Electrolytes
The nurse is assessing a 60 year old client with acute renal failure. Which electrolyte imbalance should be the priority concern for the nurse?
1.) Hypercalcemia
2.) Hyperphosphatemia
3.) Hyperkalemia
4.) Hypernatremia
Hyperkalemia because it can lead to life-threatening cardiac dysrhythmias and is priority.
ARF often leads to retention of potassium.
What is the maximum mEqs of potassium that can be administered parenterally in one hour?
20 mEq/hr. Routine potassium replacement is usually administered at 10 mEq/hr
Should not have more than 40 mEq/L
The patient should have hemodynamic monitoring and frequent potassium monitoring
High concentration potassium infusions should be administered via a central line.
ALWAYS use an infusion pump when administering parenteral potassium. Assess the IV site often as potassium is irritating to veins.
The client has arterial blood results of pH= 7.50, PaCO2= 35, HCO3= 30. What blood gas abnormality does the patient have?
Metabolic Alkalosis.
Normal K+ level
3.5-5
What are the two tests that can be done to assess for hypocalcemia?
Chvostek's sign
Trousseau's sign
Trousseau's sign is an indicator of tetany associated with hypocalcemia. Carpal spasms can be seen when a BP cuff is inflated on the client's arm.
Chevostek's sign is an indicator of tetany associated with hypocalcemia. It is contraction of facial muscles in response to a tap over the facial nerve in front of the ear.
A patient admitted with palpitations has been receiving IV potassium and IV magnesium for low levels. The nurse assesses for deep tendon reflexes and discovers that they are hypoactive. What should the nurse do?
Stop the magnesium infusion and call the physician for an order to check the magnesium level.
The nurse is caring for a client admitted with dehydration. Which factors should the nurse explore as contributing to the client's dehydration? (select all that apply).
1.) Diarrhea
2.) Hemorrhage
3.) Diabetic ketoacidosis
4.) Hypoventilation
5.) SIADH
1, 2, 3
DKA causes increased blood glucose levels which causes excess diuresis.
The client is hospitalized with a history of chronic emesis from purging. Based on the client's history, the nurse should monitor for which complication?
1.) Hyperkalemia
2.) Hyperchloremia
3.) Metabolic alkalosis
4.) Metabolic acidosis
Metabolic alkalosis, which occurs when there is a loss of acid such as prolonged vomitting.
Hypokalemia results from diarrhea/vomitting
Hypochloremia is associated with volume depletion d/t vomitting.
Normal Sodium Level
135-145
What is the Allen Test?
A positive Allen test means that the patient may have an adequate dual blood supply to the hand. A negative Allen test shows the patient may not have adequate dual blood supply, which would be a contraindication for catheterization
The nurse is caring for the 90-year-old client with hypernatremia. Which assessment findings should prompt the nurse to conclude that interventions have been ineffective?
1.) Lethargy and paresthesias
2.) Muscle cramps and spasms
3.) Restlessness and agitation
4.) Hypothermia and shivering
3: Hypernatremia results in water shifting out of cells into the extracellular fluid with resultant dehydration and shrinkage of cells. Dehydration of brain cells results in neurological manifestations such as restlessness, agitation, lethargy, seizures and even coma.
paresthesias are associated with hyperkalemia not hypernatremia
muscle cramps and spasms are associated with hyponatremia, not hypernatremia.
1.) Decreased capillary hydrostatic pressure
2.) Decreased plasma oncotic pressure
3.) Increases capillary permeability
4.) Decreased serum electrolytes
ESRD clients often have low plasma protein from malnutrition and protein restriction. These reduce plasma oncotic pressure and result in fluid remaining in the interstitial space because pressure is not great enough to pull fluid into capillaries.
Respiratory acidosis. Despite the high respiratory rate, the patient is still hypo ventilating because the airways are constricted, this results in CO2 retention and lowering of the pH.
Normal Calcium Level?
9 to 10.5
Name 5 foods high in potassium.
The nurse is caring for a client with hypotension. Which electrolytes (3) should be closely monitored by the nurse?
Sodium, potassium, and chloride.
Renin secretion occurs by the kidneys in response to hypotension (decreased renal perfusion). Renin ultimately causes the release of angiotensin II, resulting in vasoconstriction and release of ADH and Aldosterone. Aldosterone says keep Na and water, get rid of potassium. Increases in Na, decreases in K+ and increase in chloride.
**Why do you see oliguria in a patient with hypovolemia?** the RAAS being activated to conserve fluids.
The nurse determines that the client with heart failure is at risk for fluid volume overload. Which physiologic change resulting from heart failure supports the risk for excess fluid volume?
1.) Increased GFR
2.) Increased ADH
3.) Increased sodium excretion
4.) Increased cardiac output
ADH is produced in response to changes in intravascular volume. The result is increased water reabsorption.
The client with DKA has a blood sugar of 320, a respiratory rate of 32 breaths/minute, and a deep, regular respiratory effort. The nurse knows the patient has this acid/base abnormality?
The nurse knows the client is breathing like that because?
Metabolic acidosis
The client is taking deep/rapid breaths as a compensatory mechanism to get rid of CO2 to help get rid of acid.
Normal magnesium level?
1.3-2.1
You have a patient present to the clinic 4 days post thyroidectomy with abdominal cramps, diarrhea, fatigue, bleeding gums and petechiae. What electrolyte abnormality do you suspect?
Hypocalcemia. Accidental removal of parathyroid glands causing low calcium. Low calcium can increase the risk of bleeding and bruising.
The nurse is caring for a client with an NG tube that is attached to intermittent suction. The nurse should monitor which important electrolyte imbalance?
The nurse should monitor for hypokalemia and hyponatremia. NG losses contain both sodium and potassium.
A 28-year-old is admitted with severe bleeding from a fractured femur. Which IV fluid does the nurse anticipate as the most appropriate for use to replace potential fluid loses?
isotonic fluid like 0.9% NaCl
hypotonic fluids hydrates cells
isotonic fluids are used for vascular expansion
hypertonic draws water away from cells into the vascular space to be excreted (increased intracranial pressure)
What acid/base abnormality will the following patient diagnoses likely have?
COPD/Emphysema
Opioid Overdose
Panic disorder
Crohn's- Diarrhea
GERD takes excessive amounts of TUMS
Respiratory Acidosis
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis- Bicarbonate is lost through the stool
Metabolic Alkalosis- Metabolic alkalosis may be caused by consuming excessive amount of certain medications or supplements such as: Antacids, which often contain the chemical sodium bicarbonate
Normal phosphorous level?
2.8-4.5
You are caring for a patient in the ED. The labs just came back and your patient has a critically low phosphorous level. What is your priority concern?
Respiratory effort- low phosphorous levels can cause respiratory muscle fatigue. We need to make sure they are breathing okay.