38824365 electrolyte-imbalances

ELECTROLYTE IMBALANCES

SODIUM

Most abundant electrolyte in the ECF

135 to 145 mEq/L

Has a major role in controlling water distribution throughout the body

Regulated by ADH, thirst and the renin-angiotensin-aldosterone system

Primary regulator of ECF volume

Also functions in establishing the electrochemical state necessary for muscle contraction and the transmission of nerve impulses

Butter, bacon, canned food, cheese, ketchup, frankfurters, processed food, soy sauce, table salt

HYPONATREMIA

Serum sodium level lower than 135 mEq/L

Causes include: increased sodium excretion (excessive diaphoresis, diuretics, vomiting, diarrhea, wound drainage, decreased secretion of aldosterone); inadequate sodium intake; dilution of serum sodium (freshwater drowning, SIADH)

Assessment Findings

Rapid pulse rate Generalized skeletal muscle weakness Headache Diminished deep tendon reflexes Confusion Seizures Nausea Decreased urinary specific gravity Increased urine output

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

If hyponatremia is accompanied by a fluid deficit, IV sodium chloride infusions are administered

If hyponatremia is accompanied by a fluid excess, osmotic diuretics are administered

Instruct client to increase oral sodium intake and inform the client about the foods to include in the diet

If the client is taking lithium, monitor the lithium level, because hyponatremia can cause diminished lithium excretion, resulting in toxicity

HYPERNATREMIA

Is a serum sodium level that exceeds 145 mEq/L

Causes include: decreased sodium excretion, increased sodium intake, decreased water intake, increased water loss

Assessment Findings

Heart rate and BP that respond to vascular volume status

Pulmonary edema if hypervolemia is present

Spontaneous muscle twitches, irregular muscle contractions (early)

Skeletal muscle weakness (late) Altered cerebral function is the most

common manifestation Increased urinary specific gravity;

decreased urine output

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

If the cause is fluid loss, prepare to administer IV infusions

If the cause is inadequate renal excretion of sodium, prepare to administer diuretics

Restrict sodium as prescribed

POTASSIUM

Is the major intracellular electrolyte

Ranges from 3.5 to 5.1mEq/L

98% of the body’s potassium is inside the cells, the remaining 2% is in the ECF that is important in neuromuscular function

Influences both skeletal and cardiac muscle activity

Avocado, banana, cantaloupe, carrots, fish, mushroom, oranges, potatoes, raisins, spinach, strawberries, tomatoes, pork, beef

HYPOKALEMIA

Is a serum potassium level lower than 3.5meq/L

Potassium deficit is potentially life-threatening because every body system is affected

Causes include: excessive use of medications such as diuretics, vomiting, diarrhea, inadequate potassium intake, hyperinsulinism

Assessment Findings

Weak peripheral pulsesFUS – flattened T wave, U wave, ST

segment depression in ECG Shallow respirations, anxiety,

lethargy, confusion Skeletal muscle weakness Deep tendon hyporeflexia Hypoactive to absent bowel sounds Nausea and vomiting

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

Monitor electrolyte values

Administer potassium supplements orally or intravenously

Oral potassium supplements may cause nausea and vomiting and they should not be taken on an empty stomach

Liquid potassium chloride has an unpleasant taste and should be taken with juice or another liquid

Potassium is never given by IV push or by the IM or SQ route

After adding potassium to an IV solution, rotate and invert the bag to ensure that the potassium is distributed evenly

Label IV bag containing potassium properly

Potassium infusion can cause phlebitis; thus the nurse should assess the IV site frequently

Monitor renal function and I&O before administering potassium

Institute safety measures for the client experiencing muscle weakness

Potassium sparing diuretic may be prescribed instead

Instruct the client about foods that are high in potassium content

HYPERKALEMIA

Is a serum potassium level that exceeds 5.1mEq/L

Is caused by: excessive potassium intake, decreased potassium excretion, tissue damage, hypercatabolism

Assessment Findings

Slow, weak, irregular heart rate Decreased BPTWiFP – Tall peaked T waves,

widened QRS complexes, flat P waves, widened QRS complexes

Muscle twitches, cramps (early) Profound weakness (late) Diarrhea

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

Discontinue IV potassium and hold oral potassium supplements

Initiate a potassium-restricted diet

Prepare to administer potassium-excreting diuretics if renal function is not impaired

Prepare to administer sodium polysterene sulfonate (Kayexalate), cation exchange resin that promotes GI sodium absorption and potassium excretion

Prepare the client for dialysis if potassium levels are critically high

Prepare for the IV administration of hypertonic glucose with regular insulin to move excess potassium into the cells

Monitor renal function

When blood transfusions are prescribed for a client with a potassium imbalance the client should receive fresh blood

Teach the client to avoid foods high in potassium

Instruct the client to avoid the use of salt substitutes

CALCIUM

Major component of bones and teeth

Plays a major role in transmitting nerve impulses and helps regulate muscle contraction and relaxation, including cardiac muscle, also plays a role in blood coagulation

