electrolyte

Electrolyte Imbalances

Potassium Imbalances

  • Hypokalemia

    • Think "light"; associated with contracted states.

    • Symptoms:

    • 5.0 (Normal is typically 3.5-5.0 mEq/L).

    • Hypotension - low blood pressure.

    • Diarrheal - increased bowel motility leading to symptoms.

    • ST elevation, peaked T-wave on ECG, potential for
      V-FIB (ventricular fibrillation) leading to cardiac issues.

    • Paralysis in extremities - severe muscle weakness.

    • Increased deep tendon reflexes (DTR).

    • Less severe symptoms:

      • St Depression - downward shifts on ECG monitoring.

      • Flat T-wave.

      • 3.5 indicates nearing lower limits of normal.

      • Decreased motility - issues with digestion can lead to constipation.

      • Ileus (intestinal obstruction) leading to
        SBO (small bowel obstruction), and symptoms like
        abdominal distention and paralyzed limbs.

Sodium Imbalances

  • Hypernatremia

    • Remember "think SANTA!"

    • Symptoms include "Flush, Red & Rosy"; feeling Big and Bloated.

    • Normal Sodium Levels: 135-145 mEq/L.

    • Edema - swelling due to excessive sodium.

    • Low-grade fever and skin indications of excess fluids (like bedsores).

    • Red beefy tongue - indicating dehydration.

    • Polydipsia - excessive thirst.

    • Late signs:

      • Swollen dry tongue.

      • Increased muscle tone.

      • Nausea and vomiting signals indicating gastrointestinal distress.

      • Signs may include feeling deflated and lethargic.

  • Hyponatremia

    • Clinical definition: sodium levels less than 135 mEq/L.

    • Effects on the nervous system:

    • Can lead to seizures and coma.

    • Cardiovascular signs:

    • Tachycardia and weak, thready pulses.

    • Respiratory Distress / Arrest - note that the patient is not bleeding.

Benefits of Exercise

  • Reasons why movement matters:

    • Better heart efficiency → leads to stronger circulation.

    • Stronger muscles and bones → prevention of weakness and fractures.

    • Better digestion and elimination → results in less constipation.

    • Helps maintain healthy weight → combats obesity and related issues.

    • Boosts mental health → reduces feelings of depression and anxiety.

  • Rationale:

    • Regular activity is vital for maintaining the proper functioning of bodily systems; lack of movement leads to deterioration.

Effects of Immobility (Disuse Syndrome)

  • Definition:

    • Occurs when the body deteriorates due to lack of movement.

  • Causes:

    • Paralysis, prescribed immobilization (e.g., cast, traction, or bed rest), pain, weakness, stiffness.

    • Anything that inhibits movement may contribute.

  • Rationale:

    • The adage 'If you don’t use it, you lose it.' highlights that immobility affects every system in the body.

Respiratory Effects of Immobility

  • Lung expansion decrease → leads to poor ventilation.

  • Stasis of secretions → mucus accumulation occurs.

  • Risks:

    • Hypostatic pneumonia (infection from mucus pooling).

    • Respiratory acidosis due to CO₂ buildup.

  • Nursing Interventions:

    • Monitor breathing and chest movement regularly.

    • Auscultate lungs for abnormal sounds.

    • Encourage deep breathing and coughing every 2 hours.

  • Rationale:

    • Movement is necessary to clear the lungs; remaining still allows mucus to pool, thus leading to infection.

Cardiovascular Effects of Immobility

  • Orthostatic hypotension → blood pressure drops suddenly when standing.

  • Increased workload on the heart.

  • Blood pooling → risk of thrombosis (clot formation).

  • Nursing Interventions:

    • Monitor blood pressure with position changes.

    • Avoid straining activities (no Valsalva maneuver).

    • Perform leg checks and exercises every 2 hours.

    • Use compression stockings if ordered.

  • Rationale:

    • Gravity combined with immobility causes blood pooling, which may contribute to dizziness or clots.

Magnesium Imbalances

  • Chloride:

    • Functions similarly to sodium.

  • Hypermagnesemia: levels <2.1 mEq/L.

    • Symptoms: calm and quiet heart

    • Risk of heart block, hypotension, bradycardia.

    • Lungs appear calm and quiet.

    • Hypoactive bowel sounds increase constipation risk.

  • Hypomagnesemia:

    • Symptoms can be summarized as MESS:

    • ST Depression, T-wave inversion, V-FD (ventricular fibrillation), tachycardia, and increased DTR.

    • Diarrhea and shallow respiration also possible.

Calcium Imbalances

  • Remember the 3 B's: Calcium relates to:

    • Bones, Blood, and Beals (Functions).

  • Hypercalcemia:

    • Levels over 10.5 mg/dL.

    • Symptoms: Swollen and Slow.

    • Common symptoms include:

    • "Moans, groans, and stones" - related to abdominal discomfort, constipation, and kidney stones.

    • Bone pain, decreased DTR.

  • Hypocalcemia:

    • Levels at 9.0 mg/dL or less.

    • Symptoms:

    • Feelings of being overwhelmed ("cock calcium went on vacay!").

    • Arm twerk signs → Trousseau's sign (spasm of the wrist/hand).

    • Chvostek's sign (facial muscle spasm).

    • Diarrhea and tingling sensations in the extremities.

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