POTASSIUM
A patient comes in with a K+ of 6.7? Which symptom would you expect?
A. shallow respirations
B. hypoactive bowel changes
C. Fast, irregular Heart Beat
C. Fast, irregular Heart Beat
Your patient arrives with a Magnesium of 7.0. What would you expect her deep tendon reflexes to be like on assessment?
1+ or absent
Patient with low calcium is at risk for?
fracture or break in bones
The patient has a sodium of 130. What causation factor would make sense with this lab value?
A. Diarrhea and vomiting
B. Infection
C. hypertonic IV fluids
A. Diarrhea and vomiting
Increased Sodium excretion: 4 Ds
Diaphoresis
Diarrhea and vomiting
Drains (NG suction)
Diuretics
Which electrolyte has an inverse relationship with Ca?
Phosphorous
Your patient has been taking Spironolactone, would you expect to see the potassium low or high?
high, because this is a potassium sparing diuretic
The patient has been taking magnesium-containing antacids (Tums) 5 times a day for GERD. What electrolyte imbalance should you expect?
hypermagnesemia (remember Magnesium & Calcium = same)
What are some symptoms of hypocalcemia?
CATS GO NUMB
Convulsions
Arrhythmias
Tetany
Spasms and stridor
GO NUMB - numb in fingers, face, limbs
If your patient is experiencing seizures, irritability, hypotension, tachycardia, and flushed skin what would you expect to see within the brain cells- swelling or shrinkage?
brain cell shrinkage
What other electrolyte does Chloride work with to maintain fluid balance?
Na
Tammy has chronic kidney disease. Would you expect to see her K+ low or high on a Chemistry panel?
high, because she has decreased potassium excretion due to inadequate kidney function
Someone with low magnesium may have what kind of BP and HR?
high, tachycardia and hypertension
What medication or other education would you expect to give with LOW calcium?
-PO or IV calcium (adm IV slowly)
-initiate seizure precautions
-consume high calcium foods
Terry has a sodium of 150. What would you want to alert the oncoming nurse of with Terrys urine output? which in turn, would result in what trends for GFR, Urine SG, Serum osmolarity and ADH release?
Monitor urine output because it may be decreased
GFR; decreased
Urine SG- increased
serum osmolarity- increased
ADH- increased
Name one of the main functions of Phosphorous
a. Cellular Metabolism & Energy Production
i. ATP = “Adenosine Triphosphate”
b. Phospholipid bilayer of cell membranes
c. Bones & Teeth
d. INVERSE relationship with Ca++
Your friend, Lisa, would like to give her Potassium IV push quickly so she can get to lunch. What should you tell her?
You cant give K+ IV push, IM, or subQ. IV Potassium should always be diluted and given using an infusion device
On assessment, the patient had a positive Trousseaus sign and Chvostek's sign. What electrolyte imbalance do you expect?
hypocalcemia or hypomagnesemia
(remember Mg & Ca = same)
Tina has a Calcium of 13. What would you expect to see? (select all that apply)
A. Kidney stones
B. Excessive urination
C. Cardiac arrest (bounding pulses)
All of the above
excess calcium makes your kidneys work harder to filter it. This can cause excess thirst and frequent urination
What kind of foods would you educate for your patient to eat that has hyponatremia?
foods high in sodium: canned foods, packaged and processed meats, frozen meals
Use of TPN can cause an imbalance of which electrolyte?
Hypophosphatemia
A nurse is caring for a client with CKD stage 4. The nurse notes that the ordered medications include potassium chloride elixir 40 mEq by mouth 2 times a day. Prior to administering the medication, the nurse monitors the client's serum potassium level, which is 5.1 mEq/L (5.1 mmol/L). Which intervention is most important for the nurse to implement?
A. Ask the pharmacist to supply a tablet rather than an elixir since the client is on fluid restriction.
B. Hold the dose of potassium chloride and contact the HCP to report the serum potassium level.
C. Administer the dose of potassium chloride and document the serum potassium level in the medical record.
D. Calculate the milliliters of medication needed and record the amount on the fluid intake record.
Hold the dose of potassium chloride and contact the HCP to report the serum potassium level.
The serum potassium level is elevated, and administering additional potassium in any form is potentially dangerous to the client.
Skidmore-Roth, L. (2021). Mosby’s 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 1021, 1023.
Ask the pharmacist to supply a tablet rather than an elixir since the client is on fluid restriction.
The healthcare provider (HCP) must be contacted regarding this change. Since the administration of this prescription would be unsafe for the client in any form, there is another intervention that should be implemented.
Skidmore-Roth, L. (2021). Mosby’s 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 1021, 1023.
Hold the dose of potassium chloride and contact the HCP to report the serum potassium level.
The serum potassium level is elevated, and administering additional potassium in any form is potentially dangerous to the client.
Skidmore-Roth, L. (2021). Mosby’s 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 1021, 1023.
Administer the dose of potassium chloride and document the serum potassium level in the medical record.
This is not an appropriate intervention considering the client's elevated serum potassium level.
Skidmore-Roth, L. (2021). Mosby’s 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 1021, 1023.
Calculate the milliliters of medication needed and record the amount on the fluid intake record.
