Electrolyte Imbalances Flashcards
Normal Magnesium Values
1.5-2.5 mEq/L (0.75-1.25 mmol/L)
Normal Values For Potassium
3.5-5.0 mEq/L (3.5-5.0 mmol/L)
Normal Sodium values
135-145 mEq/L (135-145 mmol/L)
Normal Calcium Values
8.6-10.2 mg/dL (2.15-2.55 mmol/L)
Normal Ionized Calcium Level
4.6-5.3 mg/dL (1.16-1.32 mmol/L)
Normal Phosphate Values
2.4-4.4 mg/dL (0.78-1.42 mmol/L)
Normal Chloride Values
96-106 mEq/L (96-106 mmol/L)
Normal Bicarbonate Values
22-26 mEq/L (22-26 mmol/L)
What would you do if your patient had hypernatremia?(Sodium over 145)
Nursing Interventions?
- Treat underlying cause.
- If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline
- Diuretics
- The goal of treatment in hypernatremia is to treat the underlying cause. In primary water deficit, the continued water loss must be prevented and water replacement must be provided.
- If oral fluids cannot be ingested, IV solutions of 5% dextrose in water or hypotonic saline may be given initially. Serum sodium levels must be reduced gradually to prevent too rapid a shift of water back into the cells.
- Overly rapid correction of hypernatremia can result in cerebral edema.
- The risk is greatest in the patient who has developed hypernatremia over several days or longer.
What would you do if your patient had hyponatremia ? (Sodium under 135) ?
Fluid restriction is needed.
Severe symptoms (seizures)
Give small amount of IV hypertonic saline solution (3% NaCl).
Abnormal fluid loss= Fluid replacement with sodium-containing solution
Administer Vasopressins, a drug that blocks the activity of ADH
Symptoms of Hypernatremia? (Sodium over 145)
• Thirst, lethargy, agitation, seizures, and coma
• Impaired LOC
Produced by clinical states:
• Central or nephrogenic diabetes insipidus
• Restlessness, agitation, twitching, seizures, coma
• Intense thirst; dry, swollen tongue, sticky mucous membranes
• Postural hypotension, ↓ CVP, weight loss
• Weakness, lethargy (Lewis 313)
Symptoms of Hyponatremia?(Under 135)
Confusion, nausea, vomiting, seizures, and coma
Symptoms of Hyperkalemia
- Cramping leg pain
- Weak or paralyzed skeletal muscles
- Ventricular fibrillation or cardiac standstill
- Abdominal cramping or diarrhea
- ECG Effects of Hyperkalemia
- Irritability
- Anxiety
- Weakness of lower extremities
- Paresthesias
- Irregular pulse
- Cardiac arrest if hyperkalemia sudden or severe
What would you do if your patient had hyperkalemia? (Potassium over 5.0)
- Eliminate oral and parenteral potassium intake
- Increase elimination of potassium. This is accomplished via diuretics, dialysis, and use of ion-exchange resins such as sodium polystyrene sulfonate (Kayexalate).
Increased fluid intake can enhance renal potassium elimination.
- Force potassium from the ECF to the ICF. This is accomplished by administration of IV insulin (along with glucose so the patient does not become hypoglycemic) or via administration of IV sodium bicarbonate in the correction of acidosis. Rarely, a β-adrenergic agonist (e.g., epinephrine) is administered.
- Reverse the membrane potential effects of the elevated ECF potassium by administering calcium gluconate intravenously. Calcium ion can immediately reverse the membrane excitability.
Nursing Diagnoses for Hyperkalemia
- Risk for electrolyte imbalance related to excessive retention or cellular release of potassium.
- Risk for injury related to lower extremity muscle weakness and seizures
- Potential complication: dysrhythmias
Symptoms of Hypokalemia? (Potassium Under 3.5)
• Most serious are cardiac. • Skeletal muscle weakness (legs) • Weakness of respiratory muscles • Decreased gastrointestinal motility • Impaired regulation of arteriolar blood flow • Fatigue • Muscle weakness, leg cramps • Nausea, vomiting, paralytic ileus • Soft, flabby muscles • Paresthesias, decreased reflexes Weak, irregular pulse Polyuria Hyperglycemia
What is the most common cause of hyperkalemia?
The most common cause of hyperkalemia is renal failure
What would you do if your patient had Hypokalemia?
Hypokalemia is treated by giving potassium chloride supplements and increasing dietary intake of potassium. Potassium chloride (KCl) supplements can be given orally or intravenously. Except in severe deficiencies, KCl is never given unless there is urine output of at least 0.5 mL/kg of body weight per hour.
Safety Alert for Giving Potassium
- KCl given intravenously must always be diluted.
- Never give KCl via IV push or in concentrated amounts.
- IV bags containing KCl should be inverted several times to ensure even distribution in the bag.
- Never add KCl to a hanging IV bag to prevent giving a bolus dose.
Patient teaching for Hypokalemia
1.For all patients at risk:
•Teach the patient and/or caregiver the signs and symptoms of hypokalemia (see Table 17-6) and to report their appearance to the health care provider.
1.For all patients at risk:
•Teach the patient and/or caregiver the signs and symptoms of hypokalemia (see Table 17-6) and to report their appearance to the health care provider.
2.For patients taking potassium-losing diuretics:
•Explain the importance of increasing dietary potassium intake.
•Teach patients and/or caregivers which foods are high in potassium (see Table 47-11).
•Explain that salt substitutes contain approximately 50-60 mEq of potassium per teaspoon and help raise potassium if taking a potassium-losing diuretic.
