Electrolyte Imbalances - Nursing Care Study Notes

Electrolyte Imbalances - Study Notes

• Outcomes: Describe safe, patient-centered, evidence-based nursing care for adults at a basic level, guided by the Caritas philosophy. Discuss critical thinking and clinical reasoning to deliver quality patient care. Describe factors that create a culture of safety related to medication administration. Discuss critical thinking and clinical judgment for accurate and safe medication administration.

• Concepts: Fluid and Electrolyte: Physiological mechanisms that maintain fluid and electrolyte balance promoting bodily functions. Describe the nursing process and collaborative management of patients with common fluid and electrolyte imbalances.

• Electrolyte Imbalances—Specifics:

  • Sodium (135-145 mEq/L): Essential for nerve impulse generation and transmission, muscle contractility, and maintaining ECF osmolality. Imbalances often associated with changes in osmolality. The kidneys are the primary regulator.
  • Hypernatremia Causes: Dehydration, impaired LOC, diabetes insipidus, excessive sodium intake with inadequate water intake, and excessive IV administration of hypertonic saline (3% Sodium Chloride).
  • Hypernatremia Symptoms/Assessment: Signs of dehydration (thirst, dry mucous membranes, decreased urine output, restlessness, agitation, lethargy, muscle twitching).
  • Hypernatremia Nursing Interventions: Treat underlying cause. Water deficit-oral or IV with isotonic or hypotonic fluids (5% dextrose in water, 0.45% sodium chloride solution). Dilute sodium excess with sodium-free IV fluids and promote excretion with diuretics. Monitor serum sodium levels and response to therapy. Quickly reducing sodium levels can cause cerebral edema and neurologic complications.
  • Hyponatremia Causes: Excessive diarrhea, replacing fluid with plain water, diuretics, renal disease, profuse diaphoresis, draining wounds, excessive diarrhea/vomiting, trauma, significant blood loss, and excess fluid intake.
  • Hyponatremia Symptoms/Assessment: Confusion, headache, nausea, and seizures (severe cases).
  • Hyponatremia Nursing Interventions: Fluid restriction. Sodium replacement. Monitor neuro status. Room assignment where the patient will be central to the unit for monitoring and fall prevention.
  • Potassium (3.5-5.3 mEq/L): Major intracellular cation. Intracellular concentration in muscle cells = 140 mEq/L, compared to 3.5 to 5.0 mEq/L in ECF. Maintaining the difference in concentration is vital for neuromuscular and cardiac function. A ratio of ECF-to-ICF potassium is a major factor in the resting membrane potential of nerve and muscle cells and is commonly affected by potassium imbalances. Potassium is required for glycogen to be deposited in muscle and liver cells and assists in acid-base balance.
  • Hyperkalemia Causes: Renal failure, medications (ACE inhibitors, potassium-sparing diuretics), acidosis, and cell destruction (hemolysis, burns, trauma).
  • Hyperkalemia Symptoms/Assessment: Muscle cramps, numbness, respiratory distress, abdominal cramping, cardiac rhythm changes (peaked T wave).
  • Hyperkalemia Nursing Interventions: Decrease oral and parenteral potassium intake, increase potassium excretion (loop diuretics, dialysis, kayexalate). Monitor ECG and serum electrolytes. Rapid reduction in serum potassium can pose a risk of cerebral edema and neurologic complications due to rapid changes.
  • Hypokalemia Causes: Renal losses, GI tract losses (diarrhea, laxatives, vomiting). Low magnesium, increased aldosterone, and diuretics.
  • Hypokalemia Symptoms/Assessment: Confusion, muscle weakness, fatigue, constipation, bone pain, fractures, kidney stones (severe cases). Changes in cardiac rhythm; muscle cramps and numbness.
  • Hypokalemia Nursing Interventions: Increase dietary potassium intake. Oral K supplements (KCl). Intravenous K supplements (KCl) only if severe (never give KCl via IV push or bolus). Use diluted solutions as rapid dose administration poses risk. Monitor vital signs during administration and serum potassium levels. Continuously monitor for complications as sudden changes can severely impact the body.

• Calcium (8.5-10.5 mg/dl): Essential for bone and teeth formation, blood clotting, nerve impulse transmission, myocardial contractions, and muscle contractions.

  • Hypercalcemia Causes: Hyperparathyroidism, malignancy, prolonged immobilization.
  • Hypercalcemia Symptoms/Assessment: Lethargy, muscle weakness, confusion, decreased reflexes, constipation, bone pain, fractures, kidney stones.
  • Hypercalcemia Nursing Interventions: Loop diuretics, hydration with isotonic saline IV. Increase fluid intake (3000 to 4000 mL daily), diet low in calcium, and bisphosphonates.
  • Hypocalcemia Causes: Parathyroid hormone deficiency, vitamin D deficiency, chronic kidney disease, malabsorption, overuse of laxatives.
  • Hypocalcemia Symptoms/Assessment: Tetany, positive Trousseau's/Chvostek's sign, laryngeal stridor, dysphagia, tingling mouth/extremities, cardiac dysrhythmias (prolonged QT interval).

• Phosphate (2.5-4.5 mg/dl): Stored in bones and teeth as calcium phosphate. Essential to muscle, red blood cells, and nervous system functions. Part of the acid-base buffering system, ATP production, cellular uptake of glucose, and metabolism of carbs, proteins, and fats. The kidneys are the major route of excretion. A reciprocal relationship with calcium exists.

• Magnesium (1.5–2.5 mEq/L): Essential for cellular processes, coenzyme in protein and carbohydrate metabolism, nucleic acid and protein synthesis. Important for sodium-potassium pump, maintenance of normal calcium/potassium balance, and neuromuscular excitability.

• Hypermagnesemia Causes: Medications; impaired renal function.

• Hypermagnesemia Symptoms/Assessment: Depressed neuromuscular and CNS functions; lethargy, flaccid muscle tone, decreased reflexes, cardiac arrest.

• Hypermagnesemia Nursing Interventions: Emergency treatment (IV calcium gluconate, diuretics or dialysis). Restrict magnesium-containing foods/drugs. Treat the underlying cause.

• Hypomagnesemia Causes: Poor dietary intake, chronic alcoholism, starvation, diuretics.

• Hypomagnesemia Symptoms/Assessment: Confusion, hyperactive reflexes, muscle cramps, tremors, cardiac dysrhythmias, positive Chvostek's sign.

• Hypomagnesemia Nursing Interventions: Oral supplements, increase dietary magnesium intake. IV or IM administration of magnesium in severe cases.