metabolism | Coconote

all right so today we're going to do metabolisms this is going to be chapters 25 43 and 48 so just please be advised that these are not all chapters for chapters 43 it's just one page and chapter 48 is just these couple Pages these this is just magnesium and Hy and uh the calcium okay so hopefully by the end of this you'll able to examine the administration of sodium potassium calcium magnesium supplements as well as acid based correction supplements um and then plan nursing care for someone uh receiving medications for a low or high potassium a low or or high sodium a low and high calcium a low and high magnesium and acid base imbalance all right so it's going to be a quick overview and we'll get into it okay I'm not going to get into this too much because the role of electrolytes you learn that in nursing not here okay so we know what nerves what we know what the electrolytes do in your body now we're going to talk about how do we treat it when we have a problem okay most common problem to cause all of these hyper hypo Pro um cemas nutras and things like that is chronic kidney disease I mean it is when you can't excrete the um when you can't excrete the electrolytes you retain them and that's the most common cause for so let's get into sodium sodium we know is essential for your water balance acid base imbalances it's also good for water retention blood volume blood pressure it also has to do with your um neurons being fired and things like that like it you have to have it to fire your neurons so um I'm not going to talk about too much about how water and sodium follow we know that water follows sodium whatever sodium is water is going to be so if you keep it you're going to have excess water if you let go of it you're going to lose the water okay hypernia hypernia is excess um sodium this is above a 145 most common cause is kidney disease but there are a lot of medications that we have to be aware of okay hypertonic saline that's the 3% like normal saline okay your corticosteroids your lithium therapy those are the biggest most common causes of the hypernia besides the kidney disease okay in certain in it's very rare okay um and then medications that contain sodium okay um manitol which is a specific diuretic all right so what does it look like so when you have excess sodium you usually are dehydrated so you have that thirst the fatigue weakness and then it can lead to the muscle um I'm sorry convulsions uh altered mental status level of Consciousness that is why when we talk about how to treat these we know these symptoms because that's going to be half of the side effects okay so mild hypo hypernia we can just do low salt diet and your body will naturally excrete it we'll stop the medications that need to be stopped we'll give you the low salt diet increase your fluids you'll be good if you have chronic kidney disease you can't get rid of the sodium okay so we have to find out different ways so we can give you hypotonic IV fluids and diuretics but if you can't pee you know you can't take diuretics okay so um but really we give you fluids because you're dehydrated and if you're on dialysis we'll give you dialysis on top of the fluids and it'll help regulate it but first for First Choice is the low sodium diet okay so now we have hypon netrum so this is when we don't have enough it could be from overhydration EX of administration of hypotonic Solutions which means it doesn't have enough solutes right um it could be from vomiting GI suction diuretics we know diuretics is a big one okay once again brain sodium is brain so we have altered neurostatus we can have confusion lethargy muscle twitching and trimmers okay early signs are like the vomiting abdominal cramping and then it can like we said lead to the convulsions and things so how do we treat it though okay so treating hyponatremia from excessive dilution which means I have too much fluid in my body we just give you diuretics because we know I know which sounds crazy because um we know diuretics you lose that sodium it's okay we're going to let go of so much water that we're going to keep enough sodium around and it will regulate our body okay uh if it's because you have lost too much sodium so this is not overhydration then we can give you um sodium chloride Po and R IV so we also can encourage someone with hyponatremia with this sodium loss to drink more um I'm sorry eat more sodium and eat the like the bacon and the electrolyte fluids um the uh like Gatorade and things like that okay so we're going to talk about sodium chloride sodium chloride is a PO you can give it IV all that fun stuff okay so I'm not going to get into what this is because it's just like we said it could be um 0.9 for mild severe point it's the 3% and then we can also have like the PO for um less severe hyponatremia okay so adverse effects is hypernia because if we give you too much salt okay right if I give you too much sodium the adverse effect would be have hypernia so we already went over all of those signs and symptoms right lethargy confusion rigidity hypotension okay your 3% and your PO for all I know it says 3% but it really should say all of them all of them we have to worry about fluid retention because we know sodium and water love each other so if we keep extra sodium we may keep extra fluid so we need to make sure our patients are aware what fluid volume overload what pulmonary edema looks like so that they can let us know okay we're doing those breath mainly we're checking their breathing to see if they have crackles we're checking for pitting edema things like that okay um if you have overdose they give you diuretics if you overdose on this because it'd be hypernia we'd get it down okay um monitor your lab results okay we have to see if it's working and we have to make sure you're not in hypernia monitor for edema pulmonary edema which is like crackles we're doing our respiratory assessment right we're monitoring for hypernatremia we're monitoring for our level of Consciousness we're monitoring our fluid volume excess which is like once again crackles pulmonary edema and we're monitoring their Minal status that goes along with loc because this hyper nutria all right so now we get into potassium potassium's great we know we need it right it's essential for proper nerve and muscle function maintains that acid base IMB um balances um yeah the imbalances can be bad so hyperkalemia this is when our potassium is over five so there are a couple different treatments that we can give so this the usually the causes are potassium rich foods over over consump whether it's pottassium rich foods o over consumption of dietary supplements you're taking too many k sparing diuretics right or you have kidney disease and I can't get rid of it okay most common side effects heart right we have that dysrhythmia we have paresthesia which is the numbness and tingling that muscle twitching we can have um cramping and things like that okay the treatment if hyper Bia we have to tell them they can't eat any more potassium rich food so no more bananas no more um Tomatoes no citrus fruits no uh avocad strawberries things like that okay um and then decrease if there if it's a medication that's causing this if it's from the case bearing from an Ace inhibitor things like that stop the medication figure something else you can in um administer insulin and glucose so we know insulin needs that glucose Mo molecule and a potassium molecule to go inside the cell so when you do that you're going to give them the glucose first and then give them the insulin so that we make sure that we don't bottom out because if you can give this to non-diabetics people who are not diabetic don't have excess sugar just hanging out so if we give them extra sugar that's which is why we give them like dextrose IV and then we give them IV insulin so it takes it works really really fast and it puts it all in the cell and then it's not in the bloodstream and then