NRS 210 W6

phosphorus

This electrolyte is heavily effected by diet, PTH, Renal excretion, intestinal absorption. This is inversely related to Ca++

phosphorus

This is the reference range for what electrolyte? 2.5-4.5 mEq/dL

acute kidney injury

This offense to the kidneys is able to be recovered/healed from

ECF

Where is chloride located (cellular level)?

Na+

What electrolyte does Chloride follow?

Cl

95-105 is the reference range for what electrolyte?

Direct

Fluid volume deficit/excess (and risk), electrolyte imbalance are examples of ____ nursing priorities related to electrolytes.

Secondary

Most patients are concerned with the ____ priorities of electrolyte imbalance. These include activity intolerance, impaired oral mucosa, decreased CO, altered cardiac rhythm, changes in perfusion + oxygenation, confusion, and risk for falls

dietary changes, oral fluid intake

What are the primary nursing prevention actions for electrolyte imbalance

hyponatremia

diuretics, GI fluid loss, adrenal insufficiency, excessive intake of hypotonic solutions, SIADH are all risk factors for what electrolyte imbalance?

hypermagnesemia, hypophosphatemia, hyperphosphatemia

Monitor Is+Os is a key nursing role in electrolyte imbalances, except for these 3

both

What Na+ imbalance/imbalances require monitoring serum sodium?

saline

For hyponatremia, one of the nursing interventions is to administer IV ____ infusions. If hyponatremia is severe, seizure precautions should be taken

Hypernatremia

In which sodium imbalance do we need to measure vital signs, level of consciousness, increase water intake, and administer IV solutions without sodium

hyponatremia

The following are symptoms of what sodium imbalance?

Anorexia, nausea, and vomiting

Weakness

Lethargy

Confusion

Muscle cramps or twitching

Seizures

hypernatremia

The following are symptoms of what sodium imbalance?

Thirst

Elevated temperature

Dry mouth and sticky mucous membranes

If severe:

Hallucinations

Irritability

Lethargy

Seizures

hypernatremia

The following are symptoms of what sodium imbalance?

Excessive sodium intake

Water deprivation

Increased water loss is greater than sodium loss (e.g., profuse sweating, heat stroke, diabetes insipidus)

Administration of hypertonic tube feeding

hypokalemia

The following are causes of what K+ imbalance?

Diuretics

GI fluid loss through vomiting, gastric suction, or diarrhea

Steroid administration

Hyperaldosteronism

Anorexia or bulimia

hypokalemia

The following are symptoms of what K+ imbalance?

Fatigue

Anorexia, nausea, and vomiting

Muscle weakness

Decreased GI motility

Dysrhythmias

Paresthesia

Flat T wave on ECG

Increased sensitivity to digitalis

diet, serum potassium

What are the priority ways to monitor K+ intake in both kinds of K+ imbalances?

digoxin

What medication should we be monitoring for signs of toxicity in hypokalemia?

hyperkalemia

The following are risk factors for which electrolyte imbalance?

Renal failure

Potassium-sparing diuretics

Hypoaldosteronism

High potassium intake coupled with renal insufficiency

Acidosis

Major trauma

Hemolyzed serum sample produces pseudohyperkalemia

hyperkalemia

The following are symptoms of which electrolyte imbalance?

Muscle weakness

Dysrhythmias

Flaccid paralysis

Intestinal colic

Tall T waves on ECG

hypocalcemia

The following are risk factors for what electrolyte imbalance?

Muscle weakness

Dysrhythmias

Flaccid paralysis

Intestinal colic

Tall T waves on ECG

hypocalcemia

The following are symptoms of what electrolyte imbalance?

Diarrhea

Numbness and tingling of extremities

Muscle cramps

Tetany

Convulsions

Laryngeal spasms

Cardiac irritability

*Positive Trousseau’s and Chvostek’s signs

hypocalcemia

What calcium imbalance requires monitoring of serum calcium?

hypotonic

Which type of fluid causes cell swelling

Sodium/Chloride

Which electrolytes are the following a good dietary source of:

Breads/baked goods, cereals, condiments, cured/smoked meats, canned foods, table salt

Phosphorus

Which electrolytes are the following a good dietary source of:

Animal meats, seafood, dairy, seeds & nuts, grains, legumes, cola

Potassium

Which electrolytes are the following a good dietary source of:

Bananas, citrus foods, Green leafy veggies, potatoes, legumes, dairy, fish

Magnesium:

Nuts & seeds, legumes, whole grains, dark chocolate, avocado, peanut butter, Dried fruit, green leafy veggies

Which electrolytes are the following a good dietary source of:

Calcium

Which electrolytes are the following a good dietary source of:

Dairy, leafy greens, soy (tofu, edamame), canned fish with bones, fortified foods

K+

What electrolyte has a very narrow reference range, requiring close monitoring

Hypernatremia

The following are medical management strategies for what electrolyte imbalance?

