2-1
Sodium: 135- 145 Salt, soy sauce, pork,
cottage/ American cheese, spinach, Pickles
HYPO:
A - Adrenal insuffIciency
I - Intoxication of water
D - Diuretics
S - SIADH
S/S: Tachycardia, Headache, Personality
Change, Weakness,Hyperactive BS
Seizures.
INTERVENTIONS:
D - Diet, Cheese, Milk, Soy Sauce, Salt, Bacon,
Beef Broth
R - Restrict fluids and NPO
W - Weights daily
A - Administer IV Hypertonic Solutions
I- I&O
T - Thiazide Diuretics
HYPER:
D - Dehydration
I - IV Hypertonic Solution excess
V - Vitamins “Sodium” Supplement
A - Amount of sodium intake excess
S/S: Irregular HR, Hyperactive BS, Thirst,
Restlessness, Dyspnea, Muscle Weakness.
INTERVENTIONS:
M - Monitor sodium intake/ Labs
A - Alka-seltzer, Aspirin, and cough preps
shouldn’t be administered
G - Gravity of urine monitoring
I - I&O
C - Cardiac monitoring
Potassium: 3.5- 5.0 Avocados, Raisins,
HYPER:
M - Medications Ace, Spironolactone, NSAIDS
A - Acidosis: metabolic and respiratory
C - Cell destruction (burn, trauma, Injury)
H - Hypoaldosteronism
I - Intake excess K+
N - Nephrons/ renal failure
E - Excretion : impaired
S/S: Bradydysrhythmias, Tall “T” waves on EKG,
Cardiac Arrest, ↑BS Diarrhea, Paresthesias.
INTERVENTION:
M - Monitor EKG
D - Diet, limit green leafy veggies and avocado
K - Kayexalate administration
I - IV Sodium Bicarb, Calcium Gluconate,
D - Dialysis
Cantaloupe, Bananas, Skim milk, Spinach
HYPO:
G - GI loss (Vomiting)
O - Osmotic Diuresis
T - Thiazides and Loop diuretics
S - Severe Acid Imbalance
H - Hyperaldosteronism
O - Other meds such as Corticosteroids
T - Transcellular Shift
S/S: Tachydysrhythmias, Ortho Hypotension,
Lethargy/Fatigue, BS, Constipation, Anorexia,
Muscle Weakness, “U” waves on EKG.
INTERVENTIONS:
A- Assess EKG and ABG
I - IV Potassium Chloride ***NEVER IV PUSH***
D - Diet: green leafy veggies, oj, raisins, bananas
Calcium: 9-11 Yogurt, cheese, milk,
sardines, rhubarb
HYPO:
A - Antibiotics
C - Corticosteroids
I - Insulin
D - Diuretics
S/S: Hypotension, Bradycardia, Tetany muscle
spasm, Laryngospasm/Stridor, ↑DTR, ↑ BS
diarrhea, +Trousseau's sign, +Chvostek's sign.
INTERVENTIONS:
D - Diuretics
I - I&O
C - Calcium channel blockers /Calcium Gluconate
HYPER:
H - Hyperparathyroidism
A - Antacids
M - Malignancies cancer cells release excess
ca+
S/S: Dysrhythmias, Pallor, HTN, ↓ LOC
Disorientation, ↓ DTR, ↓ BS, Constipation.
INTERVENTIONS:
F - Sodium containing fluids
I - IV Phosphate
L - Lasix
M -Monitor Labs and I&O
www.SimpleNursing.com
2-2
Phosphorus: 2.5- 4.5 Tuna, beef liver,
pork, milk and yogurt.
HYPO:
●
Alcohol withdrawal
●
Thermal burns; Heat stroke,
●
Respiratory alkalosis; Hyperventilation
●
Hepatic encephalopathy
●
Low mag, low potassium
●
Use of diuretics and antacids
●
Refeeding syndrome
S/S: Muscle pain & weakness, Bone Pain,
Confusion.
INTERVENTION:
●
Oral or IV phosphate replacement.
●
Encourage food high in phosphate,
gradually introduce calories to a
malnourished pt receiving parenteral
nutrition.
Chloride: 97- 107
HYPO:
●
Hyponatremia, excess chloride loss from
vomiting, diarrhea or NG suction.
●
Addison's disease, DKA, excess sweating,
fever, burns, metabolic alkalosis.
●
Medications that cause hypochloremia:
diuretics (loop and thiazide) increase
excretion of chloride by the kidneys.
S/S: Dysrhythmia, Hypotension, Dyspnea,
Confusion, Coma, Seizure, Sodium Imbalance,
Tremor, Muscle Cramps.
INTERVENTION:
●
Replace chloride with IV NS or 0.45% NS.
●
Avoid free water, high chloride foods.
HYPER:
●
Excess vit D
●
Hypoparathyroidism, symptoms associated with
hypocalcemia, decreased excretion by the
kidneys.
●
Medications causing hyperphosphatemia:
Decreased excretion by the kidneys
●
Increased phosphorus absorption
S/S: Circumoral and Peripheral Parenthesis, Muscle
Spasms, Tetany.
