Electrolyte Imbalances - Nursing Care Study Notes

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Questions and Answers

What role does sodium play in the human body?

Promotes the production of hormones

Controls muscle contractility and nerve impulse transmission (correct)

Facilitates glucose absorption

Regulates blood acidity levels

What is the normal serum sodium level range?

130-140 mEq/L

150-160 mEq/L

135-145 mEq/L (correct)

120-130 mEq/L

Which condition can cause hypernatremia?

Low sodium diet

Dilutional hyponatremia

Excessive water intake

Dehydration (correct)

What is the primary regulator of sodium balance in the body?

Kidneys Signup and view all the answers

How do sodium imbalances typically affect the body's osmolality?

They typically cause parallel changes in osmolality. Signup and view all the answers

Which statement correctly reflects the serum sodium level?

It reflects the ratio of sodium to water. Signup and view all the answers

Impaired level of consciousness (LOC) can lead to which electrolyte imbalance?

Hypernatremia Signup and view all the answers

Where can sodium exit the body?

Through urine, sweat, and feces Signup and view all the answers

What condition can result from significantly impaired kidney function due to potassium retention?

Hyperkalemia Signup and view all the answers

What is a common cause of hyperkalemia?

Renal failure Signup and view all the answers

Which medication is known to potentially cause hyperkalemia?

ACE inhibitors Signup and view all the answers

What is the primary goal of treating hypernatremia?

To address the underlying cause Signup and view all the answers

What symptom is commonly associated with hyperkalemia?

Muscle cramps Signup and view all the answers

What is the risk associated with quickly reducing serum sodium levels?

Increased risk of seizures Signup and view all the answers

What change is observed in an ECG due to hyperkalemia?

Peaked T wave Signup and view all the answers

Which IV fluid is recommended for sodium excess in hypernatremia?

5% dextrose in water Signup and view all the answers

What happens to cardiac depolarization in hyperkalemia?

It is decreased Signup and view all the answers

What complication is most serious in cases of hypernatremia?

Subdural hemorrhage Signup and view all the answers

In hyperkalemia, what is the potential complication related to cardiac function?

Dysrhythmias Signup and view all the answers

What can lead to dilutional hyponatremia?

Replacing fluid loss with plain water Signup and view all the answers

What metabolic disturbance can contribute to hyperkalemia?

Acidosis Signup and view all the answers

What should be monitored during the therapy for hypernatremia?

Serum sodium levels and patient response Signup and view all the answers

What is a potential consequence of rapid correction of chronic hypernatremia?

Permanent brain damage or death Signup and view all the answers

What factor contributed to M.H.'s low serum sodium level?

Excessive consumption of plain water after diarrhea Signup and view all the answers

What is a common symptom of hypercalcemia?

Constipation Signup and view all the answers

Which of the following is an effective nursing intervention for hypercalcemia?

Increase fluid intake to 3000 to 4000 mL daily Signup and view all the answers

What role do bisphosphonates play in the treatment of hypercalcemia?

Inhibit the activity of osteoclasts Signup and view all the answers

Which of the following conditions is a potential cause of hypocalcemia?

Vitamin D deficiency Signup and view all the answers

What is a consequence of acute pancreatitis related to calcium levels?

Fatty acids combine with calcium, decreasing serum calcium levels Signup and view all the answers

How does prolonged immobilization lead to hypercalcemia?

By promoting bone mineral loss Signup and view all the answers

Which treatment can lower serum calcium levels effectively during hypercalcemia?

Intravenous isotonic saline hydration Signup and view all the answers

Which of the following is a symptom of low calcium levels?

Muscle twitching Signup and view all the answers

Which food sources are rich in calcium?

Dairy products and green leafy vegetables Signup and view all the answers

What is the primary role of vitamin D in relation to calcium?

It enhances the absorption of calcium from the diet Signup and view all the answers

What might occur if someone takes loop diuretics like furosemide without adequate potassium intake?

Hypokalemia Signup and view all the answers

How does acidosis affect ionized calcium levels?

