1
Q
Hydrostatic = _________ force
A
pushing
2
Q
Hydrostatic pushes fluid out of
A
capillaries
3
Q
Hydrostatic pressure is exerted by
A
pumping of heart
4
Q
Oncotic is the __________ force
A
pulling
5
Q
Oncotic pulls fluid out of
A
tissues and into capillaries
6
Q
Oncotic pressure is exerted by
A
non-diffusible plasma proteins … albumin
7
Q
Albumin def
A
protein that is soluble in water and coagulable by heat
8
Q
What does the body use to maintain fluid balance in the body?
A
- Kidneys
- ADH
- RAAS
- Aldosterone
- ANP
9
Q
Kidneys
A
adjust urine volume and excrete electrolytes
10
Q
ADH medication form and controls what?
A
vasopressin; controls retention
11
Q
RAAS system hormone order
A
Renin
Angiotensinogen
Angiotensin 1
Angiotensin 2
Aldosterone
12
Q
Aldosterone is a
A
water regulator
13
Q
ANP _______ ________ volume.
A
reduces fluid
14
Q
ANP stands for
A
Atrial natriuretic peptide
15
Q
Kidneys are considered
Hint: Royal
A
King
16
Q
ALWAYS check _____ __________ before med admin.
- What lab value do you check?
A
renal function
- creatinine
17
Q
High BUN but low Creatinine
A
Dehydrated
18
Q
High Creatinine and High BUN
A
renal failure
19
Q
Calcium is related to what vitamin
A
D
20
Q
What are the 7 functions of the kidneys?
A
- control ACID-base balance
- control WATER balance
- maintaining ELECTROLYTE balance
- removing TOXINS and waste products out
- controlling BLOOD PRESSURE
- producing ERYTHOPOIETIN
- activating VITAMIN D
21
Q
ADH medication
A
Vasopressin
22
Q
Vasopressin controls
A
water retention
23
Q
In the nephron, water is reabsorbed where
A
distal tubule
24
Q
If the patient’s body is dehydrated, then what chain of events occurs?
A
RAAS
25
Where fluid flows
electrolytes go
26
What is the difference between ADH and aldosterone
ADH retains water
Aldosterone retains sodium and water
27
Aldosterone causes kidneys to
retain sodium and water
28
Aldosterone causes the body to excrete
potassium
29
Low aldosterone, potassium
high (hyperkalemia)
30
High aldosterone, potassium
low (hypokalemia)
31
Aldosterone increases
fluid volume (sodium and water)
BP
32
Ultimate goal of Aldosterone and RAAS
increases reabsorption of sodium and water
excretion of potassium
33
RAAS is activated by
low serum sodium
**decreased cardiac output due to decreased ECF**
ischemia in kidneys
34
Low sodium, decreased cardiac output, and kidney ischemia can cause what to be released
renin
35
RAAS system's ultimate goal
bp elevation
increased fluid
36
Angiotensinogen is a
glycoprotein made in the liver
37
What converts Angiotensin 1 to Angiotensin 2?
an enzyme from the pulmonary bed
38
Angiotensin 2 is a powerful/POTENT
vasoconstrictor
- elevates BP through peripheral vasoconstriction
- Stimulation of aldosterone secretion
39
ACE inhibitors stop
Angiotensin 1 from converting Angiotensin 2 emzyme from working
40
Aldosterone is a
mineralocorticoid that helps control sodium utilization
41
Aldosterone is released by the
adrenal cortex
42
What does Aldosterone do?
reabsorbs water with sodium following
- increases plasma volume
43
ANP is produced and stored where?
in atria
44
BNP is released
when the heart can't pump the way it should
- heart failure and severity ( > 100 )
45
BNP is what type of lab test?
blood test
46
ANP does what?
- stops RAAS
- **decreases BP by vasodilation**
- reduces fluid volume by increasing the secretion of sodium and water
47
Hypovolemia vs Dehydration
Hypovolemia = loss of ECF including water and sodium
Dehydration = water loss alone
48
What is perfusion?
