ELECTROLYTE IMBALANCE Nursing foundation 2nd sem

B.Sc. Nursing 2nd Sem, Nursing Foundation

1. Electrolyte imbalance BABLI SHAMA M.Sc. MSN Tutor NINS Mirza

2. The normal value of electrolytes

3. HYPONATREMIA Serum sodium level <135 mEq /L Serum sodium level <115 mEq /L Is fatal and may lead to cranial edema and further seizures or even coma.

4. Risk factors Excess water intake Hypotonic tube feeding & parenteral fluids Diuretics Sweating GI fluid loss Syndrome of inappropriate ADH Malignant tumour Head trauma

5. Clinical manifestations Confusion &Apprehension Lethargy Nausea and vomiting Abdominal cramps Anorexia Headache Seizures Coma

6. Nursing interventions Monitor fluid intake and output Monitor vital signs and GCS Score. Monitor weight regularly. Monitor the patient during the administration of IV solutions Limit water intake as advised Advise taking foods high in sodium content

7. HYPERNATREMIA Serum sodium level >145 mEq /L

8. Risk factors Diarrhea Insensible water loss Water deprivation Diaphoresis Excess NS infusion Hypertonic tube feeding Excess mineralocorticoids administration Excessive salt intake Diabetes insipidus Heat stroke

9. Clinical manifestations Thirst Dry mucus membrane Lethargy Change in level of consciousness convulsions

10. Nursing Interventions Monitor intake and output Closely monitor vital signs Monitor serum sodium level Encourage consumption of fluids as prescribed Monitor weight regularly limit sodium intake

11. HYPOCALCEMIA Total serum calcium level is <8.5mg/dL Or Ionized calcium level is <4.5mg/dl.

12. Risk factors Inadequate intake of calcium Inadequate intake of Vit. D Malabsorption Hypermagnesemia Alkalosis Sepsis Alcohol abuse

13. Risk factors Hypoparathyroidism Injury or removal of parathyroid gland Thyroid carcinoma Hyperphosphatemia Kidney failure

14. Clinical manifestations Tingling of the extremities Muscle cramp Tremors Cardiac dysrhythmias Positive Trousseau's and Chvostek's sign Hyperactive deep tendon reflex Confusion and anxiety

15. Chvostek's sign

16. Trousseau's sign

17. Nursing Interventions Monitor cardiovascular and respiratory status Administer oral and parenteral calcium supplements as prescribed. Educate about dietary sources of calcium Educate about the prevention of osteoporosis to patient who are at risk of developing it.

18. HYPERCALCEMIA Serum calcium level >10.5mg/dl Or Ionized calcium level >5.5mg/dl

19. Risk factors Prolonged immobilization Malignancy of bones Paget's disease Excessive intake of calcium or Vit. D

20. Clinical manifestations Lethargy and weakness Anorexia, nausea and vomiting Bone pain Depressed deep tendon reflex Constipation Urinary calculi Polyuria Hypercalciuria Dysrhythmias Depressed deep tendon reflexes

21. Nursing Interventions Encourage the patient to mobilize and exercise. Provide plenty of fluids to keep urine diluted Advise to take foods low in calcium Explain the risk of pathological fracture

22. HYPOMAGNESEMIA Serum magnesium Level is <1.5mEq/L One of most common cause is alcoholism

23. Risk factors Nasogastric suction Fistula drainage Long-term use of diuretics Pancreatitis Burns Chronic alcoholism

24. Clinical manifestations Tremors Tachycardia Hypertension Dysrhythmias Anorexia Dysphasia Change in sensorium Increased reflexes

25. Nursing Interventions Monitor patients with digitalis therapy because low magnesium level increases the level of toxicity Risk of seizure should be identified and necessary safety measures to be applied Encourage them to take magnesium-rich foods Explain to the patient about how alcohol consumption can worsen the condition and encourage the patient to quit the alcohol

26. HYPERMAGNESEMIA Serum magnesium Level is >2.5 mEq /L

27. Risk factors Chronic renal failure Excess use of laxatives and antacids Adrenal insufficiency

28. Clinical manifestations Nausea and vomiting Peripheral vasodilation Hypotension and bradycardia Muscle weakness and paralysis Decreased deep tendon reflex Drowsiness Lethargy