INTERVENTIONS:
●
Give vit D preparations
●
Calcium binding antacids, phosphate binding gels
●
Loop diuretics
●
IV, NS, Dialysis
●
Avoid high phosphorus food
●
Manage signs of hypocalcemia
●
Teach about phosphate containing substances
HYPER:
●
Hypernatremia
●
Head injury, dehydration, severe
diarrhea, metabolic acidosis
●
Hyperparathyroidism
●
Respiratory alkalosis
S/S: Hypertension, Respiratory Alkalosis,
Tachypnea, ICP, Cognitive Changes, Diarrhea,
Dehydration, Lethargy, Weakness.
INTERVENTIONS:
●
Restore electrolyte and fluid balance, LR,
Sodium Bicarbonate diuretics.
Magnesium: 1.3- 2.1 Spinach,
HYPER:
avocado, tuna, oatmeal and milk
HYPO:
A - Alcoholism
G - GI loss
E - Excretion, Impaired
D - DKA
S/S :Seizures, Tetany, Anorexia,
Tachycardia, HTN, Mood Changes.
INTERVENTIONS:
S - Safety r/t ability to swallow
I - IV mag sulfate
M - Monitor labs and reflexes
D: DKA
A: Antacids that contain mag and mag
supplements
R: Renal failure, kidneys cannot excrete mag
K: Potassium Hyperkalemia
S/S: DTR, N/V, Bradycardia, Hypotension,
Coma.
INTERVENTIONS:
H - Hemodialysis
I - IV calcium gluconate
M - Monitor labs and DTR’s
www.SimpleNursing.com
2-3
What am i ?
Interventions:
Serum potassium level below 3.5
mEq/L. Most common cation in the ECF.
Obtained through diet; Absorbed in the
small intestine; Excreted in the kidneys.
AID
❖
Patho
Nerve impulse induction; Essential
for normal electrical conduction in
the heart; Important for, skeletal
muscle contraction. Hypokalemia
occurs when serum potassium levels
fall below 3.5 mEq/ L.
Causes
GOT SHOT
❖
G- GI loss (Vomiting;
Diarrhea)
❖
O- Osmotic Diuresis (ex:
DKA)
T- Thiazide and loop
diuretics
❖
❖
❖
❖
S- Severe Acid Imbalance
( alkalosis)
H- Hyperaldosteronism
O- Other meds such as
Corticosteroids
T- Transcellular Shift (Using
insulin to treat DKA)
Nursing Assessment
Heart- Life threatening
dysrhythmias; Prominent “U”
waves and flat T waves; Weak
pulses.
Lungs- Respiratory alkalosis;
Kussmaul respirations; Slow
shallow breath.
Neuro- Loc changes; Altered
mental status Lethargy; Anxiety.
Gi- Constipation; Nausea;
Vomiting; Paralytic ileus.
Musculoskeletal- Weakness
and cramps; Decreased DTR;
General weakness.
A- Assess EKG and
ABG’s
❖
I - IV Potassium
Chloride
❖
D - Diet: green leafy
veggies
Fun Fact
In a relationship with salty
sodium.
Never push Potassium!
Alterations in acid base
balance/low K alkalosis “your
battery is low.”
Education:
❖
❖
❖
❖
❖
Treatment
❖
❖
❖
Oral potassium
IV potassium
Potassium sparing
diuretics
❖
Labs & Diagnostics
❖
❖
❖
Serum electrolytes:
potassium less than 3.5
mEq/L.
EKG: ST depression,
shallow, flat or inverted T
wave and prominent U
wave.
www.SimpleNursing.com
Educate the client to
eat potassium rich
foods: Avocado,
bananas, cantaloupes,
carrots, fish,
mushrooms, oranges,
potatoes, pork, beef,
veal, raisins, spinach,
strawberries, tomatoes.
Intake and output
Monitoring.
Daily weights if
indicated.
Prevention of future
episodes of
hypokalemia.
The need for a
high-potassium diet,
including foods that
are good sources of
potassium.
Warning signs and
symptoms of
hyperkalemia and
hypokalemia to report
to a healthcare
practitioner.
The importance of
adhering to
scheduled follow-up
visits and laboratory
testing to evaluate
the condition and the
effectiveness of
treatment.
2-4
Assessment
What am i ?
Heart- Life threatening
dysrhythmias; elevated T Waves
could cause V-fib; wide QRS
complex.
Lungs- Could lead to your
respiratory failure.
Neuro- LOC, AMS.
GI - Hyperactive bowel sounds.
Musculoskeletal- Hyperreflexia;
Tingling; Burning and
Numbness.
Serum potassium level greater than
5 mEq/L . Most common cation in the
ECF.
Obtained through diet; Absorbed in
the small intestine; Excreted in the
kidneys.
Facilitates: Nerve impulse induction:
Essential for normal electrical
conduction in the heart: Important for
skeletal muscle contraction.
Regulated:
By the sodium/potassium pump and
the kidneys.
❖
patho
❖
Hyperkalemia is a result of serum
potassium levels rising above 5.0 mEq/L.
Occurs from deficient intake of
potassium, increased excretion of
potassium, or a shift of potassium from
extracellular to intracellular space.
Potassium imbalance can lead to muscle
weakness and flaccid paralysis because
of an ionic imbalance in neuromuscular
tissue excitability.
