Hyponatremia and Hypernatremia Overview

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Questions and Answers

Which condition is NOT a cause of hypomagnesemia?

Chronic alcoholism

Acute renal failure (correct)

Diabetic ketoacidosis

Prolonged IV infusion of magnesium-free solutions

What is a potential nursing intervention for a patient with hypomagnesemia?

Perform routine blood transfusions

Encourage avoidance of dairy products

Monitor airway and swallowing (correct)

Increase fluid intake significantly

Which medication can be administered to manage hypomagnesemia?

Sodium bicarbonate

Calcium acetate

Potassium chloride

Magnesium hydroxide (correct)

Which symptom is associated with hypomagnesemia?

Atrial dysrhythmias Signup and view all the answers

What could indicate magnesium toxicity during replacement therapy?

Hypotension Signup and view all the answers

What is the maximum rate of phosphorus administration that should not be exceeded?

10 mEq/h Signup and view all the answers

Which of the following conditions is NOT a cause of hyperphosphatemia?

Diabetes mellitus Signup and view all the answers

What is a key nursing intervention for managing patients at risk for hypophosphatemia?

Gradually introducing phosphorus solutions Signup and view all the answers

Which clinical manifestation is associated with hyperphosphatemia?

Tachycardia Signup and view all the answers

Which of the following is a preventive measure for hypophosphatemia?

Preventing infection Signup and view all the answers

What pH level indicates acidosis?

7.25 Signup and view all the answers

In which scenario might mixed acid-base disorders occur?

Respiratory and cardiac arrest Signup and view all the answers

How do the lungs compensate for metabolic disturbances?

By changing CO2 excretion Signup and view all the answers

Which clinical manifestation would indicate hypernatremia in a patient?

Tented skin turgor and thirst Signup and view all the answers

Which electrolyte is primarily responsible for determining the concentration of extracellular fluid?

Sodium Signup and view all the answers

What is a significant effect of alkalosis on potassium movement in the body?

Potassium moves from the extracellular fluid (ECF) to the intracellular fluid (ICF) Signup and view all the answers

Which food is recommended for increasing potassium intake in patients with hypokalemia?

Baked potatoes Signup and view all the answers

What is the proper administration method for potassium in cases of severe hypokalemia?

Diluted and administered using an infusion device Signup and view all the answers

Which condition must be established before administering potassium intravenously?

Adequate urine flow Signup and view all the answers

What potential complication can occur from oral potassium supplements?

Small bowel lesions Signup and view all the answers

What is a key clinical manifestation of hypokalemia?

Hypoventilation Signup and view all the answers

What should be monitored closely in patients receiving potassium supplementation?

Cardiovascular and respiratory status Signup and view all the answers

In which condition might hypokalemia likely occur due to acid-base imbalance?

Metabolic alkalosis Signup and view all the answers

What is a significant cause of dilutional hyponatremia?

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Signup and view all the answers

Which of the following is a clinical manifestation of hyponatremia?

Decreased urine sodium Signup and view all the answers

What is the primary treatment for mild hyponatremia caused by water excess?

Fluid restriction Signup and view all the answers

Which nursing intervention should be prioritized in a patient with hyponatremia?

Monitor fluid intake and output Signup and view all the answers

What is a common cause of hypernatremia?

Inadequate fluid loss Signup and view all the answers

Which medication is most likely to contribute to hypernatremia?

Corticosteroids Signup and view all the answers

In which circumstance is IV hypertonic saline typically administered?

For severe hyponatremia Signup and view all the answers

How does hyponatremia affect patients taking lithium?

It increases the risk of lithium toxicity Signup and view all the answers

Study Notes

Hyponatremia

Low sodium level (< 135 mEq/L)
Causes:
- Inadequate sodium intake
- Dilution of serum sodium
Predisposing Conditions:
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- Hyperglycemia
- Use of tap-water enemas
- Irrigation of gastric tubes with water instead of normal saline
Clinical Manifestations:
- Low serum sodium levels
- Low urine sodium levels
- Low urine specific gravity
- Low urine osmolality
Management:
- Fluid restriction
- Loop diuretics
- IV hypertonic saline
Nursing Interventions:
- Monitor fluid intake and output
- Monitor weight
- Assess level of consciousness
- Provide safety and seizure precautions
- Encourage foods and fluids high in sodium

Hypernatremia

Sodium level (exceeding 145 mEq/L)
Causes:
- Decreased sodium excretion
  - Corticosteroids
  - Cushing’s syndrome
- Increased water loss
  - Diabetes Insipidus
  - Watery diarrhea
- Increased sodium intake
- Movement of potassium from the ECF to ICF
- Magnesium deficiency

