Fundamentals of nursing (fluids and electrolytes)

Potassium (K)

3.5-5.0 mEq/L

Hypokalemia causes

Diuretics, GI fluid loss through vomiting, gastric suction or diarrhea, steroid administration, hyperaldosteronism, anorexia or bulimia

Signs and symptoms of hypokalemia

Fatigue, anorexia, nausea, vomiting, muscle weakness, decreased GI motility, dysrhythmias, paresthesia, flat T wave on EKG, increased sensitivity to digitalis

Treatment for hypokalemia

Monitor I&O, monitor Potassium levels, administer potassium supplements, encourage intake of foods rich in K, if patient is taking digoxin, monitor pulse and observe for toxicity

Nursing Interventions for Hypokalemia

Monitor HR & rhythm

Administer oral potassium

Administer IV potassium

Teach client about potassium rich foods

Teach clients how to prevent excessive loss of potassium

Hyperkalemia causes

Renal failure, potassium sparing diuretics, hypoaldosteronism, high potassium intake coupled with renal insufficiency, acidosis, major trauma

Signs and symptoms of hyperkalemia

Muscle weakness, dysrhythmias, flaccid paralysis, intestinal colic, Tall T waves on EKG,

Treatment of hyperkalemia

Monitor I&O, monitor K+ levels, caution about K+ rich food intake in patients with elevated creatinine levels

Nursing Interventions for Hyperkalemia

Identify high risk patients

Provide cardiac monitoring

Monitor I&O

Furosemide

Dialysis

Sodium polystyrene sulfonate (Kayexalate)

Sodium bicarbonate

Normal range: 95-105

Location: major anion in EFC

Function: works with sodium to maintain osmotic pressure between fluid compartments, essential for production of HCL for gastric secretions, functions as a buffer in oxygen-carbon dioxide exchange in RBCs, assists with acid-base balance

Phosphate (PO4)

Normal range: 1.7-2.6

Location: major anion in the ICF

Function: serves as a catalyst for many intracellular activities, promotes muscle and nerve action, assists with acid-base balance, important for cell division & transmission of hereditary traits

Bicarbonate (HCO3)

Normal range: 22-26

Location: major buffer in the body in ECF & ICF

Function: maintains acid-base balance by functioning as the primary buffer in the body

Sodium (Na)

Normal range: 135-145

Location: major cation in ECF

Function: regulates fluid volume, helps maintain blood volume, interacts with calcium to maintain muscle contraction, and stimulates conduction of nerve impulses

Calcium (Ca)

Normal range: 8.5-10.5

Location: most abundant electrolyte in the body

Function: promotes transmission of nerve impulses, major component of bone and teeth, regulates muscle contractions, maintains cardiac automaticity, essential factor in the formation of blood clots, catalyst for many cellular activities

Potassium (K)

Normal range: 3.5-5.0

Location: major cation in ICF

Function: maintains intercellular fluid osmolality, regulates conduction of cardiac rhythm, transmits electrical impulses in multiple body systems, assists with acid-base balance

Magnesium (Mg)

Normal range: 1.6-2.6

Location: present in skeleton &ICF & 2nd most abundant cation in ICF

Function: involved in protein and carbohydrate metabolism, necessary for protein and DNA synthesis within cell, maintains normal intracellular levels of potassium, involved in electrical activity in nerve and muscle membranes including the heart

