AMS1

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  1. What is involved in a chem 7?
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  2. What are normals for the BMP?
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  3. What are normals for the CMP?
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  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
Author:
alyn217
ID:
163798
Card Set:
AMS1
Updated:
2012-07-24 16:53:04
Tags:
AMS1T2 Electrolytes
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Description:
Electrolytes
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