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Fluid Electrolyte Concept Map

Including components: sodium, potassium, magnesium, calcium, and phosphorus.
by

Rachel Curiel

on 19 January 2013

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Transcript of Fluid Electrolyte Concept Map

By: Rachel Curiel Electrolytes Action of the electrolyte in the body
and associated physiological responses Sodium Action of the electrolyte in the body and
associated physiological responses Potassium - A coenzyme in the metabolism of carbohydrate and protein
- Targets the myoneural junction
- Affects the neuromuscular excitability
- Cellular nucleic acids and proteins Magnesium 9.0-10.5 mEq/L Calcium Phosphorus References - 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 Differentiate between increase and decrease in lab values 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. NUR 311 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. Geriatric Considerations 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). Normal Values 136-145 mEq/L - 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. Normal Values 3.5 - 5.0 mEq/L Differentiate between increase and decrease in lab values Increased:> 5.0 mEq/L
Decreased:< 3.5 mEq/L 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 Monitor: level of consciousness, vital signs, intake and output. Assess heart function (dysrhythmias) and muscle weakness. 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. Action of the electrolyte in the
body and associated physiological responses Normal Values 1.3-2.1 mEq/L Differentiate between increase
and decrease in lab values Increased:>2.1 mEq/L Decreased:<1.3 mEq/L 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 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) 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 Monitor: level of consciousness,
vitals,and heart function. Observe
other electrolyte levels. 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. Action of the electrolyte in the body
and associated physiological responses Plays a role in: transmission of nerve impulses,myocardial & muscle contraction, blood clotting, and formation of teeth & bone. Normal Values Differentiate between increase
and decrease in lab values Increased:> 10.5 mEq/L
Decreased:< 9.0 mEq/L 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 Monitor level of consciousness,
vitals and heart function. 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 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 3.5-4.5 mEq/L Differentiate between increase
and decrease in lab values Increased:> 4.5 mEq/L
Decreased:< 3.5 mEq/L 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) S/S associated with hyper/hypo values 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. Nursing Assessment, including
physical and psychosocial assessments 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 Geriatric Considerations Hypo:
Inadequate nutritional intake related to decreased GI function puts pt at risk.
Hyper:
Renal failure. 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. 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. (2000). Rn adult medical surgical nursing. (8.0 ed.). Assessment Technologies Institute.
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