NUR 330 exam 1 UPDATED ACTUAL Questions and CORRECT
Answers
electrolyte values •Sodium: 136-145 mEq/L
• Potassium: 3.5-5 mEq/L
• Calcium: 9-10.5 mg/dL
• Magnesium: 1.3-2.1 mg/dL
• Chloride 98-106 mEq/L
hyponatremia and causes •Serum sodium less than 136 mEq/L
• Actual sodium deficits can occur (sodium loss):
• GI fluid loss
• Excessive diaphoresis
• Diuretics
• Burns
• Hyperglycemia
• Relative sodium deficit (water gain):
• Excessive ingestion of water
• Kidney failure
• Heart failure
• Hypotonic solution
hyponatremia- s/s •Cerebral changes: Caused by cerebral edema
• Decreased LOC
• Seizures
• Coma
• Weakness
• Intestinal changes
• Nausea, vomiting, diarrhea
• Cardiovascular changes
• Due to hypovolemia-fluid loss)- weak thready pulse, hypotension
Water gain (hypervolemia)- bounding pulse, normal to high BP
hyponatremia- treat and assess •Treat underlying condition
• Due to sodium loss: Sodium replacement
• Depending on severity: May require hypertonic saline
• Due to water gain: Water restriction
• Diuretics
• Nutritional therapy
• Priority: monitor for response to therapy and prevent HYPERnatremia
• Assessment: I&O, daily weight, lab values, CNS changes
• Safety
,hypernatremia - causes •Serum sodium greater than 145 mEq/L
• Actual sodium excess (gain):
• Hyperaldosteronism
• Kidney failure
• Corticosteroids
• Cushing syndrome or disease
• Excessive intake or IVF with sodium
• Relative sodium excess (water loss):
• Dehydration
• Fever
• Hyperventilation
• Infection
• Excessive diaphoresis
• Diarrhea
hypernatremia- s/s •Vary with severity
• Thirst
• Nervous system:
• Change in LOC
• Agitation or confusion
• Lethargic to comatose
• Skeletal muscle:
• Twitching or abnormal contractions
• Cardiovascular:
• Decrease cardiac contractility
• BP and pulse monitoring
hypernatremia- treat •Gradual lowering of serum sodium levels
• When caused by fluid loss:
• IV fluids (NS or D5% 0.45% NS)
• If not caused by fluid loss:
• D5W
• Diuretics
• Nutritional therapy
• Continue to assess for:
• abnormal loss of water and low water intake
• over-the-counter sources of sodium
• CNS changes
hypokalemia- causes •Below-normal serum potassium <3.5 mEq/L
• Actual potassium deficits:
• Medications
• Cushing syndrome or disease
• GI losses
• NGT suctioning
• Relative potassium deficits
• Alkalosis
• Insulin administration
• TPN
• Water intoxication (fluid excess)
•
, hypokalemia- s/s •Medication history
• Diuretics, corticosteroids, IV insulin for ketoacidosis
• Cardiac changes!
• Monitor EKG , rhythm, rate, force
• Respiratory changes
• Muscle weakness and shallow resps
• Muscular changes
• Skeletal mm weakness
• Change in LOC, abdominal distension and hypoactive BS
hypokalemia- treat •Prevent potassium loss, increase K+ levels and patient safety
• Drug therapy: Potassium
• PO: can be liquid or pill
• May cause N/V - take with food
• IV: Careful administration is essential
• Never give IV push always administered through an infusion pump
• Should not exceed 10 mEq/hr
• Nutritional therapy
• Safety
hyperkalemia- causes •Serum potassium greater than 5.0 mEq/L
• Rare in patients with normal renal function
• Increased risk in older adults
• Causes: Impaired renal function, rapid administration of potassium,
hypoaldosteronism, medications, tissue trauma, acidosis
hyperkalemia- s/s •H& P
• Medications
• Cardiovascular:
• Monitor ECG, assess labs, monitor I&O, obtain apical pulse
• Neuromuscular
• Twitching, numbness, tingling
• Followed by flaccid paralysis including respiratory muscles
• Intestinal
• Diarrhea and hyperactive BS
hyperkalemia- treat •Administration of cation exchange resins (Sodium polystyrene sulfonate)
• Potassium wasting diuretics (loop) in pts with normal kidney function
• Dialysis
• Emergent care: IV calcium gluconate, IV sodium bicarbonate, IV regular insulin
and dextrose IV
• Prevention: Administer IV potassium replacement slowly and with an infusion
pump
Limitation of dietary potassium and dietary teaching
hypocalcemia- causes •Serum level less than 9 mg/dL
• Serum calcium level controlled by parathyroid hormone and calcitonin
• Causes: hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis,
multiple blood transfusions, kidney injury, medications