❖
❖
❖
❖
❖
Causes
❖
❖
❖
❖
❖
❖
❖
❖
M - Medications Ace
inhibitors,
Spironolactone,
NSAIDS.
A - Acidosis:
metabolic
and respiratory.
C - Cell destruction:
burn, trauma,
Injury.
H - Hypoaldosterone,
Hemolysis.
I - Intake of exces
K+.
N - Nephron
destruction/ renal
failure.
E - Excretion:
impaired.
Labs & Diagnostics
EKG: Tall peaked T waves, flat P
waves, widened QRS complex,
prolonged PR intervals.
Serum Potassium : > 5.0 mEq/ L
Interventions
Monitor cardiovascular, renal,
neuromuscular, and respiratory
status.
D/C IV potassium , hold oral
potassium supplements.
Administer potassium excreting
diuretics.
Prepare to administer sodium
polystyrene sulfonate ( kayexalate).
Ready the client for dialysis.
Ready IV calcium for administration.
Prepare to administer IV hypertonic
solution with regular insulin to move
K+ back into the cell.
Education
❖
❖
❖
Treatments
❖
❖
❖
❖
❖
Dialysis
IV calcium
Regular insulin
Potassium excreting diuretics
Kayexelate
www.SimpleNursing.com
Teach the client to avoid
foods high in potassium.
Teach the client to avoid the
use of salt substitutes as they
contain potassium.
Teach the client signs and
symptoms of hyperkalemia
2-5
Nursing Assessment
What am i ?
Serum calcium value lower than 8.6
mg/dL. Most abundant cation in the Human
body. 99% stored in the bones. Primary
source is in the bones. You need Vitamin D to
aid in absorption, this is obtained via diet and
absorbed in the small intestine and excreted
by the kidneys.
Function: Assists in building bones and
teeth, facilitates blood clotting, essential for
nerve impulses. Plays a key role in skeletal
muscle contraction and relaxation, important
for normal heart and muscle function.
Regulated:
1. Parathyroid hormone: excreted by the
parathyroid gland increase Ca+ concentration
in the blood.
2. Calcitriol: hormonally active Vit D.
Increases Ca+ by aiding in absorption in the
small intestine ,decreases renal transfer from
the blood to the kidneys. Increases the
release of calcium from the bones into the
blood.
3. Calcitonin: produced by the thyroid
gland, decreases blood Ca+ and increases
reabsorption into the bones.
Patho
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
Chvostek's and
Trousseau's
Serum calcium
levels
Interventions
❖
❖
❖
❖
T - Tetany
W - Wink ( chvostek's )
I - Increased hr , followed by decreased
HR
T - Trousseau’s sign
C - Circumoral numbness
H - Hyperactive deep tendon reflexes
E - Excitability ( neuromuscular)
S - Seizures
❖
❖
❖
Monitor cardiac,
respiratory and
neuromuscular status.
Administer calcium
orally or IV( warm the
solution to body
temp).
Observe for
infiltration.
Provide a quiet
environment.
Move the client
carefully to prevent
pathological fracture.
Keep 10% calcium
gluconate ready for
acute hypocalemia.
Instruct the client to
consume calcium rich
foods.
Initiate seizure
precautions.
Education
❖
Causes
Body's inability to absorb
calcium
Decreased calcium intake
Vit D deficient
Lactose intolerance
Crohn's disease
End stage kidney disease
Diarrhea, steatorrhea
Wound drainage
Hyperproteinemia
Alkalosis
Chelating agents or calcium
binders
Acute pancreatitis
Removal or damaged
parathyroid
Immobility
Hyperphosphatemia
❖
❖
H - Hyperactive bowel sounds
E - EKG changes
A reduction in total serum calcium can
result from a decrease in albumin
secondary to liver disease, nephrotic
syndrome, or malnutrition. Hypocalcemia
causes neuromuscular irritability and
tetany.
❖
Labs & Diagnostics
Heart- EKG prolonged QT interval and
ST segment. Abnormal clotting,
Bradycardia in later stages. Diminished
Peripheral Pulses, Hypotension.
Lungs- Dyspnea; Laryngospasm; Stridor,
Respiratory Arrest.
Neuro- Seizure
GI- Diarrhea; Intestinal Cramping
Hyperactive bowel sounds
Musculoskeletal- muscle and nerve
excitability, tetany, muscle spasms of the
face, hand, and feet, Circumoral
numbness( numbness around the mouth)
Paraesthesia ( numbness and tingling) ,
Hyperactive DTR, positive Trousseau's
sign, positive Chvostek's sign.
❖
❖
❖
Treatments
❖
❖
Aluminum hydroxide: reduces phosphorus
levels.
Vitamin D: Aids in calcium absorption.
www.SimpleNursing.com
Consume calcium rich
foods: cheese, collard
greens, milk, soymilk,
rhubarb, sardines,
spinach, tofu, yogurt.
Educate the client on
signs and symptoms of
low calcium.
Instruct the client to take a
calcium supplement.
Educate the client on the
medications you are
administering--some take
2 hrs apart (beta-blockers)
2-6
What am i ?