you have hypo we don't have hyperemia anymore okay they can give calcium gluconate to counteract toxicity of the heart and then the other drug we're going to talk about is sodium polystyrene okay sodium polystyrene back in the old days used to just be by itself okay um and they don't really do that anymore it's usually a combo with sorbitol it's got sorbitol in it okay and let's talk about what it does though it exchanges the sodium for potassium in the large intestines binds the potassium to the feces and causes rapid excretion which means diara okay it's causing you to have excessive diarrhea that's why I add the sorbitol in it so it can get out because this is it binds to the stool doesn't mean it's out of your body we want it out of your body so aders affects his constipation now you're going to say didn't you just say this causes diarrhea yes but here's the thing if I have some kind of blockage or some kind of if I don't have any food in my body right if I don't have anything for it to bind to I can be constipated and then this doesn't work okay the biggest adverse effects is excessive diarrhea okay um you can have a FAL impaction if you have any kind of blockage or where any kind of have that bulky stool that is more commonly blocked and then it binds to it it doesn't make it watery anymore so it may get stuck okay and then of course hypokalemia because we're lowering your potassium so uh medications that we want to avoid is in acids because of it can decrease the pottassium exchange um obviously if you already have hypokalemia don't take this okay if you have obst Ive bowel disease don't take it because we just talked about how it can get blocked okay um if you have severe heart failure or severe hypertension because this has sodium in it and it's going to raise your blood pressure okay um yeah don't heat it don't mix it okay water only if you're going to mix it it it usually comes in a liquid it's a lovely brown color uh room temperature and if you're going to give a you can give this to repository like a rectal Ena uh needs to be room temperature and make sure that the um if you use an enema first to make sure they don't have a blockage if you're getting the blockage out make sure the blockage also does um the medication you're using doesn't have sorbitol because then it's a double dose of sorbitol okay so we're going to monitor our bowel movements if we're having any kind of constipation if we're having excessive amount we're going to have excessive amounts of diarrhea but we're monitoring our B movements making sure they happen because if they're not happening it's sitting in there and it's not getting out it's got to get out so we got to monitor for that constipation we got to monitor their potassium levels we got to monitor for hypom Calia the hypom magnesia and calmia because of the diarrhea okay um monitor their calcium levels if it's even more for more than three days because of the diarrhea and then we also monitor for sodium hypernia because of the ex sodium we're giving so now we have a low potassium our low potassiums um usually from Loop Diuretics vomiting diarrhea things like that okay um very similar side uh signs and symptoms we have a dysrhythmia we have muscle weakness and lethargy um you may have those muscle cramps okay as well as I know it says weakness but you may have muscle cramps as too as well okay so if it's mild first choice for all of these the first choice is Foods okay it is mild dietary intake just increase okay if it's severe then we get talk about giving them potassium so this is potassium chloride we can give it oral we can give it IV and the oral form comes in I mean this is just straight potassium okay the oral form comes in a powder it comes in a like dissolving tablet and it comes in a tablet okay if it is a we're going to get to this a little later don't let me forget we're going to talk about it okay A lot of times our biggest side effects are nause and vomiting um with our IV forms we have a lot of serious side effects okay because we can become hyper calic really fast um it's also there got a lot of rules about how you push it and we're going to talk about it so it's uh it can cause fitis and irritation so please be sure it's in a large vessel we're not putting this through 24 in the thumb we we want a good 18 gauge okay a good large bore Ivy to give this medication because it burns really really really bad okay a lot of people dilute it which is perfectly fine you like give a piggyback a concurrent um saline and potassium uh together and so it'll the so saline will dilute it as it goes it's also safer because it slows it down and the slower the better okay um most serious side effect hyperemia um yeah so other medications we want to avoid potassium diuretics and ACE inhibitors because we know those can cause hyperkalemia and we're already taking a potassium supplement okay there's no Foods they don't we'll talk we'll get there okay if you have an overdose so we're um have too much potassium hyper calmia stop take stop whatever is going on stop the the Foods stop the IV stop the pills okay then we treat it like we just said the insulin and um and index the uh bicarb calcium gluconate or sodium polyester okay obviously a contra indication is hyperemia and kidney disease because the kid if your kidneys aren't working it can't excrete the extra potassium and then you're going to be in hyper clenia really easily okay um all right so now we're going to get into Administration your PO like we just said the PO tablets um you cannot Crush they are um inter coated um they may not say inter coated but they have this special coating they're usually delayed release too you cannot crush them you cannot chew them okay if you're giving them the LI oh it also comes in a liquid liquid um for giving them the powder that turns into a liquid the dissolving tablet which is a liquid okay they need a set up because it's very acidic so it can cause esophagitis especially if it refluxes and just sits there okay if you um dilute the the liquid forms diluting the liquid forms you can dilute it in anything okay water orange juice things like that okay orange juice is a really popular one actually because it's already orange and a lot of these like dissolving tablets are orange they look like it looks like sun uh sun-kissed like Orange Soap okay so disolving it in orange juice will actually help um we never so IV Administration is very important okay we never push potassium because that is lethal injection you will kill someone we never exceed a rate of 10 Mill equivalents an hour okay so if you have to give 40 a mill equivalent it takes four hours okay um if they have like I said check that IV site before you do it um avoid extra ex extravasation and infiltration which means it leaks outside the cell the The Vessel where you're putting it in it will cause necrosis it's very it's very acidic even when you take it orally so it's really acidic when you put it in the IV okay there are you can get the um the necrosis and not fun stuff okay um if teach them about food toward sources high in potassium they still want to take Foods you you have a potassium problem we're not saying that you should you know eat an excess like a high potassium diet but we still need to tell them how to incorporate potassium in their diet they still need potassium in their diet they need to know what foods they can take with this okay because foods are not contraindicated okay they can still have potassium rich foods um but we tell them not to use salt substitutes because that is basically a pottassium supplement okay there's a fine line okay avoid laxatives because of you can have excess potassium loss with diarrhea monitor their serum potassium before and after Administration monitor their IO their renal function their cardiac status personally they better be on a cardiac monitor if if I'm giv potassium some people disagree with that and I know a lot of Med surge places