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Electrolyte Imbalances Galen College of Nursing 40 complete solutions Electrolyte Imbalances Galen College of Nursing 40 complete solutions S/S Dehydration - ANSWER-- low grade fever - tachycardia - weak thready pulse - hypotension - orthostatic hypotension - decreased CVP - tachypnea - dizziness - sunken eyeballs S/S Fluid Overload - ANSWER--Changes in pulse rate and respiratory rate -Lung sounds-crackles -Edema -Weight gain -Neck and hand vein distention -Confusion -Decreased Hgb, Hct, and Protein Sodium (Na) - ANSWER-135-145 mEq/L Causes of Hyponatremia - ANSWER-Diuretics GI fluid loss/ suction Diet S/S Hyponatremia - ANSWER-S tupor/coma A norexia, N&V L ethargy T endon reflexes decreased L imp muscles (weakness) O rthostatic hypotension S eizures/headache S tomach cramping Tx of Hyponatremia - ANSWER-- give Na - pt does not need water - if having neuro problems: needs hypertonic saline (3% or 5% NS) Causes of Hypernatremia - ANSWER-MODEL: Electrolyte Imbalances Galen College of Nursing 40 complete solutions Medications, meals Osmotic diuretics Diabetes insipidus Excessive water loss Low water intake S/S of Hypernatremia - ANSWER-FRIED or SALTIER -- Fever (low grade), flushed Restless (irritable) Increased fluid retention and increased BP Edema (peripheral and pitting) Decreased urinary output, dry mouth SALTIER -- Skin flushed, dry, flaky / Seizures Agitation / Attention span decreased Lethargy; Low grade fever Thirst / twitching Increased urine specific gravity Edema (pulmonary) Reduce cardiac contractility, urine output Tx of Hypernatremia - ANSWER-- restrict sodium - dilute pt with fluids - daily weights, I&Os, labs Potassium (K) - ANSWER-3.5-5.0 mEq/L Causes of Hypokalemia - ANSWER-Actual total body potassium loss ~excessive use of meds such as diuretics and corticosteroids ~increased secretion of aldosterone (Cushing's Syndrome) ~Vomiting, diarrhea ~Wound drainage (gastrointestinal) ~Prolonged nasogastric suction ~Excessive diaphoresis ~Renal disease impairing reabsorption of potassium Inadequate intake of potassium: NPO Movement of potassium from the extracellular fluid to intracellular fluid ~alkalosis ~hyperinsulinism Electrolyte Imbalances Galen College of Nursing 40 complete solutions Causes of Hypermagnesemia - ANSWER-Increased magnesium intake ~Magnesium-containing antacids and laxatives ~Excessive admin of magnesium by IV Decreased renal excretion of magnesium as a result of renal insufficiency S/S of Hypermagnesemia - ANSWER-Decreased Energy Hypotension Bradycardia Decreased Respirations Decreased Reflexes Vasodilation Diaphoresis Skeletal Muscle Weakness Tx of Hypermagnesemia - ANSWER-Loop or Thiazide Diuretic Causes of Respiratory Acidosis - ANSWER-hypoventilation anasthesia intubation S/S of respiratory acidosis - ANSWER-Headache *Restlessness* Mental status changes, such as drowsiness and confusion *Visual disturbances* *Diaphoresis* *Cyanosis* as the hypoxia becomes more acute Hyperkalemia *Rapid, irregular pulse* *Dysrhythmias leading to ventricular fibrillation* Nursing Interventions for Respiratory Acidosis - ANSWER--Treatment to improve ventilation -Meds (bronchodilators/antibiotics, supplemental O2) -Pulmonary therapy (percussion, postural drainage) -Monitor I &O, VS, & ABGs -Maintain adequate hydration (2-3L fluid/day) -Monitor mechanical ventilation if necessary -Elevate HOB -Turn, Cough, Deep Breath Causes of Respiratory Alkalosis - ANSWER-hyperventilation (anxiety, PE, fear), mechanical ventilation Electrolyte Imbalances Galen College of Nursing 40 complete solutions S/S of Respiratory Alkalosis - ANSWER-*Tachypnea* (in response to hyperventilation or resp. stimulation) *pH >7.45 AND PCO2 <35 mm Hg* Headache *Lightheadedness, vertigo* Mental status changes *Paresthesia, such as tingling of the fingers and toes* Hypokalemia, hypocalcemia *Tetany*, *convulsions* Tx of Respiratory Alkalosis - ANSWER-treatment of underlying cause rebreathe CO2 paper bag Head between knees Cardiac Monitoring Emotional Support *Could lead to seizures; put on fall precautions Causes of Metabolic Acidosis - ANSWER-DKA severe diarrhea renal failure shock Aspirin Overdose S/S of Metabolic Acidosis - ANSWER-*Kussmaul respirations (deep & fast)* to attempt to exhale the excess CO2. *pH <7.35 AND HCO3- < 22 mEq/L* Headache Nausea, vomiting, *diarrhea* *Fruity-smelling breath* resulting from improper fat metabolism CNS depression: mental dullness, drowsiness, stupor, coma *Hypotension* Hyperkalemia Tx of Metabolic Acidosis - ANSWER--dialysis -insulin/fluids - D5 - antidiarrheal/antibiotics -Respiratory Assessment -Fall precautions Causes of Metabolic Alkalosis - ANSWER-severe vomiting excessive GI suctioning Electrolyte Imbalances Galen College of Nursing 40 complete solutions diuretics S/S of Metabolic Alkalosis - ANSWER-Decreased respiratory rate and depth (to conserve CO2) Nausea, vomiting *Dizziness* *Numbness* and tingling in the extremities Twitching in the extremities Hypokalemia, hypocalcemia Dysrhythmia: *tachycardia* Tx of Metabolic Alkalosis - ANSWER-Tx underlying. Monitor Respirations Cardiac Monitoring Fall & Seizure precautions K+ Supplement
