Lab Values
What is the lab value for Potassium
3.5-5.0
What are the signs and symptom's of hyperkalemia?
HYPERkalemia (over 5.0)
Heart - TIGHT & CONTRACTED
-ST elevation and Peaked T waves Wide QRS Prolong QT intervals
-Severe = Vfib or Cardiac Arrest
- Hypotension, Bradycardia
GI TRACT - TIGHT & CONTRACTED
-Diarrhea
-Hyperactive bowel sounds
NEUROMUSCULAR
- TIGHT & CONTRACTED
-Paralysis in Extremities
-Numbness and tingling in the extremities
-Profound Muscle Weakness, hyperreflexia, or areflexia (flaccid)
-(General Feeling of heaviness)
Lethargy and fatigue
Urine: Oliguria, anuria
Respiratory distress
What are the signs and symptoms of hypokalemia?
ECG: Flattened T waves, ST segment depression, Frequent PVC, weak and irregular pulse
leg cramps
Extreme fatigue
Muscle weakness and spasms
tingling and numbness
Flaccid paralysis extremities
GI: Decreased motility, hypoactive to absent bowel
sounds, Constipation
Abdominal distension
Paralytic ileus, paralyzed intestines!
*PRIORITY* for SB0 (small bowel obstruction)
-
What are the risk factors for hyperkalemia? name 2
Renal Failure
Acidosis (such as DKA) which shifts potassium from the cell into the ECF
Burns: The acute phase of a burn injury causes massive cell destruction and potassium shift to from the cell to the ECF. Immediately after burn injury, hyperkalemia (excessive potassium) may result from massive cell destruction. Hypokalemia (potassium depletion) may occur later with fluid shifts and inadequate potassium replacement. During burn shock, serum sodium levels vary in response to fluid resuscitation.
How do you assess a patients pain level?
Self-report is considered the most reliable measure of the existence and intensity of the client's pain and is recommended by the Joint Commission. Scale from 0-10 to determine the level of pain prior and post medication is the standard plan of care.
What is spironolactone?
Potassium-sparing diuretics can cause hyperkalemia, especially if given with an ACE inhibitor. It would be extremely important to assess the bedside telemetry monitor for changes to the T waves and identify risks for lethal cardiac dysrhythmias
What is the lab value for Sodium?
135-145
What are the assessment findings for hypervolemia?
Assessment findings consistent with hypervolemia include: (CV): HR (bounding pulse quality), hyperTN, peripheral edema, JVD, elevated CVP; (Resp): SOB, pulmonary congestion/crackles, cough; (General): weight gain (acute)
measuring intake and output,
monitoring weight,
assessing breath sounds,
monitoring edema, and promoting rest.
he most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds must be assessed at regular intervals.
Cardiovascular
• Bounding, increased pulse rate, elevated blood pressure, distended neck
and hand veins, elevated central venous pressure, dysrhythmias
What are the assessment findings in hypovolemic?
What are the risk factors for hypercalcemia? name 2
Bone metastasis is associated with hypercalcemia due to the cancerous destruction of bone tissue and the reabsorption of the calcium into the ECF.
Hyperparathyroidism
Immobility is a risk factor for hypercalcemia due to increased calcium absorption from bone loss so patients should be encouraged to ambulate and prevent bone loss; patients with hypercalcemia would want to decrease Ca intake from fortified breads and cereals and would want to increase fluid intake to prevent dehydration (risk factor for hypercalcemia); Vitamin D supplement increases Ca++ absorption from GI tract so should be avoided as well
When administering pain medication what are the primary nursing interventions?
Because older adults have an increased sensitivity to co-analgesic agents and more comorbidities compared with younger people, the nurse should monitor for drug toxicity. Assessing the respiratory, renal ,and the neurological system. Because older adults have an increased sensitivity to co-analgesic agents and more comorbidities compared with younger people, the nurse should monitor for drug toxicity is a primary nursing assessment pre and post medication administration
What is magnesium citrate?
magnesium citrate is an effective laxative but would be a poor choice for a patient with end stage renal failure and impaired renal function because the patient has reduced renal function to excrete the magnesium; this makes the patient at risk for hypermagnesemia to develop
What is the lab value for Chloride?
97-107
What are the symptoms of hypercalcemia?
Anorexia, nausea, vomiting, and constipation
Abdominal and bone pain may also be present, especially with bone metastasis.
STONES Renal Calculi (kidney stones)
DEEP TENDON REFLEXES Decreased DTR Severe muscle weakness
What are the symptoms of hypocalcemia? name 2
Symptoms of hypocalcemia are related to increased neural excitability, alterations in muscle function;
Positive Chvostek & Trousseau signs,
(Neuro): tetany (increased neuro excitability), seizures, hyperreflexia, paresthesia, irritability, anxiety, confusion;
(CV): HypoTN, prolonged QT, impaired clotting; (Resp): dyspnea, laryngospasm/bronchospasm
Diarrhea
Circumoral tingling
Weak bones
What are the causes for hypovolemia?
If a patient has hypovolemia what additional electrolyte should be monitored?
