Loss of extracellular fluid exceeds intake ratio of water: Electrolytes lost in same proportion as they exist in normal body fluids.
Manifestations: rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural hypotension, rapid weak pulse, increased temperature, cool clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness, cramps.
Laboratory data: elevated BUN in relation to serum creatinine, increased hematocrit. Serum electrolyte changes may occur.
Medical management: provide fluids to meet body needs: oral fluids, IV solutions
Dehydration: loss of water along with increased serum sodium level. May occur in combination with other imbalances.
Causes of dehydration: fluid loss from vomiting, diarrhea, GI suctioning (low intermittent), sweating, decreased intake, inability to gain access to fluid (limited mobility or bedrest have an inability to gain access to fluid).
Risk Factors for Dehydration: diabetes insipidus, adrenal insufficiency. osmotic diuresis, hemorrhage, coma, third-space shifts.
Fluid intake that is less than what is needed to meet body's fluid needs, results in a fluid volume deficit.
Considerations for older adults: body make up is less. Thirst mechanism is down.
Due to fluid overload or diminished homeostatic mechanisms
Risk Factors: heart failure, renal failure, cirrhosis of liver
Contributing Factors: excessive dietary sodium or sodium- containing IV solutions.
Manifestations: edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased blood pressure, pulse pressure and CVP, increased weight, increased urine output, shortness of breath and wheezing.
Medical Management: directed at cause, restriction of fluids and sodium, administration of diuretics.
Serum sodium less than 135 mEq/L
Causes: adrenal insufficiency water intoxication, SIADH or losses by vomiting, diarrhea, sweating, diuretics.
Manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abdominal cramping, neurologic changes.
Medical Management: water restriction, sodium replacement
Nursing management: assessment and prevention, dietary sodium and fluid intake, identify and monitor at-risk patients, effects of medications (diuretics, lithium)
Below-normal serum potassium (<3.5 mEq/L), may occur with normal potassium levels with alkalosis due to shift of serum potassium into cells.
Causes: GI losses, medications, alterations of acid-base balance, hyperaldosterism, poor dietary intake
Manifestations: fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness and cramps, paresthesias, glucose intolerance, decreased muscle strength.
Medical management: increased dietary potassium, potassium replacement, IV for severe deficit.
Nursing management: assessment, severe hypokalemia is life-threatening, monitor ECG and ABG's, dietary potassium, nursing care related to IV potassium administration.
Hypo and Hyperkalemia can kill a person. On monitor.
Good K+ sources- kiwi, bananas, potatoes.
IVPB not IVP- burns if infiltrates
Serum potassium greater than 5.0 mEq/L
Causes: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis.
Manifestations: cardiac changes and dysrhythmias. Cardiovascular are the most severe problems and most common cause of death. Muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations.
Medical management: monitor ECG, limitation of dietary potassium, cation-exchange resin (Kayexalate), IV sodium bicarbonate (instant), IV calcium gluconate, regular insulin and D50 (hypertonic dextrose) IV, dialysis
Nursing management: assessment of serum potassium levels, mix IV's containing K+ well, monitor medication affects, dietary potassium restriction/ dietary teaching for patients at risk.
Hemolysis of blood specimen or drawing of blood above IV site may result in false laboratory result.
Salt substitutes, medications may contain potassium
Potassium-sparing diuretics may cause elevation of potassium. potassium-sparing diuretics should not be used in patients with renal dysfunction.
Serum level less than 8.6 mg/dL, must be considered in conjunction with serum albumin level.
Causes: hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications.
Manifestations: tetany, numbness, paresthesias, hyperactive DTR's, Trousseau's sign, Chovstek's sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety.
Medical management: IV of calcium gluconate, calcium and Vitamin D supplements; diet- leafy greens and milk.
Nursing management: assessment, severe hypocalcemia is life-threatening, weight-bearing exercises to decrease bone calcium loss, patient teaching related to diet and medications, and seizure precautions.
Serum level greater than 10.2 mg/dL
Causes: malignancy and hyperparathyroidism, bone loss related to immobility.
Manifestations: muscle weakness, incoordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes, dysrhythmias.
Medical management: treat underlying cause fluids, furosemide, phosphates, calcitonin, biphosphonates.
Nursing management: assessment, hypercalcemic crisis has high mortality encourage ambulation, fluids of 3 to 4 L/d, provide fluids containing sodium unless contraindicated, fiber for constipation, ensure safety.
You can get hypercalcemia if you don't move. Anyone with an electrolyte imbalance is a fall risk
Serum level less than 1.3 mg/dL, evaluate in conjunction with serum albumin.
Causes: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood; contributing causes include diabetic ketoacidosis, sepsis, burns, hypothermia.
Manifestations: neuromuscular irritability, muscle weakness, tremors, ECG changes and dysrhythmias, alterations in mood and level of consciousness.
