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Lab Values Review

Terms in this set (64)

Sodium (Na+) normal range
135-145 mEq/L
Sodium info
Most abundant extracellular cation, regulates water in cells of the body, water follows sodium. Sodium is important in: brain, nerves, muscle cells.
Euvolemic hyponatremia causes
Water in the body increases but sodium level stays the same
Causes: SIADH, adrenal insufficiency, Addison's disease, polydipsia, excessive hypertonic IVF, low dietary intake of sodium
Hypovolemic hyponatremia causes
Water and sodium are both lost
Causes: Vomiting, diarrhea, NG suction, diuretics, burns, excessive sweating
Hypervolemic hyponatremia causes
Water in the body increases, diluting the amount of sodium in the serum causing a 'dilutional' or 'relative' hyponatremia
Causes: CHF, kidney failure, psychogenic polydipsia, excessive IV administration of hypotonic fluids, nephrotic syndrome, liver failure, water intoxication, freshwater submersion
Hyponatremia Assessment
Neuro: *SEIZURES*, confusion, lethargy, stupor, cerebral edema, increased ICP
Musculoskeletal: abdominal cramps, weakness, shallow respirations, decreased deep tendon reflexes, muscle spasms, orthostatic hypotension
GI/GU: decreased urine output, loss of appetite, hyperactive bowel sounds

Hypovolemic hyponatremia specific cardiac: weak pulse, tachycardia, hypotension, dizziness

Hypervolemic hyponatremia specific cardiac: bounding pulses, hypertension
Euvolemic hyponatremia treatment
Restrict free water, sodium tablets, encourage high salt foods, demeclocycline, tolvaptan
Hypovolemic hyponatremia treatment
Must restore volume AND sodium, for mild give 0.9% normal saline, for severe give 3% normal saline
Hypervolemic hyponatremia treatment
Restrict free water intake, osmotic diuretics, ENCOURAGE HIGH SALT FOODS
High salt/sodium foods
-bacon
-butter
-canned food
-cheese
-hot dogs
-lunch meat
-processed foods
-table salt
High calcium foods
-almonds
-broccoli
-cheese
-collard greens
-edamame
-figs
-kale
-milk
-okra
-oranges
-sardines
-tofu
-white beans
High potassium foods
-avocado
-banana
-beans
-carrots
-citrus juices
-fish
-mushrooms
-oranges
-pork
-potatoes
-raisins
-spinach
-strawberries
-tomatoes
Hyponatremia nursing interventions
Encourage increased oral sodium intake with sodium/salt rich foods, sometimes sodium tablets prescribed, *replace slowly 0.5 mEq/hr if by IV, changing sodium level too fast causes a fluid shift = cerebral edema, central pontine myelinolysis (CPM) = MONITOR FOR NUMBNESS/WEAKNESS IN FEET!*
monitor lithium levels if on lithium, monitor neuro status
Central pontine myelinolysis (CPM)
Very rare neuro condition most frequently caused by the rapid correction of hyponatremia. Clinical manifestations vary and can range from encephalopathy to coma and death.
Euvolemic hypernatremia causes
Increased insensible water loss (hyperventilation), central diabetes insipidus, nephrogenic diabetes insipidus
Hypovolemic hypernatremia causes
Water deficit > sodium deficit
Loss of fluids leads to a relative increase in the amount of sodium in the blood
Dehydration, NPO, diarrhea, vomiting, fistulas, osmotic diuretics, post-obstructive diuresis
Hypervolemic hypernatremia causes
Sodium gains > water gains
Hyptertonic IVF (0.5%, 3%, 5%), sodium bicarbonate administration (used for hyper K), increased sodium intake, insufficient free water with enteral tube feeds, corticosteroids, Cushing's, hyperaldosteronism, Conn's syndrome
Hypernatremia Assessment
Neuro: Restless, agitated, lethargic, drowsy, stupor, coma
Musculoskeletal: twitching, cramps, weakness
Other: fever, flushed skin, decreased urine output, dry mouth

Hypovolemic hypernatremia specific cardiac: decreased blood pressure, weak pulses

Hypervolemic hypernatremia specific cardiac: Increased blood pressure, bounding pulses, edema
Euvolemic hypernatremia treatment
Free water administration-based on free water deficit, PO intake is better than IV because the patients is euvolemic.
