MS1 exam 2 electrolytes

normal range for sodium

135-145

causes of hyponatremia

diuretics, vomit, diarrhea, fistulas, increased BG with glucosuria, perspiration, SIADH, hypothyroidism, adrenal insufficiency, psychotic polydipsia, heart failure, cirrhosis, nephrotic syndrome

causes of hypernatremia

decreased water intake, inability to express thirst, diabetes insipidus, hyperglycemia, neoplasms, hypercalcemia, hyperkalemia, medications

symptoms of hyponatremia

all neuro; headache, confusion, seizures, coma

why does hyponatremia cause neuro symptoms

water leaves the blood to increased sodium concentration, causing swollen cells in the brain

correction of hyponatremia

fluid restriction, diuretics, hypertonic IV fluids, sodium replacement

why don’t you want to replace sodium by more than 6-8 mEq/L in the first 24 hours

to avoid osmotic demyelination syndrome

what is osmotic demyelination syndrome

water leaves cells too quickly during sodium correction, collapsing them

symptoms of ODS

flaccid paralysis, dysarthria, seizures, confusion, paraparesis, quadparesis, coma

nursing management for hyponatremia

input and output, daily weight, neuro status, seizure precaution!!!

symptoms of hypernatremia

neuro; weakness, hallucinations, restlessness, thirst, symptoms of dehydration from cellular dehydration in brain

correction of hypernatremia

limit intake, hypotonic IV fluids

nursing management of hypernatremia

input and output, daily weight, encourage water intake, monitor serum sodium

what happens if hypernatremia is treated too quickly

cerebral edema as water moves from vessels into the cells

nutritional sources of sodium

table salts, processed foods, deli meat, pizza, canned soups, cheese, condiments, broths, processed poultry, and savory snacks

normal level of potassium

2.5-5.2

causes of hypokalemia

shift of potassium into the cells (insulin or alkalosis), losses in lower GI tract and renal system, meds, hypomagnesemia

what meds cause hypokalemia

laxatives, diuretics, aminoglycosides, steroids, beta adrenergic agonists

symptoms of hypokalemia

think muscle; cardiac arrhythmias, muscle weakness, paralytic bowels, respiratory arrest (diaphragm), nausea, vomiting, leg cramps, decreased deep tendon reflexes

correction of hypokalemia

potassium pills, diet, potassium IV fluids

only ____ mEq of potassium can be given PO at a time

40

only ____ mEq of potassium can be given IVPB at a time

10 on the floor, 20 in the ICU

no more than ____ mEq of potassium is allowed PO every day

200

what pH imbalance happens with hypokalemia

alkalosis

PIV max for potassium

10 mEq/100mL and no faster than 10 mEq/hour

CIV max for potassium

20mEq/100mL

potassium is never given ____ or ____

IVP or IM

causes of hyperkalemia

acute or chronic renal failure, excessive intake when kidneys don’t work, adrenal insufficiency, meds, shift of intracellular potassium into EVF because of massive cell lysis, acidosis

what meds cause hyperkalemia

spironolactone, NSAIDs, supplements, beta blockers, digitalis

what pH imbalance happens with hyperkalemia

acidosis

symptoms of hyperkalemia

cardiac arrhythmias or changes, diarrhea, paralysis of muscles

correction of hyperkalemia

ECG, serial serum potassium levels, dialysis if kidneys don’t work, diet, IV calcium gluconate, sodium bicarbonate, correct metabolic acidosis, IV dextrose and insulin, inhaled albuterol, loop diuretics, sodium polystyrene

why does sodium bicarbonate correct hyperkalemia

it alkalizes the blood, pushing potassium into cells

why does inhaled albuterol correct hyperkalemia

it activates that sodium, potassium, and ATPase pump

how does sodium polystyrene correct hyperkalemia

it attaches to potassium and leaves through the GI system

what does calcium gluconate do for hyperkalemia

it protects the heart, it doesn’t lower potassium

how does dextrose and insulin correct hyperkalemia

it cant get into the cell without attaching to potassium, so a bolus of both will pull potassium into the cell temporarily

nursing for hypokalemia

nutrition, monitor cardiac status, digoxin toxicity, administer potassium if there is a urine output, potassium level of 0.1 mEq/L for each 10 mEq administered

nursing for hyperkalemia

monitor and report labs, continuous cardiac monitoring, administer meds as ordered, nutrition

what meds are given for hyperkalemia

calcium gluconate, dextrose, insulin, loop diuretics, and sodium polystyrene

nutritional sources of potassium

dried apricots!!, lentils, squash, dried prunes, raisins, potatoes, beans, orange juice, avocados, dairy, meats, whole grains, spinach, banana, salmon, beef, tomato

what happens when potassium is really high

the heart slows and stops; T waves peak

normal levels of magnesium

1.8-3.0

causes of hypomagnesemia

malnutrition, excessive excretion via renal system, chronic alcohol abuse

symptoms of hypomagnesemia

think muscles; hyperexcitability, muscle weakness, tremors, athetoid movements, tetany, seizure, laryngeal stridor

