『Electrolyte Emergencies: Lifesaving Moves Every Nurse Must Know for NCLEX』のカバーアート

Electrolyte Emergencies: Lifesaving Moves Every Nurse Must Know for NCLEX

Electrolyte Emergencies: Lifesaving Moves Every Nurse Must Know for NCLEX

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 Check out thinklikeanurse.org for more#Comprehensive Notes##I. OverviewFocus: 6 electrolytes + 4 acid–base disordersGoal: Know one classic sign + one lifesaving intervention for eachNCLEX weight: High (8–16 questions across categories)Foundational rule: Always assess volume status first — dry vs overloaded guides almost every interventionII. SodiumA. HyponatremiaClassic sign: seizures (especially when levels plunge)Why: water shifts into brain → swelling → seizure riskLifesaving action: 3% hypertonic saline, rapid bolus for active seizureAdditional pearls:Chronic hyponatremia (e.g., “tea and toast” elderly patient): correct slowly to prevent osmotic demyelination syndromeLimit correction to 6–8 points in 24 hours once stableB. HypernatremiaClassic sign: intense thirst + confusionWhy: brain cells shrink from dehydrationLifesaving action: give free water (D5W IV, oral, or tube)Rule: correct slowly to prevent cerebral edemaIII. PotassiumA. HypokalemiaClassic sign: U-waves on ECGLifesaving action: potassium replacementSafety rules:Never exceed 10–20 per hour through a peripheral lineOral preferredReplace magnesium first—low magnesium prevents potassium correctionB. HyperkalemiaThe most urgent electrolyte emergencyClassic sign: tall peaked T-waves → wide QRS → sine-wave → cardiac arrestThree-step lifesaver sequence:Stabilize: calcium gluconate protects myocardiumShift: insulin + dextrose (or high-dose albuterol) moves potassium into cellsRemove: kayexalate, loop diuretics, or dialysisIV. Calcium & MagnesiumA. HypocalcemiaClassic signs:Chvostek sign (facial twitch with cheek tap)Trousseau sign (carpal spasm with BP cuff)Lifesaving action: slow IV calcium gluconateRisk of fast push: bradycardia, severe hypotensionB. HypermagnesemiaOften renal failure or magnesium infusionsClassic signs:Profound hypotensionLoss of deep tendon reflexes (areflexia)Lifesaving action:Stop magnesiumGive calcium gluconate to counteract cardiac depressionV. Acid–Base DisordersInterpretation Rule:pH + bicarbonate same direction → metabolicpH + CO₂ opposite directions → respiratoryClinical principle:Treat the patient before the numberVolume status affects everything.A. Respiratory AcidosisCause: CO₂ retention from hypoventilation (opioids, COPD flare)Signs: sleepiness, poor arousalLifesaving action: improve ventilation — stimulate, bilevel support, or intubateB. Respiratory AlkalosisCause: hyperventilation (pain, anxiety, early sepsis, PE)Signs: tingling around mouth and fingers, lightheadedLifesaving action: treat cause — calm anxiety, treat PE, manage painC. Metabolic AcidosisClassic sign: Kussmaul respirations (deep, rapid breathing)DKA clue: fruity acetone breathMnemonic for causes: MUDPILESMethanolUremiaDKAPropylene glycolIronLactic acidosisEthylene glycolSalicylatesLifesaving action: treat underlying causeDKA → insulinLactic acidosis → fix shockGive bicarbonate only when pH < 7.1 and patient is crashing.D. Metabolic AlkalosisCause: loss of stomach acid (vomiting, NG suction)Often causes: secondary low potassiumLifesaving action: normal saline + potassiumChloride allows kidneys to excrete excess bicarbonatePotassium replaces lossesConsider acetazolamide in severe cases.VI. Practice Scenarios (High-Yield NCLEX Style)1. Vomiting × 3 dayspH high + bicarbonate high → metabolic alkalosisInterventions: normal saline + potassium; consider acetazolamide2. Severe DKApH extremely low + bicarbonate low → metabolic acidosisFirst action: start regular insulin infusion3. Chronic COPDpH low + CO₂ high + bicarbonate high → partially compensated respiratory acidosis Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com
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