Fluids & Electrolytes

Question 1

Processes calcium is involved in:

Answer 1

1. ) Bone formation
2. ) Blood coagulation
3. ) Contraction of cardiac and skeletal muscle
4. ) Maintenance of muscle tone
5. ) Conduction of nerve impulses
6. ) Synthesis and regulation of endocrine and exocrine glands

Question 2

Normal calcium ranges:

Answer 2

8.6 to 10 mg/dL

Question 3

Processes magnesium is involved in:

Answer 3

1. ) Needed for use of ATP as a source of energy
2. ) Needed for the action of numerous enzyme systems:
   - Carbohydrate metabolism
   - Protein synthesis
   - Nucleic acid synthesis
   - Contraction of muscular tissue
3. ) Regulates nerve activity
4. ) Regulates the clotting mechanism

Question 4

Normal magnesium ranges:

Answer 4

1.6 to 2.6 mg/dL

Question 5

Processes potassium is involved in:

Answer 5

1. ) Nerve conduction
2. ) Muscle function
3. ) Acid-base balance
4. ) Osmotic pressure
5. ) Controls rate and force of contraction of the heart (along with calcium and magnesium)

Question 6

Normal potassium ranges:

Answer 6

3.5 to 5.1 mEq/L

Question 7

Processes phosphorous is involved in:

Answer 7

1. ) Generation of bony tissue
2. ) Metabolism of glucose and lipids
3. ) Maintenance of acid-base balance
   - Binds with H+
4. ) Storage and transfer of energy from one body site to another

Question 8

Normal phosphorous ranges:

Answer 8

2.7 to 4.5 mg/dL

Question 9

Processes sodium is involved in:

Answer 9

1. ) Regulates osmolality
2. ) Fluid balance
3. ) Promotes transmission of nerve impulses to muscles and tissues
4. ) Helps maintain acid-base balance

Question 10

Normal sodium ranges:

Answer 10

135 to 145 mEq/L

Question 11

Causes of Hypernatremia:

Answer 11

1. ) Dehydration (e.g. low fluid intake, increased metabolic rate, fever, hyperventilation, infection, excessive diaphoresis, watery diarrhea, diabetes insipidus [DI])
2. ) Excessive sodium intake
3. ) Decreased sodium output (e.g. Corticosteroids, Cushing’s Syndrome, Renal failure, Hyperaldosteronism)

Question 12

S&S of Hypernatremia:

Answer 12

1. ) Irritability, Restlessness, Confusion, Seizures, Lethargy, Coma
2. ) Thirst, Dry mucous membranes
3. ) Decreased urinary output
4. ) Flushed skin
5. ) Orthostatic hypotension (from fluid loss)
6. ) Fever
7. ) Pulmonary edema (if hypervolemia present)
8. ) Muscle changes: (Early = Muscle twitches, irregular muscle contractions; Late = Skeletal muscle weakness, depressed/absent deep tendon reflexes)
9. ) Possible edema (if hypervolemia present)
10. ) Increased urinary specific gravity
11. ) Increased BP

Question 13

Interventions for Hypernatremia:

Answer 13

1. ) Monitor cardiovascular, respiratory, neruomuscular, cerebral, renal, and integumentary status
2. ) Monitory I&O
3. ) Daily Weight (gain of 2 or more lbs in 4 days must be reported)
4. ) Assess for edema
5. ) Monitor for seizure risk
6. ) Administer IV infusion (sodium-free isotonic fluids, e.g. D5W, followed by 0.45% NS) (if cause is fluid loss)
7. ) Administer diuretics that promote sodium loss (if cause is inadequate renal excretion of sodium)
8. ) Restrict sodium and fluid intake

Question 14

Causes of Hyponatremia:

Answer 14

1. ) Increased sodium excretion (excessive diaphoresis, diuretics, vomiting, diarrhea, wound drainage [especially GI], renal disease, decreased secretion of aldosterone)
2. ) Inadequate sodium intake (NPO, Low-salt diet)
3. ) Dilution of serum sodium (Excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids, renal failure, freshwater drowning, SIADH, hyperglycemia, CHF)

