Electrolyte Imbalances Flashcards
(42 cards)
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
