ATI Notes - Electrolyte imbalances PDF

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notes on electrolyte imbalances ...

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Electrolyte imbalances: Hyponatremia: sodium below 136 mEq/L        

If hypervolemic with hyponatremia, palpate for a bounding pulse Vitals: hypothermia, tachycardia (rapid thready pulse), orthostatic hypotension, diminished peripheral pulses. Can vary based on state of extracellular fluid Neuro: HA, confusion, lethargy, muscle weakness to the point of possible respiratory compromise, fatigue, decreased DTR, seizures, lightheaded, dizzy GI: increased motility, hyperactive bowel sounds, abdominal cramping, nausea Replacement should not exceed 12 mEq/L in 24 hour period Give LR and 0.9% isotonic saline Hypertonic sodium solution may be used to decreased cerebral edema Watch for coma, seizures, respiratory arrest

Hypernatremia:       

Risk factors: DM, steroids, Burns, kidney failure, Cushings Significant neuro, endocrine, and cardiac disturbances THIRST Vitals: hyperthermia, tachycardia, orthostatic hypotension Neuro: restlessness, irritability, muscle twitching to the point of muscle weakness, including respiratory compromise, decreased or absent DTR, seizures, coma GI: dry mucous membranes, N/V/D, anorexia Report gain of 1-2 lbs in 24 hours or 3lbs in 1 week

Hypokalemia:         

Risk factors: Cushings, diuretics, steroids, loss via GI tract, kidney disease Vitals: hypotension, thready weak pulse Neuro: altered mental status, anxiety, lethargy that progresses to acute confusion, and coma ECG: flattened T wave, prominent U waves, ST depression, prolonged PR interval GI: hypoactive bowel sounds, N/V, constipation, abdominal distension, paralytic ileus Muscular: weak, DTR reduced Respiratory: swallow breathing Never give by IV, IM, or SubQ. Oral supplements only Watch for respiratory failure and cardiac arrest

Hyperkalemia:       

Vitals: hypotension, slow irregular pulse Neuro: restlessness, irritability, weakness to the point of ascending flaccid paralysis, paresthesia ECG: premature ventricular contractions, v-fib, peaked t-wave, and widened QRS GI: increased motility, diarrhea, hyperactive bowel sounds Oliguria Hct/Hgb increased with dehydration and decreased with kidney failure Priority: assess for cardiac complications and falls

Hypocalcemia:   

    

Less than 9.0 mg/dL Tetany most common finding Symptoms: Paresthesia of the fingers and lips, muscle twitching, seizures, Charley Horses, Positive Chvostek’s sign (tapping on facial nerve triggering facial twitching), and positive trousseau’s sign (hand/finger spasms with sustained blood pressure cuff inflation) CV: prolonged QT interval, risk of torsades de pointes, decreased myocardial contractility GI: hyperactive bowel sounds, diarrhea, and abdominal cramps Vitamin D supplements enhance absorption of calcium If administration of bolus required dilute in 5% dextrose with water and use infusion pump Encourage Calcium rich foods: milk, yogurt, greens, canned salmon, sardines, oysters

Hypomagnesemia:       

Less than 1.3 mg/dL Risk factors: celiac disease, Crohn’s disease, malnutrition, diarrhea Possible depressed mood, apathy, agitation Neuro: increased nerve impulse transmission  hyperactive DTR, paresthesia’s, muscle tetany, seizures. Also, positive Chvostek’s and Trousseau’s sign GI: hypoactive bowel sounds, constipation, abdominal distension, paralytic ileus IV route is used instead of IM but do not exceed 150mg/minute Foods high in magnesium: dark green veggies, nuts, whole grains, seafood, peanut butter, cocoa...