursing Management
Monitor:

Muscle strength, reflexes, cardiac rhythm, bowel function

Serum K⁺, renal function, ECG changes

Education:

High-potassium foods

Medication review (esp. diuretics, steroids)

Question 4

Hyperkalemia

Answer 4

Initial ECG required as soon as hyperkalemia is recognized

Stabilize cardiac membrane:

IV calcium gluconate (does not lower K⁺ but protects heart)

Shift K⁺ into cells:

IV insulin + Dextrose (D50) (25–40 g of D50, 10 units insulin)

Albuterol (nebulized) – beta-2 agonist promotes K⁺ uptake

Sodium bicarbonate if metabolic acidosis present

Eliminate K⁺:

Loop diuretics (e.g., furosemide)

Sodium polystyrene sulfonate (Kayexalate)

Hemodialysis in severe/refractory cases

Patiromer, zirconium cyclosilicate – GI potassium binders
⛔ CAUTION: Insulin/dextrose and albuterol temporarily shift K⁺ intracellularly—must also remove excess K⁺ from body

Question 5

Hypocalcemia

Answer 5

For symptomatic hypocalcemia:

IV calcium gluconate 0.5–1 mg/kg/hr in D5W over 10–15 minutes

Can titrate up to 2 mg/kg/hr max

Continuous infusion if needed

Correct accompanying hypomagnesemia first

Check and monitor PTH, vitamin D levels
Seizure precautions

Monitor:

Respiratory and cardiac status, ECG

Calcium levels every 4–6 hours

Educate on calcium-rich foods and adherence to meds

Ensure IV calcium is administered cautiously to avoid tissue necrosis

Question 6

Hypercalcemia

Answer 6

Identify and treat cause

Promote renal excretion:

IV fluids (NS)

Loop diuretics (furosemide)

Bisphosphonates (if malignancy-related)
Calcitonin

Dialysis if very severe or with renal failure

Increase oral fluid intake

Monitor ECG, labs (Ca²⁺, BUN, Cr)

Educate to avoid excess calcium and vitamin D
Dialysis if renal failure is present

Question 7

Hypomagnesemia

plane full of banana split

Answer 7

Oral supplements: magnesium oxide/gluconate (if mild)

IV Mg²⁺ sulfate (2–4 grams over 30–60 minutes) if severe or symptomatic

Emergency: ACLS protocol for torsades de pointes

Requires slow infusion to avoid hypotension or cardiac suppression
Monitor:

Neuromuscular status, LOC, cardiac rhythm

Vital signs during IV administration

Identify at-risk patients:

Malnourished, alcoholic, or diuretic use

Educate:

Mg²⁺-rich food sources (Box 8.3): nuts, seeds, leafy greens, legumes, whole grains

Limit alcohol intake

Evaluate for concurrent K⁺ and Ca²⁺ depletion

Question 8

Hypermagnesemia

Answer 8

Stop Mg²⁺ intake

Administer IV calcium gluconate to stabilize cardiac membrane

Use loop diuretics to promote Mg²⁺ excretion if renal function intact

Dialysis in severe renal impairment
Monitor:

Deep tendon reflexes

Cardiac/respiratory status

Educate:

Avoid Mg²⁺-containing OTC drugs in renal patients

Track fluid and electrolyte intake/output

Question 9

Hypophosphatemia

Answer 9

Phosphate replacement therapy

Question 10

Hyperphosphatemia

coexists with hypocalcemia

Answer 10

Calcium-based phosphate binders:

Sevelamer, lanthanum carbonate

Dialysis (if renal failure)