Critical Care Nursing > Electrolytes > Flashcards

Electrolytes Flashcards

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1
Q

HypoNAtremia

A

Na+ (sodium) level in the blood is <135

The concentration of sodium in the blood drops below normal

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2
Q

Causes of HypoNAtremia

A
  • Salt loss from the body is > water loss
    ex: diarrhea, NG suctioning, vomiting, sweating, salt-wasting diuretics
  • Body retains an excess amount of water compared to overall sodium level (dilution)
    ex: water intoxication, CHF, overuse of hypertonic solution
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3
Q

What do you observe with HypoNAtremia?

Increased Na+ Excretion vs Diluted Na+ level

A

Increased Na+: decreased skin turgor, dry mucous membranes, orthostatic HYPOtension, abdominal cramps

Diluted Na+: edema, crackles, distended JVD (chf)

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4
Q

If Na+ level continues to DECREASE?

A 
Headaches
Changes in LOC: 
-altered mental status
-extreme fatigue
-seizures
-coma
-death
***secondary to increased ICP and cerebral edema
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5
Q

How to treat HypoNAtremia

Increased Na+ excretion vs Diluted Na+ vs Extreme Neuro Symptoms

A

Increased Excretion:

  • fluid restriction
  • Sodium replacement
    • increased salt in diet, salt tabs,LR/ 0.9% NS

Diluted Na+:

  • Fluid restriction
  • Na+ restriction

Extreme Neuro Symptoms:
-Hypertonic IV Solution (3% NS)

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6
Q

HypERNAtremia

A

Na+ level in the blood is > 145

-The concentration of sodium in the blood is above normal

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7
Q

HypERNAtremia causes

A
  1. More salt than water is gained
    - excessive intake of Na+
    - fluid deprivation
    - Diabetes Insipidus (excessive ADH)
  2. More water than salt is lost
    - watery stools
    - Hyperventilation
    - Excessive diaphoresis
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8
Q

What to observe with HypERNAtremia

A 
*S.A.L.T.* 
S-skin flushed
A- agitation
L- low grade fever
T- thirst
-orthostatic hypotension 
-Weakness
-delusions/hallucinations
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9
Q

How to treat HypERNAtremia

A
  • Hypotonic Fluids ( D5W, 0.45% NS) or Isotonic
  • Salt wasting diuretics
  • Meds to suppress ADH (Desmopressin)
  • Increase fluid intake
  • Na+ restriction
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10
Q

NORMAL SODIUM LEVELS

A

135-145

-Helps to regulate fluid balance in the body

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11
Q

HypoKalemia

A

K+ level in the blood is < 3.5

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12
Q

NORMAL POTASSIUM LEVEL

A

3.5-5

Regulates a little of the fluid balance, but a lot of muscle contractions, and nerve signals

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13
Q

Causes of HypoKalemia

A
  • K* wasting diuretic (lasix)
  • Diarrhea/ Vomiting
  • NG suction
  • Inadequate intake (alcoholism, fasting/anorexia)
  • Chronic Kidney Disease
  • Excessive laxative use
  • Increased aldosterone
  • Diabetes-insulin causes shift
  • Metabolic Alkalosis
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14
Q

What to observe in HypoKalemia

A
  • *Levels below 3
  • Anorexia/ Fatigue
  • Muscle weakness/ cramping
  • N/V
  • Decreased bowl motility
  • Numbness/ tingling
  • Decreased deep tendon reflexes
  • Cardiac Arythmias (U wave)
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15
Q

How to treat HypoKalemia

Conservative vs Aggressive

A

Conservative:

  • Increased oral intake
  • K+ supplement

Aggressive:

  • IV replacement (K+ jumps)
  • **K+ can ONLY be given as IVPB
    • Peripheral Line= 20 mEq over 2 hrs
    • Central Line= 40 mEq over 2 hrs
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16
Q

HypERKalemia

A

Serum K+ level is > 5

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17
Q

Causes of HypERKalemia

A
  • increased K+ intake
  • K+ sparing diuretics
  • Dig-toxicity
  • Crush injuries /trauma/burns
  • Diabetes mellitis
  • Kidney failure
  • Decrease in aldosterone
  • rapid delivery/blood transfusions
  • metabolic acidosis
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18
Q

What to observe with HypERKalemia

A
  • Cardiac arythmias with EKG changes ( level > 6) ( T wave)
  • muscle weakness/ paralysis
  • nausea/ diarrhea

***Can lead to cardiac arrest (levels >8)

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19
Q

How to treat HypERKalemia

Conservative vs Aggressive

A

Conservative:

  • restrict K+ intake
  • Kayexalate (excretes K+ in stool)

Aggressive:

  • IV calcium gluconate (protects cardiac function)
  • IV insulin and dextrose solution
  • Dialysis w/ kidney failure
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20
Q

HypoCALCemia

A

Serum CA++ levels < 8.5

**Calcium level is opposite of phosphate levels

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21
Q

Causes of HypoCALCemia

A
  • limited CA++ in diet
  • Poor oral intake (malnutrition, alcoholism)
  • Hypoparathyroidism
  • Vitamin D deficiency
  • Medications (albumin based antacids)
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22
Q

