Electorlyte Imbalances

3.5 to 5

Serum K+ below 3.5

1. Decreased intake of K+
2. GI loss - Vomiting, diarrhea, NG suction
3. Alkalosis
4. Excessive renal excretion - diuretics
5. Steriod therapy
6. Diabetics - Due to insulin and glucose

1. Fatigue, muscle weakness, cramps
2. Decreased muscle tone & reflexes
3. Confusion, drowsiness, fatigue
4. Tachycardia, weak irregular pulse
5. Decreased bowel sounds, development of ileus, nausea, vomiting

1. T waves - flat/inverted
2. ST segment - depressed and prolonged
3. U Wave - present
4. PVCs

1. Encourage foods high in K+
2. Replace K+ (oral or IV)
3. Maintain accurate I/O
4. Evaluate for alkalosis
5. Provide cliet education regarding diuretics
6. Admin K+ Supplements
7. Monitor for digitalis toxicity

Serum K+ above 5.0

1. Decreased urinary excretion - Renal failure
2. Massive tissue injury - burns, trauma
3. Excesive IV admin of K+
4. Acidosis

1. Drowsiness
2. Irritability, anxiety
3. Muscle weakness to flaccid paralysis in LE
4. Irregular pulse, ventricular tachycardia, cardiac arrest

1. Peaked T waves
2. Prolonged PR intervals
3. Widened QRS complex

1. Administer diuretics - if renal function is adequate
2. Administer hypertonic glucose and insulin - to move K+ into cell
3. Utilize exchange resins - Kayexalate
4. Admin sodium bicarb - if acidotic
5. Be prepared for cardiac emergency
6. Maintain accurate I/O

1. Oral - Potassium chloride (KCl)
2. Sustained Release - K-Dur, Potassium gluconate
3. IV - Potassium

1. Give oral preparation with full glass of water/juice - Decreases GI upset
2. Ensure urinating adequately before starting admin
3. Parenteral K+ must be diluted and administered by IV drip
4. Do not give K+ IM or by IV push
5. IV K+ is irritating to the vein. If pain occurs, slow infusion rate or dilute solution in larger fluid volume
6. Admin with caution to clients with heart disease or taking digitalis preparations

135 to 145 mEq/L

Serum Na below 135

1. Inadequate Na+ intake
2. Loss of sodium-rich fluids
3. Cystic Fibrosis
4. Fluid gain
5. Decreased renal excretion - due to diuretics, adrenal insufficiency, increased ADH

1. Edema
2. Excessive administration of D5W
3. Overhydration
4. Excessive sweating
5. GI losses
6. DKA
7. Massive tissue injury - burns, trauma

1. CNS problems - Changes in LOC, confusion, seizures
2. Weakness, restlessness
3. Oliguria
4. Abdominal cramps
5. Postural hypotension
6. Flushed skin

1. CNS Problems - Confusion, headache, seizures
2. Hypertension
3. Muscle twitching, cramping
4. Increased urine

1. Maintain accurate I/O and obtain daily weight
2. Irrigate NG tubes w/ Normal Saline
3. Administer Normal Saline IV or 1/2 NS if client has sodium deficit
4. Restrict fluid intake if client has fluid excess
5. Carefully monitor clients recieving D5W

Serum sodium > 145

1. Decreased fluid intake
2. Excessive salt intake
3. Increased renal retention - i.e., renal disease
4. Cushing's syndrome

1. Pitting edema
2. Weight gain
3. Lethargic
4. Decreased hematocrit (below 36%)

1. Concentrated urine
2. Dry mucous membranes
3. Flushed skin
4. Tachycardia
5. Increased temperature
6. Decreased CVP

1. Maintain accurate I/O and daily weight
2. Administer D5W IV - if fluid is normal or there is a deficit
3. Administer diuretics to remove excess Na+
4. Restrict fluid intake - if client has fluid excess
5. Assess for cerebral edema-- Lethargy, headache, nausea, vomiting, increased BP

