AH1 Unit One Notes PDF

1/13: Electrolytes - Chapter 17 Potassium (3.5-5 mEq/L) Action: Effects muscles, nerves Storage: Potassium is mostly intracellular (not a lot in blood/serum) -​ Small variations in potassium make a big difference due to small range in blood Sources: bananas, DGL, potatoes, avocados -​ Excre...

1/13: Electrolytes - Chapter 17 Potassium (3.5-5 mEq/L) Action: Effects muscles, nerves Storage: Potassium is mostly intracellular (not a lot in blood/serum) -​ Small variations in potassium make a big difference due to small range in blood Sources: bananas, DGL, potatoes, avocados -​ Excreted by kidneys Relationship to insulin: allows glucose AND potassium to exit bloodstream and enter cells Hyperkalemia -​ Causes: -​ Decreased renal functioning (can’t eliminate enough K) -​ Meds: K sparing diuretic (spironolactone) -​ GI dysfunction: Diarrhea, vomiting ? -​ S/sx: -​ Cardiac arrhythmias (have to be on telemetry and get EKG) -​ Muscle weakness -​ Treatments: -​ Stop intake (dietary restriction) -​ Increase output -​ K wasting diuretics (furosemide) **as long as patient can pee/doesn't have urinary retention -​ Sodium polystyrene (kayexalate): osmotic laxative enema **no immediate effect, so use for hyperkalemic patients with no major arrhythmias/not best option in an emergency -​ Hide it (insulin) -​ Give Dextrose (D50) with insulin: to make potassium move from the blood serum into cells -​ Good emergency option for cardiac arrhythmias, but temporary solution so follow up with another treatment within a few hours -​ Block it’s action -​ Calcium gluconate: decreases arrhythmias (block action of potassium on the heart) Hypokalemia -​ Causes -​ Meds: K wasting diuretics (furosemide) and Thiazide diuretic (HCTZ) -​ GI loss: diarrhea, vomiting -​ NG suctioning -​ S/sx: muscle cramping/weakness -​ Treatments -​ Stop K wasting diuretics and add K sparing diuretics -​ Stop the loss (give antiemetic, antidiarrheal) -​ Increase K in diet -​ IV Potassium replacement (aka IV potassium run- give multiple bags back to back) -​ Hang 10 mEq bag, when it runs out hang another 10 or 20 mEq bag, repeat again- over span of 3-4 hours, don't give more than 10 mEq per hour  -​ IV should be in AC or forearm; never use hand IV for K run -​ Dilute with normal saline or slow drip rate, or it will burn the patient Calcium (9-10.5 mEq/L) Action: effects muscles and bones/bone density -​ Control over smooth muscles (trachea, heart, GI, around veins) -​ Control over nerves Storage: stored in bones Sources: dairy, DGL, broccoli Regulation: -​ parathyroid hormone determines how much dietary calcium needs to be absorbed -​ Vitamin D helps calcium absorb into bone from blood serum Relationship to phosphorus: inverse Hypercalcemia -​ Causes -​ Immobility hypercalcemia: calcemia leaves bones and enters blood stream -​ Hyperparathyroidism (too much PTH): PTH overcorrects and pulls too much calcium from bones into the blood serum -​ S/sx: -​ Fatigue: bones and muscles working constantly and causes fatigue -​ Bone pain -​ Fractures: losing bone density -​ Elevated BP: vasculature surrounded by smooth muscle contracts and constricts veins -​ Some EKG changes: bc smooth muscle of heart -​ Kidney stones (calcium stones) -​ Low phosphorus -​ Treatment -​ Movement: weight bearing activity will bring more calcium into bone and out of blood serum -​ Increase fluid intake to prevent kidney stones (more urine flowing prevents crystallizations) -​ Bisphosphonates (alendronate [Fosamax], risedronate [Actonel]): helps prevent bone breakdown and stops release of calcium -​ Often seen in osteoporosis patients -​ Give Vitamin D (cholecalciferol): decrease serum calcium by helping calcium enter bones -​ Monitor PTH levels Hypocalcemia -​ Causes -​ Renal disease (only electrolyte that decreases in renal failure- bc kidneys can’t produce Vit D) -​ Decreased PTH (parathyroidectomy, hypoparathyroidism) -​ Inadequate calcium intake, inadequate vitamin D intake (vit D helps uptake of calcium into bone) -​ S/sx: -​ Decrease in BP: relaxation of muscles around vasculature -​ Hyperreflexia: due to increased excitability of neurons (chvostek and trousseau) -​ Chvostek: tap on masseter muscle and if facial muscles twitch=positive chvostek  -​ Trousseau: inflate bp cuff greater than pt normal systolic and hold for 3 minutes; if hand and wrist draws in towards body and flexes = positive trousseau -​ Treatment -​ Oral replacement (oyster shell calcium with vitamin D) -​ IV replacement (calcium gluconate) - need to put on heart monitor -​ Give bisphosphonates (alendronate [Fosamax], risedronate [Actonel]); to prevent bone breakdown -​ Do frequent neuro checks, seizure precautions Magnesium (1.3-2.1 mEq/L) Action: decrease muscle contraction and relax muscles Storage: in muscles, but mostly get from dietary intake Sources: DGL, nuts, whole grains Regulation: regulated by kidneys Hypermagnesemia -​ Causes -​ Overuse of antacids (tums) -​ Renal failure (kidneys don’t excrete enough) -​ S/sx: decrease in… -​ BP, pulse, respirations -​ DTR, muscle tone -​ LOC -​ Increased flushing/warmth -​ Treatment -​ Give calcium gluconate slowly (blocks the effects of magnesium) -​ Dialysis for kidneys (filters out magnesium) -​ Ventilator (treat decreased respirations) Hypomagnesemia -​ Causes: -​ Not enough dietary intake -​ Absorbative issues, crohn’s (IBD), IBS (losing magnesium) -​ Alcohol dependence -​ S/sx: -​ Elevated BP -​ Cardiac problems, EKG changes -​ Treatments -​ Supplemental magnesium (or IV magnesium for pt with absorptive issues) Sodium (135-145 mEq/L) Action: effects neuro and fluid movement Storage: most sodium is extracellular, found in blood serum -​ mostly comes from dietary intake Sources: processed foods Relationship with HTN: pt with HTN should decrease sodium (water follows salt into bloodstream which would increase pressure) Hypernatremia -​ Causes -​ Too little water -​ Not enough in: nonverbal/can’t verbalize thirst, children, tube feeds (need to make sure these pt are getting flushed w water) -​ Too much loss: excess urine output (Diabetes insipidus, osmotic diuretics [mannitol] ***, -​ ******Too much sodium (too much in diet) -​ Excess in food **** -​ S/sx: dehydration -​ Dry mouth and tissues, thirst -​ Cerebral shrinking→neuro changes -​ Elevated BP: fluids shift into vascular system -​ Some tachycardia -​ NI: monitor I/O and daily weights Hyponatremia -​ Causes: -​ Diuretics -​ GI loss -​ Too much water (SIADH) - ADH helps conserve water **** -​ Water intoxication, psychogenic polydipsia -​ Treatment: -​ Add sodium (IV fluids/saline) -​ Restrict water intake -​ Administer diuretics -​ S/sx: -​ Edema: not enough sodium to hold water in vascular system- water enters tissues and causes edema -​ Pulmonary edema (fluid in lungs, shallow breaths) -​ Cerebral edema (neuro changes) -​ If a pt is bed bound, edema may be more present in back and butt- risk for ulcers