AMS1

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Author:
alyn217
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163798
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AMS1
Updated:
2012-07-24 12:53:04
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AMS1T2 Electrolytes
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Electrolytes
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  1. What is involved in a chem 7?
  2. What are normals for the BMP?
  3. What are normals for the CMP?
  4. Know where the electrolytes are found in quantity (ie in cells or in BS)
  5. Potassium (K+)
    • Major cation of the ICF
    • Necessary for:
    • Transmission & conduction of nerve impulses
    • Maintenance of normal cardiac rhythms
    • Skeletal muscle contraction
    • Acid-base balance
    • Normal 3.5.5.0 mEq/L
  6. K+ and pH
    • Alkalosis:
    • Decreased H+ ions
    • H+ leaves the cell
    • K+ is drawn into the cell-->HYPOkalemia          
    • Normal pH 7.35-7.45
    • Acidosis:
    • Increased H+ ions
    • H+ pushed into the cell
    • K+ pushed out of cell= HYPERkalemia
  7. Functions and sources of K+
    • Critical to action membrane potential
    • Kidneys are major route for K+ loss. (Minor loss of K+ via stool & sweat).
    • Sources of K+:
    • --Fruits & vegetables (e.g. bananas, oranges)
    • --Salt substitutes
    • --K+ medications (PO, IV)
    • --Stored blood
  8. Hyperkalemia pathophys
    • Renal failure
    • Increased cellular destruction
    • Excessive administration/ingestion of K+
    • K+ sparing diuretics
    • Low cardiac output or sodium depletion
    • Acidosis
  9. SnSs of Hyperkalemia
    • EKG – Tall, peaked T-waves, widening QRS, bradycardia, VT, VF, asystole (potentially lethal)
    • Abdominal cramps, diarrhea, hyperirritable BS
    • Lethargy, muscle weakness
    • Myocardial depression – contractility & conduction
    • Oliguria (low pee)/anuria (no pee) (if renal insufficiency or failure)

    Nursing intervension: get pt on a heart monitor!
  10. Nursing care for pt with hyperkalemia
    • Administer Ca++ chloride or gluconate IV-->Decreases cardiac irritability
    • Monitor serum K+
    • Frequent cardiac, GI, renal assessments
    • Avoid K+ in diet
    • Avoid K+ sparing diuretics
    • Treat underlying problem
  11. Rx involved in hyperkalemia Tx
    • May anticipate/administer:
    • Kayexelate PO or PR (exchanges K+ for Na+ in gut-->diarrhea)
    • Diuretic (non-K+ sparing)
    • ½ or 1 amp Dexterose 50% IVP followed by regular insulin IV
    • NaHCO3 w/confirmed acidosis
    • Dialysis
  12. Pathyophys of hypokalemia
    • K+ loss exceeding intake due to...
    • Elevated aldosterone levels
    • Loop diuretics
    • GI losses
    • Movement into cells
  13. SnSs of Hypokalemia
    • Ventricular dysrhythmias (potentially lethal)
    • Impaired repolarization
    • Increased digoxin toxicity (in those taking dig)
    • Muscle cell breakdown (leads to myoglobin in plasma & urine)
    • Decreased GI motility
    • Altered airway responsiveness
    • Impaired regulation of arterial blood flow
    • Diuresis
    • Hyperglycemia

    Nursing intervension: get pt on a heart monitor. Sound familiar?
  14. Hypokalemia nursing care
    • Administer K+ as indicated
    • *NEVER GIVE POTASSIUM IVP
    • *Consider renal function when giving K+. If impared, give less.

