Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading…
Transcript

SODIUM Na+

Normal Values:

135 - 145 mEq/L

ACTION IN THE BODY:

Sodium in the body controls the concentration and volume of the extracellular fluid.

Changes in sodium levels affect the distribution of water between intracellular and extracellular fluids

Vital in transmitting nerve impulses and regulating the body’s acid base balance.

(Lewis et al., 2011)

HYPERNATREMIA - levels >145

Caused by: excessive sodium intake, inadequate water intake, excessive water loss, diseases (diabetes insipidus, Cushing’s syndrome, uncontrolled DM, primary hyperaldosteronism)

HYPONATREMIA - levels <135

Caused by: excessive sodium loss, inadequate sodium intake, excessive water gain, and diseases (SIADH, heart failure, primary hypoaldosteronism)

(Lewis et al., 2011)

CLIENTS AT RISK FOR:

Hypernatremia: diabetes insipidus, Cushing’s syndrome, uncontrolled DM, primary hyperaldosteronism

Hyponatremia: SIADH, heart failure, primary hypoaldosteronism

(Lewis et al., 2011)

SIGNS AND SYMPTOMS

Hypernatremia: intense thirst, CNS deterioration, increased interstitial fluid, restlessness, agitation, twitching, seizure, coma, weakness, lethargy, easily activated neurons, postural hypotension, weakness, decreased skin turgor

Hyponatremia: CNS deterioration, irritability, apprehension, confusion, dizziness, seizures, coma, nausea, vomiting, diarrhea

Lewis et al., 2011)

HEALTHCARE PROVIDER PRESCRIPTIONS

Hypernatremia: Hypotonic fluid or dietary sodium restriction

Hyponatremia: Hypertonic salt solution or sodium supplement, drugs that block the activity of ADH (vasopressin), tolvaptan (Samsca) treats hyponatremia related to heart failure, liver cirrhosis and SIADH

(Adams, Holland, & Urban, 2011)

NURSING ASSESSMENTS

Monitor for:

Twitching

Seizure

Hallucinations

Mental status

Irritability

Restlessness

Apprehension

Nausea

Vomiting

Diarrhea

(Lewis et al., 2011)

LAB VALUES & DIAGNOSTIC STUDIES

Serum sodium levels

Serum osmolarity

Serum Creatinine levels

(ATI, 2010)

NURSING INTERVENTIONS:

Identify and treat underlying cause

Increase/decrease IV fluids containing sodium

Restrict/Increase fluid intake

Administer tolvaptan (if necessary)

(Lewis et al., 2011) (ATI, 2010)

GERIATRIC CONSIDERATIONS

Older adults are at a greater risk for hyponatremia due to increased chronic illness, use of diuretics, and potential insufficient sodium intake.

Older adults at are a greater risk for hypernatremia due to decreased total body water content and inadequate fluid intake

(ATI, 2010)

MAGNESIUM Mg

ACTION IN THE BODY

Second most abundant intracellular cation

50-60% Contained in bone

Coenzyme in the metabolism of protein and carbohydrates

Involved in metabolism of cellular nucleic acids and proteins

Acts directly on myoneural junction – affects neuromuscular excitability

Important for normal cardiac function - associated with cardiac dysrhythmias

(Lewis et al., 2011)

HYPERMAGNESEMIA - levels >2.1

Caused by: increased magnesium intake coupled with renal failure or renal insufficiency as well as adrenal insufficiency

HYPOMAGNESEMIA - levels <1.3

Caused by: prolonged fasting, starvation, chronic alcoholism, fluid loss is GI tract (interferes with absorption), prolonged parenteral nutrition without supplementation, diuretics, diarrhea, vomiting, large urine output, NG suction, hyperaldosteronism, poorly controlled DM.

