NUR 2392
Multidimensional
Care II Exam 2 Study
Guide
HYPERKALEMIA
Role: K+ is responsible for nerve impulse conduction & muscle contractions
Normal
... [Show More] Range 3.5-5.0 mEq/L............ > 5.0 mEq/L
> K+ in ECF
Causes: The body “CARED” too much for K+
Cellular movement of K+ from ICF to ECF (tissue damage, burn, acidosis)
Adrenal insufficiency (Addison’s disease)
Renal failure
Excessive K+ intake
Drugs (K+ sparing such as Aldactone, Triamterene, ACE inhibitors, NSAIDs)
S/S: “MURDER”
Muscle weakness
Urine production (low or absent)
Respiratory failure (muscle weakness)
Decreased cardiac contractility (weak pulse, ↓ BP)
Early signs of muscle twitching (muscle twitching, cramps-early) (flaccid-late)
Rhythm changes (tall peaked T wave, flat or absent P wave, wide QRS & prolonged PR interval)
Interventions:
Monitor cardiac, respiratory, neuromuscular, & GI status
Stop IV K+ infusion or supplements
Initiate K+ restrictive diet
Prepare patient for dialysis
Kayexalate oral or enema (promotes K+ excretion)
Hypertonic IVF to put K+ back in the cell
HYPOKALEMIA
Role: K+ is responsible for nerve impulse conduction & muscle contractions
Normal Range 3.5-5.0 mEq/L......... < 3.5 mEq/L
K+ loves ICF; serum test is ECF
Causes: “DITCH” potassium
Drugs (laxatives, diuretics, corticosteroids)Inadequate intake of K+ (NPO, anorexia, nausea)
Too much water intake (dilutes K+)
Cushing’s syndrome (↑ secretion of aldosterone)
Heavy liquid loss (Na+ suction, vomiting, diarrhea, wound drainage, sweating - DKA
S/S: Slow & Low - 7 L’s
Lethargic
Low, shallow respirations
Lethal cardiac changes
(depressed ST segment, flat or inverted T waves, prominent U-wave)
Loss of urine
Leg cramps
Limp muscles
Low BP & HR
Interventions:
Watch cardiac rhythm, respiratory status, GI & renal (urine output, BUN, Creatinine)
Watch Mg level (Mg+ & K+ go hand-in-hand)
Oral supplement-take with food, GI upset
IV infusion, not IVP, SQ, or IM, give slowly
Hold Lasix (diuretics are K+ wasting)
Encourage K+ rich foods
“POTASSIUM”
Potatoes, Pork
Oranges
Tomatoes
Avocados
Strawberries
Spinach
fIsh
mUshrooms
Musk melon-cantaloupe
Also carrots, raisins, bananas
HYPERNATREMIA
Role: Na+ helps regulate H20 in & out of the cellNormal range 136-145 mEq/L........> 145 mEq/L
Causes: “HIGH SALT”
Hypercortisolism (Cushing’s-overproduction of aldosterone = retaining Na+
Increased Na+ intake (oral or IV)
GI feeding (without adequate H20 supplement)
Hypertonic solution (e.g. 3% saline)
Sodium excretion ↓ (corticosteroids)
Aldosterone problems (↑ reabsorption of Na+)
Loss of fluids (dehydrated) fever, sweating
Thirst impairment
S/S: No “FRIED” foods for you
Fever; Flushed skin
Restlessness; Really agitated
Increased fluid retention
Edema, Extremely confused
Decreased urine output; Dry mouth/skin
Interventions:
Restrict Na+ intake
Patient safety-confused/agitated
Isotonic or hypertonic IVFs
Educate about diet & S/S of ↑ Na+ level
HYPONATREMIA
Role: Na+ helps regulate H20 in & out of the cell
Normal range 136-145 mEq/L........< 136 mEq/L
Na+ & H20 love each other
> Na+ ICF not ECF
Causes: “NO NA+”
Na+ excretion ↑ with renal problems
Overload of fluids
Na+ intake low (NPO or ↓ Na+ diet)
Antidiuretic hormone (oversecreted)S/S: “SALT LOSS”
Seizures & stupor
Abdominal cramping
Lethargic
Tendon reflex ↓; Trouble concentrating
Loss of urine & appetite