Sodium and water are linked in fluid and electrolyte balance in the body; fluid volume is regulated through the retention or excretion of sodium; fluid imbalances must also include an evaluation of sodium levels
What is furosemide?
loop diuretic
It can treat fluid retention (edema) and swelling caused by congestive heart failure, liver disease, kidney disease, and other medical conditions
monitor Potassium level
side effects: muscle cramps, weakness, unusual tiredness, confusion, severe dizziness, fainting, drowsiness, unusual dry mouth/thirst, nausea, vomiting, fast/irregular heartbeat
What is the lab value for Magnesium?
1.3-2.1
What are the assessment findings for hypernatremia?
Hypernatremia (over 145)
HYPERNATREMIA = BIG & BLOATED
1. SKIN FLUSH ‘’Red & Rosy’’ EDEMA ‘’waterbed skin’’ LOW GRADE FEVER
2. POLYDIPSIA EXCESS THIRST
3. LATE SERIOUS SIGN
SWOLLEN dry tongue
GI = nausea & vomiting
INCREASED muscle tone
What are the assessment findings with hyponatremia?
Hyponatremia (below 135)
HYPONATREMIA - DEPRESSED & DEFLATED
NEURO = Seizures & Coma
HEART = Tachycardia, & Boundy
Decreased Blood Pressure
RESPIRATORY ARREST
Causes for hyponatremia?
Common causes include diuretics, vomiting, diarrhea, congestive heart failure, renal and liver disease.
Syndrome of inappropriate antidiuretic hormone (SIADH)
Ingestion of large amounts of excessive fluids
What is third spacing? This can occur in burns, liver failure,...
Patient can present with assessment of hypovolemia however no weight loss. the patient can present with third spacing. Third-spacing occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space—the nonfunctional area between cells.
In summary:
Third spacing occurs due to a movement of fluid into the interstitial space, as with edema or ascites. Third spacing creates the potential for hypovolemia and decreased urine output. A patient with significant third spacing will have a high urine specific gravity.
When administering intravenous potassium chloride what precautions are key?
Infused via infusion pump
check site for phlebitis and pain
Must be diluted before administration. Fatal cardiac arrhythmia and cardiac arrest have occurred when potassium chloride was administered in an undiluted form.
Follow protocol for the maximum amount infused per hour by institution. 10 meq per hour is the standard for the maximum infusion per hour intravenous.
What is the lab value for Phosphate?
3.0-4.5
What are the assessment findings with hypermagnesemia?
HYPERmagnesemia (over 2.1)
1. CARDIAC - CALM & QUIET Heart block Prolonged PR intervals VITALS = bradycardia, hypotension
2. DEEP TENDON REFLEXES - CALM & QUIET Hyporeflexia - Decreased DTR
3. LUNGS - CALM & QUIET Depressed shallow respirations
4. GI - CALM & QUIET Hypoactive bowel sounds
What are the assessment findings for hypomagnesemia?
Hypomagnesemia (below 1.3)
1. CARDIAC - EKG: ST depression, T wave inversion Torsades de pointes SEVERE = V fib VITALS = Tachycardia
2. DEEP TENDON REFLEXES -
Chvostek sign by tapping the patient's facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates Chvostek sign.
Hyporeflexia - increased DTR
3. EYES Abnormal eye movements (nystagmus)
4. GI - Diarrhea
What foods should be avoided with hypernatremia?
Limit all foods that are high in sodium, including:
Canned soups
Canned beans
Frozen dinners
Commercially prepared tomato sauce and spaghetti sauce
Pizza
Potato and corn chips
Salted pretzels and crackers
Olives
Pickles
Sauerkraut
Soy sauce
Cottage, American, or feta cheeses
Canned chili and stew
Lunch meats
Processed meats, such as hot dogs and salami
What is the assessment of hyperphosphatemia?
LOW CALCIUM
1. TROUSSEAU’S SIGNS
2. CHVOSTEK’S SIGNS
3. DIARRHEA
WEAK or risk for
(fractures)
(risk for bleeding)
(cardiac dysrhythmias)
What is a glucocorticoid? How can glucocorticoids affect the electrolytes?
Glucocorticoids (GCs) are steroid hormones widely used for the treatment of inflammation, autoimmune diseases, and cancer.
Most patients who need to be treated with glucocorticoids are in a hypercatabolic state characterized by respiratory failure and sepsis; glucocorticoid therapy may accentuate the pathological mechanism of urea diuresis in these patients and can cause hypernatremia as a consequence.
What is the lab value for Calcium?
9.0-10.5
What medications can cause hypernatremia?
Drug Induced Hypernatraemia
What are the causes of hypokalemia?
The most common cause is excessive potassium loss in urine due to prescription medications that increase urination.
NG suctioning
vomiting
diarrhea
excessive sweating
alcohol use disorder
Medications such as insulin and corticosteroids
Adrenal disorders
Low Magnesium levels
What foods are high in calcium?
Spinach, Kale, Broccoli, Figs, oranges, almonds, Greek yogurt, cheddar cheese, ready to eat fortified cereals, fortified breads, milk, eggs, spinach, sardines, orka, beans, orange juice
What is a normal creatinine?
0.7-1.4
What fluid is isotonic?
• 0.9% sódio, chloride (normal saline)
• 5% dextrose in water (DWS)
• 5% dextrose in 0.225% saline (DSW/ 1/4 NS)
• Lactated Ringer’s (LR)