The top electrolyte labs that you need to know for the NCLEX here. So sodium 135 to 145. Remember the double S's of sodium. Sodium swells the body with fluid.
So with low sodium, we end up with low and slow signs and symptoms. Mental status change is a priority. As well as seizures and coma and respiratory arrest.
from low and slow respirations. And in high sodium, we get big and bloated, since it swells the body with fluid. So we see edema, our swollen body, increased muscle tone, and flushed red and rosy skin signs.
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Visit simplenursing.com. Now for potassium, this is 3.5 to 5.0. Now this is the number one electrolyte to know for the NCLEX and nursing exams. So just think of the three Ps of potassium. So potassium is priority since it pumps the muscles.
So let's cover all the key points from our med-surg video here. So just think high potassium, we have high pumps. So we get peak T waves and ST elevations for potassium over 5.0.
And the exact opposite for low potassium below 3.5, just think low pumps. So we get flat T waves and ST depression and even this weird little U wave. What the heck's a U wave?
Shut up, you. Now we have potassium wasting and potassium sparing diuretics. Potassium wasting ends in I like furosemide or hydrochlorothiazide. Both rhyme with dried. But again, be careful, not isosorbide.
That's a nitrate guys, the NCLEX will try and trick you. So remember the O's in ISO-SO make it a vasodilator, similar to nitro. Now loop diuretics like furosemide and torsemide are the first drugs we use in acute or that worsening heart failure.
So NCLEX keywords like worsening crackles, new edema in the legs, and even rapid weight gain. Guys, we give ides to make the body dried. These guys work by blocking the reabsorption of sodium in the kidneys. So with less sodium retained, we have less swelling retained, and our patient is saved.
Now we only give potassium wasters if potassium is normal, between 3.5 and 5.0. Anything less than 3.5 is a big no-no, guys. We don't give the drug.
So we encourage our patients to eat melons, bananas, green leafy veggies, and even liver. And a big no-no here, we avoid licorice root. which lowers potassium like those found in black licorice candy. That's a common select all that apply question.
So just remember the double L's here. Licorice lowers potassium. Now potassium sparing diuretics, S for spironolactone, just think S for spares the potassium.
Just like prils and sartan, this spares potassium too. But instead of blocking the angiotensin, this guy blocks aldosterone directly to let fluid out of the body and into the body. Subtitles by the Amara.org community Since spironolactone spares the potassium, we teach patients to avoid those potassium-rich foods, guys.
So we don't eat those green leafy veggies, those melons, avocados, and we avoid that salt substitute. And again and again, any potassium abnormality, the first nursing action is to place them on a cardiac monitor. Always ask them the NCLEX and exams as a priority intervention.
Lastly, since potassium pumps the muscles, NCLEX keywords like muscle spasm and even muscle cramps, this indicates a potassium problem. Even words like weakness or paresthesias. So with potassium wasters that lower potassium, think low pumps in the heart, we get flat T waves and ST depression.
And also this little weird U wave. Now a little side note, if you have to replace potassium via IV, well guys, don't kill your patient. We never push potassium IV. This means instant death. death we always give it IV bag over an hour or more guys never 30 minutes and not even 45 minutes one hour or more so the four rules of potassium revolve around protecting the heart with potassium number one our first action is heart monitor placement and secondly guys we never push potassium this means sudden death the heart will cramp up and not pump anymore Third, we only do 10-20 mLs max per hour, not 30 minutes, not even 45 minutes, per hour, a full 60 minutes or more, usually around 4 hours.
And lastly, we always put potassium on an IV pump, never a solo drip, it's too risky. And as always, slow the infusion pump if the arm starts burning, which is pretty common. Okay, now that you know how to fix the low potassium, well, how do you treat the high potassium over 5.0? With those high pumps in the heart, leading to deadly cardiac dysrhythmias. Now this gets a little tricky here.
The NCLEX loves... to ask about clients with renal failure or chronic kidney failure who have built up a lot of potassium waiting for dialysis since their kidneys are broken and can't urinate out that potassium from the body and into the potty so let's play a segment from our renal failure videos so key terms to know peak t waves happens when potassium is six to seven microequilibrium per liter ST elevation happens when potassium is between 7 to 8. And wide QRS complexes is a late sign, over 8. Basically, the heart is cramping up from too much potassium. Too much high pumps makes a very tight heart that is just basically cramping all up. You have to think that the heart's a muscle, right? So, do you really think the heart can pump normal if this muscle is cramping?