(Lewis et al., 2011)

SIGNS AND SYMPTOMS

Hypermagnesemia: lethargy, drowsiness, nausea vomiting, loss of deep tendon reflex, somnolence, respiratory arrest, cardiac arrest

Hypomagnesemia: confusion, hyperactive deep tendon reflex, tremors, seizures, cardiac dysrhythmias, development of hypocalcaemia, hypoactive bowel sounds, constipation, abdominal distention, paralytic ileus

(Lewis et al., 2011)

CLIENTS AT RISK FOR:

Hypermagnesemia: Clients with chronic kidney disease who ingest products containing magnesium (Maalox, milk of magnesia)

Hypomagnesemia: Clients with uncontrolled DM, their high glucose levels cause osmotic diuresis, which increases renal excretion of magnesium.

(Lewis et al., 2011)

LAB VALUES & DIAGNOSTIC STUDIES

Serum Magnesium

Serum Creatinine

(ATI, 2010)

NURSING ASSESSMENT

Monitor for:

Lethargy/drowsiness

Nausea or vomiting

Respiratory depression

Respiratory arrest

Tremors

Seizures

Bowel sounds

Reflexes

(Lewis et al., 2011)

HEALTHCARE PROVIDER PRESCRIPTIONS

Hypermagnesemia: IV administration of calcium chloride or calcium gluconate to reverse the effects of magnesium on the cardiac muscle. Promoting urine excretion to lower serum magnesium levels

Hypomagnesemia: Oral supplements, increased dietary intake of foods high in magnesium (green vegetables, nuts, bananas, oranges, peanut butter, chocolate), IV or IM magnesium sulfate, discontinue magnesium-losing medications (loop diuretics)

(Adams, Holland, & Urban, 2011)

NURSING INTERVENTIONS

Reverse underlying cause

Administer oral or IV magnesium sulfate (hypo)

Discontinue oral or IV magnesium sulfate (hyper)

Encourage foods high in magnesium

Monitor ECG, vitals, apical pulse

(Lewis et al., 2011) (Adams, Holland, & Urban, 2011)

GERIATRIC CONSIDERATIONS

Commonly prescribed diuretics for hypertension can cause hypomagnesemia in geriatric patients

(Craven & Hirnle, 2009)

POTASSIUM K+

ACTION IN THE BODY

Most abundant ICF cation

Critical for cellular and metabolic function

Critical for neuromuscular and cardiac function and transmission of impulses

Reciprocal action with sodium

Regulates intracellular osmolality

Promotes cellular growth

Large role in acid-base balance in the body

(Lewis et al., 2011)

HYPERKALEMIA - levels > 5.0

Caused by: excess potassium intake (parenteral administration, drugs, potassium containing salt substitute), shift of potassium out of the cells (acidosis, fever, burn, sepsis, crush injuries, tumor lysis syndrome), failure to eliminate potassium (renal disease/RENAL FAILURE, potassium sparing diuretics, adrenal insufficiency, ACE inhibitors)

HYPOKALEMIA - levels <3.5

Caused by: Potassium loss (diarrhea, vomiting, fistulas, NG suction, diuretics, hyperaldosteronism, magnesium depletion, diaphoresis, dialysis), shift of potassium into cells (increased insulin, METABOLIC ALKALOSIS, tissue repair, stress/epinephrine), lack of potassium intake (starvation, low potassium diet, lack of potassium supplements in IV fluid if NPO)

(Lewis et al., 2011)

SIGNS AND SYMPTOMS

Hyperkalemia: irritability, anxiety, abdominal cramping, cramping leg pain, diarrhea, weakness or paralysis of skeletal muscles, paresthesias, irregular pulse/ventricular fibrillation, cardiac arrest (sudden or severe)

Hypokalemia: fatigue, muscle weakness, leg cramps, nausea, vomiting, paralytic ileus, weakness of respiratory muscles, impaired regulation of arterial blood flow, PVC, bradycardia, soft/flabby muslces, paresthesias, decreased reflexes, weak/irregular pulse, polyuria, hyperglycemia

(Lewis et al., 2011)

CLIENTS AT RISK FOR

Hyperkalemia: Clients with impaired kidney function, burns, severe dehydration, taking potassium sparing diuretics, ACE inhibitors, NSAIDS, adrenal insufficiency

Hypokalemia: Clients with low blood volume or increased aldosterone levels, diets low in potassium, excessive use of diuretics

(Lewis et al., 2011)

