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
  • Chapter 13 And 15 Electrolyte Imbalance Part 5

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

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