Serum calcium value greater than 10.2
mg/dL Most abundant cation in the Human
body. 99% stored in the bones. Primary
source is in the bones. Need vit D for
absorption. Obtained via diet, absorbed in
small intestine, excreted by the kidneys.
Function: Assists in building bones and
teeth, facilitates blood clotting, essential
for nerve impulses, plays a key role in
skeletal muscle contraction and relaxation,
Important for normal heart and muscle fx.
Regulated:
1. Parathyroid hormone: Excreted by the
parathyroid gland increase Ca++
concentration in the blood.
2. Calcitriol: Hormonally active Vit D.
Increases Ca+ by aiding in absorption in the
small intestine, decreases renal transfer
from the blood to the kidneys. Increases
the release of calcium from the bones into
the blood.
3. Calcitonin: Produced by the thyroid
gland, decreases blood CA and increases
reabsorption into the bone.
Patho
Hypercalcemia is reported as elevation of
total plasma calcium levels rather than
ionized calcium levels. Acidosis decreases
the amount of calcium bound to albumin,
whereas alkalosis increases the bound
fraction of calcium. A small amount of
calcium (about 6%) is complexed to anions
such as citrate and sulfate. The remainder
is ionized calcium that is biologically active.
The most common causes of
hypercalcemia, affecting 90% of all
patients, are primary hyperparathyroidism
(HPT) and malignancy.
Assessment
HAM
❖
❖
❖
H - Hyperparathyroidism
A - Antacids containing calcium
M - Malignancies cancer cells
release excess Ca+
❖
Heart- Ekg: heart block, short
QT, wide T waves, spastic
contraction of heart muscles.
Lungs- SOB; Weak respiration.
Neuro- LOC; AMS; Decreased
DTR w/o parenthesis.
GI/ GU- Polyuria; Decreased
motility; Constipation; Renal
Calculi.
Musculoskeletal- Severe
muscle weakness; Decreased
excitability of muscle and
nerve; Bone pain.
❖
❖
Serum calcium
levels
Parathyroid
hormone levels
Imaging to check
bones density
Interventions
Slim Fast
❖
S - Safety - from falls.
❖
L - Lasix - Will excrete
electrolytes, mainly
potassium but also
Calcium as well.
❖
I - IV Phosphate Remember, Friendly Fatty
Phosphate will repel
Calcium from the blood
stream.
❖
M- Monitor EKG, I&O,
Kidney Stones.
❖
❖
❖
❖
Causes
Labs & Diagnostics
F - Fluids: Like Normal
Saline (decrease chance
of renal stone formation).
A - Avoid HIGH Calcium
Foods.
S - Serious Case =
dialysis.
T - Treat with calcium
reabsorption inhibitors:
Calcitonin,
Bisphosphonates,
prostaglandin synthesis
inhibitors (ASA, NSAIDS).
www.SimpleNursing.com
Education
❖
❖
❖
❖
❖
❖
❖
❖
❖
Increase fluid intake.
Greatly limit or stop your
intake of milk, cheese, cottage
cheese, yogurt, pudding, and
ice cream.
Avoid antacid medicines.
Don’t limit your salt intake.
Exercise.
Resume your normal activities
as directed by your healthcare
provider.
Take your medicines as
directed.
Tell your healthcare provider
about any other medicines you
are taking, including
over-the-counter or herbal
medicines and supplements.
Keep all appointments for lab
work and follow-up.
Treatments
❖
❖
❖
IV phosphorus
Calcitonin
Bisphosphonates
❖
Prostaglandin inhibitors
2-7
What am I ?
Below-normal serum magnesium
concentration 1.3 mg/dL. Second most
abundant cation in the body. 50- 65% found in
bone, the rest is in ICF and intravascular
system primary source is diet, absorbed in the
ileus, excreted in stool and urine.
Function :
❖
Maintains normal muscle function
❖
Nerve function
❖
Heart rhythm
Required for calcium and Vitamin B absorption,
stimulates parathyroid hormone which
regulates ICF calcium levels. Fights tooth
decay by binding calcium to tooth enamel. Has
a sedative effect of the neuromuscular system
causing decrease ach release causing smooth
muscle relaxation.
Regulated: Kidneys
Labs & Diagnostics
Assessment
Heart- Torsades de pointes;
Tachycardia; Hypertension;
Dysrhythmias.
Lung- Shallow respiration.
Neuro- Apathy; Confusion;
Agitation; Ataxia “poor
coordination“; Hyperactive deep
tendon reflexes.
GI/GU- Diarrhea.
MusculoskeletalHyperexcitability; Chvostek’s
and Trousseau’s signs.
❖
❖
Interventions
❖
❖
❖
❖
❖
❖
Patho
Hypomagnesemia is caused by
impaired intestinal absorption of
magnesium and is accompanied by
renal magnesium wasting which is a
result of a reabsorption defect in the
distal convoluted tubule.
Serum magnesium
levels
Deep tendon reflexes
❖
❖
❖
❖
Increase dietary intake of
magnesium.
Monitor cardiac rhythm.
Monitor reflexes.
Monitor serum electrolytes.
Keeps breathing bag, and O2
at bedside in case of
respiratory distress.
Calcium preps may be given
to counteract cardiac
dysfunction related to
magnesium intoxication from
rapid infusion.