LAB VALUES & DIAGNOSTIC STUDIES

Serum potassium,

Arterial blood gases: metabolic alkalosis/acidosis

ECG

Serum creatinine

(ATI, 2010)

NURSING ASSESSMENT

Monitor for:

Phlebitis

Intake and urine output

Respirations and breathing patterns

Heart rhythm

Level of consciousness

Bowel sounds

Kidney function

(BUN, GFR, Creatinine)

Other electrolytes

(Ca+, Mg, P)

Assist with ADLs if needed

(Lewis et al., 2011)

HEALTH PROVIDER PRESCRIPTIONS

Hyperkalemia: calcium gluconate, calcium chloride, potassium restricted diet, Administer IV dextrose and regular insulin, sodium bicarbonate to reverse acidosis, Loop diuretics, Kayexalate, dialysis

Hypokalemia: Encourage high potassium foods, IV or oral potassium supplementation, disuse of loop diuretics.

(Adams, Holland, & Urban, 2011) (ATI, 2010)

NURSING INTERVENTIONS

Maintain open airway and monitor vital signs

Treat dysrhythmias and perform continuous cardiac monitoring

Monitor level of consciousness

(Lewis et al., 2011)

GERIATRIC CONSIDERATIONS

Greater risk for hypokalemia due to prominent use of diuretics and laxatives

(ATI, 2010)

CALCIUM Ca+

ACTION IN THE BODY

Transmits nerve impulses

Myocardial contractions

Blood clotting

Formation of bone and teeth

Muscle contractions

Calcium balance controlled by PTH, Calcitonin and Vitamin D

Lewis et al., 2011)

HYPOCALCEMIA - level <9.0 Caused by: Decreased total calcium (chronic kidney disease, elevated phosphorus, primary hypoparathyroidism, vitamin D deficiency, magnesium deficiency, acute pancreatitis, loop diuretics, chronic alcoholism, diarrhea, decreased serum albumin levels), decreased ionized calcium (alkalosis)

HYPERCALCEMIA - level >10.5

Caused by: Increased total calcium levels (prolonged immobilization, vitamin D overdose, thiazide diuretics, milk-alkali syndrome, hyperparathyroidism, multiple myeloma), increased ionized calcium (acidosis)

(Lewis et al., 2011)

SIGNS AND SYMPTOMS

Hypercalcemia: lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, anorexia, vomiting, nausea, bone pain, fractures, polyuria, dehydration, nephrolithiasis, stupor, coma) (Med Surg)

Hypocalcemia: paresthesia of fingers and lips, muscle twitching, resting muscle spasm, hyperactive DTR, positive Chvostek’s sign, positive Trousseau’s sign, decreased myocardial contractility, hyperactive bowel sounds, diarrhea, abdominal Cramping

(ATI, 2010)

CLIENTS AT RISK

Hypocalcemia: Chron’s disease, hypoalbuminemia, end stage kidney disease, post-thyroidectomy, hypoparathyroidism, pancreatitis, sepsis, patients on medications that block parathyroid function

Hypercalcemia: Patients taking thiazide diuretics, hyperparathyroidism, milk-alkali syndrome, multiple myeloma, patients with malignancies with bone metastasis

(Lewis et al., 2011)(ATI, 2010)

HEALTHCARE PROVIDER PRESCRIPTIONS

Hypocalcemia: IV/oral calcium supplements, vitamin D supplements

Hypercalcemia: Hypotonic fluid or calcitonin

(Adams, Holland, & Urban, 2011)

LAB VALUES & DIAGNOSTIC STUDIES

Serum Calcium levels

ECG – prolonged QT interval

Serum creatinine

(ATI, 2010)

NURSING ASSESSMENTS

ECG changes

(ET, QT segment is shortened or lengthened)

Tachycardia

Dysrhythmia

Seizure

Spasm

Heart failure

Chvostek sign

Trousseau sign

(ATI) (Lewis et al., 2011)

NURSING INTERVENTIONS

Reversing underlying cause

Administer/stop administering IV or oral calcium supplements

Encourage foods high/low in calcium

Lewis et al., 2011)