Question 15

S&S of Hyponatremia:

Answer 15

From Sodium loss:

1. ) Irritability, apprehension, confusion
2. ) Postural hypotension and tachycardia
3. ) Decreased CVP and decreased jugular vein filling
4. ) Weight loss and dry mucous membranes
5. ) Tremors, seizures, and coma
6. ) Cerebral edema (if <125 mEq/L)

From Fluid gain:

1. ) Headache, apathy and confusion
2. ) Weight gain, increased BP, elevated CVP
   * 3.) Hallmark signs: Nausea, vomiting, anorexia, lethargy, and weakness
3. ) Increased urinary output
4. ) Cerebral edema

Question 16

Interventions for Hyponatremia:

Answer 16

1. ) Closely monitor neurologic signs during sodium replacement
2. ) Daily weights
3. ) Monitor I&O (loss or gain of 4.4 lb is equal to 2 L of fluid)
4. ) Check urine color, consistency, and amount
5. ) Monitor vital signs
6. ) Assess for intravascular overload during infusion of sodium solutions (tachypnea, tachycardia, and SOB)

Question 17

Causes of Hyperkalemia:

Answer 17

1. ) Excessive potassium intake (overingestion of K+ containing foods/medications, rapid infusion of potassium-containing IV solutions).
2. ) Decreased potassium excretion (K+ sparing diuretics, renal failure, adrenal insufficiency [Addison’s disease])
3. ) Movement of potassium from ICF to ECF (tissue damage, acidosis, hyperuricemia, hypercatabolism)

Question 18

S&S of Hyperkalemia:

Answer 18

1. ) Muscle cramps/Weakness in lower extremities
2. ) Diarrhea and hyperactive bowel sounds
3. ) Numbness and tingling in the extremities
4. ) Lethargy and fatigue
5. ) Bradycardia
6. ) Hypotension
7. ) Cardiac dysrhythmias (ectopic beats)
8. ) ECG changes
   - Tall, peaked T waves and flat or absent P waves
   - Shortened QT intervals
   - ST segment depression, prolonged PR interval, widened QRS complex ( >8 mEq/L)

Question 19

Interventions for Hyperkalemia:

Answer 19

1. ) Monitor cardiovascular, respiratory, neuromuscular, renal, and gastrointestinal status (*Place on cardiac monitor)
2. ) Discontinue IV potassium and hold oral potassium supplements
3. ) Initiate potassium-restricted diet
4. ) Prepare to administer K+ excreting diuretics if renal function is not impaired
5. ) If renal function IS impaired, administer Kayexalate (a cation exchange resin that promotes gastrointestinal Na+ absorption and K+ excretion).
6. ) Dialysis (if K+ level critically high)
7. ) IV administration of hypertonic glucose with regular insulin to move excess K+ into the cells.
8. ) Monitor renal function
9. ) Teach pt to avoid foods high in potassium
10. ) Teach pt to avoid use of salt substitutes or other K+ containing substances.

Question 20

Causes of Hypokalemia:

Answer 20

1. ) Total K+ loss (Excessive use of medications such as diuretics or corticosteroids, increased secretion of aldosterone [such as in Cushing’s syndrome], vomiting, diarrhea, wound drainage [particularly GI], prolonged NG suction, excessive diaphoresis, renal disease impairing reabsorption of K+)
2. ) Inadequate K+ intake
3. ) Movement of K+ from ECF to ICF (alkalosis, hyperinsulinism)
4. ) Dilution of serum K+ (water intoxication, IV therapy with K+ -poor solutions).

