Electrolyte imbalances

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Hypokalemia lab value description
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<3.5 mEq/L
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Hypokalemia etiology
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inadequate intake, NPO, renal losses, magnesium depletion, GI losses, vomiting, dirrhea, diuretics, enemas, beta blockers, steroids, alkalosis.
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Hypokalemia manifestations
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Slowed smooth muscle contractions, abdominal distention, constipation, muscle weakness/leg cramps, fatigue, paresthesias, hyporeflexia, irritability.
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Hypokalemia nursing interventions
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EKG monitoring, administer high K+ foods or supplements, assess H & P,determine and correct underlying cause. Severe Hypokalemia (3- 3.4 mEq/L) requires IV intervention(100- 200 mEq of IV potassium).
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Hypokalemia nursing diagnosis
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1. risk for injury- low K+ can lead to weakness, falls, or seizures. 2. imbalanced nutrition- less than body requirements
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Foods high in potassium
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Fish, whole grains, nuts, artichokes, broccoli, brussels sprouts, carrots, celery, cucumbers, apricots, bananas, melons, oranges, strawberries, brewed coffee, tomato juice, fruit juice.
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Hyperkalemia lab value description
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>5 mEq/L
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Hyperkalemia etiology (3 major causes)
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1. Retention because of decreased urine output 2. Excessive release from the cells after traumatic injury, burns, or from cell lysis or acidosis. 3. Excessive IV infusion of solutions that contain K+, especially in someone with renal disease.
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Hyperkalemia manifestations
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may not present until >7 mEq/L. Abnormal EKG, nerve and muscle irritability, tachycardia, colic, diarrhea.
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Hyperkalemia nursing interventions
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Assess H & P, EKG monitoring, treat imbalance (force fluids, IV saline, diuretics). For severe Hyperkalemia infusion of IV calcium gluconate.
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Hyperkalemia teaching
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Teach dietary potassium sources, avoid salt substitutes, and OTC medications that affect K+ balance.
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Hypocalcemia lab value
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< 4.5 mEq/L
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Hypocalcemia etiology
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Inadequate intake, inadequate intake of vit. D, diseases that impair absorption, parathyroid disease, medications, pancreatitis, Cushing’s disease, inadequate sunlight.
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Hypocalcemia manifestations
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Neuromuscular hyperexcitability, numbness and tingling of hands, toes, lips, irritability/anxiety, brittle bones/fractures. Late signs: Hypotension, dysrhythmias, trousseau’s/ Chvostek’s signs, seizures, tetany, death.
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Hypocalcemia nursing interventions
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Review H & P, replacement therapy with oral supplements, increase dairy products, treat underlying cause of Hypocalcemia. Tetany requires immediate attention. IV calcium chloride must be given slowly to avoid hypotension and bradycardia.
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Hypocalcemia teaching
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intake of a well-balanced diet, avoid high-protein diets, encourage weight bearing exercise, consult GP about supplementation.
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Hypercalcemia lab values
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>5.5 mEq/L
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Hypercalcemia etiology (3 main causes)
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1. Metastatic malignancy (lung, breast, ovary, prostate, bladder, bone, kidney, lymph) 2. hyperparathyroidism 3. thiazide diuretic therapy
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Hypercalcemia manifestations
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anorexia, n/v, polyuria, muscle weakness/fatigue/lethargy, dehydration, constipation, confusion, EKG changes, coma
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Hypercalcemia nursing interventions
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Review H & P, treat underlying condition, restore Ca+ levels. For severe hypercalcemia IV NS with furosemide to prevent fluid overload.
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Hypophosphatemia lab values
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<1.2 mEq/L
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Hypophosphatemia etiology
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long term lack of intake, increased growth or tissue repair, recovery from malnourished states, prolonged intake of antacids, burns, lead poisoning.
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Hypophosphatemia manifestations
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decreased cardiac and respiratory function, muscle weakness, fatigue, brittle bones, bone pain, confusion, seizures
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Hypophosphatemia nursing interventions
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Review H & P and lab data, restore levels with diet and supplementation. Severe Hypophosphatemia: may require TPN
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Hyperphosphatemia lab values
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> 3 mEq/L (rare but serious)
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Hyperphosphatemia etiology
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excessive intake of high phosphate foods, increased intake of vit. D, impaired colonic motility, hypoparathyroidism, addision’s disease
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Hyperphosphatemia manifestations
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tachycardia, palpitations, restlessness, anorexia, n/v, hyperreflexia, tetany, dysrhythmias.
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Hyperphosphatemia nursing interventions
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review h & p and lab data, restore normal levels by limiting high-phosphate foods like dairy, meat, fish, and carbonated beverages.
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Hypomagnesemia lab values
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< 1.5 mEq/L
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Hypomagnesemia etiology
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critically ill, alcoholics, DM, pregnancy, chronic malnutrition, crohn’s disease, pancreatits.
