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Sodium

- Major electrolyte found in ECF

- Essential for:maintenance of acid-base balance, active and passive transport mechanisms, irritability and conduction of nerve and muscle tissue

136-145 mEq/L

Increased: >145 mEq/L Decreased: <136 mEq/L

ID of clients at risk for hypo/hyper conditions related to electrolyte

Hypo:

Diarrhea, vomiting, fistulas, NG suction, diuretics, adrenal insufficiency, sodium wasting renal disease, burns/wound drainage, fasting diets, excessive hypotonic IV fluids, primary polydipsia, SIADH, heart failure, primary hypoaldosteronism.

Hyper:

Hypertonic NaCl, excessive isotonic NaCl, IV sodium bicarbonate, hypertonic tube feedings w/o water supplements, unconscious or cognitively impaired individuals who have a significant decrease in water intake, high fever, heatstroke, hyperventilation, osmotic diuretic therapy, diarrhea, diabetes insipidus, primary hyperaldosteronsim, Cushing’s Syndrome , uncontrolled diabetes mellitus (Lewis et al., 2011).

S/S associated with hyper/hypo values

Hypo - Decreased ECF Volume: Irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma, dry mucous membranes, postural hypotension, decrease CVP, tachycardia, thready pulse, cold and clammy skin. Hypo - Increased ECF Volume: Headache, apathy, confusion, muscle spasms, seizures, coma, nausea/vomiting, diarrhea, abdominal cramps, weight gain, increased BP and CVP.

Hyper - Decreased ECF Volume: Restlessness, agitation, twitching, seizures, comas, intense thirst, dry swollen tongue, sticky mucous membranes, postural hypotension, decreased CVP, weight loss, weakness, lethargy. Hyper - Increased ECF Volume: Restlessness, agitation, twitching, seizures, coma, intense thirst, flushed skin, weight gain, peripheral and pulmonary edema, increased BP, increased CVP (Lewis et al., 2011)

Labs & Diagnostic studies to determine the underlying cause of the alteration in lab values or assess for effects of the alteration

Hypo:

Serum Sodium:

Decreased (<136 mEq/L)

Serum Osmolarity:

Decreased (<270 mOsm/L)

Hyper:

Serum Sodium:

Increased (>145 mEq/L)

Serum Osmolarity:

Increased (>300mOsm/L)

Anticipated health provider prescriptions related to abnormality

Hypo:

Fluid restriction, IV hypertonic saline solution for severe cases (3% NaCl), Vasopressin, Conivaptan

Hyper:

IV Solutions of 5% dextrose and water/ hypotonic saline (dilates sodium concentration). Restrict consumption of intake of dietary sodium.

Other:

Administer loop diuretics or ACE inhibitors to those pts with heart failure.

Nursing Assessment, including physical and psychosocial assessments

Observe pt for signs of seizures. Assess vital Signs,as well as neuromusculoskeletal and GI system. Monitor: 24-hour intake and output, cardiovascular changes, and respiratory changes (cough, SOB, crackles). Assess neurological changes, especially level of consciousness. Fluid retention is shown by daily weights. Skin assessments are used to test dehydration.

Nursing interventions and prioritization of the interventions

Hypo:maintain open airway, administer oral or IV fluids to increase sodium consumption, restrict fluids (fluid excess), replace fluids (fluid loss), increase dietary sodium intake, monitor level of consciousness and prepare seizure precautions, monitor vitals, monitor intake and output and assess daily weights.

Hyper:maintain open airway, balance sodium with IV fluids, administer diuretics to eliminate excess sodium, monitor vitals, monitor psychosocial status, assess intake and output, and educate pt about a low sodium diet.

Hypo: At risk for hyponatremia because of decreased sodium intake, chronic illnesses and diuretic medications.

Hyper: Decreased thirst sensation leads up to inadequate fluid intake (dehydration).

Potassium

- Major cation for ICF

- Plays a vital role in: cell metabolism and transmission of nerve impulses

- Assesses in the functioning of cardiac and lung muscle tissue, as well as acid-base balance.

