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Flashcards in Table 52-6 Deck (24)
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1

Hyponatremia
Risk factors:

-loss of sodium
-gastrointestinal fluid loss
-sweating
-use of diuretics
-gain of water
-hypotonic tube feedings
-excessive drinking of water
-excess IV D5W administration (dextrose in h2o)
-syndrome of inappropriate ADH
-head injury, aids, malignant tumors

2

Hyponatremia
Clinical manifestations:

-lethargy, confusion, apprehension
-muscle twitching
-abdominal cramps
-anorexia, nausea, vomiting
-headache, seizures, coma

Lab findings:
Serum sodium < 135 mEq/L
Serum osmolality <280 mOsm/kg

3

Hyponatremia
Nursing interventions:

-Assess clinical manifestations
-monitor fluid intake and output
-monitor lab data
-assess client closely if administering hypertonic saline solutions
-encourage food and fluid high in sodium
-limit water intake as indicated

4

Hypernatremia
Risk factors:

-Loss of water
-insensible water loss
(hyperventilation or fever)
-diarrhea
-water deprivation
-Gain of sodium
-parental administration of saline solutions
-Hypertonic tube feedings w/o adequate water
-excessive use of table salt (1 tsp contains 2,300 mg of sodium
- conditions such as : diabetes insipidus, heat stroke

5

Hypernatremia
Clinical manifestations:

-thirst
-dry, sticky mucous membranes
-tongue dry, red, swollen
-weakness
-severe hypernatremia (fatigue, restlessness, decreased level of consciousness, disorientation, convulsions)
Lab findings:
Serum sodium >145mEq/L
Serum osmolality >300 mOsm/kg

6

Hypernatremia
Nursing interventions:

-Monitor fluid intake and output
-Monitor behavioral changes
-Monitor lab findings
-Encourage fluids as ordered
-Monitor diet as ordered (restrict intake of salt/sodium)

7

Hypokalemia
Risk factors:

-Loss of potassium
- vomiting and gastric suction
- diarrhea
-heavy perspiration
-use of potassium-wasting drugs
-poor intake of potassium ( w/ debilitated clients, alcoholics, anorexia, nervosa)
-hyperaldosteronism

8

Hypokalemia
Clinical manifestations:

-Muscle weakness, leg cramps
-Fatigue, lethargy
-anorexia, nausea, vomiting
-decreased bowel sounds, decreased bowel motility
-cardiac dysthymias
-depressed deep-tendon reflexes
-weak, irregular pulses
Lab findings:
Serum potassium < 3.5mEq\L
Arterial blood gases may show alkalosis
T-wave flattening & ST- segment depression on ECG

9

Hypokalemia
Nursing interventions:

-Monitor heart rate and rhythm
-Monitor clients receiving digitalis (digoxin) bc hypokalemia increases risk of digitalis toxicity
-administer oral K+ with food or fluid to prevent gastric irritation
-administer IV K+ at a rate no faster than 10-20mEq/h never administer undiluted K+ through IV
-Monitor pain & inflammation in injection site
-teach pt about K+ rich foods
-teach pt how to prevent excess loss of K+ (diuretics)

10

Hyperkalemia
Risk factors:

-decreased potassium excretion
-renal failure
-hypodosteronism
-K+ conserving diuretics
-high K+ intake
-excessive use of K+ containing salt substitutes
-excessive or rapid IV infusion of K+
-K+ shift out of the tissue cells into the plasma (infections, burns, acidosis)

11

Hyperkalemia
Clinical manifestations:

-Gastrointestinal hyperactivity, diarrhea
-irritability, apthay, confusion
-cardiac dysrhythmias or arrest
-muscle weakness, areflexia (absence of reflexes)
-decreased heart rate, irregular pulse, paresthesias and numbness in extremities
-lab findings:
Serum potassium > 5.0 mEq/L
Peaked T-wave, widened QRS on ECG

12

Hyperkalemia
Nursing interventions:

-closely monitor cardiac status and ECG
-administer diuretics and other meds such as glucose and insulin
-hold K+ supplements and K+ conserving diuretics
-monitor K+ levels carefully, a rapid drop may occur as K+ shifts into cells
- teach pt to avoid foods high in K+ and salt substitutes

