Electrolyte Electrolyte ImbalancesImbalances

Part VPart V

Peggy D. JohndrowPeggy D. Johndrow

20092009

HypophosphatemiaHypophosphatemia

Causes includeCauses include Malnourishment/malabsorptionMalnourishment/malabsorption Alcohol withdrawalAlcohol withdrawal Use of phosphate-binding antacidsUse of phosphate-binding antacids During parenteral nutrition with inadequate During parenteral nutrition with inadequate

replacementreplacement

Hypophosphatemia Clinical Hypophosphatemia Clinical ManifestationsManifestations

CNS depressionCNS depression Confusion Confusion Muscle weakness and painMuscle weakness and pain Dysrhythmias Dysrhythmias Cardiomyopathy Cardiomyopathy

Hypophosphatemia ManagementHypophosphatemia Management

Oral supplementationOral supplementation Ingestion of foods high in phosphorusIngestion of foods high in phosphorus May require IV administration of sodium May require IV administration of sodium

or potassium phosphate or potassium phosphate

Nursing DiagnosesNursing Diagnoses

Impaired physical mobility r/tImpaired physical mobility r/t Risk for bone injury r/tRisk for bone injury r/t Impaired gas exchange r/tImpaired gas exchange r/t Risk for falls r/tRisk for falls r/t Risk for decreased cardiac outputRisk for decreased cardiac output

Nursing ActionsNursing Actions

Monitor V/S, respiratory rate & depth Monitor V/S, respiratory rate & depth (assess S/S hypoxia)(assess S/S hypoxia)

Monitor lab valuesMonitor lab values Nutrition Therapy: increase foods high in Nutrition Therapy: increase foods high in

HPO4HPO4 Oral/IV if necessaryOral/IV if necessary Monitor ECGMonitor ECG Monitor Serum K+Monitor Serum K+ Salt substitutesSalt substitutes

Teach use of diuretics, laxatives, dietTeach use of diuretics, laxatives, diet

MagnesiumMagnesium 50-60% contained in bone50-60% contained in bone Coenzyme metabolism protein & Coenzyme metabolism protein &

carbohydrates carbohydrates Factors that regulate calcium balance Factors that regulate calcium balance

appear to influence magnesium balanceappear to influence magnesium balance Acts directly on myoneural junction Acts directly on myoneural junction Important for normal cardiac functionImportant for normal cardiac function

HypermagnesemiaHypermagnesemia

Causes includeCauses include Increased intake or ingestion of products Increased intake or ingestion of products

containing magnesium when renal containing magnesium when renal insufficiency or failure is present insufficiency or failure is present

Hypermagnesemia Clinical Hypermagnesemia Clinical ManifestationsManifestations

LethargyLethargy DrowsinessDrowsiness Somnolence Somnolence N/VN/V Reflexes impairedReflexes impaired Respiratory and cardiac arrest can occurRespiratory and cardiac arrest can occur

Hypermagnesemia ManagementHypermagnesemia Management

PreventionPrevention IV CaCl or calcium gluconateIV CaCl or calcium gluconate FluidsFluids

Nursing DiagnosesNursing Diagnoses

Risk for injury r/tRisk for injury r/t Risk for altered cardiac function r/tRisk for altered cardiac function r/t Risk for impaired gas exchangeRisk for impaired gas exchange Knowledge deficit r/tKnowledge deficit r/t

Nursing ActionsNursing Actions

Assess neuromuscular, V/S, S/S Assess neuromuscular, V/S, S/S Monitor serum Mg+ levels; ECGMonitor serum Mg+ levels; ECG Safety measuresSafety measures Teach: foods/medications high in MgTeach: foods/medications high in Mg