Hypovolemic hypernatremia treatment
Isotonic fluid, normal saline is "relatively hypotonic" to the body in hypernatremia
Hypervolemic hypernatremia treatment
Find causative agent and discontinue, 3% normal saline administration, aldosterone excess, loop diuretics, free water administration
MONITOR NEURO STATUS
Correct imbalance SLOWLY - risk for cerebral edema
Potassium, K
Normal serum range: 3.5-5
Found mostly in the cells, most abundant intracellular cation. The serum range pertains to potassium in the blood/outside of the cells. Responsible for nerve impulse conduction. Important in muscle contraction - heart muscle and skeletal muscle. Important in acid/base balance = acidic, generally means increased K.
Hyperkalemia causes
-too much potassium moved from intracellular to extracellular (burns, tissue damage)
-adrenal insufficiency
-renal failure
-dehydration
-excessive potassium intake
-acidosis
-diabetic ketoacidosis
-ACE inhibitors
-NSAIDs
-potassium-spairing diuretics
Hyperkalemia assessment
-muscle weakness
-muscle twitches
-hyperactive bowel sounds
-numbness
-cramping
-shallow respirations -> respiratory failure
-decreased urine output
-diarrhea
-impaired contractility
-weak pulses
-bradycardia
-hypotension
-EKG changes = can lead to heart block, asystole, or V-fib
-*TALL, PEAKED T wave*
-wide, flat P wave
-prolonged PR interval
-widened QRS interval
-depressed ST segment
Hyperkalemia Treatment
Interventions depend on severity and symptoms present.
*MONITOR CARDIAC RHYTHM*
-also watch respiratory, renal, and GI complications
-IV calcium gluconate or chloride (given if EKG changes are present to protect the mycardium)
-dialysis (used with severe hyper K and not responding to other interventions)
-discontinue any potassium supplements (PO or IV)
-potassium restricted diet
-drive potassium into cells with D5W and regular insulin, albuterol, or bicarbonate
-reduce total body potassium with kayexalate or diuretics (hydrochlorothiazide or lasix)
Hypokalemia causes
-loop diuretics
-laxatives
-glucocorticoids
-potassium deficient diet
-polydipsia
-Cushing's syndrome
-NG suction
-vomiting
-diarrhea
-wound drainage
-sweating
-alkalosis
-hyperinsulinism
Hypokalemia assessment
-decreased deep tendon reflexes
-weakness
-flaccidity
-shallow respirations
-vomiting
-confusion->lethargy
-decreased LOC
-orthostatic hypotension
-decreased bowel sounds
-weak, thready pulse
-polyuria
-constipation
-nausea
-CARDIAC DYSRHYTHMIAS
Hypokalemia EKG changes
-slightly prolonged PR interval
-slightly peaked P wave
-ST depression
-flat, shallow, inverted T waves
-prominent U waves
Hypokalemia treatment
*PLACE ON CARDIAC TELEMETRY*
*HOLD DIGOXIN*
-monitor respiratory and renal status
-monitor other electrolytes (magnesium, sodium, calcium, glucose)
-hold lasix or other potassium wasting drugs
-diet rich in potassium
-oral potassium supplements (give with food to avoid GI upset)
-IV potassium supplements *NEVER GIVE IV PUSH, IT WILL STOP THE PATIENT'S HEART! GIVE SLOW PER DIRECTIONS, MONITOR IV SITE, IT CAN CAUSE PHLEBITIS, IF EXTRAVASION OCCURS, IT WILL CAUSE TISSUE DAMAGE!!*
Calcium, Ca basics
-high level of calcium in the blood
-stored in bones, absorbed in GI system, exceeded by kidneys
-plays an important role in bones, teeth, nerves, and muscles
-important for coagulation
-controlled by parathyroid hormone (PTH) and vitamin D
