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electrolyte imbalances

hypokalemia lab values 3.5-5.0
Potassium located in the ecf & ICF and is regulated by aldosterone
Is crucial for heart function (maintains heart rhythms) and transmits and conducts nerve impulses in skeletal and smooth muscle potassium
If there is an imbalance of potassium which body parts does it affect? It affects the heart, skeletal muscles, specfically legs, smooth muscles (i.e. the GI tract)
Which is potentially life threatening? hypo or hyperkalemia Hypokalemia
Which is treated as an emergency and is considered most dangerous of all electrolyte imbalances? hypo or hyperkalema Hyperkalemia
Which electrolyte must be replaced daily? IN order to maintain balance, potassium needs to be replaced via diet or supplements
Cardiac function is affected first due to the harmful consequence of which imbalance? Hyperkalemia slows conduction
Hyperkalemia affects conduction in what way? It slows the heart rate, possible heart blocks and prolonged deporalization.
Which EKG would you anticipate seeing if someone is suffering from hypokalemia? An inverted (U-shaped)/flat T wave or Peaked T wave? U-shaped/Flat T wave
Which EKG would you anticipate seeing if someone is suffering from hyperkalemia? An inverted (U-shaped)/flat T wave or Peaked T wave? Peaked T wave
Cell membranes of excitable tissue such as the heart are less responsive to normal stimuli; there fore what happens when K drops When K drops, the tissue is not excited. low K interferes with exciting heart to contract.
What type of diuretics are risk of leading to hypokalemia? Loop diuretics and thiazide because they waste K....loops are the are the riskiest
Someone who has diarrhea has risk of developing this electrolyte imbalance? Hypokalemia and Hyponatremia
If someone has excessive GI drainage/diarrhea they are at risk for? Hypernatremia
There is a large amount of k in intestinal fluid, and a person is at risk dveloping Hypokalemia if they have this problem? Diarrhea
Vomiting and NG suction could lead to hypokalemia because there are large amounts of k in the intestinal fluids
why would someone have inadeqate potassium intake as it r/t diet? eating disorder (anorexia/bulimia), alcoholics diet is extremely poor
How can a patient is recieving IV therapy and they are NPO become hypokalemia? Because solution lacks potassium- it is a potassium poor solution = decrease potassium
What does low mg levels have to do with hypokalemia? K and Mg work hand in hand, and if there are low levels of mg, then it is hard for kidneys to hold onto K.
Acronym SUCTION as it r/t hypokalemia- what does S stand for? skeletal muscle weakness
Acronym SUCTION as it r/t hypokalemia- what does U stand for? The T wave is shaped like a "U" or flat if someone has hypokalemia
Acronym SUCTION as it r/t hypokalemia- what does C stand for? Constipation - remember that potassium excites smooth muscle, since GI/GU system is smooth muscle, there is nothing there to excite it to move along, there for peristalsis/constipation.
Acronym SUCTION as it r/t hypokalemia- what does T stand for? Toxic effect of digoxin, combo taking dig and lasix can lead to low levels of potassium enhances the effect of the drug causing more problems.
Acronym SUCTION as it r/t hypokalemia- what does I stand for? Irregular weak thready pulses
Acronym SUCTION as it r/t hypokalemia- what does O stand for? Orthostatic hypotension
Acronym SUCTION as it r/t hypokalemia- what does N stand for? Numbness/tingling = paresthesia
Shallow respirations and hypokalemia Resp tract is made of smooth muscle and doesn't work properly d/t lack of potassium slows it down.
Some key manifesations that stand out for hypokalemia are leg cramping, polyuria, EKG changes, dysrhythmias
What is the process of taking care of someone with hypokalemia? Assess for s/sx..P and respirations especially..BP (do orthostatic bp if hypokalemia is suspected), lethargy
Give potassium replacements IV or oral for which condition? Hypokalemia
Considerations of oral potassium supplements give with food because it cause stomach irribilaty and do not crush if extended release.
chocolate, dried fruit, nuts/seeds, oranges, bananas, potatoes, tomatoes, mushrooms, apricots, cantaloupe and carrots Potassium rich foods...depends if they need more or less K...eat them if they need K, avoid them if they have excess K.
