Adult Health 1 Exam 1 Study Set (AI GENERATED)

What serum sodium level indicates hyponatremia?

Below 136 mEq/L.

What serum sodium level indicates hypernatremia?

Above 145 mEq/L.

What happens to cells during hyponatremia?

Cellular swelling occurs and excitable membrane depolarization is reduced.

What mnemonic helps remember signs of hyponatremia?

SALT LOSS.

What does the "S" in SALT LOSS represent for hyponatremia?

Stupor/coma.

What does the "A" in SALT LOSS represent?

Anorexia.

What does the "L" in SALT LOSS represent?

Lethargy.

What does the "T" in SALT LOSS represent?

Tachycardia.

What does the "L" in SALT LOSS represent in the second part of SALT LOSS?

Limp muscles/muscle weakness.

What does the "O" in SALT LOSS represent?

Orthostatic hypotension.

What does the "S" in SALT LOSS represent in the second-to-last position?

Seizures/headache.

What does the final "S" in SALT LOSS represent?

Stomach cramping.

What are major complications of hyponatremia?

Seizures, coma, and death.

A patient has hyponatremia with a fluid deficit. What IV therapy is indicated according to the document?

IV saline infusions to restore sodium and fluid volume.

What is used for severe hyponatremia?

Small-volume 3% hypertonic saline infusions using a controller to prevent rapid infusion.

What medications may be used for hyponatremia with fluid excess?

Vasopressin receptor antagonists such as conivaptan or tolvaptan.

What medications are listed for SIADH-related hyponatremia?

Lithium or demeclocycline.

What type of medications may need dose reduction because they increase sodium loss?

Most diuretics.

What nutrition interventions are listed for hyponatremia?

Increase oral sodium intake, restrict oral fluids, and collaborate with a dietitian.

What are causes of actual sodium deficits?

GI fluid loss, vomiting, diarrhea, excessive diaphoresis, diuretics, large burns, decreased aldosterone secretion, kidney disease, and hyperglycemia.

What are causes of relative sodium deficits?

Excessive water ingestion, polydipsia, kidney failure, hypotonic-fluid irrigation, SIADH, heart failure, and liver cirrhosis.

A patient with hyponatremia develops seizures. What complication is occurring?

Severe neurologic complications of hyponatremia.

What mnemonic helps remember signs of hypernatremia?

FRIED SALT.

What does "FRIED" represent in the hypernatremia mnemonic?

Flushed skin, restless/anxious/confused, increased BP/fluid retention, edema, decreased urine output.

What does "SALT" represent in the hypernatremia mnemonic?

Skin dry, agitation, low-grade fever, thirsty.

What happens to cells during severe hypernatremia?

Water shifts out of cells, causing severe cellular dehydration and shrinkage.

What cardiovascular complication can occur with hypernatremia?

Decreased cardiac contractility.

What neurologic complications can occur with hypernatremia?

Seizures and altered mental status including agitation, confusion, lethargy, stupor, or coma.

What neuromuscular changes can occur with hypernatremia?

Muscle weakness and reduced/absent deep tendon reflexes.

In a postoperative neurologic patient, what findings may indicate diabetes insipidus according to the document?

Dilute urine, extreme thirst, dry mouth, decreased urinary output, thick lung secretions, and hypotension.

What is used for hypernatremia caused by fluid loss?

0.9% isotonic saline and D5 in 0.45% sodium chloride after glucose is metabolized.

What medications may be used when hypernatremia is caused by reduced kidney sodium excretion?

Diuretics that promote sodium loss, such as furosemide or bumetanide.

What should be assessed hourly when treating hypernatremia caused by reduced kidney sodium excretion?

Excessive losses of fluid, sodium, or potassium.

What nutrition teaching is important for hypernatremia?

Ensure adequate water intake, especially in older adults, and teach sodium-content determination.

What are causes of actual sodium excess?

