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Concept Map- Electrolytes

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by Nikki Dart on 15 January 2013

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Transcript of Concept Map- Electrolytes

Sodium- is located extracellularly and plays an important role in fluid balance, neuromuscular conduction, enzyme activity, and regulating acid-base balances (LeFever-Key, 2005). Hyponatremia (below 136 mEq/l)- "vomiting, diarrhea, gastric suction, excessive perspiration, continuous intravenous D5W, syndrome of inappropriate anti-diuretic hormone, low-sodium diet, burns, inflammatory reactions, tissue injury; psychogenic polydipsia, salt-wasting renal disease, and those taking potent diuretics" (LeFever-Key, 2005, p.401).

Hypernatremia (above 145 mEq/l)- "dehydration, severe vomiting and diarrhea, congestive heart failure, Cushing's disease, hepatic failure, high-sodium diet, and those taking cough medicines, cortisone preparations, antibiotics, laxatives, methyldopa, hydralazine, and reserpine" (LeFever-Key, 2005, p.401). Risk Factors Hyponatremia- "apprehension, anxiety, muscular twitching, muscular weakness, headaches, tachycardia, and hypotension" (LaFever-Key, 2005, p.401).

Hypernatremia- "restlessness; thirst; flushed skin; dry, sticky mucous membranes; a rough, dry tongue; and tachycardia" (LaFever-Key, 2005, p.401). Signs and Symptoms Correcting the underlying cause is first and foremost. For hyponatremic conditions, monitoring the prescribed infusions and watching for overhydration is critical. Vitals should be taken continuously to monitor the patient's cardiac condition. I&O's should also be monitored as well as serum and urine sodium levels. Nasogastric tubes and wound sites should be irrigated with normal saline instead of sterile water. Patient's should be encouraged to consume fluids with solutes (LeFever-Key, 2005).

For hypernatremic conditions monitoring I&O's and weighing the patient daily are important. Assessing for edema or overhydration due to elevated serum sodium is also critical for patient care (LeFever-Key, 2005). It is also necessary to educate the patient on avoiding high-sodium foods. Priority Nursing Interventions Assessment would first begin with reviewing the patient's medical history including current or past illness or disease, hospitalizations and surgeries, medication use, and daily activities. Inquiring about the patient's dietary intake of salt and water is also important in hypo/hypernatremic conditions, as well as the patient's output. Further assessment would focus on the patient's neurological, cardiac, and pulmonary status. Nursing Assessment Anticipated Health Provider Prescription Normal range is
136-145 mEq/l Hyponatremia- treatment would include fluid restriction and/or sodium replacement intravenously (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). Normal saline is used to treat levels from 120-130 mEq/l and 3% or 5% NaCl solutions may be used to treat levels below 115 mEq/l (LeFever-Key, 2005).

Hypernatremia- volume is replaced and sodium is diluted with sodium-free IV fluids, such as D5W (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). Geriatric Considerations Hyponatremia may occur in the elderly due to diarrhea, which can often be caused by over medicating with laxatives.
Hypernatremia occurs in the elderly due to a "decreased thirst mechanism that results in decreased fluid intake and dehydration (Johnson, Lyons, Vaughans, 2008, p.84).
Potassium- is located intracellularly and primarily responsible for resting membrane and action potentials, as well as electrical conductivity within nerve and muscle cells (Johnson, Lyons, Vaughans, 2008, p.96). Hypokalemia (below 3.5 mEq/l)- "vomiting/diarrhea, dehydration, mlanutrition/starvation, crash diet, stress, gastric suction, intestinal fistulas, diabetic acidosis, burns, renal tubular disorders, hyperaldosteronism, excessive ingestion of licorice, excessive ingestion of glucose, metabolic alkalosis. Those taking potassium-wasting diuretics, steroids, antibiotics, bicarbonate, insulin, laxatives, lithium carbonate, sodium polystyrene sulfonate, and salicylates" are also at risk (LeFever-Key, 2005, p.348).

