Fluid and Electrolyte Imbalances

Electrolyte values are a pain for nursing school ninjas to master. If a nurse wants to be fully effective in their assessment, they must memorize and understand electrolyte imbalances. Here is a little outline that helped me understand it enough to pass my test. Hopefully it can help you! Oh yeah, and there are some nursing interventions for those pesky electrolyte imbalances.

Sodium (Na)

Hyponatremia is a decrease of sodium and in increase of water causing water to shift into cells.

Assessment findings of hyponatremia

rapid thready pulse
low BP
cold clammy skin
abdominal cramps and nausea
muscle weakness, cramps, tremors
lethargy, headache, decrease in level of consciousness, confusion
diagnostics labs: sodium less than 135, a decrease in urine specific gravity, a decrease in Hct

Treatments of hyponatremia

restrict fluids
encourage high sodium foods
hypertonic sodium chloride
monitor patient’s vital signs, level of consciousness, intake and output, and weight.
Monitor labs
monitor safety
teach patient about healthy sodium and water intake

Hypernatremia

hypernatremia is an increase in sodium and the decrease of water, cellular dehydration, caused by low water intake and/or high sodium intake.

Assessment findings of hypernatremia:

restlessness, agitation to lethargy
dry mucous membranes
dry flushed skin
thirst
N & V
urine output is low
diagnostics: sodium is greater than 145 and an increase in specific gravity of urine, except for diabetes insipidus.

Treatment of hypernatremia

salt free fluids
sodium restriction
diuretics and water
vasopressin
monitor patient for vital signs, level of consciousness, intake and output, labs, and weight. Also monitor oral hygiene, patient safety, and teach patient of proper sodium and fluid intake.

Potassium (K)

Hypokalemia is a decrease in potassium in which slight changes have profound effects and is caused by not enough intake, too much output, and drugs such as diuretics.

Assessment findings of hypokalemia:

neuromuscular weakness: leg weakness, cramps, paresthesias, fatigue, apathy, respiratory weakness
decreased DI motility
cardiac problems: weak irregular pulse, palpitations, orthostatic hypotension
diagnostics: a potassium levels less than 3.5, 2.5 is severe, and increase in glucose levels, lower magnesium, ECG changes such as flat T. wave and positive U. wave, and increase Dig level.

Treatments of hypokalemia

replace potassium with high potassium foods, oral supplements, IV replacement(Max 10mEq/hr, replace Mg first.)
Monitor patient for vital signs, heart rate and rhythm, labs, dig level, intake and output
patient teaching.

Hyperkalemia

Hyperkalemia is an increase in potassium caused by too much intake, too little output, drugs such asACE and aldactone, and tissue injury.

Assessment findings of hyperkalemia

neuromuscular — paresthesias, muscle weakness, paralysis, leg muscle to respiratory muscles.
G.I. hyperactivity
cardiac — heart rate, irregular pulse, hypotension.
Diagnostics — potassium level greater than five, driven seven is severe, ECG changes such as tented T. wave, flat P. wave, wide QRS.

Treatments of hyperkalemia

restrict potassium
eliminate potassium from the body — loop diuretic, dialysis, sodium polystyrene sulfonate (Kayexalate).
Shift potassium into cells –NaHCO3, dextrose and insulin
administer calcium chloride were calcium gluconate
monitor patient’s vital signs, EKG, intake and output, dig levels, labs, and patient safety
patient teaching

Calcium (Ca)

Roles of Calcium

provides structure to bones and teeth
maintains cell membrane structure
affects muscle contraction
required for blood to clot

hypocalcemia is a decrease in calcium caused by not enough intake, too much loss, low magnesium, high phosphorus, or blood transfusions.

Assessment findings of hypocalcemia

neuromuscular — paresthesias — circumoral, twitching, tremors, muscle cramps,Chvostek’s-face, Troussau’s-arm.
Structural changes
cardiac arrhythmias
diagnostics — serum calcium less than 8.5 ionized <4.5, low albumin, ECG changes.

Treatment of hypocalcemia

administer calcium
vitamin D supplements
magnesium replacement
reduce phosphate
monitor patient — vital signs, respiratory stridor, ECG, labs,Chvostek’s & Trousseau’s.
patient safety and teaching of calcium rich foods and importance and benefits of exercise.

Hypercalcemia

Hypercalcemia is too much calcium in the serum caused by hyperparathyroidism, cancer, low phosphate, antacid abuse, excessive vitamin D and A.

