Disrupted Homeostasis: Electrolyte Imbalance PDF

Disrupted Homeostasis 1 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Electrolytes Minerals in the body that can conduct electricity. Found i...

Disrupted Homeostasis 1 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Electrolytes Minerals in the body that can conduct electricity. Found in urine, blood, tissues, as well as other body fluids. Include potassium, sodium, calcium, and magnesium. While naturally occurring in the body, can also be found in food, drinks, and supplements. 2 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Electrolytes Are Responsible For Balancing the amount of water in the body. Balancing the body’s pH (acid/base) level. Moving waste out of body cells. Moving nutrients into body cells. Allowing the body’s muscles, heart, nerves, and brain to function properly. 3 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Electrolyte Imbalance Dehydration; overhydration; certain medications; history of heart, kidney, or liver disorders; and incorrect intravenous fluids or feedings can all lead to an electrolyte imbalance. 4 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Mechanism of Disruption: Electrolyte Imbalance Potassium (K+) 3.5-5.1 mEq/L Sodium (Na+) 135-145 mEq/L Calcium (Ca2+) 8.5-10.5 mg/dL Magnesium (Mg2+) 1.8-2.2 mg/dL 5 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Potassium Levels Potassium The electrolyte potassium helps with nerve and muscle cell function while playing an important role in the muscle cells in the heart. Low potassium levels are called hypokalemia. High potassium levels are known as hyperkalemia. 6 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Sodium Levels Sodium The electrolyte sodium supports the function of nerves and muscles, helps maintain a normal blood pressure, and regulates the body’s fluid balance. Low sodium levels are called hyponatremia. High sodium levels are called hypernatremia. 7 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Calcium Calcium Maintains strong bones. Is stored in teeth and bones to support their hardness. Also helps muscles move, nerves to carry messages between the brain and body, and blood vessels. Low calcium levels are called hypocalcemia. Hypoparathyroidism (low parathyroid hormone levels) is a common cause of low calcium levels. High calcium levels are called hypercalcemia. Hypercalcemia is commonly caused by overactive parathyroid glands, or hyperparathyroidism. 8 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Magnesium Magnesium Magnesium’s role in the body is to assist in the regulation of nerve and muscle function, blood pressure and blood sugar levels; as well as making bone, protein, and DNA. Low magnesium levels are known as hypomagnesemia. High levels are called hypermagnesemia. 9 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Potassium Imbalance: Pathophysiology Hyperkalemia Potassium shift to extracellular space (out of the cell) Metabolic acidosis (i.e., DKA) Cellular damage (i.e., multiple transfusions, rhabdomyolysis) Kidney disease (rarely diagnosed if kidney function is normal) Iatrogenic therapy: Harm from a medical intervention Hypokalemia Aldosterone release: excretes K+ GI losses (N/V, suctioning) Poor dietary intake Non-potassium sparing diuretics 10 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Potassium Imbalance: Epidemiological and Etiological Risk Factors Hyperkalemia Hypokalemia Renal insufficiency Increased loss through Diabetes kidneys and GI tract Malignancies Increased loss through Acidosis cellular uptake (e.g., insulin administration, alkalosis) Medications (e.g., ACE inhibitors) Comorbidities (e.g., cardiac Rhabdomyolysis and renal disorders, Multiple blood transfusions hypomagnesemia) Smoking Age older than 65, higher Age older than 65, higher incidence in females incidence in males 11 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved. Potassium Imbalance: Impact On Overall Health Hyperkalemia Musculoskeletal: Muscle weakness, flaccid paralysis, depressed tendon reflexes, Cardiovascular: Life-threatening Dysrythmias, palpitations, syncope Neurovascular: Fatigue, peripheral neuropathy Laboratory/Diagnostics: ECG, BUN, Creatinine, Urinalysis, CBC, Blood glucose, ABGs, Dietary restriction of potassium: Potatoes, prunes, OJ, yogurt Medical interventions for reduction and prevention Medication selection and dosing Potassium binders 12 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved. Potassium Imbalance: Impact On Overall Health Hypokalemia: Symptoms appear when potassium < 3 mEq/L Musculoskeletal: Muscle weakness, muscle cramps Cardiovascular: Life-threatening dysrhythmias, U waves and flattening of the T wave Gastrointestinal: Nausea, abdominal distention, vomiting Renal: impaired renal function Laboratory/Diagnostics: ABGs, ECG, BMP, Urine, ABGs Client education regarding diuretics, laxatives, adequate dietary intake 13 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Potassium Imbalance: Role of the Nurse Hyperkalemia Limit dietary intake of potassium Maintain continuous cardiac monitoring Monitor intake and output Client education Diet (low Potassium) Monitoring serum potassium levels in chronic kidney disease Hypokalemia Encourage foods high in potassium, adequate hydration Avoid mixing potassium in dextrose solutions: May increase insulin excretion Evaluate urine output before giving IV potassium: requires adequate output Use an infusion pump for IV administration 14 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved. Potassium Imbalance: Discussion Question The client hospitalized with fluid volume overload has a potassium (K+) level of 3.0 mmol/L. What additional information do you want know? What nursing actions would you take to address the K+ level? 15 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved. Potassium Imbalance: Discussion Question The client hospitalized with fluid volume overload has a potassium (K+) level of 3.0 mmol/L. What additional What nursing actions information do you want would you take to address Trend of the K+ over the past know? the K+po K+ level? or IV days Stop loop diuretic Medications Monitor heart rhythm Medical diagnosis Correct underlying cause Assessment findings Edema I & O; is client on fluid restriction? VS Heart rhythm 16 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Sodium Imbalance: Pathophysiology Hypernatremia: >145 mEq/L Hypertonic sodium gain Hypotonic fluid loss Pure water loss: Renal, GI Hyponatremia: 160 mEq/L General symptoms: Fatigue, thirst, restlessness, irritability, muscle twitching Neurological: headache, confusion, cerebral edema Cardiovascular: hypotension Incidence: Impaired thirst, decreased fluid intake = decreased urine concentration Integumentary: dry mucous membranes, and decreased skin turgor Laboratory: serum osmolality and urine osmolality, serum electrolytes Client education: Drink adequate water, restrict sodium, IV and oral fluid replacement: not too fast! 19 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved. Sodium Imbalance: Impact On Overall Health Hyponatremia