Electrolytes

Question 1

Sodium (Na+) Levels

Answer 1

135 - 145 mEq/L

Question 2

Sodium (Na+) Facts

Answer 2

1. Most abundant electrolyte in the ECF
2. Important in regulating neuromuscular impulses in the nerve & muscle fibers
3. Attracts water
4. Controlled by renal reabsorption & excretion
5. Dietary sources are:
   a. Table salt
   b. processed/cured meat
   c. packaged food
   d. sea food
   e. cheese

Question 3

Hyponatremia Levels

Answer 3

1. Low Na+

2. < 135

Question 4

Causes of Hyponatremia

Answer 4

1. Diaphoresis
2. Wound drainage
3. Duiretic
4. Dilutional states

Question 5

Hyponatremia Manifestations

Answer 5

1. Decreased urinary output
2. Sleeplessness
3. Spasm
4. Muscle Weakness
5. Decreased deep tendon reflex
6. Coma
7. N/V
8. Anorexia

Question 6

Hyponatremia Tx

Answer 6

1. Tx cause
2. Hypertonic IV fluid (Severe case)
3. Isotonic IV fluid
4. Oral Na+ supplement
5. Restrict fluids

Question 7

Hyponatremia RN Implication

Answer 7

1. Monitor I & O
2. DW
3. Monitor labs
4. Restrict fluids
5. Increase dietary intake
6. Monitor fluid status

Question 8

Hypernatremia Levels

Answer 8

1. High Na+

2. > 145

Question 9

Causes of Hypernatremia

Answer 9

1. Increase in Na+ intake
2. Excess loss of water or inadequate intake of water
3. Dehydration

Question 10

Hypernatremia Manifestation

Answer 10

1. Irritability
2. Restlessness
3. Aagitation
4. Confusion
5. Lathargy
6. Muscle weakness
7. Twitching or seizure
8. Thirst**

Question 11

Hypernatremia Tx

Answer 11

1. Tx cause
2. Correct fluid imbalance carefully
3. IV fluids for dehydration (Isotonic & Hypertonic)

Question 12

Hypernatremia RN Implication

Answer 12

1. Monitor VS
2. Monitor I & O
3. DW
4. Monitor edema
5. Nutritional assessment

Question 13

Potassium (K+) Levels

Answer 13

3.5 - 5 mEq/L

Question 14

Potassium (K+) Facts

Answer 14

1. Major cation in the ICF
2. Important for nerve –> cell communication & the initiation of muscle contraction
3. Controlled by kidneys
   a. Aldosterone(promotes excretion) & insulin (moves K+ into cell.
4. Dietary sources:
   a. Bananas
   b. Cantaloupe
   c. Green leafy vegetables
   d. Potatoes
   e. Avocados

Question 15

Hypokalemia Level

Answer 15

< 3.5 mEq/L

Question 16

Causes of Hypokalemia

Answer 16

1. Diuretics
2. V/D
3. Nasogastric suction
4. Decreased intake

Question 17

Hypokalemia Manifestation

Answer 17

1. Muscle weakness
2. Fatigue*
3. Decreased bowel motility*
4. N/V/C
5. Ileus (Obstruction)
6. Cardiac arrhythmias
7. Orthostatic Hypotension*
8. Digoxin Sensativity
9. Shallow/Innefective Resp.*
10. Frequent Urination

Question 18

Hypokalemia Tx

Answer 18

1. K+ supplements
   a. Take c fd to minimize GI upset
2. IV K+
   a. Must be diluted
   b. Max rate of 10 mEq/hr
   c. Can cause burning sensation @ IV site
   d. Irritating to veins

Question 19

Hypokalemia RN Implication

Answer 19

1. Cardiac Monitor
2. Monitor Resp status
3. Encourage dietary intake
4. Monitor labs
5. Do not crush or chew

Question 20

Hyperkalemia Level

Answer 20

> 5

Question 21

Hyperkalemia Causes

Answer 21

1. Renal Failure
2. K+ sparing diuretics
3. K+ supplements or IV replacement
4. Lack of insulin(diabetic ketoacidosis)
5. Cell destruction(burns, trauma, infection)
6. Hemolysis of cells with extended tourniquet application.