*HAS AN INVERSE RELATIONSHIP WITH PHOSPHORUS*
Normal values are 8.4-10.2
Hypercalcemia Causes
(usually accompanied with dehydration)
-hyperparathyroidism
-cancer of the bones
-thiazide diuretics
-renal failure
-vitamin D toxicity
-excessive intake of calcium
-excessive intake of vitamin D
-glucocorticoids
-immobility
Hypercalcemia assessment
Neuro: weakness, flaccidity, decreased deep tendon reflexes, fatigue, decreased LOC
Cardio: bradycardia, cyanosis, deep vein thrombosis, *EKG CHANGES*
Gastrointestinal: decreased peristalsis, hypoactive bowel sounds, abdominal pain, nausea, vomiting, constipation, kidney stones
Hypercalcemia EKG changes
-prolonged PR interval
-shortened QT interval
Hypercalcemia treatment
-encourage PO hydration
-IV fluids, normal saline preferred
-reduce dietary intake of calcium
-loop diuretics
-calcium binders
-corticosteroids, useful when cause is vitamin D toxicity
-calcium reabsorption inhibitors: phosphorus, calcitonin, biphosphates (especially useful if the cause is malignancy), NSAIDs
-dialysis
Hypocalcemia causes
-renal failure
-acute pancreatitis
-malnutrition
-malabsorption (Celiac disease or Crohn's disease)
-alcoholism
-bulimia
-vitamin D deficiency
-hypoparathyroidism
-hyperphosphatemia
Hypocalcemia assessment
Neuro: irritability, paresthesias, tetany, muscle spasms, SEIZURES, CHVOSTEK'S SIGN, TROUSSEAU'S SIGN
Cardio: decreased contractility, bradycardia, hypotension, weak pulse, *EKG CHANGES*
Gastrointestinal: hyperactive bowel sounds, cramping, diarrhea
Hypocalcemia EKG changes
-prolonged QT interval
-prolonged ST segment
Hypocalcemia treatment
-PO calcium supplements (administer with vitamin D as it increases absorption)
-IV calcium supplements
-muscle relaxants
-decreased stimuli
-calcium rich diet
Magnesium, Mg basics
Stored in the bones and cartilage. Plays a major role in skeletal muscle contraction. Important for ATP formation. Activates vitamins, necessary for cellular growth, IS INDIRECTLY RELATED TO CALCIUM
Normal range = 1.6-2.6 mg/dL
Hypermagnesemia causes
-excessive dietary intake
-too many magnesium containing medications
-over-correction of hypomagnesemia
-renal failure
Hypermagnesemia assessment
Neuro: weakness, shallow breathing, slowed reflexes, decreased deep tendon reflexes, drowsy, lethargy, coma
Cardio: bradycardia, hypotension, vasodilation, *CARDIAC ARREST, TORSADE DE POINTES*
Hypermagnesemia EKG changes
**FLAT P WAVE**
**WIDENED QRS COMPLEX**
-prolonged PR interval
-tall T wave
Hypermagnesemia treatment
-treat the cause
-hold any fluids or meds containing magnesium
-loop diuretics
-calcium gluconate
-dialysis
Hypomagnesemia causes
**ALCOHOLISM**
-malabsorption
-malnutrition
-hypoparathyroidism
-hypocalcemia
-diarrhea
Hypomagnesemia assessment
Neuro: psychosis, confusion, numbness, tingling, tetany, seizures, **INCREASED DEEP TENDON REFLEXES**
Gastro: **DECREASED MOTILITY**, constipation, anorexia
Cardiac: EKG changes
Hypomagnesemia EKG changes
-prolonged QT interval
-flattened T wave
Hypomagnesemia treatment
-treat the cause (stop diuretics, ahminoglycosides, phosphorus)
-monitor cardiac rhythm
-administer magnesium (PO by magnesium hydroxide or IV given very slowly preferably via central line)
Phosphorus, P basics
Major role in ATP - cellular metabolism and energy production. Makes up the phospholipid bilayer of cell membranes. Large component of bones and teeth.
