1
Q
What organ excretes magnesium and calcium?
A
kidneys
2
Q
What is another way the body can lose magnesium and calcium?
A
G.I. tract
3
Q
What are the 2 main causes of hypermagnesemia?
A
- Renal failure because the kidneys excrete magnesium.
2. Antacids
4
Q
What are the 2 signs and symptoms of hypermagnesemia?
A
- Flushing and warmth
2. Vasodilation
5
Q
In hypermagnesemia or hypercalcemia do the deep tendon reflexes increase or decrease?
A
Decrease
6
Q
In hypermagnesemia or hypercalcemia is there too little sedative or too much sedative?
A
Too much!
7
Q
What are the normal lab values for magnesium?
A
1.3 to 2.1 mEq/liter
8
Q
What are the normal lab values for calcium?
A
9.0 to 10.5 mg/dL
9
Q
In hypermagnesemia or hypercalcemia how is muscle tone?
A
Weak/flaccid
10
Q
In hypermagnesemia or hypercalcemia is there a concern for arrhythmias?
A
Yes
11
Q
In hypermagnesemia or hypercalcemia what is the LOC status?
A
Decreased due to sedative effect
12
Q
In hypermagnesemia or hypercalcemia is the pulse decreasing or increasing?
A
Decreasing
13
Q
In hypermagnesemia or hypercalcemia are respirations increasing or decreasing?
A
Decreasing
14
Q
What are the 3 treatments for hypermagnesemia?
A
- If RR falls below 12 bpm, Contact MD regarding ventilator assistance.
- Dialysis if d/t kidney failure.
- Calcium gluconate; the antidote for mag toxicity. Reverses respiratory depression and/or arrhythmias. Administer IV push VERY SLOWLY at a maximum rate of 1.5 to 2 mL/minute.
15
Q
What are the 6 treatments for hypercalcemia?
A
- Move patient around bc weight bearing helps move calcium from the blood into the bone.
- Increase fluids to prevent kidney stones.
- Add phosphorus to the diet (anything with protein). Since calcium has an inverse relationship with phosphorus; more phosphorus = less calcium.
- Give steroids bc they reduce serum calcium.
- Give phosphates bc they reduce calcium.
- Give calcitonin bc it helps with bone reabsorption of calcium.
16
Q
What are the 3 causes of hypercalcemia?
A
- Hyperparathyroidism. Too much parathyroid hormone (PTH); when serum calcium gets low, PTH kicks in and pulls calcium from the bone and puts it in the blood making serum calcium go up.
- Thiazide diuretics cause the body to retain calcium.
- Immobilization leads to not enough weight bearing on the bones therefore the bones are unable to retain calcium sufficiently.
17
Q
What are the 2 signs and symptoms of hypercalcemia?
A
- Brittle bones
2. Kidney stones
18
Q
With hypomagnesemia and hypocalcemia does the client have enough sedative or not enough sedative?
A
Not enough sedative!
Muscles are rigid and tight!!
19
Q
What are the 2 main causes for hypomagnesemia?
A
- Diarrhea… Losing lots of magnesium in the intestines!
- Alcoholism;
Alcohol suppresses the release of ADH and it’s hypertonic which leads to the alcoholic not wanting to eat or drink.
Reminder: Not enough ADH leads to increased diuresing. (Like with DI)
20
Q
What are the 3 main causes of hypocalcemia?
A
- Hypoparathyroidism
- Radical neck injury
- Thyroidectomy d/t potential for loss of some parathyroid
Note: All these 🔜 not enough PTH which results in a decrease in serum calcium.
21
Q
With hypomagnesemia or hypocalcemia what is the status of the muscle tone?
A
Rigid and tight
22
Q
With hypomagnesemia or hypocalcemia could the client have a seizure?
A
YES!
23
Q
With hypomagnesemia or hypocalcemia what is the potential status of the airway?
A
Strider/laryngospasm due to smooth muscle in the airway
24
Q
What 2 tests/signs are indicative of hypomagnesemia and hypocalcemia?
A
- Chvostek’s sign (tap cheek - “C” for cheek)
2. Trousseau’s sign (pump up BP cuff look for hand and fingers to point downward and tremor)
25
With hypomagnesemia or hypocalcemia what is the potential cardiac status?
Arrhythmias bc the heart is a muscle
26
With hypomagnesemia or hypocalcemia do DTRs increase or decrease?
Increase
27
With hypomagnesemia or hypocalcemia what is the potential mind status?
Mind changes
28
Will there be swallowing problems with hypomagnesemia or hypocalcemia?
Yes d/t the esophagus being made of smooth muscle. Risk for aspiration!
29
What are the 4 main nursing interventions for hypomagnesemia?
1. Give mag
2. Check kidney function before and during IV mag
3. Seizure precautions
4. (Teaching) Eat magnesium rich foods
30
What do you do if your client reports flushing and sweating when you start IV mag?
On NCLEX you will stop the infusion and call the doctor.
31
What are some foods high in magnesium?
Leafy greens 🥬, summer squash, peppermint, halibut, cucumber 🥒, green beans, celery, sunflower seeds, sesame seeds, pumpkin seeds, and flaxseeds
Did you notice all the seeds in there?!?
32
What are the 4 main nursing interventions for hypocalcemia?
1. Give calcium
2. Administer IV calcium (GIVE SLOWLY!!) — Make sure the client is on a heart monitor!!!
3. Give vitamin D for better Utilization of calcium
4. Give phosphate binders because when you reduce phosphate then you increase calcium.
sevelamer, Calcium acetate
33
What changes are possible to see on the ECG when giving IV calcium?
