Electrolyte Imbalances in Nursing Care PDF

Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Minerals that conduct electrical impulses Electrolyte in the body....

Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Minerals that conduct electrical impulses Electrolyte in the body. A condition in which low blood volume, due to massive internal or external bleed- Hypovolemic Shock ing or extensive loss of body water, re- sults in inadequate perfusion, leading to all major organ failure. series of blood tests that measure cer- tain components of blood, including glu- cose, calcium, and electrolytes Includes: Glucose Basic Metabolic Panel (BMP) Calcium Sodium Potassium Bicarbonate (Total CO2) Chloride Blood Urea Nitrogen (BUN) Creatinine BUN (Blood Urea Nitrogen) Normal Lev- 10-20 mg/dL els nitrogenous waste excreted in the urine Creatinine 0.5-1.2 mg/dL a set of tests that include all WBC, RBC CBC (complete blood count) and platelet measurements. Elevated sodium levels above 145 mEq/L. Hypernatremia Hyponatremia Low sodium levels below 135 mEq/L. Primary determinant of extracellular fluid Sodium osmolality. 1 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Normal Level: 135-145 mEq/L Sodium Regulation Primarily regulated by the kidneys. Osmolality Concentration of solutes in body fluids. Impaired LOC or excessive sodium in- Dehydration Causes take. Thirst, dry mucous membranes, de- creased urine output. Symptoms of Hypernatremia Replace fluids and monitor serum sodi- um levels. Nursing Interventions for Hypernatremia Use isotonic or hypotonic fluids for Fluid Replacement deficits. Potential complication from rapid sodium Cerebral Edema correction. Fluid overload or loss of sodium-rich flu- Hyponatremia Causes ids. Confusion, headache, nausea, seizures. Symptoms of Hyponatremia Primary treatment for hyponatremia due Fluid Restriction to water excess. Administer IV hypertonic saline for se- Sodium Replacement vere cases. 2 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Major intracellular cation, 3.5-5.3 mEq/L. Necessary for: Transmission and conduction of nerve Potassium and muscle impulses Cellular growth Maintenance of cardiac rhythms 7.0 mEq/L or higher indicates hyper- Critical Potassium Levels kalemia. 2.5 mEq/L or less indicates hypokalemia Essential for nerve conduction and car- Potassium Functions diac rhythms. Include sodium, potassium, calcium, Common Electrolyte Imbalances phosphorus, magnesium. Involves monitoring symptoms and lab Assessment of Electrolyte Imbalances results. Systematic approach to patient care and Nursing Process management. Guides patient-centered, evi- Caritas Philosophy dence-based nursing care. Physiological mechanisms maintaining Fluid and Electrolyte Balance bodily functions. Sodium Loss Mechanisms Includes urine, sweat, and feces. Elevated potassium levels above 5.3 mEq/L. Hyperkalemia Hypokalemia Low potassium levels below 3.5 mEq/L. Critical values are 7.0 mEq/L or higher Critical values for Potassium for hyperkalemia and 2.5 mEq/L or less for hypokalemia. A mechanism in cell membranes that Sodium-potassium pump maintains the concentration difference 3 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a of sodium and potassium by pumping potassium into the cell and sodium out. Includes fruits and vegetables (e.g., ba- nanas and oranges), salt substitutes Sources of Potassium containing 50-60 mEq of potassium per teaspoon, potassium medications, and stored blood. The kidneys are the primary route for potassium loss, eliminating about 90% Potassium loss of daily intake, with the remainder lost in stool and sweat. Causes include renal failure, medica- tions (ACE inhibitors, potassium-sparing Hyperkalemia Causes diuretics), acidosis, and cell destruction (hemolysis, burns, trauma). the ability of a cell to respond to a stim- Cellular Excitability ulus by generating a rapid change in its membrane potential Symptoms include muscle cramps, numbness, weakness, respiratory dis- tress, abdominal cramping, and ECG Hyperkalemia Symptoms changes such as peaked T waves. Manifestations include peaked T waves, decreased cardiac depolarization, flat- tening of the P wave, widening of the QRS complex, and potential for ventric- ECG Effects of Hyperkalemia ular fibrillation. Interventions include decreasing oral and parenteral potassium intake, in- 4 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a creasing elimination of potassium using Hyperkalemia Nursing Interventions loop diuretics, dialysis, and Kayexalate. Includes IV insulin and dextrose, IV cal- Moderate/Severe Hyperkalemia Nursing cium gluconate or calcium chloride, and Interventions IV sodium bicarbonate for acidosis. Caused by increased loss of potassi- um via kidneys (often due to diuretics Hypokalemia Causes or low magnesium) and gastrointestinal tract losses (diarrhea, laxative abuse, vomiting). Insulin therapy, ²-adrenergic stimulation, and alkalosis can cause potassium to Factors causing potassium