IVF slides 30-56
About this set
Created by:
thelizinator on June 8, 2012
Classes:
Log in to favorite or report as inappropriate.
Order by
37 terms
Terms | Definitions |
|---|---|
 Hyponatremia is a condition in which the _____ is hyperosmolar relative to the _____. | ICF, ECF |
| What is the most common cause of hyponatremia? | Excess total body water NOT deficiency of sodium |
| What is the most important regulator of sodium? | Antidiuretic Hormone |
| What types of patient will hyponatremia be seen? | CHF, cirrhosis, drug, water intoxication |
| What is an important adverse effect of hyponatremia? | Cerebral edema |
| Signs and symptoms of hyponatremia | HTN, Bradycardia, confusion, agitation, headache, seizures, N/V, muscle cramps, weakness |
| Rapid treatment of chronic hyponatremia can result in ____________. | Myelinolysis (dissolving of myelin sheaths around nerves) |
| Who is are greatest risk for myelinolysis? | Hyponatremic >48 hours, lives transplant, etoh |
| What should be used to increase sodium levels and at what rate? | Infuse 3% saline at 1-2 ml/kg/hr and sodium level should be increased by no more than 1-2 meq/L/hr If patient is clinically stable, sodium administration should not exceed 10-15 mmol/L in 24 hours |
| What sodium level is generally considered safe for patient undergoing general anesthesia? | >130 meq/L |
| Intraoperative cerebral edema caused by hyponatremia can be manifested by what signs? | Decrease in MAC, postop agitation/confusion/somnolence |
| What is the most common cause of hypernatremia with a normal total body sodium content? | Diabetes Insipidus |
| Rapid hypernatremia results in shrinking of the brain and increased traction on intracranial veins/sinuses which can ultimately lead to what? | Intracranial hemorrhage |
| Rapid correction of hypernatremia can lead to what? | Cerebral edema |
| Signs and symptoms of hypernatremia | Lethargy, mental status changes, peripheral edema, muscular rigidity and tremor, expanded intravascular volume |
| How do you correct hypernatremia? | Hydration |
| If a patient has acute hypernatremia, what type of solution can be given rapidly? | Hypotonic |
| If a patient has chronic hypernatremia accompanied by volume depletion, correct first with what? Followed by what? | Isotonic crystalloids followed by hypotonic solutions |
| At what rate should the sodium level be lowered in hypernatremia? | 1-2 meq/hr |
| Hypernatremia increases or decreases the MAC for inhalation in animal studies? | Increases |
| At what sodium level should elective surgery be postponed? | >150meq/L |
| What is responsible for the resting membrane potential of the cell? | Potassium |
| Causes of hypokalemia | GI loss, renal loss, poor K intake, redistribution of K from ECF to ICF, diuretics, beta adrenergic stimulation, insulin, alkalosis (low PCO2, albuterol inhalers), PCN, aminoglycides, corticosteriods, hyperaldosterone, gastric suctioning, anorexia, alcoholism |
| Surgical stress may decrease serum K by how much? | 0.5 meq/L |
| Signs and Symptoms of Hypokalemia | ST depression, widened QRS, flattened T waves, ectopy, weakness, confusion |
| Hypokalemic patients on digoxin are at an increased or decreased risk for dig toxicity? | Increased |
| Intraoperative management of a patient with hypokalemia | 1. Administer IV K if arrhythmias develop 2. Avoid hyperventilation 3. Avoid use of glucose in solutions 4. Be aware of increased sensitivity to NMBA's |
| Causes of hyperkalemia | Acidosis, hemolysis, tissue necrosis, rhabdomyolysis, renal failure, potassium sparing diuretics, hypoaldosteronism, NSAIDS, beta-blockers, ACE inhibitors |
| Movement of K out of the cells can be seen in what instances? | Administration of sux, acidosis, cell lysis following chemotherapy, hemolysis, rhabdomyolysis, massive tissue trauma, hyperosmolality, digitalis overdose, administration of arginine hyperchloride and beta-2 adrenergic blockade, and during episodes of hyperkalemic periodic paralysis |
| Average increase in plasma K when sux is administered? | 0.5 meq/L (can be exaggerated following large burns or severe muscle trauma and in patient with muscle denervation/paralysis) |
| Signs and symptoms of hyperkalemia | Tall peaked T waves, widened QRS, ventricular arrhythmias, cardiac arrest, muscle weakness, confusion, parathesias |
| What is the lethal level regarding hyperkalemia? | >6.0 meq/L |
| Treatment of Hyperkalemia | 1. CALCIUM: 5-10mL of 10% calcium gluconate or 3-5 mL of 10% calcium chloride (partially antagonizes the cardiac effects of hyperkalemia--short lived dig toxicity potentiation 2. BICARB: promotes cellular uptake of K 3. BETA-AGONIST: promote cellular uptake 4. IV GLUCOSE AND INSULIN: 30-50g glucose with 10 units of insulin (promotes cellular uptake of K and lowering plasma K but often takes up to 1 hour for peak effect) 5. FUROSEMIDE 6. DIALYSIS |
| Intraoperative management of a patient with hyperkalemia | 1. Watch for arrhythmias 2. Sux and LR (2 meq K) are contraindicated 3. Avoid acidosis (may mildly hyperventilate) 4. Be aware hyperkalemia can accentuate the effects of NMDAs |
| Ionized Ca accounts for what percentage of Ca in the ECF? Where is the remainder? | 50%, 10% bound to anions, 40% bound to albumin |
| Total serum level are largely dependent on what levels? | Albumin |
| Causes of hypocalcemia | Hypoparathyroid (may be surgically induced), pancreatitis, malignancy, alkalosis, rhabdomyolysis, renal insufficiency, hypomagnsemia, low albumin due to malnutrition/sepsis/burns, extensive blood transfusions |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.