hypovolemia(FVD) causes

Diarrhea

Vomiting

GI Suctioning

Sweating

Decreased intake

hypovolemia S/S

Dehydration

Dry skin & mucous membranes

Poor skin turgor

Decreased urine output

Decreased BP

Increased HR

Increased Temp

Weight loss

Management of hypovolemia

Encourage fluids

Monitor I&O

Monitor weight

Monitor VS

Monitor LOC

Monitor skin color

Monitor breath sounds

Hypervolemia(FVE) causes

Renal failure

CHF

Cirrhosis of the liver

High sodium content meds

Aldosterone

Antidiuretic hormone

hypervolemia S/S

Distended neck veins

Bounding pulse

Peripheral edema & third spacing

Pale cool skin, central venous pressure

Wet lung sounds, crackles, SOB, wheezing

Polyuria, increased pulse, increased BP

Increased weight

Treatment of hypervolemia

Diuretics

Bed rest

Stop IV fluids containing Na

Restriction of Na & fluids

Monitor I&O, weight, & edema

Calcium

8.5-10.5

Hypocalcemia causes

Hypoparathyroidism

Alkalosis

Malabsorption

Pancreatitis

Vitamin D deficiency

hypocalcemia s/s

Diarrhea

Numbness and tingling of extremities

Muscle cramps

Tetany

Convulsions

Laryngeal spasms

Cardiac irritability

Positive trousseau's and chvosteck's signs

Hypocalcemia treatment

Monitor I&O

Monitor serum calcium

Encourage increased calcium intake

Administer calcium supplements

Hypercalcemia causes

Hyperparathyroidism

Malignant bone disease

Prolonged immobilization

Excess calcium supplementation

Thiazides diuretics

Hypercalcemia S/S

Muscle weakness

Constipation

Anorexia

Nausea

Vomiting

Polyuria & polydipsa

Kidney stones

Bizarre behavior

Bradycardia

Hypercalcemia treatment

Monitor I&O

Encourage fluid intake to prevent stone formation

Eliminate calcium supplements & limit calcium rich foods

Avoid calcium based antacids

Renal dialysis may be required

Nursing Interventions for hypocalcemia

Monitor VS & EKG

Prepare for Trach

Administer PO or IV calcium supplements

Teach pts osteoporosis 1000-1500 mg per day & regular exercise

Nursing Interventions for hypercalcemia

Monitor I&O & VS

Monitor lab values K+,Mg+, Albumin

Monitor cardiac rhythm

Hydrate w/ NS-Na+ inhibits renal absorption of Ca+

Loop diuretics never thiazide diuretics because they inhibit Ca+ excretion

Sodium (Na)

135-145

Hyponatremia causes

Diuretics

GI fluid loss

Adrenal insufficiency

Excessive intake of hypotonic solutions such as water or D5W IV fluids

Syndrome of inappropriate ADH

Hyponatremia S&S

Anorexia

Nausea

Vomiting

Weakness

Lethargy

Confusion

Muscle cramps

Twitching

Seizures

Hyponatremia treatment

Monitor I&O

Monitor sodium levels

Increase oral Na intake

Administer IV saline infusion

Take seizure precautions

Nursing Interventions for hyponatremia

Assess clinical manifestation

Oral or IV replacement Therapy

Assess closely if administering hypertonic saline solution

Monitor I&O

Restrict water intake if indicated

Daily weights

Monitor lab values

Slow replacement

Treat underlying cause (GI, sweating, diuretics)

Nursing Interventions for hypernatremia

Monitor I&O

Monitor daily weights

Monitor lab values

Monitor for dehydration

Monitor for behavior changes

Monitor salt intake

Diuretics may be used

Hypotonic solutions to dilute osmolarity

D5W for isotonic solution If both Na+ & fluid need replaced

Hypernatremia causes

Excessive sodium intake

Water deprivation

Increased water loss through profuse sweating, heat stroke, or diabetes

Administration of hypertonic tube feeding

Hypernatremia S/S

Thirst

Increased temp

Dry mouth & sticky mucous membranes

Hallucinations

Irritability

Lethargy

Seizures

Hypernatremia treatment

Monitor I&O

Monitor Na+ levels

Monitor VS & LOC

Restrict Na+ in diet

Beware of hidden Na+ in meds and foods

Increase water intake

Administer IV solutions that do not contain Na+

Effects of Aging in Fluid and Electrolyte Regulation

Reduced cardiac, renal & respiratory function

Medication

Medical procedures

CONFUSION

Clinical manifestations

Risk for fluid overload

Other Lab values

Serum osmolality 275-295

Serum osmolarity 250-900

BUN 10-31

Creatinine 0.5-1.2

HCT Males: 43%-49%

HCT Females 38%-44%

Urine levels freshly voided:

