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Electrolytes Involved in Cardiac (Heart) Conduction

Electrolytes Involved in Cardiac (Heart) Conduction

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Additional Lessons

Study Tools For Electrolytes Involved in Cardiac (Heart) Conduction

Stemi Myocardial Infarction 12 Lead EKG (Image)
Normal Sinus Rhythm (Image)
10 Common EKG Heart Rhythms (Cheatsheet)
EKG Chart (Cheatsheet)
EKG Electrical Activity Worksheet (Cheatsheet)
Heart Rhythms Signs and Symptoms (Cheatsheet)
EKG Electrical vs Mechanical Worksheet (Cheatsheet)
Heart Rhythm Identification (Cheatsheet)
Sodium (Na+) Lab Value (Picmonic)
Potassium (K+) Lab Value (Picmonic)
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Outline

Overview

  1. Electrolyte involvement in the heart’s conductivity
  2. Potassium and magnesium are the main intracellular electrolytes
  3. Sodium and Calcium are the main extracellular electrolytes

Nursing Points

General

  1. Extracellular positive ions
    1. Sodium (Na)
      1. Serum plasma levels
        1. 135-145 mEq/L
    2. Calcium (Ca)
      1. Serum plasma levels
        1. 8.4-10.2 mg/dL
  2. Intracellular positive ions
    1. Potassium (K)
      1. Serum plasma levels
        1. 3.5-5.0 mEq/L
    2. Magnesium (Mg)
      1. Serum plasma levels
        1. 1.6-2.6  mg/dL
  3. Action potential                                  
    1. Heart is resting
      1. Negative membrane potential
      2. Na and Ca channels open
      3. Na and Ca enter the cell
      4. Potassium exits the cell
        1. Electrical Stimulation
        2. Depolarization
    2. Contraction complete
      1. Na and Ca channels begin to close          
      2. Na and Ca exit  the cell
      3. Potassium channels open
      4. Potassium enters the cell
        1. Repolarization
  4. Electrolytes
    1. Na
      1. Initiates action potential
    2. Ca
      1. Increases the strength of contraction
    3. K
      1. Terminates action potential
    4. Mg
      1. Helps with repolarization

Assessment

  1. Electrolyte lab values
  2. Assess for dysrhythmias
    1. Ex: Hyperkalemia → Peaked T-waves

Therapeutic Management

  1. Recognize and report abnormal electrolytes
  2. Treat abnormal electrolytes promptly

Nursing Concepts

  1. EKG Rhythms
  2. Fluid & Electrolyte Balance

Patient Education

  1. Maintain adequate sodium, calcium  and potassium intake
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Transcript

Hey guys, in this lesson we will talk about the electrolytes involved in cardiac conduction.

Before we get started, please refer to Fluid and Electrolytes lesson for more detailed information regarding electrolytes, this presentation is specifically for the heart’s conduction and the electrolytes that affect it. So with that being said, let’s get started! Sodium, Potassium, Calcium and Magnesium are the major electrolytes involved in creating electricity so the heart can contract. Without a perfect balance of these electrolytes our hearts will have arrhythmias.

So let’s break down these 2 electrolytes first. Sodium is the major extracellular positive ion, it lives outside of the cell in the intercellular or intravascular space. Anything outside of the cell is extracellular, whether it’s in the vascular space or in between the cells. Normal sodium levels in the plasma are 135-145 mEq/L, this is the amount of sodium outside the cell, there is very little sodium inside the cell. Calcium also lives outside of the cell with sodium and with a positive charge. Normal plasma levels of calcium are 8.4-10.2mg/dL.
Now let’s talk about these two electrolytes. Potassium is the most important intracellular electrolytes in the body, it is positively charged and has a plasma concentration of 3.5-5.5mEq/L. It has a very high concentration inside the cell, so the concentration is less outside of the cell because potassium lives inside the cell. Magnesium is also positively charged with a concentration of 1.6-2.6mg/dL which is also inside the cell.

