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Copy of Copy of Electrolyte Concept Map

Alyssa Latham Evinrude Nursing 311
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Alyssa Latham

on 18 January 2013

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Transcript of Copy of Copy of Electrolyte Concept Map

Evinrude
Nursing 311 Electrolyte Concept Map
Alyssa Latham "Sodium is the main cation of the ECF and plays a major role in maintaining the concentration and volume of the ECF. Therefore sodium is the primary determinant of ECF osmolality.” (Lewis) Sodium Na+ Normal Values: 135-145 mEq/L Differentiation between an increase and decrease in the lab values:
Sodium affects the water distribution between the ECF and the ICF.
Generation and transmission of nerve impulses and the regulation of acid-base balance.
Primary water imbalance & a primary sodium imbalance. (Lewis)
These imbalances are reflected through hyper and hyponatremia.
Hypernatremia is an elevated level of serum sodium (>145 mEq/L),
while hyponatremia is a decreased level (<135 mEq/L). Risks:
Excessive sodium loss, inadequate sodium intake, excessive water gain, patient with SIADH, heart failure, primary hypoaldosteronism (Lewis) Hyponatremia Decreased ECF Volume: irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma, dry mucous membranes, postural hypotension, decreased CVP, decreased jugular venous filling, tachycardia, thread pulse, cold and clammy skin.
Normal/increased ECF volume: headache, apathy, confusion, muscle spasms, seizures, coma, nausea, vomiting, diarrhea, abdominal cramps, weight gain, increased BP and CVP (Lewis) Signs & Symptoms Labs & diagnostics: Serum sodium is decreased, Serum osmolality is decreased. Blood and urine tests.

Provider prescriptions: IV Fluids to raise sodium level, oral medications, hormone therapy. Nursing assessment & priority interventions: Monitor I/O's, look for dehydration, watch for neuromuscular changes, monitor edema or hypertension, ensure sodium intake.

Geriatric considerations: Postmenopausal women are commonly affected, falls "Potassium is critical for many cellular and metabolic functions. In addition to its role in neuromuscular and cardiac function, potassium regulates intracellular osmolality and promotes cellular growth. Also plays a role in acid-base balance." (Lewis) Disruptions in the dynamic equilibrium between ICF and ECF potassium often cause clinical problems. Factors causing potassium to move include:
Insulin
Alkalosis
Adrenergic stimulation
Rapid cell building (Lewis)
Levels of potassium below 3.5 are labeled hypokalemia, Levels above 5.0 are hyperkalemia. Normal Values: 3.5- 5.0 mEq/L Hypernatremia Signs & Symptoms Decreased ECF Volume- restlessness, agitation, twitching, seizures, coma, intense thirst, dry and swollen tongue, postural hypotension, decreased CVP, weight loss, weakness, lethargy.

Normal/increased ECF volume- restlessness, agitation, twitching, seizures, coma, intense thirst, flushed skin, weight gain, peripheral and pulmonary edema, increased BP and CVP” (Lewis) Risks: Excessive sodium intake, inadequate water intake, excessive water loss, patients with diabetes insipidus, primary hyperaldosteronism, Cushing syndrome, uncontrolled diabetes mellitus (Lewis) Labs and diagnostics: Serum sodium is increased, Serum osmolality is increased. Blood and urine.

Provider Prescriptions: IV and oral fluids to rehydrate and balance ECF Nursing assessment & priority interventions: I/O's, neurological functioning, vital signs

Geriatric considerations: Risks for falls and safety, confusion Potassium K+ Hypokalemia Signs & Symptoms Fatigue, Muscle weakness, leg cramps, nausea, vomiting, paralytic ileus, soft and flabby muscles, Paresthesias, decreased reflexes, Weak and irregular pulse,polyuria, Hyperglycemia, changes in EKG (Lewis) Risks: Potassium loss, Shift of potassium into cells, Lack of Potassium intake (Lewis) Labs and diagnostics: Blood tests

Provider prescriptions: Potassium tablets, diet rich in potassium Nursing assessment & priority interventions: Monitor I/O's, Check blood volume and venous pressure.
Identify ECG changes, Observe for dehydration.Observe for fatigue and muscular weakness.

Geriatric considerations: Paralysis, heart & kidney damage with prolonged disorder. Falls and safety. Hyperkalemia Signs & Symptoms Irritability, anxiety, abdominal cramping and diarrhea, weakness of lower extremities, Paresthesias, irregular, pulse, cardiac arrest if sudden, changes in EKG (Lewis) Risks: Excessive potassium intake, Shift of potassium outside of cells, Failure to eliminate potassium (Lewis) Labs and diagnostics: Blood tests

Provider Prescriptions: Calcium Chloride or Gluconate, Insulin, Sodium bicarbonate, Beta agonists, diuretics, Binding resins Nursing Assessment & Priority interventions: Monitor I/O's, serum potassium and ECG