Seizure precautions.
Monitor for digoxin toxicity.
Keep the client safe.
Assess ability to swallow
before giving po fluids or
meds.
Causes
cray
❖
❖
❖
❖
C - Consumption of alcohol in
excess - inhibits absorption of
Mg+ in the GI tract.
R - Really large fluid loss, NG
suction, Vomiting, Diarrhea or
Diuretics! Bc where fluids flow,
Electrolytes GO!!!
A - Antibiotics - Aminoglycoside
- Fully explained in the FULL
video.
Y - Young mothers - are HIGH
RISK for malnutrition.
Treatment
❖
❖
Education
❖
Increase intake of dietary
magnesium: green veggies,
chocolate, nuts bananas,
oranges, peanut butter.
❖
Prepare the client for IV Mg+
infusion, let them know that it will
burn going in. You can slow down
the infusion for client comfort.
❖
Educate the client on signs and
symptoms of low magnesium.
IV Mg+ Sulfate
Increase oral intake of
Magnesium
www.SimpleNursing.com
2-8
What am i ?
Serum magnesium level higher than 2.3
mg/dL. Second most abundant cation in
the body. 50- 65% found in bone, the rest
is in ICF and intravascular system primary
source is diet, absorbed in the ileus,
excreted in stool and urine.
Function : Maintains normal muscle fx,
nerve fx, and heart rhythm, required for
calcium and vit b absorption, stimulates
parathyroid hormone which regulates ICF
calcium levels. Fights tooth decay by
binding calcium to tooth enamel. Has a
sedative effect of the neuromuscular
system causing decrease ach release
causing smooth muscle relaxation.
Regulated: Kidneys
Patho
Magnesium excess affects the CNS,
neuromuscular, and cardiac organ
systems. It most commonly is
observed in renal insufficiency and in
patients receiving intravenous (IV)
magnesium for treatment of a medical
condition.
Labs & Diagnostics
❖
Serum magnesium
levels.
Neuromuscular status
checks.
❖
Interventions
Assessment
HIM
❖
❖
❖
H - Hemodialysis
I - IV calcium gluconate
M - Monitor labs and
DTR’s
Discontinue oral IV Mg+
Monitor respiratory status.
Heart- Bradycardia, cardiac.
arrest, dysrhythmias,
hypotension.
Lung- Depressed
respirations.
Neuro- Diminished or absent
deep tendon reflexes;
Drowsiness and lethargy that
progresses to coma.
GI/GU- Hypoactive bowel.
Musculoskeletal- Skeletal
muscle weakness.
Education
❖
❖
Educate client on signs
and symptoms of
hypermagnesemia.
Educate the client to
avoid magnesium
containing antacids and
other OTC medications
that contain magnesium.
Causes
DARK
❖
❖
❖
❖
Treatment
D- DKA.
A- Antacids that contain Mg+
and Mg+ supplements.
R- Renal failure, kidneys cannot
excrete Mg+
K- Potassium hyperkalemia.
❖
❖
❖
❖
www.SimpleNursing.com
Discontinue IV Mg+
Discontinue oral Mg+
Administer IV Calcium
Gluconate
Support ventilation
8-9
What am I
Hypophosphatemia is
indicated by a value below 2.5
mg/dL . Major anion in the ICF.
-phosphorus is found in the
body in combination with 02
approx. 85 % is bound with
calcium in teeth. Obtained via
diet. Absorbed in intestines
excreted by urine and stool.
Function:
Essential for bone and teeth
formation. Helps regulate
calcium. Assists in muscle
contraction, maintenance of
heart rhythm, and kidney fx.
Regulated: Parathyroid and
calcitriol.
Labs & Diagnostics
Assessment
Heart- Dysrhythmias;
Slowed peripheral
pulses.
Lung- Respiratory
alkalosis;
Hyperventilation; Shallow
respiration.
❖
Neuro- AMS, altered.
LOC; CNS depression. ❖
GI/GU- K+ excretion.
MusculoskeletalDecreased deep tendon
reflexes.
❖
Hypophosphatemia is most
often caused by long-term,
relatively low phosphate intake
in the setting of a sudden
increase in intracellular
phosphate requirements such
as occurs with refeeding.
Intestinal malabsorption can
contribute to inadequate
phosphate intake, especially if
coupled with a poor diet.
❖
❖
❖
Causes
❖
❖
❖
Alcohol withdrawal
Thermal burns; Heat stroke
Respiratory alkalosis,
Hyperventilation
Hepatic encephalopathy
Low mag, low potassium
Use of diuretics and antacids
Interventions
Oral or IV phosphate
replacement.
Encourage food high in
phosphate, gradually introduce
calories to a malnourished pt
receiving parenteral nutrition.
Education
patho
❖
❖
❖
Serum electrolyte levels
Eat more foods that contain
phosphorus.
Increase your intake of milk,
cream, cheese, cottage cheese,
yogurt, puddings, custard, and ice
cream. Add powdered milk to
foods.
Eat meat, fish, poultry, eggs, and
peanuts and other nuts and
seeds. Also eat beans, lentils,
peas, and soy products.
Eat bran cereal, granola, oatmeal,
and wheat germ.
