Electrolyte Imbalances Powerpoint Presentation

electrolyte imbalance

1. ELECTROLYTE
IMBALANCES
NCMB 312 LECTURE
DR. POTENCIANA A. MAROMA

2. LEARNING OBJECTIVES:
1.Plan effective care of patients with the following imbalances:
a.sodium deficit (hyponatremia) and sodium excess (hypernatremia);
b.potassium deficit (hypokalemia) and
c.potassium excess (hyperkalemia).
2.Describe the cause, clinical manifestations, management, and nursing
interventions for the following imbalances:
a.calcium deficit (hypocalcemia) and calcium excess (hypercalcemia);
b.magnesium deficit (hypomagnesemia) and magnesium excess
(hypermagnesemia);
c.phosphorus deficit (hypophosphatemia) and phosphorus excess
(hyperphosphatemia).

3. SODIUM

4. Hyponatremia
•Causes;
•Profuse diaphoresis & diuresis
•Excessive ingestion of plain water
•Administration of electrolyte –free
solution
•Prolonged vomiting, GI suctioning,
draining fistulas
•Addison’s disease

5. Hyponatremia
•Manifestations:
•Mental confusion, personality changes
•Muscular weakness
•Anorexia, restlessness
•Elevated BT, tachycardia, N&V
•Severe: convulsions & coma

6. Hyponatremia
•Management:
•Underlying cause is corrected
•Mild deficits: oral administration
of Na+
•Severe deficits: IV solutions

7. Hypernatremia
•Causes:
•Profuse watery diarrhea
•Excessive salt intake without sufficient water intake
•Decreased water intake (elderly, debilitated,
unconscious clients)
•Excessive administration of solutions containing Na+
•Excessive water loss without accompanying loss of
sodium

8. Hypernatremia
•Results in
•Thirst
•Dry, sticky mucous membranes
•Decreased UO
•Fever
•Rough, dry tongue
•Lethargy
•Coma if severe

9. Hypernatremia
•Treatment:
•Depends on the cause
•Oral administration of plain
water
•IV administration of hypotonic
solutions

10. Nursing Management
•Na
+
imbalances
•Early detection
•Maintain accurate I&O measurements
•Assess VS q1-4 hr
•Closely monitor IV fluid infusion
•Implements prescribed dietary restrictions or
supplements
•Gathers data that indicate increased or
decreased symptoms & notify the physician

11. POTASSIUM

12. Hypokalemia
•Causes:
•K
+
-wasting diuretics (furosemide [Lasix], ethacrynic
acid [Edecrin], hydrochlorothiazide [HydroDIURIL]
•Severe vomiting & diarrhea, draining intestinal fistula,
prolonged suctioning
•Large doses of corticosteroids
•IV administration of insulin & glucose
•Prolonged administration of non electrolyte parenteral
fluids

13. Hypokalemia
•Signs & symptoms:
•Fatigue
•Weakness
•Anorexia
•N&V
•Cardiac dysrhythmias
•Leg cramps
•Muscle weakness, paresthesias
•Severe: hypotension, flaccid paralysis, DEATH from cardiac
arrest/ respiratory arrest

14. Hypokalemia
•ECG changes
•ST-segment depression
•Flat or inverted T wave
•Increased U wave

15. Hypokalemia
•Treatment:
•Elimination of the cause
•Substitute K-wasting with K-
sparing diuretics (Spirinolactone
[Aldactone]
•Increase oral intake of K-rich foods/
K supplements (mild cases)
•KCL (severe cases)

16. Hyperkalemia
•Causes:
•Renal failure
•Severe burns
•Administration of K-sparing diuretics
•Overuse of K supplements, salt substitutes
(which contain K instead of Na), potassium
rich foods
•Crushing injuries
•Addison’s disease
•Rapid administration of parenteral K salts

17. Hyperkalemia
•Signs/Symptoms:
•Diarrhea
•Nausea
•Muscle weakness
•Paresthesias
•Cardiac dysrhythmias
•Peak T waves
•Prolonged PR intervals
•Flat or absent P wave
•Wide QRS complex

18. Hyperkalemia
•Treatment: depends on the cause and
severity
•Decrease K-rich food intake, d/c oral
potassium replacement until laboratory values
are normal (mild cases)
•Administration of cation-exchange resin like
sodium polystyrene sulfonate (kayexalate) or
combination of IV regular insulin & glucose
(severe cases)
•Peritoneal dialysis/ hemodialysis for removing
toxic substances from the blood

19. Nursing Management (K+ Imbalances)
•Assess clients for conditions with the
potential to cause potassium imbalances
•Identifies signs & symptoms
•Monitors laboratory findings
•Administer medications
•KCL – diluted in an IV solution &
administered at a rate below 10mEq/hr

20. CALCIUM

21. Hypocalcemi
a
•Causes:
•Vit D deficiency
•Hypoparathyroidism
•Acute pancreatitis
•Corticosteroids
•Rapid administration of multiple units of blood
that contain an anticalcium additive
•Intestinal malabsorption
•Accidental removal of parathyroid glands

