Adult Health: Exam #1 - Electrolytes

Hyponatremia

<136

- caused by water gain OR sodium loss

With hyponatremia it is important to REMEMBER _______ & ________

safety & seizure precautions

What are the manifestations of hyponatremia?

- low serum osmolality

- muscle cramps

- weakness

- HA/irritability

- neurological changes

- seizures

- N/V

- hypotension/shock

What are the medical interventions for hyponatremia?

- fluid replacement

- sodium replacement (hypertonic solution)

- treat cause (meds, kidney failure, etc)

- sodium supplements (for chronic hyponatremia)

What are the nurse interventions for hyponatremia?

- monitor serial sodium levels

- safety precautions (r/t confusion)

- administer hypertonic solutions

- monitor neurological status

- monitor for pulmonary edema

- monitor urine output & fluid intake hourly

What is hypernatremia?

Na > 145

REMEMBER: Safety - Give _______ fluids _______ to prevent cerebral edema or _______

hypotonic , slowly, seizures

What are the manifestations of hypernatremia?

- excessive thirst

- dry, swollen tongue

- sticky mucosa

- oliguria (r/t kidney fx)

- lightheaded/weakness

- seizures/coma

- irritability

- altered LOC

What are the medical interventions for hypernatremia?

- labs: sodium, osmolality

- oral rehydrations

- hypotonic solution

What are the nurse interventions for hypernatremia?

- assess mental/neuro status

- encourage fluids

- H2O via tube feeding

- administer hypotonic fluids slowly

- sodium restriction

- teach about low sodium foods

What is hypocalcemia?

Ca < 9

What are the manifestations of hypocalcemia?

- tetany (spasms)

- seizures

- circumoral numbness

- muscle spasms

- chvostek's sign

- trousseau's sign

- increased DTRs

- DYSRYTHMIAS

What are medical interventions for hypocalcemia?

- IV calcium chloride (if emergent)

- Calcium gluconate

- Oral calcium / Vit D

- Labs - calcium, Mg, Phos, - Vit D

What are nurse interventions for hypocalcemia?

- Assessment

- Medications administration

- Teach about weight bearing exercises

- Teach about food high in ca

REMEMBER: for hypocalcemia safety/risk for ____ and _____ precautions

fall, seizure

What is hypercalcemia?

Ca > 10.5

What are the manifestations of hypercalcemia?

- Muscle weakness

- Fatigue

- GI manifestations

- Decreased muscle tone

- DYSRHYTHMIAS

- Bone pain

- Kidney stones

- Depression

What are the medical interventions for hypercalcemia?

- Phosphates

- Biphosphates

- Calcitonin

- Labs (ionized calcium level)

- Isotonic solution

- Check current meds

What are the nurse interventions for hypercalcemia?

- Assessment

- Encourage ambulation

- Increase fluids / monitor UO

- Teach about fiber

- Teach about limitation of foods high in calcium

REMEMBER: for hypercalcemia monitor _______, encourage fluids & _______

cardiac, ambulation

What is hypokalemia?

K < 3.5

What are the manifestations of hypokalemia?

- ECG Changes

- Muscle weakness

- N/V

- Abdominal distention

- Muscle cramps

- Impaired renal fx

- Constipation

What are the medical interventions for hypokalemia?

- Potassium replacement (IV or PO)

- Higher acuity setting for IV potassium replacement

- Eliminate cause (e.g. meds)

ABGs

What are the nurse interventions for hypokalemia?

- Cardiac monitoring

- Analyze ABGs

- Potassium replacement therapy

- Monitor IV site

- Monitor kidney fx

- Teach about high potassium food

REMEMBER: for hypokalemia monitor _______.

cardiac

What is hyperkalemia?

K > 5

What are the manifestations of hyperkalemia?

- ECG changes

- Chest pain/palpitations

- Muscle weakness

- Muscle cramping

- Diarrhea

- Anxiety (jittery)

- Paresthesia

- GI manifestations

What are the medical interventions for hyperkalemia?

- Serial serum potassium

- Kayexalate/diuretics

- Calcium gluconate

- Limit potassium

- IV dextrose + insulin

- Dialysis

What are the nurse interventions for hyperkalemia?

- Monitor ECG

- Monitor meds

- Educate on foods high in potassium

REMEMBER: for hyperkalemia, monitor _____ and check _____ fx

cardiac

renal

What is hypomagnesemia?

Mg < 1.3

What are the manifestations of hypomagnesemia?

- Neuromuscular excitability

- Chvostek

- Trousseau

- Seizures

- HTN/ tachycardia

- Dysrhythmias

- Change in personality

What are medical interventions for hypomagnesemia?

- MgSO4 IV

- Oral magnesium

- Diet (increase magnesium)

- Labs - BMP (calcium & magnesium)

What are nurse interventions for hypomagnesemia?

- Assessment (neuro, respiratory & cardiovascular)

- Monitor labs

- Ensure safety

- IV site care

- Patient teaching r/t diet, medications, ETOH

REMEMBER: for hypomagnesemia monitor cardiac and _____ ______

neuromuscular exitability

What is hypermagnesemia?

Mg > 2.1

What are the manifestations of hypermagnesemia?

- CNS depression

- Lethargy/drowsiness

- Confusion/dizziness

- Decreased DTR

- Decreased respiration

- Dysrhythmias

What are the medical interventions of hypermagnesemia?

- IV calcium gluconate

- Loop diuretics

- Isotonic fluids

- Hemodialysis

What are the nurse interventions of hypermagnesemia?

- Assessment (DTR, RR)

- Patient safety

- Teach about foods/meds high in magnesium

REMEMBER: for hypermagnesemia what 3 things should you monitor?

- cardiac

- neuro depression

- fall risk

What is Hypophosphatemia?

Phos < 3

What are the manifestations of Hypophosphatemia?

- Intention tremor

- Paresthesia

- Confusion/stupor

- Seizures

- Bone pain/joint stiffness

- Hematologic changes

- Cardiovascular change

What are the medical interventions of Hypophosphatemia?

- Oral or IV phosphorus

- Vitamin D supplements

- Medications to reduce phosphate loss (calcitonin)

- Dietician referral

What are the nurse interventions of Hypophosphatemia?

- Assessment of symptoms

- Encourage food HIGH in phosphorus

- Avoid food that deplete phosphorus

What foods are HIGH in phosphorus?

Almonds, cashews, cheese, chicken, fresh fried fruit, eggs etc.

What are foods that DEPLETE phosphorus?

Hot dogs, pizza, etc.

REMEMBER: for Hypophosphatemia what should you monitor?

- bone pain

- muscle weakness

- confusion

What is hyperphosphatemia?

Phos > 4.5

What are the manifestations of hyperphosphatemia?

- Paresthesias

- Muscle weakness

- Tetany

- N/V

- Bone/joint pain

- Brittle nails/dry skin

- Abnormal heart rhythms

- Memory problems

What are the medical interventions for hyperphosphatemia?

- Dialysis

- Sevelamer (reangle)

- Other phosphate binders (calcium carbonate, aluminum hydroxide, calcium acetate, etc.)

- Dietary restrictions

What are the nurse interventions for hyperphosphatemia?

- Monitoring (renal function/labs)

- Limits foods high in phosphorus

- Medications as ordered

- Hemodialysis & Peritoneal dialysis

What foods are HIGH in phosphorus?

soft drinks, dairy, brans, nuts, etc

REMEMBER: for hyperphosphatemia the nurse needs to monitor for ______

tetany