Electrolyte balance

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  1. Potassium balance
    • normal blood level is 3.5-5 
    • potassium moves into cells: insulin(key brings sugar and K) , alkalosis(low K level) , anabolism(building cells) 
    • mostly in cells don't want too much in blood
  2. potassium balance 
    potassium moving out of cells
    • =high blood K levels 
    • extreme exercise(cell damage) 
    • acidosis 
    • trauma to cells
  3. hypokalemia etiology 
    in the blood stream
    • inadequate intake 
    • increased utilization 
    • increased losses-diarrhea
    • alkalosis 
    • renal disorders
  4. cellular electrical activity 
    • lowers the resting membrane potential 
    • which you need more stimuli to reach threshold(weak and fatigued)
  5. hypokalemia symptoms: decreased neuromuscular irratibiltiy 
    • weakness"lazy muscles"
    • speech changes-slurred
    • flaccid paralysis-floopy.droopy
    • shallow respirations, tachycardia
    • decreased intestinal motility 
    • anorexia 
    • polyuria/nocuturia --kidneys can't concentrate and blood vessels relax..
  6. hypokalemia sx: cardia smooth muscle weakness
    • due to the electrical effect K has on heart
    • arrythmias(depends on how sensitive the person is) 
    • hypotension 
    • arrest 

    main intervention is EKG
  7. hypokalemia: nursing care 
    • K replacement( squash,peaches, bananas, potatoes) orangy foods..used for long term
    • oral meds(KCl) (powder and orange juice tang) -hard on stomach
    • IV replacement: not undiluted, beware of infiltration(burn), EKG,
    • toxicity(kidney disease decrease excretion,
    • digoxin(inotropic agent-heart beats stronger and slower)/lasix-diruetic ..k wasting.. loose too much k and makes digoxin toxic 
    • never give pure K always dilute 
    • add it to iv bag(its irritating to the vein )
  8. Hyperkalemia etiology 
    • potassium retention=renal failure, decreased aldosterone production(saving K) 
    • excessive release from cells=burns, trauma, infection, acidosis 
    • excessive k iv (med error)
  9. cellular electrical activity for hyperkalemia 
    raises the rmp...lots of firing its easy to excite
  10. Hyperkalemia symptoms:increased neuromuscular irritability 
    • intestinal colic
    • diarrhea
    • muscle twitching progressing to flaccid paralysis 
    • arrythmias
  11. hyperkalemia nursing care 
    • increase excretion =kayexalate enema(exchanges na for K ) -can also give orally 
    • redistribution (glucose plus insulin)-near death=short term 
    • NaHC03- correct acidosis 
    • diuretics-lasix
    • correct ph(can be causing the problem..
    • dialysis if renal prob
  12. calcium regulation 
    • serum calcium range 9-11 
    • parathyroid hormone increase=takes ca out of bone and into blood 
    • calcitonin(thyroid) decreases=ca back into blood 
    • vitamin D (in order to absorb ca..fat soluable) 
    • ca and phosphorous inverse relationship
  13. hypocalcemia etiology 
    • low pth production(females) 
    • acute pancreatitis(dump alkaline juice) 
    • multiple blood transfusion(citrate-lacatace =base) 
    • poor diet 
    • pregnancy(need to increase ca by 50% baby takes 10% of bone mass) 
    • alkalosis 

    Presence of alkaline binds to ca; when ca is bounded it doesn't count therefore its low ( or precipitate when in iv causing it to be chunky )
  14. cellular electrical activity 
    • lowers threshold ..overall distance decreased 
    • needs little stimulation
  15. hypocalcemia sX
    same as alkalosis 
    irritability (ca decreases in presence of base)
    • tingling 
    • muscle spam(trousseau's sign-inflate bp cuff and pinky and ring finger twitch easily ) 
    • facial grimace( chvostek's sign-touch face-involuntary muscle spasm ) 
    • laryngeospasm 
    • convulsions
    • tetany 
    • ekg changes 
    • phosphorous level =high
  16. hypocalcemia nursing care 
    • oral replacement 
    • if tetany: calcium gluconate SLOWLy , watch for hypotension and bradycardia...never give IM 
    • watch for digoxin toxicity(enchanced by ca)-in presnece of low ca and K 
    • ca isn't well absorbed in presence of base 
    • citrical-acid with ca(ionized acid)
    • wouldn't give tums because it is ca with antiacid
  17. hypercalcemia etiology 
    • hyperparathyroidism 
    • immobility= goes out of bones 
    • neoplasm-increase in cancer 
    • decreased renal excretion 
    • excess vitamin d =absorbed too much 
    • antacid overdose(contains ca) 
    • acidosis= ionized calcium 
    • come out of binding once its free it causes electrical activity
  18. hyperCA electrical activity 
    raises threshold...causing a larger stimulus to occur
  19. hypercalcemia sx 
    calcium deposits (flank pain, kidney stones, renal failure
  20. hypercalcemia sx 
    decreased GI
    • consitpation 
    • peptic ulcer
    • anorexia
    • nausea 

    use tums to relief ulcer but you just got another dose of calcium
  21. hypercalcemia sx 
    decreased neuromuscular function 
    • lethargy 
    • exhaustion 
    • confusion 
    • coma
  22. hypercalcemia sx 
    bone decalcification 
    • bone pain 
    • osteoporois (holes in bones..decrease bone density) 
    • osteomalacia(weakness in bones) 
    • pathologic fractures(any stress breaks bones)
  23. hypercalemia nursing care 
    • increase excretion (diuretics) 
    • hydration with saline(increases excretion) 
    • mobilization - walking brings ca back into bones
    • synthetic calcitonin(tones down ca) 
    • -beware of allergic response : antihistamine, epinephrine, and oxygen
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Electrolyte balance
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