3.5 - 5.0 mEq/L

Differentiate between increase and decrease in lab values

ID of clients at risk for hypo/hyper conditions related to electrolyte

Hypo:

Diarrhea, vomiting, fistulas, NG suction, diuretics, hyperaldosteronism, magnesium depletion, diaphoresis, dialysis, increased insulin, alkalosis, tissue repair, increased epinephrine, starvation, decreased potassium consumption, failure to include potassium when parenteral fluids is NPO.

Hyper:

Excessive or rapid parenteral administration, potassium containing drugs/salt substitutes, acidosis, tissue catabolism, crush injury, tumor lysis syndrome, renal disease, potassium sparing diuretics, adrenal insufficiency, ACE inhibitors (Lewis et al., 2011).

S/S associated with hyper/hypo values

Hypo:

Fatigue, muscle weakness/leg cramps, nausea/ vomiting, paralytic ileus, paresthesias, decreased reflexes, weak irregular pulse, polyuria, hyperglycemia, ST segment depression, flattened T wave, presence of U Wave, ventricular dysrhythmias, bradycardia, enhanced digitalis effect.

Hyper:

Irritability, anxiety, abdominal cramping, diarrhea, weakness of lower extremities, paresthesias, irregular pulse, cardiac arrest (when severe), tall peak T wave, prolong PR interval, ST segment depression, loss of P wave, widening QRS, ventricular fibrillation, ventricular stand still (Lewis et al., 2011)

Labs & Diagnostic studies to

determine the underlying cause

of the alteration in lab values

or assess for effects of the alteration

Hypo:

Serum Potassium- Decreased

(<3.5 mEq/L)

Arterial Blood Gases- Metabolic Alkalosis (pH > 7.45)

ECG- Dysrhythmias (premature ventricular contractions, ventricular tachycardia, inverted T waves, ST depression)

Hyper:

Serum Potassium- Increased (>5.0 mEq/L)

Arterial Blood Gases- Metabolic Acidosis (pH <7.35)

ECG- Dysrhythmias (ventricular fibrillation, peaked T waves, widened QRS)

Anticipated health provider

prescriptions related to abnormality

Hypo:

Oral Potassium Chloride supplements, increased dietary intake of K+

Hyper:

Decrease potassium intake and administer IV calcium gluconate in order to reverse acidosis and force potassium in the ECF in the ICF.

Nursing Assessment, including

physical and psychosocial assessments

Nursing interventions and prioritization of the interventions

Hypo: maintain open airway, administer potassium chloride orally or through IV, increase dietary potassium consumption. Monitor the heart, vital signs, IV site, and intake and output.

Hyper: decrease potassium intake, increase fluid intake, and administer diuretics to eliminate potassium. Monitor the heart and vitals. Educate the pt about enforcing a restricted potassium diet.

Geriatric Considerations

Hypo:Use of diuretics and laxatives puts the pt at risk.

Hyper:Increased use of salt substitutes puts the pt at risk, as well as consuming potassium sparring diuretics and ACE inhibitors.

Magnesium

Action of the electrolyte in the

body and associated physiological responses

- A coenzyme in the metabolism of carbohydrate and protein

- Targets the myoneural junction

- Affects the neuromuscular excitability

- Cellular nucleic acids and proteins

Normal Values

Differentiate between increase

and decrease in lab values

ID of clients at risk for hypo/hyper conditions related to electrolyte

Hypo:

Diarrhea, vomiting, chronic alcoholism, impaired GI absorption, malabsorption syndrome/prolonged malnutrition, significant urine output, NG Suction, poorly controlled diabetes mellitus, hyperaldosteronism

Hyper:

Renal failure, excessive consumption of magnesium, adrenal insufficiency (Lewis et al., 2011)

S/S associated with hyper/hypo values

Labs & Diagnostic studies to determine the underlying cause of the alteration in lab values or assess for effects of the alteration

Hypo:

Magnesium:

Decreased

(<1.5 mEq/L)

Calcium:

<4.6 mg/dL

Phosphorus:

<2.4 mg/dL

Hyper:

Magnesium:

Increased

(>2.5mEq/L)

Calcium:

>5.28 mg/dL

Phosphorus:

>4.4 mg/dL

ECG

Anticipated health provider

prescriptions related to abnormality

Hypo:

Oral supplements,increase magnesium dietary intake, administer parenteral IV containing magnesium (severe)

Hyper:

Administer Calcium Chloride or Calcium gluconate through IV, promote urinary excretion

Other:

Those individuals who suffer chronic kidney disease are strongly discouraged not to take magnesium supplements and are required to have dialysis.