Hypokalemia

Low potassium level (< 3.5 mEq/L)
Causes:
- Inadequate potassium intake
- Increased potassium loss
Clinical Manifestations:
- Muscle weakness
- Fatigue
- Cardiac dysrhythmias
- Constipation
Management:
- Oral Potassium supplements
- IV potassium replacement
Nursing Interventions:
- Place the patient on a cardiac monitor
- Monitor cardiovascular, respiratory & neuromuscular function
- Encourage intake of foods and fluids high in potassium
- Observe for signs of metabolic alkalosis
- Administer potassium only after adequate urine flow has been established
- Assess for abdominal distention, pain, or GI bleeding

Hyperkalemia

Potassium Level (> 5.0 mEq/L)
Causes:
- Increased potassium intake
- Decreased potassium excretion
Clinical Manifestations:
- Muscle weakness
- Fatigue
- Cardiac dysrhythmias
- Nausea and vomiting
- Diarrhea
Management:
- Restrict dietary potassium
- Diuretics
- IV calcium gluconate
- Sodium polystyrene sulfonate (Kayexalate)
Nursing Interventions:
- Monitor ECG closely
- Avoid potassium-sparing diuretics
- Monitor I&O

Hypomagnesemia

Low magnesium level (< 1.5 mEq/L)
Causes:
- Inadequate magnesium intake
- Increased magnesium loss
Clinical Manifestations:
- Muscle weakness
- Fatigue
- Tremors
- Seizures
- Cardiac dysrhythmias
Management:
- Magnesium sulfate (IM)
- Magnesium hydroxide (PO)
- Magnesium-based antacids
Nursing Interventions:
- Monitor for signs of digoxin intoxication
- Monitor status of airway and swallowing
- Assess level of consciousness
- Provide quiet environment
- Auscultate bowel sounds
- Encourage intake of dairy products and green leafy vegetables

Hypermagnesemia

High magnesium level (> 2.5 mEq/L)
Causes:
- Reduced renal function
- Excessive intake or absorption
Clinical Manifestations:
- Nausea and vomiting
- Muscle weakness
- Drowsiness
- Bradycardia
- Hypotension
Management:
- Stop magnesium administration
- Diuretics
- IV calcium gluconate
- Dialysis
Nursing Interventions:
- Monitor vital signs
- Assess for signs of heart block
- Monitor intake and output

Hypophosphatemia

Low phosphate level (< 2.5 mg/dL)
Causes:
- Inadequate phosphate intake
- Increased phosphate loss
Clinical Manifestations:
- Muscle weakness
- Fatigue
- Bone pain
- Respiratory failure
- Rhabdomyolysis
Management:
- Oral phosphate supplements
- IV phosphate replacement
Nursing Interventions:
- Monitor serum phosphorus levels
- Encourage intake of foods high in phosphate
- Prevent infection

Hyperphosphatemia

High phosphate level (> 4.5 mg/dL)
Causes:
- Renal failure
- Chemotherapy
- Hypoparathyroidism
- Respiratory acidosis or DKA
- High phosphate intake
- Profound muscle necrosis
- Increased phosphorus absorption
Clinical Manifestations:
- Tetany
- Anorexia
- Nausea
- Vomiting
- Muscle weakness
- Hyperreflexia
- Tachycardia
- Decrease urine output
- Impaired vision
- Palpitations
Management:
- Treatment of underlying disorder
- Phosphate binders
- Dialysis
Nursing Interventions:
- Monitor serum phosphorus levels
- Restrict dietary phosphate
- Encourage fluid intake

Acid-Base Imbalances

Normal Values
- pH: 7.35 to 7.45
- PaCO2: 38-42 mm hg
Mixed Acid-Based Disorders
- Patients can simultaneously experience two or more independent acid–base disorders
- Normal pH in the presence of changes in the PaCO2 and plasma HCO3 concentration immediately suggest mixed disorder
Compensation
- Pulmonary and renal systems compensate for each other to return the pH to normal.
- In a single acid–base disorder, the system not causing the problem will try to compensate by returning the ratio of HCO3 to carbonic acid to the normal 20:1.
- The lungs compensate for metabolic disturbances by changing CO2 excretion.
- The kidneys compensate for respiratory disturbances by altering bicarbonate retention and H+ secretion.

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Description

This quiz covers the essential concepts of Hyponatremia and Hypernatremia, including their causes, clinical manifestations, and management strategies. It also highlights nursing interventions crucial for patient care in these conditions. Test your knowledge on sodium imbalances and improve your understanding of how to manage them effectively.