Assessment findings of hypercalcemia

neuromuscular weakness
cardiac
decreased DI motility
renal — polyurea and stones
diagnostics — total calcium >.5 ionized >.1, ECG changes, x-ray — pathological fractures

Treatment of hypercalcemia

increase calcium excretion — hydration, diuretics, IMO dialysis
block bone resorption and decrease DI uptake — steroids, phosphates
monitor patient — vital signs, level of consciousness, ECG, intake and output, labs
safety
strain urine
Ambulate
teaching

Magnesium (Mg)

Roles of Magnesium

important for cell metabolism
influences cardiac contractility
maintains electrical activity in nerves and muscles
influences calcium levels

Hypomagnesemia

Hypomagnesemia is when serum has insufficient magnesium. Serum level may not reflect actual stores. Causes of hypomagnesemia could be poor intake and absorption, increased loss, and pregnancy.

Assessment findings of hypomagnesemia

neuromuscular — change in level of consciousness, hyperactive reflexes
cardiac irritability
decreased DI motility
diagnostics — magnesium less than 1.3(1.5), may see decreased calcium or potassium, ECG changes, increased dig levels.

Treatment of hypomagnesemia

replace magnesium
oral
IV MgSO4
monitor patient — vital signs, level of consciousness, dysphagia, reflexes, intake and output
patient safety and teaching about high magnesium foods

Hypermagnesemia

Hypermagnesemia as in increase of magnesium and is uncommon but is caused by excessive intake and/or decreased excretion

Assessment findings of hypermagnesemia

neuromuscular — flushing, warmth, weakness, decreased reflexes
cardiac — lower blood pressure
diagnostics — magnesium greater than 2.5mEq/dL, ECG changes

Treatment of hypermagnesemia

increased elimination — fluids in loop diuretics
block effects — calcium gluconate
monitor patient — vital signs, level of consciousness, reflexes, intake and output, labs, ECG
Teaching patient how to to avoid magnesium and importance thereof.

Phosphorus (P)

Roles of Phosphorus

nerve and muscle function
required to activate B. vitamins
carbohydrate metabolism
works with calcium for bone structure

Hypophosphatemia

Hypophosphatemia is a decrease in phosphate which is caused by respiratory hyperventilation, malnutrition from poor intake or recede in syndrome, malabsorption, excessive urine output.

Assessment findings of hypophosphatemia

neuromuscular — weakness, confusion, signs and symptoms of hypercalcemia.
Other assessment findings of hypophosphatemia are bruising, bleeding, loss of bone density.
Diagnostics –PO4 less than 2.5 mEq/L, low magnesium and high calcium, osteomalacia from Xray.

Treatment of hypophosphatemia

increased intake with food, oral supplements, and IV KPO4.
Monitor patient — title science, especially respiratory rhythm, level of consciousness, intake and output, labs, patient safety.
Patient teaching.

Hyperphosphatemia

Hyperphosphatemia ia increase of phosphates which is caused by increased intake, cell destruction, decreased excretion — renal failure, hyperparathyroidism.

Assessment findings of hyperphosphatemia

same signs and symptoms of hypocalcemia
calcification of the eyes.
Diagnostics –PO4 > 4.5 mEq/L, lower calcium, skeletal changes shown in x-ray.

Treatment of hyperphosphatemia

decrease intake
increase excretion — fluids, diuretics, dialysis
monitor patient — vital signs, Chvostek’s & Trousseau’s, patient safety
patient teaching

Chloride (Cl)

Roles of Chloride

travels with sodium to maintain serum osmolality
works with sodium to form CSF
secreted by gastric mucosa (HCl) for digestion

Hypochloremia

Hypochloremia is not enough chlorine which is caused by a reduced intake such as from salt restricted diets, salt poor formula, IV fluids, excessive loss — G.I. tube drainage, draining fistulas, cystic fibrosis – Drugs, HCO3, steroids, laxatives, diuretics.

Assessment findings of hypochloremia

neuromuscular –Tetany, hyperactive reflexes, seizures
cardiac arrhythmias
diagnostics — chloride level less than 98mEq/L, sodium less than 135 mEq per liter — frequently present — serum pH >7.45(as chloride decreases, HC03 increases)

treatment of hypochloremia

correct the cause since it is often caused by an underlying problem
chloride replacement — salty broth,KCl if Na OK, restrict water
monitor patient — vital signs, level of consciousness, intake and output, labs, cardiac rhythm, patient safety.

Hyperchloremia

Hyperchloremia is an unsafe increase in chlorides caused by metabolic acidosis, increased intake with increased water loss, drugs such as Kayexalate.

Assessment findings of hyperchloremia

signs and symptoms of metabolic acidosis — tachypnea, Kussmaul respirations,lethargy, weakness
signs and symptoms of increased sodium — fluid retention, edema, hypertension, dyspnea
diagnostics — chlorine >108 mEq per liter, 145 > mEq per liter, pH >7.35, HCO3 < 22 mEq

Treatment of hyperchloremia

Correct the cause since it is often a result of an underlying problem
restrict sodium and chloride
increased water
IV bicarb
rarely diuretics
monitor patient — vital signs, level of consciousness, intake and output, respiratory rate, cardiac rhythm, labs, patient safety.

Fluid and electrolytes simplified