Oxygen to the bloodstream
49
Dehydration is common in the
elderly
- because they are less thirsty
50
S/S of Dehydration
**red and dry mouth**
**Thirst**
**Oliguria**
less and more concentrated urine
**dizzy, confused**
decreased skin turgor
51
Hypovolemia
ECF volume is reduced
- results in decreased tissue perfusion
52
Dehydration is
pure water loss from total body water
ECF 1/3
53
Dehydration is ALWAYS
hypernatremic
54
Treatment of dehydration
free water administration
55
Electrolytes are
separate into ions (changed particles) when dissolved in water
56
Electrolyte purposes
- ions found in our body fluids
- conduct electricity and energy
- **control body fluids**
- **maintain homeostasis**
- communicate cell to cell, nerve to nerve, organ to organ
57
Cations are a ________ charge
positive
58
Anions are a ________ charge
negative
59
Cation electrolyte
Na+
K+
Ca++
Mg+
60
Potassium is more common in the
intracellular
61
Sodium is more common in
extracellular
62
Anion electrolytes
Cl
HCO3 (Bicarbonate)
Phosphate
63
Depletion of electrolytes
Vomiting
Peeing (urination)
Pooping (BM)
Sweating
64
Magnesium (Mg+) normal levels
1.5-2.5
65
Calcium and phosphorus have a/an __________ relationship
inverse
66
Phosphorus normal levels
2.4-4.5**
67
Potassium (K+) normal levels**
3.5-5.0
68
Calcium (Ca+) normal levels
8.5-10.5**
69
Chloride (Cl-) normal levels
95-105
70
Sodium (Na+)**
135-145
71
What foods are rich in Potassium?
fruits, **green leafy vegetables, spinach**, salt substitutes
- bananas and berry families
72
What foods are rich in Sodium?
**table salt, cheese**, spices, canned, **processed foods (lunchmeat)**
73
What foods are rich in Magnesium?
**spinach, almonds**, yogurt, green vegetables
**Dark chocolate** = excellent Mg+ source
74
What foods are rich in Calcium?
**milk, cheese**, green vegetables
75
What foods are rich in phosphorus?
dairy, meats and **beans**
76
What foods are rich in Chloride?
salty foods and salt substitutes, canned foods,
Vegetables such as **tomatoes, lettuce, celery** and olives
77
Sodium functions
maintain blood pressure
blood volume
pH balance (acid-base)
controlling nerve impulses
stimulating muscle contractions
78
Sodium key items
big impact on body’s fluid balance
major electrolyte in extracellular fluid
controls water balance
regulated by ADH & aldosterone, Na+ K+ pump
79
If the patient has a low or high sodium level, what assessment would you do? Possible intervention?
Neurological
Safety and fall bundle
80
With sodium think
**Brain**, Neuro checks, Safety
81
Hyponatremia Causes
dilution on sodium
- SIADH**
- water intoxication**
- psychogenic polydipsia
- hypotonic fluids**
- inadequate sodium intake
- increased Na diet
82
SIADH
impaired water excretion caused by an **inability to suppress the secretion of ADH**
**water retention** causes dilution sodium
83
Water intoxication
retaining fluid & sodium causing hemodilution of Na+
84
Psychogenic polydipsia
excessive fluid intake without physiologic stimuli
85
Hypotonic fluids
shifts solutes into the cells
86
Inadequate sodium intake types
fasting
NPO status
low Na+ diet
87
What is the 4 D's
diarrhea
diuretics
drainage
diaphoresis (sweating)
88
What device is famous for depleting sodium and other electrolytes?
NG tube
89
Increased Na+ excretion
**4D’s - diarrhea, diuretics, drainage, diaphoresis**
Vomiting
Kidney disease
**Hypoaldosteronism (Addison’s)**
sodium loss and water retention
90
3 Flavors of Hyponatremia
Euvolemic
Hypovolemic
Hypervolemic
91
Euvolemic Hyponatremia
Low Na+ with (ECF) volume normal
92
Hypovolemic Hyponatremia
Na+ loss with ECF volume depletion
93
Hypervolemic Hyponatremia
Na+ loss with increased ECF volume
94
What is the mild S/S of hyponatremia?