Ph: 5.0-9.0

Specific gravity: 1.001-1.029

Chloride (Cl)

95-105

Hyperchloremia Causes

Renal failure

Metabolic acidosis

Hyperparathyroidism

Hyperaldosteronism

Hypernatremia

Dehydration

Hyperchloremia s/s

Hyperkalemia

Tachypnea

Lethargy

Decreased cognition

Hypochloremia causes

Kidneys decreased absorption or intake

GI tract by gastric surgery

NG Suctioning

Prolonged vomiting

Salt restricted diets

Deficit in the formula

Loss through the skin

Hypochloremia s/s

Shallow respirations

Hypotension

Hyperactive deep tendon reflexes

Muscle cramps, twitching & weakness

Hypochloremia Treatment

Replace chloride with 0.45% or 0.9% NS

Metabolic alkalosis treat with ammonium chloride

Phosphorus (P)

0.7- 2.6

Hypophosphatemia causes

Refeeding after starvation

Alcohol withdrawal

Diabetic ketoacidosis

Respiratory alkalosis

Hypophosphatemia s/s

Paresthesia

Joint stiffness

Seizures

Cardiomyopathy

Impaired tissue oxygenation

Hypophosphatemia treatment

Monitor serum phosphorus levels

Monitor calcium levels as phosphate is replaced

Start TPN slowly to avoid drops in phosphate

Hyperphosphatemia causes

Renal failure

Excess intake of phosphorus based laxatives

Chemotherapy

Hyperthyroidism

Hyperphosphatemia s/s

Short term: tetany, cramping

Long term: calcification in soft tissue

Hyperphosphatemia treatment

Monitor serum phosphorus level

Monitor for tetany

If severe administer aluminum hydroxide w/ meals to bind phosphorus

Hypomagnesemia causes

Chronic alcoholism

Malabsorption

Diabetic ketoacidosis

Prolonged gastric suction

Hypomagnesemia s/s

Neuromuscular irritability

Disorientation

Mood changes

Dysrhythmias

Increased sensitivity to digitalis

Hypomagnesemia treatment

Monitor I&O

Encourage foods high in magnesium

Avoid alcohol intake

If client is taking digoxin monitor pulse and observe for toxicity

Nursing Interventions for hypomagnesemia

Check VS

Monitor for hypotension

Monitor urinary output

Cardiac status

Seizure precautions

Administer Mg as ordered remember Mg comes in various concentrations 10% 12.5% or 50%

Hypermagnesemia causes

Renal failure

Adrenal insufficiency

Excess replacement

Hypermagnesemia s/s

Hyporeflexia, hypotension, respiratory depression, flushing and warmth of skin, drowsiness, lethargy, bradycardia

Hypermagnesemia treatment

Monitor VS & airway

Monitor reflexes

Avoid magnesium based antacids and laxatives

Restrict dietary intake of foods high in magnesium

Nursing Interventions for hypermagnesemia

Monitor VS/LOC

Resp status

Cardiac function

Monitor deep tendon reflexes

Oral or IV hydration

Calcium gluconate

Dialysis

Narrative charting

Story of care in chronological format

Tracks the clients changing status

Can be lengthy and disorganized

PIE Charting

Problem

Interventions

Evaluation

Used in problem oriented charting

Established an ongoing Plan of care

SOAP Charting

Subjective data

Objective data

Assessment

Plan

Intervention

Evaluation

Revision

Focus charting

uses DAR notes. (Data, Action, Response). it addresses the patients concerns or strengths in three columns. 1. Time and date 2. Problem 3. DAR format

Charting by exception

Focuses on deviation from the established norm or abnormal findings, highlights trends or changes

FACT documentation

Flow sheets individualize specific services

Assessment with baseline data

Concise progress notes

Timely entries