When giving IV potassium, what are some things you have to consider? dilute, do not exceed 40 mEq/liter of solution unless facility policy is different, give 10 meq/hr unless facility policy is different.
Can you give more than 10mEq/hr of potassium Although this is the amount deemed as safe, some facilities have different policies and you need to go by that policy.
Can you give potassium via gravity? No...IV potassium can only be infused via infusion device.
The clinical teacher hands you a syringe of potassium to give as an IV push to a resident, what do you do next? You tell her no, because doing this will cause cardiac arrest and could kill a patient.
Your first clinical assignment you learn that your resident is on IV potassium, what would you think you'd have to monitor? Cardiac rhythm....this pt will likely be on telemetry.
why would you monitor the IV site of someone who is recieving potassium? Potassium is vesicant and if given too rapidly could cause plebitis.
Your patient is getting Potassium, and they are c/o burning at IV site- what do you do? Then, Potassium is given too fast, you need to slow down the rate or you risk infiltration that could lead to extravasation.
IV potassium risk infiltration that could lead to extravasation.
This is the most dangerous electrolyte disorder, but it is not commonw Hyperkalemia
What happens to the heart if there is too much potassium Potassium is a depressant on the heart, too much of it can stop it all together.
How can renal impairment cause Hyperkalemia Can't excrete the potassium properly...you see this happen to people with renal failure who skip dialysis.
What is the risk of a crush injury? Hemolysis (blood cell break open) and potassium leaks into the blood stream leading to hyperkalemia
Can anything else besides crush injury cause hemolysis that could lead to hyperkalemia? yes, any trauma or infections etc can breakdown RBC's
Is there ever too much potasium...since you have to replace it all the time? yes, too you can take eat too many and could lead to hyperkalemia
Which diuretics can lead to hyperkalemia? Midamor (amiloride) or Spironolactone (aldactone) are potassium sparing diuretic.
Blood transfusions can lead to hyperkalemia if length of time given is to long. The ideal time to give a blood transfusion is 1 unit in 2 hours.
What is an early symtpom of hyperkalemia? parathesia
Why would someone with hyperkalemia have abdominal cramping and diarrhea? Because potassium excits smooth muscle tissue, gi/gu is made of smooth muscle, there fore excess of potassium will lead to increased peristalsis.
If the T wave is peaked or tented, does pt have hyper or hypokalemia hyperkalemia
If pt is irritable, and c/o muscle weakness that started in the legs, there pulse is less than then chances are this person my have hyperkalemia.
a person with hyper kalemia may have what type of heart rate and rhythm A slow heart rate and irregular rhythm.
Medicationstreatments given to treat hyperkalemia Loop diuretics, kayexalate, insulin given with D10W, and hemodialysis.
Hemodialysis Filter out blood, specifically potassium.
insulin forces potassium out of the intravascular back into the cells, why give d10w? Cause insulin drives down blood sugar, need to give dextrose to offset sugar lost to insulin therapy
Kayexelate cation exchange medication that goes to the bowel and pulls K out to be excreted.
Takes several hours to start working, but when it does, this medication last 4 to 6 hours and gives pt diarrhea kayexelate
Loop diuretic can be given to treat someone with mild case of hyperkalemia....don't bother giving to someone with renal problems cuz this won't work at all.
this electrolyte regulates fluid volume, osmolarity and distribution of ECF and maintaining neuromuscular activity sodium
Normal values of sodium 135 -145
Sodium works with potassium, and together balances the nerve response to stimulate the nerve impulses to travel to muscles and contractions
sodium with less than 135 Hyponatremia
major electrolyte in ecf potassium
Too much water and not enough salt = dilutional hyponatremia
Water goes where? Wherever sodium goes
with hyponatremia, water being pulled from the intravascular to intracellular can be dangerous if happens in brain = cerebral edema. water goes where the sodium goes and the sodium is being pulled from the bloodstream into the (intracellular) cells causing cells to swell.
