Electrolyte Imbalances

Imbalance Risk Factors Signs and Symptoms Interventions Electrolyte Imbalances Hypomagne- Malnutrition Tremors Treat underlying causes as semia Alcoholism Cramps prescribed (<1.3 meq/l) Low K revels Hyperactive reflexes Monitor IV infusions carefully Matabsorption related Seizures to prevent cardiac or to GI disorders (Crohn, Premature respiratory arrest gluten-sensitive ventricular Oral supplements enteropathy) contractions Patient teaching regarding Antibiotics (gentamicin, Ventricular dietary intake aniphotericin, fibrillation cyclosporine) Anorexia Antineoplastics (cisplatin) Nausea and Vomiting vomiting Diarrhea Confusion Polyuria Memory loss NG drainage Fatigue Aldosterone excess Hypermagne- Renal disease Diarrhea Check vital signs and reflexes semia Overtreatment of Flushing frequently (>2.5 meq/l) hypomagnesemia Slurred speech Monitor neurologic status (rare) Overuse of magnesium- Profuse sweating Educate patient against based laxative Vomiting excessive use of laxatives Antacids (Riopan, Weakness and antacids Milk of Magnesia, Shallow breathing Epsom salt) Bradycardia Deep tendon reflexes Hallucinations (severe cases) Coma (severe cases) Cardiac/respiratory arrest (severe cases)

CHAPTER_14/fluid, ELectroLyte and Add-Base Balance Imbalance Risk Factors Signs and Symptoms Interventions Electrolyte Imbalances Hyperkalemia Renal disease Dysrhythmia Caution patient against (>5.0 meq/l) K sparing diuretic use EKG changes excessive salt substitute use Addison disease Cardiac arrest with Check expiration date on Excess K supplement rapid IV infusion blood products before giving Hemolysis of K Restrict oral and IV K intake N ' Burns Diarrhea Monitor.I & 0 Crush injuries Abdominal cramping Monitor vital signs Rapid IV infusion of K Irritability Monitor EKG changes Chemotherapy IV calcium gluconate Acidosis - 1sevete cases) Infusion of old blood Dialysis (severe cases) Kayexalate (severe cases) Hypocalcemia Inadequate dietary Respiratory distress Patient teaching regarding (<8.6 mg/dl or intake or bronchospasms adequate intake of calcium 4.5 meq/l) MaLabsorption disorders Cardiac dysrhythmia Sunlight exposure Vitamin D deficiency or [KG changes Monitor vital signs Hyperphosphatemia Tetany IV calcium as ordered secondary to chronic Tingling or numbness o Monitor IV site closely laxative use Seizures Thiazide diuretic as ordered Hypoparathyroidism Irritability Alcoholism Pathologic fractures Renal disease OsteomaLacia Pancreatitis Osteoporosis Rickets (children) Hypercalcemia Hyperparathyroidism Anorexia Patient education (plenty of (>10 mg/dl or Cancer Nausea and vomiting fluids only medication 5 5 meq/l) Excessive intake of Ca4 1' Thirst cleared by doctor no smoking Prolonged Dry mucous weight beanng and strength Immobilization membranes exercise after cleared by doctor) Osteoporosis Constipation Severe Cases Thiazide diuretics Abdominal pain Calcitonin or glucocorticoids Steroid therapy Kidney stones as ordered Polyuria Loop diuretics as ordered Pathologic Monitor I & 0 fractures Possible hemodialysis Dysrhythmia Prevent stress and strain Impaired memory on bones Mood swings Exercise after cleared by doctor Coma Parathyroid removal Emotional support