It increases ionized calcium levels Signup and view all the answers

Why is it important to consult with a doctor before changing medications like diuretics?

To avoid potential drug interactions and complications Signup and view all the answers

What are the three forms of calcium present in the serum?

Ionized, bound to protein, and complexed with phosphate Signup and view all the answers

What consequence might result from low albumin levels in relation to total calcium interpretation?

Drop in total calcium levels without affecting ionized calcium Signup and view all the answers

Which of these functions is NOT associated with calcium?

Regulation of body temperature Signup and view all the answers

What is a potential cause of hypomagnesemia associated with nutrition?

Prolonged parenteral nutrition without magnesium supplementation Signup and view all the answers

Which diuretics' effect can contribute to magnesium loss?

Both thiazide and loop diuretics Signup and view all the answers

Which of the following is NOT a clinical manifestation of hypomagnesemia?

Severe fatigue Signup and view all the answers

What role does intracellular magnesium play in cellular function?

It is critical to the function of the sodium-potassium pump Signup and view all the answers

Which of the following interventions is the primary goal for managing hypomagnesemia?

Treat the underlying cause Signup and view all the answers

Which food item is recommended to increase dietary magnesium intake?

Green vegetables Signup and view all the answers

When should IV magnesium be administered for hypomagnesemia?

When severe symptoms or hypocalcemia is present Signup and view all the answers

What is a critical monitoring step when administering magnesium sulfate intravenously?

