ALL ABOUT ELECTROLYTES

ELECTROLYTES ROLE:

WORK WITH FLUIDS TO KEEP THE BODY HEALTHY AND IN BALANCE.
SOLUTES THAT ARE FOUND IN VARIOUS CONCENTRATIONS AND
MEASURES IN TERMS OF MILLIEQUIVALENT (MEQ) UNITS ;

ABOUT CALCIUM

• Needed for blood clotting
• skeletal muscle contraction and nerve function
• forms and maintain healthy teeth and bones
• Absorbed in GI Tract & stored in the bones ; excreted by kidneys
• phosphorus and calcium affect each other in opposite way.

HYPOCALCEMIA X>8.6 MG/DL " LOW CALCIUM"

• Low parathyroid hormone
• Oral intake inadequate (alcoholism, bulimia etc.)
• Wound drainage
• Celiac and Crohn's disease
• Acute pancreatitis
• Low VIT D
• Chronic kidney issues
• Increased phosphorus in blood
• Using meds such as magnesium supplements, laxatives, loop diuretics , calcium binding drugs
• Mobility issues

S/S OF HYPOCALCEMIA

• Confusion
• Reflexes hyperactive
• Arrhythmias [ prolong QT and ST intervals]
• Muscle spasms
• Positive trousseau's
• Signs of chovestek

INTERVENTIONS FOR HYPOCALCEMIA

• Seizure precautions
• Increase dietary intake of calcium
• Monitor S/S such as vomiting, diarrhea, nervousness, weakness, paresthesias and muscle cramps in the face or fingers, headaches, dysphagia, abdominal pain
• Administer phosphate binding antacids, calciferol & VIT D per Doctor's order.
• Monitor serum calcium levels
• Administer calcium supplements per Doctor order

EVALUATION FOR HYPOCALEMIA

• The client’s calcium levels are normal
• Pt states signs and symptoms to be reported to the healthcare provider
• Pt demonstrates an understanding of the drug by accurately describing drug side effects and precautions

Untitled Slide

HYPERCALCEMIA CAUSES : X>5.2 MG/DL

• Hyperparathyroidism
• Prolonged immobilization
• Excessive intake of calcium carbonate antacids
• Malignant neoplastic disease

ASSESSING FOR HYPERCALCEMIA

• Ventricular dysrhythmias
• Shallow respirations
• Weak peripheral pulse
• Decreased deep tendon reflexes
• Anorexia , vomiting ,nausea
• Disorientation

INTERVENTIONS FOR HYPERCALCEMIA:

• Encourage fluids
• Calcitonin : decrease calcium level
• Ambulation
• Prevent the development of renal calculi by increasing fluid intake , maintain acidic urine, prevent UTI
• Prevent injury
• Cardiac monitoring

Untitled Slide

ABOUT PHOSPHATE

• Phosphate Normal serum phosphate level is 3.0-4.5 mg/dL - 80% is located in bones
• It functions in acid based balance with calcium
• PTH regulates the calcium and phosphate levels in our blood

HYPOPHOSPHATEMIA

CAUSES OF HYPOPHOSPHATEMIA

• use of aluminum hydroxide or magnesium based antacids,
• hyperparathyroidism
• hypercalcemia
• respiratory alkalosis
• Uncontrolled diabetes Mellitis
• Alcohol abuse
• Kidney failure

ACCESSING HYPOPHOSPHATEMIA

• hard to find peripheral pulses, decreased contractility, stroke volume, and cardiac output - weakness and fatigue -Rhabdomyolysis my be present by the presence of lumps and indentations on the bony areas of the body - CNS changes are not apparent until severe

INTERVENING HYPOPHOSPHATEMIA

• drugs that promote phosphate loss are discontinued
• oral supplements are given along with Vit D
• IV phosphorus is given when levels fall below 1mg/dL
• phosphorus rich foods : cocoa, dairy foods, sardines, deer and chicken liver, nuts, and beans.

