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medsurg
electrolytes
| Question | Answer |
|---|---|
| normal range of Na | 135- 145 mEq/L |
| Recommended daily intake of Na: CDC dietary guidelines | no more than 2,300 mg/day |
| Recommended daily intake of Na: American Heart Association | Ideal intake less than 1500 mg/day |
| Na is important in maintaining | neuromuscular activity |
| Na is primary regulator of | the volume, osmolality and distribution of extracellular fluid |
| hypernatremia value | > than 145 mEq/L |
| hypernatremia causes | Water deprivation (unable to respond to thirst) Water loss due to fever, hyperventilation, massive burns, diarrhea Osmotic diuresis (hyperglycemia) Excessive sodium intake |
| hypernatremia results in | Hyperosmolality of extracellular fluid Cellular dehydration |
| hypernatremia signs and symptoms | Increase thirst (first manifestation) Increase serum osmolality Increased hematocrit and BUN Oliguria Dry mucous membranes Decreased skin turgor Tachycardia Hypotension |
| neuro signs and symptoms of hypernatremia | Headache, restlessness, confusion Seizures, coma |
| CMs of hypernatremia are | primarily neurologic (due to an osmotic shift of water out of brain cells) |
| Health History assessment of hypernatremia | Duration of symptoms Precipitating factors: Water deprivation, temperature, rapid breathing, diarrhea, salt intake, diabetes mellitus, perception of thirst, medications |
| Physical assessment of hypernatremia | Neurological status Vital signs Mucous membranes Manifestations of fluid volume deficit or excess |
| Tx of hypernatremia | Oral, enteral or IV water replacement Hypotonic IV fluids |
| Hypotonic IV fluids to treat hypernatremia | 0.45 % NaCl or 5% Dextrose (5% Dextrose is isotonic when administered but become hypotonic when dextrose metabolized) |
| intervention for hypernatremia | Monitor labs Monitor I & O Monitor neuro status, VS Mouth Care |
| health promotion/pt education for hypernatremia | Educate patient and/or caregiver on risks for hypernatremia Educate care giver on the need to offer fluids at regular intervals. Educate on which foods are high in sodium Educate on the need for free water flushes with tube feedings |
| hyponatremia value | <135 mEq/L |
| hyponatremia results in | Decreased serum osmolality Swelling of cells |
| depletional hyponatremia (excess sodium loss) | Diuretics Kidney disease, Adrenal insufficiency with impaired aldosterone and cortisol production GI tract (nausea/vomiting, GI suction, repeated tap water enemas) Skin ( excessive sweating, burns) |
| dilutional hyponatremia (excess water gain) | Heart failure Liver Disease Self-induced water intoxication Hypotonic IV fluids SIADH (syndrome of inappropriate secretion of antidiuretic hormone) |
| hyponatremia signs and symptoms | Muscle cramping Weakness Anorexia, nausea, vomiting, abdominal cramps, diarrhea |
| hyponatremia neuro signs and symptoms | Headache Lethargy, stupor Dull sensorium Tremors Muscle twitching Hyperflexia **If very low can lead to coma |
| Dx tests for hyponatremia | Serum sodium and serum osmolality is decreased 24 hour urine-evaluate sodium excretion: Increased in SIADH, decreased in losses of isotonic fluid |
| assessment for hyponatremia: health History | Current symptoms, duration of symptoms Precipitating factors |
| physical assessment for hyponatremia | Neurological status, LOC VS orthostatic hypotension (if associated with decreased ECF) Pulses Presence of edema Weight gain (with dilutional hyponatremia) |
| Depletional hyponatremia treatment | If both sodium and water are lost Lactated Ringers 0.9% NaCl If Na 110-115 mEq/L : 3% NaCl can be given very cautiously (ICU) |
| dilutional hyponatremia treatment | Diuretics Free water restriction Sodium tablets Treat underlying cause |
| health promotion/pt education for hyponatremia | Educate on signs and symptoms of hyponatremia Educate on the need to drink fluids that contain Na and electrolytes at frequent intervals when: Perspiring heavily Have diarrhea When environmental temperatures are high |
| potassium normal range | 3.5 – 5 mEq/L |
| what is potassium | Primary cation in intracellular fluid |
| potassium plays critical role in | conducting nerve impulses and excitability of skeletal, cardiac and smooth muscle |
| potassium is normally derived from | dietary intake |
| how much potassium is needed to maintain balance | 50-100 mEq daily |
| hyperkalemia value | >5.0 |
| hyperkalemia results from | Inadequate excretion from kidneys (primary reason) High intake Shift from intracellular to extracellular fluid |
| hyperkalemia affects | cardiac function, neuromuscular Function, respiratory and GI |