GERIATRIC CONSIDERATIONS

Aging adults have gradual loss of calcium in their bones, which can lead to osteoporosis in some patients. This can cause fractures and hypocalcemia if not treated with calcium supplements

(Craven & Hirnle, 2009)

PHOSPHORUS P

ACTION IN THE BODY

Primary anion in ICF

Essential in muscle function, red blood cell function and a functioning nervous system

Works with calcium for tooth and bone structure and formation

Involved with acid-base system

Involved with ATP production

Involved in cellular uptake of glucose

(Lewis et al., 2011)

HYPOPHOSPHATEMIA - level >4.5

Caused by: renal failure, chemotherapeutic agents, and enemas containing phosphorus, excessive ingestion of phosphorus, large vitamin D intake, and hyperparathyroidism.

HYPOPHOSPHATEMIA - level < 2.5

Caused by: malabsorption syndrome, increased carbohydrate calories (glucose administration), total parenteral nutrition, respiratory alkalosis, alcoholism/alcohol withdrawal, phosphate binding antacids, uncontrolled diabetes mellitus, renal phosphate wasting

(Lewis et al., 2011)

SIGNS AND SYMPTOMS

Hypophosphatemia: CNS dysfunction (confusion, coma), muscle weakness, respiratory weakness, cardiac problems (dysrhythmias, decreased stroke volume), osteomalacia, rhabdomylosis

Hyperphosphatemia: hypocalcemia, muscle problems (tetany), phosphate and calcium precipitates in skin, soft tissue, cornea, viscera and blood vessels.

(Lewis et al., 2011)

CLIENTS AT RISK FOR:

Hyperphosphatemia: Chronic kidney disease, patients receiving chemotherapy, patients recieveing enemas containing phosphorus, hyperparathyroidism, ketoacidosis

Hypophosphatemia: Alcoholics/alcohol withdrawal, patients taking phosphate binding antacids, uncontrolled diabetes mellitus, major burns, respiratory alkalosis, vitamin D deficiency

(Lewis et al., 2011)

HEALTHCARE PROVIDER PRESCRIPTIONS

Hyperphosphatemia: dietary phosphate restriction

Hypophosphatemia: phosphate supplements

(Adams, Holland, & Urban, 2011)

LAB VALUES & DIAGNOSTIC STUDIES

Serum phosphate

Serum creatinine

(ATI, 2010)

NURSING ASSESSMENTS

Precipitates in skin, soft tissue, cornea, viscera, blood vessels

Tetany

Pruritus

Monitor for muscle weakness

Dysrhythmias

Decreased stroke volume

Diarrhea

Nausea

Delirium

Apprehension

Tachypnea

Respiratory weakness

(Lewis et al., 2011)

NURSING INTERVENTIONS

Identify and treat underlying cause (both)

Administer oral phosphate replacement (hypo)

Encourage foods high (or low) in phosphorus

Monitor for dysrhythmias

(Lewis et al., 2011)

GERIATRIC CONSIDERATIONS

In older adults, when they are prepping for a colonoscopy if they use sodium phosphate it can cause hyperphosphatemia

(Craven & Hirnle, 2009)

REFERENCES

Adams, M.P., Holland, Jr., L.N., & Urban, C.Q. (2011). Pharmacology for nurses: A pathophysiologic approach (3rd ed.). Upper Saddle River: Pearson Education, Inc.

Assessment Technologies Institute, LLC. (2010). RN adult medical surgical nursing (8th ed.). USA: Assessment Technologies Institute

Craven, R.F., & Hirnlee, C.J. (2009). Fundamentals of nursing: Human health and function (6th ed). Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins.

Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., Bucher, L., & Camera, I.M. (2011). Medical-Surgical Nursing: Assessment and management of clinical problems (8th ed.). St Louis, Missouri: Elselvier Mosby.

Fluid & Electrolyte Concept Map

by: Molly Ann Short

NUR311

May 10, 2012

Normal Values:

9.0 - 10.5 mg/dL

Normal Values:

3.5 - 4.5 mg/dL

Normal Values:

1.3 - 2.1 mEq/dL

Normal Values:

3.5 - 5.0 mEq/dL

Learn more about creating dynamic, engaging presentations with Prezi