    Standard of care: KCl 10mEq/100mL IV over one hour


    • K+ is very irritating to peripheral veins. May be painful & not tolerated by pt.
    • Some facilities add Lidocaine … but consider …not feeling the pain does not necessarily mean the damage isn’t happening…
  15. Function of sodium (Na+)
    • Major cation of the ECF - imbalances change ECF osmolality
    • “Serum sodium” = Na+ + H2O
    • Major role in:
    • --ECF volume & concentration
    • --Generation & transmission of nerve impulses
    • --Acid-base balance
    • --Normal 135-145
  16. Hypernatremia Pathophys
    • Elevated Na+ occurs w/water loss OR Na+ gain
    • Hyperosmolality leads to cellular dehydration
    • Protected by hypothalamus because it will trigger thirst to dilute [Na+]
    • Hyperosmolar tube feedings
    • Osmotic diuretics (ie, mannitol)
    • Sensible losses (sweating to the point of losing electrolytes including Na+)
    • Na+ gain/intake
  17. Hypernatremia labs
    • (not normals. values indicate hypernatremia)
    • Serum Na+ > 145 mEq/L
    • Serum osmolality > 300 mOsm/L
    • Normal to high Hct (consider concentration vs. dilution)
    • Urine specific gravity > 1.030
  18. SnSs of hypernatremia with Hypervolemia
    • Na+ Gain
    • Edema, weight gain
    • Bounding pulses
    • Distended neck veins
    • Crackles in lungs
    • Dyspnea, orthopnea
    • Possibly low Hct
    • Tachycardia
    • Hypertension
    • Restlessness, lethargy, agitation, sz, coma
  19. Hypernatremia with hypovolemia
    • H2O Loss due to a variety of reasons including diaphoretic-- ^ [Na+] in BS-->water drawn from cells-->SnSs below:
    • Dry skin & mucous membranes
    • Tenting skin
    • Warm, flushed, dry skin
    • Initial elevated temp
    • Hypotension (esp orthostatic)
    • Tachycardia
    • Thirst
    • Oliguria
    • Restlessness, lethargy, agitation, sz, coma
  20. Nursing care for Na+ gain with hypervolemia
    • Na+ restriced diet
    • Avoid over-infusion w/saline
    • Diuretics
    • Frequent Assessments – neuro, renal, cardiac, respiratory
    • Monitor labs
    • Treat underlying cause

    In both hyper/hyponatermic cases, pt will get confused and will be high risk for falls.
  21. Nursing care for Na+ game with hypovolemia
    • Water (esp if pt needs volume)
    • IVF – consider Na+ content (e.g. ½, ¼ NaCl; D5W)
    • Frequent Assessments – neuro, renal, cardiac
    • Monitor labs
    • Treat underlying cause
  22. pathophys of Hyponatremia
    • Results from loss of sodium-containing fluids OR from excessive water intake
    • Causes hypoosmolality leading to cellular swelling and explosion
  23. Pathophys of hyponatremia with Na+ depletion
    • NaCl loss > H2O loss (usually w/FVD)
    • Diuretics
    • Diarrhea, fistula drainage
    • NG suction
    • Diaphoresis
    • Hyperglycemia (glucose-induced diuresis)
    • Adrenal insufficiency
  24. Hyponatremia pathophys due to Excessive H2O
    • Water intoxication (dilutional effect; usually w/FVE)
    • SIADH
    • Overhydration w/dextrose
    • Tap water enema
    • Hypotonic irrigating solutions (CBI)
    • HF, cirrhosis
  25. SnSs of hyponatremia due to v Na+
    • CNS – HA, malaise, muscle weakness, confusion/coma
    • FVD effects (hypotension, decrease BP/JVD, tenting, low U/O
  26. SnSs of hyponatremia due to ^H2O.
    • CNS – LOC, HA, delirium, sz
    • FVE effects (weight gain, taut skin turgor, JVD/elev CVP, hypertension, risk for pulmonary edema
  27. Nursing care for hyponatremia due to v Na+
    • Neuro checks!
    • SZ precautions
    • Diet high in sodium w/adequate fluid
    • Fluid resuscitation w/NS
    • Monitor labs
    • Frequent cardiac & renal assessments
  28. Nursing care for hyponatremia due to ^ H2O.
    • Neuro checks! w/ SZ precautions
    • Fluid restriction
    • Diuretics
    • Monitor labs
    • Frequent assessments – respiratory, renal, cardiac
    • 3% NaCl very slowly

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