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electrolytes
med surg exam 1
| Question | Answer |
|---|---|
| Normal range of sodium | 135-145 mEq/L |
| What is sodium (na+) the primary regulator of? | the volume, osmolality, and distribution of extracellular fluid |
| What is sodium important for? | maintaining neuromuscular activity |
| recommended daily intake of sodium- CDC dietary guidelines | no more than 2300 mg of sodium per day |
| recommended daily intake of sodium- American Heart Association | ideal intake less than 1500mg of sodium a day |
| hypernatremia value | greater than 145 mEq/L of sodium |
| causes of hypernatremia | water deprivation (unable to respond to thirst); water loss due to fever, hyperventilation, massive burns, diarrhea; osmotic diuresis (hyperglycemic); excessive sodium intake |
| hypernatremia results in | hyperosmolality of extracellular fluid, cellular dehydration |
| signs and symptoms of hypernatremia | increase thirst, 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 |
| 1st manifestation of hypernatremia | increased thirst |
| why are clinical manifestations of hypernatremia primarily neurologic? | due to an osmotic shift of water out of brain cells |
| Hypernatremia Assessment- health history | duration of symptoms, precipitating factors- water deprivation, temperature, rapid breathing, diarrhea, salt intake, diabetes mellitus, perception of thirst, medications |
| Hypernatremia Assessment- physical assessment | neurological status, vital signs, mucuous membranes, manifestations of fluid volume deficit or excess |
| hypernatremia treatment | oral, enteral, or IV water replacement; hypotonic IV fluids (0.45% NaCl or 5% dextrose); monitor labs, I&O, neuro status, and vital signs; mouth care |
| 5% dextrose | isotonic when administered but becomes hypotonic when dextrose is metabolized |
| hypernatremia health promotion/ patient education | educate on risks for hypernatremia, care giver on need to offer fluids at regular intervals, on which foods are high in sodium, on the need for free water flushes with tube feedings |
| hyponatremia value | less than 135 mEq/L of sodium |
| hyponatremia results in | decreased serum osmolality, swelling of cells |
| two types of hyponatremia | depletional and dilutional |
| depletional hyponatremia | excess sodium loss |
| causes of depletional hyponatremia | 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 |
| causes of dilutional hyponatremia | heart failure, liver disease, seld-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; neurological symptoms- headache, lethargy, stupor, dull sensorium, tremors, muscle twitching, hyperflexia, if very low can lead to coma |
| hyponatremia diagnostic tests | serum sodium and serum osmolality is decreased, 24 hour urine-evaluate sodium excretion- increase in SIADH, decrease in losses of isotonic fluid |
| hyponatremia assessment- health history | current symptoms, duration of symptoms, precipitating factors |
| hyponatremia assessment- physical assessment | neurological status, LOC, vital signs, 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 |
| depletional hyponatremia treatment if Na lost | 110-115 mEq/L: 3% NaCl can be given very cautiously (ICU) |
| dilutonal hyponatremia (Excess ECF) treatment | diuretics, free water restriction, sodium tablets, treat underlying cause |
| hyponatremia health promotion/patient education | educate on signs and symptoms of hyponatremia, 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 (K+) normal range | 3.5-5 mEq/L |
| potassium | primary cation in intracellular fluid |
| potassium (K+) role | plays critical role in conducting nerve impulses and excitability of skeletal, cardiac, and smooth muscle |
| How is potassium derived? | normally derived from dietary intake, 50-100 mEq daily needed to maintain balance |
| hyperkalemia value | greater than 5.0 potassium |
| what does hyperkalemia result from? | inadequate excretion from kidneys, high intake, shift from intracellular to extracellular fluid |
| primary reason of hyperkalemia | inadequate excretion from kidneys |
| hyperkalemia signs and symptoms | effects cardiac function, neuromuscular function, respiratory, and GI |
| hyperkalemia signs and symptoms- cardiac function | ECG: peaked T waves, prolonged PR and QRS intervals; bradycardia, heart block, ventricular tachycardia, cardiac arrest |
| hyperkalemia signs and symptoms- neuromuscular function | paresthesia, muscle tremors, twitching, weakness |
| hyperkalemia signs and symptoms- respiratory | dyspnea, respiratory distress |
| hyperkalemia signs and symptoms- GI | nausea, vomiting, diarrhea |
| hyperkalemia health history | symptoms and duration, precipitating factors- use of salt substitues or potassium supplements, reduced urine output, renal or endocrine disorders |
| hyperkalemia physical assessment | EKG, pulses, muscle strength, bowel sounds |
| hyperkalemia labs | electrolytes |
| hyperkalemia treatment | diuretics, binding agents (veltassa, lokelma), insulin- hypertonic dextrose, albuterol, dialysis, calcium gluconate and calcium chloride |
| diuretic for treatment of hyperkalemia | potassium wasting (furosemide) |
| veltessa (oral) for treatment of hyperkalemia | binding of potassium ions in GI tract in exchange for Ca ions in GI tract |
| lokelma (oral) for treatment of hyperkalemia | binding of potassium ions in exchange with H and Na ions in GI tract |
| Insulin, hypertonic dextrose (IV) for treatment of hyperkalemia | for K=> 6.5 mEq/L: IV regular insulin and dextrose 50%- increases potassium uptake by cells to decrease the serum concentration |
| albuterol for treatment of hyperkalemia | stimulates the Na/K pump- results in potassium shifting into the cells |
| contraindications for albuterol for treatment of hyperkalemia | in patients with unstable angina and acute MI |
| calcium gluconate for treatment of hyperkalemia | used emergently to counteract K+ effects on cardiac muscle |
| health promotion/patient education for hyperkalemia | salt substitutes, food high in potassium, over the counter supplements; educate on early signs of hyperkalemia |
| hypokalemia value | less than 3.5 |
| hypokalemia results from | Loop diuretics Inadequate intake of potassium Excessive renal or intestinal loss Redistribution between intracellular and extracellular fluid |
| how does hypokalemia affect the cardiac system? | 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 cardiac output |
| hypokalemia causes an increased risk for what type of toxicity? | digoxin |
| hypokalemia affects what in skeletal cells? | the resting membrane potential |
| what happens when hypokalemia 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 |
| Hypokalemia assessment- health history | Symptoms and duration of symptoms Precipitating factors- Diuretic use, Vomiting and diarrhea, GI suctioning, Chronic conditions (Hyperaldosteronism, Cushing syndrome) |
| Hypokalemia assessment- physical assessment | EKG- Cardiac Assessment VS, apical and peripheral pulses, orthostatic hypotension Mental Status GI assessment Muscular assessment |
| hypokalemia treatment | PO and/or IV supplements Monitor electrolytes (K+) Monitor VS, apical and peripheral pulses Monitor for Orthostatic BP |
| hypokalemia education | diet, symptoms of hypokalemia |
Created by:
camrynfoster