What to observe with HypoCALCemia

A
  • **Levels < 4.4 (severe symptoms)
  • Tetany
  • Seizures
  • Trousseau Sign
  • Chvostek Sign
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23
Q

How to treat HypoCALCemia

A
  • increase oral intake of calcium
  • Vitamin D therapy
  • IV Calcium gluconate
  • IV calcium chloride
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24
Q

Nursing Management of HypoCALCemia

A
  • watch for patients w/ removed thyroid
  • osteoporosis
  • Seizure Precaution
  • Fall precaution
  • **Keep trach tray at bedside
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25
HyperCALCemia
Serum CA++ levels > 10.2
26
What causes HyperCALCemia
- malignancies * rapid and complete bone destruction - Hyperparathyroidism * **Can lead to CARDIAC ARREST
27
What to observe with HyperCALCemia
“Bones, stones, moans, groans” - bone pain, muscle weakness - Kidney stones - Anxiety, impaired memory, confusion, lethargy - GI pain, N/V, constipation, indigestion
28
How to treat HyperCALCemia
* Treat the Cause - Chemotherapy - Partial Parathyroidectomy - Restrict CA++/ vitamin D intake * IV therapy- 0.9% NS to dilute CA++ levels and increase excretion * Ambulation * Calcitonin (intramuscularly)
29
NORMAL Magnesium Level
1. 3-2.3 - Aides in carbohydrate and protein metabolism - Important for neuromuscular function - Aides in vasodilation if cardiovascular system
30
HypOmagnesemia Causes
Low levels of magnesium - Alcohol withdrawal - NG suction - Diarrhea - IV glucose
31
HypERmagnesemia Causes
- Kidney failure - Untreated DKA - Excessive use of: antacids, laxatives
32
HypOmagnesemia Symptoms
- muscle twitches - weakness - tremors - Tetany - Trousseau’s Sign - Chvostek’s Sign - extreme agitation - torsadae's de pointes - seizures
33
HypERmagnesemia Symptoms
- HYPOtension - N/V - Lethargy - Trouble speaking - Paralysis - loss of DTRs
34
NORMAL Phosphorous
2. 5-4.5 - Helps with muscle and red blood cell function - Acid-base balance - Maintains nervous system - Provide strength for bones and teeth - Helps change food to energy
35
Hypophosphatemia Causes
- Increase intake of carbs - Malnutrition - Alcoholism - Heat stroke - Liver failure - DKA - Low K+/Mg+ levels - hyperparathyroidism - immobile
36
HypERphosphatemia Causes
- Kidney failure - Decreased urine output - Increased phosphorus intake
37
Hypophosphatemia Symptoms
- irritable - fatigue - paresthesia - Difficult swallowing/speaking - Seizures - coma
38
HypERphosphatemia Symptoms
- S/S of low Ca++ - Anorexia - N/V - Bone/Joint pain - Hyperreflexia - Tachycardia
39
HypOphosphatemia Treatment
- diet - Phosphorous supplements - Aggressive IV therapy (failing GI) - Alcohol cessation - Withdrawal protocols
40
HypERphosphatemia Treatment
* Treat underlying cause - Kidney Failure - Respiratory/ Metabolic acidosis - diet
41
Why would a nurse give insulin and dextrose solution to a patient with HypERKalemia?
Because insulin opens up our cells for K+ to return to where it should be and the dextrose will balance out the increase in insulin
42
What does aldosterone do to sodium and potassium?
If sodium increases more potassium will be excreted
43
Renin-Angiotensin-Aldosterone System
If sodium and potassium are increased or decreased kidneys stimulate aldosterone release
44
Intracellular Space (ICS)
fluid inside the cells
45
Extracellular Space (ECS)
fluid outside the cells
46
The ECF is further divided into what?
intravascular interstitial transcellular
47
What is the intravascular space?
fluid w/in the blood vessels
48
The interstitial space contains what?
fluid b/t the cells, tissues, organs, and blood vessels
49
What is an Interstitial Fluid Shift (Third Spacing)?
loss of ECF into a space that does not contribute to equilibrium b/t the ICF and ECF
50
Early Evidence of Third Spacing
decrease in urine output despite adequate fluid intake
51
What happens during Third Spacing?
Urine output decreases because fluid shifts out of the IVS; the kidneys receive less blood and try to compensate by decreasing urine output
52
S/S of Third Spacing
- increased HR - decreased BP - decreased CVP - edema - increased weight - imbalances in I/O's
53
What side effects are associated w/ Hyperkalemia?
- cardiac arrhythmias/arrest - muscle weakness/damage - kidney failure - acidosis
54
Normal movement of fluid through the capillary wall into the tissues is dependent on what two forces?
- capillary hydrostatic pressure generated by cardiac contraction and exerted by plasma on walls of vessels - plasma oncotic pressure exerted by plasma proteins
55
At the arterial end of the capillary bed fluids are filtered b/c of what?
Hydrostatic pressure exceeds oncotic pressure
56
When do fluids re-enter the capillary?
Constant oncotic pressure exceeds hydrostatic pressure at the venous end of the capillary
57
What is a normal osmotic pressure?
