lOMoARcPSD|41646858 Electrolyte imbalances chart Health/Illness Concepts (J. Sargeant Reynolds Community College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by awkwurd gurl (raachelb@aol.com) lOMoARcPSD|41646858 ELECTROLYTE IMBALANCE Hypo- natremia Hyper- natremia Hypo- kalemia Hyper- kalemia RISK FACTORS/CAUSES MANIFESTATIONS Excessive NG tube suctioning Excessive diuretics Kidney disease HF ↓ Na intake/hypotonic 昀氀uid excessive Excessive Na intake/↓ H2O Excessive glucocorticosteroid usage Kidney failure Cushing’s Diabetes insipidus Heatstroke/burns Excessive sweating LAB VALUES NURSING INTERVENTIONS ***ASSOC W/ FVO * THINK FVO: ALL LABS ↓ PO: ↑ intake of Na: beef broth, tomato juice ↑ HR, bounding pulse, BP norm/↑, ortho-hypo, dizziness Hypothermia Headache, confusion, lethargy ↓ DTR Seizure ↑ motility, abdominal cramps ***ASSOC W/ FVD ↓ urine speci昀椀c gravity IV: hypertonic (severe), isotonic (mild): LR, NS * THINK FVD: ALL LABS ↑ MONITOR: I & O, daily weights, VS, LOC (fall precautions) PO: ↑ 昀氀uids Thirst, dry mucus membranes Hyperthermia, 昀氀ushed “red & rosy” skin ↑ HR, ortho-hypo N/V/D Seizures, coma Muscle weakness, ↑ muscle tone ↑ urine speci昀椀c gravity MEDS: loop diuretics: Lasix F- fever R- restless, irritable I- ↑ 昀氀uid retention, ↑ BP E- edema (3rd spacing) D- ↓reased urine output *** Think LOW & SLOW Overuse of diuretics (loop & thiazide) NPO Loss via GI: N/V/D, NG suctioning, prolonged laxative/enema use Kidney disease (impairs K reabsorption) ↓ Mg level Shift of K: ECF —> ICF Metabolic alkalosis Shallow RR, diminished breath sounds ↓ BP, thready pulse Lethargy, confusion Ortho-hypo ↓ bowel sounds, ↓ motility Muscle 昀氀accidity ↑ urine output Excessive salt substitutes K-sparing diuretics (spironolactone) Losartan, lisinopril Older adults: ↓ renin & aldosterone, ↑ use salt sub, & ace inhibitors Rapid/excessive K replacement Kidney disease: fail to secrete adequate bicarbonate Metabolic acidosis: pushes K from ICF —> ECF —> dehydration —> body compensates by holding onto K Digoxin & Beta-blockers: block K from entering cell Dysrhythmias: Torsades De Pointes Hyperglycemia *** Think TIGHT & CONTRACTED ↓ BP severe v-昀椀b Resp failure Restless/irritable ↑ motility Premature ventricular contractions Confusion ↑ thirst & ↓ urine output Weak/paralyzed skeletal muscles Downloaded by awkwurd gurl (raachelb@aol.com) W/ FVO: limit 昀氀uid intake IV: isotonic/hypotonic 昀氀uids (D5W) ECG: 昀氀at T waves, ST depression, U waves PO: oranges, bananas, leafy green veggies, avocado, salt substitutes IV: K (IVPB ONLY!!) MAX: 10 mEq/hr Monitor s/s hyperkalmeia, continuous ECG Assess: VS, K level, lung sounds, DTR ECG: peak T waves, wide QRS complex Initiate fall precautions Insulin w/ D5W Temporary, fast Metabolic acidosis Sodium bicarbonate (IV infusion) Temporary Calcium gluconate: doesn’t treat hyperkalemia, but prevents dysrhythmias Kayexalate: permanent Slow: stimulates GI system Dialysis by central line (SEVERE: ≥6) w/ kidney disease lOMoARcPSD|41646858 Hypo- calcemia Hypoparathyroidism —> ↑ PTH Vitamin D de昀椀ciency (needed to absorb calcium) ↑ calcitonin Hyper-calcemia Excessive Ca intake/vitamin D overdose Hyperparathyroidism —> ↓ PTH Osteosarcoma: bone metastasis Hypo-magnesemia #1 cause: alcoholism Insu昀昀icient Mg intake/absorption: malnutrition, NPO, V/D, bulimia Diuretics DKA, hyperglycemia Hypoparathyroidism —> ↑ PTH Hypocalcemia Hyper-magnesemia Tetany Laryngeal spasm —> stridor (respiratory alkalosis; anxiety) numbness/tingling (mouth & extremities) Dysrhythmias (prolonged QT interval) * Trousseau’s & Chvosteck’s signs Weakness/fatigue Bone pain ↓ nerve excitability: lethargy, confusion, hallucinations, seizures, coma Kidney stones ↑ urination Excessive Mg intake (PO/IV) Renal insu昀昀iciency/failure (↓ Mg excretion) Hyperparathyroidism —> ↓ PTH Hypo-phosphatemia * Inverse of Ca* Hyper-phosphatemia Chronic alcohol use Hyperparathyroidism —> ↓ PTH DKA Malnutrition, vitamin D de昀椀ciency PTN w/ inadequate replacement of Ph Excessive use of Ph depleting antacids Respiratory alkalosis * Inverse of Ca* ↑ HR ↑ BP ↑ DTR Confusion Vertigo Trousseau’s & Chvosteck’s signs (more w/ hypocalcemia) * THINK SEDATION Confusion —> lethargy ↓ DTRs Muscle paralysis Respiratory paralysis Cardiac/respiratory arrest Facial 昀氀ushing ↓: HR, BP, RR, motility CNS depression: confusion —> coma Dysrhythmias, HF Muscle weakness, ↑luding respiratory Seizures Rickets (caused by vit D de昀椀ciency): hypercalcemia s/s Osteomalacia: bone malformation #1 cause: AKI or chronic kidney disease Hypoparathyroidism —> ↑ PTH Excessive phosphate intake: phosphate containing laxatives, red meat (liver/organ), chicken, beans, nuts, pumpkin seeds, sun昀氀ower seeds Excessive vitamin D intake: used to absorb pH Tetany —> seizures Muscle cramps, ↑ DTRs Parenthesis ↓ BP Dysrhythmias Calcium deposits —> organ dysfunction Downloaded by awkwurd gurl (raachelb@aol.com) ↑ Ph May cause ↓ Mg IV: Calcium gluconate Vitamin D supplement Tx of respiratory alkalosis (anxiety) ↓ Ph May cause ↑ Mg #1 priority: ↑ 昀氀uid intake to ↓ risk kidney stones Calcitonin: ↑ renal Ca excretion ↓ Ca in diet ↑ weight bearing activity: ↓ risk fractures ↓ Ca IV: magnesium sulfate Watch for OD: bradypnea, absent DTR, resp depression) Seizure precautions PO: magnesium oxide ↑ Ca IV: calcium gluconate Isotonic 昀氀uids (IF Na LEVEL = NORM): NS Hypotonic (IF Na LEVEL = ↑) Diuretics ↓ Mg intake ↑ Ca PO supplementation: dairy, beans, nuts, grains, seafood, 昀椀sh IV: Na or Ph phosphate Normally NaPh over 4-6 hr Monitor Ca & Ph levels q 6-12 hr ↓ Ca Tx underlying cause Correct hypocalcemia: calcium gluconate Force diuresis: 昀氀uids & diuretics Hemodialysis Restrict Ph intake