correction of hypomagnesemia

evaluation of potassium and calcium, diet, supplements

why do you watch potassium and calcium with hypomagnesemia

when magnesium is low, it keeps channels open in the kidneys, so the patient will continue to lose K and Ca as long as Mg is low

causes of hypermagnesemia

over replacement, renal insufficiency, meds with magnesium, intestinal hypomobility, soft tissue injury

symptoms of hypermagnesemia

decreased deep tendon reflexes, respiratory depression, flaccidity, nausea, vomiting, weakness, dysarthria, coma, AV heart block, cardiac arrest

nursing for hypomagnesemia

cardiac monitoring, seizure precautions, fall precautions, patient education, referral to alcohol abstinence programs, digoxin toxicity

nursing for hypermagnesemia

vital signs (BP, HR, RR), patient education

nutritional sources of magnesium

green leafy veggies, brazil nuts, whole grains, tuna, halibut, chocolate, pumpkin seeds, legumes, avocados

normal calcium levels

serum 8.2-10.2; ionized 4.6-5.3

causes of hypocalcemia

vitamin D deficiency, hypoparathyroidism, diarrhea, malnutrition, chronic alcohol use, hypomagnesemia

causes of hypercalcemia

bone malignancy, hyperparathyroidism, meds

what meds cause hypercalcemia

thiazide diuretics, lithium, calcium carbonate, theophylline, vitamin A and D

why does hypoparathyroidism cause hypocalcemia

it causes the body to absorb calcium in the gut, causes bones to break it down into the bloodstream, and causes kidneys to retain it; so if it doesn’t work, low calcium

why does a vitamin D deficiency cause hypocalcemia

vitamin d is used to absorb calcium

why does renal failure cause hypocalcemia

vitamin D is activated by the kidneys, so if no vitamin D, no calcium absorption

symptoms of hypocalcemia

primarily muscles, but also nerve excitability; muscle cramps, bleeding, ECG changes, tetany!!!, Trousseau’s, Chvostek’s, laryngeal spasms, seizure

correction of hypocalcemia

IV calcium replacement, treat other imbalances especially hypomagnesemia, oral calcium and vitamin D

symptoms of hypercalcemia

flaccidity, decreased neuromuscular excitability, weakness, incoordination, nausea, vomiting, constipation, bone pain, confusion, impaired memory, coma, hypertension, shortened QT interval

correction of hypercalcemia

hydration with normal saline, dialysis, IV biphosphates, calcitonin, treatment of malignancy, removal of parathyroid gland, walk the patient

why do IV biphosphates help with hypercalemia

they help the bone from breaking down and releasing calcium into the blood

why does calcitonin help with hypercalcemia

it is a natural hormone that keeps calcium in the blood

why does walking the patient help with hypercalcemia

it causes the bones to inhale calcium

calcium and _______ have an inverse relationship

phosphorus

nursing for hypocalcemia

protection and maintenance of airway (laryngeal spasms), cardiac monitoring, maintain access to emergent equipment, seizure precautions, maintain quiet environment, nutrition, smoking cessation, limit caffeine and alcohol

nursing for hypercalcemia

assess and monitor cardiac rhythm and mental status, encourage early and frequent ambulation, encourage hydration

nutritional sources of calcium

dairy product like milk, yogurt, and cheese, fish with bones like sardines and salmon, tofu, leafy greens, fortified orange juice, plant milks

normal phosphorus levels

2.5-4.5

where is phosphorus naturally found in the body

the intracellular fluid

purpose of phosphorus

makes RBCs and WBCs, helps platelets function, energy in the cell (ATP), metabolism of carb, protein, and fat, release of oxygen from hemoglobin, and structure of bones and teeth

causes of low phosphorus

low intake, low intestinal absorption, increased renal excretion, respiratory alkalosis

symptoms of hypophosphorusemia

bleeding, low BP, seizures, respiratory failure, weakness, no energy or metabolism, numbness, dysphagia, confusion, coma

correction of low phosphorus

fixing other imbalances, oral or IV replacement

causes of high phosphorus

renal failure, DKA, phosphorus shifts (tumor lysis, acute hemolysis, rhabdomyolysis), increased intake, hyperthyroidism, hyperparathyroidism

symptoms of high phosphorus

hypocalcemia symptoms (tetany, tingling, nausea, vomiting, bone pain, hyperreflexia, increased HR)

correction for high phosphorus

IV hydration, loop diuretics, correction of low calcium, dialysis, limiting high phosphorus food, phosphate binders (bind to phosphorus and excrete through bowels)

nursing for low phosphorus

treatment of emergency causes, typically IV, nutrition

nursing for high phosphorus

nutrition and phosphate binders

nutritional sources of phosphorus

protein rich animal products, whole grains, nuts, dairy, poultry, beans, lentils, process foods, everything