If the potassium level was within normal limits and the medication was to be given, this would be an appropriate intervention. However, since the potassium level is high, this is not the correct intervention.
Skidmore-Roth, L. (2021). Mosby’s 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 1021, 1023.
A patient with CKD stage 4 has a hemoglobin level of 7.8 g/dL (78 g/L). What action should the nurse take?
A. Obtain a urine specimen to assess for hematuria.
B. Obtain an order to start an erythropoietin stimulating agent (ESA).
C. Continue to observe the client.
D. Send the client to the hospital for a blood transfusion.
Hemoglobin is decreased as the kidneys become less able to produce erythropoietin necessary for the formation of red blood cells. ESA's will replace the erythropoietin levels.
Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 540, 832.
Obtain a urine specimen to assess for hematuria.
CKD does not result in hematuria. Clients with CKD will have proteinuria.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: concepts for interprofessional collaborative care (9th ed., p. 1404). St. Louis, MO: Elsevier.
Obtain an order to start an erythropoietin stimulating agent (ESA).
Hemoglobin is decreased as the kidneys become less able to produce erythropoietin necessary for the formation of red blood cells. ESA's will replace the erythropoietin levels.
Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 540, 832.
Continue to observe the client.
A hemoglobin level less than 8 g/dL (80 g/L) should be considered critical and should be addressed by the healthcare provider (HCP).
Send the client to the hospital for a blood transfusion.
In kidney clients who may be eligible for transplant, a blood transfusion should be avoided if possible.
Which assessment finding indicates to the nurse that the desired outcome of the calcium acetate has been achieved in the client with CKD?
A. Serum glucose of 90 mg/dL (5.0 mmol/L).
B. Serum phosphorous of 4.0 mg/dL (1.29 mmol/L).
C. Serum calcium level of 10.2 mg/dL (2.55 mmol/L).
D. Serum hemoglobin of 12 g/dL (120 g/L).
Serum phosphorous of 4.0 mg/dL (1.29 mmol/L).
Calcium acetate acts as a phosphate binder, reducing the high serum phosphorous levels commonly found in the client with CKD.
Serum glucose of 90 mg/dL (5.0 mmol/L).
This normal glucose level is managed with the client's glipizide.
Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 613.
Serum phosphorous of 4.0 mg/dL (1.29 mmol/L).
Calcium acetate acts as a phosphate binder, reducing the high serum phosphorous levels commonly found in the client with CKD.
Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 215.
Serum calcium level of 10.2 mg/dL (2.55 mmol/L).
Calcium acetate is a calcium supplement used to lower phosphorus levels. A side effect of this medication is that it can elevate serum calcium levels.
Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 215.
Serum hemoglobin of 12 g/dL (120 g/L).
Hemoglobin is not affected by the use of calcium acetate.
Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 215.
The nurses is caring for a patient with CKD stage. Which expected outcome should be included in the nurse's teaching plan?
A. Client will adhere to a low-protein diet.
B. Client will avoid canned and processed foods.
C. Client will identify the need to avoid fresh fruits and vegetables.
D. Client will identify the need to increase their fluid intake.
Clients on ESRD should restrict sodium to 2-4 grams per day. Canned and processed foods are high in sodium.
Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 837.
Nix, S. (2017). Williams' Basic Nutrition and Diet Therapy. (15thedition). St. Louis, Missouri. Elsevier. Pg. 381.
Which expected outcome should be included in the nurse's teaching plan?
Client will adhere to a low-protein diet.
Generally, clients on dialysis should not restrict protein in their diets. They should consume as much high biological quality value (HQV) protein such as dairy, eggs, meat, and fish as they can manage.
Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 837.
Nix, S. (2017). Williams' Basic Nutrition and Diet Therapy. (15thedition). St. Louis, Missouri. Elsevier. Pg. 381.
Client will avoid canned and processed foods.
Clients on ESRD should restrict sodium to 2-4 grams per day. Canned and processed foods are high in sodium.
Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 837.
Nix, S. (2017). Williams' Basic Nutrition and Diet Therapy. (15thedition). St. Louis, Missouri. Elsevier. Pg. 381.
Client will identify the need to avoid fresh fruits and vegetables.
Because fresh fruits and vegetables provide much needed vitamins, they do not need to be avoided. However, those fruits that are high in potassium should not be eaten in excessive amounts.
Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 837.
Nix, S. (2017). Williams' Basic Nutrition and Diet Therapy. (15thedition). St. Louis, Missouri. Elsevier. Pg. 381.
Client will identify the need to increase their fluid intake.
The client receiving hemodialysis will more typically need to restrict sodium and fluid intake, rather than increase the amounts consumed.
Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 837.
Nix, S. (2017). Williams' Basic Nutrition and Diet Therapy. (15thedition). St. Louis, Missouri. Elsevier. Pg. 381.
What symptoms are associated with Hypophosphatemia
a. *Symptoms related to lack of energy and damage to cell membranes
b. CV → ↓ Cardiac Output & Stroke Volume, weak pulses
c. MS → weakness, possible rhabdo (due to cell damage)
d. Skeletal → ↓ bone density, fractures
e. CNS → irritable, seizure, coma