electrolytes pt 2

blood serum levels: sodium

extracellular

135-145 mEq/L

blood serum levels: Magnesium

1.3-2.3 mEq/L

blood serum levels: Potassium

intracellular

3.5-5.0 mEq/L

blood serum levels: Calcium (total serum vs ionized)

total serum: 8.6-10.2 mg/dL

ionized: 4.5-5.1 mg/dL

blood serum levels: chloride

97-107 mEq/L

blood serum levels: Bicarbonate

22-29 mEq/L

blood serum levels: phosphate

2.5-4.5 mg/dL

role of sodium? hypernatremia

maintains water balance and when its off think nuero!

hypernatremia: results from dehydration and diet…confusion, agitation, seizures

hyponatremia can result from what? s/s?

vomiting, diarrhea, sweating, diuretics, water gain

s/s: hypotension, lethargy, seizures, headache, muscle twitching

when you hear potassium think what

cardiac…potassium facilitates cardiac contraction, electrical conductivity, and neuromuscular transmission of nerve impulses

hyperkalemia can result from what?

renal failure, hypoaldosteronism, medications, diet

tight and contracted…very slow regular HR

• s/s: muscle weakness, parasthesia, cardiac irregularities

hypokalemia can result from what? s/s? vital sign affected?

vomiting, GI suctioning, diarrhea, medications

vs: irregular HR, fast and chaotic

• s/s: muscle weakness, leg cramps, fatigue, paraesthesia, dysrhythmias

what electrolyte/vitamin do we never give IV push?

potassium

if potassium is given IV what do we need to keep in mind?

10-20 mEq/hr…dilute it because it burns pt arms

bones, blood and beats…what vitamin?

Calcium

some of the things calcium plays a role in?

→ Cell permeability → Bone and teeth formation → Blood coagulation → Nerve impulse transmission → Normal muscle contraction

hypercalcemia results from what? s/s?

cancer and hyperthyroidism

• moans, groans, stones

• n/v, confusion, lethargy, slurred speech, excess urination, bone pain

hypocalcemia results from what? s/s?

inadequate intake/asorbtion and excess loss

• numbness/tingling, tetany, cramps, seizures

trousseau’s and chvostek’s sign

positive signs of hypocalcemia 

• trousseau’s: blood pressure cuff-hands and fingers go into spasms

• chvostek’s: tap face/cheek: facial twitching of one side of mouth

magnesium does what for the body?

enhances neuromuscular communication

Hypermagnesemia results from what? s/s?

renal failure and increased use of antacids/laxatives

Calm and quiet

• s/s: n/v, weakness, flushing, lethargy, diminished DTRs, diminished respiratory depression

Hypomagnesemia results from what? s/s?

Ng suction, diarrhea, tube feedings, TPN

Buck Wild

• muscle weakness, tremors, tetany, seizures, AMS, increased DTR, respiratory paralysis

whats chloride’s role

→ Acts with sodium to maintain osmotic pressure

→ Excreted and conserved with sodium by kidneys

→ Regulated by aldosterone

high chloride levels result from what? s/s?

increased sweating, decreased glomerular filtration

• tacypnea, weakness, decreased cognition, lethargy, decreased cardiac output

low chloride levels result from what

vomiting, diarrhea, NG suction

• excited muscles, tetany, increased DTRs, cramps, weakness, seizures, coma

low potassium can also mean low what?

low choloride

whats the role of phosphate

promotes energy storage; carb, protein, fat metabolism; bone and teeth formation (regular bone maintenance)

high phosphate is a result of what? s/s?

kidney disease (holding onto something) and hypoparathyroidism

• hyperreflexia, anorexia, muscle weakness, AMS(altered mental status), dysrhythmias

low phosphate is a result of what? s/s?

alcohol withdrawal, DKA (diabetic ketoacidosis), hyperventilation, diuretics

• muscle weakness, slurred speech, dysphagia, decreased respiratory effort, paraesthesia, irritability, confusion, seizures

bicarbonate is regulated by what?

kidneys; acid base balance

high bicarb results from

over ingestion and digestive issues

low bicarb results from

diarrhea, diuretics, early renal insufficiency

kidneys function in relation to electrolytes

Regulate electrolyte levels in the ECF by selective retention of needed substances and excretion of unneeded substances

heart and blood vessels function in relation to electrolytes

circulate nutrients, water and blood

lungs function in relation to electrolytes

Remove approximately 300 mL of water daily through exhalation and hydrogen ions and corrects acid base balance in the ECF

adrenal glands function in relation to electrolytes

Regulate blood volume and sodium and potassium balance by secreting aldosterone, a mineral corticoid secreted by the adrenal cortex, causing sodium retention (and thus water retention) and potassium loss.

pituitary gland function in relation to electrolytes

regulate sodium and water intake/output with antidiuretic hormone (ADH)

parathyroid glands function in relation to electrolytes

Regulate calcium (Ca2+) and phosphate (HPO42–) balance by means of parathyroid hormone (PTH);

• PTH influences bone reabsorption, calcium absorption from the intestines, and calcium reabsorption from the renal tubules.

GI function in relation to electrolytes

Absorbs water and nutrients that enter the body

nervous system function in relation to electrolytes

Inhibits and stimulates mechanisms influencing fluid balance; acts chiefly to regulate sodium and water intake and excretion

nursing considerations assessment

I/O (all things fluids), body weight, labs, pt edu

nursing interventions: prevention

• Develop dietary plan

• Modify fluid intake

    -  Increase/Decrease/Restrict

• Administer medications

    -  Mineral electrolyte/Diuretic

• Intravenous Fluids (Skills 41-1 & 41-2)

• Blood Transfusion

• Parenteral/Enteral Nutrition

guidelines for blood transfusions

student CANNOT administer blood transfusions, follow policy, 2 RNs, large gauge IV, get VS before and after (15 minutes), only with 0.9% saline, check pt

if transfusion reaction occurs what do you?

stop transfusion immediately, KVO with 0.9 saline, notify provider