MED SURG EXAM 3

HCO_^3- normal serum electrolyte values (bicarbonate), cation or anion?

22-26, anion

Chloride normal serum electrolyte values, cation or anion?

98-106, anion

Magnesium normal serum electrolyte values, cation or anion?

1.3-2.1, cation

Potassium normal serum electrolyte values, cation or anion?

3.5-5.0, cation

sodium normal serum electrolyte values, cation or anion?

136-145, cation

BUN normal serum electrolyte values

10-20

Normal ABG values: pH

7.35-7.45

Normal ABG values: PaCO₂

35-45

Normal ABG values: HCO_3-

22-26

Calcium Normal serum electrolyte values, cation or anion?

9.0-10.5, cation

What are some causes of hypernatremia?

• excess water loss —> too much water lost causes Na build up in body - caused by increases insensible loss, diuretic therapy, and diarrhea

• inadequate water intake

• excess sodium intake —> think IV fluids or drinking salt water

What are some causes for hyponatremia?

• too much water intake

• loss of sodium-rich fluids —> lost via draining wounds, vomiting, diarrhea

• Inappropriate use of IV fluids and solution —> causes a shifting in sodium that shouldn’t be happening

what are some S&S of hypernatremia?

• thirst

• change in mental status (confusion)

• restlessness

• seizures

• coma

  (confusion —> seizures —> coma)

what are some S&S of hyponatremia? (mild and severe)

• mild:

  • headache, irritability, difficulty concentrating

• severe:

  • confusion —> seizures —> coma

what should be given to a patient with hypernatremia?

• FIRST, ID the cause

• If caused by primary water deficit (lack of water):

  PO or IV 0.9% NaCl —> isotonic solutions that dilute Na in body

• If caused by Na+ excess:

  D5W or 0.45% NaCl and diuretics —> hypotonic solution and diuretic given to expel sodium from body and cause isotonic fluid loss.

what should be given to a patient with hyponatremia?

• give 0.9% NaCl or LR IV fluids (isotonic fluids)

  • VERY RARELY - give a small amount of 3% NaCl since it’s hypertonic

• vasopressor receptor antagonists given *blocks ADH

** STOP DIURETIC THERAPY STAT

What should a nurse do for a hypernatremic patient?

• restrict dietary Na intake

• seizure precaution

• monitor serum Na+ —> a sudden shift in Na can cause edema in brain and brain problems

What should a nurse do for a hyponatremic patient?

• STOP DIURETIC THERAPY STAT

• Encourage PO salt intake

• restrict diuretics —> don’t want Na+ to be excreted via urine

• monitor serum Na and UO

• seizure precaution

• safety —> prevent falls

what are some causes of hyperkalemia?

• excess potassium intake - excess parenteral administration, potassium containing drugs, and potassium containing salt substitutes

• shift of potassium out of cells - metabolic acidosis: kidneys are unable to maintain and excrete bicarbonate (HCO₃-)

• failure to eliminate potassium - most likely due to renal disease

what are some causes of hypokalemia?

• potassium loss - via GI, renal, or skin (ex. sweating)

• shift of potassium from ECF into ICG - potassium going into the cells, where a majority of water is usually found, potassium replaced

• lack of K+ intake — very rare, caused by malnutrition

what are some S&S of hyperkalemia? (acute and severe)

Acute

• muscle cramps and weakness

• paresthesia, decreased reflexes (occurs much later)

• diarrhea and vomiting

• tetany - sustained muscle contraction

Severe

• ECG changes and arrhythmias

• paralysis (respiratory and skeletal)

**REMEMBER that the GI tract is hyperactive

what are some S&S of hypokalemia? (acute and severe)

Acute

• muscle weakness and cramps

• decreased DTR and paresthesia

• soft, flabby muscles

• constipation/paralytic ileum

Severe

• ECG changes and arrhythmias

• paralysis/arrest (respiratory arrest)

**REMEMBER that GI tract is hypoactive

what are some medications that can be given to a pt who is hyperkalemic?

1. Loop/Thiazide Diuretics

2. Patiromer

3. Kayexalate

4. IV insulin and dextrose

5. beta-adrenergic agonist

6. sodium bicarbonate

what do loop/thiazide diuretics do? when is it used?

used for pt’s with hyperkalemia (high potassium)

• inhibits reabsorption at renal tubule, increasing urine output

what does patiromer do? when is it used?

used for pt’s with hyperkalemia

• causes exchange of Ca and K at the GI tract - takes several days to work

  • often given to chronic pt’s

  • can’t be given within 6 hrs of another medication since it reduces effect

what does kayexalate do? when is it used?

used for pt’s with hyperkalemia

• binds to potassium in the bowel - causes diarrhea - works very very quickly

• often given as acute tx

what does IV insulin and dextrose do? when is it used?

used for pt’s with hyperkalemia

• IV insulin stimulates the sodium-potassium pump and dextrose given with it for repercussions of insulin

what does beta-adrenergic agonist do? when is it used?

used for pt’s with hyperkalemia

• stimulates the sodium-potassium pump

what does sodium bicarbonate do? when is it used?

given to pt’s with hyperkalemia

• given to pt’s who are acidotic

what are somethings that a nurse can do for a pt who is hyperkalemic?