Hyperaldosteronism, kidney failure, corticosteroids, Cushing syndrome/disease, excessive oral sodium, and excessive sodium-containing IV fluids.

What are causes of relative sodium excess?

Dehydration, increased metabolism, fever, hyperventilation, infection, excessive diaphoresis, and watery diarrhea.

What serum potassium level indicates hypokalemia?

Below 3.5 mEq/L.

Where is most potassium located?

Inside cells.

Why can small extracellular potassium changes be dangerous?

They cause major changes in cell membrane excitability.

What electrolyte is often low when potassium is low?

Magnesium.

Can gradual potassium loss produce symptoms immediately?

No. Gradual loss may have no symptoms until the loss is extreme.

What are common neuromuscular signs of hypokalemia?

Muscle weakness, especially in the arms and legs, and unsteady gait.

What respiratory problems can occur with hypokalemia?

Decreased respiratory muscle effectiveness, reduced ability to cough, and potential inadequate gas exchange.

What ECG changes are associated with hypokalemia?

Slightly prolonged PR interval, slightly peaked P wave, shallow T wave, prominent U wave, and ST depression.

What GI change occurs with hypokalemia?

Decreased intestinal motility.

What can severe hypokalemia cause?

Hypoxemia, hypercapnia, respiratory muscle weakness, and tissue necrosis if IV potassium infiltrates.

What potassium supplements are listed for hypokalemia?

Potassium chloride, potassium gluconate, and potassium citrate.

What is important about IV potassium administration?

It is a high-alert drug requiring careful dilution verification and must never be given IM or subcutaneously.

How should oral potassium be taken?

During or after meals, not on an empty stomach.

Why should oral potassium be taken with meals?

To prevent nausea and vomiting.

Which diuretics should be avoided in hypokalemia?

Loop diuretics such as furosemide and bumetanide and thiazide diuretics because they increase potassium excretion.

Which type of diuretic may be considered with hypokalemia?

Potassium-sparing diuretics such as spironolactone.

What is the role of potassium-rich foods in hypokalemia?

They help prevent further loss, but supplementation is needed to restore normal levels.

What are causes of actual potassium deficits?

Diuretics, corticosteroids, increased aldosterone, Cushing syndrome, diarrhea, vomiting, GI wound drainage, prolonged NG suction, excessive diaphoresis, and kidney disease impairing potassium reabsorption.

What are causes of relative potassium deficits?

Alkalosis, hyperinsulinism, hyperalimentation, TPN, water intoxication, and potassium-poor IV solutions.

How often should respiratory status be assessed in a patient with hypokalemia?

At least every 2 hours.

Why should respiratory status be assessed frequently in hypokalemia?

Respiratory insufficiency and cardiac dysrhythmias are major causes of death.

What serum potassium level indicates hyperkalemia?

Higher than 5.0 mEq/L.

Why is hyperkalemia especially dangerous?

Even small increases can affect excitable tissues, especially the heart.

What are major cardiovascular signs of hyperkalemia?

Bradycardia, hypotension, tall peaked T waves, prolonged PR intervals, flat/absent P waves, wide QRS complexes, and ectopic beats.

What are early neuromuscular signs of hyperkalemia?

Muscle twitching, tingling/burning, and numbness of the hands, feet, and around the mouth.

What progressive neuromuscular problem can occur with hyperkalemia?

Muscle weakness moving upward from hands and feet followed by flaccid paralysis.

When are respiratory muscles affected by hyperkalemia?

Not until lethal potassium levels.

What GI signs occur with hyperkalemia?

Increased intestinal motility, diarrhea, hyperactive bowel sounds, and frequent watery bowel movements.

What are life-threatening complications of hyperkalemia?

Complete heart block, asystole, and ventricular fibrillation.

At what potassium level can sudden increases cause severe problems?

Approximately 6-7 mEq/L.

At what potassium level may slow increases not cause problems until?

Approximately 8 mEq/L or higher.