Now let’s break it down a little further and I am going to explain how the electrolytes actually work. Its starts when an action potential occurs, which is the movement of ions across the cell membrane. Here we have a cell, the cell is full of Potassium, , outside of the cell is Sodium and Calcium which are also positively charged. There are more positively charged cations outside of the cell versus inside of the cell. So the negativity inside the cells initiates an action potential by opening the sodium and calcium channels. This allows sodium to enter rapidly while potassium is exciting the cell, causing the cardiac cells to depolarize or contract. As the calcium enters the cell, it increases the strength of the contraction so ensure the heart pumps out all of the blood in its chambers. So after sodium and calcium have entered the cell and potassium has exited, the threshold has been reached and the heart has finished depolarizing or contracting. Potassium can begin to enter the cell again with the help of Magnesium – it inhibits potassium channels, meaning it prevents potassium from leaking out. When potassium reenters the cell, repolarization occurs. This is seen as the T wave on an EKG waveform, when there is an excessive amount of potassium the heart does not repolarize as easily, so the T wave is elevated on an EKG. So if you see an elevated T wave make sure you know what the potassium values are. As a little side note, think of a calcium channel blocker. It will block calcium from entering the cell, so it will decrease the workload of the heart and dilate arteries because when calcium enters the cell it constricts the arteries. If the channels are blocked,the calcium will not enter the cell and the arteries will dilate. This is why calcium channel blockers are given to people with hypertension and arrhythmias because it slows down the heart’s conduction, workload/oxygen demand, and dilates the arteries.

Key points to remember about these electrolytes, sodium enters the cell and initiates action potential for contraction. It is the main extracellular cation that lives outside the cell.
Calcium is also extracellular and enters the cardiac cell to increase the strength of contraction, by doing so it constricts arteries.
Potassium is the main intracellular electrolyte that exits and re-enters the cell to produce depolarization and repolarization, it also creates the T waves on an EKG
Magnesium is an intracellular cation that assists with repolarization, if mag levels are low it can produce ventricular arrhythmias, usually potassium levels are low as well because it cannot allow the potassium to stay in the cell since it cannot inhibit potassium channels. So potassium leaks out. Mag sulfate is given IV, usually with potassium replacement as well. But need to have mag first so the potassium channels are closed and potassium stays in the cells.

Make sure to check out our other lessons and resources regarding fluid and electrolytes or any other topic you may need additional help with, and as always, go out and be your best selves today and happy nursing!

