electrolyte imbalances nursing, Cheat Sheet of Nursing

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ELECTROLYTE

IMBALANCES

POTASSIUM IMBALANCE

Potassium imbalance plays a vital role in cell METABOLISM, and TRANSITION of

nerve impulses, the functioning of cardiac, lung, muscle tissues, & acid-base balance. 3.5 - 5^ mEq/L

SIGNS & SYMPTOMS

✹ (^) TIGHT & CONTRACTED

M^ uscle cramps & weakness

U^ rine abnormalities

E^ CG changes

espiratory distress

R^ eflexes^ (↑^ DTR )

R

D^ ecreased cardiac contractility^ (↓HR,^ ↓BP)

• Tall peaked T waves
• Flat P waves
• Widened QRS complexes
• Prolonged PR intervals ✹ Thready, weak, irregular pulse ✹ Orthostatic hypotension ✹ Shallow respirations ✹ Anxiety, lethargy, confusion, coma ✹ Paresthesias ✹ Hyporeflexia ✹ Hypoactive bowel sounds (constipation) ✹ Nausea, vomiting, abdominal distention ✹ ECG changes - ST depression - Shallow or inverted T wave - Prominent U wave

MANAGEMENT

✹ Monitor EKG ✹ Discontinue IV & PO potassium ✹ Initiate a potassium-restricted diet ✹ Potassium-excreting diuretics ✹ Prepare the client for dialysis ✹ Prepare for administration: ➥ IV calcium gluconate & IV sodium bicarb ✹ Avoid the use of salt substitutes or other potassium-containing substances ✹ Oral potassium supplements ✹ Liquid potassium chloride ✹ Potassium-retaining diuretic ✹ Potassium is NEVER administered by IV push, IM, or subcut routes. ➥ IV potassium is always diluted & administered using an infusion device!

RISK FACTORS

✹ Medication ➥ Potassium-sparing diuretics (Spironolactone) ➥ Ace inhibitors ➥ NSAIDs ✹ Excessive potassium intake (Example: rapid infusion of potassium-containing IV solutions) ✹ Kidney disease or those on Dialysis ➥ Decreased potassium excretion ✹ Adrenal insufficiency (Addison’s disease) ✹ Tissue damage ✹ Acidosis ✹ Hyperuricemia ✹ Hypercatabolism ✹ Actual total body potassium loss ✹ Inadequate potassium intake ➥ Fasting, NPO ✹ Movement of potassium from the extracellular fluid to the intracellular fluid ➥ Alkalosis ➥ Hyperinsulinism ✹ Dilution of serum potassium ➥ Water intoxication ➥ IV therapy with potassium-deficient solutions Potassium imbalance can cause cardiac dysrhythmias that can be life-threatening! HYPERKALEMIA > 5 mEq/L^ HYPOKALEMIA < 3.5 mEq/L Potassium & sodium = opposites Example:^ ↑^ Na =^ ↓^ K+

MAGNESIUM IMBALANCE

Most of the magnesium found in the body is found in the bones.

Regulates BP, blood sugar, muscle contraction & nerve function. 1.5 - 2.5^ mg/dL

MANAGEMENT

✹ Diuretics ✹ IV adm. calcium chloride or calcium gluconate ✹ Restrict dietary intake of Mg containing foods ✹ Avoid the use of laxatives & antacids containing magnesium ✹ Hemodialysis ✹ Magnesium sulfate IV or PO ✹ Seizure precautions ✹ Instruct the client to increase magnesium-containing foods HYPERMAGNESEMIA > 2.5 mg/dL^ HYPOMAGNESEMIA < 1.5 mg/dL

RISK FACTORS

✹ Insufficient magnesium intake ➥ Malnutrition/vomiting/diarrhea ➥ Malabsorption syndrome ➥ Celiac & Crohn’s disease ✹ Increased magnesium excretion ➥ Diuretics or chronic alcoholism ✹ Intracellular movement of magnesium ➥ Hyperglycemia & Insulin adm. ➥ Sepsis ✹ Increased magnesium intake ➥ Magnesium-containing antacids (TUMS) & laxatives ➥ Excessive adm. of magnesium IV ✹ Renal insufficiency ➥ ↓ renal excretion of Mg = ↑ Mg in the blood ✹ DKA (Diabetic Ketoacidosis)

