1. Electrolyte Imbalance

6. Electrolytes are minerals:
regulate fluid balance and hormone production,
strengthen skeletal structures, and
act as catalysts in nerve response, muscle contraction, and the metabolism of nutrients.
Electrolytes may be (cations – magnesium, potassium, sodium, calcium) or (anions – phosphate, sulfate, chloride, bicarbonate)
Electrolytes are distributed between ICF and ECF

7. Reasons for Electrolyte Imbalances
Abnormalities occur when electrolyte concentrations are imbalanced between intercellular and extracellular fluids
Kidney Dysfunction
Lack of Water: Dehydration or Diarrhea
Medication Side Effects

8. Sodium Imbalances
Sodium (Na+) is the major electrolyte found in extracellular fluid.
It is essential for maintenance of acid-base balance, active and passive transport mechanisms, and maintaining irritability and conduction of nerve and muscle tissue.
Normal serum sodium levels are between 135 to 145 mEq/L.

9. Hyponatremia (<135mEq/L)
Net gain of water or loss of sodium-rich fluids
It leads to cellular edema
Contributing Factors
Excessive diaphoresis
Wound Drainage Diarrhea
NPO CHF Low salt diet
Renal Disease Diuretics
Compensatory mechanisms include the renal excretion of sodium-free water.

10. Cell in a hypotonic solution

11. Diagnostic Procedures and Nursing Interventions
Expected Findings
Serum sodium < 135 mEq/L
Serum osmolarity < 270 mOsm/L
Nursing Interventions
Report abnormal findings to the primary care provider

12. Assessment
Clinical indicators depend on whether it is associated with a normal, decreased, or increased ECF volume.
Vital signs: Hypothermia, tachycardia, thready pulse, hypotension, orthostatic hypotension

13. Hyponatremia (<135mEq/L)
Assessment findings:
Neuro - Generalized skeletal muscle weakness. Headache / confusion, fatigue, personality changes.
Resp.- Shallow respirations
CV - Cardiac changes depend on fluid volume
GI – Increased GI motility, Nausea, Diarrhea (explosive)
GU - Increased urine output

14. NANDA Nursing Diagnoses
Excess fluid volume
Deficient fluid volume
Impaired memory

15. Hyponatremia (<135mEq/L)
Interventions/Treatment
Restore Na levels to normal and prevent further decreases in Na.
Drug Therapy –
(FVD) - IV therapy to restore both fluid and Na. If severe may use 2-3% saline.
(FVE) – Administer osmotic diuretic (Mannitol) to excrete the water rather than the sodium.
Increase oral sodium intake and restrict oral fluid intake.

16. Foods High in Sodium Cheese Preserved meats Celery Soy sauce
Dried fruits
All prepared foods (canned and packaged) and fast foods are very high in sodium
Ketchup
Mustard
Olives
Pickles

17. Hyponatremia (<135mEq/L)
Monitor I & O and daily weight.
Monitor VS & LOC, report abnormal findings.
Encourage the client to change positions slowly.
Complications
Seizures, coma, and respiratory arrest
Seizure precautions and management
Life support interventions

18. Hypernatremia (>145mEq/L)
Hypernatremia is a serious electrolyte imbalance. It can cause significant neurological, endocrine, and cardiac disturbances.
Increased sodium causes hypertonicity of the serum.
This causes a shift of water out of the cells, making the cells dehydrated.

19. Cell in a hypertonic solution

20. Hypernatremia (>145mEq/L)
Contributing Factors
Hyperaldosteronism
Renal failure
Corticosteroids
Increase in oral Na intake
Na containing IV fluids
Decreased urine output with increased urine concentration

21. Hypernatremia (>145mEq/L)
Contributing factors (cont’d):
Diarrhea
Dehydration
Fever
Hyperventilation
Diaphoresis
Burn DI

22. Diagnostic Procedures and Nursing Interventions
Expected Findings
Serum sodium: Increased: > 145 mEq/L
Serum osmolarity: Increased: > 300 mOsm/L
Nursing Interventions
Report abnormal findings to the primary care provider.

23. Hypernatremia (>145mEq/L)
Assessment findings:
Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle weakness. Diminished deep tendon reflexes
Resp. – Pulmonary edema
CV – Diminished CO. HR and BP depend on vascular volume.
Compensatory mechanisms include increased thirst and increased production of
ADH.