Nursing:

Encourage oral hydration | Monitor neuro status/LOC | I&O | Limit salt intake | Increase H2O

Collaborative:
Hypotonic (0.45%")"or isotonic (0.9% or D5W) | Seizure precautions | Avoid in patients at risk for Increased ICP – can cause cerebral edema

Hyponatremia

The following are medical management strategies for what electrolyte imbalance?

Nursing:
Monitor I&O | Monitor sodium level | Increase oral sodium intake | IV saline /Fluid restriction

Collaborative:
Sodium supplements | Isotonic IV fluids (0.9 NS) | Severe cases: hypertonic saline (3%) via central line. | Implement seizure precautions

Hyperkalemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:

I&O | Monitor K+ level | Educate avoid K-rich foods & salt substitutes

Collaborative: (4-prong approach)

IV Calcium Gluconate | Insulin + D50W | Kayexalate/ Loop diuretic/ dialysis | Cont. cardiac monitoring

Hypokalemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:

I&O | Monitor K+ level | Educate adding K to diet | Educate on K supplementation | Ensure IV K+ is diluted & NEVER PUSHED

Collaborative:
Oral K+ supplement | IV Potassium | Cont. cardiac monitoring

Hyperphosphatemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:
Monitor serum Phos- level | Provide lotions and emollients| Educate limit phosphorus foods | Limb alert for grafts/fistulas

Collaborative:

Phosphate binder with meals (calcium) | Dialysis if severe

Hypophosphatemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:

Educate Phos- foods | Monitor respiratory status | Monitor Phos- & Ca+ during replacement | If refeeding syndrome: slowly initiate feeding

Collaborative:
TPN

Hypercalcemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:

I&O | Encourage fluids & fiber | Educate remove Ca+ rich foods, Ca+ based antacids

Collaborative:

Dialysis | Calcitonin | IV NS | Loop diuretic after rehydration

Hypocalcemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:
I&O | Monitor serum Ca+ | Educate Ca+ food in diet | Severe: seizure precautions & Monitor airway

Collaborative:
Calcium supplement + Vita D| Severe: IV Calcium gluconate | Cardiac monitoring

Hypermagnesemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:

Vital signs | DTRs | Educate restriction of Mg+ in diet

Collaborative:

Avoid Mg+ antiacids | IV Calcium | Loop diuretic with 0.9%NS for hydration

Hypomagnesemia

The following are medical management strategies for what electrolyte imbalance?

Nursing:

I&O | Encourage Mg+ Foods | Educate to avoid EtOH | DTRs during replacement

Collaborative:

Oral Mg+ (mag ox) | IV Mag Sulfate | cardiac monitoring

Hypertonic

The following are examples of _____ fluids

3% NS,D5 0.45% NS, D5 0.9% NS, D5 LR, D50W

ECV, cells

Hypertonic solutions that contain sodium encourage fluid movement into the ____. Those that do not cause fluid movement into the ____

shrinking

Hypertonic sodium containing solutions are responsible for cell _____

isotonic

D5W, 0.9%NS, LR

ECV, cells

Isotonic solutions that contain sodium encourage fluid movement into the ____. Those that do not cause fluid movement into the ____.

hypotonic

The following are examples of ____ solutions:

0.33% NS,0.45% NS

cells

Hypotonic solutions cause water movement into the ____

expansion

hypotonic solutions cause cell ____

expansion

Non-sodium containing isotonic and hypertonic solutions eventually cause cell ____.

Fluid restriction

This order requires lots of patient teaching. Very strict Is and Os. Often includes IV medications

volume

IV fluids replace _____. Blood replaces *** and restores O2 carrying capacity and clotting factors/blood components

Type and Cross

This blood order involves evaluating blood types, Rh type, and screening for infection

AB

This blood type is a universal receiver

O

This blood type is a universal donor

30 mins

Within ___ ___ of initiating blood transfusion, vitals should be taken

20G

What gauge IV should you use for blood transfusions?

NS

What is the only thing blood products can be hung with?

15 minutes

When your patient is receiving a blood transfusion, how long should you remain with them?

Remeasure vitals

Before leaving a patient after blood transfusion, you should _____ _____

4 hours

A blood transfusion must be completed within what time frame?

Vital signs

What is the first place we will see an indication of transfusion reactions?

transfusion reaction

The following are symptoms of _____ ____:

• fever

• chills

• changes in BP

• warm flushed skin

• itching

• hives

  • flank pain

stop the transfusion

What is the priority nursing action in a potential blood transfusion reaction