20. Ca & Mg Disorders Signs & Symptoms Electrolyte Excess Deficit Calcium (Ca) Hypernatremia Thirst CNS deterioration Increased interstitial fluid Hypocalcemia Tetany Chvostek’s, Trousseau’s Muscle twitching CNS changes EKG changes Magnesium (Mg) Hypermagnesemia Loss of deep tendon reflexes (DTRs) Depression of CNS Depression of neuromuscular function Hypomagnesemia Hyperactive DTRs CNS changes EKG changes
Editor's Notes
Chloride (96-106 mEq/L) Hypochloremia (<96 mEq/L) Etiology – accompanied by decreases in Na & K; loss; metabolic disorders (alkalosis); GI – suction, vomiting, diarrhea, hypokalemia, ingestion of alkaline substances; renal – advanced renal disorders, diuretics; hormonal influences – SIADH, Addison disease; altered cellular function – hypervolemic CHF & cirrhosis; skin/environment – burns, fever, large skin wounds Lab tests – serum Cl < 96 mEq/L (critical < 80); urinary Cl; ABG, serum Na & K give input Therapeutic management – correct cause Replace – oral if not too low & able to tolerate; IV if critical/unable to tolerate PO Monitor serum/urinary Cl levels; ABG Monitor I&O; B/P Dietary changes Nursing Care Assess S/S – agitation/irritability; hyperactive DTRs; slow/shallow respirations; weakness, fatigue; hypotension; muscle cramps/hypertonicity (twitching). Severe can lead to: confusion; seizures/coma, cardiac arrhythmias Nursing diagnosis – Altered nutrition less than r/t; Risk for sensory/perceptual alterations r/t; Risk for injury r/t; Fatigue r/t; Anxiety r/t; Risk for fluid volume excess r/t Nursing actions Assess neuromuscular, LOC, V/S, S/S Monitor serum/urinary Cl levels; ABG, serum Na/K Safety measures Monitor respiratory/cardiac status I&O Provide diet (tomato juice, salty broth) or oral supplements Use NS for flush/irrigation Provide quiet calm atmosphere Client education Explanation of imbalance; include risks S/S to report and when; include warning signs Teach about diet/oral supplements Medications including adverse effects (diuretics) Hyperchloremia (> 106 mEq/L) Etiology – related to Na, K and bicarb (inverse relationship with bicarb); metabolic disorders (acidosis); GI – increased retention or intake hyperkalemia/hypernatremia, severe vomiting, salicylate intoxication; renal – reduced glomerular filtration; hormonal influences – excess adrenocortical hormone production, IV or oral cortisone therapy; skin/environment – profuse perspiration; head trauma; medications-salicylates (overdose) Lab tests – serum Cl;urinary Cl; ABG, serum Na & K give input Therapeutic management – correct cause Fluids to dilute Cl Severe give IV bicarb May restrict Na and Cl Nursing Care Assess S/S – usually r/t metabolic acidosis – tachypnea, lethargy, weakness, deep/rapid respirations (Kussmaul’s), decreased mental ability. Can lead to arrrhythmias, decreased cardiac output, decreased LOC, coma. If serum Na high will have S/S hypernatremia Nursing diagnosis – Altered nutrition greater than r/t; Risk for sensory/ perceptual alterations r/t; Risk for injury r/t; Risk for impaired skin integrity r/t; Anxiety r/t Nursing actions Assess V/S, S/S Evaluate neuromuscular status Monitor serum/urinary Cl levels; ABG, serum Na/K Safety measures Monitor respiratory/cardiac status I&O Assess LOC; reorient as needed Restrict Na & Cl if ordered If receiving NaBicarb assess for S/S overcompensation (alkalosis) Client education Explanation of imbalance; include risks/complications S/S to report and when; include warning signs Teach about diet restrictions if ordered Medications including adverse effects (if prescribed) Importance of replenishing fluids especially in hot weather
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