Combo with Fundamentals 41 - Electrolytes - Imbalances and 1 other

Potassium (K+)
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Terms in this set (87)
Potassium (K+)
found in fruit, potatoes; Distribution: low in ECF, high in ICF; Important Functions: maintains resting membrane potential of skeletal, smooth, cardiac muscle, allowing for normal muscle function
Calcium (Ca2+)
found in dairy products, broccoli, oranges; Distribution: low in ECF, mostly in bones and intracellular; Important Functions: influences excitability of nerve and muscle cells, necessary for muscle contraction
Magnesium (Mg2+)
found in dark green leafy veg, whole graines; Distribution: low in ECF, mostly in bones and intracellular; Important Function: influences function of neuromuscular junctions and is cofactor for numerous enzymes
Phosphate (PO4)
found in milk, processed food, antacids; Distribution: low in ECF, higher in ICF and in bones; Important Function: necessary for production of ATP
Hypernatremia
water deficit; 2 general causes make body fluids too concentrated; loss relatively more water than salt or gain of relatively more salt than water; cells shrivil; Signs: extreme thirst, dry/flushed skin, postural hypotension, fever, restlessness, confusion, agitation, coma, seizures if develops rapidly
Hyponatremia
water excess or water intoxication; hypotonic condition; gain of relatively more water than salt or loss of relatively more salt than water; cell swells; Signs: apprehension, nausea and vomiting, headaches, decreased level of consciousness (confusion, lethargy, muscle weakness)
Hypokalemia
abnormally low potassium concentration in blood; results from decreased potassium intake and abosrption, shift of K+ from ECF into cells, increased potassium output; Common Causes: increased potassium output: diarrhea, repeated vomiting, used of potassium-wasting diuretics; Signs: muscle weakness (threatning respiratory muscles and potentially life-threat cardiac dysrhythmia)
Hyperkalemia
abnormally high potassium ion concentration in blood; results from increased potassium intake and absorption, shift in K+ from cells into ECF, decreased K+ output; Signs: muscle weakness, potentially life-threatening cardiac dysrhythmia, cardiac arrest
Hypocalcemia
abnormally low calcium concentration in blood; results from; Signs: increases neuromuscular excitability; numbness and tingling fingers and mouth; hyperactive reflexes, muscle twitching and cramping, tetany, seizures, laryngospasm, cardiac dysrhythmias
Hypercalcemia
abnormally high calcim concentrations; results from increased calcium intake and absorption, shift of calcium from bones into ECF, and decreased calcium output; Signs: anorexia, nausea/vomiting,constipation, fatigue, diminished reflexes, lethargy, decreased LOC, confusion, personality change,cardiac dysrhythmias, kidney stones (renal calculi)
Hypomagnesemiaabnormally low magnesium concentration; general causes: decreased Mg+ intake and absorption, shift or plasma magnesium to its inactive bound form, and increased magnesium output; Signs: hyperactive deep tendon reflexes, insomnia, muscle cramps/twitching, grimacing, dysphagia, tachycardia, hypertension, tetany, seizures, cardiac dysrhythmiasHypermagnesemiaabnormally high magnesium concentration; end-stage renal disease, decreased Mg intake to decreased output; Signs: decreased neuromuscular excitability,with lethargy and decreased deep tendon reflexes being most common; bradtcardia, hypotension, flushing, sensation of warmth, flaccid muscle paralysis; decreased rate and depth of respirations, cardiac dysrhythmias, cardiac arrestRespiratory Acidosisexcessive Carbonic Acid caused by hypoventilation; Signs: headache, light-headedness, decreased level of consciousness (confusion, lethargy, coma), cardiac dysrhthmia, warm/flushed skin, muscular twitchingRespiratory Alkalosisdeficient Carbonic Acid by hyperventilation; hypoxia, acute pain, anxiety, psychological distress; Signs: increased rate and depth of respirations (hypervent), light-headness, numbness and tingling of extremities, excitement and confusion poss followed by decreased LOC, cardiac dyrhythmiasMetabolic Acidosisexcessive metabolic acids; Signs: decreased LOC (lethargy, confustion, coma), abdominal pain, cardiac dysrhythmia, increased rate/depth of resp (compensatory hyperventilation)Metabolic Alkalosisdeficient metabolic acids; increase base; Signs: light-headedness, numbness