Fluid & Electrolytes

Front 1

Sodium

Back 1

(135-145)
-major cation extracellular fluid
-enters cell by diffusion

Front 2

Potassium

Back 2

(3.5-5.0)
-major cation for intracellular
-exits cell into ECF

Front 3

Hyponatremia

Back 3

> 135 Na+

-assess: mental, muscle weakness, GI distress, hypovolemia

-if excess fluid --> mannitol
-SIADH; check ADH levels
(excessive Na+ loss in urine)

Front 4

**Hypernatremia

Back 4

assess: mental status, muscle twitching, irregular muscle contractions.

-if fluid loss: hypotonic IV fluids
- if fluid & Na+ loss: isotonic IV fluid

Front 5

Hypokalemia

Back 5

> 3.5 K+

-hand grasp weak, hyporeflexia, muscle weakness,shallow respirations,pulse thready and weak, lethargic, confusion,coma,dec GI hypo activity, alkalosis, arrhythmias,lethargy

FLAT T WAVE

admin: K+ oral or IV, monitor lab work

Front 6

Hyperkalemia

Back 6

<5.0 K+

-WIDENED QRS INTERVAL
-paresthesia, GI motility,weakness, drowsiness, dysrhythmias, abdominal cramping, diarrhea, oliguria

*administer K+ excreting diuretics (Lasix) and KAEXLATE; dialysis if severe K+ insulin administration

Front 7

Hypocalcemia

Back 7

> 8.6 Ca+

-Trousseau's & Chvosteck's signs, weak thready pulse, active bowel sounds

-Admin: Calcium gluconate

**Seizure Precautions

Front 8

Hypercalcemia

Back 8

<10.2 Ca+

-slow hr, dysrhythmias, Homan's Sign, lethargic, confusion, muscle weakness, coma, deep rendon reflexes without paresthesia

-discontinue antacids, admine saline IV,lasix diuretics, calcium binders, NSAID, dialysis

Front 9

Calcium & Phosphorus

Back 9

Have an INVERSE REALTIONSHIP.

If Calcium is high, phosphorus will be low.

Front 10

Hypophosphatemia

Back 10

> 2.5 mg/dL

-causes: alcoholism, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, low magnesium, low potassium, diarrhea, vitamin D deficiency & diuretic/antacid use

-manifestations: neurological symptoms, confusion, muscle weakness, tissue hypoxia, muscle & bone pain & inc susceptibility to infection

medical management: oral or IV phosphorous replacement

nursing management: assessment, encourage foods high in phosphorous, gradually introduce calories for malnourished patients receiving parenteral nutrition

Front 11

Hyperphosphatemia

Back 11

< 4.5 K+

- causes: renal failure, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, & chemotherapy

- manifestations: few symptoms, soft-tissue calcifications, symptoms occur due to associated hypocalcemia

- medical management: treat underlying disorder, use vitamin D preparations, calcium binding antacids, phosphate-binding gels or antacid, loop diuretics, NS, IV and dialysis

Front 12

Hyperphosphatemia

Back 12

nursing management: assessment, avoid high- phosphorus foods, and provide patient teaching related to diet, phosphate containing substances, and signs of Hypocalcemia

Front 13

Hypomagnesemia

Back 13

> 1.8 Mg+

-evaluate in conduction with serum albumin
- causes: alcoholism, GI losses ( enteral or parenteral feeding deficient in magnesium), medications, rapid administration of citrated blood (diabetic ketoacidosis, sepsis, burns, and hypothermia)

Front 14

Hypomagnesemia

Back 14

Manifestations: neuromuscular irritability, muscle weakness, tremors, dysrhythmias, alterations in mood and level of consciousness

medical management: diet, oral magnesium, magnesium sulfate IV

Front 15

Hypomagnesemia

Back 15

nursing management: assessment, ensure safety, patient teaching r/t diet, medications, alcohol use, nursing care related to IV magnesium sulfate

** often accompanied by hypocalcemia so: monitor and treat potential hypocalcemia

-DYSPHAGIA IS COMMON IN MAGNESIUM-DEPLETED PATIENTS; assess ability to swallow with water

Front 16

Hypermagnesemia

Back 16

< 2.3 mg/dL Mg+

-causes: renal failure, diabetic ketoacidosis & excessive administration of magnesium

-manifestations: flushing, lowered blood pressure, nausea,vomiting,hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, dysthythmias

medical management: IV calcium gluconate, loop diuretics, IV NS of RL, hemodialysis

nursing management: assessment, patient teaching regarding magnesium-containing OTC medications

Front 17

Hypocholermia

Back 17

> 97 mEq/L

-causes: addison's disease, reduced chloride intake, GI loss, diabetic ketoacidosis, excessive sweating, fever,burns, medications, metabolic acidosis.

*loss of chloride occurs with loss of other electrolytes: potassium & sodium

*- manifestations: agitation, irritability, weakness, hyper excitability of muscles, dysrhythmias, seizures, and coma.

Front 18

Hypochloremia

Back 18

-medical management: replace chloride- IV, NS or 0.45% NS
- nursing management: assessment, AVOID FREE WATER, encourage high chloride foods, provide patient teaching r/t to high-chloride foods

*serum level more than 108

causes: excess sodium chloride infusions with water loss, head injury, hypernatremia, dehydration,severe diarrhea, respiratory alkalosis, metabolic acidosis, hyperparathyroidism, and medications.

Front 19

Hypercholermia

Back 19

-manifestations- tachypnea, lethargy, weakness, rapid deep respirations, hypertension, and cognitive changes

-normal serum anion gap

- medical management: restore electrolyte and fluid balance, LR, sodium bicarbonate, and diuretics

-nursing management: assessment, provide patient teaching related to diet and hydration