24. Hypernatremia (>145mEq/L)
GU – Dec. urine output. Inc. specific gravity
Skin – Dry, flaky skin. Edema r/t fluid volume changes.
Vital signs: Hyperthermia, tachycardia, orthostatic hypotension
Other signs: Edema, warm flushed skin, oliguria

25. NANDA Nursing Diagnoses
Deficient fluid volume
Impaired memory
Risk for injury
Impaired oral mucous membrane

26. Hypernatremia (>145mEq/L)
Interventions/Treatment
Drug therapy
(FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.
Diet therapy: Mild – Ensure water intake and discourage sodium intake.
Monitor LOC and maintain client safety.
Provide oral hygiene.
Monitor intake and output and alert the primary care provider of inadequate renal output.

27. Hypernatremia Complications and Nursing Implications
Cellular dehydration, convulsions, and death
Seizure precautions and management
Life support interventions

29. Potassium The major cation in ICF.
It plays a vital role in cell metabolism, transmission of nerve impulses, functioning of cardiac, lung, and muscle tissues, and acid-base balance.
Potassium has reciprocal action with sodium.
Normal serum potassium levels are 3.5 to 5.0 mEq/L.

30. Hypokalemia (<3.5mEq/L)
Hypokalemia is the result of increased loss of potassium from the body or movement of potassium into the cells.
Pathophysiology –
Decrease in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli

31. Hypokalemia (<3.5mEq/L)
Contributing factors:
Diuretics Inadequate dietary intake
Shift into cells Suction
Digitalis
Water intoxication
Corticosteroids
Diarrhea
Vomiting
Laxatives
Wound drainage

32. Diagnostic Procedures and Nursing Interventions
Expected Findings
Serum potassium: Decreased: < 3.5 mEq/L
Arterial Blood Gases: Metabolic alkalosis: pH > 7.45
Electrocardiogram: Dysrhythmias
Nursing Interventions
Report abnormal findings to the primary care provider.

33. Assessment
VS: Hyperthermia, weak irregular pulse, hypotension, respiratory distress
Neuromusculoskeletal:(res.collapse & paralysis), muscle cramping, decreased muscle tone and hypoactive reflexes,
paresthesias, mental confusion
ECG: Premature ventricular contractions (PVCs), bradycardia, blocks, ventricular tachycardia

34. Assessment
GI: Decreased motility, abdominal distention, constipation, ileus, nausea, vomiting, anorexia
Other signs: Polyuria (dilute urine)

36. NANDA Nursing Diagnoses
Decreased cardiac output
Ineffective breathing pattern
Risk for injury
Constipation

37. Hypokalemia (<3.5mEq/L)
Interventions
Treat the cause
Encourage potassium-rich foods
K+ replacement (IV or PO)
Monitor lab values
D/c potassium-wasting diuretics
Monitor for breathing.
Monitor the client’s cardiac rhythm
Monitor LOC and maintain client safety.
Monitor bowel sounds and abdominal distention.

38. Foods Rich in Potassium
Artichokes(أرض شوكي)
Mushrooms
Apricots
Melons
Avocado
Nuts
Banana
Oranges
Beans
Prunes
Chocolate
Potatoes
Carrots
Pumpkins
Cantaloupe
Spinach
Green Leafy Veggies
Tomatoes

39. Administering potassium iv
IV potassium supplementation:
Never IV push (high risk of cardiac arrest).
The maximum recommended rate is 5 to 10 mEq/hr.
Monitor for phlebitis (tissue irritant).
Monitor for and maintain adequate urine output.

40. Complications and Nursing Implications
Respiratory Failure
Monitor for hypoxemia and hypercapnia.
Intubation and mechanical ventilation may be required.
Cardiac Arrest
Perform continuous cardiac monitoring.
Treat life-threatening dysrhythmias.

41. Hyperkalemia (>5.0mEq/L)
Hyperkalemia is the result of:
increased intake of potassium,
movement of potassium out of the cells, or
inadequate renal excretion.
Pathophysiology – An inc. in K+ causes increased excitability of cells.

