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
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