Exam 2 Corbett Ch 5 and 7 Electrolytes

Home > Preview

The flashcards below were created by user Pandora320 on FreezingBlue Flashcards.


  1. Short hand values listed on a client's charts reflect what electrolytes?
    140 | 103
        4 | 27
    • Na | Cl
    •  K  | BiCarb
  2. What electrolytes are principal in ECF?
    • Sodium
    • Chloride
    • Bicarbonate
  3. What electrolytes are principal in ICF?
    • Potassium
    • Magnesium
    • Phosphate
  4. What electrolytes are cations?
    • (Positive ions)
    • Sodium
    • Potassium
  5. What electrolytes are anions?
    • (Negative ions)
    • Chloride
    • Bicarbonate
  6. What are the reference values for sodium?
    136-145 mEq/L
  7. What are the reference values for potassium?
    3.5-5.1 mEq/L
  8. What are the reference values for chloride?
    98-107 mEq/L
  9. What are the reference values for bicarbonate?
    21-30 mEg/L
  10. Facts about Sodium
    • Most abundant electrolyte in ECF
    • Controls and regulates water balance
    • Primary regulator of ECF volume
    • Need 2 grams of Na per day
  11. Causes of hypernatremia
    • dehydration - most frequent
    • overuse of IV saline solutions
    • exchange transfusion with stored blood
    • impaired renal function
    • unconscious - not drinking or unable to verbalize thirst
    • tumor of adrenal gland
    • (each 3 mEq/L above normal = 1 Liter depleted)
  12. Assessment findings of hypernatremia
    • subjective - complains of thirst - may be intense
    • restlessness, agitation to lethargy
    • dry mucous membranes
    • dry, flushed skin
    • nausea and vomiting
    • urine output low (< 30 mL/hr)
    • diagnostics - an increase in specific gravity of urine (> 1.020) except for diabetes insipidus
  13. Treatment of hypernatremia
    • salt free fluids
    • sodium restriction
    • diuretics and water
    • monitor client for vital signs, level of consciousness, intake and output, labs, and weight.
    • also monitor oral hygiene, client safety, and teach client proper sodium and fluid intake
    • administer IV solutions with caution - hypotonic sodium solutions such as 0.45% and 0.33% normal saline
  14. Causes of hyponatremia
    • excessive water - "dilutional" hyponatremia
    • loss of sodium by vomiting, diarrhea, GI suctioning, or sweating
    • use of diuretics, diabetic acidosis, Addison's disease, renal disease; all cause increased loss of sodium via urine
    • irrigating N/G tubes with water
    • use of D5W or hypotonic IV fluids such as 0.45%, 0.33% Normal Saline
  15. Assessment findings for hyponatremia
    • postural hypotension (assess BP, HR)
    • rapid thready weak pulse
    • cold, clammy skin
    • abdominal cramps and nausea
    • muscle weakness, cramps, tremors
    • lethargy, headache, decrease in level of consciousness, confusion
    • diagnostic labs - decreased urine specific gravity (< 1.010)
    • decrease in HCT
  16. Treatments of hyponatremia
    • identify and treat cause
    • restrict fluids
    • encourage high sodium foods
    • administer hypertonic sodium chloride very slowly (such as D5% 0.45% NS, D5% NS, D5% LR)
    • monitor client's vital signs, level of consciousness, intake and output, weight, labs, and safety
    • teach client about healthy sodium and water intake
  17. Possible nursing diagnoses related to hypernatremia
    • Deficient fluid volume
    • Excessive fluid volume related to excess sodium
    • Deficient knowledge related to need for sodium restriction
  18. Possible nursing diagnoses related to hyponatremia
    • Excess fluid volume related to water intoxication
    • Imbalanced nutrition related to sodium depletion
    • Deficient knowledge related to specific need for replenishing sodium
  19. Facts about potassium
    • vital for normal neuromuscular and cardiac function
    • excreted daily by kidneys
    • source is a balanced diet
    • need 40-80 mEq/day
  20. Causes of hyperkalemia
    • renal failure
    • too rapid IV infusion of potassium replacement
    • initial reaction to massive tissue damage (trauma, burns)
    • associated with metabolic acidosis
    • drugs such as:
    • ACE inhibitors
    • aldactone (K sparing diuretic)
    • ARBs
    • NSAIDs
    • hormonal contraceptives
  21. Signs and symptoms of hyperkalemia
    • Image Upload
    • Neuromuscular - parenthesias, muscle weakness, paralysis; leg muscle to respiratory muscles
    • GI hyperactivity
    • Cardiac - heart rate, irregular pulse, hypotension
    • Diagnostics - K > 5, ECG changes (tented T wave, flat P wave, wide QRS)
  22. What ECG changes are associated with hyperkalemia?
    • tented T wave, flat P wave, wide QRS
    • Image Upload
  23. Is the patient experiencing hyperkalemia or hypokalemia in this ECG?
    Image Upload
    Image Upload
  24. Treatment of hyperkalemia
    • Restrict potassium
    • Monitor vital signs, ECG, intake and output, digoxin levels, labs, client safety
    • Medications:
    • Lasix
    • Sodium Polystyrene Sulfonate (Kayexalate)
    • Dextrose and regular insulin given IV
    • Calcium Gluconate
    • Dialysis
  25. What are the medications that can treat hyperkalemia and how does it work to remove K+
    • Lasix: Inhibits NaCl reabsorption in the thick ascending loop of Henle (used when K is elevated but not critical)
    • Sodium Polystyrene Sulfonate (Kayexalate): potassium is exchanged with Na or Ca ions and excreted in feces.  Given orally or rectally (retention enema)
    • Dextrose and regular insulin given IV: as glucose goes into cell, K goes with it.  Must be given together as IV push.  For when K+ is very high - rapid acting
    • Calcium Gluconate: blocks the affect of K on heart.  Doesn't change the K levels but reduces the excitability of cardiomyocytes.  Used in life threatening situations
    • Dialysis: cleans the blood, artificial kidney process.
  26. Causes of hypokalemia
    • diuretics (loop, thiazides) non K sparing
    • decreased oral intake (need 40-80 mEq/day)
    • inadequate intake when NPO, vomiting, or receiving potassium-free IV feedings
    • large doses of corticosteroids
    • aftermath of tissue destruction or high stress
    • associated with metabolic alkalosis
    • prolonged diarrhea, intestinal disease with vomiting and gastric suction
  27. Signs and symptoms of hypokalemia
    • A SIC WALT:
    • Alkalosis
    • Shallow respirations
    • Irritability
    • Confusion, drowsiness
    • Weakness, fatigue
    • Arrhythmias - Tachycardia, Irregular Rhythm, and/or Bradycardia
    • Lethargy
    • Thready pulse
    • Intestinal motility, nausea, vomiting, ileus