Hyperkalemia (above 5.0 mEq/l)- "oliguria and anuria, acute renal failure, IV potassium in fluids, Addison's disease, crushed injury and burns, and metabolic or lactic acidosis. Those taking potassium-sparing diuretics, sprionolactone, triamterene, antibiotics, cephaloridine, heparin, epinephrine, histamine, and isoniazid are also at risk" (LeFever-Key, 2005, p.348). Risk Factors Hypokalemia- "vertigo, hypotension, cardiac dysrhythmias, nause, vomiting, diarrhea, abdominal distension, decreased peristalsis, muscle weakness, and leg cramps" (LaFever-Key, 2005, p.349).

Hyperkalemia- "bradycardia, abdominal cramps, oliguria and anuria, tingling, and twitching" (LaFever-Key, 2005, p.350). Signs and Symptoms Correcting the underlying cause is first and foremost. For hypokalemic conditions, monitoring the patient's respirations is priority due to weakening of skeletal muscles (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). Continually monitoring I&O's, serum potassium levels, other serum electrolyte levels, and EKG changes is advised. Behavioral changes should also be monitored. IV KCl should be administered "in a liter of parenteral fluids...never an IV or bolus push...because cardiac arrest can occur" (LeFever-Key, 2005. p.349). The IV site should be monitored for signs of infiltration or infection. The patient should also be educated on consuming a high-potassium diet.

For hyperkalemic conditions monitoring the patient's cardiac status due to dysrhythmias is priority. Urine output should also be monitored to assess kidney function. Because serum electrolyte levels can alter during treatment, these must be monitored closely (LeFever-Key, 2005).

Vitals should be continually monitored with hypo/hyperkalemic conditions. Priority Nursing Interventions Assessment would first begin with reviewing the patient's medical history including current or past illness or disease, hospitalizations and surgeries, medication use, and daily activities. Inquiring about the patient's dietary intake of potassium is also important in hypo/hyperkalemic conditions, as well as the patient's output. Further assessment would focus on the patient's cardiac and pulmonary status. Dysrhythmias can be fatal in hyperkalemia and skeletal muscle weakness can result from hypokalemia and cause decreased respirations (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). Nursing Assessment Anticipated Health Provider Prescription Normal range is
3.5-5.0 mEq/l
Hypokalemia- if diuretics are the cause, patient's are usually switched to a potassium-sparing diuretic. Antibiotics are administered if infection has caused vomiting, diarrhea, or excessive perspiration. Treatment also consists of altering a patient's dietary intake and supplementation to restore balance. Potassium chloride is often administered (Johnson, Lyons, & Vaughans, 2008).

Hyperkalemia- if the underlying cause was renal failure, dialysis would be the appropriate treatment. Antibiotics may be ordered for tissue damage or trauma leading to hypernatremia. Supplements may be used to treat electrolyte imbalances. For example, to treat hyperkalemia caused by acidosis, bicarbonate is administered to restore balance (Johnson, Lyons, & Vaughans, 2008). Geriatric Considerations Hypokalemia occurs in the elderly due to high amounts of diuretic use, which causes the kidneys to excrete water and sodium (Johnson, Lyons, Vaughans, 2008).

Hyperkalemia occurs in the elderly due to decreased regulatory function (Johnson, Lyons, Vaughans, 2008). It also occurs in patient's taking hypertension medications that "cause retention of potassium by the kidney" (Johnson, Lyons, Vaughans, 2008, p.101). Labs and Diagnostics "Labs include a 3-5ml of venous blood in a red or green-top tube...a 24-hour urine collection" may also be used (LeFever-Key, 2005, p.401-404. Labs and Diagnostics Labs include a "3-5ml of venous blood in a red-top tube. Avoid hemolysis" (LeFever-Key, 2005, p.348). An EKG would also be necessary to monitor cardiac function. BUN and Creatine levels should be tested to determine kidney function. Magensium- is located intracellularly and plays an important role in neuromuscular activity as well as electrolyte transportation. It also works as an enzyme in carbohydrate and protein metabolism (LeFever-Key, 2005). Hypomagnesemia (below 1.5mEq/l)- risks factors include "protein malnutrition, cirrhosis of the liver, alcoholism, hypoparathyroidism, hyperaldosteronism, hypokalemia, IV solutions without magnesium, chronic diarrhea, bowel resection complications, dehyrdation...those who take diuretics, calcium gluconate, amphotericin B, neomycin, and insulin" are also at risk (LeFever-Key, 2005, p.299).

