Electrolyte Balance

Front 1

Potassium Balance

Back 1

normal bl level of K+ 3.5-5
K+ moves into cells
*Insulin & K+ needed to move bl sugar into cells
*Alkalosis
*Anabolism-building new cells

Front 2

K+ out of cells

Back 2

extreme exercise
acidosis
trauma to cells-damaged cells lose K+

Front 3

Hypokalemia Etiology

Back 3

*inadequate intake-orange foods, bananas, potatoes
*increased utilization
*increased losses-diuretics, vomiting, diarrhea
*alkalosis-K+ goes into cells in exchange for H+
*renal disorders

Front 4

Cellular electrical activity & Hypokalemia

Back 4

Resting Membrane Potential-RMP--electrical charge of muscle cells @ rest
Threshold potential-TP-how much stimulation the cell needs to contract
HypoK-drops RMP, so needs bigger signal to stimulate contraction

Front 5

Hypokalemia Sx
Decreased NM irritability

Back 5

*weakness-large electrical gap
*speech changes
*flaccid paralysis
*shallow respirations & tachycardia
*decreased GI motility-smooth muscle
*Anorexia b/c decreased peristalsis
*Polyuria/nocturia-kidney doesn't concentrate urine very well: may be the CAUSE of problem

Front 6

Hypokalemia Sx
cardiac smooth muscle weakness

Back 6

arrythmias
hypotention
arrest

Front 7

Hypokalemia Nursing Care

Back 7

*K+ replacement in food
*Oral meds (KCl)
*IV Replacement--NEVER IV push or undiluted-it'll burn vein, watch for infiltration, watch EKG &
Toxicity-kidney disease decreases excretion; digosin (strengthens hrt beat) & Lasix (diuretic) potentiated by low K+--give slowly to renal pt & CHF pts

Front 8

Hyperkalemia Etiology

Back 8

*K+ retention from renal failure (decreased UO) or decreased aldosterone production (saves Na+)
*excessive release from cells-burns, trauma, infection, acidosis
*excessive K+ IV

Front 9

Cellular Electrical Activity
Hyperkalemia

Back 9

RMP is higher, so not as great of kick is needed; increased CNS irritability

Front 10

Hyperkalemia sx

Back 10

increased NM irritability
*intestinal colic
*diarrhea
*muscle twitching progressing to flaccid--paralysis
*arrythmias

Front 11

Hyperkalemia Nursing Care

Back 11

*increase excretion-removing entirely from body; kayexalate enema (exchange Na for K)
*redistribution-glucose & insulin) temp fix, glucose needed to prevent hypoglycemia
*NaHCO3- Na for K, making alkalosis to drive K into cells
*Diuretics
*correct pH?

Front 12

Pt. has severe renal disease. Serum K level is 5.5. What's primary nursing assessment?

Back 12

Think-what is life threatening? arrhythmias...so taking vital signs, not urine output, is primary assessment

Front 13

Pt. admitted c severe asthma. What's the predicted pH? K level? What's the primary problem?

Back 13

Low pH, respiratory acidosis. K+ level is high. Primary problem is acidosis, so CNS will be depressed, not irritable.

Front 14

Pt. very dehydrated, severe diarrhea, abd. cramp, THIRST. What fluid imbalance is suspect? What IV solution is best?

Back 14

Hyper-osmolality b/c losing more H2O than Na+.
0.45% NaCl.

Front 15

Calcium Regulation

Back 15

*serum calcium range 9-11
*parathyroid hormone (PTH) increases Ca level by taking from bones.
*Calcitonin decreases (Thyroid) "tone down Ca"- decreases Ca in blood by sending back into bones.
*Vit D-need it to absorb Ca
*Ca & Phosphorous inversely related, can use P to help treat Ca+ problems

Front 16

Hypocalcemia etiology

Back 16

*low PTH production- usually from thyroid surgery, part of parathyroid is unintentionally removed
*Acute Pancreatitis- pan. makes alkaline juices, overproduction when inflamed; Ca+ precipitates in presence of alkaline solution
*multiple blood transfusions-lactate turns to bicarb in body
*Poor diet
*Pregnancy-baby is taking Ca
*Alkalosis

Front 17

Cellular Electrical Activity-Hypocalcemia

Back 17

Ca affects TR-drops ceiling,
takes smaller kick to get muscle cell to fire

Front 18

hypocalcemia sx

Back 18

*tingling in extremities and circum oral
*muscle spasm-Trousseau's sign
*facial grimace-Chvostek's sign
*laryngeospasm-high pitched, air way closing, if completely closed, tracheostomy is on tx-usually in ICU
*Convulsions
*Tetany
*EKG changes
*High phosphorous level

Front 19

Chvostek's sign

Back 19

tap facial nerve on side of face; positive response results in twitching of lip/side of face-indicates Hypocalcemia

Front 20

Trousseau's sign

Back 20

look for carpal pedal spasm signs with blown up BP cuff;
Watch pts c removed thyroids for sx.

Front 21

Hypocalcemia nursing care

Back 21

*oral replacement-dietary
*If tetany, can't give orally:
--calcium gluconate or CaCl IV push SLOWLY, watch for hypotension, bradycardia, never IM (it will kill tissue)
--watch for digoxin toxicity-it's enhanced by Ca

Front 22

IV push for Ca+

Back 22

*never put Ca in alkaline IV (lactated ringers), it will precipitate
*Always flush IV 1st before giving Ca+, and then again after giving--good tip for any Ca IV push

Front 23

Hypercalcemia Etiology

Back 23

*Hyperparathyroidism
*immobility b/c Ca falls out of bones and enters bl stream *neoplasm-paraneoplastic syndrome
*decreased renal excretion
*excess Vit D
*antacid overdose (contains Ca-Tums)
*Acidosis-ionizes calcium

Front 24

Cellular Electrical Activity
Hypercalcemia

Back 24

High TP- need bigger kick for contraction of muscle; will cause weakness

Front 25

Hypercalcemia Sx
Ca deposits

Back 25

*flank pain
*kidney stones- Ca starts to *crystalize
*renal failure

Front 26

Hypercalcemia sx
decreased GI motility

Back 26

*constipation
*peptic ulcer-Ca in stomach increases acid production; Ca deposits on GI tract walls
*anorexia
*nausea

Front 27

Hypercalcemia sx
decreased neuromuscular function

Back 27

*lethargy
*exhaustion
*confusion
*coma

Front 28

Hypercalcemia sx
bone decalcification

Back 28

*bone pain
*osteoporosis-holes
*osteomalacia-soft bones
*pathologic fractures-no trauma, cause of falls in elderly, "bones broke, then they fell"

Front 29

Hypercalcemia Nursing Care

Back 29

*increase excretion (diuretics)
*hydration c saline-increases excretion
*mobilization
*synthetic calcitonin