Boris Review

What does sodium (Na+) do in the body?

Retains water, causing swelling, and is linked to seizure risks for both hypo and hyper states.

What precautions should be taken for sodium imbalance?

Seizure precautions including fall risk measures, guard rails, aspiration precautions, and suction readiness.

How to remember sodium's characteristics?

Think 'SALTY'—associated with the face one makes during seizures.

What should be assessed for sodium imbalance?

Frequent neuro checks.

How would you replace sodium in the body?

Increase sodium slowly—4-6 mEq per 24 hours.

How does salt affect water in the body?

Salt goes where water flows.

What are the big three for sodium?

Seizure precaution, frequent neuro checks, and increase sodium SLOWLY.

What is the role of magnesium in the body?

Relaxes muscles but can lead to decreased respirations and heart rates if too high.

What are the normal magnesium levels?

1.5 to 2.5—think of magnifying glass to remember.

What mnemonic helps remember magnesium's effects?

Mag mellows: MUSCLE.

What to watch for with magnesium imbalance?

Too relaxed muscles.

What is calcium's role in the body?

Contracts muscles and maintains bone health.

What is necessary for proper calcium absorption?

Vitamin D.

What is the calcium range?

Break a bone, call 9-11

What are signs of hypercalcemia?

Constipation, osteoporosis leading to pathologic fractures, and renal calculi.

What are signs of hypocalcemia?

Cramps and muscular spasms.

What neurotransmitters are connected to electrolytes?

Calcium, magnesium, and sodium.

What signs indicate low or high calcium or magnesium levels?

Positive Trousseau's sign and positive Chvostek's sign.

What does phosphorus do?

Helps with vitamin absorption, especially with teeth and bones.

With which electrolyte does phosphorus go hand in hand?

Calcium—phosphorus stimulates calcium release from bones.

What does high calcium inhibit?

Phosphorus absorption.

What is the normal range for phosphorus?

2.5 to 4.5—'Perfect teeth phor (4) us (2)'.

What is chloride's function in the body?

Helps with fluid shift, especially within cells.

What is the normal chloride range?

97 to 107.

What is potassium's main role?

Pumps the heart.

What should you never do with potassium?

Never do an IV PUSH.

How is hyperkalemia treated?

By administering IV insulin and 50% dextrose.

What does insulin do to potassium?

Pushes potassium back into cells, which requires retaking the blood sugar due to drop.

What is serum osmolality?

The number of particles within a certain solution, usually sodium, urea, proteins, and glucose.

What does dehydrated urine look like?

More concentrated.

What does overhydrated urine look like?

Diluted.

What is third spacing?

Loss of extracellular fluid, similar to edema.

What is albumin's role in the body?

Helps prevent extracellular fluid from leaking.

When might you see third spacing?

When albumin levels are low.

What is a common temperature sign in dehydrated persons?

Higher body temperature.

What is the main component of body fluid?

Water.

What does interstitial fluid refer to?

Fluid in tissue interspaces.

What is intravascular fluid?

Fluid found in the blood vessels (IV).

What is transcellular fluid?

Cerebrospinal fluid, sparse in GI tract, also in chest tubes/drains.

What is intracellular fluid?

Fluid within the cells.

What regulates body fluids?

The renin-angiotensin system.

What is the renin-angiotensin system?

The kidney releases renin, converting angiotensinogen which leads to vasoconstriction and reabsorption of water and sodium.

Where is antidiuretic hormone released from?

The pituitary gland.

What do antidiuretics do?

Help control water excretion into the urine.

What does aldosterone do?

Responds to reduced circulating blood volume by stimulating reabsorption of water and sodium.

What is SIADH?

Syndrome of inappropriate anti-diuretic hormone secretion.

What is heart failure?

The inability to pump/supply enough blood.

What characterizes systolic heart failure?

Ventricles cannot pump enough blood, commonly left-sided HF affecting the lungs, expect crackles.

What characterizes diastolic heart failure?

Insufficient blood filling the ventricles, stiff heart affects the body resulting in edema and jugular vein distention.

What is CHF?

Chronic heart failure, occurring when both sides of the heart fail.

What is a common cause of right-sided heart failure while left side is normal?

Pulmonary issues, known as Cor pulmonale.

What are the names for fluid excess?

Fluid volume excess, fluid overload, overhydration, hypervolemia, fluid retention.

What are the names for fluid volume deficit?

Dehydration, hypovolemia.

What causes fluid excess?

Excessive fluid intake, excretion issues, kidney dysfunction, cirrhosis.

What is the treatment for fluid excess?

Restrict fluid/sodium, daily weights, diuretics, and oxygen therapy.

What are signs of fluid excess?

Edema, crackles, high BP, high HR, bounding pulse, high RR, diluted labs, increased risk for skin breakdown due to edema/third spacing.

What can be delegated for fluid excess?

Daily weights, strict I&O, fluid restriction.

What is a risk if a patient has problems with fluid excretion?

Increased risk for toxins to stay in the body.

What does unequal chest expansion indicate?

One side of the lung is not functioning properly.

What does fluid volume deficit indicate?

Fluid output exceeds fluid intake, also called hypovolemic.

What are common causes of dehydration?

GI loss from vomiting/diarrhea, polyuria from diabetes, and hemorrhage.

What are signs of fluid volume deficit?

Dry skin, poor turgor, low BP, high HR, high RR, concentrated and low urine volume unless diabetic (polyuria), flattened jugular veins, weak and thready pulse, high BUN.

What does a high BUN indicate?

Dehydration.

What is the treatment for hypovolemia?

IV fluids, albumin, or transfusion.

What types of diuretics exist?

Potassium-wasting diuretics and potassium-sparing diuretics.

What are potassium-wasting diuretics?

Lasix (furosemide); taken in the morning due to increased urination, and used in kidney failure patients.

What precautions are taken with Lasix?

Push Lasix slowly to avoid kidney failure, and monitor BUN and creatinine (Cr).

What is the first-line potassium-wasting diuretic?

Thiazide, unless heart failure is present.

What is Mannitol used for?

To decrease intraocular and intracranial pressure; can crystalize if cold.

What are carbonic anhydrase inhibitors used for?

Diamox is used in glaucoma and epilepsy patients.

What is a potassium-sparing drug?

Aldactone (spironolactone), which elevates potassium levels.

What could result from excessive diuretics?

Dehydration, electrolyte deficits, and orthostatic hypotension.

What diuretic is common in heart failure?

Lasix.

What must a patient on a potassium-wasting diuretic consume?

Foods high in potassium or potassium supplements; opposite for potassium-sparing diuretics.

What tests should be ordered for a patient complaining of chest pain?

Cardiac enzymes like troponins, CK, EKG, chest x-ray, and heart catheterization.

What do troponin levels indicate?

Trending lab values that may indicate heart tissue damage; can be elevated in cocaine users.

What is a heart catheterization used for?

To examine blood flow in cardiac arteries, check for blockages, and perform interventions like stenting.