SIGNS & SYMPTOMS

✹ LOW EVERYTHING AKA SEDATED ✹ Low energy (drowsiness / coma) ✹ Low HR (bradycardia) ✹ Low BP (hypotension) ✹ Low RR (bradypnea) ✹ ↓ Respirations (shallow) ✹ ↓ Bowel sounds ✹ ↓ DTR’s (deep tendon reflex) ✹ HIGH EVERYTHING AKA NOT SEDATED ✹ High HR (tachycardia) ✹ High BP (hypertension) ✹ Increased deep tendon reflex (hyperreflexia) ✹ Shallow respirations ✹ Twitches, paresthesias ✹ Tetany & seizures ✹ Irritability & confusion

POSITIVE TROUSSEAU’S:

Carpal spasm caused by inflating a blood pressure cuff

CHVOSTEK’S SIGNS:

Contraction of facial muscles w/ light tap over the facial nerve Magnesium & Calcium = SAME Example:^ ↑^ Mg =^ ↑^ Ca+

REMEMBER:REMEMBER:

Also seen in hypocalcemia. Ca & Mg rise and fall together!

MEMORYMEMORY MAGNESIUM IS A SEDATIVE!

TRICKTRICK

SODIUM IMBALANCE

Sodium is a major ELECTROLYTE found in ECF. Essential for acid-base, fluid balance,

active & passive transport mechanism, irritability & CONDUCTION of nerve-muscle tissue 135 - 145^ mEq/L ✹ (^) BIG & BLOATED ✹ If due to fluid loss: ➥ Administer IV infusions ✹ If the cause is inadequate renal excretion of sodium: ➥ Give diuretics that promote sodium loss ✹ Restrict sodium & fluid intake as prescribed

F^ lushed skin

R^ estless, anxious, confused, irritable

ecreased urine output ow-grade fever

D

L

ncreased BP & fluid retention kin flushed & dry hirst (dry mucous membranes)

S

T

I

dema (pitting) gitation

E

A

S^ tupor/coma

A norexia (nausea/vomiting)

L^ ethargy^ (weakness/fatigue)

T^ achycardia^ (thready pulse)

S^ eizures/headache

imp muscles (muscle weakness) tomach cramping (hyperactive bowels)

L

S

0 rthostatic hypotension

RISK FACTORS

✹ Increased sodium intake ➥ Excess oral sodium ingestion ➥ Excess administration of IV fluids w/ sodium ➥ Hypertonic IV fluids ✹ LOSS OF FLUIDS! ➥ Fever ➥ Watery diarrhea ➥ Diabetes insipidus ➥ Excessive diaphoresis ➥ Infection ✹ Decreased sodium excretion ➥ Kidney problems

SIGNS & SYMPTOMS

HYPERNATREMIA > 145 mEq/L^ HYPONATREMIA < 135 mEq/L

HYPOVOLEMIC HYPONATREMIA:

↓ (^) of fluid & sodium

HYPERVOLEMIC HYPONATREMIA:

↑ (^) body water that is greater than Na+ hemoconcentration

Increased sodium! ✹ Increased sodium excretion ➥ Diaphoresis (ex: high fever) ➥ Diarrhea & vomiting ➥ Drains (NGT suction) ➥ Diuretics (Thiazide & loop diuretics) ✹ SIADH ✹ Adrenal insufficiency (adrenal crisis) ✹ Inadequate sodium intake ➥ Fasting, NPO, Low-salt diet ✹ Kidney disease ✹ Heart failure 4 d’

s

MANAGEMENT

ADMINISTER IV sodium chloride infusions (Only if due to hypovolemia) DIURETICS (If due to hypervolemia) Hyponatremia → high fluids & low salt = hemodilution Daily Weights Where sodium goes, water FLOWS Safety (orthostatic hypotension AKA risk for falls) Airway protection (NPO) Don’t give food to a lethargic, confused client (INCREASED RISK FOR ASPIRATION) Limit water intake Hypervolemic hyponatremia (high fluid & low salt) Teach about foods high in sodium (Canned food, packaged/processed meats, etc.)