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Copy of Copy of Electrolytes Concept Map

NUR311, Jan 26, 2012

lillian dauod

on 11 January 2013

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Transcript of Copy of Copy of Electrolytes Concept Map

Electrolytes Concept Map By: Kristin Ruttan
1/26/12 Na's Action in the body Maintains ECF concentration and volume
Generates and transmits nerve impulses
Regulates acid-base balance
Conducts muscle impulses
Inverse relationship with K
Absorbed in GI tract, excreted in kidneys SODIUM Na+ Normal Values: 135-145mEq/L
Hypernatremia > 145mEq/L
Hyponatremia < 135mEq/L POTASSIUM K+ Normal Values: 3.5-5mEq/L
Hyperkalemia > 5mEq/L
Hypokalemia < 3.5mEq/L MAGNESIUM Mg2+ Normal Values: 1.5-2.5mEq/L
Hypermagnesemia > 2.5mEq/L
Hypomagnesemia < 1.5mEq/L CALCIUM Ca2+ Normal Values: 8.6-10.2mg/dL
Hypercalcemia > 10.2mg/dL
Hypocalcemia < 8.6mg/dL PHOSPHATE PO4(3-) Normal Values: 2.4-4.4mg/dL
Hyperphosphatemia > 4.4mg/dL
Hypophosphatemia < 2.4mg/dL (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011)
(Crawford & Harris, 2011) Clients at risk for sodium imbalance Clients at risk for potassium imbalance Clients at risk for magnesium imbalance Clients at risk for calcium imbalance Clients at risk for phosphate imbalance K's Action in the body Mg's Action in the body Ca's Action in the body PO4's Action in the body (Lewis at al., 2011), (Crawford & Harris, 2011) (Lewis at al., 2011), (Crawford & Harris, 2011) (Lewis at al., 2011), (Crawford & Harris, 2012) (Lewis at al., 2011), (Crawford & Harris, 2012) Na-K pump maintains ICF:ECF ratio (~49:1)
Maintains resting potential - neuromuscular and cardiac function depend on K
Promotes cellular growth
Enters cells during tissue formation, leaves during tissue breakdown
Regulates acid-base balance
Exchanges freely with hydrogen ions Aids in function of Na-K pump and creation of ATP
Affects cardiac function through vasodilation
Acts as coenzyme to metabolize carbohydrates, proteins, nucleic acids
stimulates PTH secretion, affecting Ca levels
Absorbed in GI tract, excreted by kidneys
50-60% contained in bone Stored in teeth/bones
Transmits nerve impulses, myocardial and muscle contractions
Ionized (active), bound to albumin, or complexed
Acidosis causes calcium binding, alkalosis causes calcium ionization
Activates enzymes to stimulate chemical reactions
Aids in blood clotting Maintains functionality of muscle, RBC's, nervous system
Deposited with Ca in teeth/bones
Inverted relationship with Ca
Aids in carbohydrate, protein, fat metabolism
Aids platelet function and phagocytosis Hypernatremia Hyponatremia Diabetes insipidus, inability to obtain fluids, concentrated hyperosmolar tube feedings, uncontrolled diabetes mellitus, hyperglycemia, diaphoresis, hyperventilation, Cushing's syndrome, diarrhea, renal failure, hyperaldosteronism, hypertonic saline solution, excessive sodium bicarbonate or steroid use, or near drowning in salt water. Excessive sodium-free or hypotonic IV fluids, SIADH (syndrome of inappropriate secretion of antidiuretic hormone), heart failure, hypoaldosteronism, diarrhea, vomiting, fistula, NG suction, diuretics, renal failure, diaphoresis, significant blood loss, Addison's disease, postoperative patients. (Lewis et al., 2011), (Crawford & Harris, 2011) Hyperphosphatemia Hypophosphatemia Hypermagnesemia Hypomagnesemia Hypercalcemia Hypocalcemia Hyperphosphatemia Hypophosphatemia Metabolic acidosis, trauma to cells, digoxin-like drugs, beta-blockers, renal failure, K-sparing diuretics, ACE-inhibitors, hypoaldosteronism, K IV administration, Addison's disease, NSAIDs, infections, burns. Insulin, metabolic acidosis, beta-adrenergic stimulation, rapid cell building, K-wasting diuretics, diarrhea, laxative abuse, vomiting, ileostomy drainage, hyperaldosteronism, diaphoresis (Lewis et al., 2011), (Crawford & Harris, 2011) (Lewis et al., 2011), (Crawford & Harris, 2011) (Lewis et al., 2011), (Crawford & Harris, 2012) (Lewis et al., 2011), (Crawford & Harris, 2012) Imbalances mirror Ca: treatment of eclampsia, hypoaldosteronism, renal failure, Addison's disease, Diabetic ketoacidosis, tumor lysis syndrome, overuse of laxatives/antacids. Imbalances mirror Ca: fasting/starving, chronic alcoholic, vomiting, diarrhea, NG suction, diuretics, uncontrolled diabetes, hypokalemia, cyclosporine, some proton pump inhibitors, IV citrated blood. Hyperparathyroidism, hyperthyroidism, malignancies, multiple myeloma, immobilized/bed rest, multiple fractures, excessive vitamin D, osteoporosis, thiazide diuretic, lithium, hypophosphatemia. Post-thyroid surgery, IV citrated blood, sudden alkalosis, excessive laxative use, malabsorption syndrome, inadequate Ca intake, hypomagnesemia, hyperphosphatemia, pancreatitis. Renal failure, chemotherapy, excessive PO4 ingestion, excessive vitamin D, tumor lysis syndrome, rhabdomyolysis, lactic acidosis, hypoparathyroidism, ketoacidosis. Malnourishment, alcohol withdrawal, overuse of antacids, repiratory alkalosis, hyperparathyroidism, chronic diarrhea, major thermal burns, vitamin D deficiency. Labs and
Diagnostic studies