    • Image Upload
    • Neuromuscular weakness: leg weakness, cramps, paresthesias, fatigue, lethargy, apathy, respiratory weakness
    • Decreased GI motility, decreased bowel sounds
    • Cardiac problems: weak irregular pulse, palpitations, orthostatic hypotension
    • Diagnostics: potassium level less than 3.5, 2.5 is severe, an increase in glucose levels, lower magnesium, increase Digoxin level and ECG changes such as flat T wave and positive U wave - critical situation
  28. What ECG changes are associated with hypokalemia?
    • Flat T wave
    • positive U wave
    • Image Upload
  29. Is the patient experiencing hyperkalemia or hypokalemia in this ECG?Image Upload
    • Hypokalemia
    • Image Upload
  30. Treatments of hypokalemia
    • Replace potassium with high potassium foods, oral supplements, IV replacement (max 10 mEq/hr, replace Mg first)
    • Monitor vital signs, HR and rhythm, labs, digoxin level, intake and output
    • Patient education - list dietary sources of potassium: dried fruits, potatoes, bananas, oranges, leafy greens, meat
    • Never direct injection of potassium - fatal
    • Avoid layering
  31. Medications that can cause hyperkalemia
    • ACE inhibitors
    • ARBs
    • Hormonal contraceptives
    • Potassium sparing diuretics
    • NSAIDs (ibuprofen)
  32. Possible nursing diagnoses related to hyperkalemia
    • Risk for injury related to effect of hyperkalemia on heart and other muscles
    • Deficient knowledge related to sources of potassium
    • Risk for injury related to subsequent development of hypokalemia
  33. Possible nursing diagnoses related to hypokalemia
    • Altered cardiac output related to development of arrhythmias
    • Risk for injury related to development of muscle weakness
    • Risk for injury related to use of IV potassium
    • Deficient knowledge related to oral potassium supplements
    • Deficient knowledge related to dietary sources of potassium
  34. Facts about chloride
    • Travels with sodium to maintain serum osmolality
    • Works with sodium to for CSF
    • Secreted by gastric mucosa (HCl) for digestion
  35. Hyperchloremia must be evaluated in relation to
    • an increase in sodium levels
    • a decrease in bicarbonate
  36. Causes of hyperchloremia
    • metabolic acidosis
    • increased intake with increased water loss
    • drugs such as Kayexalate
  37. Signs and symptoms of hyperchloremia
    • Signs and symptoms of metabolic acidosis - tachypnea, Kussmaul respirations, lethargy, weakness
    • Signs and symptoms of hypernatremia - fluid retention, edema, hypertension, dyspnea
  38. Treatment of hyperchloremia
    • Correct the cause
    • Restrict sodium and chloride
    • Increase water
    • IV bicarbonate
    • rarely use diuretics
    • monitor vital signs, level of consciousness, intake and output, respiratory rate, cardiac rhythm, labs, safety
  39. Causes of hypochloremia
    • reduced intake due to salt restricted diets, salt poor formula
    • excessive loss due to - vomiting, gastric suction, diarrhea, draining fistulas, cystic fibrosis
    • drugs, increased bicarbonate level, steroids, laxatives and diuretics
  40. Signs and symptoms of hypochloremia
    • Neuromuscular - Tetany, hyperactive relexes, seizures
    • Cardiac arrhythmias
    • Diagnostics - sodium less than 135 mEq/L, serum pH > 7.45 (as chloride decreases, bicarbonate increases)
  41. Treatment of hypochloremia
    • Correct the cause - hypochloremia is caused by an underlying problem
    • Chloride replacement - salty broth, KCl if sodium level is ok, restrict water
    • Monitor vital signs, level of consciousness, intake and output, labs, cardiac rhythm, safety
  42. Possible nursing diagnoses for hyperchloremia
    If increase in chloride level is related to increase in sodium level then use hypernatremia nursing diagnoses.
  43. Possible nursing diagnoses for hypochloremia
    Imbalanced nutrition related to chloride losses
  44. Facts about bicarbonate
    Important component for the equation that keeps the acid-base status of the body in balance
  45. What are the reference values for calcium?