Well, no. So this leads to bradycardia, that low heart rate, since the heart is too tight and can't beat correctly. And which ultimately results in weakness, fatigue, and lethargy from less cardiac output, meaning less oxygen out of the heart into the body. And then finally, leading to deadly ventricular dysrhythmias like VTAC and VFib, that ventricular tachycardia and ventricular fibrillation.
If not treated immediately, this will cause death by cardiac arrest. Basically, that stopped heart. So that's why potassium is priority on the NCLEX and nursing exams, since it pumps those heart muscles.
Now Kaplan had a scenario asking a client with kidney disease is very weak, lethargic, and bradycardic. Asking for a suspected finding for this patient. So the key term here is kidney disease. That is weak, lethargic, and bradycardic, that low heart rate. So you have to automatically prioritize and think about potassium here.
So potassium 8.5 is the lab value to be suspected. Now, in terms of treatments, the long-term solution is to wash the blood with dialysis. But this can take some time to set up. So the immediate priority solution in treatment is to lower the potassium and protect the heart from deadly dysrhythmias. We do this with drugs in a very specific order.
So write this down for priority treatment. Number one is IV calcium gluconate. For the key term, write this down, dysrhythmias. Just think. Gluconates helps to glue down those crazy heart muscles, preventing deadly dysrhythmias, like wide QRS complexes, which will eventually progress into deadly VTAC and VFib.
We must glue down those heart muscles with calcium gluconate. Now, if the key term of dysrhythmias is not involved in the question, then we progress to number two, which is IV 50% dextrose and regular insulin. This helps to lower the potassium.
So just think, insulin puts sugar and potassium into the cell, out of the blood and into the cell, which lowers blood serum and potassium. Most effective way to lower blood potassium very quickly. But insulin also lowers blood glucose too, basically that blood sugar.
So that's why we also give dextrose to help prevent that low blood sugar, that hypoglycemia. Now, don't let the NCLEX trick you here. What if the key term dysrhythmias is not in the question? Well, then we progress to option two, which is just to give the IV dextrose and insulin first.
to lower that high potassium. And lastly, three and four, we can also give K-exolate, that polystyrene sulfonate, as well as dialysis. But again, these typically take longer to lower potassium, so that's why we put them last here on the list, because they take a longer time.
Now for the top two missed NCLEX questions. So question number one, a patient with chronic kidney disease missed three dialysis sessions. Uh-oh.
With key terms here, Potassium level of 8.1, wide QRS complexes, a heart rate of 58, and lethargy. Which order or prescription should the nurse implement first? So the key term here is high potassium with wide QRS complexes. That key term indicates dysrhythmias. So just think, you have to give calcium gluconate first to glue down those crazy heart muscles.
and prevent the progression into those deadly heart dysrhythmias. So option number four, IV calcium gluconate, because the key term was about dysrhythmias and high potassium. Now question number two, end-stage renal disease with a potassium of 7.2, a BUN of 35, creatinine of 38, and urinary output of 300 mLs in 24 hours.
Which order is priority? So this question says high potassium, right? But nothing about ECG dysrhythmias or basically heart dysrhythmias.
So we need to lower that potassium first with insulin, which puts sugar and potassium into the cell. So option number one, IV regular insulin and 50% dextrose. Yes, we give this first. Not loop diuretics and not...
dialysis. This is used later and definitely not option number four, the vacation time, even though it's pretty tempting. Now, next up is calcium 9.0 to 10.5.
Think of the double C's. Calcium contracts the muscles with smooth contractions here when it's in balance. So for low calcium, we have diarrhea, not so smooth contractions of the GI tract.
And we have two dance moves, T and C. We have trussos, is a twerking arm with a BP cuff on. And for C, we have shavostics, or just fostics.
Think C, the cheek smile when stroking the face. And for high calcium, just think high contractions. We have stones, moans, and groans.
So all that calcium leads to kidney stones. And high contractions inside the GI will lead to constipation. Next is magnesium. 1.3 to 2.1. Just think of the double M's.
Magnesium mellows out the muscles. So low magnesium, we get low mellow. Basically, hyper excitability, the opposite of mellow. So we have torsades de pointes and V-fib, two deadly cardiac dysrhythmias that will kill your patient.
So write those down. Remember, on the NCLEX, the most deadly complication is the most tested complication. Next is hyperreflexia, as well as increased DTRs, those deep tendon reflexes.
And for high magnesium, we have high mellow. Everything is just mellowed out. So decreased DTRs and hyporeflexia here.
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