like they give potassium without them being on a heart monitor it makes me scared I don't like it I don't give IV pottassium without the being on a heart monitor personal reference okay um monitor for hyperemia monitor cardia activity what what like I was just saying if we're giving IV um potassium I expect their their EKG to change if they're in hyper calmia I mean hypokalemia and we have that specific drimia I expect the drimia to uh have resolution I expect the the muscle weakness to get better I'm checking to make sure it's working okay that's how you know it's working it's all all these symptoms getting better if they're not they're getting worse we have problems okay all right so now acid and base we're not going to get into this hardcore you're going to learn this in level four and you're also going to learn this a little later in level two so we're doing down and dirty nothing deep okay alkal ois means that you have you're have a base U more basic blood a acidosis is you're more acidic okay they are fatal if you have it bad you can die very easily okay um yeah we have what's it called mechanisms that try to fix themselves okay so like our our um hold on our colon will try to if we're uh acidic we might have diarrhea so that we can get more acids out because we know potassium it's in your stomach if you poop it out yeah or if you vomit right and then if your lungs are have excessive um your lungs breathe off bases so if we're more um alkalic we might have increased respiratory rate because we're trying to Breathe It Off faster and so we have these natural mechanis Ms that are trying to compensate for it but if we our body is going to give up eventually it can't fix it ever okay so like we said acidosis is more acidic alkalosis more basic okay find this some underlying disorder and fix it um all right so acidosis and alol we talked about this we just talked about this um so if you're in acidosis now I have too much acid I have too much acid in my body okay so I am there is could be respiratory it could be metabolic I could have um acidosis I could have kidney failure so I'm keeping too much potassium right I could have alcoholism diabetes I'm keeping too much my Sugar's 500 that means there's excess potassium trying to pick it up and take it in the cell and it can't okay if it's respiratory you could have hypo ventilation um you could have Airway constriction things like that because then the bases you know are um anyway they're going to get into it I'm not going to get into it sorry how we how do we treat it we give you sodium bicarb okay sodium biocard is a base um yeah sodium biocard this is not the same thing as like normal sailing this is sodium Bard it is its own thing okay it's po it's IV mainly IV but it is a base that we can give you very fast okay all right the most common adverse effect is alkalosis okay so now we have too much sodium bicarb sorry too much sodium bicarb and we become alkalic right when we become alkalotic we'll have that confusion irritability you can have the slow respiratory rate okay um vomiting if this happens if any of these symptoms happen which we need to know you need to stop this infusion you need to stop it because we are alkalic and we've gone too far stop it will hopefully if if you catch it early enough it will fix itself but we have to know these problems okay um potassium chloride and ammonia chloride can um reverse the alkalosis so that's like the treatment overdose okay um all right it's also got sodium in it so we have to monitor for hypernia and fluid retention all right um milk we kept away stay away from milk okay because milk is already a base and it will change the pH of your stomach so if you take milk with this sodium bicarb poo it will cause this milk Alkali syndrome which means it's just severe hypercalcemia andoss kidney failure okay so don't drink milk while you're taking this medication especially at the same time um if you're having vomiting continuous suction because these things are going to make you more um I'm vomiting I will uh get rid of at more acids and then become more Al I'm going to become alkalotic and then if I give you this to make you alkalic I'm going to put you into alkalosis so these are causes of alkalosis we don't want to give you to okay if you have kidney disease and cardiac because of the sodium Administration okay the kidney disease is a big one because they can't get rid of this extra sodium okay and they're already probably I know they could be acidic but we have to be sure that they are going to dialysis soon that's really the for for your kidney patients they may not get this at all okay they may just go straight to dialysis and it'll fix their acid base imbalances because it might be a potassium problem okay um so chronic kidney disease is a big contraindication with this because they can't get rid of the sodium and they the acid bases are already messed up okay and we can throw them into alcalosis real fast um do not add oral preparations to calcium containing supplements give it to it by itself you want to take it 2 to 3 hours before uh or after a meals or other mens so basically an empty stomach okay monitor their blood pH that's their abg's arterial blood gases and do not take it with milk all right so now we're in to alkalosis so now we're too basic so hyper I said we breathe off U I'm sorry you breathe off your bases um and that's true but we breathe in I'm sorry we breathe in our bases and so when we have hyperventilation we're breathing in too much of that carbon di um monoxide and yeah yeah yeah okay um hyperventilation so you're trapping it and it can't get out okay you're trying to prevent it um constipation because we're keeping on to the um we're not letting go we are having um potassium problems potassium is a very acidic medication I swear these are opposite yeah okay severe vomiting yeah severe vomiting because vomiting you throw up all of your your acids because that's where potassium lives and now you're alkalic okay so we' already talked about ossis systems um signs and symptoms that's the confusion that's the um they can have convulsions you can have slower shallow respirations okay um so our treatment our treatment is to give you ammonia ammonia ammonia why can't I say that ammonium that's not how you say that hold on just a second my brain hurts ammonium this sounds wrong ammonium chloride for severe for mild cases we can give you a sodium and potassium chloride this is like a u like a big bag of a lot of sodium a little bit of potassium okay um because we know potassium is an acid it will help increase or decrease your pH okay all right hypocalcemia so hyp hypocalcemia we know calcium lives in the bone right our parathyroid is responsible for stimulating uh our bones to break down it also stimulates uh calcitonin uh to be released from your thyroid which stimulates your bone um stimulates your body to put the calcium into the bone okay so your bare thyroid hormon takes a lot has a lot to do with your um with your calcium because if it doesn't work we're going to have problems and we know vitamin D is a necessary vitamin and if you don't have it you cannot absorb calcium okay okay all right so hypo calcemia we um hypo could be because we have cell membranes become too hyper excitable so they let go of it okay um you can have convulsions or mus muscle spasms with the high that's when we have the shx and the T truso with the hypocalcemia hyper calcemia um it could be from excessive bone loss it could be from of parathyroid hormone um that metastatic bone disease what I was talking about and then your um trying to think of the last one parathyroid that one it's in the book but here's the here's the the deal hypercalcemia we treat the underlying problem okay so if you're parathyroids messed up oh yeah if your parathyroids messed up we fix your parathyroid if it's your medic bone um metastatic bone cancer we fix your bone cancer you know we treat the symptoms