Hypermagnesemia (above 2.5 mEq/l)- risk factors include kidney failure, use of enemas containing magnesium, over-use of laxatives, pain relievers, and magnesium-containing antacids (Johnson, Lyons, & Vaughans, 2008). Dehydration, leukemia, and diabetes mellitus also pose a risk (LeFever-Key, 2005). Risk Factors Hypomagnesemia- "tetany, restlessness, confusion, and arrhythmia" (LaFever-Key, 2005, p.300).

Hypermagnesemia- "flushing, a feeling of warmth, increased perspiration, muscular weakness, diminished reflex, respiratory distress, hypotension, and a sedative effect" (LaFever-Key, 2005, p.300). Signs and Symptoms Correcting the underlying cause is first and foremost. For hypomagnesemic conditions, monitoring the patient's cardiac condition including heart rate and blood pressure is priority. While infusing magnesium it is crucial to administer slowly because cardiac or respiratory arrest can develop (Johnson, Lyons, & Vaughans, 2008). It is also important to monitor all serum electrolyte levels because other deficits may occur with hypomagnesemia (LeFever-Key, 2005).

For hypermagnesemic conditions monitoring the patient's cardiac and repiratory status due to CNS depression effects is priority. Excess magnesium also affects the neurological system by having a "sedative impact, particularly on nerves and muscles" (Johnson, Lyons, & Vaughans, 2008, p.127). Because of this, safety and preventing falls is also a priority. Urine output should also be monitored to assess kidney function and fluids should be provided as restoration. Educating the patient on avoiding magnesium-containing products such as antacids or laxatives would be expected (LeFever-Key, 2005).

Vitals should be continually monitored with hypo/hypermagnesemic conditions. Priority Nursing Interventions Assessment would first begin with reviewing the patient's medical history including current or past illness or disease, hospitalizations and surgeries, medication use, and daily activities. Because magnesium is readily excreted by the kidneys, it would be important to know how well they function. Inquiring about the patient's dietary intake or use of magnesium-containing products, such as over the counter medications, is also crucial in hypo/hypermagnesemia conditions. Further assessment would focus on the patient's cardiac and neurological status (reflexes, muscle strength, etc.) (Johnson, Lyons, & Vaughans, 2008). Nursing Assessment Anticipated Health Provider Prescription Normal range is
1.5-2.5 mEq/l Hypomagnesemia- general treatment includes supplementation of magnesium either orally or in severe cases, it can be given intravenously or intramuscularly (Johnson, Lyons, & Vaughans, 2008).

Hypermagnesemia- treatment often relies on prevention for patient's with renal insufficiency or renal failure. Avoiding foods and medications high in magnesium is particularly important. In severe cases, calcium can be given intravenously along with fluids to flush the system of excess magnesium. Hemodialysis is also used for those with renal failure (Johnson, Lyons, & Vaughans, 2008). Geriatric Considerations Hypomagnesemia occurs in the elderly just as hypokalemia does. This is due to high amounts of diuretic use (Johnson, Lyons, Vaughans, 2008). According to Sica (2004), thiazide and loop-diuretics increase excretion of magnesium.

