Electrolyte Imbalance

1. Electrolyte Imbalance

6. Electrolytes are minerals: • regulate fluid balance and hormone production, • strengthen skeletal structures, and • act as catalysts in nerve response, muscle contraction, and the metabolism of nutrients. • Electrolytes may be (cations – magnesium, potassium, sodium, calcium) or (anions – phosphate, sulfate, chloride, bicarbonate) • Electrolytes are distributed between ICF and ECF

7. Reasons for Electrolyte Imbalances Abnormalities occur when electrolyte concentrations are imbalanced between intercellular and extracellular fluids Kidney Dysfunction Lack of Water: Dehydration or Diarrhea Medication Side Effects

8. Sodium Imbalances Sodium (Na+) is the major electrolyte found in extracellular fluid. It is essential for maintenance of acid-base balance, active and passive transport mechanisms, and maintaining irritability and conduction of nerve and muscle tissue. Normal serum sodium levels are between 135 to 145 mEq/L.

9. Hyponatremia (<135mEq/L) • Net gain of water or loss of sodium-rich fluids • It leads to cellular edema • Contributing Factors • Excessive diaphoresis • Wound Drainage - Diarrhea • NPO - CHF - Low salt diet • Renal Disease - Diuretics • Compensatory mechanisms include the renal excretion of sodium-free water.

10. Cell in a hypotonic solution

11. Diagnostic Procedures and Nursing Interventions • Expected Findings • Serum sodium < 135 mEq/L • Serum osmolarity< 270 mOsm/L • Nursing Interventions • Report abnormal findings to the primary care provider

12. Assessment Clinical indicators depend on whether it is associated with a normal, decreased, or increased ECF volume. Vital signs: Hypothermia, tachycardia, thready pulse, hypotension, orthostatic hypotension

13. Hyponatremia (<135mEq/L) • Assessment findings: • Neuro - Generalized skeletal muscle weakness. Headache / confusion, fatigue, personality changes. • Resp.- Shallow respirations • CV - Cardiac changes depend on fluid volume • GI – Increased GI motility, Nausea, Diarrhea (explosive) • GU - Increased urine output

14. NANDA Nursing Diagnoses Excess fluid volume Deficient fluid volume Impaired memory

15. Hyponatremia (<135mEq/L) • Interventions/Treatment • Restore Na levels to normal and prevent further decreases in Na. • Drug Therapy – • (FVD) - IV therapy to restore both fluid and Na. If severe may use 2-3% saline. • (FVE) – Administer osmotic diuretic (Mannitol) to excrete the water rather than the sodium. • Increase oral sodium intake and restrict oral fluid intake.

16. Foods High in Sodium Cheese Celery Dried fruits Ketchup Mustard Olives Pickles Preserved meats Soy sauce All prepared foods (canned and packaged) and fast foods are very high in sodium

17. Hyponatremia (<135mEq/L) • Monitor I & O and daily weight. • Monitor VS & LOC, report abnormal findings. • Encourage the client to change positions slowly. • Complications • Seizures, coma, and respiratory arrest • Seizure precautions and management • Life support interventions

18. Hypernatremia (>145mEq/L) Hypernatremia is a serious electrolyte imbalance. It can cause significant neurological, endocrine, and cardiac disturbances. Increased sodium causes hypertonicity of the serum. This causes a shift of water out of the cells, making the cells dehydrated.

19. Cell in a hypertonic solution

20. Hypernatremia (>145mEq/L) • Contributing Factors • Hyperaldosteronism • Renal failure • Corticosteroids • Increase in oral Na intake • Na containing IV fluids • Decreased urine output with increased urine concentration

21. Hypernatremia (>145mEq/L) • Contributing factors (cont’d): • Diarrhea • Dehydration • Fever • Hyperventilation • Diaphoresis • Burn • DI

22. Diagnostic Procedures and Nursing Interventions • Expected Findings • Serum sodium: Increased: > 145 mEq/L • Serum osmolarity: Increased: > 300 mOsm/L • Nursing Interventions • Report abnormal findings to the primary care provider.

23. Hypernatremia (>145mEq/L) • Assessment findings: • Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle weakness. Diminished deep tendon reflexes • Resp. – Pulmonary edema • CV – Diminished CO. HR and BP depend on vascular volume. • Compensatory mechanisms include increased thirst and increased production of • ADH.

24. Hypernatremia (>145mEq/L) GU – Dec. urine output. Inc. specific gravity Skin – Dry, flaky skin. Edema r/t fluid volume changes. Vital signs: Hyperthermia, tachycardia, orthostatic hypotension Other signs: Edema, warm flushed skin, oliguria

25. NANDA Nursing Diagnoses Deficient fluid volume Impaired memory Risk for injury Impaired oral mucous membrane

26. Hypernatremia (>145mEq/L) • Interventions/Treatment • Drug therapy • (FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics. • Diet therapy: Mild – Ensure water intake and discourage sodium intake. • Monitor LOC and maintain client safety. • Provide oral hygiene. • Monitor intake and output and alert the primary care provider of inadequate renal output.