there's really no treatment for it okay um for hypo it's could be from vitamin D deficiency it could be from Olive the uh your body just doesn't absorb it there's lots of different reasons okay so we can give you straight calcium calcium salts is what it's called so that's your calcium carbonate your calcium citrate calcium carbonate that's just Tums okay they literally just give you Tums um these can poo it's obviously not TS if it's IV okay but it can be um it's a synthetic calcium supplement so adverse effects is hyper calcemia I give you too much now I have this lethargy weakness um because with hypo remember we have the the tetany the um the spasms this will have the weak weakness the nause and vomiting we could have kidney stones okay um yeah so also if it extrav extra if extravasation occurs which means it leaks outside the vessel you can have severe necrosis or slopping of your of the skin okay um so we have to make sure we're having an we have an adequate IV we're checking placement before we give anything IV um medications we want to avoid it uh dexin calcium channel blockers okay because these are going to mess up our dexin and calcium Trum blockers work in the heart calcium works on muscles we don't want to affect the heart anymore than it is zinc rich foods alcohol caffeine carbonated beverages is a big one too um and then like your oxyc acid that's like your spinage Beats if I have a cardiac dys rythmia don't give me the this because I am going to have a worsening dis man I already have a kidney stone don't do it I have metastatic bone cancer because I'm going to have excessive calcium loss okay if I already have hyper calcemia don't give it to me all right um if we're taking it by mouth we give it with meals or within an hour of taking meals we like it food to be on the stomach okay if you're giving it Ivy it needs to go slow because we want to avoid hypotension dysmas Cardiac Arrest biggest deals especially with the IV Administration is that we monitor our blood pressure our heart rate and our EKG okay we're monitoring electrolytes because that's what we want to happen we're monitoring for symptoms of hypercalcemia or monitoring for symptoms um of worsening hypocalcemia okay it's just basically I mean it's it's just extra calcium so then we have calci rol calcitrol is vitamin D so this is what we it's an active form of vitamin D we give it to you if that's your pro like if you're having hypocalcemia because you don't have vitamin D they give you calcitrol okay um a lot of side effects hypercalcemia because now I'm absorbing too much so I have the same things we just talked about okay medications we want to avoid thide diuretics is a big one thyoides because of our um it actually will decrease the vitamin D availability and then it it basically inactivates this medication because it will decrease your vitamin D so we don't want that thides is a big one thides can also cause hypocalcemia because of it in inactivates the vitamin D um and magnesium and acid supplements because it interferes with absorption okay we want to teach them about um calcium rich foods they still need calcium rich foods okay but our large amounts like we don't need 20 ounces of milk a day okay because we can go into hyper calcemia we still need calcium rich foods we don't need that many okay um signs and symptoms are hypercalcemia hyper phosph um phosphate emia that's our overdose and then we just treat it um symptomatically obviously if I already have hypercalcemia don't give me this if I have a vitamin D toxicity so I have too much vitamin D don't give me this the um the capsules are usually like a gel capsule they're like clear um protect it from light and heat because it can it's gelatin so we it'll dissolve if you get it really hot I left mine in the car one time they melted together so don't do that um protect it from the light because it is uh vitamin D sunlight yeah okay um monitor electrolytes we're monitoring our calcium we're monitoring that phosphorus um or monitoring for symptoms of hypercalcemia tell them to still eat calcium rich foods but in in moderation right okay um and do not concurrently give it with an acids because that will dis um disrupt the absorption I'm sorry all right so now we're about magnesium so we know magnesium is essential for proper neuromuscular function it is um I'm sorry we can use it to prevent or terminate seizures in eclampsia so you're going to get this again next semester magnesium three semesters in a row okay um the oral forms can be used as cathartics so or for complete evacuation of the colon so our oral forms that's our magnesium Hydro oxide right that's the milk of magnesia um so if you have hypom magnesia sometimes they just give you milk of magnesia and or magnesium hydroxide and it helps you it raises your um mag magnesium they use mag sulfate um because uh we only use it for severe magnesium deficiency so this is mag sulfate you're going to learn this again in next semester okay it is a mineral replacement overdose of magnesium guess what it looks like hyper magnesia okay hyper per magnesia is that um de mag is a drag so if I'm giving you a bunch of magnesium I'm I may have hyper magnesia hyper magnesia looks like a drag so my my my deep end reflexus may be um decreased I may have sedation that flushing of the skin okay intense thirst muscle weakness once again that those deep tendon reflexes are down are diminished or absent okay extreme levels of magnesium overdose we can have respiratory paralysis circulatory collapse don't like that okay um alcohol is a big one we don't give Al you should not take alcohol if for taking magnesium because alcohol actually interferes with the absorption of magnesium so you can't take them together shouldn't take them at all um if we're having overdose overdose looks like these extreme levels so we treat the symptoms okay the calcium gluconate is the only thing they can give for hyper magnesia I know it's like not a slide on here it's on your drug cabinet that is the only treatment for hyper magnesia is calcium gluconate otherwise your body naturally gets rid of it the calcium gluconate um just like it works for the potassium it works for the Magnesium it prevents that mag toxicity of the heart muscle the cardiac irritability and irregularities okay if I have CK D I do not want to get this medication because that's how you lose magnesium is through your urine okay and if I can't get rid of it I'm going to keep on it I'm going to have that severe overdose okay um if I have cardiac disease um we have our oral we might need parental route okay that's when I'm sorry if I cardiac disease I may do oral over parental because the parental or the IV is W to work really fast it's going to be a lot in my body really really fast okay the oral Administration we um the contraindications are feal impaction because sometimes that's our milk of magnesia right and if we're already impacted we can't poop okay abdominal pain intestinal obstruction um all right so for when we give it IV we definitely need to monitor our cardiac function uh we have to continuously monitor their patient during the IV infusions for early signs of decreased cardiac function we have to monitor their serums magnesium that's what we're giving it for right monitor for hyper magnesium monitor the respiratory status okay monitor those deep tendon reflexes IO and kidney function so we have to monitor all those things and that is the end of metabolism if you have any questions please put it in the discussion board By the end of the class, the student will be able to: 1. Examine the administration of sodium, potassium, calcium, and magnesium supplements and acid- base correction supplements as well as methods to correct deficiency and excess. 2. Plan nursing care for a patient receiving medication for hypokalemia, hyperkalemia, hyponatremia, hypernatremia, hypocalcemia, hypercalcemia, hypomagnesemia, hypermagnesemia, and acid-base imbalances.

