Fluids & Electrolytes

Front 1

Hyponatremia range

Back 1

<135 mEq/L

Front 2

Hyponatremia etiology

Back 2

vomiting, diarrhea, diaphoresis, diuretics, aldosterone deficiency (SIADH)

Front 3

Hyponatremia S/S

Back 3

anorexia, N/V, HA, dizziness, weight gain, edema, confusion, muscle cramps, dry skin and mucosa, increased pulse, low BP, abd cramp, increase active bowel sounds. <115 causes severe neurological changes such as confusion & convulsions/seizures and may result in death due to excessive water shift. Increase urine output. Check skin turgor.

Front 4

Hyponatremia TX

Back 4

Increase dietary sodium: butter, ketchup, bacon, can food, preservatives, lunch meat. Restrict oral intake to 800 mL/24 hrs. Replace fluids c LR or isotonic NS. If severe neurologic symtoms, admin hypertonic solutions (3% NS).

Front 5

Hyponatremia Nursing Interventions

Back 5

Strict I & O, daily weights, monitor serum sodium, urine sodium, & specific gravity. Monitor FVO. Fall precautions.

Front 6

Hypernatremia range

Back 6

>145 mEq/L

Front 7

Hypernatremia etiology

Back 7

Causes include: fluid deprivation , Diabetes Insipidus (if the patient does not respond to thirst or if fluids are excessively restricted). Other causes that are less common are heat stroke, near-drowning in sea water, malfunction of hemodialysis or peritoneal dialysis systems, and administration of IV hypertonic saline or excessive use of NaHCO3

Front 8

Hypernatremia S/S

Back 8

Thirst, fever, sticky mucous membranes, hallucinations, lethargy, irritable, restless, pulmonary edema, increased pulse, increased BP.
If hypernatremia persists have circulatory overload, shock, respiratory distress, and renal failure can occur.
If hypernatremia is severe, permanent brain damage can occur, especially in children. Brain damage is a result of subarachnoid hemorrhages that result from brain contraction.

Front 9

Hypernatremia TX

Back 9

Decrease sodium intake; hypotonic solution or nonsaline isotonic solution (D5W); Promote sodium excretion with diuretics; Continue to monitor client for S/S of hypernatremia and LOC changes; Restore balance

Front 10

Hypernatremia nursing interventions

Back 10

accurate I&O, daily weights, and monitor those clients with or at risk for sodium excess. Also assess for patient’s response to fluids (serum NA levels) and by observing for changes in neurologic signs.
Teach on dietary management of low NA diet

Front 11

Hypokalemia range

Back 11

<3.5 mEq/L

Front 12

Hypokalemia etiology

Back 12

occur frequently with diarrhea due to the relatively large amounts of K that is contained in intestinal fluids. Other causes include: prolonged intestinal suctioning, a recent ileostomy, and intestinal tumors. Patients who do not eat a normal diet for a prolonged period are at risk also (debilitated elderly, alcoholics, anorexics and bulimics)

Front 13

Hypokalemia S/S

Back 13

weakness and fatigue, anorexia, N, V, polyuria, paresthesias (numbness and tingling), leg cramps, decreased BP, irregular pulse. On EKG, you may see flattened T waves, prominent U waves, ST depression and prolonged PR interval.

Front 14

Hypokalemia TX

Back 14

oral or IV replacement if it cannot be corrected by increased dietary intake. dietary intake consist of salt substitutes, foods high in K+ such as bananas, fruit juices, milk, meat, eggs, baked potatoes, cooked dried beans, coffee, tea, and cocoa
Oral potassium supplements can produce small bowel lesions so assess for and caution about abdominal distention, pain, and GI bleeding.

Front 15

Hypokalemia nursing interventions

Back 15

closely monitor these clients or clients at risk for K deficit. FYI: If you are replacing K via IV infusion, must use an infusion pump and place them on a cardiac monitor to detect any rhythm changes. Potassium is never administered IV push or IM!!!
If a patient is on digitalis monitor for dig toxicity because hypokalemia potentiates the action of digitalis.

Front 16

Hyperkalemia range

Back 16

>5.3 mEq/L

Front 17

Hyperkalemia etiology

Back 17

seldom occurs in clients that have normal renal function. Although hyperkalemia occurs less frequently than hypokalemia, it is usually more dangerous because cardiac arrest is more frequently associated with high K levels. The 3 major causes are decreased renal excretion of K, rapid administration of potassium, and movement of potassium from ICF to ECF compartment.

