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Chapter 13 And 15 Electrolyte Imbalance Part 5
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Chapter 13 And 15 Electrolyte Imbalance Part 5

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  • Magnesium (1.5-2.5 mEq/L) General facts 50-60% in bone Catalyst for many enzyme functions; especially CHO, protein, Na-K pump Neuromuscular activity affected r/t transmission of neural impulses Factors regulate Ca++ -play role in regulating Mg and vitamin D Kidneys – excrete; diuretics on Henle’s loop increase Mg excretion Bound to protein & ionized – ionized only has neuromuscular effect Deficit – increase muscular irritability Excess – sedative effect ETOH – deficit secondary to decreased diet intakeHypomagnesium < 1.5 mEq/L Etiology - Decreased absorption GI; increased excretion urine; mannitol/urea/glucose; renal disease; pancreatitis; diabetes (osmotic diuresis due to hyperglycemia) Lab tests- Serum Mg, Serum albumin, Serum K+, Serum Ca++, ECG Therapeutic Management Increased diet intake of Mg Mg++ antacids Severe – give Mg sulfate IV; give slowly, monitor carefully Nursing Care Assess S/S - vertigo, hallucinate, laryngeal stridor, hypotension, tachycardia, hypotension, sensitive to digoxin, Trousseau’s/Chvostek’s signs, paresthesias, N/V, anorexia Nursing Diagnosis - Risk for injury r/t, Risk for altered cardiac function r/t, Altered nutrition less than requirements r/t; Knowledge deficit Nursing actions Monitor serum levels Oral Mg Diet – foods high in Mg (green vegetables, nuts, peanut butter, chocolate, grapefruit, orange juice IV – MgSO4 if severe Ca gluconate – for tetany Monitor respiratory status, V/S, HR, ECG Teach use of diuretics, laxatives, diet Client education Explanation of condition; include risk factors Strategies to prevent further episodes Foods high in Mg Medication therapy including possible side effects S/S and what and when to reportHypermagnesemia > 2.5 mEq/L– decreased excitability of muscles; vasodilation Etiology – Mg antacids, renal failure, DM ketoacidosis Lab tests - Serum Mg+, ECG Therapeutic management Prevent! D/C foods, meds high in Mg Adequate renal function – give 1/2 NS & diuretics to excrete excess IV Ca gluconate Respiratory support Hemodialysis Nursing Care Assess S/S - hypotension, irregular HR, lethargy, drowsy, confusion, muscle weakness, coma, decreased DTR's Nursing diagnosis - Risk for injury r/t; Risk for altered cardiac function r/t; risk for altered respiratory status; Knowledge deficit r/t Nursing actions Assess neuromuscular, V/S, S/S Monitor serum Mg+ levels; ECG Safety measures Teach: foods/medications high in Mg Client education Explanation of condition; include risk factors Strategies to prevent further episodes Foods high in Mg Medication therapy including possible side effects S/S and what and when to report
  • Transcript

    • 1. Electrolyte Imbalances Part V Peggy D. Johndrow 2009
    • 2. Hypophosphatemia
      • Causes include
        • Malnourishment/malabsorption
        • Alcohol withdrawal
        • Use of phosphate-binding antacids
        • During parenteral nutrition with inadequate replacement
    • 3. Hypophosphatemia Clinical Manifestations
      • CNS depression
      • Confusion
      • Muscle weakness and pain
      • Dysrhythmias
      • Cardiomyopathy
    • 4. Hypophosphatemia Management
      • Oral supplementation
      • Ingestion of foods high in phosphorus
      • May require IV administration of sodium or potassium phosphate
    • 5. Nursing Diagnoses
      • Impaired physical mobility r/t
      • Risk for bone injury r/t
      • Impaired gas exchange r/t
      • Risk for falls r/t
      • Risk for decreased cardiac output
    • 6. Nursing Actions
      • Monitor V/S, respiratory rate & depth (assess S/S hypoxia)
      • Monitor lab values
      • Nutrition Therapy: increase foods high in HPO4
      • Oral/IV if necessary
      • Monitor ECG
      • Monitor Serum K+
      • Salt substitutes
      • Teach use of diuretics, laxatives, diet
    • 7.  
    • 8. Magnesium
      • 50-60% contained in bone
      • Coenzyme metabolism protein & carbohydrates
      • Factors that regulate calcium balance appear to influence magnesium balance
      • Acts directly on myoneural junction
      • Important for normal cardiac function
    • 9. Hypermagnesemia
      • Causes include
        • Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present
    • 10.  
    • 11. Hypermagnesemia Clinical Manifestations
      • Lethargy
      • Drowsiness
      • Somnolence
      • N/V
      • Reflexes impaired
      • Respiratory and cardiac arrest can occur
    • 12. Hypermagnesemia Management
      • Prevention
      • IV CaCl or calcium gluconate
      • Fluids
    • 13. Nursing Diagnoses
      • Risk for injury r/t
      • Risk for altered cardiac function r/t
      • Risk for impaired gas exchange
      • Knowledge deficit r/t
    • 14. Nursing Actions
      • Assess neuromuscular, V/S, S/S
      • Monitor serum Mg+ levels; ECG
      • Safety measures
      • Teach: foods/medications high in Mg

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