all right so today we're going to do metabolisms this is going to be chapters 25 43 and 48 so just please be advised that these are not all chapters for chapters 43 it's just one page and chapter 48 is just these couple Pages these this is just magnesium and Hy and uh the calcium okay so hopefully by the end of this you'll able to examine the administration of sodium potassium calcium magnesium supplements as well as acid based correction supplements um and then plan nursing care for someone uh receiving medications for a low or high potassium a low or or high sodium a low and high calcium a low and high magnesium and acid base imbalance all right so it's going to be a quick overview and we'll get into it okay I'm not going to get into this too much because the role of electrolytes you learn that in nursing not here okay so we know what nerves what we know what the electrolytes do in your body now we're going to talk about how do we treat it when we have a problem okay most common problem to cause all of these hyper hypo Pro um cemas nutras and things like that is chronic kidney disease I mean it is when you can't excrete the um when you can't excrete the electrolytes you retain them and that's the most common cause for so let's get into sodium sodium we know is essential for your water balance acid base imbalances it's also good for water retention blood volume blood pressure it also has to do with your um neurons being fired and things like that like it you have to have it to fire your neurons so um I'm not going to talk about too much about how water and sodium follow we know that water follows sodium whatever sodium is water is going to be so if you keep it you're going to have excess water if you let go of it you're going to lose the water okay hypernia hypernia is excess um sodium this is above a 145 most common cause is kidney disease but there are a lot of medications that we have to be aware of okay hypertonic saline that's the 3% like normal saline okay your corticosteroids your lithium therapy those are the biggest most common causes of the hypernia besides the kidney disease okay in certain in it's very rare okay um and then medications that contain sodium okay um manitol which is a specific diuretic all right so what does it look like so when you have excess sodium you usually are dehydrated so you have that thirst the fatigue weakness and then it can lead to the muscle um I'm sorry convulsions uh altered mental status level of Consciousness that is why when we talk about how to treat these we know these symptoms because that's going to be half of the side effects okay so mild hypo hypernia we can just do low salt diet and your body will naturally excrete it we'll stop the medications that need to be stopped we'll give you the low salt diet increase your fluids you'll be good if you have chronic kidney disease you can't get rid of the sodium okay so we have to find out different ways so we can give you hypotonic IV fluids and diuretics but if you can't pee you know you can't take diuretics okay so um but really we give you fluids because you're dehydrated and if you're on dialysis we'll give you dialysis on top of the fluids and it'll help regulate it but first for First Choice is the low sodium diet okay so now we have hypon netrum so this is when we don't have enough it could be from overhydration EX of administration of hypotonic Solutions which means it doesn't have enough solutes right um it could be from vomiting GI suction diuretics we know diuretics is a big one okay once again brain sodium is brain so we have altered neurostatus we can have confusion lethargy muscle twitching and trimmers okay early signs are like the vomiting abdominal cramping and then it can like we said lead to the convulsions and things so how do we treat it though okay so treating hyponatremia from excessive dilution which means I have too much fluid in my body we just give you diuretics because we know I know which sounds crazy because um we know diuretics you lose that sodium it's okay we're going to let go of so much water that we're going to keep enough sodium around and it will regulate our body okay uh if it's because you have lost too much sodium so this is not overhydration then we can give you um sodium chloride Po and R IV so we also can encourage someone with hyponatremia with this sodium loss to drink more um I'm sorry eat more sodium and eat the like the bacon and the electrolyte fluids um the uh like Gatorade and things like that okay so we're going to talk about sodium chloride sodium chloride is a PO you can give it IV all that fun stuff okay so I'm not going to get into what this is because it's just like we said it could be um 0.9 for mild severe point it's the 3% and then we can also have like the PO for um less severe hyponatremia okay so adverse effects is hypernia because if we give you too much salt okay right if I give you too much sodium the adverse effect would be have hypernia so we already went over all of those signs and symptoms right lethargy confusion rigidity hypotension okay your 3% and your PO for all I know it says 3% but it really should say all of them all of them we have to worry about fluid retention because we know sodium and water love each other so if we keep extra sodium we may keep extra fluid so we need to make sure our patients are aware what fluid volume overload what pulmonary edema looks like so that they can let us know okay we're doing those breath mainly we're checking their breathing to see if they have crackles we're checking for pitting edema things like that okay um if you have overdose they give you diuretics if you overdose on this because it'd be hypernia we'd get it down okay um monitor your lab results okay we have to see if it's working and we have to make sure you're not in hypernia monitor for edema pulmonary edema which is like crackles we're doing our respiratory assessment right we're monitoring for hypernatremia we're monitoring for our level of Consciousness we're monitoring our fluid volume excess which is like once again crackles pulmonary edema and we're monitoring their Minal status that goes along with loc because this hyper nutria all right so now we get into potassium potassium's great we know we need it right it's essential for proper nerve and muscle function maintains that acid base IMB um balances um yeah the imbalances can be bad so hyperkalemia this is when our potassium is over five so there are a couple different treatments that we can give so this the usually the causes are potassium rich foods over over consump whether it's pottassium rich foods o over consumption of dietary supplements you're taking too many k sparing diuretics right or you have kidney disease and I can't get rid of it okay most common side effects heart right we have that dysrhythmia we have paresthesia which is the numbness and tingling that muscle twitching we can have um cramping and things like that okay the treatment if hyper Bia we have to tell them they can't eat any more potassium rich food so no more bananas no more um Tomatoes no citrus fruits no uh avocad strawberries things like that okay um and then decrease if there if it's a medication that's causing this if it's from the case bearing from an Ace inhibitor things like that stop the medication figure something else you can in um administer insulin and glucose so we know insulin needs that glucose Mo molecule and a potassium molecule to go inside the cell so when you do that you're going to give them the glucose first and then give them the insulin so that we make sure that we don't bottom out because if you can give this to non-diabetics people who are not diabetic don't have excess sugar just hanging out so if we give them extra sugar that's which is why we give them like dextrose IV and then we give them IV insulin so it takes it works really really fast and it puts it all in the cell and then it's not in the bloodstream and then you have hypo we don't have