What does patiromer do?

Binds potassium in the GI tract and decreases potassium absorption.

When can potassium-excreting diuretics be used for hyperkalemia?

When kidney function is normal.

How do IV glucose and insulin treat hyperkalemia?

They temporarily move potassium from the ECF into cells by increasing sodium-potassium pump activity.

What should be monitored when IV glucose and insulin are used for hyperkalemia?

Hypokalemia and hypoglycemia.

What is the first action if a patient is receiving potassium-containing IV fluids and develops hyperkalemia?

Stop the potassium-containing IV infusion.

What should happen to IV access after stopping potassium-containing fluids?

Keep IV access open.

What oral medication should be withheld in hyperkalemia?

Oral potassium supplements.

What diet is appropriate for hyperkalemia?

A low-potassium diet.

What should patients with hyperkalemia avoid as a salt substitute?

Salt substitutes because they contain potassium.

A patient at risk for hyperkalemia has a heart rate of 54/min and spiked T waves. What should the nurse do according to the document?

Notify the Rapid Response Team.

What are causes of actual potassium excess?

Potassium-containing foods/medications, salt substitutes, potassium chloride, rapid potassium IV infusion, IV potassium boluses, blood transfusions, adrenal insufficiency, kidney failure, potassium-sparing diuretics, and ACE inhibitors.

What are causes of relative potassium excess?

Tissue damage, acidosis, hyperuricemia, and uncontrolled diabetes mellitus.

What serum calcium level indicates hypocalcemia?

Below 9.0 mg/dL.

Why is calcium important for excitable membranes?

Calcium decreases sodium movement across membranes and slows depolarization.

What happens to sodium movement when calcium is low?

Sodium movement increases, allowing depolarization to occur more easily and at inappropriate times.

What are early symptoms of hypocalcemia?

Paresthesias or tingling/numbness of the hands, feet, lips, nose, and ears.

What progressive neuromuscular symptoms occur with hypocalcemia?

Muscle twitching, painful cramps, and spasms.

What is a positive Trousseau sign?

Hand and fingers go into spasm in palmar flexion when the BP cuff is inflated above systolic pressure for 1-4 minutes.

What is a positive Chvostek sign?

Facial twitching when the facial nerve is tapped.

What chronic skeletal changes can occur with hypocalcemia?

Loss of bone density, brittle bones, vertebral compression, loss of height, and unexplained bone pain.

What are major complications of hypocalcemia?

Tetany and pathological fractures.

What is the treatment for acute/severe hypocalcemia?

IV calcium gluconate.

What is listed for mild-to-moderate hypocalcemia?

Oral calcitriol and calcium carbonate.

What is listed for mild hypocalcemia?

Oral vitamin D supplementation.

What is used for long-term hypocalcemia therapy?

Daily oral calcium, usually calcium carbonate.

What is the goal of long-term calcium therapy?

Keep calcium in the low-normal range while preventing symptoms and avoiding kidney stones.

What foods are listed as calcium-rich foods?

Milk, yogurt, cheese, and ice cream in moderation.

What environmental interventions are appropriate for hypocalcemia?

Keep the room quiet, limit visitors, adjust lighting, and use a soft voice.

Why is environmental control important with hypocalcemia?

It reduces stimulation of the overstimulated nervous system.

How should a patient with fragile bones from hypocalcemia be moved?

Use a lift sheet rather than pulling the patient.

What should be assessed for injury in chronic hypocalcemia?

Normal joint range of motion and unusual surface bumps or depressions suggesting fractures.

What are causes of actual calcium deficits?

Inadequate calcium intake, lactose intolerance, malabsorption, vitamin D deficiency, end-stage kidney disease, diarrhea, steatorrhea, and GI wound drainage.

What are causes of relative calcium deficits?

Hyperproteinemia, alkalosis, acute pancreatitis, hyperphosphatemia, immobility, and removal/destruction of parathyroid glands.