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Imbalancemnemonic S/SxCausesInterventionsValue
Hyponatremia SALT LOSS Stupor/coma Anorexia, N&V Lethargy Tendon reflexes decrease Limp muscles (weakness) Orthostatic hypotention Seizures/headache Stomach cramping Fluid imbalance (excessive intake of hypotonic fluids); Kidney failure; NPO; Hyperglycemia; low-salt diet; SIADH; Dependent on fluid volume (increase oral Na+ intake, possibly restrict fluid intake); focus on patient safety, skin protection, monitoring F&E Na+ <135
Dehydration Hypotension; Tachycardia; Increased respiratory rate; Flat neck veins; delayed cap refill; Dry mucous membranes; tenting skin turgor; decreased urine output; Change in mental status and temperature; SG of urine >1.030 (concentrated); Hemoconcentration Vomiting/Diarrhea; Long term NPO; Fever; GI suction; Diabetes insipidus; Hemorrhage; Severe wounds Monitor pulse rate and quality, Urine output; Encourage oral fluid intake; IV therapy; Antidiarrheal medication HemoconcentrationElevated hemoglobin, hematocrit, serum osmolarity, glucose, protein, BUN, and various electrolytes Urine SG > 1.030
Fluid Overload Crackles in lungs; Jugular vein distention; Bounding pulse; Increased respirations; Nocturnal dyspena; Increased BP; Tachycardia; Peripheral edema; Weight gain; Hemodilution Excessive fluid replacement; Kidney failure; Heart failure; long term corticosteroid use; SIADH; polydipsia; Water intoxication Diuretics; monitor weight, electrolyte levels; restrict fluid/Na+; Hemodilution Decreased hemoglobin, hematocrit, and protein; serum electrolyte values normal Urine SG??
Hyperkalemia MURDER Muscle Cramps Urine abnormalities Respiratory distress Decreased cardiac contractility (Bradycardia) EKG changes (Peaked T-wave) Reflexes Diarrhea; Unusual tingling in hands, feet, and face K+ sparing diuretics; ACE inhibitors; Salt substitutes; Decreased kidney function Drug therapy (glucose&insulin); Monitor EKG; Primary prevention (diet, drugs, read labels-no salt substitutes K+>5.0
Hypokalemia A SIC WALT Alkalosis Shallow Respirations Irritability Confusion and drowsiness Weakness and fatigue Arrhythmias Lethargy Thready Pulse Constipation; Hypoactive bowel sounds; Abdominal dystention; Flat ST wave on EKG; Inadequate intake of K+; Diarrhea; Vomiting; Wound drainage; Cushings syndrome; Diuretics; Increased aldosterone; Nasogastric suctioning; Assess meds that excrete K+; prevent accidental overdose of K+ (no more than 10 mL/hr); Monitor Cardiac rhythm, RR, O2 sat; Bed rest to reduce fall risk K+ < 3.5
Hypernatremia FRIED; SALT; SWINE Flushed skin, low grade fever Restless Increased fluid retention and increased BP Edema: peripheral and pitting Decreased urine output Skin flushed Agitation Low grade fever Thirst Sleepy Weakness Neuromuscular excitability Edema MODEL- Medications/Meals Osmotic diuretics Diabetes insipidus Excessive water loss Low water intake Cushings syndrome; Water loss from diaphoresis, fever, respiratory infection Diuretics to promote Na+ loss; IV therapy; monitor to prevent hyponatremia and dehydration; Encourage fluid intake; Low Na+ diet Na+ >145
Created by: Jennwyo83