Electrolyte Imbalances Flashcards
Sodium
Na
135 mEq/L-145 mEq/L
hyponatremia
hypernatremia
Potassium
K
3.5 mEq/L-5 mEq/L
hypokalemia
hyperkalemia
Calcium
Calcium
8.5 mg/dL-10.5 mg/dL
hypocalcemia
hypercalcemia
Magnesium
Mg
1.8 mg/dL-2.7 mg/dL
hypomagnesemia
hypermagnesemia
Phosphorus
P
2.5 mg/dL-4.5 mg/dL
hypophosphatemia
hyperphosphatemia
Chloride
Cl
96 mEq/L-108 mEq/L
hypochloremia
hyperchloremia
Hyponatremia
causes & manifestations
- serum sodium < 135 mEq/L
- causes: adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating, diuretics
- manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased BP, nausea, abdominal cramping neurologic changes.
Hyponatremia
medical & nursing management
-medical: water restriction, sodium replacement.
-nursing: assessment and prevention, dietary sodium and fluid intake, identify and monitor at-risk patients, effects of medications (diuretics, lithium)
-replacement can be in form of isotonic solution
(lactated ringers, sodium chloride)
Hypernatremia
causes & manifestations
- serum sodium >145 mEq/L
- causes: excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions.
- manifestations: thirst; elevated temperature; dry, swollen tongue; sticky mucosa; neurologic symptoms; restlessness; weakness.
Hypernatremia
medical & nursing management
- medical: hypotonic electrolyte solution or D5W.
- nursing: assessment and prevention, assess for OTC sources of sodium, offer and encourage fluids to meet patient needs, provide sufficient water with tube feedings.
Hypokalemia
causes & manifestations
below-normal serum potassium (<30 because it can cause cardiac dysrhythmias, which can be lethal.
Hypokalemia
medical & nursing management
- medical: increased dietary potassium, potassium replacement, IV for severe deficit.
- nursing: assessment, severe hypokalemia is life-threatening, monitor ECG and ABGs, dietary potassium, nursing care r/t IV potassium administration.
- infusion pump used to ensure medication is not being given too quickly.
- PO potassium is irritating drug–give with food to prevent gastric irritation.
Hyperkalemia
causes
- serum potassium >5 mEq/L
- causes: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis.
- seen in patients w/ untreated renal failure or patients who have missed dialysis.
- seen in patients w/ Addison’s disease because adrenal hormones lead to sodium loss–w/ sodium loss you get potassium retention.
Hyperkalemia
manifestations
- cardiac changes and dysrhythmias
- muscle weakness with potential respiratory impairment
- paresthesias
- anxiety
- GI manifestations
Hyperkalemia
medical management
- monitor ECG
- limitation of dietary potassium
- cation-exchange resin (Kayexalate)
- IV sodium bicarbonate
- IV calcium gluconate
- regular insulin and hypertonic dextrose IV
- beta-2 agonists
- dialysis
Hyperkalemia
nursing management
- assessment of serum potassium levels
- mix IVs containing K+ well
- monitor medication affects
- dietary potassium restriction/dietary teaching for patients at risk
- Hemolysis of blood specimen or drawing of blood above IV site may result in false lab result (sometimes when blood is hemolysized potassium is released)
- salt substitutes, medications may contain potassium
- potassium-sparing diuretics may cause elevation of potassium (should not be used in patients with renal dysfunction)
The ECG change that is specific to hyperkalemia is a peaked T wave.
TRUE or FALSE
TRUE
- The ECG changes that are specific to hyperkalemia are peaked T wave; wide, flat P wave; and wide QRS complex.
- The increased potassium slows down conduction.
- ECG changes specific to hypokalemia are flattened T wave and the appearance of a U wave.
Hypocalcemia
causes
serum level <8.5 mg/dL–must be considered in conjunction with serum albumin level. (for every 1 g/dL drop in serum albumin there is a drop in calcium)
-causes: hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications, other.
