What constitutes Hyponatremia?
<135MEq/L
What constitutes Hypernatremia?
>145 mEqL
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What constitutes Hyponatremia?
<135MEq/L
What constitutes Hypernatremia?
>145 mEqL
What are some causes of hyponatremia?
Hypovolemic hyponatremia
Diuretics
GI fluid loss (vomiting, diarrhea)
Profuse diaphoresis
Water intoxication
Prolonged use of hypotonic IV solutions
SIADH
What are some causes of excess sodium?
Excessive sodium intake
Hypertonic IV solutions
Hypertonic enteral feedings without adequate water
What are some causes of excessive water loss?
Diarrhea
Inadequate intake of water
Insensible loss due to fever
What are some clinical manifestations of hyponatremia?
Lethargy, confusion, weakness
Muscle cramping
Seizures
Anorexia, nausea, vomiting
Serum osmolality <285 mOsm/kg
What are some clinical manifestations of hypernatremia?
Thirst, dry and sticky mucous membranes, weakness, elevated temperature
Severe: confusion and irritability, decreased levels of consciousness, hallucinations, and seizures
Serum osmolality >290 mOsm/kg
What are the interventions for hyponatremia?
Monitor V/S, I&O
Monitor laboratory results
Serum sodium and serum osmolality
Monitor to ensure that Na+ levels increase by only 4 to 6 mEq/L in any 24-hour period.
Encourage foods high in sodium.
Restrict water intake.
Hypertonic IV saline solutions
What are the interventions for hypernatremia?
Monitor V/S, I&O
Monitor laboratory results
Serum sodium and serum osmolality
Monitor level of consciousness.
Limit salt intake and foods high in sodium.
Increase water intake.
Hypotonic IV solutions.
What is the function of sodium?
Responsible for resting membrane potential
Essential in depolarization
Principal cation of the ECF
Na-K pump important mechanism
What is homeostasis of sodium ?
Moves out of cell by Na-K pump
Regulated by aldosterone and ANP
How do obtain sodium in our diet?
Breads, cereals, chips, cheese, processed meats such as lunch meats, hot dogs, bacon, ham
Commercially canned foods
Table salt
What is the function of Potassium?
With Na+, produces resting membrane potential
Essential in depolarization
Principal cation of the ICF
Essential component of Na-K pump
Involved in protein synthesis
What is the homeostasis of Potassium?
Moves into cell by Na-K pump
Regulated by the kidneys
Where can you get Potassium in your diet?
Fish, excluding shellfish; whole grains, nuts, broccoli, cabbage, carrots, celery, cucumbers, potatoes with skins, spinach, tomatoes, apricots, bananas, cantaloupe, nectarines, oranges, tangerines
What are the values of hypokalemia?
<3.5 mEq/L
What are the values of hyperkalemia?
>5 mEq/L
What are the causes of hypokalemia?
Loss of potassium due to:
Vomiting, gastric suction, diarrhea
Laxative abuse, frequent enemas
Use of potassium-wasting diuretics
Inadequate intake
Hyperaldosteronism
What are the causes of hyperkalemia?
Renal failure
Massive trauma, crushing injuries, burns
Hemolysis
IV potassium
Potassium-sparing diuretics
Acidosis, especially diabetic ketoacidosis
What are some clinical manifestations of hypokalemia?
Weak, irregular pulse
Fatigue, lethargy
Anorexia, nausea, vomiting
Muscle weakness and cramping
Decreased peristalsis, hypoactive bowel sounds
Paresthesia
Cardiac dysrhythmias
Increased risk for digitalis toxicity
What are the clinical manifestations of hyperkalemia?
Anxiety, irritability, confusion
Dysrhythmias, including bradycardia and heart block
Muscle weakness, flaccid paralysis
Paresthesia
Abdominal cramping
What are some intervention of hypokalemia?
Monitor V/S, especially HR
Monitor ECG
Monitor laboratory results
Serum potassium
Assess for signs of digitalis toxicity.
Encourage foods high in potassium.
Administer potassium supplements
IV potassium:
Diluted & administered slowly
Usually by infusion.
NEVER administer potassium as an IV bolus or IV push.
What are some interventions for hyperkalemia?
Monitor V/S, especially HR
Monitor ECG
Monitor laboratory results
Serum potassium
Limit potassium-rich foods.
Administer
Cation-exchange resins (Kayexalate)
Glucose and Insulin
What is the function of calcium?
Primary component of bones and teeth
Role in:
Blood clotting
Nerve impulse transmission
Cardiac conduction
Muscle contraction
What is it called when there is an imbalance of calcium?
Deficit: PTH and calcitriol
Excess: Calcitonin
Deficit: PTH and calcitriol
Excess: Calcitonin
Cheese, ice cream, milk, yogurt, rhubarb, spinach, tofu
What constitutes hypocalcemia?
<9 md/dL
What constitutes hypercalcemia?
>10.5 mg/dL
What causes hypocalcemia?
Hypoparathyroidism
Pancreatitis
Vitamin D deficiency
Inadequate intake of calcium-rich foods
Hyperphosphatemia
Chronic alcoholism
What causes hypercalcemia?
Prolonged bed rest
Hyperparathyroidism
Bone malignancy
Paget disease
Osteoporosis
Clinical manifestations of hypocalcemia?
Confusion, anxiety
Numbness and tingling of extremities
Muscle cramps that progress to tetany and seizures
Hyperactive reflexes
Cardiac dysrhythmias
Positive Chvostek and Trousseau signs
Clinical manifestations of hypercalcemia?
Lethargy, stupor, coma
Decreased muscle strength and tone
Anorexia, nausea, and vomiting
Constipation
Pathologic fractures
Dysrhythmias
Renal calculi
Interventions for hypocalcemia?
Monitor V/S, especially HR
Monitor ECG
Institute fall and seizure precautions.
Administer oral and/or IV calcium supplements as ordered.
Encourage calcium-rich foods.
Interventions for hypercalcemia?
Monitor V/S, especially HR
Monitor ECG
Encourage increased fluid intake.
Increase patient activity, including active ROM