Hypermagnesemia occurs in the elderly due to "decreased renal function and a tendency for increased laxative and antacid use" (Johnson, Lyons, Vaughans, 2008, p.126). Labs and Diagnostics Labs include a "3-5ml of venous blood in a red-top tube. Avoid hemolysis" (LeFever-Key, 2005, p.299). An EKG may also be necessary to monitor cardiac function especially in cases of hypermagnesemia. BUN and Creatine levels should be tested to determine kidney function. Calcium- is located in both the ICF and ECF and is primarily responsible for "maintaining strong bones and teeth...as well as normal cell function, neural transmission, muscle contractility, wound healing, and intracellular signaling" (Johnson, Lyons, Vaughans, 2008, p.112). Hypocalcemia (below 8.4 mg/dl)- risk factors include lack of calcium in the diet, lack of vitamin D, improper absorption of calcium, hyperphosphatemia, and hypoparathyroidism (Johson, Lyons, & Vaughans, 2008).

Hypercalcemia (above 10.5 mg/dl)- risk factors include "hypervitaminosis D, hyperparathyroidism, malignancies, multiple myelomas, prolonged immobilization, multiple fractures, renal calculi, exercise, alcoholism, milk-alkali syndrome" (LeFever-Key, 2005, p.94). Risk Factors Hypocalcemia- "tetany, parathesia, facial spasms, and spasmodic contractions (LaFever-Key, 2005, p. 94).

Hypercalemia- "lethargy, headaches, weakness, muscle flaccidity, heart block, anorexia, nausea, and vomiting" (LaFever-Key, 2005, p.95). Signs and Symptoms Correcting the underlying cause is first and foremost. For hypocalcemic conditions, priority interventions would be stabilizing the patient's cardiac and respiratory status, as well as their neurological status, which can be affected by tetany. Serum calcium values and I&O's should be monitored during IV therapy. With IV therapy, the site should continually be checked for signs of infection, infiltration, or extravasation, which can damage the tissue (Johnson, Lyons, & Vaughans, 2008). Educating the patient on diets high in calcium, avoiding smoking, and to use laxatives or antacids cautiously is also necessary (LeFever-Key, 2005).

For hypercalcemic conditions monitoring the patient's cardiac status due to dysrhythmias and monitoring their neurological status is priority. Because hypercalcemiamia can cause muscle weakness and confusion, it is vital to ensure patient safety. I&O's should also be monitored while the patient is treated with diuretics and IV therapy. With hypercalcemia, there is less calcium in the bone so taking precautions while moving the patient is necessary in preventing fractures or injury. Proper education would include avoiding diets high in calcium, drinking an adequate amount of fluids, and performing weight-bearing activities (Johnson, Lyons, & Vaughans, 2008).

Vitals should be continually monitored with hypo/hypercalcemic conditions. Priority Nursing Interventions Assessment would first begin with reviewing the patient's medical history including current or past illness or disease, hospitalizations and surgeries, medication use, and daily activities. Inquiring about the patient's dietary intake of calcium hypo/hypercalcemic conditions. Further assessment would focus on the patient's neurological and cardiac status because hypercalcemia can cause symptoms such a disorientation and dysrhythmias, as well as tetany caused by hypocalcemia (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). Nursing Assessment Anticipated Health Provider Prescription Normal range is
8.4-10.5 mg/dl
Hypocalcemia is typically treated with oral supplementation of calcium or by IV (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010).

Hypercalcemia is often treated with loop-diuretics to rid the body of excess calcium. An isotonic solution is infused to help restore fluid balance (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). Geriatric Considerations Hypocalcemia may occur in the elderly due to high amounts of laxative use related to slowed GI motility (Johnson, Lyons, Vaughans, 2008).

Hypercalcemia may occur in the elderly if they become immobile or bedridden, which contributes to bone mineral loss (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). This puts the elderly population at greater risk for fractures. Labs and Diagnostics The lab workup would include a blood draw of calcium, phosphorous, magnesium, albumin, vitamin D, and PTH. BUN and Creatine would be used to determine kidney function as well as test for "liver function, and bone density also may be beneficial" (Johnson, Lyons, & Vaughans, 2010, p.114). An EKG would also be necessary to monitor cardiac function. Phosphorus- is located intracellularly and plays an important role in muscle function, red blood cells, and the nervous system (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010). Hypophosphatemia (below 2.4 mEq/l)- "starvation, malabsorption syndrome, hyperparathyroidism, hypercalcemia, hypomagnesemia, chronic alcoholism, vitamin D deficiency, diabetic acidosis, myxedema, continuous IV fluids with glucose...and those taking antacids" (LeFever-Key, 2005, p.336).