Question 21

S&S of Hypokalemia:

Answer 21

1. ) Fatigue and weakness (early sign)
2. ) Leg cramps (early sign)
3. ) Weak, irregular pulse
4. ) Hyperglycemia cause by the impaired release of insulin
5. ) Decreased GI motility - Nausea, vomiting, and paralytic ileus
6. ) Bradycardia
7. ) ECG changes
   - Flattened T wave, eventual prominent U wave
   - ST segment depression, slightly peaked P wave
   - Frequent premature ventricular contractions (PVCs)
   - Inability to concentrate urine and diuresis

Question 22

Interventions for Hypokalemia:

Answer 22

1. ) Monitor cardiovascular, respiratory, neuromuscular, GI, and renal status (*Place on cardiac monitor)
2. ) Monitor electrolyte values
3. ) Administer K+ supplements orally, IV
4. ) Oral potassium supplements (should not be taken on empty stomach)
5. ) IV administered K+
6. ) If taking a K+ -losing diuretic, it may be d/c (may be replaced with a K+ -sparing diuretic)
7. ) Instruct about foods high in K+ content.

Question 23

What is the recommended amount of Potassium to infuse through IV?

Answer 23

Recommended: A dilution of no more than 1 mEq/10 mL of solution

• After adding K+ to the IV solution, rotate and invert the bag to distribute the K+.
• The MAX recommended infusion rate is 5 to 10 mEq/hr, NEVER to exceed 20 mEq/hr
• Potassium can cause irritation or phlebitis to blood vessels. Therefore, frequently check the site. Stop the infusion immediately if this occurs.
• Monitor renal function before administering K+.

Question 24

Causes of Hypocalcemia:

Answer 24

1. ) Inhibition of calcium absorption from the GI tract (inadequate oral intake of calcium, lactose intolerance, malabsorption syndromes [celiac sprue, Crohn’s disease], inadequate intake of vitamin D, End-stage renal disease)
2. ) Increase calcium excretion (renal failure [polyuric phase], diarrhea, steatorrhea, wound drainage [especially GI]
3. ) Conditions that decrease the ionized fraction of calcium (hyperproteinemia, alkalosis, medications such as calcium chelators or binders, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of the parathyroid glands)

Question 25

S&S of Hypocalcemia:

Answer 25

1. ) Muscle spasms or cramps in calf muscles or foot during rest 2. ) Tetany (numbness and tingling of nose, fingertips, and fingertips [paresthesias]) 3. ) Positive Chvostek sign 4. ) Positive Toursseau sign 5. ) Hyperreflexia 6. ) Laryngospasm 7. ) Dysrhythmias - Ventricular fibrillation - Prolonged QT interval >0.48 seconds - Elongation of ST segment 8. ) Cardiac contractility and BP decreases 9. ) Hypomagnesemia frequently occurs

Question 26

Interventions for Hypocalcemia:

Answer 26

1. ) Monitor cardiovascular, respiratory, neuromuscular, and GI status; Place pt on cardiac monitor 2. ) Administer calcium supplements orally or calcium IV - Warm the solution to body temperature before administering and administer slowly. 3. ) Administer medications that increase calcium absorption (Vitamin D, Aluminum hydroxide [reduces serum phosphorous, thereby increasing calcium levels]). 4. ) Reduce environmental stimuli 5. ) Initiate seizure precautions 6. )Move the client carefully, and monitor for signs of pathological Fx 7. ) Keep 10% calcium gluconate available for treatment of acute calcium deficit 8. ) Instruct the client to consume foods high in calcium.

Question 27

Causes of Hypercalcemia:

Answer 27

1. ) Increased calcium absorption (Excessive oral intake or calcium, Excessive oral intake of vitamin D) 2. ) Decreased calcium excretion (renal failure, use of thiazide diuretics) 3. ) Increased bone resorption of calcium (hyperparathyroidism, hyperthyroidism, malignancy [bone destruction from metastatic tumors], immobility, use of glucocorticoids) 4. ) Hemoconcentration (dehydration, use of lithium, adrenal insufficiency)

Question 28

S&S of Hypercalcemia:

Answer 28

1. ) Anorexia, nausea, and fatigue 2. ) Constipation 3. ) Polyuria 4. ) Dehydration 5. ) ECG changes - Shortened QT interval and ST segment - Depressed T wave - Bradycardia - Heart block

Question 29

Interventions for Hypercalcemia:

Answer 29

1. ) Monitor cardiovascular, respiratory, neuromuscular, renal, and GI status; Place pt on cardiac monitor. 2. ) D/C IV infusions of solutions containing calcium and oral medications containing calcium or Vitamin D. 3. ) D/C thiazide diuretics and replace with diuretics that enhance calcium excretion 4. ) Administer prescribed medications that inhibit calcium resorption from the bone (such as phosphorous, calcitonin [Calcimar], bisphosphonates, and prostaglandin synthesis inhibitors [aspirin, NSAIDS]) 5. ) Dialysis (if severe) 6. ) Monitor for urinary stone development 7. ) Instruct pt to avoid foods high in calcium. 8. ) Encourage increased oral fluid intake 9. ) Assess for changes in neurologic status q4h. 10. ) Encourage increased mobility

Question 30

Causes of Hypomagnesemia:

Answer 30

1. ) Insufficient magnesium intake (malnutrition/starvation, vomiting or diarrhea, malabsorption syndrome, celiac disease, Crohn's disease) 2. ) Increased magnesium secretion (medications such as diuretics, chronic alcoholism) 3. ) Intracellular movement of magnesium (hyperglycemia, insulin administration, sepsis)

Question 31

S&S of Hypomagnesemia:

Answer 31

1. ) Increased neruomuscular ability (secondary to hypocalcemia) - Leg and foot cramping - Tremors and hyperactive deep tendon reflexes - Twitching (positive Chvostek and Trousseau signs) 2. ) Cardiac dysrhythmias (atrial fibrillation and frequent PVCs) 3. ) Dysphagia 4. ) Paralytic ileus

Question 32

Interventions for Hypomagnesemia:

Answer 32

1. ) Review pt's medications for causes of low magnesium 2. ) Assess for dysphagia 3. ) Assess lab values for presence of hypokalemia and hypocalcemia 4. ) Instruct about magnesium-rich foods 5. ) Possible d/c of diuretics 6. ) Replace magnesium either orally or parenterally. - For IV, use magnesium sulfate - Administer at a slow rate (<150 mg/min) - *Never give magnesium as an IV bolus, may cause cardiac arrest 7. ) Seizure precautions

Question 33

Causes of Hypermagnesemia:

Answer 33

1. ) Increased magnesium intake (magnesium-containing antacids and laxatives, excessive administration of magnesium intravenously) 2. ) Decreased renal excretion of magnesium as a result of renal insufficiency

Question 34

S&S of Hypermagnesemia:

Answer 34

1. ) Muscular weakness, lethargy, drowsiness 2. ) Nausea, vomiting, and diaphoresis 3. ) hypotension, bradypnea, and bradycardia 4. ) Decreased deep tendon reflexes 5. ) Decreased LOC

Question 35

Interventions for Hypermagnesemia:

Answer 35

1. ) Assess neurologic status for mental status and reflex changes. 2. ) Closely monitor I&O and kidney function 3. ) Monitor vital signs; watch for bradycardia and hypotension 4. ) Provide a list of foods and drugs containing magnesium that should be avoided 5. ) Continuous cardiac monitoring for pts with elevated levels - Report a prolonged QT interval, a wide QRS complex, or presence of an atrioventricular (AV) block. 6. ) Carefully monitor serum magnesium levels in obstetric clients receiving magenium sulfate for the Tx of preeclampsia and preterm labor. 7. ) Evaluate the newborn's magnesium levels if the mother received magnesium sulfate immediately before delivery. 8. ) Administer IV solution containing calcium salts (calcium gluconate) for severe hypermagnesemia. 9. ) Administer diuretics for clients with normal renal function 10. ) D/C use of medications containing magnesium 11. ) Dialysis (if have renal failure)

Question 36

Causes of Hypophosphatemia:

Answer 36

1. ) Insufficient phosphorus intake (malnutrition, starvation) 2. ) Increased phosphorus excretion (hyperparathyroidism, malignancy, use of magnesium-based or aluminum hydroxide-based antacids) 3. ) Intracellular shift (hyperglycemia, respiratory alkalosis).