N ursi ngfundamentalsdemystified Imbalance Risk Factors Signs and Symptoms Interventions Electrolyte Imbalances Hyponatremia Renal disease Headache Administer IV fluids as ordered: (<134 rneq/l) Adrenal insufficiency Tiredness Restrict free water intake 1' Water intake Dry mucous as ordered Excess D5W IV Infusion membranes Monitor for excessive fluid Diuretics ' Nausea or vomiting and Na intake Anorexia Abdominal cramping Monitor I & 0 GI losses Dry pale skin Monitor weights Vomiting Disoriented Monitor laboratory values Diarrhea Muscle cramps and (glucose, electrolytes) Tap water enemas muscle weakness Monitor for neurologic changes Burns Tachycardia 'Seizure precautions Heart failure Seizures Cirrhosis SIADH Hypernatremia Diabetes insipidus Thirst Verify fluid orders before (>146 meq/l) High Na* intake Dry flushed skin initiating IV infusion. Vomiting Sticky tongue or Infuse fluids at prescribed rate Diarrhea mucous membranes (should be infused slowly) Excessive amounts of Fever Avoid overhydrating patient hypertonic IV solution Nausea or vomiting Seizure precautions I Water loss Anorexia Monitor for neurologic changes a Excessive sweating Excessive urination Provide oral hygiene care Overcorrection of acidosis (polyuria) with sodium bicarbonate Tachycardia Neurologic changes (restlessness, agitation, irritability, confusion, seizures) Hypokalemia Diuretics Disonentation Oral potassium replacement (<3 4 meq/l) Excessive sweating or confusion as prescnbed Diarrhea Tiredness Intravenous potassium as Fasting or starvation Abdomen distention prescribed with serious deficits Crash diets Paralytic Ileus Patient teaching-potassium Anorexia nervosa Nausea and vomiting rich foods Magnesium deficiency Constipation Monitor pulse rhythm Alkalosis Polyuria (apical also) Insulin therapy Tachypnea Monitor EKG changes Cirrhosis Tachycardia or Monitor IV site for phlebitis Heart failure dysrhythmia and infiltration Hyperaldosteronism EKG changes Alcoholism Coma

cttyiance 243 Imbalance Risk Factors Signs and Symptoms Interventions Fluid Imbalances Fluid volume Excessive IV fluid intake Rapid weight gain Restrict Na intake as ordered excess or. Excessive water intake I BP Administer diuretics as ordered water excess (uncommon) Bounding pulses Dialysis as ordered Excessive Na intake Neck vein distention Monitor I & 0 Renal disease Edema Daily weights Neurologic disorders Dyspnea Monitor for signs of Respiratory disorders Ra[es* overcorrection (see Heart failure Ascaria Hypovolemia) SIADH Ascites Monitor for electrolyte Cirrhosis of the liver Headache imbalances '1' Aldosterone or steroid Lethargy Hyponatremia levels Personality Hypophosphatemia changes Hypercalcemia Irritability Hypomagnesemia Confusion Seizure Coma Fluid volume Diarrhea Weight loss ' Oral and IV fluid repacement deficit or Vomiting Thirst as ordered water deficit L Oral fluid intake Poor skin turgor Blood transfusion as ordered Draining tubes Dry mucous Fall precautions Burns membranes Hemorrhage.L BP with standing Excessive perspiration (orthostatic Fever hypotension) Diuretics Slow vein filling Third space shifting Weak rapid pulse L Urine output. 1' Urine specific gravity Neuroogic changes (dizziness, confusion, seizures, coma, agitation) (Continued)

/H 0 Potential Nursing Planning (Goats and Assessment Diagnoses (Examples) Outcomes) Implementation Evaluation Risk Factors Infection, Risk for Prevention or control MedicaL and surgical Determine Defense mechanisms KnowLedge, Deficient of infection aseptic techniques progress toward Age Skin Integrity, Impaired Patient or family Monitor for sighs, achieving goals Heredity SociaL Interaction, knowledge of preventing symptoms, and and outcomes ' Stress Impaired and controlling infection laboratory and Determine the Current health status Caregiver Role Strain, Maintenance of skin diagnostic results effectiveness of Medication or Risk for integrity that suggest the interventions procedures SociaL interaction through presence of infection Modify the plan Nutritional status means that do not Teach the patient and of care as ClinicaL Findings interfere with infection family how to prevent needed Signs and symptoms of control infection and how infection Adequate resources to to recognize early Laboratory and prevent caregiver role signs of infection diagnostic test resufts strain Provide means for Impacf of existfng social interaction infection on patient (visitor using or family functioning appropriate infection control precautions, telephone interactions, and written - communication) Assist the patient or family to identify resources that will minimize caregiver role strain

