Podcast
Questions and Answers
Which treatment is indicated for severe hypercalcemia when drug therapy fails to lower serum calcium levels adequately?
Which treatment is indicated for severe hypercalcemia when drug therapy fails to lower serum calcium levels adequately?
- Use of calcium chelators
- Furosemide administration
- Dialysis (correct)
- IV normal saline
What is the primary reason for discontinuing thiazide diuretics in patients with hypercalcemia?
What is the primary reason for discontinuing thiazide diuretics in patients with hypercalcemia?
- They enhance potassium retention
- They lead to fluid overload
- They promote calcium absorption
- They decrease calcium excretion (correct)
What must be monitored due to the effects of increased calcium in patients taking digitalis?
What must be monitored due to the effects of increased calcium in patients taking digitalis?
- Renal function and fluid balance
- Cardiac rhythm and output (correct)
- Nutritional status and dietary intake
- Temperature and respiration rate
Which agent functions as a calcium-chelator to reduce serum calcium levels?
Which agent functions as a calcium-chelator to reduce serum calcium levels?
Which symptom is NOT typically associated with digitalis toxicity that might be exacerbated by hypercalcemia?
Which symptom is NOT typically associated with digitalis toxicity that might be exacerbated by hypercalcemia?
What primary physiological change occurs in cells due to hypernatremia?
What primary physiological change occurs in cells due to hypernatremia?
Which of the following is a common clinical manifestation of hypernatremia?
Which of the following is a common clinical manifestation of hypernatremia?
Which condition can lead to decreased sodium excretion contributing to hypernatremia?
Which condition can lead to decreased sodium excretion contributing to hypernatremia?
What is the primary trigger for thirst in patients with hypernatremia?
What is the primary trigger for thirst in patients with hypernatremia?
In which scenario would a patient with hypernatremia likely exhibit confusion and agitation?
In which scenario would a patient with hypernatremia likely exhibit confusion and agitation?
In cases of acute hypernatremia, what are the potential severe symptoms observed due to cellular dehydration?
In cases of acute hypernatremia, what are the potential severe symptoms observed due to cellular dehydration?
Which factor is least likely to contribute to hypernatremia?
Which factor is least likely to contribute to hypernatremia?
What does severe hypernatremia often lead to in terms of neurological function?
What does severe hypernatremia often lead to in terms of neurological function?
Which ECG change indicates extreme hypokalemia?
Which ECG change indicates extreme hypokalemia?
What is the maximum concentration of potassium that should be administered through a peripheral IV line?
What is the maximum concentration of potassium that should be administered through a peripheral IV line?
Which of the following symptoms is NOT typically associated with hypokalemia?
Which of the following symptoms is NOT typically associated with hypokalemia?
Why should potassium chloride not be given as an undiluted bolus IV push?
Why should potassium chloride not be given as an undiluted bolus IV push?
Which nursing diagnosis is appropriate for a patient with skeletal muscle weakness due to hypokalemia?
Which nursing diagnosis is appropriate for a patient with skeletal muscle weakness due to hypokalemia?
What is a primary goal of nursing interventions for patients with hypokalemia?
What is a primary goal of nursing interventions for patients with hypokalemia?
Under what condition should potassium replacement therapy be treated cautiously?
Under what condition should potassium replacement therapy be treated cautiously?
Which electrolyte imbalance is frequently associated with respiratory insufficiency in patients with hypokalemia?
Which electrolyte imbalance is frequently associated with respiratory insufficiency in patients with hypokalemia?
What percentage of the body's potassium is found inside the cells?
What percentage of the body's potassium is found inside the cells?
Which hormone is responsible for enhancing potassium excretion in the kidneys?
Which hormone is responsible for enhancing potassium excretion in the kidneys?
What is the normal range for serum potassium concentration?
What is the normal range for serum potassium concentration?
What physiological effect occurs when serum potassium levels decrease below 3.5 mEq/L?
What physiological effect occurs when serum potassium levels decrease below 3.5 mEq/L?
Which of the following conditions is a common cause of hypokalemia?
Which of the following conditions is a common cause of hypokalemia?
How does rapid reduction of serum potassium levels affect the body?
How does rapid reduction of serum potassium levels affect the body?
What is the consequence of gradual potassium loss from the extracellular fluid (ECF)?
