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Chapter 13 And 15 Electrolyte Imbalance Part 1


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Chapter 13 And 15 Electrolyte Imbalance Part 1

  1. 1. Electrolyte Imbalances Part I Peggy D. Johndrow 2009
  2. 4. Sodium <ul><li>Major cation in extracellular fluid </li></ul><ul><li>Imbalances typically associated with parallel changes in osmolality </li></ul><ul><li>Sources: processed/preserved foods highest sodium (ham, bacon, pickles, tomato juice, canned soups), snacks often high (potatoes chips) </li></ul>
  3. 5. Sodium-Potassium Pump
  4. 6. Hypernatremia <ul><li>Elevated serum sodium occurring with water loss or sodium gain </li></ul><ul><li>Causes hyperosmolality leading to cellular dehydration </li></ul><ul><li>Primary protection is thirst from hypothalamus </li></ul>
  5. 7. Hypernatremia Manifestations <ul><li>Include thirst, lethargy, red/swollen tongue; agitation, seizures, and coma </li></ul><ul><li>If secondary to water deficiency, often results of impaired LOC </li></ul><ul><li>Can be produced by clinical states such as central or nephrogenic diabetes insipidus </li></ul>
  6. 8. Nursing Diagnoses <ul><li>IW Bullets p 186 </li></ul><ul><li>Risk for injury r/t </li></ul><ul><li>Risk for sensory/perceptional alterations r/t </li></ul><ul><li>Risk for fluid deficit r/t </li></ul><ul><li>Risk for altered mucous membranes </li></ul>
  7. 9. Nursing Actions <ul><li>Oral fluids </li></ul><ul><li>IV fluids/ tube feedings </li></ul><ul><li>Assess changes in sensoruim, thirst, oral mucous membrane temperature </li></ul><ul><li>I&O, daily weight </li></ul><ul><li>Oral care </li></ul><ul><li>Monitor foods & medications for Na+ content </li></ul><ul><li>Assess changes in mental status </li></ul><ul><li>Monitor serum Na+ & urine specific gravity </li></ul>
  8. 10. Hypernatremia Management <ul><li>Includes </li></ul><ul><ul><li>Treat underlying cause </li></ul></ul><ul><ul><li>If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline </li></ul></ul><ul><ul><li>Diuretics </li></ul></ul><ul><li>Serum sodium levels must be reduced gradually to avoid cerebral edema </li></ul>
  9. 11. Hyponatremia <ul><li>Results from loss of sodium-containing fluids or from water excess </li></ul><ul><li>Clinical manifestations include confusion, nausea, vomiting, seizures, and coma </li></ul>
  10. 12. Hyponatremia Management <ul><li>Cause water excess, fluid restriction needed </li></ul><ul><li>Severe symptoms (seizures) occur, small amount of intravenous hypertonic saline solution (3% NaCl) given </li></ul><ul><li>Associated with abnormal fluid loss, fluid replacement with sodium-containing solution needed </li></ul>
  11. 13. Nursing Diagnoses <ul><li>Risk for injury </li></ul><ul><li>Risk for fluid volume excess </li></ul><ul><li>Risk for sensory/perceptional alterations </li></ul><ul><li>Risk for altered mucous membranes </li></ul><ul><li>Altered thought processes </li></ul><ul><li>Risk for impaired skin integrity </li></ul>
  12. 14. Nursing Actions <ul><li>Safety measures </li></ul><ul><li>I&O (may be hourly), daily wt </li></ul><ul><li>Assess for source of Na+ loss </li></ul><ul><li>Monitor lab - Serum Na+, urine specific gravity </li></ul><ul><li>Assess for third space loss </li></ul><ul><li>Give food & fluids high in Na+ </li></ul><ul><li>Assess for fluid overload; lung sounds, respiratory status, edema </li></ul><ul><li>Care with cardiac & CV disease </li></ul><ul><li>Assess mental status </li></ul><ul><li>Neuro checks/LOC/orientation (monitor for seizures& V/S </li></ul>