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Fluid and Electrolytes

Cations Positive electrical charges. (Examples Na++ K+ Ca+ & Mg
Anions Negative electrical charges. (examples Cl- HCO3- PO4-
Nursing Diagnosis R/T Electrolyte Imbalances Risk for Injury R/T sensory or motor deficits caused by electrolyte imbalance Decreased Cardiac Output
Sodium Normal Range 135-145 mEq/L
Functions of Sodium maintains proper water balance through serum osmolality by attracting fluid, helps transmit impulses in nerve and muscle fibers, combines with chloride and bicarbonate to regulate acid-base balance
Hyponatremia Diagnostic Levels Serum Na less than 134mEq/L
Causes of Hyponatermia Sodium loss-water gain, Decreased Na intake, V/D, GI suctioning, profuse sweating, burns, wound drainage, Diuretic drugs, oral hypoglycemics, sedatives, antipsychotics,anticonvulsants, an increase in fluids which do not contain sodium
Signs and Symptoms of Hyponatremia Neurological Primarly neurological symptoms: headache, changes in mental status, muscle twitching, tremors, if serum sodium is less than 110mEq/L could lead to seizures or comas.
Sign and Symptoms of Hyponatremia: GI/Skin/VS GI: Nausea, abd cramps. Skin: Poor skin tugor, dry cracked mucous membranes. VS: weak rapid pulse and decreased BP
Signs and Symptoms of Hyponatremia Lab values Low urine specific gravity, serum osmolality less than 280 mOsm/kg
Interventions for Hyponatremia Restrict Fluids; Monitor VS: P, BP, Lung sounds, neurochecks. Correct or eliminate the cause, administer hypertonic saline or PO sodium broth.
Hypernatremia Diagnostic levels Serum Na greater than 145mEq/L
Signs and Symptoms of Hypernatremia Neurological Restlessness, agitation, weakness, lethargy
Signs and Symptoms of hypernatremia: SALT S- Skin flushed, A- Agitation, L- Low grade fever, T-Thirst
Signs and symptoms of hypernatremia: VS High BO with a bounding pulse. Dyspnea (Short of breath), Olguria( low urine output)
Signs and symptoms of hypernatremia: Lab Values oliguria with ^ specific gravity. greater than 1.03
Causes of Hypernatremia Excessive intake of Na, , inability to drink in response to thirst, high protein feedings without water, severe watery diarrhea, hyperglycemia
Nursing Interventions for Hypernatremia Monitor VS; neurochecks, hypotonic/isotonic IV fluids, diuretics, desmopressin (ADH analog), mouth care, H20 intake PO/NG, Insure pt safety (neuro)
Normal Range of Potassium 3.5-5 mEq/L (same range as albumin, ironically)
Function of Potassium Maintains electrical neutrality of cells, nerve impulse transmission, metabolism of cell, Assists skeletal and cardiac muscle contraction and electrical conductivity
Dietary Sources of Potassium potatoes, chocolate, various fruits, salt substitutes contain K+. KCl, etc.
Nursing Diagnoses R/T K+ imbalances constipation r/t hypokalemia can cause GI complications… even paralytic ileus. Hyperkalemia can = diarrhea, activity intolerance, decreased cardiac output
Diagnostic value of Hypokalemia Serum K+ level less than 3.5mEq/L
Causes of Hypokalemia • Use of laxatives/diuretics. Excessive sweating. Diarrhea. Alkalosis. Vomiting. NG suctioning
Signs and Symptoms of Hypokalemia (SUCTION) S-skeletal muscle weakness and cramping, U- U wave (EKG changes), C- constipation, ileus, T- toxicity of digitalis glycosides. (digoxin, etc), I- irregular, weak pulse; resp depression, O – orthostatic hypotension, N – numbness (paresthesias)
Definition of paresthesias Changes or alterations in sensations
Nursing Interventions for Hypokalemia Monitor AP, BP, Respiration, Monitor Urine Output(keep above 30ml/hr), Notify Dr. of abnormals
Causes of Hyperkalemia Increased dietary intake without urinary output, cellular injury releases K+ into serum, Renal Failure, Acidosis, False Positives.
Medications that can cause Hyperkalemia Beta Blockers (end in lol), K+ sparing diuresis, Some antibiotics (Penicillin G), Drugs decreasing aldosterone secretion (steroids), Chemotherapy
Signs and Symptoms of Hyperkalemeia: PINT P- Parestheia, I- Irritability (emotionally or muscular) N- Nausea, abd cramping, diarrhea, T- Tall, tented T waves (EKG)
Normal Range for Serum Calcium 8.5-10.5 mg/dL About 1/2 of calcium is bound to albumin. Ionized calcium- free and active
Functions of Calcium Forms blood and teeth, helps maintain cell structure, affects cardiac, smooth and skeletal muscle contraction, aids in clotting of blood, binds with protein
Dietary sources of Calcium Almonds, dairy, green leafy veggies, whole grains.