| how does hyperkalemia affect cardiac function | ECG: peaked T waves, prolonged PR and QRS interval Bradycardia, heart block, ventricular tachycardia, cardiac arrest (severe) |
| how does hyperkalemia affect neuromuscular function | Muscle tremors, twitching, weakness |
| how does hyperkalemia affect respiratory function | Dyspnea, respiratory distress |
| how does hyperkalemia affect GI function | n/v/d |
| health history for hyperkalemia | Symptoms and duration Precipitating factors: use of salt substitutes or potassium supplements, reduced urine output, renal or endocrine disorders |
| physical assessment for hyperkalemia | EGK Pulses Muscle strength Bowel sounds |
| labs for hyperkalemia | electrolytes |
| treatments for hyperkalemia | diuretics, binding agents, insulin (hypertonic dextrose), albuterol, calcium gluconate and calcium chloride, dialysis |
| treatments for hyperkalemia: Diuretics | potassium-wasting (Furosemide) - drops potassium down |
| treatments for hyperkalemia: binding agents | binds potassium in exchange for calcium veltessa, lokelma |
| veltessa | Binding of potassium ions in GI tract in exchange for Ca ions in GI tract |
| lokelma | Binding of potassium ions in exchange with H and Na ions in GI tract |
| treatments for hyperkalemia: Insulin, hypertonic dextrose (IV) | for K= > 6.5 mEq/L: IV regular insulin and Dextrose 50% - increases potassium uptake by cells to decrease the serum concentration |
| treatments for hyperkalemia: albuterol | Stimulates the Na/K pump- results in potassium shifting into the cells Contraindicated in patients with unstable angina and acute MI |
| treatments for hyperkalemia: Calcium Gluconate and Calcium Chloride | Used emergently to counteract K+ effects on cardiac muscle |
| dietary restriction for hyperkalemia | Salt substitute, Food high in potassium, over-the counter supplements |
| Patient Education for hyperkalemia | Educate on early signs of hyperkalemia |
| hypokalemia value | <3.5 |
| hypokalemia results from | Loop diuretics Inadequate intake of potassium Excessive renal or intestinal loss Redistribution between intracellular and extracellular fluid |
| hypokalemia cardiac affects | Interferes with regulation and transmission of cardiac impulses Decreases contractibility of cardiac muscle ECG: flatten T wave, U waves, depressed ST segment, atrial and ventricular dysrhythmias Decreased CO Increase risk for digoxin toxicity |
| what else does hypokalemia affect | Affects the resting membrane potential in skeletal cells Slows peristalsis of GI tract Decreases sensitivity to ADH – affects ability to concentrate urine |
| signs and symptoms of hypokalemia | Muscle weakness, leg cramps Nausea and vomiting, decreased bowel sounds, ileus Polyuria, altered kidney function |
| hypokalemia diagnostic tests | ECG Electrolytes Arterial blood gases: increase in pH (alkalosis) often associated with hypokalemia Renal function studies: creatinine, BUN |
| Health History of hypokalemia | Symptoms and duration of symptoms Precipitating factors: diuretic use, vomiting and diarrhea, GI suctioning Chronic conditions: hyperaldosteronism, cushing syndrome |
| physical assessment of hypokalemia | EKG- Cardiac Assessment VS, apical and peripheral pulses, orthostatic hypotension Mental Status GI assessment Muscular assessment |
| treatment for hypokalemia | PO and/or IV supplements Monitor electrolytes (K+) Monitor VS, apical and peripheral pulses Monitor for Orthostatic BP |
| education for hypokalemia | Diet Symptoms of hypokalemia |
| normal range of calcium | 8.5-10 mg/dL |
| calcium function | 99% found in bone and teeth Supports structure and function Vascular contraction and dilation Muscle function Nerve transmission Intracellular signaling Hormonal secretion |
| hypercalcemia value | > 10 mg/dL |
| hypercalcemia results from | Increased resorption of calcium from bone, excessive gastrointestinal absorption (rare but increased with decreased renal excretion) decreased renal excretion of calcium Excessive levels of Vitamin D |
| hypercalcemia: increased resorption of calcium from bone | hyperparathyroidism, malignancies, prolonged immobility |
| hyperparathyroidism | Excess parathyroid hormone excretion |
| malignancies causing increased resorption of calcium from bone | Bone destruction Tumor excretion of hormone-like substance |
| prolonged immobility | Lack of weight bearing |
| signs and symptoms of hypercalcemia | Muscle weakness Fatigue Anorexia, nausea/vomiting, constipation Confusion, lethargy, behavior changes ECG- Dysrhythmias Increase thirst Increase in urine output Kidney stones |
| health history for hypercalcemia | Symptoms and duration of symptoms Precipitating factor Excessive intake of Calcium Immobility Malignancy Renal or endocrine disorders |