3.For patients taking potassium-sparing diuretics:
•Instruct the patient and/or caregiver that salt substitutes and foods high in potassium should be avoided.
4.For patients taking oral potassium supplements:
•Instruct the patient to take the medication as prescribed to prevent overdosage and to take the supplement with a full glass of water to help it dissolve in the GI tract.
5.For patients taking digitalis preparations and others at risk for hypokalemia:
•Explain the importance of having serum potassium levels regularly monitored because low potassium enhances the action of digitalis.
Nursing Interventions/ Treatment of Hypercalcemia
The basic treatment of hypercalcemia is promotion of excretion of calcium in urine by administration of a loop diuretic (e.g., furosemide [Lasix]), and hydration of the patient with isotonic saline infusions.
In hypercalcemia, the patient must drink 3000 to 4000 mL of fluid daily to promote the renal excretion of calcium and to decrease the possibility of kidney stone formation.
Clinical Manifestations of Hypercalcemia?
Lethargy, weakness
Depressed reflexes
Decreased memory
Confusion, personality changes, psychosis
Anorexia, nausea, vomiting
Bone pain, fractures
Polyuria, dehydration
Nephrolithiasis
Stupor, coma
Polyuria, dehydration
Nephrolithiasis
Stupor, coma
Hypercalcemia measurment?
Over 10.2 mg/dl
Hypocalcemia measurement?
Less than 8.6 mg/dl
Hyponatremia
Less than 135
Hypernatremia
More than 145
Hyperkalemia
More than 5.0
Hypokalemia
Less than 3.5
Hypocalcemia measurment
Less than 8.6 mg/dl
Hypercalcemia measurement
More than 10.2mg/dL
Hypomagnesemia
Less than 1.5 mEq/L
Hypermagnesemia
Greater than 2.5 mEq/L
Symptoms of Hypocalcemia?
Easy fatigability
Depression, anxiety, confusion
Numbness and tingling in extremities and region around mouth
Hyperreflexia, muscle cramps
Chvostek’s sign
Trousseau’s sign
Laryngeal spasm
Tetany, seizures
Nursing interventions for Hypocalcemia?
- The primary goal in treatment of hypocalcemia is aimed at treating the cause.
- Hypocalcemia can be treated with oral or IV calcium supplements.
- Calcium is not given intramuscularly (IM) because it may cause severe local reactions, such as burning, necrosis, and tissue sloughing.
- Intravenous preparations of calcium, such as calcium gluconate, are given when severe symptoms of hypocalcemia are impending or present.
- A diet high in calcium-rich foods is usually ordered along with vitamin D supplements for the patient with hypocalcemia.
- Oral calcium supplements, such as calcium carbonate, may be used when patients are unable to consume enough dietary calcium, such as those who do not tolerate dairy products.
- Pain and anxiety must be adequately treated in the patient with suspected hypocalcemia because hyperventilation-induced respiratory alkalosis can precipitate hypocalcemic symptoms.
- Any patient who has had thyroid or neck surgery must be closely observed in the immediate postoperative period for manifestations of hypocalcemia because of the proximity of the surgery to the parathyroid glands.
Nursing Diagnoses for Hypocalcemia?
- Risk for electrolyte imbalance related to decreased production of PTH
- Risk for injury related to tetany and seizures
- Potential complications: fracture, respiratory arrest
Nursing Diagnoses for Hypercalcemia?
- Risk for electrolyte imbalance related to excessive bone destruction
- Risk for injury related to neuromuscular and sensorium changes
- Potential complication: dysrhythmias
Nursing Diagnoses for Hypokalemia?
- Risk for electrolyte imbalance related to excessive loss of potassium
- Risk for injury related to muscle weakness and hyporeflexia
- Potential complication: dysrhythmias
Nursing Diagnoses for Hyponatremia?
- Risk for injury related to altered sensorium and decreased level of consciousness secondary to abnormal CNS function
- Risk for electrolyte imbalance related to excessive loss of sodium and/or excessive intake or retention of water
- Potential complication: severe neurologic changes
Nursing Diagnoses for Hypernatremia?
- Risk for injury related to altered sensorium and seizures secondary to abnormal CNS function
- Risk for electrolyte imbalance related to excessive intake of sodium and/or loss of water
- Potential complication: seizures and coma leading to irreversible brain damage
Signs andsymptoms of Hypomagnesemia?
Diarrhea
Vomiting
Chronic alcoholism
Impaired GI absorption
Malabsorption syndrome
Prolonged malnutrition
Large urine output
NG suction
Poorly controlled diabetes mellitus
Hyperaldosteronism
Symptoms of Hypermagnesemia?
Initial clinical manifestations of a mildly elevated serum magnesium concentration include lethargy, drowsiness, and nausea and vomiting.
As the levels of serum magnesium increase, deep tendon reflexes are lost, followed by somnolence, and then respiratory and, ultimately, cardiac arrest can occur.
Renal failure (especially if patient is given magnesium products)
Excessive administration of magnesium for treatment of eclampsia
Adrenal insufficiency
Nursing Management/Treatment of HyperMagnesemia?
Management of hypermagnesemia should focus on prevention.
Persons with chronic kidney disease should not take magnesium-containing drugs and must be cautioned to review all over-the-counter drug labels for magnesium content.
The emergency treatment of hypermagnesemia is IV administration of calcium chloride or calcium gluconate to physiologically oppose the effects of the magnesium on cardiac muscle.
Promoting urinary excretion with fluid will decrease serum magnesium levels. The patient with impaired renal function will require dialysis because the kidneys are the major route of excretion for magnesium.