Orthostatic hypotension; Overactive bowel sounds
Shallow respirations (late sign) due to skeletal muscle weakness
Spasms of muscles
Interventions:
Hypovolemic-Hypertonic IV solution
Hypervolemic-restrict fluids, diuretics
Restrict fluids
Consume fluids rich in Na+ or tablets
Na+ Rich Foods:
Bacon
Butter
Canned foods
Hot dogs
Cheese
Processed foods
Table salt
Lunchmeat
HYPOMAGNESEMIA
Role: Mg+ is responsible for cell function such as transferring & storing energy
Regulation of the parathyroid hormone (plays a role in Ca+ level)
Metabolizes carbs, lipids, & proteins
Regulates BP
Absorbed in small intestine & excreted in the kidneys
*When release of Mg+ is inhibited Ca+ ↓ along with K+
Normal range 1.8-2.6 mEq/L........< 1.8 mEq/LCauses: “LOW MAG”
Limited intake of Mg+ (starvation)
Other electrolyte issues can cause ↓ Mg+; hypOkalemia; hypOcalcemia
Wasting Mg+ via kidneys (loop, thiazide, & cyclosporines)
Metabolism issues (Crohn’s, Celiac, “prazoles”)
Alcohol (poor dietary intake); stimulates kidneys to waste Mg+ & acute pancreatitis
Glycemic issues (DKA, insulin administration)
S/S: “TWITCHING”
Trousseau’s (due to ↓ Ca+)
Weak respirations
Irritability
Torsades de pointes (lethal rhythm); Tetany (involuntary contraction of muscles)
Cardiac changes (tall T waves, depressed ST segments; Chvostek’s +)
Hypertension
Involuntary movement
Nausea
GI issues (↓ bowel sounds, mobility)
Interventions:
Monitor cardiac, GI, respiratory, neuro
Give K+ oral supplements
Give Ca+ oral supplements
Administer Mg+ sulfate IV, monitor closely for diminished or absent DTRs
Place on seizure precautions
Oral Mg+ can cause diarrhea-wastes Mg+
Encourage Mg+ rich foods
Always Get Plenty Of Foods Containing Large Numbers Of Magnesium
Avocados
Green, leafy veggies
Peanut butter; Pork
Oatmeal
Fish
Cauliflower; Chocolate (dark)
Legumes
Nuts
OrangesMilk
HYPOMAGNESEMIA
Role: Mg+ is responsible for cell function such as transferring & storing energy
Regulation of the parathyroid hormone (plays a role in Ca+ level)
Metabolizes carbs, lipids, & proteins
Regulates BP
Absorbed in small intestine & excreted in the kidneys
*When release of Mg+ is inhibited Ca+ ↓ along with K+
Normal range 1.8-2.6 mEq/L........< 1.8 mEq/L
Causes: “LOW MAG”
Limited intake of Mg+ (starvation)
Other electrolyte issues can cause ↓ Mg+; hypOkalemia; hypOcalcemia
Wasting Mg+ via kidneys (loop, thiazide, & cyclosporines)
Metabolism issues (Crohn’s, Celiac, “prazoles”)
Alcohol (poor dietary intake); stimulates kidneys to waste Mg+ & acute pancreatitis
Glycemic issues (DKA, insulin administration)
S/S: “TWITCHING”
Trousseau’s (due to ↓ Ca+)
Weak respirations
Irritability
Torsades de pointes (lethal rhythm); Tetany (involuntary contraction of muscles)
Cardiac changes (tall T waves, depressed ST segments; Chvostek’s +)
Hypertension
Involuntary movement
Nausea
GI issues (↓ bowel sounds, mobility)
Interventions:
Monitor cardiac, GI, respiratory, neuro
Give K+ oral supplements
Give Ca+ oral supplements
Administer Mg+ sulfate IV, monitor closely for diminished or absent DTRs
Place on seizure precautionsOral Mg+ can cause diarrhea-wastes Mg+
Encourage Mg+ rich foods
Always Get Plenty Of Foods Containing Large Numbers Of Magnesium
Avocados
Green, leafy veggies
Peanut butter; Pork
Oatmeal
Fish
Cauliflower; Chocolate (dark)
Legumes
Nuts
Oranges
Milk [Show Less]