    9.0-10.5 mg/dL
  46. Facts about calcium
    • Necessary for bone and teeth structure
    • Maintaining cell membrane structure
    • Muscle contraction
    • Required for blood to clot
    • Intake: 1 g/day for adults
    • Sources: dairy, calcium supplements and Vitamin D
  47. Causes of hypercalcemia
    • false rise caused by dehydration
    • hyperparathyroidism (phosphate decreased)
    • malignant tumors (bone cancer)
    • immobilization
    • thiazide diuretics
    • Vitamin D intoxication (phosphate increased)
    • excessive vitamin A
    • low phosphate
  48. Signs and symptoms of hypercalcemia
    • Bone pain
    • Neuromuscular weakness
    • Decreased motility - anorexia, nausea, vomiting, constipation
    • Renal - polyurea and stones
    • Diagnostics - ECG changes, x-ray - pathological fractures
  49. Treatment of hypercalcemia
    • Increase calcium excretion - hydration (0.9% NS, 200-300 mL/hour, loop diuretics, renal dialysis
    • Monitor vital signs, level of consciousness, ECG, intake and output, labs
    • Safety
    • Strain urine
    • Ambulate
    • Patient education
  50. Causes of hypocalcemia
    • false decrease caused by low albumin levels (hypoalbuminemia)
    • hypoparathyroidism (phosphate increased)
    • chronic renal disease (phosphate increased)
    • pancreatitis
    • massive blood transfusions
    • severe malnutrition (phosphate decreased)
    • low magnesium
    • high phosphorus
    • vitamin D deficiency
  51. Signs and symptoms of hypocalcemia
    • Neuromuscular - paresthesias - circumoral, twitching, tremors, muscle cramps, Chvostek's face, Troussau's arm/hand
    • Structural changes
    • Cardiac arrhythmias
    • Anorexia
  52. Treatment for hypocalcemia
    • Administer calcium gluconate
    • Vitamin D supplements
    • Increase dietary intake
    • Reduce phosphate
    • Monitor vital signs, respiratory stridor, ECG, labs, Chvostek's and Trousseau's
    • Client safety and education
  53. Possible nursing diagnoses for hypercalcemia
    • Imbalanced fluid requirements related to risk for injury from formation of kidney stones
    • Risk for injury related to slowing of reflexes
    • Risk for altered cardiac output
    • Risk for injury and impaired mobility related to development of pathologic fractures
    • Deficient knowledge related to therapy for hypercalcemia
    • Imbalanced nutrition - related to possible dietary restrictions
    • Impaired skin integrity
  54. Possible nursing diagnoses for hypocalcemia
    • Risk for injury related to the development of tetany
    • Risk for injury related to replacement of calcium
    • Deficient knowledge related to use of oral calcium supplements
    • Imbalanced nutrition - requirement for calcium
    • Deficient knowledge related to phosphate binders
  55. What are the reference values for phosphate?
    3.0-4.5 mg/dL
  56. Facts about phosphate
    • Required to activate B vitamins
    • Carbohydrate metabolism
    • Works with calcium to maintain bone structure and teeth
    • Nerve and muscle function
  57. Causes of hyperphosphatemia
    • increased intake
    • cell descruction
    • decreased excretion due to:
    • -hypoparathyroidism (and hypocalcemia)
    • -renal failure (and hypocalcemia)
    • increased growth hormone
    • vitamin D intoxication (and hypercalcemia)
    • phosphate intoxication from sodium phosphate enemas
  58. Signs and symptoms of hyperphosphatemia
    • Same signs as hypocalcemia: anorexic, dysphagia, and circumoral numbness
    • Calcification of the eyes
    • Diagnostics - lower calcium, skeletal changes shown in x-ray
  59. Treatment of hyperphosphatemia
    • Decrease intake
    • Increase excretion - fluids, diuretics, dialysis
    • Monitor vital signs, Chvostek's & Trousseau's, safety and education
  60. Causes of hypophosphatemia
    • respiratory hyperventilation
    • hyperparathyroidsm (and hypercalcemia)
    • diuresis (increased urine production)
    • malabsorption, or malnutrition (and hypocalcemia)
    • carbohydrate loading or refeeding syndrome (Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished or metabolically stressed due to severe illness)