42. Risk Factors/Causes of Hyperkalemia
Increased total body potassium: IV potassium administration, salt substitute.
Extracellular shift: Decreased insulin, acidosis (DKA), tissue catabolism (sepsis, trauma, surgery, fever, MI)
Hypertonic states: Uncontrolled diabetes
Decreased excretion of potassium: Renal failure, severe dehydration, potassium-sparing diuretics, ACE Inhibitors, NSAIDs, adrenal insufficiency

43. Diagnostic Procedures and Nursing Interventions
Expected Findings
Serum potassium: Increased: > 5.0 mEq/L
ABGs: Metabolic acidosis: pH < 7.35
Electrocardiogram: Dysrhythmias
Nursing Interventions
Report abnormal findings to the primary care provider.

44. Assessment: Hyperkalemia (>5.0mEq/L)
VS: Slow, irregular pulse, hypotension
Neuromusculoskeletal: Restlessness, irritability, weakness (ascending flaccid paralysis), paresthesias
ECG: Ventricular fibrillation
Gastrointestinal: N, V, D
Other signs: Oliguria

46. NANDA Nursing Diagnoses
Decreased cardiac output
Risk for injury
Diarrhea

47. Hyperkalemia (>5.0mEq/L)
Interventions
Need to restore normal K+ balance:
Eliminate K+ administration
Inc. K+ excretion: Lasix, Kayexalate
Promote movement of potassium from ECF to ICF:
Administer dextrose and R insulin IV Administer sodium bicarbonate (reverse acidosis).
Monitor the client’s cardiac rhythm and intervene promptly as needed.
Infuse glucose and insulin
Cardiac Monitoring

48. Complications and Nursing Implications
Cardiac Arrest
Perform continuous cardiac monitoring.
Treat life-threatening dysrhythmias.

50. Hypocalcemia (<9.0mg/dL)
Contributing factors:
Dec. oral intake
Lactose intolerance
Dec. Vitamin D intake
End stage renal disease
Diarrhea

51. Hypocalcemia (<9.0mg/dL)
Contributing factors (cont’d):
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid gland
Malabsorption
Post thyroidectomy

52. Hypocalcemia (<9.0mg/dL)
Assessment findings:
Neuro –Irritable muscle twitches.
Muscle twitches/tetany
Frequent, painful muscle spasms at rest
Hyperactive deep tendon reflexes
Positive Trousseau’s sign (hand/finger spasms with sustained BP cuff inflation).
Positive Chvostek’s sign (tap on facial nerve triggers facial twitching)

53. Positive Trousseau’s Sign

54. Positive Chvostek’s Sign

55. Assessment Resp. – Resp. failure d/t muscle tetany. Cardiovascular
Decreased myocardial contractility: Decreased heart rate and hypotension
ECG changes: Prolonged QT interval
GI: Hyperactive bowel sounds, diarrhea, abdominal cramping

56. Hypocalcemia (<9.0mg/dL)
Interventions/Treatment
Drug Therapy
Calcium supplements
Vitamin D
Diet Therapy
High calcium diet
Prevention of Injury
Seizure precautions

57. Foods High in Calcium Cheese Okra Milk
Calcium fortified foods (such as some orange juice, oatmeal, and breakfast cereals )
Broccoli
Yogurt
Sardines
White beans
Mustard
Almonds
Dark Greens (spinach, collards الملفوف , etc.)
Sesame Seeds
Soybeans

58. Hypercalcemia (>10.5mg/dL)
Contributing factors:
Excessive calcium intake
Excessive vitamin D intake
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism

59. Hypercalcemia (>10.5mg/dL)
Assessment findings:
Neuro – Disorientation, lethargy, coma, profound muscle weakness
Resp. – Ineffective resp. movement
CV - Inc. HR, Inc. BP. , Bounding peripheral pulses, Positive Homan’s sign.
Late Phase – Bradycardia, Cardiac arrest
GI – Dec. motility. Dec. BS. Constipation
GU – Inc. urine output. Formation of renal calculi

60. Hypercalcemia (>10.5mg/dL)
Interventions/Treatment
Eliminate calcium administration
Drug Therapy
Isotonic NaCL (Inc. the excretion of Ca)
Diuretics
Calcium reabsorption inhibitors (Phosphorus)
Cardiac Monitoring