Electrolyte imbalances

Hypokalemia lab value description
<3.5 mEq/L
Hypokalemia etiology
inadequate intake, NPO, renal losses, magnesium depletion, GI losses, vomiting, dirrhea, diuretics, enemas, beta blockers, steroids, alkalosis.
Hypokalemia manifestations
Slowed smooth muscle contractions, abdominal distention, constipation, muscle weakness/leg cramps, fatigue, paresthesias, hyporeflexia, irritability.
Hypokalemia nursing interventions
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).
Hypokalemia nursing diagnosis
1. risk for injury- low K+ can lead to weakness, falls, or seizures.
2. imbalanced nutrition- less than body requirements
Foods high in potassium
Fish, whole grains, nuts, artichokes, broccoli, brussels sprouts, carrots, celery, cucumbers, apricots, bananas, melons, oranges, strawberries, brewed coffee, tomato juice, fruit juice.
Hyperkalemia lab value description
>5 mEq/L
Hyperkalemia etiology (3 major causes)
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.
Hyperkalemia manifestations
may not present until >7 mEq/L. Abnormal EKG, nerve and muscle irritability, tachycardia, colic, diarrhea.
Hyperkalemia nursing interventions
Assess H & P, EKG monitoring, treat imbalance (force fluids, IV saline, diuretics). For severe Hyperkalemia infusion of IV calcium gluconate.
Hyperkalemia teaching
Teach dietary potassium sources, avoid salt substitutes, and OTC medications that affect K+ balance.
Hypocalcemia lab value
< 4.5 mEq/L
Hypocalcemia etiology
Inadequate intake, inadequate intake of vit. D, diseases that impair absorption, parathyroid disease, medications, pancreatitis, Cushing’s disease, inadequate sunlight.
Hypocalcemia manifestations
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.
Hypocalcemia nursing interventions
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.
Hypocalcemia teaching
intake of a well-balanced diet, avoid high-protein diets, encourage weight bearing exercise, consult GP about supplementation.
Hypercalcemia lab values
>5.5 mEq/L
Hypercalcemia etiology (3 main causes)
1. Metastatic malignancy (lung, breast, ovary, prostate, bladder, bone, kidney, lymph)
2. hyperparathyroidism
3. thiazide diuretic therapy
Hypercalcemia manifestations
anorexia, n/v, polyuria, muscle weakness/fatigue/lethargy, dehydration, constipation, confusion, EKG changes, coma
Hypercalcemia nursing interventions
Review H & P, treat underlying condition, restore Ca+ levels. For severe hypercalcemia IV NS with furosemide to prevent fluid overload.
Hypophosphatemia lab values
<1.2 mEq/L
Hypophosphatemia etiology
long term lack of intake, increased growth or tissue repair, recovery from malnourished states, prolonged intake of antacids, burns, lead poisoning.
Hypophosphatemia manifestations
decreased cardiac and respiratory function, muscle weakness, fatigue, brittle bones, bone pain, confusion, seizures
Hypophosphatemia nursing interventions
Review H & P and lab data, restore levels with diet and supplementation. Severe Hypophosphatemia: may require TPN
Hyperphosphatemia lab values
> 3 mEq/L (rare but serious)
Hyperphosphatemia etiology
excessive intake of high phosphate foods, increased intake of vit. D, impaired colonic motility, hypoparathyroidism, addision’s disease
Hyperphosphatemia manifestations
tachycardia, palpitations, restlessness, anorexia, n/v, hyperreflexia, tetany, dysrhythmias.
Hyperphosphatemia nursing interventions
review h & p and lab data, restore normal levels by limiting high-phosphate foods like dairy, meat, fish, and carbonated beverages.
Hypomagnesemia lab values
< 1.5 mEq/L
Hypomagnesemia etiology
critically ill, alcoholics, DM, pregnancy, chronic malnutrition, crohn’s disease, pancreatits.
Hypomagnesemia manifestations
myocardial irritability, anorexia, nausea, abdominal distention, depression, psychosis, confusion.
Hypomagnesemia nursing interventions
EKG monitoring, correct underlying cause (oral mag replacement), monitor vital signs, IV mag may be necessary.
High magnesium foods
Cashews, chili, halibut, swiss chard, tofu, wheat germ.
Hypemagnesemia lab value
> 2.5 mEq/L (rare disorder)
Hypemagnesemia etiology
renal insufficiency, excessive use of laxatives or antacids, K+ sparing medications, severe dehydration, over-correction of premature labor or pre-eclampsia.
Hypemagnesemia manifestations
decreased muscle cell activity, hypotension, EKG changes, lethargy/drowsiness, loss of deep tendon reflexes, respiratory paralysis, loss of consciousness, PVC’s, elevated t-waves
Hypemagnesemia nursing interventions
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.
When the normal compensation for fluid loss in the bloodstream cannot be corrected by stored fluid elsewhere.
mild dehydration
loss of 1-2 L of water (2% of body weight)
moderate dehydration
loss of 3-5 L of water (5% of body weight)
severe dehydration
loss of 5-10 L of water (8% of body weight)
Why are older adults at risk for dehydration?
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.
ADH and aldosterone- role during dehydration
secretion increases to reabsorb water and sodium in the kidneys.
Baroreceptors- role during dehydration
Sense low blood pressure and the sympathetic NS is stimulated to increase peripheral vasoconstriction and HR.
Hyponatremia lab value
<135 mEq/L (most common electrolyte disorder)
Hypovolemic Hyponatremia – cause
Renal loss of sodium from diuretic use, diabetic glycosuria, aldosterone deficiency, intrinsic renal disease, increased sweating, vomiting, diarrhea, high volume ileostomy.
Euvolemic Hyponatremia- cause
Sodium deficit resulting from SIADH (syndrome of inappropriate secretion of antidiuretic hormone), or increased ADH because of pain, emotion, medication.
Hypervolemic Hyponatremia- cause
Edematous disorders resulting in sodium deficits: congestive heart failure, cirrhosis of liver, nephtotic syndrome, acute and chronic renal failure, psychogenic polydipsia.
Redistributive Hyponatremia- cause
Pseudohyponatremia, hyperglycemia, hyperlipidemia.
Hyponatremia manifestations
Headache, hallucinations/seizures, behavioral changes, hypotension, tachycardia, tachypnea, n/v, diarrhea
Hyponatremia nursing interventions
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.
Hypernatremia lab values
> 145 mEq/L
Hypernatremia etiology
inadequate water intake, lack of access to drinkable water, physical or chemical restraint, mental confusion and NPO status. Increased sodium intake, retention of sodium
Hypernatremia manifestations
polyuria, oliguria, anorexia, nausea, vomiting, weakness, restlessness.
Hypernatremia nursing interventions
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.
severe generalized, massive edema. Often occurs in congestive heart failure, liver failure, or renal disease
Overhydration manifestations
coughing, dyspnea, crackles, pallor, cyanosis, decreased tissue o2 levels, anxiety, increased CO2 levels, jugular vein distention, bounding pulse, elevated BP, confusion, headache, lethargy.
Dehydration manifestations
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.
Hypotonic Solution
Replaces deficits of total body water. (D5W) no electrolytes, supplies 170 kcal/L and free water.
Isotonic Solutions
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.
Hypertonic Solutions
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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