What functions slow down d/t hyponatremia Membrane excitability slows down and delayed cellular activity
A construction worker sweating in summer sun and marathon have what in common. Both at risk for developing hyponatremia due to excessive diaphoresis
Which drug could lead to hyponatremia diuretics because they block Na from reabsorbing into the body.
How could an wound cause hyponatremia? A large wound with lots of drainage.
You mom prepares cardiac diet meals and you were rushed to the hospital to find out that you have hyponatremia. why? d/t low salt diet
A patient returned home from Mexico and had been vomiting and has had diarrhea for 2 days...which electrolytes would this effect? Possible hypokalemia, and hyponatremia.
How could renal disease cause hyponatremia? Not functioning properly to regulate Na.
What does hyperglycemia have in common with hyponatremia? High BS causes blood stream to be Hyperosmotic (thicker), fluids follow glucose so the more diuresis the more sodium is lost.
How can a marathon runner who drinks plenty of water become hyponatremia? Excessive water intake can lead to intoxication,they dilute a marathon runner needs to replace with electrolytes as well d/t excessive sweating.
Psycogenic polydipsia A schizophrenic disorder where a person compulsively drinks water and dilutes sodium.
Early manifestations of Hyponatremia neurovascular function (muscle cramps, weakness,)and fatigue d/t effects on muscle cells
N&V, abdominal cramping and diarrhea early manifestations of hyponatremia that affect the GI system
As sodium levels decrease and water shifts from ECF to intracellular cells swell causing cellular edema.
what are some later signs of hyponatremia and levels fall below 120 neurological signs appear and include headache, stupor, mental status changes, confusion, lethargy. short attention span, muscle twicthing, tremors,
Pt will go into coma with very low levels of sodium
a pt comes into the er and has bounding radial pulse and low BP, you suspect hyponatremia. what other assesments would you do you would check other pulse sities to compare.
Decreased temperature another sign of hyp0natreia.
How would you treat someone with hyponatremia Fluid restrictions as fluids will shift back into ECF if fluids are restricted
Why would you give a loop diuretic for hyponatremia This is given when there is excess water in the ECF.
Give oral Na supplements for hyponatremia
Using IV to treate hyponatremia use 0.9% NS...which will gradually replace sodium in bloodstream via osmosis
A higher concentration of Na+ in bloodstream d/t Na leaving intracellular cells, causing them to shrink call hypernatremia
Too much salt in the diet causes hypernatremia
Osmotic diuretics cause Hypernatremia because it pulls out the water only; osmotic diuretics block the reabsorption of water back into the body.
Other ways to lose water that the sodium levels end up concentrated excessive GI drainage, diuresis and diarrhea
how does sweating cause hypernatremia lose so much water that sodium levels are concentrated.
What are signs and symptoms of hypernatremia: acronym SALTHO- "S" Skin flushed
What are signs and symptoms of hypernatremia: acronym SALTHO- "A" Agitation
What are signs and symptoms of hypernatremia: acronym SALTHO- "L" low grade fever, lethargy, low urine output
What are signs and symptoms of hypernatremia: acronym SALTHO- "T" Thirst
What are signs and symptoms of hypernatremia: acronym SALTHO- "H" Hypertension
What are signs and symptoms of hypernatremia: acronym SALTHO- "O" Orthostatic hypotension
How to treat hypernatremia treat underlying cause
Give what type of IV fluids for hypernatremia D5W gradually over 48hours
Restrict fluids and provide oral replacement with no electrolytes for hypernatremia.
Created by: Wends1984