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48 Cards in this Set

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Normal Serum Potassium (K+)
3.5 to 5
Hypokalemia Lab Values
Serum K+ below 3.5
Hypokalemia Causes
1. Decreased intake of K+
2. GI loss - Vomiting, diarrhea, NG suction
3. Alkalosis
4. Excessive renal excretion - diuretics
5. Steriod therapy
6. Diabetics - Due to insulin and glucose
Hypokalemia Signs/Symptoms
1. Fatigue, muscle weakness, cramps
2. Decreased muscle tone & reflexes
3. Confusion, drowsiness, fatigue
4. Tachycardia, weak irregular pulse
5. Decreased bowel sounds, development of ileus, nausea, vomiting
Hypokalemia ECG Changes
1. T waves - flat/inverted
2. ST segment - depressed and prolonged
3. U Wave - present
4. PVCs
Hypokalemia Nursing Implications
1. Encourage foods high in K+
2. Replace K+ (oral or IV)
3. Maintain accurate I/O
4. Evaluate for alkalosis
5. Provide cliet education regarding diuretics
6. Admin K+ Supplements
7. Monitor for digitalis toxicity
Hyperkalemia Lab Value
Serum K+ above 5.0
Hyperkalemia Causes
1. Decreased urinary excretion - Renal failure
2. Massive tissue injury - burns, trauma
3. Excesive IV admin of K+
4. Acidosis
Hyperkalemia Signs/Symptoms
1. Drowsiness
2. Irritability, anxiety
3. Muscle weakness to flaccid paralysis in LE
4. Irregular pulse, ventricular tachycardia, cardiac arrest
Hyperkalemia ECG Changes
1. Peaked T waves
2. Prolonged PR intervals
3. Widened QRS complex
Hyperkalemia Nursing Implications
1. Administer diuretics - if renal function is adequate
2. Administer hypertonic glucose and insulin - to move K+ into cell
3. Utilize exchange resins - Kayexalate
4. Admin sodium bicarb - if acidotic
5. Be prepared for cardiac emergency
6. Maintain accurate I/O
Potassium Supplements
1. Oral - Potassium chloride (KCl)
2. Sustained Release - K-Dur, Potassium gluconate
3. IV - Potassium
Potassium Supplements Nursing Implications
1. Give oral preparation with full glass of water/juice - Decreases GI upset
2. Ensure urinating adequately before starting admin
3. Parenteral K+ must be diluted and administered by IV drip
4. Do not give K+ IM or by IV push
5. IV K+ is irritating to the vein. If pain occurs, slow infusion rate or dilute solution in larger fluid volume
6. Admin with caution to clients with heart disease or taking digitalis preparations
Normal Serum Sodium (Na)
135 to 145 mEq/L
Hyponatremia Lab
Serum Na below 135
Hyponatremia Causes
1. Inadequate Na+ intake
2. Loss of sodium-rich fluids
3. Cystic Fibrosis
4. Fluid gain
5. Decreased renal excretion - due to diuretics, adrenal insufficiency, increased ADH
Hyponatremia Causes
1. Edema
2. Excessive administration of D5W
3. Overhydration
4. Excessive sweating
5. GI losses
6. DKA
7. Massive tissue injury - burns, trauma
Hyponatremia Signs/Symptoms - Due to Na+ Loss
1. CNS problems - Changes in LOC, confusion, seizures
2. Weakness, restlessness
3. Oliguria
4. Abdominal cramps
5. Postural hypotension
6. Flushed skin
Hyponatremia Signs/Symptoms - Due to Water Excess
1. CNS Problems - Confusion, headache, seizures
2. Hypertension
3. Muscle twitching, cramping
4. Increased urine
Hyponatremia Nursing Implications
1. Maintain accurate I/O and obtain daily weight
2. Irrigate NG tubes w/ Normal Saline
3. Administer Normal Saline IV or 1/2 NS if client has sodium deficit
4. Restrict fluid intake if client has fluid excess
5. Carefully monitor clients recieving D5W
Hypernatremia
Serum sodium > 145
Hypernatremia Causes
1. Decreased fluid intake
2. Excessive salt intake
3. Increased renal retention - i.e., renal disease
4. Cushing's syndrome
Hypernatremia Signs/Symptoms - Due to fluid excess (Na+ Retention)
1. Pitting edema
2. Weight gain
3. Lethargic
4. Decreased hematocrit (below 36%)
Hypernatremia Signs/Symptoms - Due to fluid deficit (Hemoconcentration of Na+, water loss)
1. Concentrated urine
2. Dry mucous membranes
3. Flushed skin
4. Tachycardia
5. Increased temperature
6. Decreased CVP
Hypernatremia Nursing Implications
1. Maintain accurate I/O and daily weight
2. Administer D5W IV - if fluid is normal or there is a deficit
3. Administer diuretics to remove excess Na+
4. Restrict fluid intake - if client has fluid excess
5. Assess for cerebral edema-- Lethargy, headache, nausea, vomiting, increased BP
Sodium Supplements
1. Sodium Chloride (table salt)
2. Saline solutions - 0.9% and 0.45% saline solutions
Sodium Supplements Nursing Implications
1. Admin with caution in clients w/ CHF, renal problems, edema, or hypertension
2. Determine daily wt and maintain accurate I/O - Evaluates for fluid retention
3. Evaluate serum Na+ levels
Normal Serum Calcium
9 to 11 mg/dL
Hypocalcemia
Serum calcium < 9 mg/dL
Hypocalcemia Causes
1. Acute pancreatitis
2. Dietary lack of Ca+ and vitamin D
3. Hypoparathyroidism
4. Hyperphosphatemia
5. Excessive transfuion of citrated blood or IV fluids
6. Alkalosis
Hypocalcemia
Signs/Symptoms
1. Tetany: + Chvostek's or Trousseau's signs
2. Neuromuscular irritability
3. Numbness and tingling of extremities
4. Seizures
5. Abdominal cramping, distention
6. Hyperreflexia
7. Dysrhythmias
Trousseau's Sign
Contraction of the finger and hand, when a BP cuff is kept inflated on the upper arm for 5 minutes at diastolic pressure. Sign of hypocalcemia.
