Electrolyte Imbalances

What is sodium largely responsible for?

regulating fluid balance

What is a common cause of hypernatremia in young children?

diarrhea

symptoms of hypernatremia (4)

1. thirst, dry mucous membranes
2. signs of dehydration
3. oliguria
4. disorientation, altered neuro status

What can too rapid of a correction of hypernatremia result in?

cerebral edema

normal potassium range

3.5-5.0

What is the main electrolyte in extracellular fluid?

sodium

sodium level

135-145

What should be assessed while infusing hypertonic solutions?

sodium levels

major sodium food sources (2)

1. processed foods and meats
2. snack foods (cookies and crackers)

causes of hyponatremia (3)

1. loss of GI fluids
2. diuretics
3. gain of water

sodium levels in hyponatremia

< 135

What electrolyte imbalance would be seen in athletes that compete in endurance events and are drinking a lot of water?

hyponatremia

cause of hypernatremia

water deficiency

Who is hypernatremia most commonly seen in?

older adults and young children

How should correction of hypernatremia be done?

do not want to treat to fast/rapid -> correction should be slow

What is the main intracellular electrolyte?

potassium

What is recommended daily intake of potassium?

4.7 g/day

What does potassium do?

lowers blood pressure

What is the number one cause of hypokalemia?

use of diuretics

sodium levels in hypernatremia

> 145

potassium levels in hypokalemia

< 3.5

What should patient be careful of if they are taking potassium sparing diuretics?

be careful with salt substitutes (they are high in potassium)

How should oral potassium supplements be given?

given with a full glass of water

What should be done if patient is receiving IV potassium?

patient should be put on telemetry

causes of hypokalemia (4)

1. diarrhea
2. gastric suction
3. vomiting
4. diuretics

complications of hypokalemia (2)

1. arrhythmias
2. muscle weakness, muscle cramps

What should never be done with administering IV potassium?

should NEVER be given IV push

If patient is receiving peripheral IV potassium, what concentration should they be receiving?

no more than 40 mEq

What should nurse do if patient reports that infusion site is burning if they are receiving IV potassium?

slow the infusion

If a patient is on a medsurg floor and doctor ordered for patient to receive 40 mEq IV potassium, what should be done?

patient should be moved off the unit to a cardiac unit to be on telemetry/cardiac monitor

potassium levels in hyperkalemia

> 5.0

causes of hyperkalemia (4)

1. decreased aldosterone
2. renal failure
3. tissue injury and burns
4. medications (ACE-I, beta blockers, NSAIDS)

What can give false potassium results?

hemolyzed blood specimens

What should nurse tell patient not to do when getting hemolyzed blood specimens?

don't clench hands

complication of hyperkalemia

arrhythmias

medications for hyperkalemia (4)

1. IV insulin and glucose
2. IV calcium gluconate
3. sodium polystyrene sulfonate (Kayexalate)
4. loop diuretics

normal calcium levels

8.6-10

How is calcium balance in the blood achieved?

through Vit D and hormones (PTH)

What should be taken with calcium to enhance absorption?

Vitamin D

causes of hypocalcemia (3)

1. hypoparathyroidism
2. acute pancreatitis, alcoholism
3. chronic kidney disease

What can hypocalcemia lead to?

osteoporosis

calcium levels in hypocalcemia

< 8.5

nursing considerations of patient taking oral calcium (2)

1. take with meals
2. may require Vitamin D supplementation to help with absorption

nursing care for hypocalcemia (3)

1. seizure precautions
2. reduce alcohol/caffeine intake
3. monitor phosphorus level

if calcium is high, phosphorus is ______

low

if calcium is low, phosphorus is ______

high

symptoms of hypocalcemia (3)

1. tetany
2. Troussaeu and Chvostek's sign
3. arrhythmias

What is Chvostek's sign?

push the cheek and it spasms and eye will close

What is Trousseau's sign?

BP cuff inflated and causes a carpal spasm (hand will contract)

causes of hypercalcemia (2)

1. hyperparathyroidism
2. breast and lung malignancies

calcium levels in hypercalcemia

> 10.5

What can be done to treat hypercalcemia? (3)

1. loop diuretics
2. hydrate with isotonic fluids
3. increase physical activity

What should be done to reduce renal calculi stones?

increase fluid intake

symptoms of hypercalcemia (3)

1. muscle weakness and decreased DTR
2. confusion
3. arrhythmias

normal magnesium levels

1.6-2.6

symptoms of hypomagnesium (3)

1. twitching
2. muscle weakness
3. convulsions

magnesium levels in hypomagnesium

< 1.5

What should not be done in administration of IV magnesium? Why?

do NOT push to fast, because it can lead to cardiac arrest

magnesium levels in hypermagnesium

> 2.1

What is treatment for eeclampsia?

magnesium sulfate

Who is at high risk for hypermagnesium? Why?

older adults because they are obsessed with regulation of bowel movements

normal phosphorus levels

2.7-4.5

What works inversely with calcium?

phosphorus

If kidneys are not working, then what can build up?

phosphorus

phosphorus levels in hypophosphatemia

< 2.5

phosphorus levels in hyperphosphatemia

> 4.5

What is hyperphosphatemia mostly related to?

hypocalcemia

symptoms of hyperphosphatemia (3)

1. numbness, tingling to mouth and fingers
2. muscle spasms
3. nausea and vomiting

What should patient on dialysis take to prevent hyperphosphatemia?

phosphate binders

nursing education for patient taking liquid iron supplements

they can stain teeth so rinse mouth and brush teeth after

What is iron best absorbed with?

Vitamin C

for best absorption, do not give iron with ________

milk

What may children with high lead levels benefit from?

iron supplementation

What is zinc used for?

wound healing

What causes a goiter?

iodine deficiency

What does fluoride do?

helps prevent tooth decay by developing tooth enamel

What does chromium do?

helps regulate blood glucose levels

What does ROME acronym mean?

respiratory opposite, metabolic equal

normal blood pH

7.35-7.45

normal PCO2

35-45

normal PO2

80-100

normal HCO3

22-26

low pH, high CO2

respiratory acidosis

What should be done to treat respiratory acidosis?

hyperventilation

What should be monitored in respiratory acidosis?

monitor for hyperkalemia

high pH, low CO2

respiratory alkalosis

What should be done to treat respiratory alkalosis?

hypoventilation

What should be monitored in respiratory alkalosis?

monitor for hypocalcemia and hypokalemia

low pH, low HCO3

metabolic acidosis

high pH, high HCO3

metabolic alkalosis

treatment for metabolic alkalosis (2)

1. isotonic fluid replacement (NS)
2. replace potassium

What is SIADH caused by?

increased ADH production

What does SIADH result in?

hyponatremia

manifestations of SIADH (4)

1. decreased UO
2. increased urine SG (> 1.030)
3. hyponatremia
4. increased body weight

nursing management of SIADH (3)

1. hypertonic solutions
2. restriction of electrolyte-free fluids
3. high salt, high protein diet

What causes diabetes insipidus?

insufficient ADH production

What does diabetes insipidus result in?

increased fluid loss and hypernatremia

manifestations of diabetes insipidus (4)

1. polyuria and polydipsia
2. dilute urine SG (< 1.010)
3. decreased body weight
4. hypernatremia

nursing management of diabetes insipidus (3)

1. fluid replacement
2. vasopressin
3. low salt diet and thiazide diuretics

A nurse is conducting a nutritional class on minerals and electrolytes. The nurse should include which of the following foods as a major source of magnesium?:
A. Tuna
B. Tomatoes
C. Eggs
D. Oranges

A. Tuna