ELECTROLYTE IMBALANCES PRACTICE EXAM QUESTIONS WITH ALL CORRECT SOLUTIONS!!

ELECTROLYTE IMBALANCES PRACTICE EXAM QUESTIONS WITH ALL CORRECT SOLUTIONS!! hyponatremia assessment findings - Answer-Neuro - Generalized skeletal muscle weakness. Headache / personality changes, confusion. CV - Cardiac changes depend on fluid volume GI - Increased GI motility, Nausea, Diarrhea (explosive) GU - Increased urine output CONFUSION IS THE FIRST SIGN OF HYPONATREMIA Think cellular swelling.....first manifested in the CNS hyponatremia Interventions/Treatment - Answer-Fluid restriction- 1500mL/day Only in severe cases do we administer drugs to reverse treat depending on cause: Na imbalance is usually result of fluid imbalance FVE- restrict fluids FVD- replace fluids with isotonic sodium containing solutions, encourage oral intake, withhold diuretics Severe cases: FVD- small amounts of IV hypertonic saline (2-3% sodium chloride) can be given. FVE- Administer osmotic diuretic (Mannitol) to excrete the water rather than the sodium. Hypernatremia (145mEq/L) contributing factors - Answer-Iv fluids- Hypertonic and excessive isotonic solution High fever, heatstroke Diarrhea Diabetes insipidus (A disorder of salt and water metabolism marked by intense thirst and heavy urination.) Uncontrolled diabetes mellitus Dehydration hypernatremia Assessment findings: - Answer-Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle weakness. Diminished deep tendon reflexes CV - Diminished CO. HR and BP depend on vascular volume. GI- Intense thirst- polydipsia GU - Dec. urine output. Inc. specific gravity Skin - Dry, flaky skin. hypernatremia Interventions/Treatment - Answer-Drug therapy .45% NS or D5W (5% dextrose in water) Diet therapy Mild - Ensure water intake precaution in administering Na - Answer-serum Na levels should not be decreased by more than 8-15 mEq/L in an 8 hour period. quickly reducing levels can cause a rapid shift of water into the cells resulting in edema. this risk is greatest in those who developed hypernatremia over several days calcium function - Answer-Formation of teeth and bone Blood clotting Transmission of nerve impulses Myocardial contractions Muscle contractions Calcium is necessary for many metabolic processes. Hypocalcemia (9.0mg/dL) Contributing factors: - Answer-Dec. oral intake (source of calcium in diet) Lactose intolerance Dec. Vitamin D intake mostly seen in end stage renal disease and diarrhea Hyperphosphatemia Immobility- long term like paralyized Hypocalcemia can be caused by any condition that results in a decrease in the production of PTH (parathyroid hormone). This may occur with surgical removal of a portion of or injury to the parathyroid glands during thyroid or neck surgery. Acute pancreatitis is another potential cause of hypocalcemia. Lipolysis, a consequence of pancreatitis, produces fatty acids that combine with calcium ions, decreasing serum calcium levels. Sudden alkalosis may also result in symptomatic hypocalcemia despite a normal total serum calcium level. The high pH increases calcium binding to protein, decreasing the amount of ionized calcium. Hypocalcemia can occur if there is increased loss of calcium as a result of laxative abuse and malabsorption syndromes adverse result of blood transfusion on calcium - Answer-hypocalcemia can result becasue the citrate used to anticoagulate the blood binds with calcium decreasing ionized calcium levels (free/active calcium) hypocalcemia assessment findings - Answer-Neuro -Irritable muscle twitches. Positive Trousseau's sign. -BP cuff on for 2 minutes, hand curls up into claw. (carpopedal spasm) Positive Chvostek's sign- twitching of the facial muscles in response to tapping over the area of the facial nerve. Dysphagia- trouble swallowing FIRST SIGN: Tingling around the mouth or in the extremities Resp. - Resp. failure r/t muscle tetany (sustained muscle contraction) CV -Dec. HR., dec. BP, diminished peripheral pulses GI - Inc. motility. Inc. BS. Diarrhea how does low calcium levels effect action potential - Answer-Low levels of calcium allow sodium to move into excitable cells, decreasing the threshold of action potentials with subsequent depolarization of the cells. This results in increased nerve excitability and sustained muscle contraction (tetany). hypocalcemia interventions and treatment - Answer-Drug Therapy: Calcium supplements Vitamin D Diet Therapy High calcium diet (dairy) Prevention of Injury Seizure precautions- Keep the bed low, padded side rails. If they have a seizure roll them on their side in case they vomit and make sure they don't hurt them selves. Just let them have the seizure. Most will stop on their own. Document when it started, how long it lasted, what it looked like (arm, full body, etc.) babies seizing is rhythmic. Adults is jerky. what vitamin activates calcium - Answer-Vitamin D hypercalcemia (10.5mg/dL) S/S - Answer-Leads to reduced excitability of both muscle and nerves. Depressed reflexes Weakness Confusion n/v Cardiac changes hypercalcemia contributing factors - Answer-Excessive calcium intake- usually supplements Excessive vitamin D intake Renal failure Hyperparathyroidism (80%) Malignancy (cancers)- destruction from tumor invasion or tumor secretion of parathyroid related proteins which stimulate clacium release from bones. Hyperthyroidism Prolonged immobilization