Electrolyte Imbalances

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TomWruble
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155472
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Electrolyte Imbalances
Updated:
2013-03-17 23:14:55
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electrolyte imbalances keynursing
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What it IS and what it DOES
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  1. Hypercalcemia (Ca2+): Is and Does
    • > 10.5 mg/dL
    • Calcium facilitates blood clotting and hypercalcemia causes faster clotting time to the point where they may occur when not needed.

    Like many electrolyte imbalances that affect the heart (the most serious affect of hyperCa), initially it causes inc P and BP, but then prolonged Ca imbalance depresses electrical conduction slowing the heart.
  2. Hyperphosphatemia: Is and Does
    > 4.5 mg/dL

    This is well tolerated by most body systems.

    The problem is that it often coincides with Hypocalcemia because of the balanced relationship.
  3. Intestinal changes from hyponatremia?
    < 135 mEq/L

    Increased motility.

    • Sounds are hyperactive with rushes and gurgles over the splenic flexure and in LLQ.
    • BMs are freq and watery.
  4. Cardio changes from hyponatremia?
    • < 135 mEq/L
    • Hypovolemia w/ rapid weak thready peripheral pulses. May have severe orthostatic hypotension. Note hyponatremia can occur with hypervolemia -> rapid bounding pulses.
  5. Mechanisms of Hypernatremia problems?
    • > 145 mEq/L
    • increases excitable depolarization
    • severe cellular dehydration, which may render "excitable" dehydrated tissues no longer able to respond to stimuli
  6. Nervous system changes from Hypernatremia?
    • > 145 mEq/L
    • with DECREASED fluid volume: short attention span, agitated or confused, manic episodes or seizures
    • with INCREASED fluid volume: lethargic, drowsy, stuporous or even comatose
  7. Neuromuscular changes of hypernatremia?
    > 145 mEq/L

    Deep tendon reflexes reduced or absent (those that function to keep muscles at more-or-less the same length. (SAME as hypO)

    • At mild rises in Na+, muscle twitching and irregular contractions, but as condition worsens, muscle WEAKNESS, same as HYPO. Test strength in arms (grip or curls) and legs
    • push/pull. A weakness should lead to an evaluation of the respiratory effectiveness (S02) since ventilation depends on adequate muscle strength.
  8. Cardio changes from hypernatremia?
    • > 145 mEq/L
    • Hypovolemia w/ rapid weak thready peripheral pulses. May have severe orthostatic hypotension.
    • Note hyponatremia can occur with hypervolemia -> slow to normal (NOT rapid) bounding pulses. BP, especially diastolic, is increased.
  9. Hyperkalemia
    • > 5.0 mEq/L
    • Since 98% of K+ is ICF, increases in serum K+ reduce the difference between ICE and ECF concentrations of K+. This makes excitable membranes even more sensitive, even prone to spontaneous discharge. This is nowhere more important than the heart where high K+ values can cause dysrhythmias, which are the most severe problems from hyper-K and the most common cause of death. Ectopic (beats outside of normal conduction system) may occur.
    • Sudden rises can cause severe problems in the 6-7 range, whereas a slow rise may not cause problems until 8.
    • Hyperkalemia is rare in people with normal kidney function.
  10. Neuromuscular changes of hyperkalemia?
    > 5.0 mEq/L

    tingling, burning and numbness of the hands and feet and around the mouth paresthesia

    At mild rises in K+, muscle twitching and irregular contractions, but as condition worsens, muscle WEAKNESS, same as HYPO.

    Respirator muscles are not affected until K+ reaches lethal levels.
  11. Intestinal changes from hyperkalemia?
    • > 5.0 mEq/L
    • Increased motility. Sounds are hyperactive with rushes and gurgles over the splenic flexure and in LLQ. BMs are frequent and watery.
  12. This is the same as Hyponatremia!!!!
  13. Laboratory data to confirm hyperkalemia?
    • > 5.0 mEq/L
    • If caused by dehydration, levels of other electrolytes, hematocrit, and hemoglobin also are elevated.
    • Hyperkalemia caused by renal failure occurs with elevated serum creatinine and blood urea nitrogen, decreased blood pH, and normal or low hematocrit and hemoglobin levels.
  14. Mechanisms of Hyponatremia problems?
    • < 135 mEq/L
    • reduced excitable depolarization
    • cellular swelling
  15. Common causes of low sodium levels?
    • < 135 mEq/L
    • Prolonged use or overuse of diuretics, especially in older adults
  16. What cell types are most affected by hyponatremia?
    • < 135 mEq/L
    • cerebral, neuromuscular, and intestinal smooth muscle
  17. Cerebral changes from hyponatremia?
    • < 135 mEq/L
    • Depressed and excessive activity and sometimes both can occur leading to acute confusion or increased confusion.
  18. Neuromuscular changes of hyponatremia?
    < 135 mEq/L

    Deep tendon reflexes may diminish (those that function to keep muscles at more-or-less the same length.

    • Test strength in arms (grip or curls) and legs push/pull. A weakness should lead to an eval of the respiratory effectiveness (S02) since ventilation depends on adequate
    • muscle strength.
  19. Intestinal changes from hyponatremia?
    • < 135 mEq/L
    • Increased motility. Sounds are hyperactive with rushes and gurgles over the splenic flexure and in LLQ. BMs are freq and watery.
  20. Cardio changes from hyponatremia?
    • < 135 mEq/L
    • Hypovolemia w/ rapid weak thready peripheral pulses. May have severe orthostatic hypotension. Note hyponatremia can occur with hypervolemia -> rapid bounding pulses.
  21. Hypokalemia?
    • < 3.5 mEq/L
    • May be actual or relative
    • Drugs such as diuretics, corticosteroids and beta-adrenergic agonists or antagonists can inc loss through kidneys
  22. Respiratory changes from Hypokalemia?
    • < 3.5 mEq/L
    • skeletal muscle weakness results in shallow respirations
    • Respiratory efficiency is critical because insufficiency is a major cause of death.
  23. Intestinal changes from hypokalemia?
    • < 3.5 mEq/L
    • Decreased motility. Sounds are hypoactive. Pt may have nausea, vomiting, constipation and abdominal distention.
  24. Hypocalcemia intestinal changes
    Increased peristaltic activity
  25. Hypocalcemia skeletal changes
    bones break easily

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