Chvostek's Sign
Spasm of the muscles inervated by the facial nerve when the client's face is tapped lightly below the temple. Sign of hypocalcemia.
Hypocalcemia Nursing Implications
1. Keep Ca+ replacement meds easily accessible for clients who have had thyroid or parathyroid surgically removed
2. Assess for tetany
3. Reduce environmental stimuli
5. Institute seizure precautions
Hypercalcemia
Serum calcium > 11 mg/dL
Hypercalcemia Causes
1. Metastatic malignancy
2. Hyperparathyroidism
3. Thiazide diuretics
4. Prolonged immobilization
Hypercalcemia Signs/Symptoms
1. Anorexia, nausea, constipation
2. CNS depression
3. Decreasing muscle tone, coordination
4. Renal calculi
5. Pathological fractures
6. Dysrhythmias
Hypercalcemia Nursing Implications
1. Administer loop diuretics - Facilitates removal of excess Ca+
2. Increase fluid intake to 3000 to 4000 mL/day - decreases calculi formation
3. Encourage client mobility
4. Assess client taking digitalis for toxicity
5. Increase fiber intake
Calcium Supplements
1. Calcium citrate: PO
2. Calcium gluconate: PO, IV
3. Calcium carbonate: PO
Calcium Supplements Nursing Implications
1. Give with Vitamin D to enhance absorption
2. Take PO 1/2 to 1 hour after meals
3. Prevent IV infiltration - can cause tissue hypoxia and sloughing
4. Do not add Ca+ to solutions containing carbonates or phosphates
5. Use w/ caution in client getting digitalis
6. Monitor infusion rate - sudden increase in serum Ca+ may precipitate severe dysrhythmias
High-Calcium Foods
1. Dairy products: cheese - ice cream - milk - yogurt
2. Instant oatmeal
3. Rhubarb
4. Spinach
5. Tofu
Low-Calcium Foods
1. Apples, bananas
2. Chicken
3. Hamburger
4. Cooked oatmeal
5. Pasta
6. Vegetable juices
High-Potassium Foods
1. Fish (not shellfish)
2. Whole grains, nuts
3. Beverages: brewed coffee - tomato juice - fruit juice
High-Potassium Vegetables
1. Artichokes
2. Broccoli
3. Brussel sprouts, cabbage
4. Carrots
5. Celery
6. Cucumber
7. Mushrooms
8. Potatoes WITH skins
9. Spinach
10. Tomatoes
High-Potassium Fruits
1. Apricots
2. Banana
3. Cantaloupe, honeydew melon
4. Orange
5. Prunes
6. Strawberries
7. Tangerines, nectarines
8. Water-melon
Low-Potassium Foods
1. Vegetables: corn - sweet potato - lima beans - french fried potatoes
2. Fruits: apples - blueberries - cranberries
3. Beverages: instant coffee - cola - ginger ale - noncarbonated drinks - cranberry & apple juice
High-Sodium Foods
1. Breads
2. Cereals - most instant hot and cold cereals
3. Chips
4. Cheeses
5. Meats: sausage - luncheon - frankfurters - bacon - ham
6. Convenience foods: pizza - pot pies - ravioli - soups
Low-Sodium Foods
1. Fruits - fresh, frozen, or canned
2. Vegetables - fresh, frozen, or canned
3. Cooked oatmeal
4. Puffed rice
6. Shreaded wheat
7. Fresh meat, chicken, fish