Chapter 13 And 15 Electrolyte Imbalance Part 1
- 1. Electrolyte Imbalances Part I Peggy D. Johndrow 2009
- 4. Sodium Major cation in extracellular fluid Imbalances typically associated with parallel changes in osmolality Sources: processed/preserved foods highest sodium (ham, bacon, pickles, tomato juice, canned soups), snacks often high (potatoes chips)
- 6. Hypernatremia Elevated serum sodium occurring with water loss or sodium gain Causes hyperosmolality leading to cellular dehydration Primary protection is thirst from hypothalamus
- 7. Hypernatremia Manifestations Include thirst, lethargy, red/swollen tongue; agitation, seizures, and coma If secondary to water deficiency, often results of impaired LOC Can be produced by clinical states such as central or nephrogenic diabetes insipidus
- 8. Nursing Diagnoses IW Bullets p 186 Risk for injury r/t Risk for sensory/perceptional alterations r/t Risk for fluid deficit r/t Risk for altered mucous membranes
- 9. Nursing Actions Oral fluids IV fluids/ tube feedings Assess changes in sensoruim, thirst, oral mucous membrane temperature I&O, daily weight Oral care Monitor foods & medications for Na+ content Assess changes in mental status Monitor serum Na+ & urine specific gravity
- 10. Hypernatremia Management Includes Treat underlying cause If oral fluids cannot be ingested, IV solution of 5% dextrose in water or hypotonic saline Diuretics Serum sodium levels must be reduced gradually to avoid cerebral edema
- 11. Hyponatremia Results from loss of sodium-containing fluids or from water excess Clinical manifestations include confusion, nausea, vomiting, seizures, and coma
- 12. Hyponatremia Management Cause water excess, fluid restriction needed Severe symptoms (seizures) occur, small amount of intravenous hypertonic saline solution (3% NaCl) given Associated with abnormal fluid loss, fluid replacement with sodium-containing solution needed
- 13. Nursing Diagnoses Risk for injury Risk for fluid volume excess Risk for sensory/perceptional alterations Risk for altered mucous membranes Altered thought processes Risk for impaired skin integrity
- 14. Nursing Actions Safety measures I&O (may be hourly), daily wt Assess for source of Na+ loss Monitor lab - Serum Na+, urine specific gravity Assess for third space loss Give food & fluids high in Na+ Assess for fluid overload; lung sounds, respiratory status, edema Care with cardiac & CV disease Assess mental status Neuro checks/LOC/orientation (monitor for seizures& V/S
Editor's Notes
- #3: Electrolytes - chemical substances that when dissolved in a solution form electrically charged particles (ions) Cations – (+) Na+, K+, Ca++, Mg ++ Anions – (-) Cl-, HcO3-, HPO4 -- Distribution – all present in ICF and ECF, but in different concentrations ECF – Large quantities of Na+, Cl-, Ca++, HCO3- ICF – Large quantities of K+. HPO4- -, Mg++
- #4: Sodium General facts Intake 6 gm/day – sources (cellular, dietary) Absorb GI Major cation (135-145 Meq/L); major determinant of osmolality (normal serum osmolality 280-300 mOsm/kg); primary regulator of ECF volume Conditions causing imbalance – excessive vomiting, failure to excrete Na; change in Cl ECF – any change in Na reflects body water imbalance Hypernatremia- > 145 mEq/L; excess of Na+ in ECF; hyperosmolar state in presence of fluid deficit. Etiology - lack of fluid intake, diarrhea, increased salt, profuse sweating, diabetes insipidus, increased loss of water, heart disease (CHF), renal disease (CRF) Lab tests Serum Na+; Serum osmolality; Urine specific gravity Therapeutic Management Treat underlying cause Restrict/limit Na; low Na foods/fluids With normal fluid; water replacement With hypovolemia; give NS initially to correct fluid deficit With hypervolemia, remove source of sodium, give diuretics and replace water as needed (loop and thiazide diuretrics) Decrease Na level gradually to decrease risk of cerebral edema Nursing Care Assess - S/S – thirst; red/dry/swollen tongue; increased T; neuro – disoriented, lethargy, irritable, seizures, hallucinations Nursing Diagnosis - Risk for injury r/t; Risk for sensory/perceptional alterations r/t; Risk for fluid deficit r/t; Risk for altered mucous membranes Nursing Actions Oral fluids IV fluids/ tube feedings Assess changes in sensoruim, thirst, oral mucous membrane temperature I&O, daily weight Oral care Monitor foods & medications for Na+ content Assess changes in mental status Monitor serum Na+ & urine specific gravity Client education Explanation of condition; include risk factors Medication therapy and possible side effects Dietary changes and possible fluid restrictions Teach to read labels for Na content S/S and what and when to report Need to monitor weight daily Hyponatremia - < 135 mEq/L; usually hypoosmolar state (more water than Na) Etiology - GI, renal, third space, skin losses, adrenal insufficiency (aldosterone), diuretics, low salt intake, increased body water, increased fluid intake (oral or IV), heart failure, nephrotic syndrome, cirrhosis;SIADH; medications- nicotine, oxytocin induction of labor; diabenase, morphine, barbiturates, isuprel, parenteral hypotonic fluids (D5W) Lab Tests - Serum Na +; Serum osmolality; Urine Na; Urine specific gravity Therapeutic Management Administer Na+ - oral, enteral (tube feeding), IV; if plasma volume below normal give NS or LR; if plasma volume normal or increased give small amts of 0.3 NS or .45 % NS; if severe Na deficit may give 3% saline-monitor carefully! Water retention -water restriction rather than give Na Restore normal ECF volume Correct any other electrolyte imbalances such as K or bicarbonate Nursing Care Assess - S/S-anorexia; N&V; muscle cramps; fatigue; DOE; postural B/P change; poor skin turgor; decreased veins; flushed skin; neuro- lethargy, weakness, confusion, hemiparesis; pitting edema with ICF excess; history to assess for risk factors (vomiting, diarrhea, eating disorders, low Na diet) and medications (diuretics) Nursing Diagnosis – Risk for fluid volume excess; risk for sensory/perceptional alterations; risk for injury; risk for altered mucous membranes; Altered mental status; risk for impaired skin integrity Nursing Actions Safety measures I&O (may be hourly), daily wt. Assess for source of Na+ loss Monitor lab - Serum Na+, urine specific gravity Assess for third space loss Give food & fluids high in Na+ Assess for fluid overload; lung sounds, respiratory status, edema Care with cardiac & CV disease Assess mental status Neuro checks/LOC/orientation (monitor for seizures& V/S Client education Explanation of condition Medication therapy and possible side effects Dietary changes and possible fluid restrictions S/S and what and when to report Need to monitor weight daily