💓 Savvy NurseLouvri aplikasyon an

🫀 Adaptasyon Fizyolojik · Leson 2 sou 10 · 8 min

Sodyòm, Kalsyòm ak Manyezyòm: Kontraksyon, Kriz ak Vin Plat

Sodium, Calcium and Magnesium: Twitching, Seizing and Going Flat

😮 Tape machwè yon pasyan epi lèv la tranble: kalsyòm ba. Gonfle yon manchèt tansyon epi men an fè spasm: kalsyòm ba. Pèdi refleks jenou yo sou yon perfusion manyezyòm: sispann perfusion an. Egzamen an montre ou siy la epi li vle elektwolit la.

😮 Tap a client's cheek and the lip twitches: low calcium. Inflate a blood pressure cuff and the hand spasms: low calcium. Lose the knee reflexes on a magnesium drip: stop the drip. The exam shows you the sign and wants the electrolyte.

💡 Ide prensipal

Kalsyòm ba ak manyezyòm ba tranble epi fè spasm; kalsyòm wo ak manyezyòm wo vin feb epi kalm. Yo korije sodyòm dousman nan toude direksyon pou pwoteje sèvo a.

Low calcium and low magnesium twitch and spasm; high calcium and high magnesium go weak and quiet. Sodium is corrected slowly in both directions to protect the brain.

🧠 Poukisa sa enpòtan

SODYÒM, nòmal 135 rive 145: IPONATREMI lakòz maltèt, noze, konfizyon ak kriz, soti nan eksè likid, SIADH, dyiretik oswa likid ipotonik; trete selon kòz la, ak restriksyon likid pou eksè likid oswa SIADH ak saline izotonik (0.9%) pou pèt likid tankou nan dyiretik; lè li grav, bay saline ipètonik, monte sodyòm nan dousman, anjeneral pa plis pase 8 rive 10 mEq/L nan 24 èdtan, paske koreksyon rapid lakòz demiyelinizasyon osmotik. IPÈNATREMI lakòz swaf, manbràn mikèz sèk, ajitasyon ak kriz, soti nan dezidratasyon oswa dyabèt ensipid; korije dousman ak likid ipotonik pou evite èdèm serebral. KALSYÒM, nòmal anviwon 9 rive 10.5 mg/dL: IPOKALSEMI, apre operasyon tiwoyid oswa paratiwoyid, ak vitamin D ba, pankreyatit oswa maladi ren, lakòz pikotman, kranp nan misk, TETANI, laringospasm, yon siy CHVOSTEK pozitif (kontraksyon vizaj) ak siy TROUSSEAU (spasm nan ponyèt ak yon manchèt), ak yon QT pwolonje; trete ak IV calcium gluconate epi kenbe li bò kabann nan apre thyroidectomy. IPÈKALSEMI, soti nan ipèparatiwoyidism, kansè ak imobilite, lakòz letaji, konstipasyon, pyè nan ren, feblès nan misk ak yon QT vin pi kout; trete ak likid, dyiretik loop, calcitonin ak bisphosphonates. MANYEZYÒM, nòmal anviwon 1.5 rive 2.5 mEq/L: IPOMANYEZEMI, komen nan twoub itilizasyon alkòl ak malnitrisyon, lakòz tranbleman, ipèreflèksi, tetani ak torsades de pointes; IPÈMANYEZEMI, soti nan ensifizans ren oswa perfusion manyezyòm, lakòz pèt refleks, letaji, ipotansyon, bradikadi ak depresyon respiratwa, trete lè w sispann manyezyòm epi bay calcium gluconate.

SODIUM, normal 135 to 145: HYPONATREMIA causes headache, nausea, confusion and seizures, from fluid excess, SIADH, diuretics or hypotonic fluids; treat by cause, with fluid restriction for fluid excess or SIADH and isotonic (0.9%) saline for fluid loss such as from diuretics; when severe, give hypertonic saline, raising sodium slowly, generally no more than 8 to 10 mEq/L in 24 hours, because rapid correction causes osmotic demyelination. HYPERNATREMIA causes thirst, dry mucous membranes, restlessness and seizures, from dehydration or diabetes insipidus; correct slowly with hypotonic fluids to avoid cerebral edema. CALCIUM, normal about 9 to 10.5 mg/dL: HYPOCALCEMIA, after thyroid or parathyroid surgery, with low vitamin D, pancreatitis or kidney disease, causes tingling, muscle cramps, TETANY, laryngospasm, a positive CHVOSTEK'S sign (facial twitch) and TROUSSEAU'S sign (carpal spasm with a cuff), and a prolonged QT; treat with IV calcium gluconate and keep it at the bedside after thyroidectomy. HYPERCALCEMIA, from hyperparathyroidism, cancer and immobility, causes lethargy, constipation, kidney stones, muscle weakness and a shortened QT; treat with fluids, loop diuretics, calcitonin and bisphosphonates. MAGNESIUM, normal about 1.5 to 2.5 mEq/L: HYPOMAGNESEMIA, common in alcohol use disorder and malnutrition, causes tremors, hyperreflexia, tetany and torsades de pointes; HYPERMAGNESEMIA, from kidney failure or magnesium infusions, causes loss of reflexes, lethargy, hypotension, bradycardia and respiratory depression, treated by stopping magnesium and giving calcium gluconate.