27. Hypernatremia • Complications and Nursing Implications • Cellular dehydration, convulsions, and death • Seizure precautions and management • Life support interventions

29. Potassium The major cation in ICF. It plays a vital role in cell metabolism, transmission of nerve impulses, functioning of cardiac, lung, and muscle tissues, and acid-base balance. Potassium has reciprocal action with sodium. Normal serum potassium levels are 3.5 to 5.0 mEq/L.

30. Hypokalemia (<3.5mEq/L) • Hypokalemia is the result of increased loss of potassium from the body or movement of potassium into the cells. • Pathophysiology – • Decrease in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli

31. Hypokalemia (<3.5mEq/L) • Contributing factors: • Diuretics - Inadequate dietary intake • Shift into cells - Suction • Digitalis • Water intoxication • Corticosteroids • Diarrhea • Vomiting • Laxatives • Wound drainage

32. Diagnostic Procedures and Nursing Interventions • Expected Findings • Serum potassium: Decreased: < 3.5 mEq/L • Arterial Blood Gases: Metabolic alkalosis: pH > 7.45 • Electrocardiogram: Dysrhythmias • Nursing Interventions • Report abnormal findings to the primary care provider.

33. Assessment VS: Hyperthermia, weak irregular pulse, hypotension, respiratory distress Neuromusculoskeletal:(res.collapse & paralysis), muscle cramping, decreased muscle tone and hypoactive reflexes, paresthesias, mental confusion ECG: Premature ventricular contractions (PVCs), bradycardia, blocks, ventricular tachycardia

34. Assessment GI: Decreased motility, abdominal distention, constipation, ileus, nausea, vomiting, anorexia Other signs: Polyuria (dilute urine)

36. NANDA Nursing Diagnoses Decreased cardiac output Ineffective breathing pattern Risk for injury Constipation

37. Hypokalemia (<3.5mEq/L) • Interventions • Treat the cause • Encourage potassium-rich foods • K+ replacement (IV or PO) • Monitor lab values • D/c potassium-wasting diuretics • Monitor for breathing. • Monitor the client’s cardiac rhythm • Monitor LOC and maintain client safety. • Monitor bowel sounds and abdominal distention.

38. Foods Rich in Potassium Artichokes(أرض شوكي) Apricots Avocado Banana Beans Chocolate Carrots Cantaloupe Green Leafy Veggies Mushrooms Melons Nuts Oranges Prunes Potatoes Pumpkins Spinach Tomatoes

39. Administering potassium iv IV potassium supplementation: Never IV push (high risk of cardiac arrest). The maximum recommended rate is 5 to 10 mEq/hr. Monitor for phlebitis (tissue irritant). Monitor for and maintain adequate urine output.

40. Complications and Nursing Implications • Respiratory Failure • Monitor for hypoxemia and hypercapnia. • Intubation and mechanical ventilation may be required. • Cardiac Arrest • Perform continuous cardiac monitoring. • Treat life-threatening dysrhythmias.

41. Hyperkalemia (>5.0mEq/L) • Hyperkalemia is the result of: • increased intake of potassium, • movement of potassium out of the cells, or • inadequate renal excretion. • Pathophysiology – An inc. in K+ causes increased excitability of cells.

42. Risk Factors/Causes of Hyperkalemia Increased total body potassium: IV potassium administration, saltsubstitute. Extracellular shift: Decreased insulin, acidosis (DKA), tissue catabolism (sepsis, trauma, surgery, fever, MI) Hypertonic states: Uncontrolled diabetes Decreased excretion of potassium: Renal failure, severe dehydration, potassium-sparing diuretics, ACE Inhibitors, NSAIDs, adrenal insufficiency

43. Diagnostic Procedures and Nursing Interventions • Expected Findings • Serum potassium: Increased: > 5.0 mEq/L • ABGs: Metabolic acidosis: pH < 7.35 • Electrocardiogram: Dysrhythmias • Nursing Interventions • Report abnormal findings to the primary care provider.

44. Assessment: Hyperkalemia (>5.0mEq/L) • VS: Slow, irregular pulse, hypotension • Neuromusculoskeletal: Restlessness, irritability, weakness (ascending flaccid paralysis), paresthesias • ECG: Ventricular fibrillation • Gastrointestinal: N, V, D • Other signs: Oliguria

46. NANDA Nursing Diagnoses Decreased cardiac output Risk for injury Diarrhea

47. Hyperkalemia (>5.0mEq/L) • Interventions • Need to restore normal K+ balance: • Eliminate K+ administration • Inc. K+ excretion: Lasix, Kayexalate • Promote movement of potassium from ECF to ICF: • Administer dextrose and R insulin IV Administer sodium bicarbonate (reverse acidosis). • Monitor the client’s cardiac rhythm and intervene promptly as needed. • Infuse glucose and insulin • Cardiac Monitoring

48. Complications and Nursing Implications Cardiac Arrest Perform continuous cardiac monitoring. Treat life-threatening dysrhythmias.

50. Hypocalcemia (<9.0mg/dL) • Contributing factors: • Dec. oral intake • Lactose intolerance • Dec. Vitamin D intake • End stage renal disease • Diarrhea