8.6 to 10mg/dL

The serum calcium level is controlled by parathyroid hormone and calcitonin

Cheese, milk, soy milk, sardines, spinach, tofu, yogurt

HYPOCALCEMIA

Is a serum calcium level lower than 8.6 mg/dL

Causes include: inadequate oral intake of calcium, lactose intolerance, inadequate intake of vitamin D, diarrhea, steatorrhea, hyperphosphatemia, , acute pancreatitis, removal or destruction of the parathyroid glands

Assessment Findings

Decreased heart rate Hypotension Diminsihed peripheral pulses Prolonged ST interval, prolonged QT

interval Twitches, cramps Painful muscle spasms during periods

of inactivity Positive Trousseau’s and

Chvostek’s sign

Trousseau’s sign

Inflate a blood pressure cuff around the client’s upper arm for 1 to 4 minutes above the systolic pressure

In a client with hypocalcemia, the hand and fingers become spastic and go into palmar flexion

Chvostek’s sign

Tap the face just below and in front of the ear

Facial twitching on that side of the face indicates a positive test

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

Administer calcium supplements orally or calcium intravenously

When administering calcium IV, warm the injection solution to body temperature before administration and administer slowly

Monitor for ECG changes, observe for infiltration, and monitor for hypercalcemia during therapy

Administer medications that increase calcium absorption (aluminum hydroxide, vitamin D)

Provide a quiet environment to reduce stimuli

Initiate seizure precautions

Move the client carefully, and monitor for signs of a fracture

Keep 10% calcium gluconate available for treatment of acute calcium deficit

Instruct client to consume foods high in calcium

HYPERCALCEMIA

Is a serum calcium level that exceeds 10mg/dL

Causes include: increased calcium absorption, decreased calcium excretion (use of thiazide diuretics), hyperparathyroidism, malignancy, immobility

Assessment Findings

Increased heart rate in early phase, bradycardia that can lead to cardiac arrest in late phases

Increased BP Shortened ST segment, widened T

wave Profound muscle weakness Increased urinary output Formation of renal calculi

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

Discontinue IV infusions of solutions containing calcium and oral medications containing calcium or vitamin D

Discontinue thiazide diuretics and replace with diuretics that enhance the excretion of calcium

Prepare client with severe hypercalcemia for dialysis

Move client carefully and monitor for signs of fracture

Monitor for flank or abdominal pain, and strain the urine to check for the presence of urinary stones

Instruct client to avoid calcium rich foods

MAGNESIUM

Acts as an activator for many intracellular enzyme systems and plays a role in both carbohydrate and protein metabolism

Acts peripherally to produce vasodilation

Affect neuromuscular irritability and contractility

1.6 to 2.6 mg/dL

Avocado, canned white tuna, cauliflower, milk, green leafy vegetables, oatmeal, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt

HYPOMAGNESEMIA

Is a serum magnesium level lower than 1.6 mg/dL

Causes include: insufficient magnesium intake, chronic alcoholism, malnutrition and starvation, insulin administration

Assessment Findings

Tall T waves, depressed ST segments Tachycardia Twitches Hyperreflexia Seizures Irritability Confusion

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

Monitor serum magnesium levels frequently

Initiate seizure precautions

Instruct client to increase intake of foods that contain magnesium

HYPERMAGNESEMIA

Is a serum magnesium level that exceeds 2.6 mg/dL

Causes include: increased magnesium intake, decreased renal excretion of magnesium

Assessment Findings

Bradycardia Hypotension Prolonged PR interval, widened QRS

complexes Skeletal muscle weakness Drowsiness and lethargy

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

Diuretics are prescribed to increase renal excretion

Instruct client to restrict dietary intake of magnesium-containing foods

Intravenously administered calcium chloride or calcium gluconate may be prescribed to reverse the effects of magnesium on cardiac muscle

Instruct the client to avoid the use of laxatives and antacids containing magnesium

PHOSPHORUS

Essential to the function of muscle and red blood cells, formation of ATP, maintenance of acid base balance

Provides structural support to bones and teeth

2.7 to 4.5 mg/dL

Fish, organ meats, nuts, pork, beef, chicken, whole grain breads and cereals

HYPOPHOSPHATEMIA

Is a serum phosphorus level lower than 2.7mg/dL

A decrease in the serum phosphorus level is accompanied by an increase in the serum calcium level

Causes include: insufficient intake, malnutrition, starvation, hyperparathyroidism

Assessment Findings

Decreased contractility and cardiac output

Weakness Decreased bone density Irritability Confusion seizures

Interventions

Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status

Administer phosphorus orally along with vitamin D supplement

Prepare to administer phosphorus IV

Assess renal system before administering phosphorus

Move client carefully, and monitor for signs of fracture

Instruct client to increase intake of phosphorus containing foods while decreasing the intake of calcium-containing foods

HYPERPHOSPHATEMIA

Serum phosphorus level that exceeds 4.5mg/dL

Increase in serum phosphorus is accompanied by a decrease in serum calcium

Causes include: decreased renal excretion, increased intake of phosphorus, hypoparathyroidsm

Assessment Findings

Same as assessment of hypocalcemia

Interventions

Entails management of hypocalcemia

Instruct client to avoid phosphate containing medications

Instruct client to decrease the intake of food that