🏥 Nan lavi reyèl

🦋 Douz èdtan apre yon thyroidectomy yon pasyan rapòte pikotman alantou bouch la ak nan pwent dwèt yo. Enfimyè a tape devan zorèy la epi lèv pasyan an tranble. Yo te deranje glann paratiwoyid yo pandan operasyon an epi kalsyòm ap bese. Yo bay calcium gluconate, ki te deja bò kabann nan selon pwotokòl la. Laringospasm, pwochen etap nan ipòkalsemi ki pa trete, pa janm rive.

🦋 Twelve hours after a thyroidectomy a client reports tingling around the mouth and in the fingertips. The nurse taps in front of the ear and the client's lip twitches. The parathyroid glands were disturbed during surgery and calcium is falling. Calcium gluconate, already at the bedside per protocol, is given. Laryngospasm, the next step in untreated hypocalcemia, never happens.

📌 Sa pou retni

  • Iponatremi: konfizyon ak kriz; korije pa pi vit pase 8 rive 10 mEq/L pa jouHyponatremia: confusion and seizures; correct no faster than 8 to 10 mEq/L a day
  • Ipòkalsemi: Chvostek, Trousseau, tetani; calcium gluconate bò kabann nan apre thyroidectomyHypocalcemia: Chvostek's, Trousseau's, tetany; calcium gluconate at the bedside after thyroidectomy
  • Ipèmanyezyemi: refleks pèdi ak respirasyon ralanti; sispann perfusion an, bay calcium gluconateHypermagnesemia: lost reflexes and slow breathing; stop the drip, give calcium gluconate

📖 Tèm nan leson sa a

Iponatremi (Hyponatremia): Sodyòm pi ba pase 135 mEq/L, ki lakòz konfizyon ak kriz; yo korije l dousman pou pwoteje sèvo a.

Siy Chvostek (Chvostek's sign): Yon kontraksyon nan vizaj lè yo tape machwè a, yon siy kalsyòm ba.

Siy Trousseau (Trousseau's sign): Yon spasm nan men lè yo gonfle yon mansèt tansyon, yon siy kalsyòm ba.

SALT LOSS (siy iponatremi) (SALT LOSS (hyponatremia signs)): Seizures, Abdominal cramps, Lethargy, Tendon reflexes diminished, Loss of urine and appetite, Orthostatic hypotension, Shallow breathing, Spasms (kriz, kramp nan vant, letaji, refleks tandon diminye, pèt pipi ak apeti, ipotansyon òtostatik, respirasyon sifasyèl, spasm): siy sodyòm pi ba pase 135 mEq/L.

FRIED (siy ipernatremi) (FRIED (hypernatremia signs)): Fever and flushed skin, Restlessness, Increased fluid retention and blood pressure, Edema, Decreased urine output and dry mouth (lafyèv ak po wouj, ajitasyon, retansyon likid ak tansyon ogmante, èdèm, pwodiksyon pipi diminye ak bouch sèk): siy sodyòm pi wo pase 145 mEq/L, ansanm ak swaf.

CATS (siy ipokalsemi) (CATS (hypocalcemia signs)): Convulsions, Arrhythmias, Tetany, Spasms and stridor (konvilsyon, aritmi, tetani, spasm ak stridor): siy ipokalsemi, kalsyòm total pi ba pase 9 mg/dL; ti bès lakòz pikotman, siy grav pre 7; siveye apre chiriji tiwoyid oswa paratiwoyid.

Sodyòm (Na+) (Sodium (Na+)): Nòmal 135 jiska 145 mEq/L; anba 135 pote konfizyon ak kriz lè l bese vit, pi wo pase 145 swaf ak ajitasyon; kritik anba 120 oswa pi wo pase 160, epi koreksyon an pa ale pi vit pase apeprè 8 jiska 10 mEq/L pa jou.

Kalsyòm total (Ca) (Total calcium (Ca)): Nòmal 9 jiska 10.5 mg/dL; ba pote pikotman, tetani, siy Chvostek ak Trousseau ak laringospasm, wo pote feblès, konstipasyon, wòch ak konfizyon, epi anba apeprè 6 oswa pi wo pase apeprè 13 kritik.

Kalsyòm iyonize (Ionized calcium): Kalsyòm aktif, ki pa mare, nòmalman apeprè 4.5 jiska 5.6 mg/dL (1.1 jiska 1.4 mmol/L); se valè pou fè konfyans lè albumin ba, paske yon albumin ba rale kalsyòm total la desann san l pa chanje fraksyon iyonize a.