Question 22

Hypekalemia Manifestation

Answer 22

1. Muscle cramps, weakness
2. N/D
3. Low BP
4. Bradycardia
5. Arrhythmias
6. Numbness or Tingling of:
   a. Face
   b. Tongue
   c. Hands
   d. Feet
7. Fatigue
8. Drowsiness
9. Confusion

Question 23

Hyperkalemia Tx

Answer 23

1. Insulin moves K+ from ECF to ICF (Give dextrose if needed)
2. Diuretics
3. Na+ polystyrene sulfate, binds c K+ preventing absorption c fecal excretion
4. Dialysis
5. IV Ca++ to minimize cardiac toxicity

Question 24

Hyperkalemia RN Implication

Answer 24

1. Monitor Renal Function
2. Monitor intake - FD & Medication
3. Cardiac Mmonitor
4. Dialysis if needed

Question 25

Calcium (Ca++) Level

Answer 25

8.5 - 10.5 mg/dl

Question 26

Calcium (Ca++) Facts

Answer 26

1. Most abundant mineral in body 2. Provides mass & strength to bones & teeth 3. Works closely c Phosphorus & Magnesium As Phos increases, Ca++ decreases** As Mg increases, Ca++ increases 4. Necessary for transmission of nerve impulses, Normal muscle contraction, regulation of heart, hormone secretion & formation of blood clots. 5. Controlled by vitamin D, Parathyroid hormone, Calcitonin & serum concentration: a. Intestinal absorption b. Renal reabsorption & excretion c. Bone breakdown & uptake 6. Dietary sources: a. Milk b. Yogurt c. Cheese d. egg yolk e. Cauliflower f. Soybeans g. Green leafy vegetables

Question 27

Hypocalcemia Level

Answer 27

< 8.5

Question 28

Hypocalcemia Causes

Answer 28

1. Renal failure 2. Decreased intake or absorption 3. Acute pancreatitis 4. Hyperparathyroidism 5. Vitamin D deficiency 6. Low Mg level 7. Low serum albumin 8. Increased Phos

Question 29

Hypocalcemia Manifestation

Answer 29

1. Skeletal muscle spasm, cramps, tetany 2. Convulsions 3. Parasthesias of lips & extremeties 4. Chvostek's sign 5. Trousseau's sign 6. Cardiac arrhythmias 7. Osteoporosis

Question 30

Hypocalcemia Tx

Answer 30

1. Tx cause 2. IV Ca++ gluconate - monitor IV for tissue necrosis 3. Oral supplements c Vitamin D c fd.

Question 31

Hypocalcemia RN Implication

Answer 31

1. Monitor electrolyte levels 2. Cardiac monitor 3. Monitor respiratory status

Question 32

Hypercalcemia Level

Answer 32

> 10.5 | Greater than 12 mg/dl is life threatening!

Question 33

Hhypercalcemia Causes

Answer 33

1. Excess intake or absorption 2. Hyperparathyroidism 3. Bone cancer cause breakdown of bone 4. Multiple fractures 5. Prolonged immobilization 6. Prolonged use of aluminum-containing antacids

Question 34

Hypercalcemia Manifestation

Answer 34

1. Anorexia, N/V/C 2. Muscle weakness 3. Decreased deep tendon reflex 4. Lethargy 5. Polydipsia, Polyuria, Dehydration 6. Impaired concentration 7. Confusion 8. Blurred vision 9. Bone pain 10. Cardiac Arrhythmias

Question 35

Hypercalcemia Tx

Answer 35

1. Diuretic** 2. IV hydration c NS to increase renal blood flow & urinary excretion 3. IV bisphophonates - obstruct Ca++ release from bone 4. Calcitonin - inhibits release from bone & promotes renal excretion

Question 36

Hypercalcemia RN Implication

Answer 36

1. Encourage oral fluids (3-4L/day) 2. Monitor VS 3. Cardiac monitor 4. Monitor neuro status 5. Encourage mobility

Question 37

Magnesium (Mg++) Level

Answer 37

1.8 - 2.5 mEq/dl

Question 38

Magnesium (Mg++) Facts

Answer 38

1. 2nd most abundant cation in ICF 2. Activating co-factor c more than 300 enzymes 3. Necessary for formation & function of healthy bones 4. Influences parathyroid hormone & Ca++ levels 5. Important in blood clotting, DNA & RNA synthesis, Cardiovascular regulation 6. Increased/Decreases c K+ 7. Dietary sources: a. Vegetables: Spinach Broccoli Avocado Potato Whole Grain Beef Chicken Tuna Milk Yogurt Raisins