Hyponatremia
Risk factors:
- loss of sodium
- gastrointestinal fluid loss
- sweating
- use of diuretics
- gain of water
- hypotonic tube feedings
- excessive drinking of water
- excess IV D5W administration (dextrose in h2o)
- syndrome of inappropriate ADH
- head injury, aids, malignant tumors
Hyponatremia
Clinical manifestations:
- lethargy, confusion, apprehension
- muscle twitching
- abdominal cramps
- anorexia, nausea, vomiting
- headache, seizures, coma
Lab findings:
Serum sodium < 135 mEq/L
Serum osmolality <280 mOsm/kg
Hyponatremia
Nursing interventions:
- Assess clinical manifestations
- monitor fluid intake and output
- monitor lab data
- assess client closely if administering hypertonic saline solutions
- encourage food and fluid high in sodium
- limit water intake as indicated
Hypernatremia
Risk factors:
-Loss of water
-insensible water loss
(hyperventilation or fever)
-diarrhea
-water deprivation
-Gain of sodium
-parental administration of saline solutions
-Hypertonic tube feedings w/o adequate water
-excessive use of table salt (1 tsp contains 2,300 mg of sodium
- conditions such as : diabetes insipidus, heat stroke
Hypernatremia
Clinical manifestations:
-thirst
-dry, sticky mucous membranes
-tongue dry, red, swollen
-weakness
-severe hypernatremia (fatigue, restlessness, decreased level of consciousness, disorientation, convulsions)
Lab findings:
Serum sodium >145mEq/L
Serum osmolality >300 mOsm/kg
Hypernatremia
Nursing interventions:
- Monitor fluid intake and output
- Monitor behavioral changes
- Monitor lab findings
- Encourage fluids as ordered
- Monitor diet as ordered (restrict intake of salt/sodium)
Hypokalemia
Risk factors:
- Loss of potassium
- vomiting and gastric suction
- diarrhea
- heavy perspiration
- use of potassium-wasting drugs
- poor intake of potassium ( w/ debilitated clients, alcoholics, anorexia, nervosa)
- hyperaldosteronism
Hypokalemia
Clinical manifestations:
-Muscle weakness, leg cramps
-Fatigue, lethargy
-anorexia, nausea, vomiting
-decreased bowel sounds, decreased bowel motility
-cardiac dysthymias
-depressed deep-tendon reflexes
-weak, irregular pulses
Lab findings:
Serum potassium < 3.5mEq\L
Arterial blood gases may show alkalosis
T-wave flattening & ST- segment depression on ECG
Hypokalemia
Nursing interventions:
- Monitor heart rate and rhythm
- Monitor clients receiving digitalis (digoxin) bc hypokalemia increases risk of digitalis toxicity
- administer oral K+ with food or fluid to prevent gastric irritation
- administer IV K+ at a rate no faster than 10-20mEq/h never administer undiluted K+ through IV
- Monitor pain & inflammation in injection site
- teach pt about K+ rich foods
- teach pt how to prevent excess loss of K+ (diuretics)
Hyperkalemia
Risk factors:
- decreased potassium excretion
- renal failure
- hypodosteronism
- K+ conserving diuretics
- high K+ intake
- excessive use of K+ containing salt substitutes
- excessive or rapid IV infusion of K+
- K+ shift out of the tissue cells into the plasma (infections, burns, acidosis)
Hyperkalemia
Clinical manifestations:
-Gastrointestinal hyperactivity, diarrhea
-irritability, apthay, confusion
-cardiac dysrhythmias or arrest
-muscle weakness, areflexia (absence of reflexes)
-decreased heart rate, irregular pulse, paresthesias and numbness in extremities
-lab findings:
Serum potassium > 5.0 mEq/L
Peaked T-wave, widened QRS on ECG
Hyperkalemia
Nursing interventions:
- closely monitor cardiac status and ECG
- administer diuretics and other meds such as glucose and insulin
- hold K+ supplements and K+ conserving diuretics
- monitor K+ levels carefully, a rapid drop may occur as K+ shifts into cells
- teach pt to avoid foods high in K+ and salt substitutes
Hypocalcemia
Risk factors:
-Surgical removal of the parathyroid glands
-conditions such as:
hypoparathyroidism, acute pancreatitis,
hyperphosphatemia, thyroid carcinoma
-inadequate vitamin D intake
-malabsorption
-hypomagnesemia
-alkalosis
-sepsis
-alcohol abuse
Hypocalcemia
Clinical manifestations:
-numbness, tingling of the extremities and around the mouth
-muscle tremors, cramps; if severe can progress to tetany and convulsions
-cardiac dysrhythmias ; decreased cardiac output
-positive trousseaus and chvosteks signs; confusion, anxiety, possible psychoses, hyperactive deep-tendon reflexes
Lab findings:
Calcium <8.5 mg/dL (total) or 4.5 mEq/L (ionized)
Lengthened QT intervals
Prolonged ST segments
Hypocalcemia
Nursing interventions:
- Closely monitor respiratory and cardiovascular status
- take precautions to protect a confused client
- administer oral or parenteral calcium, when administering IV closely monitor cardiac status and ECG during infusion
- Teach pt’s at high risk for osteoporosis: dietary sources rich in calcium, recommend 1000-1500 mg of calcium per day, calcium supplements, reg exercise, estrogen replacement therapy
Hypercalcemia
Risk factors:
-prolonged immobilization
Conditions as such: hyperparathyroidism, malignancy of the bone, Paget’s disease
Hypercalcemia
Clinical manifestations:
-lethargy, weakness
-depressed deep tendon reflexes
-bone pain
-anorexia, nausea, vomiting
-constipation
-polyuria, hypercalciuria
-flank pain secondary to urinary calculi (kidney infection)
-dysrhythmias, possible heart block
Lab findings:
Calcium > 10.5 mg/dL total or 5.5 ionized
Shortened QT intervals, ST segments
Hypercalcemia
Nursing interventions:
- increase pt movement and exercise
- encourage fluids to dilute urine
- teach pts to limit intake of food and fluid high in calcium
- encourage ingestion of fiber to prevent constipation
- protect a confused pt; monitor for pathological fractures in pts w/ long term hypercalcemia
- encourage intake of acid-ash fluids (prune juice) to counteract deposits of calcium salts in urine
Hypomagnesemia
Risk factors:
- excess loss from GI tract
- long term use of certain drugs (diuretics )
- conditions such as : chronic alcoholism, pancreatitis, burns
Hypomagnesemia
Clinical manifestations:
-neuromuscular irritability w/ tremors
-increased reflexes, tremors, convulsions
-positive chvosteks and trousseaus signs
-tachycardia, elevated blood pressure, dysrhythmias
-disorientation & confusion
-vertigo, anorexia, dysphagia
-respiratory difficulties
Lab findings:
Magnesium <1.5mEq/L, prolonged QT intervals, depressed ST segments, broad flattened T waves, prominent U waves
Hypomagnesemia
Nursing interventions:
- Assess pts receiving digitalis for dig toxicity
- hypomagnesemia increases the risk of toxicity
- take protective measures when there is a possibility of seizures
- assess the pts ability to swallow water prior to initiating oral feeding
- initiate safety measures to prevent injury during seizure activity
- carefully administer magnesium salts as ordered
- encourage pts to eat magnesium rich foods
- refer pts to alcohol treatment programs as needed
Hypermagnesemia
Risk factors:
Abnormal retention of magnesium, as in :
Renal failure
Adrenal insufficiency
Treatment w/ magnesium salts
Hypermagnesemia
Clinical manifestations:
-peripheral vasodilation, flushing
-nausea, vomiting
-muscle weakness, paralysis
-hypotension, bradycardia
-depressed deep tendon reflexes
-lethargy, drowsiness
-respiratory depression, coma
-respiratory and cardiac arrest if hypermagnesemia is severe
Lab findings:
Magnesium >2.5 mEq/L
ECG w/ prolonged PR interval, widened QRS, tall Twave
Hypermagnesemia
Nursing interventions:
- Monitor VS and level of consciousness when pts at risk
- if patellar reflexes are absent, notify PHCP
- advise pts who have renal disease to contact their provider before taking OTC meds