• stop PO and IV K+ intake

• start hemodyalisis - for renal failure (removes excess, waste, and toxins

• continuous ECG monitoring

• increase potassium excretion with diuretics

• reverse effects/damage done to the heart with IV CaCl or Ca gluconate

What are somethings that a nurse can do for a pt who is hypokalemic?

• give PO or IV KCl supplements *know rules

• Educate pt on potassium-rich foods and how to prevent

• monitor ECG continuously

• monitor serum K and urine output

what are the rules for IV KCl⁺ use?

1. dilute KCl with 0.9% NaCl, never give concentrated amounts

2. don’t give via IV push or bolus

3. give over 10 mEq/hr

4. Invert bad several times to ensure that it’s mixed well

5. don’t add KCl to IV bag to prevent a bolus dose

6. give via central line - IV potassium can be irritating tot he vein, should be assessed q1h for phlebitis and infiltration

what are some causes of hypercalcemia?

• increase of total calcium — caused by hyperparathyroidism, cancer

• increased ionized calcium - caused by acidosis

what are some causes of hypocalcemia?

• parathyroid deficiency - could be caused by:

  • surgical removal/injury

  • radiation to neck

what are some S&S of hypercalcemia?

• bone pain/frequent fractures

• depressed DTRs (deep tendon reflexes)

• ECG changes (arrhythmias)

• nephrolithiasis - kidney stones

• seizures

• coma

what are some S&S of hypocalcemia?

• ECG changes - arrhythmias

• spasm (laryngeal) and stridor

• numbness of fingers, face (mouth), and limbs

• Tetany (prolonged muscle contraction)

  • Positive for Chvostek’s - when you tap in front of the ear, face muscles contract

  • Positive for Trousseau’s - when BP cuff is inflated around the arm, carpal spasms occur

• irritability

what kind of medications can be given for hypercalcemia?

Often medications are given for severe cases of hypercalcemia

• give 0.9% NaCl

• Biphosphonate —> “GOLD STANDARD”

  • take 2-4 days to work

  • interferes with osteoclast activity - prevents bone breakdown

• Calcitonin —> short-term, USED FOR THE FIRST FEW DAYS

  • rapidly increases renal-calcium excretion

• Dialysis - if renal impairment is found

what are some kids of medications that can be given for a pt with hypocalcemia?

Often, hypocalcemia is treated when the pt begins to experience symptoms, such as: tetany and arrhythmias

• give IV Calcium gluconate

what are some things that a nurse can do for a pt who is hypercalcemic?

Nursing intervention for pt is determined by how severe the pt is.

Mild severity:

• stop calcium-containing meds —> such as Tum’s

• decrease dietary calcium by starting pt on a low calcium diet

• increase weight bearing exercises

• maintain adequate hydration by educating the pt on drinking 3-4L/day —> this will help excrete calcium

• To decrease acidity caused by kidney stones - have pt drink prune and cranberry juice

Severe: start on IV 0.9 NaCl, biphosphonate, or calcitonin

what are some nursing intervention that can be done for a pt that hypocalcemia?

when treating a pt who is hypocalcemic, you start by determining the severity of the pt.

If the pt is asymptomatic/mild, start:

• diet high in calcium

• PO calcium supplements and vitamins

If the pt is hyperventilating, experiencing tetany, or spasms, have the pt:

• breathe into a paper bag - promoting CO2 retention

• sedate pt - pt will calm down and it will promote CO2 retention

• Tx pain and anxiety - since both increase breathing

What are some causes of hypermagnesemia?

• renal failure

• IV administration of magnesium

• antacids, laxatives

what are some causes of hypomagnesemia?

• GI tract fluid losses

• chronic alcohol use - can’t absorb nutrients and vitamins

• malnutrition

• increased urine output (caused by diuretics)

what are some S&S of hypermagnesemia?

Initially the pt will experience:

• hypertension

• bradycardia

• facial flushing, warm skin

• confusion

• urinary retention

LATER on….

diminished and absent DTR

what are some S&S of hypomagnesemia?

• hyperactive DTRs:

  • positive for Chvostek’s

  • positive for Trusseau’s

• hypertension

• tachycardia

• paresthesia

• muscle cramps/tremors

• seizures

*these are similar to hypercalcemia

what are some medications that can be given to a pt who has hypermagnesemia?

• given IV calcium gluconate — this will reduce cardiac effects

what are some medications that can be given to a pt with hypomagnesemia?

Tx pt with hypomagnesemia when they are experiencing severe symptoms, give:

• IV Mg ²⁺ sulfate — use IV pump

what are some nursing interventions that can be done on a pt who has hypermagnesemia?

• have pt avoid magnesium containing drugs

• limit intake of foods that contain magnesium

• increase IV fluids - help dilute

• give diuretics — help pee out Mg

• dialysis

what are some nursing intervention that can be done on a pt who has hypomagnesemia?

if experiencing mild symptoms:

• give PO Mg²⁺

• increase dietary intake of magnesium - educate on foods that are high in magnesium

If severe:

• monitor VS and give IV Mg²⁺ sulfate using IV pump