hyperemia anymore okay they can give calcium gluconate to counteract toxicity of the heart and then the other drug we're going to talk about is sodium polystyrene okay sodium polystyrene back in the old days used to just be by itself okay um and they don't really do that anymore it's usually a combo with sorbitol it's got sorbitol in it okay and let's talk about what it does though it exchanges the sodium for potassium in the large intestines binds the potassium to the feces and causes rapid excretion which means diara okay it's causing you to have excessive diarrhea that's why I add the sorbitol in it so it can get out because this is it binds to the stool doesn't mean it's out of your body we want it out of your body so aders affects his constipation now you're going to say didn't you just say this causes diarrhea yes but here's the thing if I have some kind of blockage or some kind of if I don't have any food in my body right if I don't have anything for it to bind to I can be constipated and then this doesn't work okay the biggest adverse effects is excessive diarrhea okay um you can have a FAL impaction if you have any kind of blockage or where any kind of have that bulky stool that is more commonly blocked and then it binds to it it doesn't make it watery anymore so it may get stuck okay and then of course hypokalemia because we're lowering your potassium so uh medications that we want to avoid is in acids because of it can decrease the pottassium exchange um obviously if you already have hypokalemia don't take this okay if you have obst Ive bowel disease don't take it because we just talked about how it can get blocked okay um if you have severe heart failure or severe hypertension because this has sodium in it and it's going to raise your blood pressure okay um yeah don't heat it don't mix it okay water only if you're going to mix it it it usually comes in a liquid it's a lovely brown color uh room temperature and if you're going to give a you can give this to repository like a rectal Ena uh needs to be room temperature and make sure that the um if you use an enema first to make sure they don't have a blockage if you're getting the blockage out make sure the blockage also does um the medication you're using doesn't have sorbitol because then it's a double dose of sorbitol okay so we're going to monitor our bowel movements if we're having any kind of constipation if we're having excessive amount we're going to have excessive amounts of diarrhea but we're monitoring our B movements making sure they happen because if they're not happening it's sitting in there and it's not getting out it's got to get out so we got to monitor for that constipation we got to monitor their potassium levels we got to monitor for hypom Calia the hypom magnesia and calmia because of the diarrhea okay um monitor their calcium levels if it's even more for more than three days because of the diarrhea and then we also monitor for sodium hypernia because of the ex sodium we're giving so now we have a low potassium our low potassiums um usually from Loop Diuretics vomiting diarrhea things like that okay um very similar side uh signs and symptoms we have a dysrhythmia we have muscle weakness and lethargy um you may have those muscle cramps okay as well as I know it says weakness but you may have muscle cramps as too as well okay so if it's mild first choice for all of these the first choice is Foods okay it is mild dietary intake just increase okay if it's severe then we get talk about giving them potassium so this is potassium chloride we can give it oral we can give it IV and the oral form comes in I mean this is just straight potassium okay the oral form comes in a powder it comes in a like dissolving tablet and it comes in a tablet okay if it is a we're going to get to this a little later don't let me forget we're going to talk about it okay A lot of times our biggest side effects are nause and vomiting um with our IV forms we have a lot of serious side effects okay because we can become hyper calic really fast um it's also there got a lot of rules about how you push it and we're going to talk about it so it's uh it can cause fitis and irritation so please be sure it's in a large vessel we're not putting this through 24 in the thumb we we want a good 18 gauge okay a good large bore Ivy to give this medication because it burns really really really bad okay a lot of people dilute it which is perfectly fine you like give a piggyback a concurrent um saline and potassium uh together and so it'll the so saline will dilute it as it goes it's also safer because it slows it down and the slower the better okay um most serious side effect hyperemia um yeah so other medications we want to avoid potassium diuretics and ACE inhibitors because we know those can cause hyperkalemia and we're already taking a potassium supplement okay there's no Foods they don't we'll talk we'll get there okay if you have an overdose so we're um have too much potassium hyper calmia stop take stop whatever is going on stop the the Foods stop the IV stop the pills okay then we treat it like we just said the insulin and um and index the uh bicarb calcium gluconate or sodium polyester okay obviously a contra indication is hyperemia and kidney disease because the kid if your kidneys aren't working it can't excrete the extra potassium and then you're going to be in hyper clenia really easily okay um all right so now we're going to get into Administration your PO like we just said the PO tablets um you cannot Crush they are um inter coated um they may not say inter coated but they have this special coating they're usually delayed release too you cannot crush them you cannot chew them okay if you're giving them the LI oh it also comes in a liquid liquid um for giving them the powder that turns into a liquid the dissolving tablet which is a liquid okay they need a set up because it's very acidic so it can cause esophagitis especially if it refluxes and just sits there okay if you um dilute the the liquid forms diluting the liquid forms you can dilute it in anything okay water orange juice things like that okay orange juice is a really popular one actually because it's already orange and a lot of these like dissolving tablets are orange they look like it looks like sun uh sun-kissed like Orange Soap okay so disolving it in orange juice will actually help um we never so IV Administration is very important okay we never push potassium because that is lethal injection you will kill someone we never exceed a rate of 10 Mill equivalents an hour okay so if you have to give 40 a mill equivalent it takes four hours okay um if they have like I said check that IV site before you do it um avoid extra ex extravasation and infiltration which means it leaks outside the cell the The Vessel where you're putting it in it will cause necrosis it's very it's very acidic even when you take it orally so it's really acidic when you put it in the IV okay there are you can get the um the necrosis and not fun stuff okay um if teach them about food toward sources high in potassium they still want to take Foods you you have a potassium problem we're not saying that you should you know eat an excess like a high potassium diet but we still need to tell them how to incorporate potassium in their diet they still need potassium in their diet they need to know what foods they can take with this okay because foods are not contraindicated okay they can still have potassium rich foods um but we tell them not to use salt substitutes because that is basically a pottassium supplement okay there's a fine line okay avoid laxatives because of you can have excess potassium loss with diarrhea monitor their serum potassium before and after Administration monitor their IO their renal function their cardiac status personally they better be on a cardiac monitor if if I'm giv potassium some people disagree with that and I know a lot of Med surge places like they give potassium without them being