Hypocalcemia
manifestation
- tetany
- circumoral numbness
- parethesias
- hyperactive DTRs
- Trousseau’s sign
- Chovstek’s sign
- seizures
- respiratory symptoms of dyspnea and laryngospasm
- abnormal clotting
- anxiety
- ECG changes: may have a prolonged QT interval causes ventricular irritability–at high risk for ventricular tachycardia.
Trousseau’s sign
-patients fingers go into spasm because of low calcium
Chovstek’s sign
-gently touch side of face and patient will twitch
Hypocalcemia
medical management
- IV of calcium gluconate,
- calcium and vitamin D supplements
- diet
- treatment includes supplementation–given PO if tolerated.
- when mixing IV calcium gluconate mix w/ D5W (if mixed w/ normal saline it will precipitate out and patient will not receive it).
Hypocalcemia
nursing management
- assessment
- severe hypocalcemia is life-threatening
- weight-bearing exercises to decrease bone calcium loss
- patient teaching r/t diet and medications
- nursing care r/t IV calcium administration.
Hypercalcemia
causes & manifestations
serum level >10.5 mg/dL
- causes: malignancy and hyperparathyroidism, bone loss r/t immobility.
- manifestations: muscle weakness, incoordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes, dysrhythmias.
- the higher the Ca levels, the more the symptoms can occur.
Hypercalcemia
medical management
- treat underlying cause
- fluids
- furosemide (lasix–anything that will get rid of potassium)
- phosphates
- calcitonin
- biphosphonates
Hypercalcemia
nursing management
- assessment (essential)
- hypercalcemic crisis has high mortality
- encourage ambulation
- fluids of 3-4 L/d
- provide fluids containing sodium unless contraindicated
- fiber for constipation
- ensure safety
Hypomagnesemia
causes
serum level <1.8 mg/dL–evaluate in conjunction with serum albumin
- causes: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood, contributing causes include diabetic ketoacidosis, sepsis, burns, hypothermia.
- loss of Mg is usually through the GI tract (intestines through fistulas, the distal sm bowel)
Hypomagnesemia
manifestations
- neuromuscular irritability
- muscle weakness
- tremors
- athetoid movements
- ECG changes and dysrhythmias
- alterations in mood and level of consciousness
Hypomagnesemia
medical management
- diet
- oral magnesium
- magnesium sulfate IV
- check for Chovstek and Trousseau’s sign
- increase in deep tendon reflexes
Hypomagnesemia
nursing management
- assessment
- ensure safety
- patient teaching r/t diet, medications, alcohol use
- nursing care r/t IV magnesium sulfate (patient should be on cardiac monitor)
- hypomagnesemia often accompanied by hypcalcemia–monitor urine output and potential for hypocalcemia
- dysphasia common in magnesium-depleted patients–assess ability to swallow with water before administering food or medications.
- vital signs checked q15 min
- IV on pump
Hypermagnesemia
causes
serum level >2.7 mg/dL
- renal failure
- diabetic ketoacidosis (because of catabolism that occurs and release of Mg)
- excessive administration of magnesium
- relatively uncommon
Hypermagnesemia
manifestations
- flushing
- lowered BP
- nausea
- vomiting
- hypoactive reflexes
- drowsiness
- muscle weakness
- depressed respirations
- ECG changes
- dysrhythmias
Hypermagnesemia
medical management
- IV calcium gluconate
- loop diuretics
- IV NS of RL
- hemodialysis
- drugs can cause hypermagnesemia (antacids, laxatives)–give fluids and raise urine output to get rid of it.
- elderly @ higher risk because of renal insufficiency
- pregnant women preterm labor w/ hypertension @ high risk.