| physical assessment for hypercalcemia | VS, apical pulses Mental Status, LOC GI assessment Muscle strength, deep tendon reflexes |
| diagnostic tests for hypercalcemia | Serum Electrolytes Serum parathyroid hormone levels ECG Bone density scans |
| what to look for in ECG to Dx hypercalcemia | shorten QT interval, shorten and depressed ST segment, widen T wave |
| Bone density scans Dx for hypercalcemia | monitor bone resorption, effect of treatment |
| hypercalcemia treatment depends on | severity |
| Mild hypercalcemia value | <12 mg/dL |
| Moderate hypercalcemia value | 12 and 14 mg/dL |
| Severe hypercalcemia value | >14 mg/dL |
| Mild, moderate with no symptoms hypercalcemia: treatment | Weight-bearing activities Fluid intake of at least six to eight glasses of water per day Limit intake of Calcium |
| Moderate with symptoms to severe hypercalcemia: treatment | IV fluids (isotonic) Bisphosphonates Calcitonin |
| Bisphosphonates treatment for hypercalcemia | For treatment of malignancy-associated hypercalcemia Reduce Calcium resorption from bone |
| Calcitonin treatment for hypercalcemia | Can administer calcitonin (along with a bisphosphonate) in patients with calcium >14 mg/dL with symptoms |
| patient education for hypercalcemia | Avoid: thiazide diuretics lithium carbonate therapy volume depletion prolonged bed rest or inactivity high calcium diet (>1000 mg/day) Limit over the counter Calcium |
| patient education for hypercalcemia: water | Drink at lease six to eight glasses per day – minimizes risk of kidney stones |
| hypocalcemia value | <8.5 |
| hypocalcemia results from | Decreased total calcium stores Low levels of extracellular calcium with normal levels of calcium stores in bones |
| risk factors for hypocalcemia | Older adults (particularly women) Removal of parathyroid gland Lactose intolerance Bariatric surgery |
| Removal of parathyroid gland | thyroid and radical neck surgery |
| Lactose intolerance | no milk products |
| bariatric surgery | decrease in food consumption and malabsorption |
| signs and symptoms of hypocalcemia | Numbness, tingling Muscle cramping Hyperactive reflexes Tetany Carpopedal and laryngeal spasms Bone pain, fractures Osteoporosis |
| Health History: hypocalcemia | Symptoms and duration of symptoms Precipitating factors: Older adults (particularly women) Removal of parathyroid gland Lactose intolerance Bariatric surgery |
| physical assessment: hypocalcemia | VS Neuromuscular irritability Laryngospasm-Monitor airway and respiratory status Cardiac dysrhythmias Seizure precautions |
| hypocalcemia hallmark signs | Cyvostek’s Sign Trousseau’s sign |
| Cyvostek’s Sign | Spasm of the facial muscles elicited by tapping the facial nerve in front of the ear |
| Trousseau’s sign | Place a blood pressure cuff on the arm Inflate the cuff slightly above the systolic pressure Leave the cuff inflated 2 to 3 minutes A carpal spasm is a positive response. |
| hypocalcemia diagnostic tests | total serum calcium, serum albumin, serum magnesium level, serum phosphate level, parathyroid hormone level, ECG |
| hypocalcemia diagnostic tests: serum albumin | When albumin is low, ionized calcium may remain normal when total calcium is low Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 (4.0 - serum albumin [g/dL]) |
| hypocalcemia diagnostic tests: serum magnesium level | Low Mg level must be restored to correct Ca level |
| hypocalcemia diagnostic tests: serum phosphate level | Hyperphosphatemia can lead to hypocalcemia (inverse relationship) |
| treatment for hypocalcemia | Oral or IV calcium Vitamin D Monitor VS Monitor airway and respiratory status Monitor neuromuscular status |
| Health Promotion/ Patient Education for hypocalcemia | Encourage weight-bearing exercise Bone screening for older woman Teaching regarding diet and supplements If oral calcium supplement take with a full glass of water |
| phosphate value | 2.5-4.5 mg/dL |
| phosphate function | Production of ATP Red blood cell function, O2 delivery to tissues Nervous system and muscular function Metabolism for fats, carbs and proteins Assists in maintaining acid-base balance |
| hyperphosphatemia value | >4.5 mg/dL |
| hyperphosphatemia results from | Impaired secretion Excessive intake Shift from intracellular to extracellular fluid Lowering of serum calcium levels |
| Impaired secretion primary cause | Renal Failure |
| excessive intake of phosphate | Rapid administration of phosphate containing solutions |
| Shift from intracellular to extracellular fluid | Chemotherapy, sepsis, trauma, heat stroke, hypothermia |