Treatment
Hypophosphatemia (serum phosphate 1-2 mg/dL),
providing oral phosphate replacement may be
desirable. It is recommended that oral phosphate
replacement be used in patients who are
symptomatic and have phosphate levels between
1.0-1.9 mg/dL.
www.SimpleNursing.com
2-10
Labs & Diagnostics
About Me
Serum phosphorus level that
exceeds 4.5 mg/dL. Major anion in
the ICF. -phosphorus is found in the
body in combination with 02 approx.
85 % is bound with calcium in teeth.
obtained via diet. Absorbed in
intestines excreted by urine and
stool.
Function:
Essential for bone and teeth
formation. Helps regulate calcium.
Assists in muscle contraction,
maintenance of heart rhythm, and
kidney fx.
Regulated:
Parathyroid and calcitriol.
❖
❖
Assessment
Heart- Prolonged ST
interval; Prolonged QT
interval; Diminished
peripheral pulses.
Lungs- Soft tissue
calcification in lungs.
Neuro- Altered LOC, AMS;
Hyperactive reflexes.
GI/GU- Nausea/Vomiting.
Musculoskeletal- Muscle
weakness.
Interventions
❖
❖
Patho
The most common cause of
hyperphosphatemia in renal failure.
Other, less common causes are,
increased phosphate intake,
decreased phosphate output, or a
shift of phosphate from the
intracellular to the extracellular
space. Decreased sodium levels will
also cause a decrease in phosphate
levels.
❖
❖
❖
❖
❖
Give vit D preparations.
Calcium binding antacids, phosphate binding
gels.
Loop diuretics.
IV, NS, Dialysis.
Avoid high phosphorus food.
Manage signs of hypocalcemia.
Teach about phosphate containing
substances.
Education
❖
Causes
❖
❖
❖
❖
Excess vit D.
Hypoparathyroidism,
symptoms associated with
hypocalcemia, decreased
excretion by the kidneys.
Medications that may cause
hyperphosphatemia:
decreased excretion by the
kidneys.
Increased phosphorus
absorption.
❖
Serum sodium levels
Serum phosphate
levels
Neuromuscular
assessments
Client education will be identical to client
education for a client with a Sodium
imbalance .
Treatment
❖
www.SimpleNursing.com
Oral replacement therapy (1000
mg/d) Mild hypophosphatemia
should be managed with oral
replacement therapy (1000 mg/d).
2-11
What am I ?
Assessment
Hypochloremia is a serum chloride level
below 97 mEq/L . Major ANION in the
ECF, functions primarily with sodium and
chloride to maintain a balance between
intra and extracellular fluid. When sodium
is retained so is chloride. Chloride is
retained continuously in the intestines
along with sodium, kidneys are responsible
for reabsorption and excretion of sodium
and chloride.
Function: Combines with hydrogen in the
stomach to produce hydrochloric acid;
Works with magnesium and calcium to
maintain nerve transmission and normal
muscle contraction/relaxation; Imbalance
never occurs alone, always check
bicarbonate, K+ , and sodium as well.
Regulation
Primarily by the kidneys.
Heart- Dysrhythmia,
hypotension
Lung- Dyspnea; SOB
Neuro- Agitation; Irritability;
Seizure; Coma; Confusion
GI/GU- Sodium imbalance
Musculoskeletal- Tremor;
Muscle cramps
Patho
Hypochloremia occurs in the
presence of other abnormalities. It’s
often associated with hypoventilation
and can be associated with chronic
respiratory acidosis. If it occurs
together with metabolic alkalosis
(decreased blood acidity) it is often
due to vomiting. It is usually the
result of hyponatremia or elevated
bicarbonate concentration. It occurs
often in cystic fibrosis.
Causes
❖
❖
❖
Hyponatremia, excess
chloride loss from
vomiting, diarrhea or NG
suction.
Addison's disease, DKA,
excess sweating, fever,
burns, metabolic
alkalosis.
Medications that cause
hypochloremia: diuretics
(loop and thiazide)
increase excretion of
chloride by the kidneys.
Labs & Diagnostics
❖
❖
❖
❖
❖
Complications
❖
❖
❖
Respiratory arrest
Seizures
Coma
Serum chloride level is less
than 97 mEq/L.
Serum sodium level is less
than 135 mEq/L.
Metabolic alkalosis.
Serum pH is greater than
7.45.
Serum carbon dioxide level
is less than 35 mEq/L.
Interventions
❖
❖
Replace chloride with IV
NS or 0.45% NS.
Avoid free water, high
chloride foods.
Treatments
❖
❖
❖
❖
❖
❖
Treatment of underlying
condition.
Treatment of associated
metabolic alkalosis or
electrolyte imbalances.
Fluid resuscitation with
normal saline I.V.
solution.
Electrolyte replacement
therapy, including
potassium chloride and
sodium chloride.
Nonsteroidal
anti-inflammatory drugs
(NSAIDs) such as
indomethacin.
Carbonic anhydrase
inhibitors such as
acetazolamide.
Education
❖
❖
❖
❖
❖
❖
❖
www.SimpleNursing.com
❖
Signs and symptoms of electrolyte
imbalances, including hyperchloremia
and hypochloremia, hyponatremia
and hypernatremia, and hypokalemia
and hyperkalemia.