Mild = headache, nausea/vomiting, fatigue
95
What are the moderate S/S of hyponatremia?
lethargy, weakness, **altered LOC**
96
What are the severe S/S of hyponatremia? (Below 120)
**seizures, respiratory arrest, death**
brainstem herniation
97
What can a nurse do when suspecting Hyponatremia
Replace Sodium slowly
Stop Sodium Wasting Diuretics
Provide IV Fluids/medications
98
Every time you give an electrolyte, you give it
SLOWLY and recommended rate
99
Why do you Replace Sodium slowly
**avoid fluid overload** due to fluid shifting with sodium
can **lead to neuro damage if given too rapidly**
**0.5 mEq/L per hour MAXIMUM**
6 - 12 pts in a 24-hour period
**Check Na+ levels every 2-4 hours**
100
Stop Sodium Wasting Diuretics
loop diuretics; thiazides
may need to switch to spironolactone
101
Spironolactone is a
potassium sparing
102
The thiazide and loop diuretics need to have strict monitoring of
electrolytes
103
What fluid would you give to someone with mild to moderate hypovolemic hyponatremia?
0.9% Normal saline to correct fluid volume status & Na+
104
What fluid would you give to someone **with severe
hypovolemic hyponatremia**?
**3% normal saline (hypertonic solution)**
- give through a central line = highly caustic on veins
- gets rid of cell swelling away from the brain
105
What medication would you give to someone with hypervolemic hyponatremia?
give osmotic diuretics and fluid restriction
- **Mannitol – excretes water but not Na+**
106
What fluid would you use for SIADH?
EUVOLEMIC (normal volume with low Na)
- restrict fluid intake
107
Severe hyponatremia is
less than 120
- not increase by more than 6-12 mEq/L in first 24 hours
108
What is the order of interventions during severe hyponatremia?
**administer 3% saline IV slowly** - 6 to12 pts in a 24-hour period
Plan for CVAD
Insert indwelling catheter for **strict I&Os**
Perform **neurologic checks every 2-4 hours**
Keep on **bedrest**
109
What is key when dealing with cerebral involvement?
safety
110
When administering 3% saline why go through a CVAD?
highly caustic to veins
- But can be given through peripheral veins
111
If hyponatremia is overcorrected too quickly,
**demyelination syndrome** causing damage to nerve cells in the brain
- **Locked-in syndrome**
112
SIADH full name
Syndrome of Inappropriate Anti-diuretic hormone
113
SIADH-euvolemic hyponatremia
**TOO MUCH ADH**
high levels of ADH = **retain water**
upsets electrolytes, especially SODIUM
Increased water retention
**Diluted sodium**
114
Mnemonic for SIADH
**SI**ADH
- **S**oaked **I**nside
- **S**top **U**rination
115
Causes (3 Ss) of SIADH: Most common
Small cell lung cancer
**Severe brain trauma**
**Sepsis infections of the brain**
116
ADH is created in
pituitary gland
117
Mnemonic for ADH
**A**dds **D**a **H**2O
118
What are the different types of Synthetic ADH?
Desmopressin, Vasopressin
** Pressin the BP up**
119
ADH ________ urine output
decreases
120
If SIADH or low Na, what is the priority problem?
**Headaches**
Low Na = seizures, DEATH
121
What is the best/accurate way to monitor fluid changes?
Daily weight (I&Os, then BP)
122
Treatment for SIADH
**Fluid restriction = 800-1000 mL/day**
Demeclocycline
Diuretics
Increase oral sodium intake
**Daily weight
I&O**
123
Demeclocycline
blocks the effect of ADH resulting in more dilute urine
124
T/F: caffeine is a diuretic used in the treatment of SIADH.
True
125
Types of oral sodium intake
salt tablets
bacon
processed foods
126
Causes of Hypernatremia
Decreased sodium excretion
- **corticosteroids** - retain sodium
- **Cushing's** syndrome
- **kidney disease**
Increased sodium intake
Decrease Water intake
Increased water loss (hemoconcentration)
127
If the patient had Hypernatremia what should the nurse be most concerned about?
