Clinical Manifestions and Interventions

Question 1

Hyper

What r sodium (NA) clinical manifestations and primary interventions?

Answer 1

S – Skin flush/dry
A – Agitation/confusion
L – Loss of consciousness (Coma)
T - Thirst
S - Seizures

Primary Interventions
Administer oral free water
Administer IV hypotonic solution

Question 2

Hyper

What r potassium (K) clinical manifestations and primary interventions?

Answer 2

1. Abdominal cramps
2. Diarrhea
3. Cardiac dysrhythmias/arrest

Primary Interventions

1. IV calcium (stabilizes heart)
2. Insulin (moves K into ICF) and glucose (avoids hypoglycemia)
3. Kayexalate (binds k+ and pushes into feces), K+ wasting diuretics

Question 3

Hyper

What r calcium (Ca) clinical manifestations and primary interventions?

Answer 3

1. NMJ: decreased reflexes
2. Dysrhythmias, cardiac arrest
3. Kidney stones
4. Lethargy, decreased LOC

Primary Interventions

1. Mild cases – increase fluid intake to 3-4L/day.
2. Severe – IV fluids and loop diuretics
3. IV drugs – calcitonin, bisphosphonates, glucocorticoids

Question 4

Hyper

What r magnesium (Mg) clinical manifestations and primary interventions?

Answer 4

1. NMJ: decreased DTRs, paralysis, shallow resp rate/rhythm
2. Bradycardia, hypotension
3. Cardiac dysrhythmias/arrest
4. Apprehension
5. Skin flush and diaphoretic

Primary Interventions

1. Admin IV calcium
2. Admin IV fluids
3. Renal dialysis is very severe

Question 5

Hyper

What r phosphate (PO) clinical manifestations and primary interventions?

Answer 5

1. Twitching/tetany
2. Pos chvosteks and Trousseau’s
3. Confusion
4. NMJ: weakness/fatigue
5. ECG changes, dysrhythmias, tachycardia.

Primary Interventions
1.	Limit foods high in PO
2.	Admin aluminum-based antacids (binds PO in GI tract).
	Ampgogel, alternagel
	Admin diuretics

Question 6

Hypo

What r sodium (NA) clinical manifestations and primary interventions?

Answer 6

1. Confusion, HA, seizures
2. Muscle cramps/fatigue/weakness
3. N/V/D
4. Anorexia; hyperactive bowel sounds

PI

1. Monitor I/O, daily weight, labs
2. Assess neuro and muscle str
3. Admin PO salt tabs or fluids containing Na
4. Admin IV hypertonic (3-5% saline) if very low.

Question 7

Hypo

What r potassium (K) clinical manifestations and primary interventions?

Answer 7

1. Muscle fatigue, weakness, cramps
2. ECG changes (depressed Twave)
3. Shallow, ineffective respirations
4. Death due to cardiopulmonary arrest (muscle funct cessation)

PI

1. Admin oral supps (40-80 meq/day). Dilute in full glass and take with meals.
2. Assess renal funct; monitor output
3. Major SE of replacement is NVD, bad taste

Question 8

Hypo

What r calcium (Ca) clinical manifestations and primary interventions?

Answer 8

1. NMJ – twitches, tetany, paresthesia
2. Pos Chvostek (tapping facial nerve= triggers facial twitching)
3. Pos. Trousseau (sustained inflated BP cuff = hand/finger spasms)
4. Cardiac dysrhythmias/reduced contractility
5. GI: N/V; increased peristalsis
6. Seizures.

PI

1. Oral calcium admin
2. IV Ca if emergent (Ca gluconate or CaCl); watch for phlebitis.

Question 9

Hypo

What r magnesium (Mg) clinical manifestations and primary interventions?

Answer 9

1. NMJ: hyperactive DTRs, tatany, paresthesia
2. Pos Chvostek and Trousseau
3. Tachycardia, HTN, dysrhythmias
4. Anorexia, N/V

PI

1. Encourage Mg diet (green, leafy veges, whole grains, fish, nuts)
2. Admin Mg (PO, IV, IM)
3. Monitor reflexes before IV dose

Question 10

Hypo

What r phosphate (PO) clinical manifestations and primary interventions?

Answer 10

1. Muscle weakness, bone pain
2. Decreased DTRs
3. Confusion
4. Anorexia

PI

1. Mild – Increase dietary sources (dairy, meat, fish, nuts)
2. Admin oral supps (K-phosphate, neutral-phos K, Phospha-soda) May cause diahrrhea, vol overload, hyperkalemia
3. Severe – IV phosphate or NaPO

Question 11

FVD (volume imbalance)

What r Clinical Manifestations & Nursing Interventions

Answer 11

Clinical Manifestations
 Thirst, weight loss, and dry mucous membranes (dry/sunken eyes, mouth/tongue/palate).
 Oliguria
 Weak, thread pulse
 Orthostatic hypotension: Greater than 15% increase in HR and greater than 15 mmHg drop in systolic BP when standing.
 Confusion
 Decreased skin turgor (hand turgor not reliable in older adults; use sternum or forehead).
 Decreased venous filing

Nursing Interventions
 Assess for cause of losses
 Assess I/Os (min of 30ml/hr urinary output)
 Assess vitals and daily weights.
 IV fluid replacement (requires an oder).