Widened QRS complex
| If heart rate slows down too much; asystole. (Remember this would require CPR!)
34
What is key to remember with sodium in regards to electrolyte balance?
Neuro changes! The brain does not like sodium problems, because sodium affects how much water you have in your blood.
35
Which electrolyte imbalance is defined as too much sodium not enough water?
Hypernatremia
Think DEHYDRATION!!
36
What electrolyte imbalance is defined as too much water and not enough sodium?
Hyponatremia
Think DILUTION!!
37
What are the 3 main causes for hypernatremia?
1. Hyperventilation
2. Heat stroke
3. DI
The "hyper" sodium molecule is running around sweating profusely, mouth breathing, and needs to pee all the time!
38
What are the 4 main causes of hyponatremia?
1. Drinking water instead of electrolytes for fluid replacement (vomiting, sweating). There’s only replaces water and dilutes the blood.
2. Psychogenic polydipsia; someone that loves to drink water
3. D5W
4. SIADH (retaining water)
The sad/slow sodium molecule just floats on his D5W tube down the SIADH swollen lazy river, bc some psycho keeps drinking water, but the water keeps filling up the tissues (making the ground soggier), so he sends his friends vomitus and sweat to give the crazy drinker a message, but she just keeps drinking more water instead of electrolytes to helping him lose some belly and get off that tube and out of the river.
39
What are the 4 main signs and symptoms of hypernatremia?
1. Dry mouth
2. THIRST! If you’re thirsty you’re already dehydrated
3. Swollen tongue
4. Neuro changes
Think TOO much sodium = Crazy-making Dehydration!
40
What are the 3 signs and symptoms of hyponatremia?
1. Headache
2. Seizure
3. Coma
That sad/slow sodium molecule can't get off his D5W raft and is stuck in the sun going around the lazy SIADH river... so he develops a H/A that advances to a seizure and finally passes out into a coma.
41
What are the 5 main nursing interventions for hypernatremia?
1. Restrict sodium
2. Dilute client with hypotonic fluids to make sodium go down
3. Get daily weights
4. Strict I&Os
5. Monitor lab work
42
What are the 3 main nursing interventions for treating hyponatremia?
1. Give sodium
2. Limit water intake (too dilutes as it is!)
3. If having Neuro problems; SLOWLY give hypertonic fluids; 3% NS or 5% NS in an ICU setting.
43
What organ excretes potassium?
kidneys
44
What are the 2 main causes for hyperkalemia?
1. Kidney trouble
| 2. Spironolactone
45
What are the 4 main causes for hypokalemia?
1. Vomiting
2. NG suction because we have lots of potassium in her stomach
3. Not eating
4. Diuretics
Nothing in the tummy and diuretics!
Remember:
"PM" (potassium in upper GI and Mag in lower GI)
46
What is the life-threatening sign or symptom of hyperkalemia?
Muscle Twitching because it can cause arrhythmias.
(T)Too much potassium 🔜 (T) Twitching
47
What is the life-threatening sign or symptom of Hypokalemia?
Muscle Cramping because it can lead to arrhythmias.
(C) Can’t get enough potassium 🔜 (C) Cramping
48
What are the other 2 signs and symptoms of hyperkalemia?
1. Muscle weakness
| 2. That progresses to flaccid paralysis
49
What is the 1 other sign and symptom of hypokalemia?
Muscle weakness (which can lead to arrhythmias)
50
What are the 7 ECG changes with hyperkalemia?
1. Bradycardia
2. Flat or absent P waves
3. Prolonged PR intervals
4. Widened QRS
5. Tall and peaked T waves
6. Conduction blocks
7. V-Fib (very deadly) - squiggly line
51
What are the 3 ECG changes with hypokalemia?
1. PVCs
2. U waves
3. V-Tach - Sawtooth waves (Shark atTACK)
52
What are the 4 nursing interventions for hyperkalemia?
1. Dialysis if the kidneys aren’t working
2. Calcium gluconate to decrease arrhythmias
3. Glucose and insulin because insulin carries glucose and potassium into the cell. Anytime you give IV insulin, worry about hypokalemia and hypoglycemia. Therefore watch labs and blood glucose.
4. Sodium polystyrene sulfonate (Kayexalate)
Watch for dehydration. Sodium and potassium have an inverse relationship, therefore when you don’t have enough potassium you’ll have too much sodium. Again watch labs!!
53
What are the 3 nursing interventions for hypokalemia?
1. Give potassium
2. Give Spironolactone
3. Teach client to eat more potassium-rich foods
54
What is the major problem with oral potassium supplementation?
G.I. upset, therefore give with food!
55
What should be frequently assessed before and during IV potassium?
Urinary output
| remember NA and K have an inverse relationship
56
Always put IV potassium on a pump. True or false?
True
| Also, mix it well
57
Should potassium ever be given via IV push?
NO!!!
58
Does IV potassium burn during infusion?
Yes, watch IV site carefully.
59
What are some foods high in potassium?
Fennel, Leafy greens 🥬, Eggplant 🍆 , Cantaloupe 🍈, Tomatoes 🍅, cucumber 🥒,, bell pepper, apricots, ginger root, strawberries 🍓, avocado 🥑, banans 🍌, tuna, halibut, cauliflower, 🥝 kiwi, oranges 🍊, lima beans, potatoes 🥔,
NCLEX RN Review
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