    • antacid abuse
  61. Signs and symptoms of hypophosphatemia
    • Neuromuscular - weakness, confusion, signs and symptoms of hypercalcemia
    • Bruising, bleeding, loss of bone density
    • Diagnostics - low magnesium and high calcium, osteomalacia from x-ray
  62. Treatment of hypophosphatemia
    • Increase intake with food such as meat, fish, dairy, egg yolks, beans, nuts, or oral supplements
    • Monitor vital signs, respiratory rate/rhythm, level of consciousness, intake and output, labs, safety and education
  63. Possible nursing diagnoses related to increased phosphate levels
    • Imbalanced nutrition - requirement for calcium and phosphorus
    • Deficient knowledge related to use of phosphate binders
  64. Possible nursing diagnoses related to decreased phosphate levels
    • Risk for injury related to neuromuscular deficits
    • Risk for injury related to replacement therapies
    • Imbalanced nutrition - related to decreased phosphorus
  65. What are the reference values for magnesium?
    1.8-3.0 mEq/L
  66. Facts about magnesium
    • 2nd most abundant intracellular cation
    • Important for cell metabolism
    • Influences cardiac contractility
    • Maintains electrical activity in nerves and muscles
    • Influences calcium levels
  67. Causes of hypermagnesemia
    • excessive intake and/or decreased excretion
    • renal failure
    • IV administration of MgSO4
  68. Signs and symptoms of hypermagnesemia
    • Neuromuscular - flushing, warmth, weakness, decreased reflexes
    • Cardiac - lower blood pressure
    • Diagnostics - ECG changes
  69. Treatment of hypermagnesemia
    • Increased elimination - fluids in loop diuretics
    • Block effects - calcium gluconate (serious cases)
    • Monitor vital signs, level of consciousness, reflexes, intake and output, labs, ECG
  70. Causes of hypomagnesemia
    • poor intake and absorption
    • increased loss
    • pregnancy
    • chronic malnutrition (e.g., alcoholism)
    • diarrhea or draining GI fistulas
    • diuretics
    • diabetes
    • hypercalcemia or other complex metabolic disorders
    • refeeding syndrome (Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished or metabolically stressed due to severe illness)
    • Serum levels may not reflect actual stores
  71. Signs and symptoms of hypomagnesemia
    • Neuromuscular - change in level of consciousness, hyperactive reflexes
    • Cardiac irritability
    • Diagnostics - may see decreased calcium or potassium, ECG changes, increased digoxin levels
  72. Treatment of hypomagnesemia
    • Replace Mg - Oral or IV MgSO
    • Monitor vital signs, level of consciousness, dysphagia, reflexes, intake and output
    • Monitor client for safety and educate about high Mg foods such as leafy greens, whole grains, beans
  73. Possible nursing diagnoses related to increased magnesium levels
    • Risk for injury related to altered neuromuscular functioning
    • Deficient knowledge related to hidden sources of magnesium
  74. Possible nursing diagnoses related to decreased magnesium levels
    • Imbalanced nutrition - less than body requirements
    • Risk for injury related to alteration in cardiac output
    • Altered comfort related to neuromuscular irritability
    • Risk for injury related to magnesium replacements
  75. Food sources for Sodium
    salt, salty foods, processed and canned foods
  76. Food sources for Chloride
    salty foods, lettuce, celery, olives
  77. Food sources for Potassium
    dried fruits, potatoes, oranges, bananas, leafy greens, meats, cantaloupe
  78. Food sources for Magnesium
    leafy greens, whole grains, beans
  79. Food sources for Calcium
    dairy products, leafy greens, shellfish
  80. Food sources for Phosphorus
    meats, fish, dairy, egg yolks, beans, nuts

Card Set Information

Author:
Pandora320
ID:
334987
Filename:
Exam 2 Corbett Ch 5 and 7 Electrolytes
Updated:
2017-10-19 01:34:00
Tags:
BCC ADN NUR 101
Folders:

Description:
Exam 2 - Corbett Electrolytes, includes addition info from course booklet
Show Answers:

Home > Flashcards > Print Preview