Electrolyte Electrolyte ImbalancesImbalances

Part IPart I

Peggy D. JohndrowPeggy D. Johndrow

20092009

SodiumSodium Major cation in extracellular fluidMajor cation in extracellular fluid Imbalances typically associated with parallel Imbalances typically associated with parallel

changes in osmolality changes in osmolality Sources: processed/preserved foods highest Sources: processed/preserved foods highest

sodium (ham, bacon, pickles, tomato juice, sodium (ham, bacon, pickles, tomato juice, canned soups), snacks often high (potatoes canned soups), snacks often high (potatoes chips)chips)

Sodium-Potassium PumpSodium-Potassium Pump

HypernatremiaHypernatremia

Elevated serum sodium occurring with Elevated serum sodium occurring with water loss or sodium gainwater loss or sodium gain

Causes hyperosmolality leading to Causes hyperosmolality leading to cellular dehydration cellular dehydration

Primary protection is thirst from Primary protection is thirst from hypothalamus hypothalamus

Hypernatremia ManifestationsHypernatremia Manifestations

Include thirst, lethargy, red/swollen Include thirst, lethargy, red/swollen tongue; agitation, seizures, and comatongue; agitation, seizures, and coma

If secondary to water deficiency, often If secondary to water deficiency, often results of impaired LOCresults of impaired LOC

Can be produced by clinical states such Can be produced by clinical states such as central or nephrogenic diabetes as central or nephrogenic diabetes insipidusinsipidus

Nursing DiagnosesNursing Diagnoses

IW Bullets p 186IW Bullets p 186 Risk for injury r/tRisk for injury r/t Risk for sensory/perceptional alterations Risk for sensory/perceptional alterations

r/tr/t Risk for fluid deficit r/tRisk for fluid deficit r/t Risk for altered mucous membranesRisk for altered mucous membranes

Nursing ActionsNursing Actions

Oral fluidsOral fluids IV fluids/ tube feedingsIV fluids/ tube feedings Assess changes in sensoruim, thirst, oral Assess changes in sensoruim, thirst, oral

mucous membrane temperaturemucous membrane temperature I&O, daily weightI&O, daily weight Oral careOral care Monitor foods & medications for Na+ contentMonitor foods & medications for Na+ content Assess changes in mental statusAssess changes in mental status Monitor serum Na+ & urine specific gravityMonitor serum Na+ & urine specific gravity

Hypernatremia ManagementHypernatremia Management

IncludesIncludes Treat underlying causeTreat underlying cause If oral fluids cannot be ingested, IV solution If oral fluids cannot be ingested, IV solution

of 5% dextrose in water or hypotonic salineof 5% dextrose in water or hypotonic saline Diuretics Diuretics

Serum sodium levels must be reduced Serum sodium levels must be reduced gradually to avoid cerebral edemagradually to avoid cerebral edema

HyponatremiaHyponatremia

Results from loss of sodium-containing Results from loss of sodium-containing fluids or from water excessfluids or from water excess

Clinical manifestations include confusion, Clinical manifestations include confusion, nausea, vomiting, seizures, and comanausea, vomiting, seizures, and coma

Hyponatremia ManagementHyponatremia Management

Cause water excess, fluid restriction neededCause water excess, fluid restriction needed Severe symptoms (seizures) occur, small Severe symptoms (seizures) occur, small

amount of intravenous hypertonic saline amount of intravenous hypertonic saline solution (3% NaCl) givensolution (3% NaCl) given

Associated with abnormal fluid loss, fluid Associated with abnormal fluid loss, fluid replacement with sodium-containing solution replacement with sodium-containing solution neededneeded

Nursing DiagnosesNursing Diagnoses

Risk for injuryRisk for injury Risk for fluid volume excessRisk for fluid volume excess Risk for sensory/perceptional alterationsRisk for sensory/perceptional alterations Risk for altered mucous membranesRisk for altered mucous membranes Altered thought processesAltered thought processes Risk for impaired skin integrityRisk for impaired skin integrity

Nursing ActionsNursing Actions Safety measuresSafety measures I&O (may be hourly), daily wtI&O (may be hourly), daily wt Assess for source of Na+ lossAssess for source of Na+ loss Monitor lab - Serum Na+, urine specific gravityMonitor lab - Serum Na+, urine specific gravity Assess for third space lossAssess for third space loss Give food & fluids high in Na+Give food & fluids high in Na+ Assess for fluid overload; lung sounds, respiratory Assess for fluid overload; lung sounds, respiratory

status, edemastatus, edema Care with cardiac & CV diseaseCare with cardiac & CV disease Assess mental statusAssess mental status Neuro checks/LOC/orientation (monitor for Neuro checks/LOC/orientation (monitor for

seizures& V/Sseizures& V/S