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electrolytes 2
med surg exam 1
| Question | Answer |
|---|---|
| calcium normal range | 8.5-10mg/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 level | less than 10mg/dL |
| hypercalcemia results from | increased resorption of Ca from bone (hyperparathyroidism), malignancies- bone destruct., tumor excretion of hormone-like subs. prolonged immobility- lack of weight bearing; excessive GI absorption, decreased renal excretion of Ca, excess levels of vit. D |
| hypercalcemia signs and symptoms | Muscle weakness Fatigue Anorexia, nausea/vomiting, constipation Confusion, lethargy, behavior changes ECG- Dysrhythmias Increase thirst Increase in urine output Kidney stones |
| hypercalcemia assessment- health history | Symptoms and duration of symptoms Precipitating factor- Excessive intake of Calcium, Immobility, Malignancy, Renal or endocrine disorders |
| hypercalcemia assessment- physical assessment | VS, apical pulses Mental Status, LOC GI assessment Muscle strength, deep tendon reflexes |
| hypercalcemia diagnostic tests | Serum Electrolytes Serum parathyroid hormone levels ECG Bone density scans |
| what would you see on an ECG when diagnosing hypercalcemia? | shorten QT interval, shorten and depressed ST segment, widen T wave |
| what would you look for on a bone density scan when diagnosing hypercalcemia? | Monitor bone resorption, effect of treatment |
| what does hypercalcemia treatment depend on? | severity |
| mild hypercalcemia value | <12 mg/dL |
| moderate hypercalcemia value | 12 and 14 mg/dL |
| severe hypercalcemia value | >14 mg/dL |
| hypercalcemia treatment mild, moderate with no symptoms | Weight-bearing activities Fluid intake of at least six to eight glasses of water per day Limit intake of Calcium |
| hypercalcemia treatment moderate with symptoms to severe | IV fluids (isotonic) Bisphosphonates- For treatment of malignancy-associated hypercalcemia, Reduce Calcium resorption from bone; Calcitonin - Can administer (along with a bisphosphonate) in patients with calcium >14 mg/dL with symptoms |
| hypercalcemia patient education | Avoid factors that can cause it- thiazide diuretics, lithium carbonate therapy, volume depletion, prolonged bed rest or inactivity, high Ca diet (>1000 mg/day), Limit OTC Ca; Water: at least 6-8 glasses per day – minimizes risk of kidney stones |
| hypocalcemia value | less than 8.5 |
| what does hypocalcemia result from? | Decreased total calcium stores; Low levels of extracellular calcium with normal levels of calcium stores in bones |
| hypocalcemia risk factors | Older adults (particularly women) Removal of parathyroid gland Thyroid and radical neck surgery Lactose intolerance- No milk products Bariatric surgery- Decrease in food consumption and malabsorption |
| hypocalcemia signs and symptoms | Numbness, tingling Muscle cramping Hyperactive reflexes Tetany Carpopedal and laryngeal spasms Bone pain, fractures Osteoporosis |
| hypocalcemia assessment- health history | Symptoms and duration of symptoms Precipitating factors- Older adults (particularly women), Removal of parathyroid gland, Lactose intolerance, Bariatric surgery |
| hypocalcemia assessment- physical assessment | VS Neuromuscular irritability Laryngospasm-Monitor airway and respiratory status Cardiac dysrhythmias Seizure precautions |
| hypocalcemia signs and symptoms | Cyvostek’s Sign, trousseau's sign, |
| What is Cyvostek's Sign? | Spasm of the facial muscles elicited by tapping the facial nerve in front of the ear |
| What is 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 Ca Serum albumin Serum magnesium level Low Mg level must be restored to correct Ca level Serum phosphate level Hyperphosphatemia can lead to hypocalcemia (inverse relationship) Parathyroid home level ECG |
| What does it mean when albumin is low when testing for hypocalcemia? | ionized calcium may remain normal when total calcium is low |
| Correct calcium formula (serum albumin- hypocalcemia) | (mg/dL) = measured total Ca (mg/dL) + 0.8 (4.0 - serum albumin [g/dL]) |
| hypocalcemia treatment | Oral or IV calcium Vitamin D Monitor VS Monitor airway and respiratory status Monitor neuromuscular status |
| hypocalcemia patient education | 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 normal range | 2.5-4.5 mg/dL |
| phosphate function | Production of ATP RBC function, O2 delivery to tissues Nervous system and muscular function Metabolism for fats, carbs, and proteins Assists in maintaining acid-base balance |
| hyperphosphatemia value | greater than 4.5 mg/dL |
