fluid/ electrolyte deficits and nursing considerations

Fluid volume overload ➡pulmonary edema (con be from too much if fluid, heart failure, renal failure)

Looks like: dyspnea, crackles, pink frothy sputum, JVD, edema, HTN, decreased O2 sat, anxiety, air hunger.

Why it’s dangerous: fluid floods alveoli➡ respiratory failure

What nurses do: priority is breathing so sit patient upright, oxygen, stop IV fluids, administer IV diuretic, monitor lung sounds, daily weights, strict I&O

Hyperkalemia ( causes: renal failure, k-sparring diuretics, cell breakdown like burns & trauma, acidosis)

Looks like: muscle weakness, paresthesia, cardiac dysrhythmias, ECG: peaked T waves, widened QRS, bradycardia ➡ventricular arrest.

Hyperkalemia makes heart stops.

What nurses do: cardiac monitoring, stop potassium intake, administer: calcium gluconate( cardiac membrane protection), insulin + glucose ( push k+ into cells), albuterol, sodium bicarbonate, prepare for dialysis if severe.

Hypokalemia ( causes: diuretics, vomiting/diarrhea, NG suction)

Looks like: muscle cramps, weakness, ileus, ECG: flattened T waves, U waves, ventricular dysthymias.

Hypokalemia leads to lethal arrhythmia

What nurses do: replace potassium slowly, cardiac monitoring, NEVER IV push potassium, monitor renal function, encourage K+ rich food.

Hypovolemic shock ( severe fluid volume deficit from massive vomiting/ diarrhea, hemorrhage, burns, over-diuresis)

Looks like: hypotension, tachycardia, weak, Thready pulse, dry mucous membranes, decreased urine output (less than 30 ml/hr), altered LOC, cool, clammy skin.

It’s dangerous bc organs aren’t being perfused ➡shock➡organ failure➡ death.

What nurses do: priority is circulation, rapid IV access( large bore), isotonic fluids (NS or LR), strict I&O, monitor VS q5-15min, trend labs( Hgb,Hct, BUN/Cr), oxygen, prepare for blood products if hemorrhage.

Sodium (brain danger )

Hyponatremia caused from excess water, SIADH, hypotonic in fluids)

Looks like: headache, confusion, nausea, seizures, decreased LOC.

Low sodium = cerebral edema ➡ brain herniation

What nurses do: neuro checks, seizure precautions, fluid restriction, hypertonic saline (3%) slowly, monitor sodium closely.

Hypernatremia (caused: dehydration, diabetes insipidus, excess sodium intake)

Looks like: intense thirst, dry skin, restlessness, confusion, seizures

Brain cell dehydration ➡ intracranial bleeding

What nurses do: gradual hypotonic fluids, oral water if safe, monitor neuro status, strict I&O

Hypocalcemia

Looks like: tingling, muscle spasms, trousseau & Chvostek signs, seizures, prolonged QT

Nursing actions: IV calcium gluconate, seizure precautions, cardiac monitoring

Hypercalcemia ( causes: malignancy, hyperparathyroidism, excess calcium or vitamin D, prolonged immobilization, thiazides)

Looks like: bone pain, pathological fractures, kidney stones, flank pin, polyuria, confusion, lethargy, weakness, reduced reflexes, shortened QT interval, bradycardia, heart block, nausea, constipation, decreased bowel sounds.

Cardiac dysrhythmias + renal failure + coma

What nurses do: cardiac monitoring, hydration first (NS to dilute calcium), loop diuretics, bisphosphonates, calcitonin, encourage oral fluids if stable, monitor labs, strict I&O, safety/ fall precautions.

Hypomagnesemia ( causes: chronic alcoholism, diuretic, diarrhea, malnutrition, NG suction, DKA)

1. Looks like: tremors, hyperflexia, seizures, confusion, ventricular dysrhythmias, prolonged QT, torsades, muscle cramps, tetanty.

2. What nurses do: cardiac monitoring, seizure precautions, IV magnesium sulfate. Monitor deep tendon reflex, respiratory status, check K & Ca levels, educate on magnesium rich foods.

Hypermagnesemia

Looks like: lethargy, hypotension, decreased reflexes, respiratory depression, bradycardia,

Nurse actions: stop magnesium, calcium gluconate, respiratory support, monitor reflexes.