38824365 electrolyte-imbalances


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38824365 electrolyte-imbalances

  1. 1.  Most abundant electrolyte in the ECF 135 to 145 mEq/L Has a major role in controlling water distribution throughout the body Regulated by ADH, thirst and the renin- angiotensin-aldosterone system
  2. 2.  Primary regulator of ECF volume Also functions in establishing the electrochemical state necessary for muscle contraction and the transmission of nerve impulses
  3. 3.  Butter, bacon, canned food, cheese, ketchup, frankfurters, processed food, soy sauce, table salt
  4. 4.  Serum sodium level lower than 135 mEq/L Causes include: increased sodium excretion (excessive diaphoresis, diuretics, vomiting, diarrhea, wound drainage, decreased secretion of aldosterone); inadequate sodium intake; dilution of serum sodium (freshwater drowning, SIADH)
  5. 5.  Rapid pulse rate Generalized skeletal muscle weakness Headache Diminished deep tendon reflexes Confusion Seizures Nausea Decreased urinary specific gravity Increased urine output
  6. 6.  Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status If hyponatremia is accompanied by a fluid deficit, IV sodium chloride infusions are administered If hyponatremia is accompanied by a fluid excess, osmotic diuretics are administered
  7. 7.  Instruct client to increase oral sodium intake and inform the client about the foods to include in the diet If the client is taking lithium, monitor the lithium level, because hyponatremia can cause diminished lithium excretion, resulting in toxicity
  8. 8.  Is a serum sodium level that exceeds 145 mEq/L Causes include: decreased sodium excretion, increased sodium intake, decreased water intake, increased water loss
  9. 9.  Heart rate and BP that respond to vascular volume status Pulmonary edema if hypervolemia is present Spontaneous muscle twitches, irregular muscle contractions (early) Skeletal muscle weakness (late) Altered cerebral function is the most common manifestation Increased urinary specific gravity; decreased urine output
  10. 10.  Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status If the cause is fluid loss, prepare to administer IV infusions If the cause is inadequate renal excretion of sodium, prepare to administer diuretics Restrict sodium as prescribed
  11. 11.  Is the major intracellular electrolyte Ranges from 3.5 to 5.1mEq/L 98% of the body’s potassium is inside the cells, the remaining 2% is in the ECF that is important in neuromuscular function Influences both skeletal and cardiac muscle activity
  12. 12.  Avocado, banana, cantaloupe, carrots, fish, mushroom, oranges, potatoes, raisins, spinach, strawberries, tomatoes, pork, beef
  13. 13.  Is a serum potassium level lower than 3.5meq/L Potassium deficit is potentially life-threatening because every body system is affected Causes include: excessive use of medications such as diuretics, vomiting, diarrhea, inadequate potassium intake, hyperinsulinism
  14. 14.  Weak peripheral pulses FUS – flattened T wave, U wave, ST segment depression in ECG Shallow respirations, anxiety, lethargy, confusion Skeletal muscle weakness Deep tendon hyporeflexia Hypoactive to absent bowel sounds Nausea and vomiting
  15. 15.  Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status Monitor electrolyte values Administer potassium supplements orally or intravenously
  16. 16.  Oral potassium supplements may cause nausea and vomiting and they should not be taken on an empty stomach Liquid potassium chloride has an unpleasant taste and should be taken with juice or another liquid Potassium is never given by IV push or by the IM or SQ route
  17. 17.  After adding potassium to an IV solution, rotate and invert the bag to ensure that the potassium is distributed evenly Label IV bag containing potassium properly Potassium infusion can cause phlebitis; thus the nurse should assess the IV site frequently Monitor renal function and I&O before administering potassium
  18. 18.  Institute safety measures for the client experiencing muscle weakness Potassium sparing diuretic may be prescribed instead Instruct the client about foods that are high in potassium content
  19. 19.  Is a serum potassium level that exceeds 5.1mEq/L Is caused by: excessive potassium intake, decreased potassium excretion, tissue damage, hypercatabolism
  20. 20.  Slow, weak, irregular heart rate Decreased BP TWiFP – Tall peaked T waves, widened QRS complexes, flat P waves, widened QRS complexes Muscle twitches, cramps (early) Profound weakness (late) Diarrhea
  21. 21.  Monitor cardiovascular, respiratory, neuromuscular, c erebral, renal, and GI status Discontinue IV potassium and hold oral potassium supplements Initiate a potassium-restricted diet Prepare to administer potassium-excreting diuretics if renal function is not impaired
  22. 22.  Prepare to administer sodium polysterene sulfonate (Kayexalate), cation exchange resin that promotes GI sodium absorption and potassium excretion Prepare the client for dialysis if potassium levels are critically high Prepare for the IV administration of hypertonic glucose with regular insulin to move excess potassium into the cells
  23. 23.  Monitor renal function When blood transfusions are prescribed for a client with a potassium imbalance the client should receive fresh blood Teach the client to avoid foods high in potassium Instruct the client to avoid the use of salt substitutes
  24. 24.  Major component of bones and teeth Plays a major role in transmitting nerve impulses and helps regulate muscle contraction and relaxation, including cardiac muscle, also plays a role in blood coagulation 8.6 to 10mg/dL
