NURS 344: Fundamentals Electrolytes

Calcium (Ca+) expected range

9 - 10.5 mg/dl

Causes of hypocalcemia

Hypoparathyroidism
Acute pancreatitis
Vitamin D deficiency

Symptoms of hypocalcemia

Positive Chvostek's and Trousseau's signs
Muscle Spams
Paresthesia

Causes of hypercalcemia

Hyperparathyroidism
Cancer
Prolonged immobility
Long-term corticosteroid use

Symptoms of hypercalcemia

Kidney stones
GI upset
Constipation
Bone pain
Muscle Weakness
Confusion

Chloride (Cl-) expected range

98 - 106 mEq/L

Causes of hypochloremia

Metabolic alkalosis
GI losses (vomiting, EG suctioning, etc.)
Diuretics
Heart failure

Symptoms of hypochloremia

Weakness
Fatigue
Dyspnea
Confusion

Causes of hyperchloremia

Metabolic acidosis
Dehydration
Excess salt intake

Symptoms of hyperchloremia

Weakness
Fatigue
Thirst
Muscle cramps

Magnesium (MG++) expected range

1.3 - 2.1 mEq/L

Causes of hypomagnesemia

GI loses (diarrhea)
Diuretics
Malnutrition
Alcohol abuse

Symptoms of hypomagnesemia

Dysrhythmias (Torsade's de pointes)
Tachycardia
Hypertensions
Tremors
Seizures
HIGH DTRs

Causes of hypermasnesemia

Kidney disease
Laxatives containing Mg

Symptoms of hypermagesemia

Hypotension
Lethargy
Muscle weakness
LOW DTRs
Respiratory depression
Dysrhythmias
Cardiac Arrest

Phosphorus (P+) expected range

3.0 - 4.5 mg/dL

Causes of hypophosphatemia

Alcoholism
Excessive antacids
Malnutrition

Symptoms of hypophosphatemia

Kidney stones
GI upset
Constipation
Bone pain
Muscle Weakness
Confusion

Causes of hyperphosphatemia

Kidney disease

Symptoms of hyperphosphatemia

Positive Chvostek's and Trousseau's signs
Muscle Spams
Paresthesia

Potassium (K+) expected range

3.5 - 5.1 mEq/L

Causes of hypokalemia

Diuretics (furosemide)
GI loses
Cushing's syndrome
Metabolic alkalosis

Symptoms of hypokalemia

Dysrhythmias
Muscle weakness
Constipation/ileus
Hypotension
Weak pulses

Causes of hyperkalemia

Diabetic Ketoacidosis (DKA)
Metabolic acidosis
Salt substitutes
Kidney failure

Symptoms of hyperkalemia

Dysrhythmias
Muscle twitching/weakness
Paresthesia
Diarrhea

Sodium (Na+) expected range

135 - 145 mEq/L

Causes of hyponatrimia

Diuretics
Kidney failure
Diaphoresis
SIADH
Hyperglycemia
Heart failure
Fluid volume overload

Symptoms of hyponatrimia

Confusion (common in elderly!)
Fatigue
Nausea/vomiting
Headache
Seizures

Causes of hypernatrimia

Kidney failure
Cushing's syndrome
Diabetes Insipidus
Fever
NPO

Symptoms of hypernatrimia

Thirst
Lethargy
Confusion
GI upset
Muscle twitching
Seizures
Irritability/agitation

Which IV solution is similar to plasma concentration & its purpose is to treat FVD?

0.9% NS (Isotonic)

Symptoms of this electrolyte problem include increased temperature, increased thirst, irritability and agitation, weakness, headache, lethargy, seizures, tachycardia, weak/thready pulse, and edema.

What is a Hypernatremia

1) What is a common severe adverse reaction to albumin?
2) Third spacing is indicated by what assessment findings?

1) Pulmonary edema
2) Peripheral Edema

To test for this electrolyte imbalance, the healthcare provider taps on the patient's facial nerve. A positive response will be a spasm or twitching showing increased neuromuscular irritability

What is Chvostek's sign associated with Hypocalcemia?

Diuretic therapy are a cause of what two electrolyte abnormalities?

What are sodium and potassium?

0.25% dextrose
0.45% dextrose
0.33% dextrose

Hypotonic solutions

A deadly complication of hyponatremia is ____?

cerebral edema

-Provide additional calories
-Treats severe hyponatremia

Hypertonic solutions

Contains potassium, don't use with renal failure patients
Don't use with liver disease, cant metabolize lactate.
Don't give to patients with metabolic alkalosis Will increase bicarbonate levels

Lactated Ringer's (LR)

In Dehydration and DI which electrolyte imbalance is most likely?