270-310
58
What is Osmosis?
movement of water caused by a concentration gradient
59
What determines the Osmolality of a solution?
the number of dissolved particles contained in a unit of fluid
60
Tonicity
ability of all the solutes to cause an osmotic driving force that promotes water movement from one compartment to another
61
Intravenous solutions are termed as what?
- isotonic - hypotonic - hypertonic
62
What does it mean if a solution is termed Isotonic?
it has the same effective osmolality as body fluids
63
What is Osmotic diuresis?
increase in urine output
64
What causes Osmotic diuresis?
excretion of substances such as Glucose, Mannitol, or contrast agents in the urine which exert an osmotic pull on water
65
What happens when glucose is excreted in the urine?
It will bring water causing Polyuria w/ resulting FVD
66
Diffusion
natural tendency of substance to move from an area of high concentration to one of low concentration
67
Filtration
movement of water/solutes occurs from an area of high hydrostatic pressure to low hydrostatic pressure
68
How does sodium tend to enter the cell?
Diffusion
69
The Sodium-Potassium Pump moves sodium from the cell to where?
ECF
70
Osmolality
the concentration of fluid that affects the movement of water b/t fluid compartments by osmosis
71
Serum Osmolality primarily reflects the concentration of what?
Sodium
72
What is the most reliable indicator of the concentrating abilities of the kidneys?
Serum osmolality measured w/ urine osmolality
73
When concerned about renal concentrating ability what will be obtained at the same time?
Serum and urine osmolality test
74
What is the normal ratio of urine and serum?
3:1
75
The specific gravity of urine measures what?
the kidney's ability to excrete or conserve water
76
What is the normal range of urine specific gravity?
1.010 to 1.025
77
Why is specific gravity a less reliable indicator of concentration than urine osmolality?
B/c it is influenced by both the number and size of particles in the urine
78
What is a normal BUN level?
10-20
79
Factors that increase BUN levels are?
- decreased kidney function - GI bleeding - dehydration - increased protein - fever/sepsis
80
Factors that decrease BUN are?
- end stage liver disease - low protein diet - starvation - SIADH - expanded fluid volume (pregnancy)
81
What is a better indicator of kidney function than BUN?
Creatinine
82
Why is creatinine better than a BUN?
B/c it does not vary w/ protein intake and metabolic state
83
Normal Serum Creatinine
0.6-1.4
84
FVD or Hypovolemia
loss of ECF volume exceeds the intake of fluid
85
When does Hypovolemia occur?
when water AND electrolytes are lost in the same proportion as they exist in normal fluids
86
Dehydration
loss of water ALONE with increased serum sodium levels
87
Causes of FVD
- vomiting - diarrhea - GI suctioning - fever - sweating - burns - diabetes insipidus - diuretics - hemorrhage
88
S/S of Hypovolemia
- weight loss - decreased skin turgor - oliguria - postural hypotension - weak rapid HR - decreased CVP - cool, clammy skin
89
Lab Results for patient w/ Hypovolemia/Dehydration
- elevated BUN - elevated hematocrit/hemoglobin - elevated serum osmolarity - elevated glucose - elevated protein - hemoconcentration
90
What is frequently used to treat hypotensive patients w/ FVD?
Isotonic Electrolyte Solutions (Lactate Ringer, 0.9% sodium chloride) b/c they expand plasma volume
91
Weight loss is common w/ FVD, but if the patient is edematous or third spacing the nurse may see what?
Weight gain
92
FVD or Hypervolemia
abnormal retention of water secondary to an increase in overall sodium content
93
Hypervolemic Hyponatremia
increased volume that decreased sodium related to dilution
94
S/S of FVE
- edema - JVD - crackles - tachycardia/bounding pulse - increased BP/pulse pressure/CVP - increased urine output - dyspnea
95
Lab Values for Hypervolemia due to hemodilation
- decreased BUN - decreased HCT - azotemia
96
Management for Hypervolemia
- fluid and Na+ restriction - diuretic therapy - hourly I/O's - hemodialysis w/ impaired kidney failure - monitor ABG's/labs
97
Causes of Edema
- increased venous pressure/DVT - lymphatic drainage system - decreased plasma albumin - increased capillary leakage - infections
98
Acidosis leads to what?
Hyperkalemia
99
Alkalosis leads to what?
Hypokalemia
100
Oral potassium can produce what?
Small-bowel lesions
101
Patients taking oral potassium must be cautioned and assessed for what?
abdominal distention pain GI bleed
102
Potassium should only be administered after what has been established?
Adequate urine flow
103
What is an indication to stop a potassium infision?
urine volume less than 20 mL/hr for 2 consecutive hours
104
Potassium should never be administered how?
IV push or IM | W/o an infusion pump
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