shift move from the extracellular fluid (ECF) to the intracellular fluid (ICF). Serum potassium level of 2.8 and hema- T.M.'s Lab Results tocrit of 66%, indicating probable dehy- dration and hypokalemia. Assess for muscle weakness, cardiac ir- Clinical manifestations to assess in T.M. regularities, and signs of dehydration. Potassium concentration within muscle Potassium concentration in muscle cells cells is approximately 140 mEq/L. Potassium concentration in the extracel- Potassium concentration in ECF lular fluid (ECF) is 3.5 to 5.0 mEq/L. There is an inverse relationship between Inverse relationship in kidneys sodium and potassium reabsorption in the kidneys. Potassium is required for glycogen to be Potassium's role in glycogen deposited in muscle and liver cells. Potassium plays a role in maintaining Potassium's role in acid-base balance acid-base balance in the body. Patients with hyperkalemia are at risk for Risk for activity intolerance activity intolerance and injury related to lower extremity muscle weakness. 5 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Patients with hyperkalemia are at risk Risk for electrolyte imbalance for electrolyte imbalance due to altered potassium levels. Dysrhythmias are a potential complica- Potential complication of hyperkalemia tion associated with hyperkalemia. Include risk for activity intolerance, risk Nursing Diagnoses for Hyperkalemia for electrolyte imbalance, and risk for in- jury. A diuretic that increases urine produc- Lasix tion. Increased urine production and excre- Diuresis tion. Percentage of blood volume occupied by Hematocrit (Hct) red cells. Irregular heartbeats that can be Cardiac Dysrhythmias life-threatening. Reduced strength in leg muscles due to Skeletal Muscle Weakness low potassium. Weakness leading to shallow breathing Respiratory Muscle Weakness and low respiratory rate. Excessive urination often due to diuret- Polyuria ics. Hyperglycemia Elevated blood glucose levels. Loss of extracellular fluid affecting blood ECF Fluid Loss concentration. Supplement used to treat or prevent hy- Potassium Chloride (KCl) pokalemia. IV KCl Administration Must be diluted; never given as a bolus. Maximum KCl Rate Should not exceed 10-20 mEq/hr. Symptoms include muscle weakness Signs of Hypokalemia and leg cramps. Includes dairy, green leafy vegetables, Dietary Potassium Sources and beans. 6 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Essential for calcium absorption from the Vitamin D diet. Increases serum calcium levels by mobi- Parathyroid Hormone (PTH) lizing from bones. Lowers serum calcium levels by promot- Calcitonin ing bone deposition. Condition leading to decreased blood Fluid Volume Deficit volume and pressure. Potential for decreased physical activity Risk for Activity Intolerance due to weakness. Potential for abnormal electrolyte levels Risk for Electrolyte Imbalance affecting health. Increased likelihood of harm due to Risk for Injury weakness or hypotension. Continuous observation for heart rhythm Cardiac Monitoring changes. Symptoms include poor skin turgor and Signs of Fluid Imbalance lethargy. Contain potassium; useful for those on Salt Substitutes diuretics. Essential for bone health, muscle con- Calcium Functions tractions, and blood clotting. Free calcium in serum, crucial for physi- Ionized Calcium ological functions. Total Serum Calcium Includes all forms of calcium in the blood. Decreases calcium binding to albumin, Acidosis Effect on Calcium increasing ionized calcium. Increases calcium binding to albumin, Alkalosis Effect on Calcium decreasing ionized calcium. Most common cause of hypercalcemia, Hyperparathyroidism two-thirds of cases. Causes hypercalcemia through bone de- Malignancy struction or protein secretion. 7 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Leads to bone mineral loss and in- Prolonged Immobilization creased calcium levels. Elevated plasma calcium concentration Hypercalcemia causing various symptoms. lethargy, muscle weakness, confusion, Symptoms of Hypercalcemia constipation, Bone pain, fractures, and Kidney stones Hyperparathyroidism (two thirds of cas- es) Malignancy Causes of Hypercalcemia Prolonged immobilization - results in bone mineral loss and in- creased plasma calcium concentration Loop diuretics- promote excretion Hydrating with isotonic saline IV PO Fluid 3000 to 4000 mL daily to pro- mote the renal excretion of calcium and decrease kidney stone formation Nursing Interventions for Hypercalcemia Diet low in calcium (Vitamins) Increase in weight-bearing activity to enhance bone mineralization. Synthetic Calcitonin given IM or subcu- taneously lowers serum calcium levels. Bisphosphonates (example: Fosamax) Promote calcium excretion in hypercal- Loop Diuretics cemia treatment. Most effective agents in treating hyper- calcemia and osteoporosis Medication inhibits the activity of osteo- Bisphosphonates clasts (cells that break down bone and result in calcium release) (example: Fosamax) Hydration method to promote renal calci- Isotonic Saline IV um excretion. 