HYPERPHOSPHATEMIA

CAUSES OF HYPERPHOSPHATEMIA

• kidney disease, certain cancer treatments, increased phosphorus consumption, hypoparathyoidism, DKA, crush injuries, and sepsis
• certain cancer treatments
• increased phosphorus consumption
• hypoparathyoidism
• DKA
• Crush injuries
• Sepsis

ASSESSING FOR HYPERPHOSPHATEMIA:

• Decrease phosphate levels
• hard to find peripheral pulses,
• decreased contractility, stroke volume , and cardiac output
• weakness and fatigue
• Rhabdomyolysis my be present by the presence of lumps and indentations on the bony areas of the body
• CNS changes isn't apparent until severe

PLANNING / IMPLEMENT

• diet low in high phosphorus foods ( AVOID fish, organ meats, nuts, pork, beef, chicken, whole grains
• drugs that may increase phosphate excretion include sevelamer (Renagel), and lanthanum (Fosrenol
• Avoid using phosphate medication such as laxatives and enema
• Prepare patient for dialysis if patient in renal failure

SODIUM ROLE

• Therapeutic levels: -Extracellular fluid is 136-146 mEq/L - Intracellular fluid is 9-14 mEq/dL - essential for skeletal muscle contractions, cardiac contraction, nerve impulse transmission ; Serum sodium balance is regulated by the kidney

CAUSES FOR HYPONATREMIA X

• diuretic usage, excessive diaphoresis, decreased secretion of aldosterone, hyperlipidemia, kidney disease, low salt diet, and hyperglycemia

ASSESSING HYPONATREMIA

• Cerebral changes
• Neuromuscular changes
• Gi changes
• Skeletal muscle changes
• Cardiovascular changes

INTERVENTIONS FOR HYPONATREMIA:

• Drug therapy and nutritional therapy are used to restore sodium levels ; Priorities include monitoring the patients response to therapy and preventing hypernatremia and fluid overload ; Drug therapy includes reducing use of diuretics, and IV saline infusion may be ordered

CAUSES OF HYPERNATREMIA:

• hyperaldosteronism, kidney failure, corticosteroids, Cushing syndrome or disease, excessive oral sodium consumption, excessive administration of sodium containing IV fluids

ACCESSING HYPERNATREMIA

• Nervous system changes
• Skeletal muscle changes
• Cardiovascular changes

INTERVENTION HYPERNATREMIA:

• Priorities include monitoring patients response to therapy and ensure patient safety by preventing hyponatremia and dehydration; Drug therapy is used to restore fluid balance ; Diuretics maybe used in those with poor kidney excretion

ABOUT POTASSIUM

• Potassium normal level ( 3.5- 5.1 mEq/l)milliequivalent

ASSESSING FOR HYPERKALEMIA X>5.1

• EKG changes- peak T waves, wide QRS complexes
• Dysrhythmias, ventricular fibrillation, heart block
• Cardiac block
• muscle twitching and weakness
• numbness in hands and feet and around the mouth
• nausea and vomiting

ASSESSING FOR SIGNS AND SYMPTOMS

• Anorexia,nausea, vomiting,weak peripheral pulse, muscle weakness, decreased deep tendon reflexes, impaired urine concentration,ventricular dysrhythmias,Potential for digitalis toxicity, shallow respiration.

PLANNING & INTERVENING :

• Patient will maintain normal serum electrolyte balance within Three weeks as evidence by potassium level of 3.5 to 5.1 mEq/L. Milliequivalent
• Administration of oral potassium supplements- dilute in juice and give with meals to avoid gastric irritation.
• Increase dietary intake
• IV supplements 20-40 mEq/L stop solutions immediately if burning occurs
• Risk for digitalis toxicity
• Access renal status prior to administration

EXPECTED OUTCOMES

• Maintain potassium level within normal limits (3.5 to 5.0 mEq/L). • Regain normal muscle strength. • Remain free of injury. • Verbalize understanding of the effects of diuretic therapy
• Report increase intake of potassium rich foods and fluid.