Medical management: diet, oral magnesium, magnesium sulfate IV.
Diet: vegetables high in Magnesium-> beans and nuts, green leafy vegetables, whole grains.
Nursing management: assessment, ensure safety, patient teaching related to diet, medications, alcohol use, and nursing care related to IV magnesium sulfate.
Hypomagnesemia often accompanied by hypocalcemia-> need to monitor, treat potential hypocalcemia.
Dysphasia common in magnesium-depleted patients. -> assess ability to swallow with water before administering food or medications
Serum level greater than 2.3 mg/dL
Causes: renal failure, diabetic ketoacidosis, excessive administration of magnesium.
Manifestations: flushing, lowered BP, nausea, vomiting, hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias.
Medical management: IV calcium gluconate, loop diuretics, IV NS, hemodialysis.
Nursing management: assessment, do not administer medications containing magnesium, patient teaching regarding magnesium-containing OTC medications.
Serum level below 2. mg/dL
Causes: alcoholism, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns. Most effects are related to decreased energy metabolism and imbalances of other electrolytes and body fluids.
Manifestations: neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increased susceptibility to infection.
Medical management: oral or IV phosphorus replacement, Vitamin D supplements.
Nursing management: assessment, encourage foods high in phosphorus, gradually introduce calories for malnourished patients receiving parenteral nutrition.
Serum level above 4.5 mg/ dL
Causes: renal failure, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, chemotherapy.
Manifestations: few symptoms; soft-tissue calcifications, symptoms occur due to hypocalcemia.
Medical management: treat underlying disorder vitamin-D preparations, calcium-binding antacids, phosphate-binding gels or antacids, loop diuretics, NS IV, dialysis
Nursing management: assessment, avoid high-phosphorus foods; patient teaching related to diet, phosphate-containing substances, signs of hypocalcemia
High phosphorus foods: soft drinks, chocolate, ice cream, hot dogs, frozen pizza.
Calcium and phosphorus opposite of each other
Serum level less than 97 mEq/L
Causes: Addison's disease, reduced chloride intake, GI loss, diabetic ketoacidosis, excessive sweating, fever, burns, medications, metabolic alkalosis
Loss of chloride occurs with loss of other electrolytes, potassium, sodium.
Manifestations: agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma
Medical management: replace chloride- IV NS or 0.45% NS
Nursing management: assessment, avoid free water, encourage high-chloride foods, patient teaching related to high-chloride foods
Serum level more than 107 mEq/L
Causes: excess sodium chloride infusions with water loss, head injury, hypernatremia, dehydration, severe diarrhea, respiratory alkalosis, metabolic acidosis, hyperparathyroidism, medications.
Manifestations: tachypnea, lethargy, weakness, rapid deep respirations, hypertension, cognitive changes.
Norma serum anion gap.
Medical management: restore electrolyte and fluid balance, LR, sodium bicarbonate, diuretics.
Nursing management: assessment, patient teaching related to diet and hydration.
Low pH <7.35
Low bicarbonate <22 mEq/L
Most commonly due to renal failure.
Manifestations: headache, confusion, drowsiness, increased respiratory rate and depth, decreased BP, decreased cardiac output, dysrhythmias, shock; if decrease is slow, patient may be asymptomatic until bicarbonate is 15 mEq/L or less
Correct underlying problem, correct imbalance.-> bicarbonate may be administered
With acidosis, hyperkalemia may occur as potassium shifts out of cell.
As acidosis is corrected, potassium shifts back into cell, potassium levels decrease.
Monitor potassium levels.
Serum calcium levels may be low with chronic metabolic acidosis-> must be corrected before treating acidosis
physical examination, palpation, percussion, auscultation, medications, nutrition, elimination, activity, exercise, sleep, rest, VS, self-perception, self-concept, roles, relationships, sexuality, reproduction, coping, stress tolerance, prevention strategies, family history cause of dysrhythmia, contributing factors. Assess indicators of cardiac output and oxygenation. Health history: include presence of coexisting conditions, indications of previous occurence. All medications (prescribed and OTC). Psychosocial assessment: patient's "perception" of dysrhythmia. Physical assessment include: skin (pale and cool), signs of fluid retention (JVD, lung auscultation), signs of decreased CO (cardiac output) (altered LOC), rate, rhythm of apical, peripheral pulses, heart sounds, blood pressure, pulse pressure. Fever, new heart murmur, friction rub at left lower sternal border (pericarditis), Osler nodes, Janeway lesions, Roth spots, and splinter hemorrhages in nailbeds (rheumatic). Cardiomegaly, heart failure, tachycardia, splenomegaly, fatigue, dyspnea, syncope, palpitations, chest pain (myocarditis). Diagnostic tools: blood cultures, echocardiogram, CBC, rheumatoid factor, ESR, CRP, urinalysis, ECG, cardiac catheterization, CMR imaging, TEE, CT scan.