Monitor vital signs Signup and view all the answers

Study Notes

Electrolyte Imbalances - Study Notes

Outcomes: Describe safe, patient-centered, evidence-based nursing care for adults at a basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to deliver quality patient care. Describe factors that create a culture of safety related to medication administration. Discuss critical thinking and clinical judgment for accurate and safe medication administration.
Concepts: Fluid and Electrolyte: Physiological mechanisms that maintain fluid and electrolyte balance promoting bodily functions. Describe the nursing process and collaborative management of patients with common fluid and electrolyte imbalances.
Electrolyte Imbalances—Specifics:
- Sodium (135-145 mEq/L): Essential for nerve impulse generation and transmission, muscle contractility, and maintaining ECF osmolality. Imbalances often associated with changes in osmolality. The kidneys are the primary regulator.
- Hypernatremia Causes: Dehydration, impaired LOC, diabetes insipidus, excessive sodium intake with inadequate water intake, and excessive IV administration of hypertonic saline (3% Sodium Chloride).
- Hypernatremia Symptoms/Assessment: Signs of dehydration (thirst, dry mucous membranes, decreased urine output, restlessness, agitation, lethargy, muscle twitching).
- Hypernatremia Nursing Interventions: Treat underlying cause. Water deficit-oral or IV with isotonic or hypotonic fluids (5% dextrose in water, 0.45% sodium chloride solution). Dilute sodium excess with sodium-free IV fluids and promote excretion with diuretics. Monitor serum sodium levels and response to therapy. Quickly reducing sodium levels can cause cerebral edema and neurologic complications.
- Hyponatremia Causes: Excessive diarrhea, replacing fluid with plain water, diuretics, renal disease, profuse diaphoresis, draining wounds, excessive diarrhea/vomiting, trauma, significant blood loss, and excess fluid intake.
- Hyponatremia Symptoms/Assessment: Confusion, headache, nausea, and seizures (severe cases).
- Hyponatremia Nursing Interventions: Fluid restriction. Sodium replacement. Monitor neuro status. Room assignment where the patient will be central to the unit for monitoring and fall prevention.
- Potassium (3.5-5.3 mEq/L): Major intracellular cation. Intracellular concentration in muscle cells = 140 mEq/L, compared to 3.5 to 5.0 mEq/L in ECF. Maintaining the difference in concentration is vital for neuromuscular and cardiac function. A ratio of ECF-to-ICF potassium is a major factor in the resting membrane potential of nerve and muscle cells and is commonly affected by potassium imbalances. Potassium is required for glycogen to be deposited in muscle and liver cells and assists in acid-base balance.
- Hyperkalemia Causes: Renal failure, medications (ACE inhibitors, potassium-sparing diuretics), acidosis, and cell destruction (hemolysis, burns, trauma).
- Hyperkalemia Symptoms/Assessment: Muscle cramps, numbness, respiratory distress, abdominal cramping, cardiac rhythm changes (peaked T wave).
- Hyperkalemia Nursing Interventions: Decrease oral and parenteral potassium intake, increase potassium excretion (loop diuretics, dialysis, kayexalate). Monitor ECG and serum electrolytes. Rapid reduction in serum potassium can pose a risk of cerebral edema and neurologic complications due to rapid changes.
- Hypokalemia Causes: Renal losses, GI tract losses (diarrhea, laxatives, vomiting). Low magnesium, increased aldosterone, and diuretics.
- Hypokalemia Symptoms/Assessment: Confusion, muscle weakness, fatigue, constipation, bone pain, fractures, kidney stones (severe cases). Changes in cardiac rhythm; muscle cramps and numbness.
- Hypokalemia Nursing Interventions: Increase dietary potassium intake. Oral K supplements (KCl). Intravenous K supplements (KCl) only if severe (never give KCl via IV push or bolus). Use diluted solutions as rapid dose administration poses risk. Monitor vital signs during administration and serum potassium levels. Continuously monitor for complications as sudden changes can severely impact the body.
Calcium (8.5-10.5 mg/dl): Essential for bone and teeth formation, blood clotting, nerve impulse transmission, myocardial contractions, and muscle contractions.
- Hypercalcemia Causes: Hyperparathyroidism, malignancy, prolonged immobilization.
- Hypercalcemia Symptoms/Assessment: Lethargy, muscle weakness, confusion, decreased reflexes, constipation, bone pain, fractures, kidney stones.
- Hypercalcemia Nursing Interventions: Loop diuretics, hydration with isotonic saline IV. Increase fluid intake (3000 to 4000 mL daily), diet low in calcium, and bisphosphonates.
- Hypocalcemia Causes: Parathyroid hormone deficiency, vitamin D deficiency, chronic kidney disease, malabsorption, overuse of laxatives.
- Hypocalcemia Symptoms/Assessment: Tetany, positive Trousseau's/Chvostek's sign, laryngeal stridor, dysphagia, tingling mouth/extremities, cardiac dysrhythmias (prolonged QT interval).
Phosphate (2.5-4.5 mg/dl): Stored in bones and teeth as calcium phosphate. Essential to muscle, red blood cells, and nervous system functions. Part of the acid-base buffering system, ATP production, cellular uptake of glucose, and metabolism of carbs, proteins, and fats. The kidneys are the major route of excretion. A reciprocal relationship with calcium exists.
Magnesium (1.5–2.5 mEq/L): Essential for cellular processes, coenzyme in protein and carbohydrate metabolism, nucleic acid and protein synthesis. Important for sodium-potassium pump, maintenance of normal calcium/potassium balance, and neuromuscular excitability.
Hypermagnesemia Causes: Medications; impaired renal function.
Hypermagnesemia Symptoms/Assessment: Depressed neuromuscular and CNS functions; lethargy, flaccid muscle tone, decreased reflexes, cardiac arrest.
Hypermagnesemia Nursing Interventions: Emergency treatment (IV calcium gluconate, diuretics or dialysis). Restrict magnesium-containing foods/drugs. Treat the underlying cause.
Hypomagnesemia Causes: Poor dietary intake, chronic alcoholism, starvation, diuretics.
Hypomagnesemia Symptoms/Assessment: Confusion, hyperactive reflexes, muscle cramps, tremors, cardiac dysrhythmias, positive Chvostek's sign.
Hypomagnesemia Nursing Interventions: Oral supplements, increase dietary magnesium intake. IV or IM administration of magnesium in severe cases.

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Description

Explore the foundational concepts of electrolyte imbalances and their impact on patient care in nursing. This study note covers critical thinking, clinical reasoning, and safe medication administration, guided by the Caritas philosophy. Learn about the physiological mechanisms of fluid and electrolyte balance essential for quality patient care.