Front 18

Hyperkalemia S/S

Back 18

dysrhythmias, parasthesias, flaccid paralysis, intestinal colic, cramps, irritability, anxiety.
Cardiac effects are usually not significant when levels are less than 7 mEq/L. Earliest changes often occur at 6 mEq/L which include: ECG of tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression. Ventricular dysrhythmias and cardiac arrest may occur at any point.

Front 19

Hyperkalemia TX

Back 19

An EKG should be obtained and cardiac rhythm should be continuously monitored. Hemodialysis or peritoneal dialysis for renal failure.
Kayexalate by mouth or enema (pulls K+ and water into intestines).
K levels are dangerously high may administer IV Calcium gluconate to counteract effect of K+ on heart muscle. Monitor BP and ECG when administering.
IV sodium bicarb may be administered in dangerously high levels.
Loop diuretics may be used also.
Restrict dietary K+

Front 20

Hyperkalemia nursing interventions

Back 20

monitor these clients with or at risk for K excess (those taking K+ Supplements and those with renal insufficiency/failure). monitor their lab values and report as needed. caution clients using salt substitutes if they are taking other supplementary forms of K or K-conserving diuretics. teach them about their dietary management

Front 21

Hypocalcemia range

Back 21

<9 mg/dL

Front 22

Hypocalcemia etiology

Back 22

primary and surgical hypoparathyroidism. It is also associated with thyroid surgery and renal failure. Other causes are inadequate vitamin D consuption, magnesium deficit, alkalosis, and alcohol abuse. Elderly people and those with disabilities that spend increased amount of time in bed are at increased risk because bedrest increases bone resorption.

Front 23

Hypocalcemia S/S

Back 23

numbness, tingling of fingers, toes, + Trousseau’s sign and Chvostek’s sign, seizures, hyperactive DTRs, irritability, anxiety, impaired clotting time, and decreased prothrombin.

Front 24

Hypocalcemia TX

Back 24

IV administration of calcium (gluconate used more because Ca Chloride more irritating and causes sloughing of tissue if it infiltrates). It should be diluted in D5W and given as a slow bolus or on an infusion pump. During IV replacement, the client is to remain on bed rest and the BP is monitored due to postural hypotension. Too rapid infusion causes bradycardia and cardiac arrest. If patient on digitalis administration of Ca is dangerous because can cause dig toxicity with adverse cardiac effects.

Front 25

Hypocalcemia nursing interventions

Back 25

other treatments include vitamin D therapy, increase dietary intake of calcium, calcium containing meds (aluminum hydroxide, calcium acetate, calcium carbonate antacids)
identify and observe those clients that have or are at risk for a Ca deficit. If severe, you may want to initiate seizure precautions. Airway and safety should also be a priority especially if they have laryngeal stridor or if confusion is present.
Our teaching plan for dietary management should include an increased intake of calcium rich foods. If unable to do so, a Ca supplement may be needed. Caution regarding high intake of alcohol and caffeine and overuse of laxatives and antacids that contain phosphorus, because decreases Ca absorption

Front 26

Hypercalcemia range

Back 26

>11 mg/dL

Front 27

Hypercalcemia etiology

Back 27

most common causes of hypercalcemia are malignancies and hyperparathryoidism. Immobilization may also cause an increase of Ca due to bone mineral lost.
If not treated promptly, a hypercalcemia crisis could end up in demise of the patient (cardiac arrest).

Front 28

Hypercalcemia S/S

Back 28

muscular weakness, constipation, anorexia, N, V, dehydration, polyuria and polydipsia, flank pain, hypoactive DTRs, lethergy, deep bone pain, pathologic fractures, ECG changes.
Confusion, impaired memory, slurred speech, lethargy, acute psychotic behavior, or coma may occur (usually see with levels >16).

Front 29

Hypercalcemia TX

Back 29

Treat underlying cause. Administer fluids to dilute serum Ca and promote renal excretion, mobilizing the patient, and restricting dietary calcium intake.NS, IV phosphate, and Lasix may be given to drop Ca levels. Calcitonin IM may also be used. IV phosphate therapy is used with extreme caution because can cause severe calcification in various tissues, hypotension, tetany, and acute renal failure.

Front 30

Hypercalcemia nursing interventions

Back 30

monitor Ca levels and report appropriately. Also instruct the client to avoid foods high in Ca and to increase their fluid intake if not contraindicated.
Administer medications as ordered

Front 31

Phosphatemia

Back 31

For clients receiving TPN, PO4 may need to be added or increased. We need to prevent infection, monitor PO4 levels, and encourage clients to increase foods rich in PO4: beef, pork, turkey, milk, whole grain cereals (Cheerios).