CAUSE OF HYPERKALEMIA

• Renal failure
• Use of potassium supplements
• Severe infections
• Burns
• Potassium sparing Diuretics
• Ace inhibitors
• Burns

NURSING DX OF HYPERKALEMIA

• Activity intolerance related to skeletal muscle weakness • Risk for decreased cardiac output related to hyperkalemia •

PLANNING / IMPLEMENTATIONS

• Monitor intake and output • Monitor serum potassium and ECG closely • Teach causes of hyperkalemia and the relationship between hemodialysis and hyperkalemia. • Discuss importance of avoiding foods high in potassium

EVALUATION

• Gradually resume usual physical activities. • Maintain serum potassium level within normal range.
• Muscle strength has returned to near normal. Patient's EKG and Serum potassium levels have returned to normal

ABOUT MAGNESIUM

• needed for proper muscle, nerve, and enzyme function; helps the body use energy ; needed to move other electrolytes (potassium and sodium) into and out of cells.
• Adult: 1.8-2.6 milligrams per deciliter (mg/dL) Child: 1.7-2.1 mg/dL (0.70-0.86 mmol/L) Newborn: 1.5-2.2 mg/dL (0.62-0.91 mmol/L)
• found in the bones and inside the cells.
• tiny amount of magnesium is normally present in the blood

ASSESSING FOR S/S OF HYPOMAGNESIUMEMIA

• ​Alcohol abuse or withdrawal ​•​Complications from diabetes, such as diabetic ketoacidosis ​•​High blood calcium levels (hypercalcemia) ​•​pancreatitis ​•​Kidney disease ​•​Long-term diarrhea ​•​Not getting enough magnesium in the foods you eat
• ​Pregnancy, especially in the second or 3rd trimester
• hypoparathyroidism

CAUSES OF MAGNESIUM

• CAUSES OF HYPERMAGNESEMIA
• Dehydration . • Diseases of the adrenal glands, such as Addison's disease . • An overactive parathyroid gland ( hyperparathyroidism ). • An underactive thyroid gland ( hypothyroidism ). • Kidney failure . • The use of medicine that contains magnesium, such as antacids and laxatives.

INTERVENING FOR HYPOMAGNESEMIA

• Monitor cardiac, GI, respiratory, neuro status.
• May administer potassium supplements due to hypokalemia
• Place patient in seizure precautions
• electrolyte levels like calcium and potassium
• Encourage magnesium rich foods

ASSESSING 4 HYPERMAGNESEMIA

• Diseases of the adrenal glands, such as Addison's disease. ​•​An overactive parathyroid gland (hyperparathyroidism). ​•​An underactive thyroid gland (hypothyroidism). ​•​Kidney failure. ​•​The use of medicine that contains magnesium, such as antacids and laxatives.

INTERVENING FOR HYPERMAGNESEMIA:

• Monitor cardiac, respiratory, neuro system, renal status. Put patient on cardiac monitor (watch for EKG changes) Ensure safety due to lethargic/drowsiness Prevention: Avoid giving Magnesium containing antacids/laxative to patients with renal failure Assess for hypermagnesemia during IV infusions of magnesium sulfate for hypomagnesemia (sign and symptom would be diminished/absent deep tendon reflexes) Withhold foods high in magnesium, such as:

FLUID DEFICIT

• NEUROLOGIC CHANGES: CONFUSION
• RESPIRATORY CHANGES: INCREASED RESPIRATORY RATE
• CARDIOVASCULAR CHANGES: HYPOTENSION, TACHYCARDIA, WEAK PERIPHERAL PULSES, NECK AND HAND VEINS ARE FLAT. SKIN CHANGES : POOR SKIN TURGOR, MUCOUS MEMBRANE DRY
• RENAL CHANGES: DECREASED URINE OUTPUT, CONCENTRATED URINE

FLUID OVERLOAD

• NEUROMUSCULAR CHANGES: ALTERED LEVEL OF CONSCIOUSNESS, HEADACHE, VISUAL DISTURBANCES, SKELETAL MUSCLE WEAKNESS, PARESTHESIAS
• RESPIRATORY-INCREASED RESPIRATORY RATE, SHALLOW RESPIRATIONS, SHORTNESS OF BREATH, CRACKLES
• CARDIOVASCULAR CHANGES- ^ PULSE , BOUNDING PULSE, ELEVATED BLOOD PRESSURE, DISTENDED NECK AND HAND VEINS, WEIGHT GAIN
• GI changes : INCREASED MOTILITY, ENLARGED LIVER

Untitled Slide

WE ARE NOW IN THERAPEUTIC RANGE 😍

Untitled Slide

Untitled Slide

Untitled Slide