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Study Plan Lessons

Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)
Blood Grouping
Blood Plasma
Blood Pressure (BP) Control
Breathing Control
Breathing Movements
Causes of Poor Gas Exchange Nursing Mnemonic (All People Can Value Lungs)
EKG (ECG) Waveforms
Electrolytes – Location in Body Nursing Mnemonic (PISO)
Electrolytes Involved in Cardiac (Heart) Conduction
Fluid & Electrolytes Course Introduction
Fluid Volume Deficit
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Nursing Care Plan (NCP) for Fluid Volume Deficit
Renal (Kidney) Fluid & Electrolyte Balance
Renal (Kidney) Acid-Base Balance
Respiratory Functions of Blood
Tonicity of Solutions – Live Tutoring Archive
Trach Suctioning
12 Points to Answering Pharmacology Questions
ACLS (Advanced cardiac life support) Drugs
Anti-Infective – Antifungals
Anti-Platelet Aggregate
Antianxiety Meds
Antidepressants
Barbiturates
Buspirone (Buspar) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Hydralazine
IM Injections
Injectable Medications
Insulin
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin Mixing
Interactive Pharmacology Practice
IV Infusions (Solutions)
IV Push Medications
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
Medication Errors
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Montelukast (Singulair) Nursing Considerations
Mood Stabilizers
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Rh Immune Globulin in Pregnancy
SubQ Injections
The SOCK Method – Overview
Introduction to Metabolism
Anti-Infective – Antifungals
Antiviral Agents for Treatment
Hb (Hepatitis) Vaccine
Infection or Inflammation? The Quick & Dirty on CBCs – Live Tutoring Archive
Infection or Inflammation? The Quick & Dirty on CBCs 2 – Live Tutoring Archive
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Tonicity of Solutions – Live Tutoring Archive
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Calling for RRT, Code Blue
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Delegation of Tasks to Assistive Personnel for Certified Emergency Nursing (CEN)
Drugs for Bradycardia & Low Blood Pressure Nursing Mnemonic (IDEA)
Dysrhythmia Emergencies
EKG Basics – Live Tutoring Archive
Fall and Injury Prevention
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Hypertensive Emergency
Increased Intracranial Pressure
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Pulmonary Embolism
Rapid Sequence Intubation
Premature Ventricular Contraction (PVC)
Premature Atrial Contraction (PAC)
Safety Check Nursing Mnemonic (MADLE)
Stress and Crisis
Supraventricular Tachycardia (SVT)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)
Aggressive & Violent Patients
Cultural Awareness and Influences on Development
Developmental Stages and Milestones
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Kohlberg’s Theory of Moral Development
Overview of Childhood Growth & Development
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Piaget’s Theory of Cognitive Development
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Cardiac (Heart) Disease in Pregnancy
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Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Day in the Life of a Labor Nurse
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Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
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Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
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Cardiac Terminology
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Acute Renal (Kidney) Module Intro
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Cardiac Stress Test
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Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
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Circulatory Checks (5 P’s) Nursing Mnemonic (The 5 P’s)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Coagulation Studies (PT, PTT, INR)
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Complications of Immobility
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Coronary Artery Disease Concept Map
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Diverticulitis Complications Nursing Mnemonic (Please Fix His Abscess SOon)
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Fibromyalgia
Fluid Volume Overload
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Genitourinary (GU) Assessment
Glaucoma
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Hearing Loss
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Hemodialysis (Renal Dialysis)
Heparin (Hep-Lock) Nursing Considerations
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
HMG-CoA Reductase Inhibitors (Statins)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hyperthermia (Thermoregulation)
Hypertonic Solutions (IV solutions)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoparathyroidism
Hypotonic Solutions (IV solutions)
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
Individualized Physical Assessments for Certified Perioperative Nurse (CNOR)
Informed Consent
Insulin Mnemonic (Ready, Set, Inject, Love)
Intake and Output (I&O)
Integumentary (Skin) Important Points
Interventions for Aphasia Nursing Mnemonic (PROP)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Isoniazid (Niazid) Nursing Considerations
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Losartan (Cozaar) Nursing Considerations
Macular Degeneration
Malignant Hyperthermia
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Mechanical Aids
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meniere’s Disease
Metabolic Acidosis (interpretation and nursing diagnosis)
Methylprednisolone (Solu-Medrol) Nursing Considerations
Mobility & Assistive Devices
Montelukast (Singulair) Nursing Considerations
Myocardial Infarction Nursing Mnemonic (MONATAS)
Naproxen (Aleve) Nursing Considerations
Neurogenic Shock for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Compartment Syndrome
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Epididymitis
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Osteomyelitis
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology for Rheumatoid Arthritis (RA)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for SIRS & MODS
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Thoracentesis (Procedure)
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan for Amputation
Nursing Care Plan for Compartment Syndrome
Nursing Care Plan for Distributive Shock
Nursing Case Study for Pneumonia
Nursing Case Study for Diabetic Foot Ulcer
Oncology Important Points
Oxygen Delivery Module Intro
Pain and Nonpharmacological Comfort Measures
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Patient Consent for Treatment for Certified Emergency Nursing (CEN)
Patient Communication Techniques for Certified Perioperative Nurse (CNOR)
Patients with Communication Difficulties
Perioperative Nursing Course Introduction
Peritoneal Dialysis (PD)
Pneumonia Concept Map
PPE Donning & Doffing
Pressure Ulcers/Pressure injuries (Braden scale)
Propylthiouracil (PTU) Nursing Considerations
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Sepsis Concept Map
Sepsis Labs
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Specialty Diets (Nutrition)
Stages of Hepatitis Nursing Mnemonic (PIP)
Strabismus
Stroke Assessment (CVA)
TB Drugs Nursing Mnemonic (RIPE)
The Medical Team
Thrombolytics
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Trach Care
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Understanding Blood Pressure Meds! – Live Tutoring Archive
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasopressin
Warfarin (Coumadin) Nursing Considerations
Who Needs Dialysis Nursing Mnemonic (AEIOU)
Wound Infections for Certified Emergency Nursing (CEN)