Geriatric Considerations: Neuromuscular and cardiac problems related to medication Magnesium Mg "Magnesium functions as a coenzyme in the metabolism of carbohydrates and protein. It is also involved in metabolism of cellular nucleic acids and proteins." (Lewis) It is also directly related to calcium and potassium balance. Normal Values: 1.5-2.5 mEq/L Differentiation between an increase and decrease in the lab values: Magnesium acts directly on the myoneural junction, and neuromuscular excitability is profoundly affected by alterations in serum magnesium levels. (Lewis) Levels below 1.5 are hypomagnesemia, levels above 2.5 are hypermagnesemia. Hypomagnesemia Signs & Symptoms Confusion, hyperactive deep tendon reflexes, tremors, and seizures. Cardiac dysrythmias. (Lewis) Risks: Diarrhea, vomiting, chronic alcoholism, impaired GI absorption, malabsorption syndrome, prolonged malnutrition, large urine output, NG suction, Poorly controlled diabetes mellitus, hyperaldosteronism. (Lewis) Labs & Diagnostics: ECG results, low potassium and calcium levels, blood and urine

Provider Prescriptions: IV fluid, Mg medications, medications for symptoms Nursing Assessment & Priority interventions: Neurological state, vitals signs, muscular issues, nerves. Monitor blood levels.

Geriatric considerations: Risk for respiratory and cardiac arrest increases Hypermagnesemia Signs & Symptoms
Depresses neuromuscular and CNS functions, lethargy, drowsiness, nausea and vomiting. Loss of deep tendon reflexes, respiratory and cardiac arrest for severe cases. (Lewis) Risks: Renal failure, excessive administration of magnesium, adrenal insufficiency Labs & diagnostics: High Serum magnesium level

Provider Prescriptions: IV calcium gluconate, diuretics, dialysis Nursing Assessment & Priority Interventions: Neurological state, muscle weakness, vital signs, reflexes, monitor blood levels.

Geriatric Considerations: Renal failure, cardiac problems, confusion Calcium Ca "The functions of calcium include transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth and bones, and muscle contractions." (Lewis) Normal Values: 8.6- 10.2 mg/dL Differentiation between an increase and decrease in the lab values: Calcium is present in the serum in three forms: free or ionized, bound to protein, or or complexed with phosphate, citrate, or carbonate. (Lewis) Levels below 8.6 are considered hypocalcemia, and levels above 10.2 are hypercalcemia. Hypocalcemia Signs & Symptoms Fatigue, depression, anxiety, confusion, numbness and tingling in extremities or around mouth, hyperreflexia, muscle cramps, Chvostek's sign, Trousseau's sign, Laryngeal spasm, Tetany, seizures. (Lewis) Risks: Decreased total calcium & Decreased ionized calcium (Lewis) Labs & diagnostics: Calcium serum levels

Provider Prescriptions: IV Calcium and magnesium, oral supplement, Vitamin D Nursing Assessment & Priority Interventions: neuromuscular, neurological signs, vital signs, I/O's

Geriatric Considerations: Mental status and heart complications Hypercalcemia Signs & Symptoms Lethargy, Weakness, Depressed reflexes, decreased memory, confusion, personality changes, psychosis, anorexia, nausea, vomiting, bone pain, fractures, polyuria, dehydration, nephrolithiasis, stupor, coma (Lewis) Risks: Increased total calcium, Increased Ionized Calcium (Lewis) Labs & Diagnostics: Elevated Serum calcium levels

Provider Prescriptions: Volume expansion and saline diuresis, dialysis, reduce absorption Nursing Assessment & Priority Interventions: Encourage mobilization, Blood samples, ECG, neuromuscular status, seizure precautions

Geriatric Considerations: Mobility, and cardiac precautions, safety. Phosphorus Normal Values: 2.4-4.4 mg/dL Differentiation between an increase and decrease in the lab values: Maintenance of normal phosphate balance requires adequate renal functioning because the kidneys are the major route of phosphate excretion. High serum phosphate levels tend to cause to cause low calcium concentration in the serum. Levels lower than 2.4 are labeled hypophosphatemia and levels above 4.4 are hyperphosphatemia. Phosphorus is a primary anion in the ICF and is essential to the function of muscle, RBCs, and the nervous system, acid-base buffering system, mitochondrial production of ATP, cellular uptake and use of glucose and the metabolism of carbohydrates, proteins and fats. Hypophosphatemia Signs & Symptoms CNS dysfunction, muscle weakness, renal tubular wasting, cardiac problems, osteomalacia, rhabdomyolysis (Lewis) Risks: malabsorption syndrome, nutritional recovery syndrome, glucose administration, total parenteral nutrition, alcohol withdrawal, phosphate-binding antacids, recovery from diabetic ketoacidosis, respiratory alkalosis (Lewis) Labs & diagnostics: Anemia, heart muscle damage

Provider Prescriptions: IV or oral replacement Nursing Assessment & Priority Interventions: neurological deficits, irregularities of the heart, malnutrition, breathing

Geriatric Considerations: Heart conditions and pain Hyperphosphatemia Signs & Symptoms Risks: Renal failure, chemotherapeutic agents, enemas, excessive ingestion, large vitamin D intake, hypoparathyroidism Labs & diagnostics: High levels of phosphate in the blood

Provider Prescriptions: Initiate therapy, limit intake, enhance renal excretion. Nursing Assessment & Priority Interventions: Tetany, numbness, renal functions, BP

Geriatric Considerations: neuromuscular function and falls, renal failure THE END! Hypercalcemia, muscle problems, tetany S
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