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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