on a heart monitor it makes me scared I don't like it I don't give IV pottassium without the being on a heart monitor personal reference okay um monitor for hyperemia monitor cardia activity what what like I was just saying if we're giving IV um potassium I expect their their EKG to change if they're in hyper calmia I mean hypokalemia and we have that specific drimia I expect the drimia to uh have resolution I expect the the muscle weakness to get better I'm checking to make sure it's working okay that's how you know it's working it's all all these symptoms getting better if they're not they're getting worse we have problems okay all right so now acid and base we're not going to get into this hardcore you're going to learn this in level four and you're also going to learn this a little later in level two so we're doing down and dirty nothing deep okay alkal ois means that you have you're have a base U more basic blood a acidosis is you're more acidic okay they are fatal if you have it bad you can die very easily okay um yeah we have what's it called mechanisms that try to fix themselves okay so like our our um hold on our colon will try to if we're uh acidic we might have diarrhea so that we can get more acids out because we know potassium it's in your stomach if you poop it out yeah or if you vomit right and then if your lungs are have excessive um your lungs breathe off bases so if we're more um alkalic we might have increased respiratory rate because we're trying to Breathe It Off faster and so we have these natural mechanis Ms that are trying to compensate for it but if we our body is going to give up eventually it can't fix it ever okay so like we said acidosis is more acidic alkalosis more basic okay find this some underlying disorder and fix it um all right so acidosis and alol we talked about this we just talked about this um so if you're in acidosis now I have too much acid I have too much acid in my body okay so I am there is could be respiratory it could be metabolic I could have um acidosis I could have kidney failure so I'm keeping too much potassium right I could have alcoholism diabetes I'm keeping too much my Sugar's 500 that means there's excess potassium trying to pick it up and take it in the cell and it can't okay if it's respiratory you could have hypo ventilation um you could have Airway constriction things like that because then the bases you know are um anyway they're going to get into it I'm not going to get into it sorry how we how do we treat it we give you sodium bicarb okay sodium biocard is a base um yeah sodium biocard this is not the same thing as like normal sailing this is sodium Bard it is its own thing okay it's po it's IV mainly IV but it is a base that we can give you very fast okay all right the most common adverse effect is alkalosis okay so now we have too much sodium bicarb sorry too much sodium bicarb and we become alkalic right when we become alkalotic we'll have that confusion irritability you can have the slow respiratory rate okay um vomiting if this happens if any of these symptoms happen which we need to know you need to stop this infusion you need to stop it because we are alkalic and we've gone too far stop it will hopefully if if you catch it early enough it will fix itself but we have to know these problems okay um potassium chloride and ammonia chloride can um reverse the alkalosis so that's like the treatment overdose okay um all right it's also got sodium in it so we have to monitor for hypernia and fluid retention all right um milk we kept away stay away from milk okay because milk is already a base and it will change the pH of your stomach so if you take milk with this sodium bicarb poo it will cause this milk Alkali syndrome which means it's just severe hypercalcemia andoss kidney failure okay so don't drink milk while you're taking this medication especially at the same time um if you're having vomiting continuous suction because these things are going to make you more um I'm vomiting I will uh get rid of at more acids and then become more Al I'm going to become alkalotic and then if I give you this to make you alkalic I'm going to put you into alkalosis so these are causes of alkalosis we don't want to give you to okay if you have kidney disease and cardiac because of the sodium Administration okay the kidney disease is a big one because they can't get rid of this extra sodium okay and they're already probably I know they could be acidic but we have to be sure that they are going to dialysis soon that's really the for for your kidney patients they may not get this at all okay they may just go straight to dialysis and it'll fix their acid base imbalances because it might be a potassium problem okay um so chronic kidney disease is a big contraindication with this because they can't get rid of the sodium and they the acid bases are already messed up okay and we can throw them into alcalosis real fast um do not add oral preparations to calcium containing supplements give it to it by itself you want to take it 2 to 3 hours before uh or after a meals or other mens so basically an empty stomach okay monitor their blood pH that's their abg's arterial blood gases and do not take it with milk all right so now we're in to alkalosis so now we're too basic so hyper I said we breathe off U I'm sorry you breathe off your bases um and that's true but we breathe in I'm sorry we breathe in our bases and so when we have hyperventilation we're breathing in too much of that carbon di um monoxide and yeah yeah yeah okay um hyperventilation so you're trapping it and it can't get out okay you're trying to prevent it um constipation because we're keeping on to the um we're not letting go we are having um potassium problems potassium is a very acidic medication I swear these are opposite yeah okay severe vomiting yeah severe vomiting because vomiting you throw up all of your your acids because that's where potassium lives and now you're alkalic okay so we' already talked about ossis systems um signs and symptoms that's the confusion that's the um they can have convulsions you can have slower shallow respirations okay um so our treatment our treatment is to give you ammonia ammonia ammonia why can't I say that ammonium that's not how you say that hold on just a second my brain hurts ammonium this sounds wrong ammonium chloride for severe for mild cases we can give you a sodium and potassium chloride this is like a u like a big bag of a lot of sodium a little bit of potassium okay um because we know potassium is an acid it will help increase or decrease your pH okay all right hypocalcemia so hyp hypocalcemia we know calcium lives in the bone right our parathyroid is responsible for stimulating uh our bones to break down it also stimulates uh calcitonin uh to be released from your thyroid which stimulates your bone um stimulates your body to put the calcium into the bone okay so your bare thyroid hormon takes a lot has a lot to do with your um with your calcium because if it doesn't work we're going to have problems and we know vitamin D is a necessary vitamin and if you don't have it you cannot absorb calcium okay okay all right so hypo calcemia we um hypo could be because we have cell membranes become too hyper excitable so they let go of it okay um you can have convulsions or mus muscle spasms with the high that's when we have the shx and the T truso with the hypocalcemia hyper calcemia um it could be from excessive bone loss it could be from of parathyroid hormone um that metastatic bone disease what I was talking about and then your um trying to think of the last one parathyroid that one it's in the book but here's the here's the the deal hypercalcemia we treat the underlying problem okay so if you're parathyroids messed up oh yeah if your parathyroids messed up we fix your parathyroid if it's your medic bone um metastatic bone cancer we fix your bone cancer you know we treat the symptoms there's really no treatment for it okay um for