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Potassium balance
- normal blood level is 3.5-5
- potassium moves into cells: insulin(key brings sugar and K) , alkalosis(low K level) , anabolism(building cells)
- mostly in cells don't want too much in blood
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potassium balance
potassium moving out of cells
- =high blood K levels
- extreme exercise(cell damage)
- acidosis
- trauma to cells
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hypokalemia etiology
in the blood stream
- inadequate intake
- increased utilization
- increased losses-diarrhea
- alkalosis
- renal disorders
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cellular electrical activity
- lowers the resting membrane potential
- which you need more stimuli to reach threshold(weak and fatigued)
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hypokalemia symptoms: decreased neuromuscular irratibiltiy
- weakness"lazy muscles"
- speech changes-slurred
- flaccid paralysis-floopy.droopy
- shallow respirations, tachycardia
- decreased intestinal motility
- anorexia
- polyuria/nocuturia --kidneys can't concentrate and blood vessels relax..
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hypokalemia sx: cardia smooth muscle weakness
- due to the electrical effect K has on heart
- arrythmias(depends on how sensitive the person is)
- hypotension
- arrest
main intervention is EKG
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hypokalemia: nursing care
- K replacement( squash,peaches, bananas, potatoes) orangy foods..used for long term
- oral meds(KCl) (powder and orange juice tang) -hard on stomach
- IV replacement: not undiluted, beware of infiltration(burn), EKG,
- toxicity(kidney disease decrease excretion,
- digoxin(inotropic agent-heart beats stronger and slower)/lasix-diruetic ..k wasting.. loose too much k and makes digoxin toxic
- never give pure K always dilute
- add it to iv bag(its irritating to the vein )
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Hyperkalemia etiology
- potassium retention=renal failure, decreased aldosterone production(saving K)
- excessive release from cells=burns, trauma, infection, acidosis
- excessive k iv (med error)
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cellular electrical activity for hyperkalemia
raises the rmp...lots of firing its easy to excite
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Hyperkalemia symptoms:increased neuromuscular irritability
- intestinal colic
- diarrhea
- muscle twitching progressing to flaccid paralysis
- arrythmias
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hyperkalemia nursing care
- increase excretion =kayexalate enema(exchanges na for K ) -can also give orally
- redistribution (glucose plus insulin)-near death=short term
- NaHC03- correct acidosis
- diuretics-lasix
- correct ph(can be causing the problem..
- dialysis if renal prob
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calcium regulation
- serum calcium range 9-11
- parathyroid hormone increase=takes ca out of bone and into blood
- calcitonin(thyroid) decreases=ca back into blood
- vitamin D (in order to absorb ca..fat soluable)
- ca and phosphorous inverse relationship
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hypocalcemia etiology
- low pth production(females)
- acute pancreatitis(dump alkaline juice)
- multiple blood transfusion(citrate-lacatace =base)
- poor diet
- pregnancy(need to increase ca by 50% baby takes 10% of bone mass)
- alkalosis
Presence of alkaline binds to ca; when ca is bounded it doesn't count therefore its low ( or precipitate when in iv causing it to be chunky )
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cellular electrical activity
- lowers threshold ..overall distance decreased
- needs little stimulation
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hypocalcemia sX
same as alkalosis
irritability (ca decreases in presence of base)
- tingling
- muscle spam(trousseau's sign-inflate bp cuff and pinky and ring finger twitch easily )
- facial grimace( chvostek's sign-touch face-involuntary muscle spasm )
- laryngeospasm
- convulsions
- tetany
- ekg changes
- phosphorous level =high
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hypocalcemia nursing care
- oral replacement
- if tetany: calcium gluconate SLOWLy , watch for hypotension and bradycardia...never give IM
- watch for digoxin toxicity(enchanced by ca)-in presnece of low ca and K
- ca isn't well absorbed in presence of base
- citrical-acid with ca(ionized acid)
- wouldn't give tums because it is ca with antiacid
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hypercalcemia etiology
- hyperparathyroidism
- immobility= goes out of bones
- neoplasm-increase in cancer
- decreased renal excretion
- excess vitamin d =absorbed too much
- antacid overdose(contains ca)
- acidosis= ionized calcium
- come out of binding once its free it causes electrical activity
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hyperCA electrical activity
raises threshold...causing a larger stimulus to occur
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hypercalcemia sx
calcium deposits (flank pain, kidney stones, renal failure
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hypercalcemia sx
decreased GI
- consitpation
- peptic ulcer
- anorexia
- nausea
use tums to relief ulcer but you just got another dose of calcium
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hypercalcemia sx
decreased neuromuscular function
- lethargy
- exhaustion
- confusion
- coma
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hypercalcemia sx
bone decalcification
- bone pain
- osteoporois (holes in bones..decrease bone density)
- osteomalacia(weakness in bones)
- pathologic fractures(any stress breaks bones)
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hypercalemia nursing care
- increase excretion (diuretics)
- hydration with saline(increases excretion)
- mobilization - walking brings ca back into bones
- synthetic calcitonin(tones down ca)
- -beware of allergic response : antihistamine, epinephrine, and oxygen
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