Hypernatremia

What assessments as a nurse will you take before giving a isotonic solution?

vital signs, edema status, lung sounds, and heart sounds

This electrolyte is found in large amounts in cantaloupes, raisins, bananas, oranges, green leafy vegetables, and lentils

Potassium

Expands volume for hypotensive patient
Replace abnormal losses through N/V

Isotonic solution

Thirst, altered LOC, hypotension, tachycardia, weak/thready pulse, flat jugular veins, dry mucous membranes, oliguria, weight loss, sunken fontanelles (infant)

Fluid Volume Deficit (FVD)

IV solutions given to correct Hypoalbuminemia
Malnutrition
Circulatory collapse due to third-shift spacing
Quicker response and remains in vascular space longer than crystalloids (NS/LR).
Requires less amount of fluid compared to crystalloids

Albumin (Colloid IV solution)

D10W + 0.9 NS
3% NACI
TPN ( amino acids and 15-50% dextrose)
D5W + .45 NS

Hypertonic solutions

1. Plasma expander
2. May worsen existing hypovolemia and hypotension causing cardiovascular collapse.
-Monitor for signs of fluid volume deficit, such as confusion in older adults and dizziness.
-Never administer to patients at risk for increased ICP as the potential fluid shift may cause cerebral edema.
-Avoid in patients with liver disease, trauma or burns

1. Albumin
2. General nursing considerations for hypotonic solution

These solutions can pass through the semipermeable membrane, contain electrolytes and water

Crystalloids

1. Can lead to overload
-Use with caution in patients with heart failure of edema
2. Provides colloidal oncotic pressure, which serves to mobilize fluid from extravascular tissues back into intravascular space

1) What is Isotonic solutions (0.9% sodium chloride (Normal Saline) ( NaCI))
2) albumin

Identify the physiologic reason for fluid deficit in the elderly.

blunted thirst response

3% solution used for treatment of severe, critical symptomatic hyponatremia.
Give slowly and cautiously to avoid intravascular fluid volume overload and pulmonary edema
Pulls fluid out of the intracellular compartment

Hypertonic solution

1. This electrolyte follows glucose into the cells of the body.

2. In severe cases of hyperkalemia, these medication may be given to facilitate the diffusion of potassium back into the cells

1. What is K+

2. What is dextrose and Insulin?

How to treat:
Shock
Hyponatremia
Blood transfusions
Resuscitation
Fluid changes
DKA

0.9% NS

Flattened T-waves, prominent U-waves, and/or ST depression may be caused by which electrolyte disturbance?

What is Hypokalemia

This is the antidote for Magnesium Toxicity

What is Calcium Gluconate or Calcium Chloride

Contraindicated in patients who cannot metabolize lactate, (i.e. liver disease) or experiencing lactic acidosis. Caution in patients with renal failure

What is Lactated ringers?
(LR contains some potassium and hyperkalemia can occur)

Clinical manifestations of this type of electrolyte imbalance reflect a decreased cell membrane excitability.
Possible symptoms can include dysrhythmias, decreased DTRs, Hyporeflexia, abdominal pain, bone pain

Hypercalcemia

This electrolyte has an inverse relationship with calcium and is found in dairy, protein sources (i.e. chicken, beef, fish, and nuts), grains, and carbonated beverages.

Phosphorus

Which electrolyte disturbance is of concern when caring for a client with alcoholism

Magnesium

1. Which class of diuretic can cause hyponatremia

2. Mannitol is an example of which class of diuretic?

1) What are Thiazide or Loop

2) Osmotic diuretic

Monitor for circulatory overload due to ECF expansion.
These solutions pull from ICF, so don't administer in conditions causing cellular dehydration (DKA).
Avoid in patients with impaired cardiac or renal function.
Must be given through Central Access.
√ neuro, VS, UOP, Na+

precautions for Hypertonic solution

This solution is isotonic only in the container; becomes hypotonic in body after dextrose is metabolized

What is D5W

Treating:
Water replacement & rehydration of cells
DKA
HHNK
Gastric fluid loss from NG or vomiting

What is 0.45% sodium chloride (1/2 NS)

This nursing intervention is used to treat hyponatremia

free water restriction

Kayexalate enemas are used to treat this electrolyte imbalance

What is Hyperkalemia