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Fluid & Electrolytes Flashcards

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Fluid and Electrolytes
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1. Sodium Normal
Range
135-145 mEq/L
2. What are the major - ECF volume and serum osmolality
roles of sodium? - Generation and transmission of nerve impulses
3. What is the major Sodium
ECF electrolyte?
4. What does the
Ratio of sodium:water
serum sodium level reflect?
5. Sodium imbalChanges in sodium concentration, they may reflect
ances may not
changes in fluid
necessarily reflect
what?
6. How can the body - Kidneys (urine)
lose sodium?
- Skin (sweat)
- GI tract (feces)
7. What organ is the Kidneys
primary regulator
of sodium balance?
8. Hypernatremia
Lab Value
Na+ >145 mEq/L
9. What does hyper- Hyperosmolality leading to cellular dehydration
natremia cause?
10. What is hypernatremia?
Elevated serum sodium with water loss or sodium gain
11. What is the body's Thirst activated by the hypothalamus
primary protection
mechanism from
hypernatremia?
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12. What are the the
causes of hypernatremia?
- Impaired LOC/inability to swallow
- Illnesses that cause profound diuresis
- Alterations in metabolism
- Diabetes mellitus
- Excessive sweating
- Excessive sodium intake without water intake
13. What are sodiOsmolality
um imbalances
typically associated with parallel
changes in?
14. Clinical Manifesta- - Symptomatic hypernatremia is rare
tions of Hyperna- - Impaired LOC
tremia
- Thirst, lethargy, agitation, seizures, coma
- Symptoms of fluid volume deficit may occur
15. Because sympWater shifting out of the cells and into the ECF, resulting
tomatic hyperna- in cellular dehydration and shrinkage
tremia is rare,
when symptoms
do occur, what are
they the result of?
16. Where does celNeurologic system
lular dehydration
and shrinkage
(such as that
cause by water
shifting out of the
cells and into the
ECF) first manifest?
17. What is the top
Preventing injury related to compromised neurologic stanursing priority for tus
hypernatremia?
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18. Which electrolyte Hypernatremia
imbalance creates
risk for fluid volume deficit?
19. Nursing Manage- If due to a primary water deficit: Replace fluid orally or IV
ment for Hyperna- with isotonic or hypotonic fluids
tremia
If due to excess sodium: Dilute with sodium-free IV fluids
20. Hyponatremia Lab Na+ <135 mEq/L
Value
21. What may hy- A loss of sodium containing fluids
ponatremia result - Water excess in relation to the amount of sodium (dilufrom?
tion hyponatremia)
- Combination of both
22. What are the caus- - Profuse diaphoresis
es of hyponatrem- - Draining wounds
ia?
- Excessive diarrhea or vomiting
- Trauma with significant blood loss.
- Water excess
- Psychiatric disorders
- Metabolic alterations
23. Clinical Manifesta- - Confusion
tions of Hypona- - Irritability
tremia
- Headache
- Seizures, coma, death
24. Nursing Manage- If caused by water excess: Fluid restriction
ment for Hyponatremia
In severe cases: Small amounts of IV hypertonic sale
solution; Drugs that block ADH
25. Potassium Normal 3.5-5.3 mEq/L
Range
26.
Potassium
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What is the major
ICF cation?
27. What are the func- - Transmission and conduction of nerve and muscle imtions of potassi- pulses
um?
- Maintenance of cardiac rhythms
- Acid-base balance
28. Where must potas- Daily oral consumption, it is not saved by the body
sium come from?
29. What is the prima- Kidneys
ry route of potassium loss?
30. How is potassium Kidneys
regulated?
31. Hyperkalemia Lab K+ >5.3 mEq/L
Value
32. What does an
Increased cell excitability
increase in the
concentration of
potassium outside
of the cell (due
to hyperkalemia)
cause?
33. What are the
causes of hyperkalemia?
- Impaired renal excretion (most common)
- Shift from ICF to ECF
- Excessive intake (over-correction)
34. Clinical Manifesta- - Cramping leg pain
tions of Hyper- Weak or paralyzed skeletal muscles, including respirakalemia
tory muscles
- Abdominal cramping or diarrhea
- Cardiac dysrhythmias
35.
Cardiac dysrhythmias
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What is the top
nursing priority for
hyperkalemia?