Signs and symptoms of metabolic
alkalosis and metabolic acidosis.
Use of dietary supplements and
appropriate food choices; food
sources for chloride.
Prescribed drugs, including drug
names, dosages, rationales for use,
and schedule of administration.
Possible adverse effects of NSAIDs (if
ordered), such as GI upset and
increased risk of bleeding.
Importance of adequate fluid intake
to maintain hydration status.
Signs and symptoms of dehydration
and the need to notify a practitioner if
any occur.
Importance of continued follow-up
and laboratory testing to evaluate the
condition and effectiveness of
therapy.
2-12
Assessment
What am I ?
Hyperchloremia exists when the
serum level of chloride exceeds 107
mEq/L . Major ANION in the ECF,
functions primarily with sodium and
chloride to maintain a balance
between intra and extracellular fluid.
When sodium is retained so is
chloride. Chloride is retained
continuously in the intestines along
with sodium, kidneys are responsible
for reabsorption and excretion of
sodium and chloride.
Function: combines with hydrogen in
the stomach to produce hydrochloric
acid; Works with magnesium and
calcium to maintain nerve transmission
and normal muscle
contraction/relaxation; Imbalance
never occurs alone, always check
bicarbonate, K+ , and sodium as well.
Regulation
Primarily by the kidneys.
Patho
❖
❖
❖
❖
❖
Hypernatremia
Head injury, dehydration,
severe diarrhea, metabolic
acidosis
Hyperparathyroidism
Respiratory alkalosis
Loss of pancreatic secretion
❖
❖
❖
❖
Labs & Diagnostics
❖
❖
❖
Serum chloride level is
greater than 107 mEq/L.
With metabolic acidosis,
serum pH is less than
7.35, serum HCO3 level is
less than 22 mEq/L, and
the anion gap is normal.
Serum sodium level is
greater than 145 mEq/L.
Interventions
❖
❖
❖
❖
❖
Chloride is secreted by stomach
mucosa as hydrochloric acid; it
provides an acid medium that aids
digestion and activation of enzymes.
Chloride helps to maintain acid-base
and body water balances, influences
the osmolality or tonicity of
extracellular fluid, plays a role in the
exchange of oxygen and carbon
dioxide in red blood cells, and helps
activate salivary amylase (which, in
turn, activates the digestive process).
An inverse relationship exists between
❖
chloride and bicarbonate. When the
❖
level of one goes up, the level of the
other goes down.
❖
Causes
Heart - Hypertension
Lungs - Respiratory
alkalosis ,rapid deep
respirations, tachypnea
Neuro - ICP, cognitive
changes.
GI/GU - Diarrhea, diuresis,
dehydration
Musculoskeletal - lethargy,
weakness
❖
❖
❖
❖
❖
❖
❖
❖
❖
Auscultate heart and lung
sounds for changes.
Continuous cardiac
monitoring.
Evaluate muscle strength and
adjust activity level.
Assess neurologic status
closely. Reorient the patient as
necessary.
Assess for signs and
symptoms of metabolic
alkalosis.
Serum electrolyte levels,
especially sodium, chloride,
and potassium levels.
Monitor
Respiratory status.
Signs of metabolic alkalosis.
Intake and output.
Daily weight.
Location and extent of edema.
Neurologic status.
Cardiopulmonary status,
including cardiac rhythm.
Arterial blood gas (ABG)
levels.
Education
❖
❖
❖
❖
Treatments
Treatment of underlying cause.
Restoring fluid, electrolyte, and
acid-base balance.
Treatment-Diet: Restricted sodium
and chloride intake.
Treatment-Activity: As tolerated.
Treatment-Medications: Sodium
bicarbonate IV.
IV fluid therapy with lactated Ringer's
solution.
Loop diuretics to address fluid
overload.
www.SimpleNursing.com
Signs and symptoms
associated with
complications, including
recurrence of elevated
chloride levels.
Dietary or fluid restrictions,
as indicated.
Prescribed medications,
including drug names,
dosages, schedule of
administration, and possible
adverse effects.
Recommendations for
follow-up evaluation,
including laboratory testing
for electrolyte levels.
2-13
What am i ?
Hyponatremia refers to a serum
sodium level that is less than 135
mEq/L. Major cation in the ECF,
obtained via diet and absorbed in
the small intestines excreted via
kidneys.
Function: maintains blood volume
and blood pressure. Regulated by
aldosterone: conserves sodium.
Regulation
ADH: thru dilution or retention of
h20 NA+ K+ PUMP: moves in and
out of cells via active transport.
Patho
Hyponatremia can result from
improper blood collection,
excessively high water intake, or,
most commonly, an inability of the
kidneys to excrete free water.
Sodium is regulated through the
sodium potassium pump and dilution
or concentration of sodium can be
altered by ADH and aldosterone
imbalances.
Causes
❖
❖
❖
❖
❖
S - SIADH
I - intoxication of water Hemodilution leading to
LOW sodium!
A - adrenal insufficiency
like Adrenal Crisis with
Addison's Patients wastes
sodium from the body.
D - diuretics - Thiazides and
loop diuretics Generic
names are
(hydrochlorothiazide and
furosemide), Excretes that
sodium.