| hyperphosphatemia results from | Impaired secretion Excessive intake Rapid administration of PO4 containing solutions Shift from ICF to ECF Lowering of serum Ca levels (inverse relationship) Serum PO4 combines with ionized Ca to make Ca PO4 which decreases serum Ca levels |
| primary cause of impaired secretions in hyperphosphatemia | renal failure |
| causes of hyperphosphatemia: excessive intake | Rapid administration of phosphate containing solutions |
| causes of hyperphosphatemia: shift from intracellular to extracellular fluid | Chemotherapy, sepsis, trauma, heat stroke, hypothermia |
| what are symptoms of hyperphosphatemia caused by? | Symptoms more a cause of low calcium then high phosphate |
| hyperphosphatemia signs and symptoms | Muscle cramps and pains Paresthesia Tingling around mouth Muscle spasms Tetany Nausea/vomiting Dysphagia Decreased Bp Cardiac dysrhythmias |
| hyperphosphatemia treatment | Monitor lab values- High phosphate, low calcium Monitor VS Monitor airway and respiratory status Monitor neuromuscular status Treatment of cause |
| hyperphosphatemia health promotion/ patient education | Limitation of phosphate intake High-phosphate foods (dairy products, meats, nuts, processed foods, and dark colas) Avoidance of phosphate edemas, laxatives |
| hypophosphatemia value | less than 2.5 mg/dL |
| hypophosphatemia results from | Total body deficit- GI absorption, increased renal excretion Shrift into intracellular space- Hyperventilation, resp. alkalosis Iatrogenic (related to treatment)- IV glucose, antacids, steroids, diuretics Alcoholism- Can effect intake and absorption |
| most symptoms of hypophosphatemia are caused by? | depletion of ATP and impaired O2 delivery to cells |
| hypophosphatemia can effect? | every major organ |
| hypophosphatemia signs and symptoms | Intention tremor Paresthesia Confusion, stupor, seizures Bone pain, joint stiffness Bleeding disorders Impaired white blood cell function Decreased O2 delivery to cells RBC destruction Decrease O2 to heart muscle Chest pain, dysrhythmias |
| hypophosphatemia treatment | Treat underlying cause Dietary and oral supplements of phosphate IV phosphate (< 1mg/dL) Monitor electrolytes |
| hypophosphatemia health promotion/ patient education | Educate on symptoms, avoidance of phosphorus-binding antacids, well-balanced diet |
| magnesium normal range | 1.8-2.5 mEq/L |
| what is magnesium obtained through? | diet (green vegetables, grains, nuts, seafood) |
| What is magnesium excreted by? | kidneys |
| function of magnesium (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 value | greater than 2.5 mEq/L |
| what does hypermagnesium result from? | Renal failure Over-the-counter laxatives |
| what does hypermagnesium result in | Interference with neuromuscular transmission Depresses CNS Compromises cardiovascular system- bradycardia, heart block, cardiac arrest |
| hypermagnesium signs and symptoms | Confusion Lethargy, weakness Weak or absent deep tendon reflexes Nausea/vomiting Respiratory depression Hypotension Cardiac dysrhythmias- Bradycardia, heart block, cardiac arrest |
| hypermagnesium treatment | Treat underlying cause w/hold meds w/ Mg Ca Gluconate (IV) to reverse NM & cardiac effects resp. support as needed If heart block- may need pacer Monitor CV, VS, neuro status I &O, Deep tendon reflexes Monitor electrolytes |
| hypomagnesium value | less than 1.8 mEq/L |
| what does hypomagnesium result from? | Deficit in Mg intake-protein-calorie malnutrition, starvation Alcoholism Excessive losses- GI losses (ileostomy, diarrhea) Shift between ICF and ECF Anti-rejection drug (Cyclosporine) Excessive urination (diabetic ketoacidosis) |
| why does hypomagnesium occur along with? | low serum potassium and calcium |
| what does hypomagnesium cause? | Cardiac dysrhythmias, sudden death Increased neuromuscular excitability CNS- Increased neural excitability Hypertension (vasoconstriction) |
| hypomagnesium signs and symptoms | Cardiac dysrhythmias- Torsades de Pointes Mental changes, seizures Hyperactive reflexes Positive Babinski, Cyvostek, Trousseau Signs Nystagmus Hypertension Tachycardia |
| hypomagnesium diagnostic tests | Serum electrolytes ECG- Prolonged PR intervals, widen QRS complex, ST depression, T wave inversion |
| hypomagnesium treatment | Prevention and identification of underlying cause Magnesium IV |
| our jobs as nurses when monitoring for electrolyte imbalance | Identify pts who are likely to develop imbalances 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:
camrynfoster