13

Hypocalcemia
Risk factors:

-Surgical removal of the parathyroid glands
-conditions such as:
hypoparathyroidism, acute pancreatitis,
hyperphosphatemia, thyroid carcinoma
-inadequate vitamin D intake
-malabsorption
-hypomagnesemia
-alkalosis
-sepsis
-alcohol abuse

14

Hypocalcemia
Clinical manifestations:

-numbness, tingling of the extremities and around the mouth
-muscle tremors, cramps; if severe can progress to tetany and convulsions
-cardiac dysrhythmias ; decreased cardiac output
-positive trousseaus and chvosteks signs; confusion, anxiety, possible psychoses, hyperactive deep-tendon reflexes
Lab findings:
Calcium <8.5 mg/dL (total) or 4.5 mEq/L (ionized)
Lengthened QT intervals
Prolonged ST segments

15

Hypocalcemia
Nursing interventions:

-Closely monitor respiratory and cardiovascular status
-take precautions to protect a confused client
-administer oral or parenteral calcium, when administering IV closely monitor cardiac status and ECG during infusion
-Teach pt's at high risk for osteoporosis: dietary sources rich in calcium, recommend 1000-1500 mg of calcium per day, calcium supplements, reg exercise, estrogen replacement therapy

16

Hypercalcemia
Risk factors:

-prolonged immobilization
Conditions as such: hyperparathyroidism, malignancy of the bone, Paget's disease

17

Hypercalcemia
Clinical manifestations:

-lethargy, weakness
-depressed deep tendon reflexes
-bone pain
-anorexia, nausea, vomiting
-constipation
-polyuria, hypercalciuria
-flank pain secondary to urinary calculi (kidney infection)
-dysrhythmias, possible heart block
Lab findings:
Calcium > 10.5 mg/dL total or 5.5 ionized
Shortened QT intervals, ST segments

18

Hypercalcemia
Nursing interventions:

-increase pt movement and exercise
-encourage fluids to dilute urine
-teach pts to limit intake of food and fluid high in calcium
-encourage ingestion of fiber to prevent constipation
-protect a confused pt; monitor for pathological fractures in pts w/ long term hypercalcemia
-encourage intake of acid-ash fluids (prune juice) to counteract deposits of calcium salts in urine

19

Hypomagnesemia
Risk factors:

-excess loss from GI tract
-long term use of certain drugs (diuretics )
-conditions such as : chronic alcoholism, pancreatitis, burns

20

Hypomagnesemia
Clinical manifestations:

-neuromuscular irritability w/ tremors
-increased reflexes, tremors, convulsions
-positive chvosteks and trousseaus signs
-tachycardia, elevated blood pressure, dysrhythmias
-disorientation & confusion
-vertigo, anorexia, dysphagia
-respiratory difficulties
Lab findings:
Magnesium <1.5mEq/L, prolonged QT intervals, depressed ST segments, broad flattened T waves, prominent U waves

21

Hypomagnesemia
Nursing interventions:

-Assess pts receiving digitalis for dig toxicity
-hypomagnesemia increases the risk of toxicity
-take protective measures when there is a possibility of seizures
-assess the pts ability to swallow water prior to initiating oral feeding
-initiate safety measures to prevent injury during seizure activity
-carefully administer magnesium salts as ordered
-encourage pts to eat magnesium rich foods
-refer pts to alcohol treatment programs as needed

22

Hypermagnesemia
Risk factors:

Abnormal retention of magnesium, as in :
Renal failure
Adrenal insufficiency
Treatment w/ magnesium salts

23

Hypermagnesemia
Clinical manifestations:

-peripheral vasodilation, flushing
-nausea, vomiting
-muscle weakness, paralysis
-hypotension, bradycardia
-depressed deep tendon reflexes
-lethargy, drowsiness
-respiratory depression, coma
-respiratory and cardiac arrest if hypermagnesemia is severe
Lab findings:
Magnesium >2.5 mEq/L
ECG w/ prolonged PR interval, widened QRS, tall Twave

24

Hypermagnesemia
Nursing interventions:

-Monitor VS and level of consciousness when pts at risk
-if patellar reflexes are absent, notify PHCP
-advise pts who have renal disease to contact their provider before taking OTC meds