36. Nursing Management for Hyperkalemia
When elevation is mild and the kidneys are still functioning:
- Eliminate oral and parenteral K intake
- Increase elimination of K (diuretics, dialysis, Kayexalate)
When hyperkalemia is clinically significant:
Cardiac monitoring
When hyperkalemia is moderate:
Force K from ECF to ICF by IV insulin
37. Hypokalemia Lab K+ <3.5 mEq/L
Value
38. What are the
causes of hypokalemia?
- Abnormal loss from the gastrointestinal tract (most
common)
- Abnormal loss from the kidneys
- Dietary K+ deficiency
39. Clinical Manifestations of Hypokalemia
- Life-threatening cardiac dysrhythmias
- Skeletal muscle weakness (legs)
- Weakness of respiratory muscles
(can lead to shallow respirations and respiratory arrest)
- Decreased gastrointestinal motility
40. Nursing Management for Hypokalemia
- KCl supplements orally or IV
- Increase dietary potassium
41. Considerations of
IV KCl Supplements (Treatment
of Hypokalemia)
- Always dilute IV KCL
- NEVER give KCL via IV push or as a bolus
- Should not exceed a rate of 10 mEq/hr in order to
prevent hyperkalemia and cardiac arrest
- Assess IV site at least hourly
- Except in severe deficiencies, potassium is not given
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unless there is a urine output of at least 30 mL/hour (this
is an indication of adequate kidney function)
42. Calcium Normal
Range
8.6-10.2 mg/dL
43. Calcium Functions - Formation of teeth and bone
- Blood clotting
- Transmission of nerve impulses
- Myocardial contractions
- Muscle contractions
44. Where is calcium
obtained from?
Ingested foods
45. What does absorp- Active form of Vitamin D
tion of calcium require?
46. What does serum All 3 forms of calcium
calcium measure?
47. What is balance of - Parathyroid home (PTH)
calcium controlled - Calcitonin
by?
48. Calcitonin
- 1 of 2 hormones that balances calcium
- Produced by the thyroid gland
- Stimulated by high serum calcium levels
- Opposes the action of parathyroid hormone and lowers
the level of serum calcium by decreasing GI absorption,
increasing calcium deposition into bone, and promoting
renal excretion
49. Parathyroid Hormone (PTH)
- 1 of 2 hormones the balances calcium
- Produced by the parathyroid gland
- Production and release are stimulated by low serum
calcium levels
- Increases movement of calcium out of bones, increases
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GI absorption of calcium, and increases renal tubule
reabsorption of calcium
50. Hypercalcemia
Lab Value
Ca+ >10.2 mg/dL
51. What are the caus- - Hyperparathyroidism (T of cases)
es of hypercal- Malignancy (final S of cases)
cemia?
- Prolonged immobilization
52. How does malignancy cause hypercalcemia?
Bone destruction from tumor invasion or through tumor
secretion of a parathyroid-related protein, which stimulates calcium release from bones
53. How does proResults in bone mineral loss and increased plasma callonged immobicium concentration
lization lead to hypercalcemia?
54. Clinical Manifesta- - Lethargy, weakness, stupor, coma
tions of Hypercal- - Depressed reflexes
cemia
- Decreased memory
- Confusion, personality changes, psychosis
55. Management of
Hypercalcemia
- Mobilization (when not excessive)
- Hydration (orally or isotonic saline infusion)
- Excretion of Ca with loop diuretic
- Low calcium diet
56. Hypocalcemia Lab < Ca+ 8.6 mg/dL
Value
57. What are the caus- - Decreased production of PTH
es of hypocal- Acute pancreatitis
cemia?
- Increased calcium loss (Laxative abuse; Malabsorption
syndromes)
58. Clinical Manifesta- - Positive Trousseau's or Chvostek's sign
tions of Hypocal- - Dysphagia/ laryngospasm
cemia
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- Tingling around the mouth or in the extremities
- Cardiac dysrhythmias
59. Which electrolyte Hypocalcemia
imbalance can
cause acute pain?
60. What can hypocal- - Acute pain
cemia result in?
- Ineffective breathing patter
- Fracture or respiratory arrest
(Consequences,
not Clinical
Manifestations)
61. Nursing Manage- - Oral or IV calcium supplements (Dairy products; Calciment for Hypocal- um carbonate)
cemia
- Severe manifestations require IV preparations
62. Phosphate Normal 2.4-4.4 mg/dL
Range
63. Functions of
Potassium
- Primary anion in ICF
- Most phosphorus is in the bones and teeth as calcium
phosphate
- Essential to function of muscle, red blood cells, and
nervous system
64. What is serum
phosphate controlled by?