cerebral hemorrhage
128
Hypernatremia level
greater then 145
129
Corticosteroids causes
kidneys to retain sodium
130
Cushing's syndrome
occurs due to prolonged exposure to glucocorticoids (prednisone) or a tumor producing excessive cortisol by adrenals
131
Hyperaldosteronism
high sodium and water retention
132
Severe hypernatremia level
greater then 160
133
Hypernatremia Cause
Increased sodium intake
excessive oral sodium ingestion
too many processed foods
Hypertonic solutions (3% NS or 5%NS)
Alka seltzer, aspirin
134
Decreased water intake due to
fasting; NPO status
135
Hemoconcentration is caused by
dehydration
too much water loss & Na+ gain
Infection
Diabetes Insipidus
136
Hypernatremia Interventions
- Bring **sodium levels down slowly**
- Provide IV/Meds of **hypotonic solutions** in case of fluid loss
- **Diuretics**
- Avoid high sodium meds
- Restrict sodium and fluid intake as prescribed
- Free water intake to help with hemodilution
- pt safety: confused and agitated
- Daily weight I&Os
- **Neurologic precautions (checks)**
137
Why do you bring a sodium level down slowly?
rapid correction can lead to **seizures** due to rapid
**fluid shifts in the brain**
138
What solutions would you give a hypernatremic patient?
hypotonic
- **1/2 NS, D5W**
139
If inadequate renal excretion of sodium, administer
diuretics
-**thiazides; loop diuretics**
140
Patient S/S of mild hypernatremia
faint feeling
muscle fatigue
weakness
141
Patient S/S of moderate hypernatremia
(monitor closely)
**confusion**, irritability,
**swollen and dry red tongue**
hyperreflexia
**muscle twitching**
edema
**thirst**
142
Patient S/S of severe hypernatremia
nausea & vomiting
increased muscle tone
**seizures**
**coma**
143
Diabetes Inspidus =
hypernatremia
144
Diabetes Insipidus is when the
the pituitary gland produces **insufficient ADH (vasopressin)**
- ADH deficiency
145
S/S of diabetes insipidus
*polydipsia*
*polyuria*
**dry inside = labs high**
- increased sodium and diluted urine
**Dehydrated (DIE ADH)
146
Causes of ADH
damage to brain
tumors
trauma
147
Polydipsia
extreme thirst
148
Polyuria
excrete dilute urine, greater than 200 mL
149
If the patient is having their pitcher refilled every 15-20 mins and peeing constantly, what would you suspect and intervention?
Diabetes Insipidus
- record I&Os
150
What are the differences between DI and SIADH
DI
-low AD and water in the body
- **High UO, polyuria
- High sodium**
- High H&H and osmolality from dehydration
- **Risk of hypovolemic shock
- Tx: ADH**
SIADH
- high ADH, water intoxication
- **Low UO, oliguria
- low sodium (dilutional)**
- low osmolality
- weight gain
- **Risk: seizures
- Tx: hypertonic saline**
151
Potassium is the king of
hearts
152
What is the major electrolyte in **intracellular** fluid?
Potassium
153
Potassium purposes
Maintains **heart** & muscle contraction
**Regulated by kidneys and aldosterone**
Acid-Base balance
- Increased K+ in the cell------H+ moves out
- Increased H+ in the cell------K+ moves out
**Diet is the main source of K+**
154
Hypokalemia
potassium loss
Inadequate potassium intake
Alkalosis, metabolic
155
Potassium loss can occur from what
Diuretics - furosemide and digoxin
**Corticosteroids**
**Inadequate intake of Potassium ( NPO, anorexia, nausea)**
Increased secretion of aldosterone (Cushing's)
GI loss
Excessive diaphoresis
Kidney disease
156
Digoxin toxicity
– low K+ causes dig toxicity;
caution using diuretics with digoxin = increased risk for hypokalemia
157
How do corticosteroids cause potassium loss?
water retention causing hemodilution
158
Aldosterone causes potassium loss
K+ excretion through kidneys; higher levels of aldosterone cause more K+ excretion
159
Ways of Potassium GI loss
Vomiting
diarrhea
prolonged NG suction
160
Inadequate Potassium Intake causes
movement of **K+ from ECF to ICF**
**excess insulin** – moves K+ into the cell
161
What happens during Metabolic Alkalosis
in alkalosis, there is less H+ in the blood-----causes H+ to shift out of cells and K+ to shift into cells
excess insulin – moves K+ into the cell
162
Severe Potassium level
less than 2.5
163
When remembering S/S of hypokalemia, what do you remember?