Causes of Hypocalcemia Malfunction of the parathyroid gland, Malabsorption R/T pancreatic insufficiency, Inadequate intake, too much dietary sodium, Hypoalbuminemia, Renal failure.
Medications that cause hypocalcemia Calcitonin, osteoporosis drugs, anticonvulsants, diuretics, gentamicin
Signs and Symptoms of hypocalcemia: Trousseaus's When a BP duff is applied to an arm or a leg it performs a curling motion at the hand or wrist
Signs and Symptoms of Hypocalcemia: Chvosteks When a pts face is touch, they will wink/cringe/snarl one side of their face
Signs and Symptoms of hypocalcemia Paresthsias= numbness, seizures, tetany(involuntary contraction of the muscle), muscle spasms
Interventions for Hypocalcemia Monitor VS esp resp and EKG, have tracheotomy tray at bedside table, put on seizure precautions, administer an Calcium IV in dextrose only- no saline, Magnesium replacement, increase dietary calcium, Vitamin D supplements Monitor for Hypercalcemia
Causes of Hypercalcemia Increased calcium bone reabsortion, Hyperparathytroidism (too much PTH pulls bone into blood), cancers- esp bone, hyperthyroidism, multiple fracturesm prolonged immobility, hypophosphatemia, acidosis, medications
Signs and Symptoms of Hypercalcemia: GI Anorexiea, N/V, constipation, paralytic ileus
Signs and Symptoms of hypercalcemia: Neuro Fatigue, lethargy, decreased DTR, confusion, personality changes, decreased LOC
Signs and Symptoms: VS Polyuria, Extreme thirst, Bone pain, hypertension, EKG changes and cardiac signs
Interventions for Hypercalcemia: Resctrict Calcium, Hydrate pt (IV- 200-500 ml/hr; PO- 3-4 qts of H2O/day), administer diuretics, strain urine for stones, ambulate as much as possible, put on safety precautions (falls, fractures)
Normal Range for Magnesium 1.5- 2.5 mEq/l
Function of Magnesium Aids in CHO metabolism, helps to produce ATP, Aids in protein synthesis, influences vasodilation, helps Na & K ions cross the cell membrane
Dietary sources of Magnesium Fish, beans, tofu, dark green leafy veggies
Diagnostic range for hypormagnesemia Levels less than 1.5 mEq/L
Causes of hypomagnesmia Low serum albumin levels, starvation, alcoholism, diuretics, laxatives, GI losses- NG suction, diarrhea, lower bowel surgery, Insulin resolving DKA (magnesium moves inside of the cells)
Signs and symptoms of Hypomagnesmia: STARVED S- seizures, T-tetany, A-anorexia and arrhythmias, R-rapid heart rate, V-Vomiting, E-Emotional lability, D-Deep tendon reflexes
Interventions for Hypomagnesia Monitor cardiac if Mg is below 1 mEq/L (Ventricular tachycardia- torsades de poites/v. Fibrillation present
Diagnostic range for hypermagnesia levels greater than 2.5 mEq/L
Causes of hypermagnesia usually caused by renal failure- impared magnesium secretion, addisons disease- untreated DKA, Dialysate with Mg, TPN with Mg, Laxatives and antacids containing MG
Signs and Symptoms of Hypermagnesia RENAL R-Reflexes decreased, E- EKG changes (bradycardia) N-N/V, A- Flushed appearance, L- Lethargy (possible coma)
Interventions for Hypermagnesia Administer calcium gluconate IV(Mg antagonist) Respiratory support (ventilator), Hydrate pt PO/IV, Monitor VS, EKG, LOC, DTRS, Hemodialysis with no Mg in dialysate (if all else fails)
Normal Range for Chloride 90-110 mEq/L
Functions of Chloride Major anion of ECF, Follows sodium, secreated by the gastric mucosa as HCL acid, Has inverse relationship with HCO3
Dietary Sources of Chloride anything with sodium, fruit, veggies, most processed foods
Hypochloremia is usually due to Losses from the GI tract, diuresis, diaphoresis
Hyperchloremia is ually due to increased Na intake without an intake in water
Electrolyte Lab Test Serum Test: Are not arterial, usually include sodium, potassium, cholride, and CO2. CO2 Total reflect amt of bicarbonate component is in the blood
Created by: dgreen158