| Lowering of serum calcium levels | inverse relationship Serum phosphate combines with ionized calcium to make calcium phosphate which decreases serum calcium levels |
| Symptoms of hyperphosphatermia are more a cause of | low calcium then high phosphate |
| signs and symptoms of hyperphosphatemia | Muscle cramps and pains Paresthesia Tingling around mouth Muscle spasms Tetany Nausea/vomiting Dysphagia Decreased Bp Cardiac dysrhythmias |
| treatment for hyperphosphatemia | Monitor lab values: high phosphate, low calcium Monitor VS Monitor airway and respiratory status Monitor neuromuscular status Treatment of cause |
| Health Promotion/Patient Education for hyperphosphatemia | Limitation of phosphate intake High-phosphate foods (dairy products, meats, nuts, processed foods, and dark colas) Avoidance of phosphate edemas, laxatives |
| hypophosphatemia value | <2.5 mg/dL |
| hypophosphatemia results from | Total body deficit Shrift into intracellular space Iatrogenic (related to treatment) Alcoholism |
| Alcoholism affect on hypophosphatemia | Can effect intake and absorption |
| Iatrogenic (related to treatment) affect on hypophosphatemia | IV glucose, antacids, steroids, diuretics |
| Shrift into intracellular space affect on hypophosphatemia | Hyperventilation, respiratory alkalosis |
| Total body deficit affect on hypophosphatemia | GI absorption, increased renal excretion |
| Most symptoms of hypophosphatemia are caused by | depletion of ATP and impaired O2 delivery to cells |
| hypophosphatemia can affect | every major organ |
| signs and symptoms of hypophosphatemia | Intention tremor Paresthesia Confusion, stupor, seizures Bone pain, joint stiffness Bleeding disorders Impaired WBC function Decreased O2 delivery to cells RBC destruction Decrease O2 to heart muscle CP, dysrhythmias |
| Intention tremor | occurs when a voluntary movement is made |
| Treatment of hypophosphatemia | Treat underlying cause Dietary and oral supplements of phosphate IV phosphate (< 1mg/dL) Monitor electrolytes |
| health promotion/patient education for hypophosphatemia | Educate on symptoms Educate on avoidance of phosphorus-binding antacids Educate on well-balanced diet |
| magnesium normal range | 1.8-2.5 mEq/L |
| how is magnesium obtained | through diet (green vegetables, grains, nuts, seafood) |
| how is magnesium excreted | by kidneys |
| magnesium is vital in | Intracellular processes, enzyme reaction, synthesis of proteins and nucleic acids Exerts sedative effect at neuromuscular junction Decreasing acetylcholine release Essential for neuromuscular and cardiovascular function |
| hypermagnesium | >2.5 mEq/L |
| hypermagnesium results from | Renal failure Over-the-counter laxatives |
| hypermagnesium results in | interference with neuromuscular transmission Depresses CNS Compromises cardiovascular system |
| how does hypermagnesium compromise cardiovascular system | bradycardia, heart block, cardiac arrest |
| signs and symptoms of hypermagnesium | Confusion Lethargy, weakness Weak or absent deep tendon reflexes Nausea/vomiting Respiratory depression Hypotension Cardiac dysrhythmias: bradycardia, heart block, cardiac arrest |
| treatment of hypermagnesium | Treat underlying cause Hold meds with Mg Calcium Gluconate (IV) to reverse neuromuscular and cardiac effects Respiratory support PRN Monitor CV status, VS, neuro status, I &O, Deep tendon reflexes Monitor electrolytes |
| If heart block in hypermagnesium, you may need a | pacer |
| hypomagnesium value | < 1.8 mEq/L |
| hypomagnesium results from | Deficit in magnesium intake: protein-calorie malnutrition, starvation, alcoholism Excessive losses GI losses (ileostomy, diarrhea) Shift between intracellular and extracellular fluids Anti-rejection drug (Cyclosporine) Excessive urination (DKA) |
| hypomagnesium occurs along with | Occurs along with low serum potassium and calcium |
| hypomagnesium causes | Cardiac dysrhythmias, sudden death Increased neuromuscular excitability CNS- Increased neural excitability Hypertension (vasoconstriction) |
| signs and symptoms of hypomagnesium | Cardiac dysrhythmias: Torsades de Pointes Mental changes, seizures Hyperactive reflexes Positive Babinski, Cyvostek, Trousseau Signs Nystagmus HTN Tachycardia |
| Dx tests for hypomagnesium | serum electrolytes ECG |
| dx ECG results for hypomagnesium | prolonged PR intervals, widen QRS complex, ST depression, T wave inversion |
| Tx for hypomagnesium | Prevention and identification of underlying cause Magnesium IV |
| our jobs as nurses | Identify and monitor pts who are likely to develop imbalances Monitor pts for early manifestations Implement interventions to correct and prevent imbalances Education patients on prevention |
Created by:
leh195