Fluid and Electrolytes
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| Cations | Positive electrical charges. (Examples Na++ K+ Ca+ & Mg
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| Anions | Negative electrical charges. (examples Cl- HCO3- PO4-
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| Nursing Diagnosis R/T Electrolyte Imbalances | Risk for Injury R/T sensory or motor deficits caused by electrolyte imbalance
Decreased Cardiac Output
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| Sodium Normal Range | 135-145 mEq/L
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| 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
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| Hyponatremia Diagnostic Levels | Serum Na less than 134mEq/L
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| 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
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| 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.
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| 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
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| Signs and Symptoms of Hyponatremia Lab values | Low urine specific gravity, serum osmolality less than 280 mOsm/kg
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| Interventions for Hyponatremia | Restrict Fluids; Monitor VS: P, BP, Lung sounds, neurochecks. Correct or eliminate the cause, administer hypertonic saline or PO sodium broth.
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| Hypernatremia Diagnostic levels | Serum Na greater than 145mEq/L
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| Signs and Symptoms of Hypernatremia Neurological | Restlessness, agitation, weakness, lethargy
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| Signs and Symptoms of hypernatremia: SALT | S- Skin flushed, A- Agitation, L- Low grade fever, T-Thirst
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| Signs and symptoms of hypernatremia: VS | High BO with a bounding pulse. Dyspnea (Short of breath), Olguria( low urine output)
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| Signs and symptoms of hypernatremia: Lab Values | oliguria with ^ specific gravity. greater than 1.03
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| Causes of Hypernatremia | Excessive intake of Na, , inability to drink in response to thirst, high protein feedings without water, severe watery diarrhea, hyperglycemia
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| 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)
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| Normal Range of Potassium | 3.5-5 mEq/L (same range as albumin, ironically)
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| Function of Potassium | Maintains electrical neutrality of cells, nerve impulse transmission, metabolism of cell, Assists skeletal and cardiac muscle contraction and electrical conductivity
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| Dietary Sources of Potassium | potatoes, chocolate, various fruits, salt substitutes contain K+. KCl, etc.
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| 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
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| Diagnostic value of Hypokalemia | Serum K+ level less than 3.5mEq/L
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| Causes of Hypokalemia | • Use of laxatives/diuretics. Excessive sweating. Diarrhea. Alkalosis. Vomiting. NG suctioning
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| 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)
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| Definition of paresthesias | Changes or alterations in sensations
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| Nursing Interventions for Hypokalemia | Monitor AP, BP, Respiration, Monitor Urine Output(keep above 30ml/hr), Notify Dr. of abnormals
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| Causes of Hyperkalemia | Increased dietary intake without urinary output, cellular injury releases K+ into serum, Renal Failure, Acidosis, False Positives.
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| Medications that can cause Hyperkalemia | Beta Blockers (end in lol), K+ sparing diuresis, Some antibiotics (Penicillin G), Drugs decreasing aldosterone secretion (steroids), Chemotherapy
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| Signs and Symptoms of Hyperkalemeia: PINT | P- Parestheia, I- Irritability (emotionally or muscular) N- Nausea, abd cramping, diarrhea, T- Tall, tented T waves (EKG)
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| 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
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| 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
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| Dietary sources of Calcium | Almonds, dairy, green leafy veggies, whole grains.
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| Causes of Hypocalcemia | Malfunction of the parathyroid gland, Malabsorption R/T pancreatic insufficiency, Inadequate intake, too much dietary sodium, Hypoalbuminemia, Renal failure.
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| Medications that cause hypocalcemia | Calcitonin, osteoporosis drugs, anticonvulsants, diuretics, gentamicin
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| 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
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| Signs and Symptoms of Hypocalcemia: Chvosteks | When a pts face is touch, they will wink/cringe/snarl one side of their face
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| Signs and Symptoms of hypocalcemia | Paresthsias= numbness, seizures, tetany(involuntary contraction of the muscle), muscle spasms
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| 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
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| 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
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| Signs and Symptoms of Hypercalcemia: GI | Anorexiea, N/V, constipation, paralytic ileus
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| Signs and Symptoms of hypercalcemia: Neuro | Fatigue, lethargy, decreased DTR, confusion, personality changes, decreased LOC
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| Signs and Symptoms: VS | Polyuria, Extreme thirst, Bone pain, hypertension, EKG changes and cardiac signs
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| 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)
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| Normal Range for Magnesium | 1.5- 2.5 mEq/l
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| 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
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| Dietary sources of Magnesium | Fish, beans, tofu, dark green leafy veggies
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| Diagnostic range for hypormagnesemia | Levels less than 1.5 mEq/L
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| 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)
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| 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
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| Interventions for Hypomagnesia | Monitor cardiac if Mg is below 1 mEq/L (Ventricular tachycardia- torsades de poites/v. Fibrillation present
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| Diagnostic range for hypermagnesia | levels greater than 2.5 mEq/L
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| 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
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| Signs and Symptoms of Hypermagnesia RENAL | R-Reflexes decreased, E- EKG changes (bradycardia) N-N/V, A- Flushed appearance, L- Lethargy (possible coma)
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| 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)
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| Normal Range for Chloride | 90-110 mEq/L
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| Functions of Chloride | Major anion of ECF, Follows sodium, secreated by the gastric mucosa as HCL acid, Has inverse relationship with HCO3
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| Dietary Sources of Chloride | anything with sodium, fruit, veggies, most processed foods
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| Hypochloremia is usually due to | Losses from the GI tract, diuresis, diaphoresis
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| Hyperchloremia is ually due to | increased Na intake without an intake in water
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| 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
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