Nursing Assessment, including

physical and psychosocial assessments

Nursing interventions and

prioritization of the interventions

Hypo:administer IV or magnesium supplements, monitor heart for dysrhythmias, educate pt on magnesium diet

Hyper:discontinue IV or magnesium supplements, monitor respiratory failure, promote urinary excretion, monitor for weakness (pt at risk for falls)

Geriatric Considerations

Hypo:

Impaired absorption is caused by GI dysfunction.

Hyper:

Pt at risk for renal failure or decreased renal function.

Calcium

Action of the electrolyte in the body

and associated physiological responses

Normal Values

Differentiate between increase

and decrease in lab values

ID of clients at risk for hypo/hyper conditions related to electrolyte

Hypo:

Chronic Kidney disease, elevated phosphorus, primary hypoparathyroidism, Vit D deficiency, magnesium deficiency, acute pancreatitis, loop diuretics, chronic alcoholism, diarrhea, decreased serum albumin, alkalosis, excess administration of citrated blood

Hyper:

Mulitple myeloma, malignancies with bone metastasis, prolonged immobilization, hyperparathyroidism, vit D overdose, thiazide diuretics, milk alkali syndrome, acidosis (Lewis et al., 2011)

S/S associated with

hyper/hypo values

Hypo:

Fatigability, depression, anxiety, confusion, numbness and tingling (around mouth), hyperreflexia, muscle cramps, Chvostek’s Sign, Trousseau’s Sign, Laryngeal spasm, tetany, seizures, elongation of ST segment, prolong QT interval, ventricular tachycardia

Hyper:

Lethargy/weakness, depressed reflexes, decreased memory/confusion, personality changes/psychosis, anorexia, nausea/vomiting, bone pain, factures, polyuria, dehydration, nephrolithiasis, stupor, coma, shortened ST segment, ventricular dysrhythmias, increased digitalis effect (Lewis et al., 2011)

Labs & Diagnostic studies to

determine the underlying cause

of the alteration in lab values

or assess for effects of the alteration

Hypo:

Calcium- Decreased < 9.0 mg/dL

pH- >7.45

Magnesium- <1.5 mEq/L

Phosphorus- > 4.4 mg/dL

Vitamin D- < 30 mg/ml

ECG: Elongation of ST segment,

Prolonged QT interval, ventricular tachycardia

Hyper:

Calcium- Increased > 10.2 mg/dL

pH- < 7.35

Magnesium- > 2.5 mEq/L

Phosphorus- > 4.4 mg/dL

ECG:

Shortened ST segment, Shortened QT interval, ventricular dysrhythmias, increased digitalis effect

Anticipated health provider

prescriptions related to abnormality

Hypo:

Oral or IV Calcium supplements and encourage

dietary calcium intake.

Hyper:

Administer Lasix loop diuretics and isotonic

saline infusions for hydration. Encouraged to increase fluid intake up to 4000 mL daily and be put on a low calcium diet.

Nursing Assessment, including

physical and psychosocial assessments

Nursing interventions and

prioritization of the interventions

Hypo:monitor for dysrhythmias, administer calcium supplements or IV, monitor for anxiety, monitor for hypertension, have emergency equipment prepared, educate pt on increasing calcium diet.