- prevent by knowing what the patient is taking for medications
Hypermagnesemia
nursing management
- assessment
- DO NOT administer medications containing magnesium
- patient teaching regarding magnesium containing OTC medications
Patient with Crohn's disease develops tremors while receving total parental nutrition. Suspecting she may have hypomagnesemia, you assess her neuromuscular system. You expect to see:
A. non reactive pupil response
B. Trousseau's sign
C. decreased reflexes
D. lethargyB. Trousseau’s sign
- patients who have low Mg also have low Ca and would have the same symptoms–positive Trousseau’s sign
- they have hyper reflexes
Hypophosphatemia
causes
serum level <2.5 mg/dL
- alcoholism
- refeeding of patients after starvation (when P as supplementation is not sufficient enough, P shifts into the cells–usually occurs 3+ days after feeding begins)
- pain
- heat stroke
- respiratory alkalosis
- hyperventilation
- diabetic ketoacidosis
- hepatic encephalopathy
- major burns
- hyperparathyroidism
- low Mg
- low K
- diarrhea
- vitamin D deficiency
- use of diuretic and antacids
- inverse relationship between Ca and P–increased Ca/decreased P.
Hypophosphatemia
manifestations
- neurologic symptoms
- confusion
- muscle weakness
- tissue hypoxia
- muscle and bone pain
- increased susceptibility to infection and respiratory symptoms
Hypophosphatemia
medical management
- oral or IV phosphorus replacement
* mild-moderate is treated with diet–eggs, nuts, whole grain, meat, fish, poultry, milk
Hypophosphatemia
nursing management
- assessment
- encourage foods high in phosphorus (eggs, nuts, whole grain, meat, fish, poultry, milk)
- gradually introduce calories for malnourished patients receiving parenteral nutrition
Hyperphosphatemia
causes
serum level >4.5 mg/dL
- severe when >6.0 mg/dL
- renal failure
- excess phosphorus
- excess vitamin D
- acidosis
- hypoparathyroidism
- chemotherapy
- anything that causes cellular destruction also causes an increase in the release of phosphorus
Hyperphosphatemia
manifestations
- few symptoms
- soft-tissue calcifications
- symptoms occur due to associated hypocalcemia
Hyperphosphatemia
medical management
- treat underlying disorder
- vitamin D preparations
- calcium binding antacids
- phosphate binding gels or antacids
- loop diuretics
- NS IV
- dialysis
Hyperphosphatemia
nursing management
- assessment (I&Os, vital signs, fluid&electrolytes)
- avoid high-phosphorus foods
- patient teaching r/t diet, phosphate-containing substances, signs of hypocalcemia
Hypochloremia
causes
serum level s disease
- reduced chloride intake
- GI loss
- diabetic ketoacidosis
- excessive sweating
- fever
- burns
- medications
- metabolic alkalosis
- loss of chloride occurs w/ loss of other electrolytes: potassium, sodium
Hypochloremia
manifestations
- agitation
- irritability
- weakness
- hyperexcitability of muscles
- dysrhythmias
- seizures
- coma
- most common presentation–acid-base imbalance (usually metabolic alkalosis
Hypochloremia
medical management
- replace chloride
- IV NS or 0.45% NS
Hypochloremia
nursing management
- assessment
- avoid free water (shouldn’t drink excess amount of water because it will dilute the chloride)
- encourage high-chloride foods
- patient teaching r/t high chloride
Hyperchloremia
causes
serum level >108 mEq/L
- excess sodium chloride infusions w/ water loss
- head injury
- hypernatremia
- dehydration
- severe diarrhea
- respiratory alkalosis
- metabolic acidosis
- hyperparathyroidism
- medications
- typically occurs when there is excessive ingestion of aluminum chloride
Hyperchloremia
manifestations
- tachypnea
- lethargy
- weakness
- rapid, deep respirations
- hypertension
- cognitive changes
Hyperchloremia
medical management
- restore electrolyte and fluid balance
- Lactaed Ringers
- sodium bicarbonate
- diuretics
Hyperchloremia
nursing management
- assessment
- patient teaching r/t diet and hydration