1. Sodium Chloride (table salt)
2. Saline solutions - 0.9% and 0.45% saline solutions

1. Admin with caution in clients w/ CHF, renal problems, edema, or hypertension
2. Determine daily wt and maintain accurate I/O - Evaluates for fluid retention
3. Evaluate serum Na+ levels

9 to 11 mg/dL

Serum calcium < 9 mg/dL

1. Acute pancreatitis
2. Dietary lack of Ca+ and vitamin D
3. Hypoparathyroidism
4. Hyperphosphatemia
5. Excessive transfuion of citrated blood or IV fluids
6. Alkalosis

1. Tetany: + Chvostek's or Trousseau's signs
2. Neuromuscular irritability
3. Numbness and tingling of extremities
4. Seizures
5. Abdominal cramping, distention
6. Hyperreflexia
7. Dysrhythmias

Contraction of the finger and hand, when a BP cuff is kept inflated on the upper arm for 5 minutes at diastolic pressure. Sign of hypocalcemia.

Spasm of the muscles inervated by the facial nerve when the client's face is tapped lightly below the temple. Sign of hypocalcemia.

1. Keep Ca+ replacement meds easily accessible for clients who have had thyroid or parathyroid surgically removed
2. Assess for tetany
3. Reduce environmental stimuli
5. Institute seizure precautions

Serum calcium > 11 mg/dL

1. Metastatic malignancy
2. Hyperparathyroidism
3. Thiazide diuretics
4. Prolonged immobilization

1. Anorexia, nausea, constipation
2. CNS depression
3. Decreasing muscle tone, coordination
4. Renal calculi
5. Pathological fractures
6. Dysrhythmias

1. Administer loop diuretics - Facilitates removal of excess Ca+
2. Increase fluid intake to 3000 to 4000 mL/day - decreases calculi formation
3. Encourage client mobility
4. Assess client taking digitalis for toxicity
5. Increase fiber intake

1. Calcium citrate: PO
2. Calcium gluconate: PO, IV
3. Calcium carbonate: PO

1. Give with Vitamin D to enhance absorption
2. Take PO 1/2 to 1 hour after meals
3. Prevent IV infiltration - can cause tissue hypoxia and sloughing
4. Do not add Ca+ to solutions containing carbonates or phosphates
5. Use w/ caution in client getting digitalis
6. Monitor infusion rate - sudden increase in serum Ca+ may precipitate severe dysrhythmias

1. Dairy products: cheese - ice cream - milk - yogurt
2. Instant oatmeal
3. Rhubarb
4. Spinach
5. Tofu

1. Apples, bananas
2. Chicken
3. Hamburger
4. Cooked oatmeal
5. Pasta
6. Vegetable juices

1. Fish (not shellfish)
2. Whole grains, nuts
3. Beverages: brewed coffee - tomato juice - fruit juice

1. Artichokes
2. Broccoli
3. Brussel sprouts, cabbage
4. Carrots
5. Celery
6. Cucumber
7. Mushrooms
8. Potatoes WITH skins
9. Spinach
10. Tomatoes

1. Apricots
2. Banana
3. Cantaloupe, honeydew melon
4. Orange
5. Prunes
6. Strawberries
7. Tangerines, nectarines
8. Water-melon

1. Vegetables: corn - sweet potato - lima beans - french fried potatoes
2. Fruits: apples - blueberries - cranberries
3. Beverages: instant coffee - cola - ginger ale - noncarbonated drinks - cranberry & apple juice

1. Breads
2. Cereals - most instant hot and cold cereals
3. Chips
4. Cheeses
5. Meats: sausage - luncheon - frankfurters - bacon - ham
6. Convenience foods: pizza - pot pies - ravioli - soups

1. Fruits - fresh, frozen, or canned
2. Vegetables - fresh, frozen, or canned
3. Cooked oatmeal
4. Puffed rice
6. Shreaded wheat
7. Fresh meat, chicken, fish