Serum sodium
Serum osmolarity
Serum Creatinine (ATI, 2010) Labs and
Diagnostic Studies
Serum potassium
Arterial blood gases
Serum Creatinine (ATI, 2010) Labs and
Diagnostic Studies

Serum Magnesium
Serum Creatinine (ATI, 2010) Labs and
Diagnostic Studies

Serum calcium
Serum Creatinine (ATI, 2010) Labs and
Diagnostic Studies

Serum phosphate
Serum Creatinine (ATI, 2010) Signs and
Symptoms Signs and
Symptoms Signs and
Symptoms Signs and
Symptoms Signs and
Symptoms Hyperphosphatemia:
phosphate and calcium readily bind, increases can develop calcified deposits in soft tissue, neuromuscular excitability, tetany Hypercalcemia:
reduced muscle/nerve excitability, lethargy, weakness, bone pain, polyuria, confusion, depressed reflexes Hypermagnesemia:
depressed neuromuscular and CNS function, drowsiness, lethargy, nausea, vomiting, loss of deep tendon reflexes, respiratory depression, cardiac arrest Hyperkalemia:
increased cellular excitability, cramping leg pain, weakness/paralysis of skeletal muscles, cardiac rhythm changes, irritability, abdominal cramping, diarrhea. Hypernatremia:
due to cellular dehydration and shrinking, agitation, thirst, lethargy, seizures, neurons become hyperactive, orthostatic hypotension, weakness, decreased skin turgor. (Lewis et al., 2011) (Lewis et al., 2011) (Lewis et al., 2011) (Lewis et al., 2011) (Lewis et al., 2011) Hypophosphatemia:
impaired cellular energy and oxygen delivery, confusion, muscle weakness, weakened heart, dysrhythmias, osteomalacia Hypocalcemia:
allows sodium to move into cells causing nerve and muscle hyperexcitability, tetany, numbness, tingling, hyperreflexia, muscle cramps Hypomagnesemia:
neuromuscular and CNS hyperexcitability, confusion, hyperactive deep tendon reflexes, tremors, seizures Hypokalemia:
reduces cellular excitability, irregular heartbeat, skeletal muscle weakness, paralysis of respiratory muscles, nausea, vomiting, paralytic ileus, decreased blood flow through arteries, impaired insulin release, polyuria. Hyponatremia:
due to cellular swelling, irritability, apprehension, confusion, seizures, coma Anticipated prescriptions:
Depending on underlying cause:
ADH replacement, insulin, glucocorticoids, antidiarrheals, diuretics, aldosterone antagonist, carbonic anhydrase inhibitors, ACE inhibitors, beta blockers, aldosterone, antiemetics, sodium replacement
(Adams, Holland, & Urban, 2011) Anticipated prescriptions:
Depending on underlying cause:
Diuretics, carbonic anhydrase inhibitors, aldosterone, glucocorticoids, beta blockers, antidiarrheals, antiemetics, aldosterone antagonist
(Adams, Holland, & Urban, 2011) Anticipated prescriptions:
Depending on underlying cause:
aldosterone, diuretics, carbonic anhydrase inhibitors, glucocorticoids, antiemetics, antidiarrheals, insulin, potassium, magnesium
(Adams, Holland, & Urban, 2011) Anticipated prescriptions:
Depending on underlying cause:
phosphate, calcium, magnesium, pancreatic enzyme, loop diuretic, plicamycin (inhibits bone resorption), osteoclast inhibitor
(Adams, Holland, & Urban, 2011) Anticipated prescriptions:
Depending on underlying cause:
PTH replacement, diuretics, carbonic anhydrase inhibitors, antidiarrheals, vitamin D, phosphate
(Adams, Holland, & Urban, 2011) NURSING ASSESSMENT NURSING ASSESSMENT NURSING ASSESSMENT NURSING ASSESSMENT NURSING ASSESSMENT NURSING INTERVENTIONS NURSING INTERVENTIONS NURSING INTERVENTIONS NURSING INTERVENTIONS NURSING INTERVENTIONS Hypernatremia: monitor for capillary refills, twitching, hallucinations, dry or sticky mucous membranes, flushed skin, tachycardia, orthostatic hypotension, fever. Hyponatremia: monitor for headache, change in mental status, nausea, vomiting, diarrhea, twitcing, seizures Hyperkalemia: monitor for changes from cardiac baseline, muscle weakness, respiratory depression, impaired speech, nausea, diarrhea Hypokalemia: monitor