Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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? 1 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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? 2 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 3 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 4 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 5 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 6 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 7 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy - 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 8 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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. 10 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 11 / 12 Fluid and Electrolytes Study online at https://quizlet.com/_avl6oy 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 12 / 12
