Session 5-6 Electrolytes Balance and Disturbance -Revised 2024 PDF

Chapter 13 Class Session 5-6 Electrolytes Imbalances Page: 264-278 LEARNING OBJECTIVE ❖ Describe the causes, clinical manifestations, diagnosis and management of patients with electrolyte imbalances. Copyright © 2018 Wolters Kluwer · All Right...

Chapter 13 Class Session 5-6 Electrolytes Imbalances Page: 264-278 LEARNING OBJECTIVE ❖ Describe the causes, clinical manifestations, diagnosis and management of patients with electrolyte imbalances. Copyright © 2018 Wolters Kluwer · All Rights Reserved Electrolytes ❖ Active chemicals that carry positive (cations) and negative (anions) electrical charges o Major cations: sodium, potassium, calcium, magnesium, hydrogen ions o Major anions: chloride, bicarbonate, phosphate, sulfate, proteinate ions o Expressed in terms of millequivalents (mEq) ❖ Electrolyte concentrations differ in fluid compartments Copyright © 2018 Wolters Kluwer · All Rights Reserved Electrolyte Imbalances ❖ Sodium: hyponatremia, hypernatremia ❖ Potassium: hypokalemia, hyperkalemia ❖ Calcium: hypocalcemia, hypercalcemia ❖ Magnesium: hypomagnesemia, hypermagnesemia ❖ Phosphorus: hypophosphatemia, hyperphosphatemia ❖ Chloride: hypochloremia, hyperchloremia Copyright © 2018 Wolters Kluwer · All Rights Reserved ELECTROLYTE NORMAL VALUES ❖ SODIUM – 135-145 mEq/L or 135-145 mmol/L ❖ POTASSIUM – 3.5 -5 mEq/L or 3.5 – 5 mmol/L ❖ CALCIUM – 8.6 – 10.2 mg/dL or 2.2 -2.6 mmol/L Copyright © 2018 Wolters Kluwer · All Rights Reserved  1. Hyponatremia (Sodium Deficit) ❖ Serum sodium less than 135 mEq/L ❖ Acute o Result of fluid overload of a surgical patient ❖ Chronic o Seen outside of hospital setting, has a longer duration, less serious neurologic sequelae ❖ Exercise associated o More common in women of small stature, extreme temperatures, excessive fluid intake, prolonged exercise Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Causes and Clinical Manifestations #1 Causes Manifestations o Imbalance of water, o Poor skin turgor, o losses by vomiting, o Dry mucosa, o diarrhea, sweating, o Headache, o diuretics, o Decreased o adrenal insufficiency, salivation, o Anticonvulsants medications, o Decreased blood pressure, o SIADH o Nausea, o Abdominal cramping, o Neurologic changes Copyright © 2018 Wolters Kluwer · All Rights Reserved  Management of Hyponatremia Treat underlying condition ✔ Sodium replacement- by mouth, nasogastric tube, or a parenteral route ✔ Water restriction ✔ Medication Nursing Management: ✔ I&O, daily weight, monitor laboratory values- sodium , CNS changes ✔ Encourage dietary sodium ✔ Monitor fluid intake ✔ Effects of medications (diuretics, lithium) Copyright © 2018 Wolters Kluwer · All Rights Reserved 2. Hypernatremia (Sodium Excess) ❖ Serum sodium greater than 145 mEq/L ❖ Occurs in patients with normal fluid volume, FVD, FVE ❖ Most affected are very old, very young, and cognitively impaired Copyright © 2018 Wolters Kluwer · All Rights Reserved  Causes and Clinical Manifestations #2 ❖ Causes: Manifestations: ✔ Thirst; ▪ Fluid deprivation, ✔ Elevated ▪ Excess sodium temperature administration, ▪ Diabetes insipidus, ▪ Heat stroke, ▪ Hypertonic IV solutions Copyright © 2018 Wolters Kluwer · All Rights Reserved Management of Hypernatremia ❖ Gradual lowering of serum sodium level via infusion of hypotonic electrolyte solution ❖ Diuretics ❖ Assessment for abnormal loss of water and low water intake ❖ Assess for over-the-counter sources of sodium ❖ Monitor for CNS changes Copyright © 2018 Wolters Kluwer · All Rights Reserved  Nursing Management - Hypernatremia Preventing Hypernatremia: ✔ Provide oral fluids at regular intervals ✔ For patients with diabetes insipidus, adequate water intake must be ensured ✔ Parenteral fluid replacement - decreased level of consciousness Copyright © 2018 Wolters Kluwer · All Rights Reserved  3. Hypokalemia (Potassium Deficit) ❖ Below-normal serum potassium ❖