22. Hypocalcemia
•Signs & symptoms:
•Tingling sensations (extremities, around the mouth)
•Muscle & abdominal cramps
•Carpopedal spasms (+ Trousseau’s sign)
•Mental changes
•+ Chvostek’s sign (spasm of facial muscle)
•Laryngeal spasms
•Tetany (muscle twisting)
•Seizures
•Bleeding
•Cardiac dysrhythmias

24. Hypocalcemia
•Treatment:
•Administration of oral Ca
++
& Vitamin D
(mild cases)
•IV administration of Ca
++
salts (Calcium
gluconate) – severe cases

25. Hypercalcemia
•Associated with
•Parathyroid gland tumors
•Multiple fractures
•Hyperparathyroidism
•Excessive doses of vitamin D
•Prolonged immobilization
•Certain malignant diseases (multiple myeloma, acute
leukemia, lymphomas)

26. Hypercalcemia
•Signs & symptoms
•Deep bone pain
•Constipation, anorexia, N & V
•thirst
•Pathologic fractures
•Mental changes (decreased memory &
attention span)
•Kidney stones

27. Hypercalcemia
•Management
•Determining & correcting the cause
•Increase fluid intake & limit Ca
++
consumption
(mild cases)
•0.45% or 0.9%NaCL (acute cases) and diuretics:
furosemide (Lasix); oral phosphates; calcitonin
(Cibacalcin)
•Corticosteroids or plicamycin (Mithracin) – used
for malignant diseases that do not respond to other
forms of therapy

28. Nursing Management: Ca++ Imbalances
•HypoCa
++
:
•Closely monitor for neurologic
manifestations (tetany, seizures, spasms)
•Seizure precautions
•Provide bed rest for comfort, avoid falls
•Cardiac dysrhythmias & airway obstruction
•Check for signs of bruising or bleeding

29. Nursing Management: Ca++ Imbalances
•HyperCa
++
•Encourage increased fluid intake
•Collaborates with dietitian to limit
food sources of Ca
++
•Ambulation as tolerated!!!
•Provide assistance; avoid falls

30. MAGNESIUM

31. Hypomagnesemia
•Causes:
•Chronic alcoholism
•Severe renal disease
•Severe malnutrition
•Intestinal malabsorption syndromes
•Excessive diuresis (drug induced)
•Prolonged gastric suction

32. Hypomagnesemia
•Signs & symptoms:
•Tachycardia & other dyshrythmias
•Neuromuscular irritability
•Paresthesias of the extremities
•Leg & foot cramps
•Mental changes
•(+) Chvostek’s & Trousseau’s sign
•Seizures

33. Hypomagnesemia
•Management:
•Oral magnesium salts/
magnesium rich foods
•IV magnesium sulfate

34. Hypermagnesemia
•Causes:
•Renal failure, Excessive use of antacids or laxatives
•Signs & symptoms:
•Flushing, warmth, hypotension, lethargy, drowsiness, bradycardia,
muscle weakness, depressed respirations, coma
•Management:
•Decrease oral magnesium intake
•Discontinue parenteral replacement
•Hemodialysis (severe cases)

35. Nursing Management: Mg++ Imbalances
•Closely observe for dysrhythmias & early signs of
neuromuscular irritability
•If giving MgSO
4, always check the BP!!!
(vasodilation)
•Antidote: Calcium gluconate (kept available)
•Monitor vital signs
•Provide health teaching

36. Identify the electrolyte imbalance each
client is most likely manifesting:
•Client 1. nauseated & weak. The ECG shows a prominent U
wave
•Client 2. muscle twitching and tingling around mouth. When
the nurse applies a BP cuff to the client’s arm and occludes
blood flow for 3 minutes, the fingers and wrist become flexed
•Client 3. thirsty, lethargic and excreting only scant urine.

37. PHOSPHORUS

38. PHOSPHORUS IMBALANCE
•Phosphorus imbalance refers to conditions in which the
element phosphorus is present in the body at too high a
level (hyperphosphatemia) or too low a level
(hypophosphatemia).

39. •Almost all of the phosphorus in the body occurs as phosphate
(phosphorus combined with four oxygen atoms), and most of the
body's phosphate (85%) is located in the skeletal system, where it
combines with calcium to give bones their hardness. The remaining
amount (15%) exists in the cells of the body, where it plays an
important role in the formation of key nucleic acids, such as DNA,
and in the process by which the body turns food into energy
(metabolism). The body regulates phosphate levels in the blood
through the controlled release of parathyroid hormone (PTH) from
the parathyroid gland and calcitonin from the
 
thyroid gland. PTH
keeps phosphate levels from becoming too high by stimulating the
excretion of phosphate in urine and causing the release of calcium
from bones (phosphate blood levels are inversely proportional to
calcium blood levels). Calcitonin keeps phosphate blood levels in
check by moving phosphates out of the blood and into the bone
matrix to form a mineral salt with calcium.