What is the consequence of gradual potassium loss from the extracellular fluid (ECF)?
Which of the following medications can lead to potassium deficit?
Which of the following medications can lead to potassium deficit?
At what serum calcium level do severe symptoms typically begin to appear?
At what serum calcium level do severe symptoms typically begin to appear?
What is a potential consequence of severe hypercalcemia?
What is a potential consequence of severe hypercalcemia?
Which diagnostic finding suggests the possibility of hyperparathyroidism?
Which diagnostic finding suggests the possibility of hyperparathyroidism?
Which treatment is not typically employed in the management of hypercalcemia?
Which treatment is not typically employed in the management of hypercalcemia?
What characterizes a hypercalcemic crisis?
What characterizes a hypercalcemic crisis?
What symptom is commonly associated with hypercalcemia?
What symptom is commonly associated with hypercalcemia?
What effect does IV phosphate have when administered for hypercalcemia?
What effect does IV phosphate have when administered for hypercalcemia?
Which of the following cardiovascular changes is associated with hypercalcemia?
Which of the following cardiovascular changes is associated with hypercalcemia?
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Study Notes
Sodium Imbalances
- Hypernatremia: Defined as a serum sodium level exceeding 145 mEq/L (145 mmol/L).
- Caused by sodium gain exceeding water or water loss exceeding sodium.
- Increased serum sodium causes osmolarity rise, prompting water to shift from ICF to ECF, leading to cellular dehydration.
- Common Causes:
- Actual Sodium Excesses: Hyperaldosteronism, renal failure, corticosteroids, Cushing syndrome/disease, excessive sodium ingestion or IV fluids.
- Relative Sodium Excesses: Decreased water intake (NPO) or increased water loss through metabolism, fever, hyperventilation, infection, excessive sweating, or diarrhea.
- Clinical Manifestations:
- Thirst is the primary symptom and a key regulator of sodium levels.
- Cognitive alterations include agitation, confusion, and potential seizures.
- Severe cases may present lethargy, stupor, or coma.
Potassium Imbalances
- Potassium: Major intracellular electrolyte; 98% is intracellular. Normal serum level ranges from 3.5 to 5.0 mEq/L.
- Potassium is vital for neuromuscular function, affecting skeletal and cardiac muscles.
- Hypokalemia: Serum potassium level below 3.5 mEq/L, a serious electrolyte imbalance with life-threatening potential.
- Pathophysiology:
- Low potassium leads to decreased cell responsiveness, significant symptoms occurring only with rapid drops in potassium levels.
- Common Causes:
- Actual potassium deficits from medications (diuretics, digitalis, corticosteroids), increased aldosterone secretion, or diarrhea (loss of potassium).
- Manifestations:
- Cardiovascular: Dysrhythmias, vertigo, hypotension, flattened/inverted T waves on ECG.
- Respiratory: Shallow breaths, shortness of breath.
- Neurological: Fatigue, confusion, depression.
- Renal: Polyuria and reduced serum osmolality.
- Diagnostic Findings: ECG changes, decreased K levels, increased urine potassium, elevated pH.
- Medical Management:
- Oral potassium chloride supplements or careful IV potassium replacement therapy.
- Gastric irritation; must be taken with fluids.
- IV potassium should be diluted, never given as bolus, and central line used for high concentrations.
Hypercalcemia
- Hypercalcemia: Serum calcium level exceeding 10.2 mg/dL (2.6 mmol/L) can lead to a hypercalcemic crisis at levels above 17 mg/dL (4.3 mmol/L).
- Symptoms include severe thirst, polyuria, nausea, lethargy, and potential cardiac issues.
- Assessment Findings:
- Cardiovascular changes such as dysrhythmias and changes in QT interval.
- Use double-antibody PTH test to differentiate causes.
- Medical Management:
- Treat underlying causes (chemotherapy for malignancy).
- IV fluids (0.9% sodium chloride) help temporarily lower calcium; administer furosemide to increase calcium excretion.
- Discontinue calcium-containing medications and dietary sources.
- Use calcitonin and calcium chelators to lower calcium levels.
- Consider dialysis for severe, life-threatening cases unresponsive to other treatments.
- Cardiac Monitoring: Monitor for digitalis toxicity and ECG changes related to increased calcium levels.
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