SLOW AND LOW
164
Hypokalemia S/S Cardiovascular
**torsades de pointes**- twisting of points
irregular apical HR
lethal **dysrhythmias**
**bradycardia**
165
Hypokalemia S/S Neuromuscular
confusion, lethargy
**muscle weakness**
diminished DTRs
166
Hypokalemia S/S GI
Constipation - paralytic ileus
167
If bowel sounds are absent, think
paralytic ileus – portion of bowel not moving and can lead to small bowel obstruction
168
What other electrolyte should you check with hypokalemia? If low?
Magnesium
if Mg+ is low, it exacerbates K+ losses;
**correct Mg+ first to correct K+**
169
torsades de pointes is also known as
Long QT Interval
170
If the patient faints, then what do you think?
cardiac, and neurological
171
Long QT Interval means
heart is taking longer to electrically charge for the next heartbeat
172
Congenital Long QT Syndrome
born with altered DNA that causes long QT syndrome
173
Why is Long QT syndrome bad?
This electrical glitch sets up the potential for something to catch the heart off guard and electrically trip it up, causing a spinning rhythm out of control
174
acquired long QT syndrome
occur later in life due to some medical conditions, certain drugs, or mineral imbalances.
175
Irregular QRS complexes
appearing to wrap around the EKG baseline
176
Torsades de Pointes in hypokalemia Tx
**IV Mg+** is treatment (slow 2G IVP)
177
EKG in Hypokalemia
increased amplitude and width of P wave, T wave flattening and inversion, prominent U waves and apparent long QT intervals due to merging of the T and U wave.
178
Comparison of Hypokalaemia and Hyperkalaemia EKG
Hypokalaemia: T wave inversion ST depression Prominent U wave
**Hyperkalaemia: Peaked T waves, P wave flattening, PR prolongation, Wide QRS complex**
179
Hypokalemia Interventions
Monitor **Cardiac and respiratory status**
Administer K+ supplements orally or IV
administer K+ **SLOWLY** – can be lethal when given too fast
If patient in taking a diuretic may need to stop
**Spironolactone (K+ sparing diuretic)**
K+ rich foods
if taking orally, must take with food – **never give
on an empty stomach**
Monitor for **digoxin toxicity**
180
Potassium is never administered IV push, potassium is always diluted
and administered using an infusion pump.
How do you give potassium?
IV, intramuscular, or subcutaneous routes, PO
181
IV potassium is always diluted
and administered
using an infusion pump
182
Causes of Hyperkalemia
Excess Potassium intake
Decreased Potassium secretion
Adrenal insufficiency
**Renal failure - #1 cause**
Traumatic **burns**
- **Metabolic Acidosis**
183
ACE inhibitors drugs end in
pril
184
What are the reasons for decreased potassium excretion?
K+ sparing diuretics (spironolactone)
**Ace inhibitors**
NSAIDs (decrease renal perfusion)
185
Adrenal insufficiency causes
- **Addisons** = low aldosterone = retention of K+
- **hypoaldosteronism** causes large amounts of sodium excretion and retains K+ (Addison's = destruction of adrenal gland)
186
Metabolic Acidosis
there is **more H+ in blood**
causes **H+ to shift into the cells and K+ to shift out in the cells**
- Excretion of H+ ions by kidneys is accomplished by conserving bicarbonate, secretion of ammonia, and excretion of hydrogen in exchange for sodium.
187
S/S of Hyperkalemia
Cardiovascular
bradycardia
**dysrhythmias – V-fib and cardiac standstill**
GI increased motility = hyperactive bowel sounds
**diarrhea**
**Muscle weakness**
can result in paralysis and respiratory arrest
188
Severe potassium level high
greater than 6.5
189
Lethal high level of potassium
greater than 8.5
190
EKG and High Potassium
peaked narrow T wave,
ST segment depressed,
prolonged PR interval
191
Mild Hyperkalemia Interventions
Monitor **cardiac rhythm** changes
Restrict K+ in diet
Diuretics
Cation exchange resins
**sodium polystyrene sulfate (Kayexalate)**
**PO or rectal = explosive diarrhea **
Stop medication causing an increase in K+
**Dialysis for renal failure**
192
When do you stop Ca Gluconate 10% IV?
bradycardia
193
Ca+ Gluconate 10% IV
Purpose?