for changes in apical pulse, ECG, decreased deep tendon reflexes, muscle weakness, I/O's, hypoactive bowel sounds, respiratory function Hypermagnesemia: monitor for lethargy, respiratory depression, hypotension with nausea and vomiting, bradycardia, hyporeflexia Hypomagnesemia: monitor for tremors, weakness, athetoid movements, tetany, seizures, laryngeal stridor, Chvostek sign, Trousseau sign, cardiac irregularities Hypercalcemia: monitor for neuroexcitability, ECG changes: shortened QT wave, prolonged PR interval Hypocalcemia: monitor for heart failure, laryngospasm, seizures, Chvostek sign, Trousseau sign Hyperphosphatemia: monitor for neuroexcitability, seizures, tetany, pruritis, arthritis, nausea, vomiting, weakness, hyperreflexia, tachycardia Hypophosphatemia: monitor for weakness, malaise, diarrhea, vomiting, nausea, tachypnea, delerium, apprehension (Crawford & Harris, 2012) (Crawford & Harris, 2012) (Crawford & Harris, 2012) (Crawford & Harris, 2012) (Crawford & Harris, 2011) (Crawford & Harris, 2011) (Crawford & Harris, 2011) (Crawford & Harris, 2011) (Crawford & Harris, 2011) (Crawford & Harris, 2011) Hypernatremia: treat the underlying cause, increase Na-free fluids, increase IV fluids slowly, monitor Na, Hgb, Hct Hyponatremia: treat the underlying cause, replace Na PO or IV, restrict water intake, administer tolvaptan if necessary Hyperkalemia: treat the underlying cause, administer cation exchange resins, administer diuretics, restrict K intake. Hypokalemia: administer IV K very cautiously while monitorying ECG, provide PO K if patient will tolerate, monitor for signs of hyperkalemia Hypermagnesemia: treat the underlying cause, administer IV Ca and IV fluids, monitor continuos ECG and apical pulse Hypomagnesemia: treat the underlying cause, administer Mg IV, PO, or through diet, monitor ECG and vital signs Hypercalcemia: treat the underlying cause, administer IV fluids, administer calcitonin or biphosphonates Hypocalcemia: treat the underlying cause, administer IV Ca, administer vitamin D if sufficient or with hypoparathyroidism, monitor vital signs Hyperphosphatemia: treat the underlying cause, advise a low PO4 diet, administer phosphate binders Hypophosphatemia: treat the underlying cause, administer PO or IV PO4, monitor for dysrhythmias Geriatric Considerations: kidneys have fewer nephrons, less ability to conserve fluids, imbalances common secondary to chronic diseases
(Craven & Hirnle, 2009) Geriatric Considerations: excessive use of laxatives and sodium phosphate in preparation for colonoscopy can cause hypokalemia
(Craven & Hirnle, 2009) Geriatric Considerations: diuretics commonely prescribed to treat hypertension can cause hypomagnesemia
(Craven & Hirnle, 2009) Geriatric Considerations: older adults have a gradual loss of calcium in their bones, leading to osteoporosis in some, which can cause fractures
(Craven & Hirnle, 2009) Geriatric Considerations: in preparation for colonoscopy, the use of sodium phosphate can cause hyperphosphatemia
(Craven & Hirnle, 2009) References Adams, M. P., Holland, 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. & Hirnle, C. J. (2009). Fundamentals of nursing: Human health and function (6th ed.). Philadelphia: Wolters Kluwer Lippincott Williams & Wilkins
Crawford, A., & Harris, H. (2011). Balancing act: Hypomagnesemia & hypermagnesemia. Nursing2011, 41 (10), 52-55. doi: 10.1097/01.NURSE.0000403378.71042.f0
Crawford, A., & Harris, H. (2011). Balancing act: Na+ Sodium K+ Potassium. Nursing2011, 41 (7), 44-50. doi: 10.1097/01.NURSE.0000397838.20260.12
Crawford, A., & Harris, H. (2012). Fluid and Electrolyte Series Balancing act: Calcium & phosphorus. Nursing2012, 42 (1), 36-42. doi: 10.1097/01.NURSE.0000408492.25896.04
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: Elsevier Mosby
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