40. PHOSPHATE (HPO4)


Phosphorus primary anion in ICF


Most deposited with calcium in bones


Maintenance requires adequate renal functioning


Sources: meats, fish, dairy products, nuts

41. •Hypophosphatemia
•Hypophosphatemia (low blood phosphate) has various causes.
 
•Hyperparathyroidism, 
a condition in which the parathyroid gland
produces too much PTH, is one primary cause. Poor kidney function,
in which the renal tubules do not adequately reabsorb phosphorus,
can result in hypophosphatemia, as can overuse of
 
diuretics, 
such as
theophylline, and antacids containing aluminum hydroxide.
•Problems involving the intestinal absorption of phosphate, such as
chronic
 
diarrhea 
or a deficiency of vitamin D (needed by the intestines
to properly absorb phosphates) can cause the condition.
•Malnutrition due to chronic alcoholism can result in an inadequate intake
of phosphorus. Recovery from conditions such as
 
diabetic
ketoacidosis 
or severe burns can provoke hypophosphatemia, since the
body must use larger-than-normal amounts of phosphate.
•Respiratory alkylosis, brought on by hyperventilation, can also result in
temporary hypophosphatemia.

42. SYMPTOMS
•Symptoms generally occur only when phosphate levels
have decreased profoundly.
•They include muscle
weakness,
 
tingling 
sensations, 
tremors, 
and bone
weakness.
•Hypophosphatemia may also result in confusion and
memory loss, seizures, and coma.

43. •Hyperphosphatemia
•Hyperphosphatemia (high blood phosphate) also has various causes.
It is most often caused by a decline in the normal excretion of
phosphate in urine as a result of kidney failure or impaired function.
 
•Hypoparathyroidism, 
a condition in which the parathyroid
gland does not produce enough PTH, or
pseudoparathyroidism, a condition in which the kidneys lose
their ability to respond to PTH, can also contribute to
decreased phosphate excretion.
•Hyperphosphatemia can also result from the overuse of
 
laxatives 
or
enemas that contain phosphate.
 
Hypocalcemia 
(abnormally low
blood calcium) can cause phosphate blood levels to increase
abnormally. A side-effect of hyperphosphatemia is the formation of
calcium-phosphate crystals in the blood and soft tissue.

44. SYMPTOMS
•Hyperphosphatemia is generally asymptomatic; however,
it can occur in conjunction with hypocalcemia, the
symptoms of which are
 
numbness and tingling 
in the
extemities,
 
muscle cramps 
and spasms, depression,
memory loss, and convulsions.
•When calcium-phosphate crystals build up in the blood
vessels, they can cause arteriosclerosis, which can lead to
heart attacks or strokes. When the crystals build up in the
skin, they can cause severe itching.

45. Diagnosis
•Disorders of phosphate metabolism are assessed by
measuring serum or plasma levels of phosphate and
calcium. Hypophosphatemia is diagnosed if the blood
phosphate level is less than 2.5 milligrams per deciliter of
blood.
•Hyperphosphatemia is diagnosed if the blood phosphate
level is above 4.5 milligrams per deciliter of blood.
Appropriate tests are also used to determine if the
underlying cause of the imbalance, including assessments
of kidney function, dietary intake, and appropriate
hormone levels.

46. MANAGEMENT
•Treatment of phosphorus imbalances focuses on
correcting the underlying cause of the imbalance and
restoring equilibrium. Treating the underlying condition
may involve surgical removal of the parathyroid gland in
the case of hypophosphatemia caused by
hyperparathyroidism; initiating hormone therapy in cases
of hyperphosphatemia caused by hypoparathyroidism;
ceasing intake of drugs or medications that contribute to
phosphorus imbalance; or instigating measures to restore
proper kidney function.

47. MANAGEMENT
•Restoring phosphorus equilibrium in cases of mild
hypophosphatemia may include drinking a prescribed solution
that is rich in phosphorus; however, since this solution can
cause diarrhea, many doctors recommend that patients drink 1
qt (0.9 L) of skim milk per day instead, since milk and other
diary products are significant sources of phosphate. Other
phosphate-rich foods include green, leafy vegetables; peas
and beans; nuts; chocolate; beef liver; turkey; and some cola
drinks. Severe hypophosphatemia may be treated with the
administration of an intravenous solution containing
phosphate.

48. MANAGEMENT
•Restoring phosphorus equilibrium in cases of mild
hyperphosphatemia involves restricting intake of
phosphorus-rich foods and taking a calcium-based
antacid that binds to the phosphate and blocks its
absorption in the intestines. In cases of severe
hyperphosphatemia, an intravenous infusion of calcium
gluconate may be administered. Dialysis may also be
required in severe cases to help remove excess phosphate
from the blood

49. THANK YOU AND STUDY YOUR
LESSONS…