Monitor?
**protects heart from myocardial irritability**
= DOES NOT LOWER potassium
- dysrhythmias, BP and HR
194
If the patient has a potassium level of 6.5 or higher, what emergency medical tx would occur
**Ca+ Gluconate 10% IV** - must be given over 3-5 minutes
**Hypertonic glucose & insulin** = Moves excess K+ into the cells
NaHCO3 if acidosis = K+ shifts into the cell and raises pH
195
What is the most abundant cation in the body?
Calcium
196
Calcium and Magnesium levels are
best friends (One goes up the other follows
197
Calcium functions
Calcium will help with function of Mg+ when Mg+ is low
Keeps the 3 B’s strong
= Bone – 90% of body’s calcium - fractures
= Blood clotting - bleeding
= Beat (heart rate) myocardial contraction
198
What 3 hormones regulate Calcium?
Parathyroid
Calcitonin
Calcitrol
199
Parathyroid hormone and Calcium relationship
the parathyroid gland makes it
- releases when Ca+ levels are low
- stops if Calcium is too high
200
Where are the parathyroid and thyroid glands located?
Neck
201
Calcitonin and Calcium relationship
– regulated by thyroid;
released when Ca+ levels are high to **lower Ca+ and put back into the bone**
202
**____ increases blood calcium levels; __________ decreases blood calcium levels**
PTH; Calcitonin
203
calcitriol
– Vitamin D analog; controls blood calcium by suppressing the release of PTH
204
Calcium normal levels
8.5-10.5
205
Ionized Calcium
**NOT TESTED**
Calcium in blood not attached to proteins (free calcium)
**Most accurate test for assessing true calcium status**
Important if abnormal levels of proteins
May be drawn **if signs of bone, kidney, liver, or parathyroid disease**
206
Ionized Calcium normal levels
**NOT TESTED**
4.8-5.6
207
Calcium and phosphorus relationship
inverse
208
Hypocalcemia Causes
**Vitamin D deficiency** - required for the absorption of Ca+
Long-term **corticosteroids**
**Hypoparathyroidism** - decrease in parathyroid hormone, removal of parathyroid glands
Renal disease
Massive diarrhea
**Hyperphosphatemia – inverse relationship with calcium**
Medications – diuretics; laxatives; **corticosteroids (contribute to bone loss)**
Thyroidectomy or any neck surgery can inadvertently irritate or remove
parathyroid glands
209
S/S of hypocalcemia
Cardiovascular
hypotension
dysrhythmias (V Tach)
decreased HR
Neuromuscular
irritable skeletal muscles – twitching, cramps, **tetany, seizures, paresthesias**
painful muscle spasms in calf or foot
**positive Trousseau’s and Chvostek’s signs**
hyperactive deep tendon reflexes (DTRs)
osteoporosis – body trying to get more calcium
GI
hyperactive bowel sounds
diarrhea
210
Chvostek and Trouseau Signs hypocalcemia
ouch the face near the ear and if they flinch then positive
contraction of hand after bp
211
Hypocalcemia Interventions
Replace Calcium (IV or PO)
**IV calcium gluconate 10% over 10 – 20 minutes
monitor BP, HR & place patient on heart monitor**
**Vitamin D** if giving PO
Aluminum hydroxide **(Tums) calcium supplements**
Initiate **seizure precautions & bleeding precautions**
**Move patient carefully**
Educate on calcium-rich foods
**dairy, cheese, milk, yogurt
collard greens, broccoli**
212
Hypercalcemia Causes
**Hyperparathyroidism**
Antacids
Excessive oral intake of calcium & vitamin D
**Malignancies – of the bone**; bone destruction = calcium is released into the bloodstream
Renal disease – inability to excrete
213
What gland abnormality causes the following?