H - Heat Exhaustion or HIGH
fever Causes massive
sweating called
“Diaphoresis.”
Labs & Diagnostics
Assessment
Heart- Cardiac
Dysrhythmias; Weight gain
Lungs- SOB; Dyspnea
Neuro- Restlessness,
confusion, seizures, coma
GI/GU- Nausea/Vomiting;
Abdominal cramping
Musculoskeletal- General
weakness
❖
❖
❖
Interventions
❖
❖
❖
Treatments
❖
❖
❖
❖
❖
❖
Replace deficit with NS over
6-12 hours until signs of ECF
deficit are stable.
Rate of 10-12 mEq/L in 24
hrs or 18 mEq/L in 48 hrs.
Water restriction.
Diuretic therapy.
Increased Na+ intake.
SLOW correction <12
mEq/L/day If too rapid, it
may cause acute decrease in
brain cell volume, which may
lead to demyelination =
permanent brain injury.
Serum sodium <135
mEq/L
- Critical value <120
mEq/L
- Serum osmolality
<280 mOsm/kg
❖
❖
❖
❖
A - Administer IV Saline
solutions.
D - Diuretics Or Dialysis.
D - daily weights.
S - Safet: orthostatic
hypotension.
A - Airway protection!
L - Limit Water Intake for patients with HYPER
volemia.
T - Teach Foods HIGH
in salt.
Education
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
Deficit causes
Prevention
Treatment regimen: Medication, Nutrition
Foods High in Sodium: Foods High in Added Sodium
Processed Meats & Fish (bacon, sausage, smoked fish)
Dairy Products (cheeses, cottage cheese, ice cream)
Canned Goods (meats, soups, vegetables)
Processed Grains (dry cereals, graham crackers)
Condiments & Food Additives (barbecue sauce,
ketchup, pickles, salad dressings)
Snack Foods (gelatin desserts, nuts, potato chips)
Foods High in Sodium: Foods Naturally High in
Sodium
Carrots, clams, crab, dried fruits, lobster, oysters,
shrimp, spinach
www.SimpleNursing.com
2-14
Assessment
What am I ?
Hypernatremia refers to a serum
sodium level that is greater than 145
mEq/L. Major cation in the ECF,
obtained via diet and absorbed in the
small intestines excreted via kidneys.
Function: Maintains blood volume and
blood pressure. Regulated by
aldosterone: conserves sodium
Regulation
ADH: thru dilution or retention of h20
NA+ K+ PUMP: moves in and out of cells
via active transport.
❖
❖
❖
❖
D- Dehydration.
I - IV hypertonic
solution excess.
V - Vitamins “sodium”
supplements.
A - amount of sodium
intake in excess.
❖
NURSING ACTION:
❖
Cerebral cells are
highly sensitive to
changes in sodium
level and fluid volume.
Brain cells swell in
cases of hyponatremia
and shrink in cases of
hypernatremia. These
changes may lead to
Seizures, coma, and
death.
- DO NOT INCREASE
SODIUM TOO FAST,
IT MAY CAUSE
NEUROLOGICAL
SYMPTOMS
Serum >145 mEq/L
Increased osm in plasma.
Decreased osm in urine,
increased Hematocrit.
Dry mucous membrane.
Interventions
❖
Patho
Causes
❖
❖
❖
❖
❖
Sodium concentration in serum is more
than 145 mEq/L. Hypertonicity of ECF =
cellular dehydration.hypernatremia
occurs when there is a large decrease
in fluid volume and brain volume which
is caused by an an osmotic shift of free
water out of the cells.
Labs & Diagnostics
Heart: Hypertension
Lungs : Respiratory alkalosis,
rapid deep respirations,
tachypnea
Neuro : ICP, cognitive changes
GI/GU:Diarrhea, diuresis,
dehydration
Musculoskeletal: lethargy,
weakness
❖
❖
❖
M - monitor sodium
intake and labs.
A- Alka-seltzer, Aspirin,
and cough preps should
not be administered.
G- gravity of urine should
be monitored.
I- I&O strict monitoring.
C- Cardiac monitoring.
Monitor response to therapy
prevent hyponatremia and
dehydration.
Education
Treatment
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
❖
Limit all foods that are high in
sodium.
Drink more fluids.
Have your sodium levels checked.
Replace your body fluids after
vomiting or diarrhea.
Take all medicine as directed.
❖
With hypovolemia: restore fluid balance.
❖
Hypotonic (0.225% NaCl) IV infusions.
❖
With poor renal excretion of Na+: diuretics
such as furosemide/Lasix or
bumetanide/Bumex.
❖
Assess hourly for excessive fluid loss, Na
loss, K+ loss.
Call your hcp if you have
Nutrition interventions.
❖
Muscle twitching, spasms, or cramps
For mild hypernatremia.
Ensure adequate water intake, esp. w/
❖
Fatigue
older adults.
❖
Confusion
Dietary Na restriction w/ kidney problems.
❖
Seizures
Fluid restrictions often necessary.
❖
Loss of consciousness or fainting
Collaborate w/ dietician for patient
❖
Dizziness or lightheadedness
education.
www.SimpleNursing.com