Manyezyòm (Mg) (Magnesium (Mg)): Nòmal apeprè 1.5 jiska 2.5 mEq/L (kèk laboratwa 1.3 jiska 2.1); ba pote tranbleman, ipèrefleksi ak torsades, wo pote refleks pèdi, ipotansyon ak depresyon respiratwa, epi anba apeprè 1 oswa pi wo pase apeprè 5 kritik.

Saline ipètonik (3%) (Hypertonic saline (3%)): Enfizyon sèl konsantre pou iponatremi grav sentomatik pou retresi selil sèvo anfle; bay pa ponp jan yo òdone a (ti bolus pou kriz oswa koma, sinon enfizyon kontwole), tcheke sodyòm chak kèk èdtan; pa janm korije pi vit pase 8 a 10 mEq/L nan 24 èdtan, pou anpeche demyelinizasyon.

✅ Teste tèt ou

Yon pasyan ki gen yon nivo sodyòm 118 mEq/L ap resevwa saline 3%. Poukisa enfimyè a kontwole nivo sodyòm chak kèk èdtan?A client with a sodium level of 118 mEq/L is receiving 3% saline. Why does the nurse monitor sodium levels every few hours?
  1. Pasyan an ka devlope dyabèt ensipid nefwojenikThe client may develop nephrogenic diabetes insipidus
  2. Nivo sodyòm afekte batman kè a sèlmanSodium levels affect the heart rate only
  3. Koreksyon rapid riske demiyelinizasyon osmotikRapid correction risks osmotic demyelination
  4. Saline ipètonik lakòz ipòkalemi ak kranp nan miskHypertonic saline causes hypokalemia and muscle cramps

Repons: C · Koreksyon rapid riske demiyelinizasyon osmotik

Monte sodyòm twò vit retresi selil sèvo yo epi li ka lakòz domaj newolojik pèmanan; koreksyon limite a anviwon 8 rive 10 mEq/L nan 24 èdtan. Ipòkalemi ak kranp nan misk se pa rezon pou verifye sodyòm souvan; danje y ap swiv la se vitès sodyòm nan monte.

Raising sodium too fast shrinks brain cells and can cause permanent neurologic damage; correction is limited to about 8 to 10 mEq/L in 24 hours. Hypokalemia and muscle cramps are not the reason for frequent sodium checks; the danger being tracked is how fast the sodium rises.

Ki rezilta ki endike ipòkalsemi nan yon pasyan apre yon parathyroidectomy?Which finding indicates hypocalcemia in a client after a parathyroidectomy?
  1. Konstipasyon, letaji ak pyè nan renConstipation, lethargy and kidney stones
  2. Poliuri, doulè nan flan ak feblès nan miskPolyuria, flank pain and muscle weakness
  3. Spasm nan men lè yon manchèt gonfleHand spasm when a cuff is inflated
  4. Entèval QT vin pi koutShortened QT interval

Repons: C · Spasm nan men lè yon manchèt gonfle

Siy Trousseau (spasm nan ponyèt ak gonfleman manchèt) endike iritabilite newomiskilè soti nan kalsyòm ba. Yon entèval QT vin pi kout montre move direksyon an: li rive ak kalsyòm wo, alòske kalsyòm ba pwolonje QT a.

Trousseau's sign (carpal spasm with cuff inflation) indicates neuromuscular irritability from low calcium. A shortened QT interval points the wrong way: it occurs with high calcium, while low calcium prolongs the QT.

Yon pasyan ki gen maladi ren kwonik gen yon nivo manyezyòm 4.8 mEq/L. Ki rezilta evalyasyon enfimyè a dwe espere?A client with chronic kidney disease has a magnesium level of 4.8 mEq/L. Which assessment finding would the nurse expect?
  1. Refleks tandon pwofon ipèaktifHyperactive deep tendon reflexes
  2. Siy Chvostek ak Trousseau pozitifPositive Chvostek's and Trousseau's signs
  3. Takipne ak kranp nan misk ak tranblemanTachypnea with muscle cramps and tremor
  4. Refleks tandon pwofon diminyeDiminished deep tendon reflexes

Repons: D · Refleks tandon pwofon diminye

Manyezyòm wo deprime sistèm newomiskilè a, li pwodui iporeflèksi, letaji ak depresyon respiratwa. Refleks tandon pwofon ipèaktif se imaj opoze a, yo wè li ak manyezyòm ba olye yon nivo 4.8 mEq/L.

High magnesium depresses the neuromuscular system, producing hyporeflexia, lethargy and respiratory depression. Hyperactive deep tendon reflexes are the opposite picture, seen with low magnesium rather than a level of 4.8 mEq/L.

Kòmanse leson sa a gratis →

Kesyon tankou NCLEX, XP ak seri jou nan aplikasyon an, an angle ak èd an kreyòl. Pa bezwen enskri.

Plis nan Adaptasyon Fizyolojik

🔗 Leson ki gen rapò