Question

3. Describe common electrolyte imbalances and their signs and symptoms. a. Describe the nursing intervention for each electrolyte imbalance

Answer 1

*Hyponatremia

Hyponatremia = too much water; Serum Na+ <135 mEq/L; results from intake and subsequent retention of water / impairment in renal water excretion
- High mortality: can cause cerebral oedema

common causes - diuretics - GI fluid loss - Diaphoresis
Symptoms: lethargy, confusion, apprehension, muscle twitching, abdominal cramps, headache, nausea, vomiting, seizures, coma
Treatment: restore sodium levels, fluids are restricted, intake of a balanced diet.

Nursing interventions:

Watch cardiac, respiratory, neural, renal, and G.I. status

Assess clinical manifestations,

Monitor I&O,

Monitor serum sodium

Encourage intake of food and fluid high in sodium,

Limit water intake as indicated

*Hypernatremia:

Hypernatremia = too little water = Serum Na+ >145 mEq/L

Common Causes

- Diabetes Insipidus

- heart stroke

-water deprivation

- watery diarrhoea

-renal failure

-Cushing syndrome

- hyperventilation
Symptoms: Thirst -hyperpyrexia- dry mouth- sticky mucous membranes - hallucinations- lethargy- irritability- seizures - Na>145mEq/L
Treatment: Decrease total body sodium and replace the fluid loss, either a hypo-osmolar electrolyte solution (0.2% or 0.45 NaCl) or 5% dextrose in water is administered. These solutions cause the plasma sodium level to gradually decrease as excess sodium is excreted.

Nursing Interventions:

Monitor I&O

Monitor behaviour changes

Monitor lab findings

Encourage fluids as ordered

Monitor diet as ordered

Restrict the intake of salt and foods high in sodium

*Hypokalemia:

Hypokalemia is defined as the potassium level of less than 3.5 mEq/L. There is mild, moderate, and severe hypokalemia, each separated by a degree of 0.5. Mild = 3.5 - 3; moderate = 3 - 2.5; severe = less than 2.5

Common Causes- diuretics -diarrhoea - vomiting - gastric suctioning- steroid administration - hyperaldosteronism - Bulimia - Cushing Syndrome
Symptoms:

Muscle weakness, leg cramps, fatigue, lethargy, anorexia, nausea, vomiting, decreased bowel sounds, decreased bowel motility, cardiac dysrhythmias, depressed tendon reflexes, weak & irregular pulse
Treatment: Restore potassium levels.

Nursing interventions:

Monitor heart rate and rhythm

Monitor clients receiving digitalis,

Administer oral potassium as ordered with fluid to prevent gastric irritation

Administer IV potassium solutions

Teach client about potassium-rich foods

Teach the client how to prevent excessive loss of potassium

*Hyperkalemia:

-A potentially serious condition which can cause life-threatening cardiac dysrhythmia.
-Hyperkalemia is defined as a potassium level greater than 5.5 mEq/L.

5.5-6.0 mEq/L - Mild Hyperkalemia
6.1-7.0 mEq/L - Moderate Hyperkalemia
7.0 mEq/L and greater - Severe Hyperkalemia

Symptoms: Muscle weakness

- bradycardia

- dysrhythmias

- flaccid paralysis

- intestinal colic

- Tall T waves on EKG

- K+>5mEq/L
Treatment: Restore potassium balance

Nursing Interventions:

closely monitor cardiac status and ECG, administer diuretics, administer glucose or insulin, hold potassium supplements and potassium-conserving diuretics, teach clients to avoid foods high in potassium

Hypocalcemia:

Hypocalcemia is the presence of low serum calcium levels in the blood. Physiologically, blood calcium is tightly regulated within a narrow range for proper cellular processes. Calcium in the blood exists in three primary states: bound to proteins (mainly albumin), bound to anions such as phosphate and citrate, and as free (unbound) ionized calcium. Only the ionized calcium is physiologically active. Normal blood calcium level is between 8.5 to 10.5 mg/dL (2.12 to 2.62 mmol/L) and that of ionized calcium is 4.65 to 5.25 mg/dL (1.16 to 1.31 mmol/L).

Common Causes- Renal Failure - hypoparathyroidism - malabsorption- pancreatitis - alkalosis

Symptoms:

numbness, tingling around the mouth and extremities, muscle tremors, cramps, tetany, convulsions, cardiac dysrhythmias, decreased cardiac output, positive Trousseau's and Chvostek's signs, confusion, anxiety, hyperactive deep tendon reflexes, lengthened QT intervals
Treatment: Restore calcium balance

Nursing Interventions:

monitor respiratory and cardiovascular status, take precautions to protect a confused client, administer oral or parenteral calcium supplements, teach clients about dietary sources high in calcium and regular exercise

Hypomagnesemia:

Is defined as magnesium level <1.3 mg/dL and may be associated with hypokalemia and hypocalcemia

Common Causes: Alcoholism, malabsorption- Diabetic Ketoacidosis- Prolonged gastric suctioning - diuretics
Symptoms: neuromuscular irritability with tremors, increased reflexes & tremors & convulsions; positive Trousseau's and Chvostek's signs; tachycardia, elevated BP, dysrhythmias, disorientation, confusion, vertigo, anorexia, dysphagia, respiratory difficulties
Treatment: Oral magnesium replacement in the form of magnesium-containing antacids or parenteral magnesium sulfate. Increase dietary intake of mag also helps ensure balance and stability.

Nursing interventions:

assess clients receiving digitalis for digitalis toxicity, take protective measures for clients with seizures - assess client's ability to swallow, initiate safety measures, carefully administer magnesium salts as ordered; encourage the client to eat foods rich in magnesium, refer clients to alcohol treatment programs as indicated

Hypermagnesemia:

Hypermagnesemia is rare and the level is >2.3 mg/dL

Common Causes: Renal Failure - adrenal insufficiency - excessive replacement
Symptoms: peripheral vasodilation, flushing, nausea, vomiting, muscle weakness, paralysis, hypotension, bradycardia, depressed deep tendon reflexes, lethargy, drowsiness, respiratory depression, coma, tall T waves, prolonged PR interval
Treatment: Decrease the use of magnesium sulfate. Saline infusion with a diuretic increased renal elimination of magnesium. Albuterol has also been used to reduce magnesium levels.

Nursing Interventions:

monitor vital signs and LOC, if patellar reflexes absent notify physician, advise clients who have a renal disease to contact a physician before taking OTC drugs