**HAS AN INVERSE RELATIONSHIP WITH CALCIUM**
Normal values = 3.0-4.5 mg/dL
Hyperphosphatemia causes
-renal failure
-tumor lysis syndrome
-excessive dietary intake of phosphorus
-hypoparathyroidism -> hypocalcemia/hyperphosphatemia
Hyperphosphatemia assessment
NOT COMMON! Doesn't produce many symptoms. Symptoms are related to hypocalcemia secondary to hyperphosphatemia.
Neuro: numbness, tingling, tetany, muscle spasms, seizures, Chvostek's sign, Trousseau's sign
Cardio: decreased contractility, bradycardia, hypotension, weak pulse
Gastro: HYPERactive bowel sounds, cramping, diarrhea
Hyperphosphatemia treatment
-phosphate binders, given with food
-manage hypocalcemia
Phosphorus rich foods
*CASHEWS*
-almonds
-Brazil nuts
-dried beans
-mushrooms
-pumpkin seeds
Hypophosphatemia causes
-malnutrition
-starvation
-alcoholism
-long-term total parenteral nutrition (TPN) - hyperparathyroidism -> hypercalcemia
-refeeding syndrome
-renal failure
Hypophosphatemia assessment
Musculoskeletal: weakness, rhabdomyolysis, decreased bone density, fractures
Cardio: decreased stroke volume, decreased cardiac output, weak pulses, hypotension
Neuro: irritability, seizures, coma
Hypophosphatemia treatment
-treat the cause
-stop drugs that decrease phosphorus (antacids, calcium, osmotic diuretics)
-phosphorus replacement (PO or IV - given slowly!)
-phosphorus rich diet
-diet low in calcium (no dairy, decreased greens)
Chvostek's sign
Associated with hypocalcemia, or low levels of calcium in the blood.
Clinical sign refers to a twitch of the facial muscles that occurs when gently tapping an individual's cheek in front of the ear.
Trousseau's sign
Associated with hypocalcemia.
Considered positive when a carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes.
Chloride, Cl basics
Most abundant extracellular anion. Works with sodium to maintain fluid balance. Binds with hydrogen ions to form stomach acid (HCl).
INVERSELY RELATED TO BICARBONATE (base the kidneys make)
DIRECTLY RELATED TO SODIUM AND POTASSIUM
Normal values = 96-108 mEq/L
Hypercholoremia causes
-dehydration
-metabolic acidosis
-acute renal failure
-Cushing's disease
Hypercholoremia assessment
Produces very few symptoms
Neuro: restless, agitated, lethargic, drowsy, stupor, coma
Musculoskeletal: twitching, cramps, weakness
Other: fever, flushed skin, decreased urine output, dry mouth
Hypercholoremia treatment
-treat the underlying cause
-correct the imbalance (bicarbonate administration, discontinue any sodium containing meds, no normal saline for IVF's - consider LR)
-monitor all electrolytes - IT ISN'T USUALLY THE ONLY ONE OUT OF BALANCE!
Hypocholoremia causes
-volume overload
-CHF
-water intoxication
-metabolic alkalosis
-cystic fibrosis
-Addison's disease
-salt losses: burns, sweating, vomiting, diarrhea
Hypocholoremia assessment
Produces few symptoms. (These are S&S of hyponatremia)
Neuro: SEIZURES, confusion, lethargy, stupor, cerebral edema, increased ICP
Musculoskeletal: abdominal cramps, weakness, shallow respirations, decreased deep tendon reflexes, muscle spasms, orthostatic hypotension
GI/GU: decreased urine output, loss of appetite, hyperactive bowel sounds
Hypocholoremia treatment
-treat the underlying cause
-correct the imbalance (normal saline 0.9%)
-monitor all electrolytes as it is usually not the only out of balance
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