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Hypomagnesemia manifestations
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myocardial irritability, anorexia, nausea, abdominal distention, depression, psychosis, confusion.
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Hypomagnesemia nursing interventions
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EKG monitoring, correct underlying cause (oral mag replacement), monitor vital signs, IV mag may be necessary.
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High magnesium foods
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Cashews, chili, halibut, swiss chard, tofu, wheat germ.
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Hypemagnesemia lab value
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> 2.5 mEq/L (rare disorder)
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Hypemagnesemia etiology
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renal insufficiency, excessive use of laxatives or antacids, K+ sparing medications, severe dehydration, over-correction of premature labor or pre-eclampsia.
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Hypemagnesemia manifestations
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decreased muscle cell activity, hypotension, EKG changes, lethargy/drowsiness, loss of deep tendon reflexes, respiratory paralysis, loss of consciousness, PVC’s, elevated t-waves
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Hypemagnesemia nursing interventions
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decrease use of mag sulfate, use saline solution with a diuretic, IV calcium, monitor vitals and EKG, urinary output, ventilator assistance, dialysis in extreme cases.
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Dehydration
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When the normal compensation for fluid loss in the bloodstream cannot be corrected by stored fluid elsewhere.
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mild dehydration
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loss of 1-2 L of water (2% of body weight)
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moderate dehydration
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loss of 3-5 L of water (5% of body weight)
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severe dehydration
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loss of 5-10 L of water (8% of body weight)
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Why are older adults at risk for dehydration?
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1. decreased renal concentration of urine 2. Altered ADH response 3. Increase in body fat and thus a decrease in total quantity of body water in proportion to body weight.
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ADH and aldosterone- role during dehydration
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secretion increases to reabsorb water and sodium in the kidneys.
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Baroreceptors- role during dehydration
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Sense low blood pressure and the sympathetic NS is stimulated to increase peripheral vasoconstriction and HR.
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Hyponatremia lab value
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<135 mEq/L (most common electrolyte disorder)
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Hypovolemic Hyponatremia – cause
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Renal loss of sodium from diuretic use, diabetic glycosuria, aldosterone deficiency, intrinsic renal disease, increased sweating, vomiting, diarrhea, high volume ileostomy.
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Euvolemic Hyponatremia- cause
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Sodium deficit resulting from SIADH (syndrome of inappropriate secretion of antidiuretic hormone), or increased ADH because of pain, emotion, medication.
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Hypervolemic Hyponatremia- cause
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Edematous disorders resulting in sodium deficits: congestive heart failure, cirrhosis of liver, nephtotic syndrome, acute and chronic renal failure, psychogenic polydipsia.
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Redistributive Hyponatremia- cause
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Pseudohyponatremia, hyperglycemia, hyperlipidemia.
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Hyponatremia manifestations
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Headache, hallucinations/seizures, behavioral changes, hypotension, tachycardia, tachypnea, n/v, diarrhea
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Hyponatremia nursing interventions
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asses h & p, get detailed info on diet and medications, measure client’s body weight, treat underlying cause and imbalance. Restrict fluids, increase sodium ingestion, NS or LR. If sodium is <115 concentrated solution of 3% NaCl may be indicated.
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Hypernatremia lab values
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> 145 mEq/L
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Hypernatremia etiology
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inadequate water intake, lack of access to drinkable water, physical or chemical restraint, mental confusion and NPO status. Increased sodium intake, retention of sodium
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Hypernatremia manifestations
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polyuria, oliguria, anorexia, nausea, vomiting, weakness, restlessness.
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Hypernatremia nursing interventions
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H & P, daily weights, hypo-osmolar electrolyte solution (0.2% or 0.45% Nacl) or (D5W), monitor lung sounds, treat underlying cause. Must reduce levels slowly to prevent cerebral edema.
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Anasarca
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severe generalized, massive edema. Often occurs in congestive heart failure, liver failure, or renal disease
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Overhydration manifestations
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coughing, dyspnea, crackles, pallor, cyanosis, decreased tissue o2 levels, anxiety, increased CO2 levels, jugular vein distention, bounding pulse, elevated BP, confusion, headache, lethargy.
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Dehydration manifestations
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loss of body weight, thirst, oliguria, decrease in systolic blood pressure, weak pulse, decreased cardiac output, postural hypotension, lethargic*, increased cap refill time*, dry mucous membranes*, sunken eyes, slow skin turgor.
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Hypotonic Solution
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Replaces deficits of total body water. (D5W) no electrolytes, supplies 170 kcal/L and free water.
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Isotonic Solutions
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0.9% NaCl, LR. For pt’s with low serum Na or Cl and for fluid loss from burns, bleeding, dehydration from loss of bile or diarrhea.
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Hypertonic Solutions
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D5/LR, D5/0.9NS, D5/0.45NS, D5/1/2NS, Commonly used as maintenance fluid, provides modest calories, provides more water than sodium.

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