Hyperphosphatemia (above 4.5 mEq/l)- "renal insufficiency, renal failure, hypoparathyroidism, hypocalcemia, hypervitaminosis D, bone tumors, acromegaly, fractures...and those taking antibiotics, phenytoin, heparin, Lipomul, and laxatives with phosphate" (LeFever-Key, 2005, p.337). Risk Factors Hypophosphatemia- "anorexia and pain in the muscles and bones" (LeFever-Key, 2005, p.337).

Hyperphosphatemia- "neuromuscular irritability, tetany, and calcified deposits in soft tissues." (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010, p.5). Signs and Symptoms Correcting the underlying cause is first and foremost. For hypophosphatemia conditions assessing "motor strength and neurologic and mental status would take priority. Vital signs also should be monitored closely, with particular emphasis on respiratory rate and pattern and blood pressure" (Johnson, Lyons, & Vaughans, 2008, p.141). The patient should be educated on foods high in phosphorus and to avoid carbonated drinks, such as soda, that are high in phosphorus. The patient should be instructed to avoid "antacids containing aluminum hydroxide" (LeFever-Key, p.338).

For hyperphosphatemia conditions, correcting the hypocalcemia will take priority. The phosphate and calcium levels should be monitored closely from there. Emphasis should be on educating renal patient's to stick to proper diet (low-phosphorus foods and avoiding sodas) and lifestyle as well as avoiding antacids, enemas, and laxatives without first discussing it with their provide (Johnson, Lyons, & Vaughans, 2008). Priority Nursing Interventions Assessment would first begin with reviewing the patient's medical history including current or past illness or disease, hospitalizations and surgeries, medication use, and daily activities. Inquiring about the patient's use of alcohol and antacids is important for hypophosphatemia, as well as those suspected of anorexia or malnourishment. It is also important to question enema and laxative use to prevent hyperphosphatemia. Further assessment would focus on the patient's neurological and mental status. (Johnson, Lyons, & Vaughans, 2008).
Nursing Assessment Anticipated Health Provider Prescription Normal range is
2.4-4.5 mEq/l
Hypophosphatemia treatment includes oral or IV replacement of phosphorous (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2010).

Hyperphosphatemia- (Johnson, Lyons, & Vaughans, 2008). Geriatric Considerations Hypophosphatemia occurs in the elderly due to high amounts of diuretic use, which causes the kidneys to excrete water and sodium (Johnson, Lyons, Vaughans, 2008).

Hyperphosphatemia often occurs secondary to diseases such as sepsis (Johnson, Lyons, Vaughans, 2008). The elderly is susceptible to developing hyperphosphatemia in medical facilities if they are exposed to a systemic infection due to their weakened immune system. Labs and Diagnostics Labs include a "3-5ml of venous blood in a red-top tube. Avoid hemolysis" (LeFever-Key, 2005, p.348). Also, an electrolyte panel consisting of calcium, sodium, potassium, magnesium, and chloride would be necessary, as well as PTH and Vitamin D. A 24-hour urine specimen may also be ordered (Johnson, Lyons, Vaughans, 2008). References

Johnson, J. Y., Lyons, E., & Vaughans, B. W. (2008). Fluids and electrolytes demystified. New York: McGraw-Hill Medical.

LeFever-Key, J. (2005). Laboratory and Diagnostic Test with Nursing Implications (7 ed.). Upper Saddle River, New Jersey: Pearson.

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2010). Medical-surgical nursing: assessment and management of clinical problems (8th ed.). St. Louis, Mo.: Elsevier/Mosby.

Sica, D. A. (n.d.). Diuretic-Related Side Effects: Development and Treatment. Medscape: Medscape Access. Retrieved January 14, 2013, from http://www.medscape.com/viewarticle/489
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