8 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Lowers serum calcium levels via IM or Synthetic Calcitonin subcutaneous injection. Inhibit osteoclast activity, treating hyper- Bisphosphonates calcemia and osteoporosis. Low serum calcium levels leading to neu- Hypocalcemia romuscular excitability. Includes parathyroid deficiency, vita- min D deficiency, and malabsorption. Causes of Hypocalcemia (Overuse of laxatives, Disease such as Crohns or Celiacs) Trousseau's sign, Chvostek's sign, tetany, Laryngeal Stridor, Dysphagia, Hypocalcemia Assessment Tingling around mouth, Cardiac Dys- rhythmias etc. Sustained muscle contraction due to low Tetany calcium levels. Carpal spasm from inflating a BP cuff Trousseau's Sign above systolic pressure. Facial muscle contraction from tapping Chvostek's Sign the facial nerve. Diet high in calcium and vitamin D sup- Mild Hypocalcemia Management plementation. IV calcium preparations like calcium glu- Severe Hypocalcemia Management conate or chloride. Stored in the bones and teeth as calci- um phosphate uSerum levels controlled by parathyroid hormone (PTH) uEssential to function of muscle, red Phosphate blood cells, and nervous system uInvolved in acid-base buffering system, ATP production, cellular uptake of glu- cose, and metabolism of carbohydrates, proteins, and fats 9 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Maintained between 2.5 - 4.5 mg/dl in Normal Phosphate Levels serum. Kidneys control phosphate excretion and Renal Function and Phosphate reabsorption. High phosphate levels can lower calcium Reciprocal Relationship concentrations. Rare, and Often asymptomatic, can Hyperphosphatemia cause hypocalcemia symptoms. Parathyroid hormone (PTH) regulates calcium concentration Acute hypoparathyroidism (low PTH) causes Hyperphosphatemia Clinical Application low plasma calcium (tetany) high plasma phosphate level Hypoparathyroid tetany is treated with IV calcium gluconate Restrict phosphorus intake and use Management of Hyperphosphatemia phosphate-binding agents. Phosphate-binding agent limiting intesti- Calcium Carbonate nal phosphate absorption. Increases calcium levels to normalize Hydration in Hyperphosphatemia phosphate levels. Low PTH causing low calcium and high Hypoparathyroidism phosphate. Muscle spasms due to low calcium lev- Hypoparathyroid Tetany els. IV Calcium Gluconate Treatment for hypoparathyroid tetany. Low phosphorus levels, often asympto- Hypophosphatemia matic. Malnourishment, alcoholism, phos- Causes of Hypophosphatemia phate-binding antacids. Mild: Often Asymptomatic Symptoms of Hypophosphatemia Severe: CNS depression, confusion, muscle weakness.H 10 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Oral supplementation Neutra-Phos Dietary increase in phosphorus Hypophosphatemia Interventions dairy products IV administration of potassium phos- phate Energy molecule affected by phosphorus Cellular ATP deficiency. 2,3-Diphosphoglycerate (2,3-DPG) Enzyme aiding oxygen delivery in RBCs. Oral phosphorus supplement for hy- Neutra-Phos pophosphatemia. IV treatment for symptomatic hypophos- Potassium Phosphate phatemia. Essential for cellular processes and en- Magnesium zyme activation. Normal Magnesium Levels 1.5 - 2.5 mEq/L for physiological function. Neuromuscular Excitability Affected by serum magnesium levels. Excess magnesium, often due to renal Hypermagnesemia insufficiency. Depressed Neuromuscular and CNS functions Symptoms of Hypermagnesemia Lethargy, decreased reflexes, muscle tone issues. Low magnesium levels causing neuro- Hypomagnesemia muscular issues. Poor intake (starvation), chronic alco- Causes of Hypomagnesemia holism, diuretics. Confusion Hyperactive reflexes Symptoms of Hypomagnesemia Muscle cramps, tremors Cardiac dysrhythmias Positive Chvostek's sign 11 / 12  Electrolyte Imbalances in Nursing Care Study online at https://quizlet.com/_g3p98a Oral supplements Increase dietary intake green vegetables, nuts, bananas, or- Treatment of Hypomagnasemia anges, peanut butter, and chocolate Parenteral IV or IM magnesium when severe Positive sign indicating hypomagne- Chvostek's Sign semia or hypocalcemia. IV treatment for severe hypomagne- Magnesium Sulfate semia. Green vegetables, nuts, bananas, Dietary Sources of Magnesium chocolate. Interferes with magnesium absorption in Fluid Loss Effects GI tract. Monitoring Vital Signs Essential during magnesium sulfate ad- Use an infusion pump- too rapid ad- ministration. ministration of magnesium can lead to cardiac or respiratory arrest. Prevents rapid magnesium administra- Infusion Pump Use tion complications. Normal Sodium Levels 135-145 mEq/L 3.5 - 5.3 mEq/L Normal Potassium Levels Critical values 7.0 mEq/L or higher Critical values 2.5 mEq/L or less Normal Calcium Levels 8.5-10.5 mg/dL a consequence of pancreatitis, produces Lipolysis fatty acids that combine with calcium ions, decreasing serum calcium levels. 12 / 12