  25. 25.  The serum calcium level is controlled by parathyroid hormone and calcitonin Cheese, milk, soy milk, sardines, spinach, tofu, yogurt
  26. 26.  Is a serum calcium level lower than 8.6 mg/dL Causes include: inadequate oral intake of calcium, lactose intolerance, inadequate intake of vitamin D, diarrhea, steatorrhea, hyperphosphatemia, , acute pancreatitis, removal or destruction of the parathyroid glands
  27. 27.  Decreased heart rate Hypotension Diminsihed peripheral pulses Prolonged ST interval, prolonged QT interval Twitches, cramps Painful muscle spasms during periods of inactivity Positive Trousseau’s and Chvostek’s sign
  28. 28.  Inflate a blood pressure cuff around the client’s upper arm for 1 to 4 minutes above the systolic pressure In a client with hypocalcemia, the hand and fingers become spastic and go into palmar flexion
  29. 29.  Tap the face just below and in front of the ear Facial twitching on that side of the face indicates a positive test
  30. 30.  Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status Administer calcium supplements orally or calcium intravenously When administering calcium IV, warm the injection solution to body temperature before administration and administer slowly
  31. 31.  Monitor for ECG changes, observe for infiltration, and monitor for hypercalcemia during therapy Administer medications that increase calcium absorption (aluminum hydroxide, vitamin D) Provide a quiet environment to reduce stimuli
  32. 32.  Initiate seizure precautions Move the client carefully, and monitor for signs of a fracture Keep 10% calcium gluconate available for treatment of acute calcium deficit Instruct client to consume foods high in calcium
  33. 33.  Is a serum calcium level that exceeds 10mg/dL Causes include: increased calcium absorption, decreased calcium excretion (use of thiazide diuretics), hyperparathyroidism, malignancy, immobility
  34. 34.  Increased heart rate in early phase, bradycardia that can lead to cardiac arrest in late phases Increased BP Shortened ST segment, widened T wave Profound muscle weakness Increased urinary output Formation of renal calculi
  35. 35.  Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status Discontinue IV infusions of solutions containing calcium and oral medications containing calcium or vitamin D Discontinue thiazide diuretics and replace with diuretics that enhance the excretion of calcium
  36. 36.  Prepare client with severe hypercalcemia for dialysis Move client carefully and monitor for signs of fracture Monitor for flank or abdominal pain, and strain the urine to check for the presence of urinary stones Instruct client to avoid calcium rich foods
  37. 37.  Acts as an activator for many intracellular enzyme systems and plays a role in both carbohydrate and protein metabolism Acts peripherally to produce vasodilation Affect neuromuscular irritability and contractility
  38. 38.  1.6 to 2.6 mg/dL Avocado, canned white tuna, cauliflower, milk, green leafy vegetables, oatmeal, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt
  39. 39.  Is a serum magnesium level lower than 1.6 mg/dL Causes include: insufficient magnesium intake, chronic alcoholism, malnutrition and starvation, insulin administration
  40. 40.  Tall T waves, depressed ST segments Tachycardia Twitches Hyperreflexia Seizures Irritability Confusion
  41. 41.  Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal, and GI status Monitor serum magnesium levels frequently Initiate seizure precautions Instruct client to increase intake of foods that contain magnesium
  42. 42.  Is a serum magnesium level that exceeds 2.6 mg/dL Causes include: increased magnesium intake, decreased renal excretion of magnesium
  43. 43.  Bradycardia Hypotension Prolonged PR interval, widened QRS complexes Skeletal muscle weakness Drowsiness and lethargy
  44. 44.  Monitor cardiovascular, respiratory, neuromuscular, c erebral, renal, and GI status Diuretics are prescribed to increase renal excretion Instruct client to restrict dietary intake of magnesium-containing foods
  45. 45.  Intravenously administered calcium chloride or calcium gluconate may be prescribed to reverse the effects of magnesium on cardiac muscle Instruct the client to avoid the use of laxatives and antacids containing magnesium
  46. 46.  Essential to the function of muscle and red blood cells, formation of ATP, maintenance of acid base balance Provides structural support to bones and teeth 2.7 to 4.5 mg/dL
  47. 47.  Fish, organ meats, nuts, pork, beef, chicken, whole grain breads and cereals
  48. 48.  Is a serum phosphorus level lower than 2.7mg/dL A decrease in the serum phosphorus level is accompanied by an increase in the serum calcium level Causes include: insufficient intake, malnutrition, starvation, hyperparath yroidism
  49. 49.  Decreased contractility and cardiac output Weakness Decreased bone density Irritability Confusion seizures
  50. 50.  Monitor cardiovascular, respiratory, neuromuscular, c erebral, renal, and GI status Administer phosphorus orally along with vitamin D supplement Prepare to administer phosphorus IV Assess renal system before administering phosphorus
  51. 51.  Move client carefully, and monitor for signs of fracture Instruct client to increase intake of phosphorus containing foods while decreasing the intake of calcium-containing foods
  52. 52.  Serum phosphorus level that exceeds 4.5mg/dL Increase in serum phosphorus is accompanied by a decrease in serum calcium Causes include: decreased renal excretion, increased intake of phosphorus, hypoparathyroidsm
  53. 53.  Same as assessment of hypocalcemia
  54. 54.  Entails management of hypocalcemia Instruct client to avoid phosphate containing medications Instruct client to decrease the intake of food that