and tingling of fingers, toes, and circumoral regions, poss excitement and confusion followed by decreased LOC, cardiac dysrhythmias (poss caused by hypokalemia)Insensible losses of fluids- occurs through the skin and lungs - usually not noticeable and cannot be measuredSensible loss of fluidsloss that is perceived or is measurable. (wound drainage, GI tract, urine)Antidiuretic hormone (ADH)regulates water excretion from the kidneysSodium (Na)135-145 mEq/LPotassium (K)3.5-5.0 mEq/LSources of potassiumavocado, raw carrot, baked potato, raw tomato, spinach, beef , cod, pork, veal, dried fruits (raisins, dates), banana, apricot, cantaloupe, orange, milk, apricot nectarSources of sodiumbacon, ham, processed cheese, table saltCalcium (Ca)8.5-10.5 mg/dLSources of calciummilk and milk products, canned salmon, Collard greens, sardinesMagnesium (Mg)1.5-2.5 mEq/LSources of magnesiumcereal grains, nuts, dried fruits, legumes, green leafy vegetables, dairy products, meat and fishPhosphate (PO)2.5-4.5 mg/dLSources of phosphatemeat, fish, poultry, milk products, legumesFluid Volume Deficit (FVD)often called hypovolemiaCauses of FVDAbnormal losses through the skin, GI tract, or kidneys Decreased intake of fluid Bleeding Movement of fluid into a third spaceFluid Volume Excess (FVE)commonly called hypervolemiaCauses of FVE- Excessive intake of sodium chloride - Administering sodium-containing infusions too rapidly - Disease processes such as heart failure, renal failure, cirrhosis of the liver, and Cushing's SyndromeUrine Specific Gravityan indicator of urine concentration (usually 1.010-1.025) - When urine is concentrated, specific gravity is high - In dilute, urine, specific gravity is lowWhat do Hypotonic Solutions do?a hypotonic solution is given to dilute extracellular fluid and shift water back into the cells via osmosis so that both the ecf and icf compartments can achieve equal expansion or osmolality. it needs to be given cautiously because hypotonic fluids have the potential to cause fluid overload and cellular swelling if overdone.What solutions are hypotonic?0.45% sodium cl (normal saline) 1/2 NS 0.225% NaCl (normal saline) 1/4 NS 0.33% NaCl (1/3 NS)What do Hypertonic Solutions do?a hypertonic solution can be used to pull water out of the cells and into the extracellular fluid. it can pretty useful in hypovolemia to increase the vascular volume or hyponatremia if symptoms are serious (i.e confusion,seizures) as a result cerebral edema (fluid shifting into brain cells)What do Isotonic Solutions do?and isotonic of course only explands the ecf has no effect on the icf and is administered in the case when a patient has both fluid and sodium losses it is also effective in hypovolemic shock to expand vascular fluid volumes. keeping in mind that excessive administration of isotonic solutions can also cause fluid overload and hypernatremia.What is hypertonic dehydration?Water loss exceeds electrolyte loss Water moves from the Intracellular space to the plasma and Interstitial space fluid spaces causes dehydration ----Causes----excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early stage renal failure, diabetes insipidusWhat is hypotonic dehydration?Electrolyte loss exceeds water loss. Moves fluid from plasma and Interstitial space causing the cell to swell. ----Causes----Chronic illness, Excessive fluid replacement, Renal Failure, Chronic MalnutritionWhat is Anti Diuretic Hormone?Stimulates re-absorption of water by the kidney tubules to cause concentration of urine and also it stimulates contraction of muscular tissues of the capillaries and arterioles, raising the blood pressure.What does Alcohol do to ADH?Suppresses it and dehydrates you (less water in the blood).How many mL of water is normal to secrete in a day?2500-2600ml/dayWhat Labs to run for Electrolytes?BUN 8-24 Creatinine 0.5-1.4 mg Specific Gravity (Urine)1.010-1.030 Hemoglobin - 13.2-16.2 Hematocrit - 40-52% CHF? look at BNP MI? Look at Troponine, Creatine, ABGsHyponatremia Risk factors?Steroids and it could cause Cushings DiseaseWhere is the a central venous catheter introduced?To the subclavian or internal jugular veins and passed to the superior vena cava just above the right atrium.What is the most abundant electrolyte in the body?CalciumIf the parathyroid gland was removed, what electrolyte would show an imbalance?Calcium and PhosphorusIf a patient was receiving chemo what long term device