Electrolytes
What regulates sodium in the body?
Kidneys
Aldosterone
ADH
Natriuretic Peptides
What type of fluids would a patient with severe hyponatremia most likely be started on?
Hypertonic
Ex. 3%
Ms. Smith's lab test revealed that her serum calcium is 2.5 mEq/L (normal = 4.4-5.2 mEq/L). Which assessment data does the nurse document when a client diagnosed with hypocalcemia develops a carpopedal spasm after the blood-pressure cuff is inflated?
Positive Trousseau's Sign (carpopedal spasm associated with low calcium)
Chovstek's = Cheek (twitching of the facial nerve when tapping below the earlobe)
Overexcitement of the nervous system is characterized is which acid/base imbalances? Acidosis or Alkalosis?
Alkalosis = tetany/convlusions
Acidosis would be depression of central nervous system -> disorienation/coma
The physician ordered IV replacement of potassium for a patient with severe hypokalemia. The nurse would administer this:
Rapid bolus
Diluted IV mixture over 1 hour
Diluted IV mixture over 10 minutes
IV push
Diluted over 1 hour
NEVER rapid adminirations
Given in Large Bore IV (18g/20g)
Does the patient have urine output?
Diaphoresis, use of diuretics, renal disease, SIADH, and hyperglycemia all have which effect of Sodium levels?
Hyponatremia
Na <136
There can either be water gain (dilutional effect) or sodium deficit (loss of Na other ways - urine, diarrhea, hormones, etc.)
What fluids are used in the initial hydration of a patient with DKA?
Isotonic fluids (0.9 NS)
Other treatments: IV insulin, electrolyte replacement PRN
Lab tests reveal that a patient's Na level is 170 mEq/L (normal = 136-145). Which clinical manifestations would the nurse expect to assess?
Tented skin turgor and thirst
Muscle twitching and tetany
Fruity breath and Kussmaul's respirations
Muscle weakness and parasthesias
Tented skin turgor/thirst
Hypernatremia Na >145
More s/s: dry, sticky mucous membranes, lethargy, restlessness
pH 7.57
PaCO2 22
HCO3 17
PaO2 55
Compensated or not?
Respiratory Alkalosis
Partially Compensated (all 3 values out of range trying to get normal pH)
Fully compensated would be normal pH!
Uncompensated would be a normal HCO3.
HCO3 is out of range, in acidic direction trying to normalize pH
Sodium is primarily _____cellular ion
Potassium is primarily _____cellular ion
Intra/extracellular??
Sodium = extracellular
Potassium = intracellular
Renal failure, Trauma, NSAIDs, ACE, and metabolic acidosis are all likely to contribute to which electrolyte abnormality?
Hyperkalemia
S/S - bradycardia, hypotension, muscle weakness, oliguria, peaked T waves
Which IV fluids cause the cell to swell by moving fluid from intravascular space to the intracellular and interstitial spaces?
What will this do to the sodium level?
Hypotonic fluids = hydrate the cell (swell)
0.45% NS
Will lower the sodium level
Can make cerebral edema worse!
Dehydration!
High=Dry
pH 7.39
PaCO2 44
HCO3 26
PaCO2 89
NORMAL ABG
What is the role of calcium gluconate in hypermagnesemia?
It competes for binding site and is cardioprotective.
Antagonize the cardiac effects of magnesium
The thyroid releases what substance in response to elevated calcium levels in the blood?
Calcitonin
Negative Feedback Loop!
Increased Calcium in blood tells the thyroid to release Calcitonin. This will help put calcium back into the bones (out of bloodstream), leave it in the intestines (also not in the bloodstream), as well as decreases resorption from the urine (not building up in bloodstream)
What IV fluids would be prescribed for a patient with severe hyponatremia?
Hypertonic Saline (3% NS or D5 NS)
How does Vitamin D deficiency contribute to an increased risk of glucose dysregulation?
Leads to insulin resistance and decreased insulin production
Think lifestyle factors - poor diet, infection, stress, lack of physical activity, impaired circulation, certain medications
pH 7.55
PaCO2 25
HCO3 22
PaO2 100
Respiratory Alkalosis
Uncompensated (the HCO3 is normal)
Which early morning hyperglycemia complication of insulin can be treated by adding/increasing the bedtime dose of insulin?
Dawn Phenomenon (Dawn is Rising) - continuous rise of glucose all night long
Somogyi Effect (Opposite) - nighttime hypogylcemia with rebound hyperglycemia in morning.
Tx: Omit night time insulin or add bedtime snack.
Need to check 3AM BS to see which is happening.
Bone pain and kidney stones are s/s of which electrolyte imbalance?
Hypercalcemia
Think of bone cancer (multiple myeloma) - destruction of bone - increased level in blood
calcium struvite stones are common!
Edema (common in ankles and feet)
Crackles
High BP
Cough
JVD
SOB
Bounding pulse
Difficulty breathing laying down (orthopnea)
What medication is potentially dangerous for a diabetic patient taking insulin?
Beta Blockers - can mask or prolong signs of hypoglycemia
Glucagon is given for symptomatic overdose of beta blockers
pH 7.17
PaCO2 48
HCO3 36
PaO2 45
Respiratory Acidosis
Partially Compensated
Why should a patient who is sick and vomiting and not feeling well continue to take their insulin?
Infection, illness, stress can all actually cause increased BS even if they are not eating
S - sugar - continue to monitor as normal, or more. BS can still rise even if not eating
I - insulin -never stop taking the insulin, will lead to ketone development
C - carbs - hydrate and maintain carb intake. hydrate with sugary fluids if vomiting/can't eat,
K - ketones (Type 1 only) type 2 have enough insulin production to prevent ketone development. need to increase insulin if ketones are present. stay hydrated!