Question 37

S&S of Hypophosphatemia:

Answer 37

1. ) Neurolgic symptoms: - Acute = confusion, seizures, coma - Chronic = memory loss, lethargy 2. ) Decreased strength: - Acute = difficulty speaking, weakness of respiratory muscles - Chronic = lethargy, weakness, joint stiffness 3. ) Decreased myocardial contractility with decreased cardiac output and BP *Acute symptoms result from a sudden decrease in phosphate; chronic symptoms occur when the loss is gradual

Question 38

Interventions for Hypophatemia:

Answer 38

1. ) Assess changes in LOC and orientation - Teach neurologic changes are temporary 2. ) Closely monitor rate of infusion of IV phosphorous 3. ) Monitor for sudden hypocalcemia, secondary to calcium phosphate binding, as a complication of IV phosphorus administration. 4. ) Cardiac monitoring during infusion of phosphorus (because of increased risk of dysrhythmias). 5. ) Assess for hypoxemia (because pts on ventilators are at higher risk for developing hypophosphatemia) 6. ) Evaluate mobility and the presence of bone pain. 7. ) (If Mild) Increase intake of foods high in phosphorus (dairy products). 8. ) (If Moderate) Treat with oral phosphorus supplements (Neutra-Phos) 9. ) (If Severe) Treat with IV infusion of phosphate.

Question 39

Causes of Hyperphosphatemia:

Answer 39

1. ) Decreased renal excretion (resulting from renal insufficiency) 2. ) Tumor lysis syndrome 3. ) Increased intake of phosphorus (including dietary intake or overuse of phosphate-containing laxatives or enemas) 4. ) Hypoparathyroidism

Question 40

S&S of Hyperphosphatemia:

Answer 40

*Reciprocal relationship to calcium exists. High phosphorus level relates to a low calcium level, which leads to hypocalcemia* 1. ) Tetany and twitching of muscles, especially of the hands and feet 2. ) Tingling, numbness, and cramps 3. ) Nervousness, irritability, and apprehension 4. ) Anorexia, nausea, and vomiting 5. ) Tachycardia, dysrhythmias, and conduction problems

Question 41

Interventions for Hyperphosphatemia:

Answer 41

1. ) Assess for constipation (caused by phosphate binders) 2. ) Assess for signs of hypocalcemia (tetany) 3. ) Monitor serum phosphate and calcium levels 4. ) Teach client to limit foods and substances (e.g. laxatives, enemas) high in phosphate

Question 42

Common food sources for Sodium:

Answer 42

Bacon, Butter, Canned food, Cheese, Frankfurters, Ketchup, Lunch Meat, Milk, Mustard, Processed food, Snack food, Soy sauce, Table salt, White and whole-wheat bread

Question 43

Common food sources for Potassium:

Answer 43

Avocado, Bananas, Cantalope, Carrots, Fish, Mushrooms, Oranges, Potatoes, Pork, Beef, Veal, Raisin, Spinach, Strawberries, Tomatoes

Question 44

Common food sources for Calcium:

Answer 44

Cheese, Collard greens, Milk and soy milk, Rhubarb, Sardines, Spinach, Tofu, Yogurt

Question 45

Common food sources for Magnesium:

Answer 45

Avocado, Canned white tuna, Cauliflower, Green leafy vegetables (e.g. spinach, broccoli), Milk, Oatmeal, Peanut butter, Peas, Pork, Beef, Chicken, Potatoes, Raisins, Yogurt

Question 46

Common food sources for Phosphorus:

Answer 46

Fish, Organ meats, Nuts, Pork, Beef, Chicken, Whole-grain breads and cereals