Vital Signs Influencin g Factors Temperature Pulse Respirations Blood Pressure Age Greater variation during I- Pulse with increased L Respirations with 1' BP with increased age infancy age increased age L Temperature related to increase surface loss for infants and elderly people Activity and I Activity or stress 1' Pulse with increased I Respirations with I BP with increased stress I Temperature activity increased activity activity Environment I EnvironmentaL temperture I Environmental I Environmental temperature I Body temperature temperature I pulse temperature I body I 4- Environmental temperature I 4- Environmental 4- Body temperature temperature 4- pulse temperature, which - may I respiratory rate Medications I Temperature related to Stimulants I pulse Narcotics, sedatives, Antihypertensives and hypersensitivity reaction to Depressants 1- pulse hypnotics, and general opioids L BP medication anesthetics L Decongestants, certain respiratory rate illicit drugs, oral contraceptives may I BP Disease and I Temperature with I Pulse with acute pain, L Respiratory rate with Kidney disease, others infections, hyperthyroidism hemorrhage, infection acute pain, anemia, cardiovascular disease, L Temperature with Cardiovascular disease smoking, I altitude pain may all I BP hypothyroidism cause irregular pulse!- Respiratory rate with BP may I hemorrhage, head trauma injury heart attack, and involving brain stem change to upright position (orthostatic or postural hypotension) BP = blood pressure. I

ied CHAPTER_14/FLuid,_ELectroLyte and Acid-Base BaLance H247 TI Imbalance Risk Factors Signs and Symptoms Interventions Electrolyte Imbalances.ly Hypophos- Diabetic ketoaciddsis Muscle weakness Patient teaching (foods phatemia Respiratory alkatosis Repiratorydistress containing phosphojoüs (<2.5 mg/dl) Sepsis Ilypotension and food preparation to Refeeding syndrome Pale skin secondary minimize phosphorous loss (secondary to to hemotytic anemia Monitor for respiratory distress mätabsorption Altered mental Monitor fqr bleeding Malabsorption disorders status (?anging Implement measures to Overuse of aluminum- from irritability protect against infection básedàntadds to coma) Administer IV phosphate as Hyperparathyroidism WorsenThg ordered Alcoholism infection Administer slowly Loop diuretics (secondary to. Dilute Vitamin D deficiency WBC destruction) Do not infuse with calcium Anorexia nervosa - - Severe burns Hyperphos- Renal disease Numbness Patient teaching (excessive phatemia Hypoparathyroidism Tingling intake, foods containing (>4.5 mg/dl) Excess intake (foods, Muscle spasms phosphorous, reading labels, laxatives, enemas) Tetany laxative and enema use) Prolonged exercise Seizures Monitor vital signs (rhabdomyolysis) Tachycardia Check reflexes Chemotherapy Anorexia Monitor urine output Respiratory acidosis Nausea Administer calcium as ordered Calcium or magnesium Vomiting deficiency Diarrhea I Vitamin D level [KG changes Acid-Base Imbalances Metabolic Diabetic ketoacidosis Note: Signs and Monitor vital signs closely acidosis Lactic acidosis symptoms depend on Monitor respiratory status ph <7.35 Hypoxemia the underlying cause closely (especially if patient HCO ^20 Respiratory or heart of the acidosis and is on 02 therapy meq1l failure (causing 1- tissue are nonspecific. Monitor blood gases and perfusion) Possible signs and report and abnormal values CO <23 E 'L Renal failure symptoms include: Correct underlying causes < mlq/ L Hyperaldosteronism Blurred Bicarbonate as ordered with Mp over ose Diarrhea vision severe cases Laxative overuse Tinnitus/ Monitor patient closely for Excessive intake of iron Vertigo complications if bicarbonate or aspirin Neurologic changes is given: Acetazolamide (headache, e Fluid overload confusion, coma) Hypokalemia Dyspnea '1' CO2 Tachypnea Tissue hypoxia Hyperpnea Alkalosis Hyperventilation (Continued)

252 Nursing FundamentaLs Demystified CHAPTER 1 Oral fluid replacement C Fluid restriction C Intravenous fluid therapy (Box 14-2) C Blood transfusion (Box 14-3) BOX 14-2 'Procedure Tip: Administering Intravenous FLuids tfr r ccjlij I]r Ij,ric Y1) )!Tr< ri1'lthir' j cj L 1ft:!J1 Yrrz)

CHAPTER 14/Fluid, ELectyte, and Acid-Base BaLance 2 53rC BOX 14-3 Procedure Tip: Administering a BLood Transfusion EVALUATION Evaluation of the patient's status and the effectiveness of interventions must be ongoing. To prevent the occurrence of life-threatening situations, the nurse must evaluate data accurately and respond quickly because excessive treatment of fluid, electrolyte, or acid-base imbalance can result in the occurrence of the opposite condition (eg, overcorrection of hyponatremia may cause hypematremia). Careful determination that treatment has been effective can