Parathyroid Hormone
65. What is the major Kidneys
route of phosphate
excretion?
66. Which electrolytes Phosphate & Calcium
have a reciprocal
relationship?
67.
PO4 >4.4 mg/dL
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Hyperphosphatemia Lab
Value
68. What are the caus- - Acute kidney injury or chronic kidney disease
es of hyperphos- - Chemotherapy
phatemia?
- Excessive ingestion of phosphate or vitamin D
69. Clinical Manifesta- - Mild hyperphosphatemia is often asymptomatic
tions of Hyper- Neuromuscular irritability and tetany (hypocalcemia)
phosphatemia
- Calcified deposition in soft tissue such as joints, arteries, skin, kidneys, and corneas (can cause organ dysfunction)
70. Nursing Management for Hyperphosphatemia
- Restrict foods and fluids containing phosphorus (dairy)
- Phosphate-binding agents
- Adequate hydration and correction of hypocalcemic
conditions
- Hemodialysis (in severe cases)
71. Hypophosphatemia Lab
Value
PO4 <2.4 mg/dL
72. What are the caus- - Malnourishment/ malabsorption
es of hypophos- (Is otherwise rare)
phatemia?
- Excessive alcohol intake
- Excessive use of antacids
- Hyperparathyroidism (hypercalcemia)
73. Clinical Manifestations of Hypophosphatemia
Acute:
- CNS depression
- Confusion, other mental changes
Other:
- Muscle weakness and pain
- Dysrhythmias (rare)
74. What are the
Impaired cellular energy and oxygen
clinical manifesta9 / 12
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tions of hypophosphatemia caused
by?
75. Mild vs Severe Hy- - Mild to moderate is often asymptomatic
pophosphatemia - Severe may be fatal due to decreased cellular function
76. Nursing Management for Hypophosphatemia
Mild:
- Oral supplementnation
- Consumption of high phosphorous foods (dairy)
Symptomatic:
- IV administration of potassium phosphate
77. Magnesium Normal Range
1.3-2.1 mEq/L
78. What is magne- Coenzyme in metabolism of protein and carbohydrates
sium's role in cel- - Required for nucleic acid and protein synthesis
lular processes? - Helps maintain calcium and potassium balance
- Necessary for sodium-potassium pump
79. Magnesium works Muscles: Serum magnesium levels profoundly affect
directly on which neuromuscular excitability and contractility, including
cells?
cardiac function
80. Where is magnesium located?
- 50-60% in bone
- Small amount in the ECF
- Remainder inside the cell
81. Where is magnesium absorbed?
GI tract
82. Where is magnesium excreted?
Kidneys
83. Hypermagnesemia Lab Value
Mg >2.5 mEq/L
84.
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What are the caus- - Increased intake or ingestion of products containing
es of hypermagne- magnesium (Maalox, milk of magnesia) when renal insemia?
sufficiency or failure is present
- Excess intravenous magnesium administration
85. Clinical Manifesta- - Lethargy
tions of Hyper(Due to depressed neuromuscular and CNS functions)
magnesemia
- Nausea and vomiting
- Impaired reflexes (flaccid)
- Somnolence
- Respiratory and cardiac arrest
86. Nursing Management for Hypermagnesemia
- Prevention first: Restrict magnesium intake in high-risk
patients (renal insufficiency)
- Fluids and IV furosemide to promote urinary excretion
- Dialysis
87. Hypomagnesemia Mg <1.5 mEq/L
Lab Value
88. What are the caus- - Prolonged fasting or starvation
es of hypomagne- - Chronic alcoholism
semia?
- Fluid loss from gastrointestinal tract
- Prolonged TPN without magnesium supplementation
- Diuretics
89. Clinical Manifesta- Hypomagnesemia produces neuromuscular and CNS
tions of Hypomag- hyperirritability:
nesemia
- Hyperactive deep tendon reflexes
- Muscle cramps
- Tremors
- Seizures
- Cardiac dysrhythmias
- Confusion
90. Management of
Mild:
Hypomagnesemia - Oral supplements
- Increase dietary intake
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Severe:
- Parenteral IV or IM magnesium (magnesium sulfate)
- Monitor vital signs and use an infusion pump as too
rapid administration of magnesium can lead to cardiac
or respiratory arrest
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