would be used to administer medications?CVADWhat is the kidneys role in Acid/Base Balance?The kidneys are responsible for this balance, if the client is in renal failure and the kidneys can not regulate the H+ and bicarb ions, the patient becomes (Metabolic Acidosis)Which venous cath is mostly used at home?PICC lineIf a ph is 7.20, what is a physiologic process that can restore the pH to normal?Increase respiration (Hyperventilation) This will increase CO2 and that will increase pH.Hyperventilationrespiratory alkalosisHypoventilationrespiratory acidosisWhat is the thirst center in the hypothalamus stimulated by?intracellular dehydration and decreased blood volumeIs 0.45% NaCl Hypotonic or Hypertonic?HypotonicIs 5% dextrose in .45% NaCl Hyper or Hypotonic?HypertonicIncreased K retention = what?Increase in Sodium excretionWhat is Chvosteks and Trousseaus sign indicative of?Hypocalcemia/hypomagnesemiaChvosteksThis sign causes spasms of the facial nerve indicating calcium deficitTrousseaussign of low calcium -when taking BP, hand points down with fingers togetherLab ValuesCalcium - 8.6-10.2 mg/dL Magnesium - 1.3-2.3 Phosphate - 2.5-4.5 Chloride - 97-107 Urine Specific Gravity - 1.010-1.030How many Mg a day of Sodium?500mg/dayWhat does Magnesium bind to?AlbuminAverage intake and loss per day?2000mlFluid Volume Deficitincrease in: urine specific gravity hematocrit BUN Serum SodiumFluid Volume Excessdecrease in: urine specific gravity hematocrit BUN Serum SodiumIsotonic SolutionsD5W .9% NaCl (normal saline) can tx DKA Lactated Ringers used to tx hypovolemia, burns,diarrheaHypotonic.33% NaCl .45% Na Cl can tx hypernatremiaHypertonic5% Dextrose in .45% NaCl (can tx hypovolemia) D10W used for (PPN) 5% Dextrose in NaCl (Normal Saline)What are the 3 buffers?Blood - Fast Respiratory - Medium Kidneys - SlowBlood Bufferrespond to pH changes immediatelyRespiratory BufferActs within one to three minutes by increasing or decreasing the breathing depth and rate to offset acidosis or alkalosis, respectivelyKidney Bufferslowest- minutes to hours can restore system back to normal excreting or retaining H+ and HCO3- has 2 types of cells type A is acidosis and Type B is AlkalosisWhat Respirations are Compensatory for metabolic acidosis?Kuss-Mal - Deep, Rapid Respirations causing Resp Alkalosis (hyperV)What Respirations are Compensatory for metabolic alkalosis?Slow Shallow breathing causing Resp Acidosis (Hypo V)What are some Fluid Balance Problems for the Older Adult?Decreased thirst sensation Loss of Nephrons Decreased Renal FlowFor any adverse RXN to a blood transfusion, the nurse should first do what?D/C the transfusionAllergic Reaction to Blood ?Hives, itching, Anaphylaxis Stop TransfusionFebrile Reaction to Blood Transfusion?Fever, Chills, Malaise Stop transfusion but keep vein open to give normal saline.Hemolytic transfusion reaction- destruction of red blood cells as a result of transfusion of incompatible blood. - Stop infusion - obtain first voided urine Spec - obtain blood samples from site - Send unit, tubing and filter to labCirculatory overload regarding Blood transfusion?- too much blood at once - S/S - cough, crackles, hypertension, JVD, tachycardia - Stop or slow infusion, sit patient up, evaluate lungs, O2 and diuretics as ordered, monitor VS/IOBacterial Reaction to blood tranfusion?Caused by organisms contaminating blood products. Rapid Onset. S/S include: Tachycardia, Hypotension, Fever, Chills, Shock. Give ABX STAT!What to consider for catheter site selection?1. Accessibility of vein 2. Condition of vein 3. Type of fluid to be infused (hypertonic sol need a large vein) 4. Anticipated Duration of InfusionPeripheral Venous CathetersShort time therapy, <3 inch catheter, most common type used. Rotate site every 72-96 hours. Used to administer chemotherapy agents, analgesics, antibiotics, removal of blood specimens, and administration of blood products.Midline Peripheral CathetersLength normal 3-8 inches can stay in 1-7 wks, for therapy that is 2-4 wks. Inserted above/below the antecubital fossa in the proximal basilca/cephalic veins. Distal tip dwells in basilic/cephalic/ or brachial vein at or below the axillary level distal to the shoulder. SHOULD NOT be used for irritating solutions.Central Venous Access Devices1. PICC line (peripherally inserted central cath) 2. Nontunneled percutaneous central venous catheters 3. Tunneled central venous catheters 4. Implanted ports