hypo it's could be from vitamin D deficiency it could be from Olive the uh your body just doesn't absorb it there's lots of different reasons okay so we can give you straight calcium calcium salts is what it's called so that's your calcium carbonate your calcium citrate calcium carbonate that's just Tums okay they literally just give you Tums um these can poo it's obviously not TS if it's IV okay but it can be um it's a synthetic calcium supplement so adverse effects is hyper calcemia I give you too much now I have this lethargy weakness um because with hypo remember we have the the tetany the um the spasms this will have the weak weakness the nause and vomiting we could have kidney stones okay um yeah so also if it extrav extra if extravasation occurs which means it leaks outside the vessel you can have severe necrosis or slopping of your of the skin okay um so we have to make sure we're having an we have an adequate IV we're checking placement before we give anything IV um medications we want to avoid it uh dexin calcium channel blockers okay because these are going to mess up our dexin and calcium Trum blockers work in the heart calcium works on muscles we don't want to affect the heart anymore than it is zinc rich foods alcohol caffeine carbonated beverages is a big one too um and then like your oxyc acid that's like your spinage Beats if I have a cardiac dys rythmia don't give me the this because I am going to have a worsening dis man I already have a kidney stone don't do it I have metastatic bone cancer because I'm going to have excessive calcium loss okay if I already have hyper calcemia don't give it to me all right um if we're taking it by mouth we give it with meals or within an hour of taking meals we like it food to be on the stomach okay if you're giving it Ivy it needs to go slow because we want to avoid hypotension dysmas Cardiac Arrest biggest deals especially with the IV Administration is that we monitor our blood pressure our heart rate and our EKG okay we're monitoring electrolytes because that's what we want to happen we're monitoring for symptoms of hypercalcemia or monitoring for symptoms um of worsening hypocalcemia okay it's just basically I mean it's it's just extra calcium so then we have calci rol calcitrol is vitamin D so this is what we it's an active form of vitamin D we give it to you if that's your pro like if you're having hypocalcemia because you don't have vitamin D they give you calcitrol okay um a lot of side effects hypercalcemia because now I'm absorbing too much so I have the same things we just talked about okay medications we want to avoid thide diuretics is a big one thyoides because of our um it actually will decrease the vitamin D availability and then it it basically inactivates this medication because it will decrease your vitamin D so we don't want that thides is a big one thides can also cause hypocalcemia because of it in inactivates the vitamin D um and magnesium and acid supplements because it interferes with absorption okay we want to teach them about um calcium rich foods they still need calcium rich foods okay but our large amounts like we don't need 20 ounces of milk a day okay because we can go into hyper calcemia we still need calcium rich foods we don't need that many okay um signs and symptoms are hypercalcemia hyper phosph um phosphate emia that's our overdose and then we just treat it um symptomatically obviously if I already have hypercalcemia don't give me this if I have a vitamin D toxicity so I have too much vitamin D don't give me this the um the capsules are usually like a gel capsule they're like clear um protect it from light and heat because it can it's gelatin so we it'll dissolve if you get it really hot I left mine in the car one time they melted together so don't do that um protect it from the light because it is uh vitamin D sunlight yeah okay um monitor electrolytes we're monitoring our calcium we're monitoring that phosphorus um or monitoring for symptoms of hypercalcemia tell them to still eat calcium rich foods but in in moderation right okay um and do not concurrently give it with an acids because that will dis um disrupt the absorption I'm sorry all right so now we're about magnesium so we know magnesium is essential for proper neuromuscular function it is um I'm sorry we can use it to prevent or terminate seizures in eclampsia so you're going to get this again next semester magnesium three semesters in a row okay um the oral forms can be used as cathartics so or for complete evacuation of the colon so our oral forms that's our magnesium Hydro oxide right that's the milk of magnesia um so if you have hypom magnesia sometimes they just give you milk of magnesia and or magnesium hydroxide and it helps you it raises your um mag magnesium they use mag sulfate um because uh we only use it for severe magnesium deficiency so this is mag sulfate you're going to learn this again in next semester okay it is a mineral replacement overdose of magnesium guess what it looks like hyper magnesia okay hyper per magnesia is that um de mag is a drag so if I'm giving you a bunch of magnesium I'm I may have hyper magnesia hyper magnesia looks like a drag so my my my deep end reflexus may be um decreased I may have sedation that flushing of the skin okay intense thirst muscle weakness once again that those deep tendon reflexes are down are diminished or absent okay extreme levels of magnesium overdose we can have respiratory paralysis circulatory collapse don't like that okay um alcohol is a big one we don't give Al you should not take alcohol if for taking magnesium because alcohol actually interferes with the absorption of magnesium so you can't take them together shouldn't take them at all um if we're having overdose overdose looks like these extreme levels so we treat the symptoms okay the calcium gluconate is the only thing they can give for hyper magnesia I know it's like not a slide on here it's on your drug cabinet that is the only treatment for hyper magnesia is calcium gluconate otherwise your body naturally gets rid of it the calcium gluconate um just like it works for the potassium it works for the Magnesium it prevents that mag toxicity of the heart muscle the cardiac irritability and irregularities okay if I have CK D I do not want to get this medication because that's how you lose magnesium is through your urine okay and if I can't get rid of it I'm going to keep on it I'm going to have that severe overdose okay um if I have cardiac disease um we have our oral we might need parental route okay that's when I'm sorry if I cardiac disease I may do oral over parental because the parental or the IV is W to work really fast it's going to be a lot in my body really really fast okay the oral Administration we um the contraindications are feal impaction because sometimes that's our milk of magnesia right and if we're already impacted we can't poop okay abdominal pain intestinal obstruction um all right so for when we give it IV we definitely need to monitor our cardiac function uh we have to continuously monitor their patient during the IV infusions for early signs of decreased cardiac function we have to monitor their serums magnesium that's what we're giving it for right monitor for hyper magnesium monitor the respiratory status okay monitor those deep tendon reflexes IO and kidney function so we have to monitor all those things and that is the end of metabolism if you have any questions please put it in the discussion board By the end of the class, the student will be able to:
1. Examine the administration of sodium, potassium, 
calcium, and magnesium supplements and acid-
base correction supplements as well as methods to 
correct deficiency and excess.
2. Plan nursing care for a patient receiving medication
for hypokalemia, hyperkalemia, hyponatremia, 
hypernatremia, hypocalcemia, hypercalcemia, 
hypomagnesemia, hypermagnesemia, and acid-base 
imbalances.

Transcript for:metabolism

Transcript for:
metabolism