Hyper:discontinue consumption of calcium, monitor vitals, administer diuretic to increase urinary excretion (containing calcium), intake 4000 mL of fluid, monitor muscle weakness, educate pt about low calcium diet

Geriatric Considerations

Hypo:

Increased use of diuretic medications, chronic kidney diseases, and impaired renal function puts pt at risk

Hyper:

Cancer and Thiazide diuretic use

Phosphorus

Action of the electrolyte in the body

and associated physiological responses

- Deposited with calcium for bone and tooth structure

- Essential for the function of: muscles, RBC, and the nervous system

- Involved in: acid-base buffering system, mitochondrial energy production of ATP, celluar uptake, use of glucose, metabolism of carbohydrates, proteins and fats

Normal Values

Differentiate between increase

and decrease in lab values

ID of clients at risk for hypo/hyper conditions related to electrolyte

Hypo:

Malabsorption & nutritional recovery syndrome, glucose administration, TPN, alcohol withdrawal, phosphate binding antacid, recovery from diabetics ketoacidosis, respiratory alkalosis

Hyper:

Renal failure, chemotherapeutic agents, enemas containing phosphorus, excess ingestion, large vit D intake, hypoparathyroidism (Lewis et al., 2011)

Hypo:

CNS dysfunction, muscle weakness, renal tubular wasting, cardiac problems, osteomalacia, rhabdomyolysis

Hyper:

Hypocalcemia, muscle problems, tetany (Lewis et al., 2011)

Labs & Diagnostic studies to determine the underlying cause of the alteration in lab values or assess for effects of the alteration

Hypo:

Phosphorus- Decreased <2.4 mg/dL

Magnesium- <2.5 mEq/L

Calcium- <4.6 mg/dL

Hyper:

Phosphorus- Increased >4.4mg/dL

Magnesium- >2.5 mEq/L

Calcium- >5.28 mg/dL

ECG

Anticipated health provider prescriptions

related to abnormality

Hypo:

Oral supplements, increased intake of foods high in phosphorus, IV administration containing sodium phosphate or potassium phosphate (if severe)

Hyper:

Restrict calcium supplements, phosphate binding agents, and intake of phosphate.

Monitor level of consciousness, vitals, heart & respiratory function. Assess other electrolyte levels. Monitor for sudden symptomatic hypocalcemia when IV treatment is in use.

Nursing interventions and

prioritization of the interventions

Hypo:administer drugs to replace phosphorus, monitor for heart function (dysrhthmias), monitor for CNS irritability, educate pt on consuming a high phosphorus diet

Hyper:discontinue intake of phosphorus, administer prescribed drugs, maintain hydration, restrict high consumption of phosphorus, monitor calcium levels

Hypo:

Inadequate nutritional intake related to decreased GI function puts pt at risk.

Hyper:

Renal failure.

1.3-2.1 mEq/L

Increased:>2.1 mEq/L Decreased:<1.3 mEq/L

Hypo:

Neuromuscular hyperirritability, CNS hyperirritability

Hyper:

Neuromuscular function depression, CNS function depression, lethargy/drowsiness, nausea/vomiting, deep tendon reflex loss, respiratory and cardiac arrest (Lewis et al., 2011)

Normal Values

Action of the electrolyte in the body and

associated physiological responses

Monitor: level of consciousness,

vitals,and heart function. Observe

other electrolyte levels.

Increased:> 5.0 mEq/L

Decreased:< 3.5 mEq/L

Monitor: level of consciousness, vital signs, intake and output. Assess heart function (dysrhythmias) and muscle weakness.

9.0-10.5 mEq/L

Plays a role in: transmission of nerve impulses,myocardial & muscle contraction, blood clotting, and formation of teeth & bone.

Monitor level of consciousness,

vitals and heart function.

Increased:> 10.5 mEq/L

Decreased:< 9.0 mEq/L

Normal Values

Electrolytes

Geriatric Considerations

Action of the electrolyte in the body

and associated physiological responses

By: Rachel Curiel

Differentiate between increase and decrease in lab values

NUR 311

Nursing Assessment, including

physical and psychosocial assessments

Geriatric Considerations

(2000). Rn adult medical surgical nursing. (8.0 ed.). Assessment Technologies Institute.

S/S associated with hyper/hypo values

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., et al, L., & Camera, I. M. C. (2011). Medical-surgical nursing, assessment and management of clinical problems. (8th ed. ed.). St. Louis, Missouri: Mosby.

Increased:> 4.5 mEq/L

Decreased:< 3.5 mEq/L

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing care plans, guidelines for individualizing client care across the life span. (8th ed.). Philadelphia: F A Davis Co.

3.5-4.5 mEq/L

References

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