Question

Write a paper on Electrolyte imbalance. Issues explored on electrolyye imbalance, cardiac issues, and other complications or possible complications for patient. what imbalance there are and what you would look for as well as how you correct a high or low. how do you monitor for high and low? Why?

Answer 1

Electrolyte imbalances :-

Hyponatremia S&S (signs & symptoms)

Tachycardia, Hypotension, seizures, Headache, AMS (altered Mental Status),personality changes/irritability, muscular weaknes, abdominal cramping/hyperactive BS (bowel sounds), muscle cramps, specific gravity <1.010

Hyponatremia Causes

Heart failure, Renal failure,increased Na excretion, excessive diaphoresis, diuretics, wound drainage, vomiting/diarrhea/GI suctioning, inadequate Na intake

Hypernatremia S&S

Tachycardia, restlessness, thirst, flushed skin, dry sticky mucous membranes, rough dry tongue, specific gravity > 1.030

Hypernatremia Causes

Fever, Hyperventillation (not same as rpid RR), decreased excretion, increased intake, hepatic failure, renal failure, fever, hyperventilation, watery diarrhea, diaphoresis, excessive aldosterone secretion, cushing syndrome

Hypokalemia S&S

Tachydysrhythmia, "U" waves on EKG, Orthostatic Hypotention, lethargy, fatigue, decreased bowel sounds, nausea vomiting, diarrhea, abdominal distention, constipation, anorexia, muscle weakness, "U" waves on EKG

Hypokalemia Causes

insufficient intake, constipation (book states diarrhea p 349) , vomiting, loop diuretics, lasix, increased NGT drainage, renal disease

Hyperkalemia S&S

Bradycardia (slow pulse), peaked "T" waves on EKG, cardiac arrest, increased bowel sounds, diarrhea

Hyperkalemia Causes

Increased intake, decreased excretion, rapid IV infusion, Addisons disease, renal failure, K sparing diuretics (aldactone, spirololactone), ACE inhibitors

Hypocalcemia S&S

Hypotension, bradycardia, tetany (muscle spasm), laryngospasm (noted by stridor), increased DTR (Deep Tendon reflexes), Trousseaus sign (hand), Chvosteks sign (cheek)

Hypocalcemia Causes

Indadequate Calcium or Vitamin D intake, Lactose intolerant, Crohn's disease, malabsorption syndrome (intestines), ESRD (end stage renal disease), diarrhea, acute pancreatitis, hyperphosphatemia

#. Nursing interventions :-

Hypocalcemia

* administer oral/IV calcium supplements, while doing so we monitor cardiovascular and respiratory.

*initate seizure precuations

*keep emergency equipemnt on standby

*encourage foods high in calicum (dairy products and dark green veggies)

Hypercalcemia

*increase pt activity level

*limit dietary calicum intake

*promote fluid to promte urinary excretion, decrease risk for renal calculi stone formation

*encourage fiber to promote bowel elimination

*implement saftey precautions if pt confused

*monitor for clots, measure circumfrance of calf.

Hypokalemia

*report findings outside of refernece ranges to provider

*replace K+, by providing dietatry education, foods high in K+ include avacodes, dried fruit, potatoes, bananas, spinach.

*provide oral K+ supplements

*tx underline cause

*monitor and maintian urine output

*moniotr for shallow ineffictve respiartions and dimished breath sounds.

*monitor cardiac rhythm and intervene promptly as needed

* monitor pt for recieveing dogoxin, hypokalemia will increase risk for dogoxin.

*monitor LOC and insure saftey

*monitor bowel sounds and distention and intervene as needed.

IV K+ supplementation

*mixed by pharmacist

*checked by 2 RN's prior to administeration

*diluate K+ to concentration no more than 1 MEQ K+ to 10ML of solution, and insfuse slowly, no faster than 10 MEQ/HR

*monitor for phelibits, if occurs discountine and notify providor for infilteration of K+

*NEVER IV BOLUS K+, HIGH RISK FOR CARDIAC ARREST.

Hyperkalemia

*report to provdior about levels outside of reference ranges

*decrease K+ intake, stop infusion of IV K+ withhold oral K+ supplemments

*place pt on K+ limiting diet

*if K+ is extremlty high, dialsis may be required

*promote movemnt of K+ to ECF to ICF through the administration of IV fluids with dextrose

*monitor cardiac rhyth and intervene promptly as needed

*maintain IV access, prpare pt for diyalsis if prescribed

*administer a loop diuretic if kidey function is adequet such as furosemine.

*give Kayexalate, given orally or enema

Hyponatremia

*report irregular lab findings to providor.

*monitor I's &o's

* weight pt same time everyday with the same scale

*monitor v/s

*LOC

*report irregular findings

* educate pt to move and change position slowly (orthostatic hypotension)

*follow prescribed fluid restrictions. If have fluid overload, restrict water intake as prescribed

*restoration of normal ECF volume

*administered hypertonic IV therapy (3% NaCl)

*acute hyponatremia you administer IV hypotonic fluids as prescribed. Encourgae foods and fluids high in sodium, milk, cheese, condiments.

Hypernatremia

*report labs outside of refrences to provider

*monitor LOC and ensure saftey

*provide oral hygine and other comfort measures to decrease thirst

*monitor I& O

*alert provider if uriniary output is inadequate

*if fliuid loss, administer IV hypotonic fluids

* for excess Na+ enourage water intake and less Na+ intake

*administer loop diuretics

Hypomagnesimea

*dicountinue Mg loosing meds

* administer oral/IV Mg sulfate, IV route is used bc IM injection can cause pain and tissue damage, oral can cause diaareha

* monitor DTR during infusion of Mg sulfate to prevent hypermagnesiem

*encourge foods high in Mg, whole grains & dark leafy green veggies

* implement seizure precautions

Hypermagneisum

*perform feequent focued assement

*notify provirdor of changes or absent reflexes

* monitor respiratory and caridac status

* administer loop diuretics and Mg free IV fluids if kidney function is adequet

*administer Ca+ for any sever cardiac changes

* Ca+ glucanate