29. Nursing Interventions Monitor patient receiving IV magnesium continuously Assess the level of consciousness Place patient on Continuous cardiac monitoring Advise to avoid taking OTC medication which contains magnesium

30. HYPOCHLOREMIA Serum chloride level <95mEq/L

31. Risk factors Severe vomiting Diarrhea Drainage through gastric tube Metabolic alkalosis Burns Use of diuretics

32. Clinical manifestations Alkalosis Muscle twitching Tremors Tetany Hyperactive deep tendon reflexes

33. Nursing interventions Monitor muscle strength and movement Monitor acid-base balance Monitor intake output Avoid consumption of foods containing high amounts of chloride. Eg : olives, tomato, leafy vegetables, and celery.

34. HYPERCHLOREMIA Serum chloride level >108mEq/L

35. Risk factors Metabolic acidosis Excess replacement of sodium chloride or potassium chloride Head trauma Renal failure

36. Clinical manifestations Acidosis Weakness Hypertension Decreased cardiac output Tachypnea Diminised congestive ability Risk of dysrhythmias

37. Nursing interventions Monitor vital signs Monitor intake output Fluid restriction Dilatory management

38. HYPOPHOSPHATEMIA Serum phosphate level is <2.5mg/dL

39. Risk factors Alcohol withdrawal Diabetic ketoacidosis Hyperalimentation Anorexia nervosa Protein calorie malnutrition Respiratory alkalosis Diuretic use for longer period of time

40. Clinical manifestations Acute respiratory failure Seizures Joint stiffness Neurological changes Lethargy

41. Nursing interventions Heigh risk of infection, due to diminished immune response, so strict aseptic measures should be taken. Parental phosphate should be given under keen observation TPN should be administered steadily under observation to malnourished patient Advise food rich in phosphorus: milk, fish, nuts, whole grain and poultry.

42. HYPERPHOSPHATEMIA Serum phosphate level is >4.5 mg/dL

43. Risk factors Renal failure Large intake of milk Excess intake of phosphate containing laxatives Excess intake of Vit. D Hyperthyroidism Respiratory acidosis Chemotherapy

44. Clinical manifestations Tingling around mouth and fingers Muscle spasm Numbness

45. Nursing interventions Monitor symptoms of tetany. Careful administration of laxatives which contain phosphate. Instruct to avoid food high in phosphorus. Educate about signs of hyperphosphatemia.

46. HYPOKALEMIA Hypokalemia is deficit potassium, which is less than 3.5mEq/L

47. Risk factors Diarrhea Vomiting and gastric suction Ileostomy Diaphoresis Trauma, burn and fistulas Poor nutrition intake Excessive use of diuretics Excessive aldosterones

48. Clinical manifestations Leg cramps Muscle Weakness Paresthesia Decreased bowel sound Constipation Nausea and vomiting Diminised reflexes Cardiac dysrhythmias Respiratory and cardiac arrest

49. Nursing Interventions Monitor heart rate and rhythm Monitor bowel sound Monitor intake and output Patient at digitalis therapy with low level of potassium are at higher risk of digitalis toxicity Administer oral potassium as prescribed with food and fluid to about bowel irritation

50. Nursing Interventions Administer IV potassium diluted and using an Infusion pump to control flow rate not exceeding faster then 10-20 mEq / hr Teach patient about potassium rich diet.

51. HYPERKALEMIA Hypokalemia is excess of potassium, which is >5mEq/L

52. Risk factors Renal failure Excess potassium intake Rapid IV infusion of potassium 3rd space shift due to trauma and burn Potassium sparing diuretics use Adrenal insufficiency Metabolic acidosis Infusion of large amount of blood nearing expiring date

53. Clinical manifestations Irritability, apathy and confusion Diarrhea Cardiac dysrhythmias Muscle weakness Irregular pulse Numbness and paresthesia Cardiac arrest

54. Nursing Interventions Monitor vital signs Monitor intake output. Assess bowel sound Reduced intake of potassium rich foods Hold potassium supplements and potassium sparing diuretics