Kidney stones, painful bones, moans
from constipation, nausea & vomiting
Parathyroid
214
S/S of Hypercalcemia
- Neuromuscular
muscle weakness
**diminished or absent DTRs**
- GI
hypoactive bowel sounds (constipation)
- Renal
kidney stones
-Stones, bones, abdominal moans
215
Hypercalcemia Interventions
**Administer IV fluids = 0.9% saline to get the kidneys to excrete calcium**
**D/C calcium**
discontinue oral meds with calcium & vitamin
Loop diuretics
furosemide
Medications
phosphorous
inverse relationship with calcium
calcitonin
bisphosphonates
**Dialysis if medications fail
Educate on avoiding calcium-rich foods**
216
Less severe hypercalcemia interventions
IV NS
and loop diuretics
217
Magnesium normal levels
1.5-2.5
218
Magnesium functions
**Support muscle and nerve function & energy production**
- Direct relationship with calcium
- Inverse relationship with phosphorous
Helps to maintain
**- blood glucose control
- blood pressure
- skeletal muscle contraction**
- neurologic function
- ATP formation
- **Immune system – fights inflammation**
219
Causes of hypomagnesemia
**Chronic alcohol use - #1 cause**
- **poor diet/malnutrition; starvation
- malabsorption** due to the effects of alcohol on the GI tract
Renal loss – overuse of alcohol **increases excretion of Mg**
GI loss – NG, diarrhea, **vomiting**
Diuretics
220
If the patient is unable to maintain order; everything goes crazy.
What condition is this?
**Hint: Magnum PI**
hypomagnesemia
221
S/S Hypomagnesemia
Neuromuscular
**tetany, twitches, paresthesias
positive Trousseau’s & Chvostek’s signs**
- due to direct relationship with Ca+
Increased DTRs
**Laryngeal stridor: can't breath
Tachycardia**
222
What electrolytes are best friends
Calcium and Magnesium
223
Hypomagnesemia Interventions
**replace Mg+ and Ca+** (IV or PO)
when replacing **Mg+ IV give slowly** (can slow HR)
seizure precautions
**monitor DTRs – if diminished or absent = hypermagnesemia**
discontinue medications that cause Mg+ loss
Monitor K+ if magnesium is low
Secondary K+ depletion
224
Hypocalcemia accompanies ________________; interventions
aim to restore ________ levels
hypomagnesemia; calcium
225
Treat _____________ prior to ____________;
when the body is in a state of low Mg+, it is unable to process & absorb K+
hypomagnesemia; hypokalemia
226
Causes of Hypermagnesemia
Increased Mg+ intake (OTC and meds contraindicated - laxatives)
**Decreased renal excretion of Mg+**
**Calm and Slow**
227
Hypermagnesemia S/S
- Heart – calm & quiet
respirations low and shallow
bradycardia
hypotension
- Lung
respirations low and shallow
- GI
hypoactive bowel sounds
Neurological
drowsiness, lethargy
- MS
**Diminished or absent DTR’s**
228
What is the antidote of a magnesium overdose?
Calcium Gluconate
229
Hypermagnesemia Interventions
**Calcium Gluconate for magnesium overdose**
**Diuretics** for Mg+ excretion
230
Phosphorus normal levels
2.4-4.5
231
Phosphorus Main functions
Regulated by parathyroid and calcitriol
**Helps regulate calcium**
**inverse relationship with calcium and magnesium**
Cellular metabolism and energy production through ATP (Adenosine Triphosphate)
Essential for **bone and teeth**
232
Hypophosphatemia Causes
- Insufficient phosphorous intake
malnutrition
starvation
‘Refeeding Syndrome’ – fatal shift of fluids &
electrolytes that may occur in malnourished patients
- Increased phosphorous excretion
hyperparathyroidism – calcium rises; phosphorous drops
malignancy
diuretics and diarrhea
use of magnesium-based or aluminum-based antacids
**increased Ca+ depletes phosphorous**
233
S/S of Hypophophatemia
Cardiovascular
decreased BP, HR
GI – hypoactive bowel sounds
GU – kidney stones
Neurological–altered LOC decreased DTR
Musculoskeletal – severe muscle weakness
Bone pain & fractures
**MOANS GROANS AND STONES**
234
Hypophosphatemia Interventions
**Replace phosphorous IV or PO slow**
phosphorous slow if severely low
administer oral phosphorous with Vitamin D
**Fracture precautions**
235
Hyperphosphatemia Causes
Increased phosphorous intake
Overuse of laxative and enemas with phosphorous
Decreased excretion of P- due to renal insufficiency
Hyperparathyroidism
**Hypocalcemia**
236
hyperphosphatemia S/S
*Neuromuscular
irritable skeletal muscles – twitching, cramps, tetany, seizures, paresthesias
**painful muscle spasms in calf or foot
positive Trousseau’s and Chvostek’s signs**
hyperactive deep tendon reflexes (DTRs)
osteoporosis – body trying to get more calcium
-GI
hyperactive bowel sounds
diarrhea
237
Hyperphosphatemia Interventions
Same interventions as hypocalcemia
Replace Calcium (IV or PO)
IV calcium gluconate 10%
monitor BP, HR & place patient on heart
Vitamin D if giving PO
Aluminum hydroxide (Tums) calcium supplements
Initiate seizure precautions & bleeding precautions
Move patient carefully
Educate on calcium rich foods
dairy, cheese, milk, yogurt
collard greens, broccoli
238
Chloride functions
**Major anion of ECF**
**Sodium is major cation of ECF**
Moves in and out of the cell with sodium
Involved in regulating acid base balance
**chloride likes sodium; if Na+ loss = Cl- loss**
239
What is the major anion of the ECF?