Answers
electrolyte values •Sodium: 136-145 mEq/L
• Potassium: 3.5-5 mEq/L
• Calcium: 9-10.5 mg/dL
• Magnesium: 1.3-2.1 mg/dL
• Chloride 98-106 mEq/L
hyponatremia and causes •Serum sodium less than 136 mEq/L
• Actual sodium deficits can occur (sodium loss):
• GI fluid loss
• Excessive diaphoresis
• Diuretics
• Burns
• Hyperglycemia
• Relative sodium deficit (water gain):
• Excessive ingestion of water
• Kidney failure
• Heart failure
• Hypotonic solution
hyponatremia- s/s •Cerebral changes: Caused by cerebral edema
• Decreased LOC
• Seizures
• Coma
• Weakness
• Intestinal changes
• Nausea, vomiting, diarrhea
• Cardiovascular changes
• Due to hypovolemia-fluid loss)- weak thready pulse, hypotension
Water gain (hypervolemia)- bounding pulse, normal to high BP
hyponatremia- treat and assess •Treat underlying condition
• Due to sodium loss: Sodium replacement
• Depending on severity: May require hypertonic saline
• Due to water gain: Water restriction
• Diuretics
• Nutritional therapy
• Priority: monitor for response to therapy and prevent HYPERnatremia
• Assessment: I&O, daily weight, lab values, CNS changes
• Safety
,hypernatremia - causes •Serum sodium greater than 145 mEq/L
• Actual sodium excess (gain):
• Hyperaldosteronism
• Kidney failure
• Corticosteroids
• Cushing syndrome or disease
• Excessive intake or IVF with sodium
• Relative sodium excess (water loss):
• Dehydration
• Fever
• Hyperventilation
• Infection
• Excessive diaphoresis
• Diarrhea
hypernatremia- s/s •Vary with severity
• Thirst
• Nervous system:
• Change in LOC
• Agitation or confusion
• Lethargic to comatose
• Skeletal muscle:
• Twitching or abnormal contractions
• Cardiovascular:
• Decrease cardiac contractility
• BP and pulse monitoring
hypernatremia- treat •Gradual lowering of serum sodium levels
• When caused by fluid loss:
• IV fluids (NS or D5% 0.45% NS)
• If not caused by fluid loss:
• D5W
• Diuretics
• Nutritional therapy
• Continue to assess for:
• abnormal loss of water and low water intake
• over-the-counter sources of sodium
• CNS changes
hypokalemia- causes •Below-normal serum potassium <3.5 mEq/L
• Actual potassium deficits:
• Medications
• Cushing syndrome or disease
• GI losses
• NGT suctioning
• Relative potassium deficits
• Alkalosis
• Insulin administration
• TPN
• Water intoxication (fluid excess)
•
, hypokalemia- s/s •Medication history
• Diuretics, corticosteroids, IV insulin for ketoacidosis
• Cardiac changes!
• Monitor EKG , rhythm, rate, force
• Respiratory changes
• Muscle weakness and shallow resps
• Muscular changes
• Skeletal mm weakness
• Change in LOC, abdominal distension and hypoactive BS
hypokalemia- treat •Prevent potassium loss, increase K+ levels and patient safety
• Drug therapy: Potassium
• PO: can be liquid or pill
• May cause N/V - take with food
• IV: Careful administration is essential
• Never give IV push always administered through an infusion pump
• Should not exceed 10 mEq/hr
• Nutritional therapy
• Safety
hyperkalemia- causes •Serum potassium greater than 5.0 mEq/L
• Rare in patients with normal renal function
• Increased risk in older adults
• Causes: Impaired renal function, rapid administration of potassium,
hypoaldosteronism, medications, tissue trauma, acidosis
hyperkalemia- s/s •H& P
• Medications
• Cardiovascular:
• Monitor ECG, assess labs, monitor I&O, obtain apical pulse
• Neuromuscular
• Twitching, numbness, tingling
• Followed by flaccid paralysis including respiratory muscles
• Intestinal
• Diarrhea and hyperactive BS
hyperkalemia- treat •Administration of cation exchange resins (Sodium polystyrene sulfonate)
• Potassium wasting diuretics (loop) in pts with normal kidney function
• Dialysis
• Emergent care: IV calcium gluconate, IV sodium bicarbonate, IV regular insulin
and dextrose IV
• Prevention: Administer IV potassium replacement slowly and with an infusion
pump
Limitation of dietary potassium and dietary teaching
hypocalcemia- causes •Serum level less than 9 mg/dL
• Serum calcium level controlled by parathyroid hormone and calcitonin
• Causes: hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis,
multiple blood transfusions, kidney injury, medications
