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electrolyte imbalances
| Question | Answer |
|---|---|
| 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
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