Chloride
240
Chloride normal levels
95-105
241
Corticosteroids
bone loss; increased blood glucose; Na+ retention
- low potassium
242
Ace Inhibitors, Spironolactone (Aldactone), ARBs
hold on to K+
- low sodium
243
Insulin
move K+ into the cell
244
Furosemide
potent diuretic; should monitor all electrolytes
Laxatives (Mg)
245
NSAIDs (Ibuprofen)
decrease renal perfusion
246
Potassium normally lives in what fluid
Intracelular
247
Potassium is responsible for
Nerve impulse induction and muscle contraction
248
Medications to avoid renal failure
Ace inhibitors
steroids (hold)
furosemide (hold)
give this instead = spironolactone (Aldactone)
ARBs
NSAIDs
249
If a patient with renal failure needs NSAIDs, what is a safer alternative?
Tylenol
250
What is the best/accurate way to monitor fluid changes?
Daily weight
251
ARBs
Angiotensin Resistant Blockers
252
What do you hold when the patient is in renal failure or high potassium?
ACEs and ARBs
253
Laxatives contain what if in renal failure?
Mg
254
Lisionopril is a
ACE inhibitor
255
Spirinolactone is a
potassium sparing diuretic
256
ARBs end in
sartans (valsartan)
257
If the patient is in post-cardiac arrest, what is the organ that was affected besides the heart?
kidney acute failure
258
If there is a sudden change in LOC, then what do you think might be the cause?
Hypoxia (low O2)
259
With Lasix, what do you monitor? How slow do you give it?
BP; 2-4 mins
If you don't v-fib, hearing loss, hypotension, lethal dysrhythmia
260
If you do not give Lasix at 2-4 mins, then what can occur
v-fib, hearing loss, hypotension, lethal dysrhythmia
261
What patient might have Furosemide?
**heart failure**
, liver, renal
262
calcium is high, phosphorous
low
263
If you have lupus and have a high-dose steroid, what ELECTROLYTE IMBALANCES might occur?
osteoporosis
- hypocalcemia
hypernatremia
hypokalemia
increases blood glucose
suppresses immune system
264
If magnesium is out of order, then
chaos and not order of electrolytes
265
Why is magnesium needed?
help nerve function
**controls glucose
immune system stronger
helps calcium**
sleep and focused
266
If you have heart failure and have high doses of furosemide, then what lab would you need to know?
Potassium (worry about hypokalemia)
Magnesium (if not normal take care of first)
267
If you have a low potassium level, then check
magnesium level
268
Why should you never give potassium on an empty stomach?
GI upset
269
What should also be given if you send home a patient on a diuretic?
What should you stop if you run out of diuretics?
Potassium, yes
270
What is given if the patient has hypokalemia
Kayexssolate **Insulin**
271
If I over-treat a diabetes inspidus patient, what will happen?
water intoxication (HA, altered LOC)
272
When monitoring a client for hyponatremia, which assessment findings would the nurse consider significant? Select all that apply.
- Thirst
- Seizures
- Erythema
- Confusion
- Constipation
Seizures
Confusion
Module 2 (Skills)
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