1. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Medical Surgical Nursing Preparation for Practice CHAPTERCHAPTER Fluids and Electrolytes 18

2. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa LEARNING OBJECTIVE 1 Explain the normal composition of fluids and electrolytes in the body.

3. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Body Fluid Composition Compartments –ICF  Cell cytoplasm and nucleus –ECF  Serum and interstitial fluid  Cerebral spinal fluid  GI fluids

4. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Functions of Body Fluids Salivary enzymes Transport to body tissues: – Electrolytes – Oxygen – Nutrient – Hormones – Immune Cells

5. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Functions of Body Fluids Elimination of waste products –Bowel –Bladder Movement of electrolytes between ICF/ECF Temperature regulation –Perspiration –Capillary dilatation

6. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa LEARNING OBJECTIVE 2 Describe the normal osmolality of the blood and urine.

7. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Osmolality Number of solutes per kilogram of water –Isotonic –Hypertonic –Hypotonic

8. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Regulation of Body Fluids Osmosis –Movement of water Diffusion –Movement of molecules

9. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Osmosis & Diffusion

10. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Diffusion Molecule size Electrical charges Pressure gradient Active diffusion Passive diffusion

11. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Filtration Movement is result of hydrostatic pressure –Pressure of water on surrounding tissues –Created by heart action –Arterial pressure is greater than venous pressure Filtration is opposed by oncotic pressure Plasma proteins produce oncotic pressure

12. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa LEARNING OBJECTIVE 3 Evaluate fluid status of an adult according to normal fluid and electrolyte values.

13. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Evaluation of Fluid Status Osmolality –Normal is 275 – 295 mOsm/kg –Water deficit – >295 mOsm/kg –Water excess – <275 mOsm/kg –Multiply sodium x2

14. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Evaluation of Fluid Status Normal serum hematocrit –40 – 50% Dilute serum –Low hematocrit and electrolyte levels Concentrated serum –Elevated hematocrit and electrolyte levels

15. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Distribution of Body Fluids Overhydration: osmosis shifts water from blood to ICF and ECF ECF: lower extremity/sacral edema ICF: cellular edema Causes –Decreased renal excretion –Cirrhosis –Congestive heart failure

16. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Fluid Accumulation Can also occur in lung capillaries, alveoli –Crackles heard on auscultation –Decrease in gas exchange –Respiratory acidosis Accumulation in heart atria –S3 heart sound

17. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Dehydration Causes –Excessive urinary water loss –Hyperglycemia –Inadequate fluid intake –Diuretic overuse

18. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Dehydration and the Elderly Increased risks for dehydration –Decrease in thirst –Lack of fluid replacement –Use of diuretic medications for high BP –Susceptibility to contagious diseases

19. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Dehydration Thirst; dry mouth and tongue Tenting of skin Elevated temperature Orthostatic hypotension Tachycardia and weak pulse Mottled skin

20. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa LEARNING OBJECTIVE 4 Define the normal ranges of electrolytes in the body.

21. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Electrolytes Sodium Chloride Potassium Calcium Phosphorus Magnesium

22. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Sodium Most abundant cation in ECF Functions –ECF volume –Acid-base balance –Nerve impulse control Normal serum values –135-145 mEq/L

23. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Sodium Regulation Aldosterone –Sodium retention Antidiuretic hormone (ADH) –Water reabsorption Atrial natriuretic peptide (ANP) –Sodium excretion

24. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Potassium Intracellular cation Normal serum levels: 3.5 – 5.0 mEq/L Functions –Cellular integrity –Neuromuscular impulse transmission –Acid-base balance –Conversion of carbohydrate to energy –Formation of proteins

25. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Potassium Food sources include bananas, meat, potatoes Anabolic states –Stored in cells Catabolic states –Moves into blood Excreted via kidney and GI tract

26. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Calcium Cation found in both ICF and ECF but > in ECF. Normal serum levels: 8.5 – 10.5 mg/dL Neuromuscular transmission; muscle contraction Blood clotting; cell membrane function Found mainly in bones and teeth Exists in ionized and non-ionized forms –Acidosis and alkalosis

27. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Calcium Regulation Vitamin D –Calcium absorption Calcitonin –Inhibits resorption in bone –Inhibits renal excretion Parathyroid hormone –Mobilizes calcium from bone –Increases kidney reabsorption

28. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Magnesium Intracellular Cation Normal serum levels: 1.4 – 2.1 mg/dL Co-factor of enzymatic reactions Neuromuscular interactions Cardiac contractility Food sources

29. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Phosphorus Intracellular anion Normal serum levels: 1.5 – 2.5 mg/dL Needed for metabolism, nerve and muscle function Part of energy units Component of phospholipids Regulated by calcitonin, parathyroid hormone and Vitamin D

30. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Chloride Primary extracellular anion Normal serum levels: 95 – 108 mEq/L Creates electrical neutrality when combined with sodium Hydrochloric acid Buffers carbonic acid Anion gap - calculated AG = (Na + K) – (Cl + HC03 (metabolic acidosis)

31. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa LEARNING OBJECTIVE 4 Discuss various circumstances that place the patient at risk for fluid and electrolyte imbalances.

32. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes of Hypernatremia Deficit of water relative to sodium Causes –Excessive water losses  Sweating  Diabetes insipidus –Sodium retention  Cushing's syndrome

33. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Hypernatremia Thirst Low grade fever Edema Altered mental status Hypertension Weight gain Coma and seizures

34. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes of Hyponatremia Water retention Inadequate sodium intake Loss of sodium-rich fluid Excess use of 5% dextrose solution Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)

35. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Hyponatremia Depolarization and repolarization of cells Neurological symptoms –Lethargy –Headache –Personality changes –Seizures Permanent brain damage below 115 mEq/L

36. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Hyponatremia Fluid overload causes dilutional hyponatremia Symptoms: –Hypertension –Bounding pulse –Fluid retention –Weight gain

37. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes of Hyperkalemia Increased potassium intake –Inappropriate potassium supplementation Decreased urinary excretion of potassium –Acute and chronic renal failure –Potassium-sparing diuretic Cellular release of potassium

38. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestation of Hyperkalemia Muscle weakness and cramping ECG changes – peaked T waves Irregular pulse Irritability Abdominal distention and cramping Muscle weakness Paresthesia Diarrhea

39. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Hyperkalemia in Cardiac rhythm

40. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes of Hypokalemia Sweat, urinary and GI losses Diarrhea Decreased intake Increased insulin levels Cushing’s disease Stress Hypomagnesemia

41. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Hypokalemia Muscle weakness Cramps Nausea Vomiting Decreased bowel sounds Paresthesias ECG changes

42. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa ECG changes in hypokalemia

43. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes of Hypercalcemia Primary hyperparathyroidism –Calcium mobilization from bones Bone malignancy –Calcium liberation from bones Drug toxicity –Thiazide diuretics –Vitamin A and D

44. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Hypercalcemia Neuromuscular Renal Gastrointestinal Cardiovascular Musculoskeletal Eye and skin

45. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes of Hypocalcemia Reduced calcium intake or absorption Low parathyroid hormone Increased phosphorus Decreased magnesium Hypoalbuminemia Alkalosis

46. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Hypocalcemia Decreased cardiac contractility Neuromuscular symptoms Mental changes Pathological fractures Trousseau’s sign https://www.youtube.com/watch?v=H13yn9AwtPY&feature=relmfu https://www.youtube.com/watch?v=H13yn9AwtPY&feature=relmfu Chvostek sign https://www.youtube.com/watch?v=ep6IEqnyxJU https://www.youtube.com/watch?v=ep6IEqnyxJU

47. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes and Manifestation of Hypermagnesemia Causes –Renal failure –Treatment for pregnancy-induced HTN Manifestations –Decreased neuromuscular activity –Respiratory depression and cardiac arrest –Nausea, vomiting, drowsiness

48. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes of Hypomagnesemia Decrease in GI absorption –Excessive calcium absorption Malnutrition –Intake of phytates, oxalates and fat Increased kidney excretion –Diuresis –Alcoholism

49. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Manifestations of Hypomagnesemia More evident at serum levels <1 mg/dL –Confusion –Lethargy –Nausea and vomiting –Seizures and hyperactive reflexes –Cardiac symptoms – Torsades de Pointes

50. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa

51. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes and Manifestations of Hyperphosphatemia Causes –Decreased renal excretion –Excessive phosphate replacement –Extracellular shifts –Cellular destruction Manifestations –Calcium phosphate deposits –Hypocalcemia

52. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes and Manifestations of Hypophosphatemia Causes –Malabsorption, alcoholism, vitamin D deficiency –Excessive use of phosphate-binding agents Manifestations –Impaired neurological function –Hypoxia –Dysrhythmias

53. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes and Manifestations of Hyperchloremia Causes –Hyperparathyroidism, dehydration –Respiratory acidosis Manifestations –Lethargy, disorientation –Increased rate and depth of respirations

54. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Causes and Manifestations of Hypochloremia Causes –Loss of gastric fluid –Osmotic diuresis Manifestations –Reflects alkalosis –Paresthesias, muscle spasms, slow respirations –Dehydration

55. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa LEARNING OBJECTIVE 5 Identify nursing interventions to restore fluid and electrolyte balance.

56. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Fluid Imbalances Assessment of fluid imbalances –Dehydration –Overhydration Monitor weight, intake and output Monitor bowel patterns Collaboration with dietician

57. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hypernatremia Replace fluids slowly over 48 – 72 hours Sodium decrease no more than 0.5 – 1 mEq/L per hour Nursing interventions: –Close monitoring of BP, pulse, temperature, and sodium level –Assessment of level of consciousness, lethargy, headache, nausea and vomiting

58. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hyponatremia Depends on cause –Limit water intake –Provide sodium-replacing foods –Correct other electrolytes as needed –Hypertonic IV solutions used only in severe cases, only enough to correct symptoms

59. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hyperkalemia Assess for risk factors –Administer potassium-reducing agents –If these are insufficient, dialysis may be needed

60. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hypokalemia Correction of underlying cause –Oral and IV potassium replacement –Potassium-rich foods

61. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Intravenous Potassium Administration Indicated for low levels and cardiac symptom –Never administer IV push –Avoid rapid infusion –Diluted in normal saline –Determine urine output is adequate

62. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hypercalcemia Treatment of underlying causes –Normal saline to promote excretion –Bisphosphonates –Monitor for fluid overload –Avoid potential pathological fractures

63. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hypocalcemia Correction of hyperphosphatemia –IV calcium replacement  Avoid rapid administration  Determine if digitalis is taken –Magnesium supplementation –Calcium and vitamin D supplements

64. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hypermagnesemia Close assessment –Tendon reflexes –Respiratory status Discontinue products containing magnesium Normal saline and diuretics Calcium gluconate for levels above 8 – 10 mg/dL

65. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hypomagnesemia Parenteral magnesium supplements –Close monitoring to prevent overcorrection Oral magnesium supplements –Magnesium salts –Antacids –Food sources

66. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hyperphosphatemia Phosphorus-binding agents –Decrease phosphate absorption –Increase phosphate excretion Treatment of hypocalcemia

67. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hypophosphatemia Treat underlying causes High-phosphate diet Milk, eggs, beans, nuts, whole grains –Oral phosphorus supplements IV phosphate replacement only in severe cases or non-functioning bowel

68. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Nursing Interventions for Hyperchloremia/Hypochloremia Treat underlying causes and conditions Asessment –Metabolic acidosis –Metabolic alkalosis –Compensation of acid-base imbalances

69. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa LEARNING OBJECTIVE 6 Explain discharge teaching implications to assist patients to maintain fluid and electrolyte balance.

70. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Discharge Teaching for Hydration Maintain adequate hydration Recognize signs and symptoms Daily self-monitoring –Weight –Fluid intake –Urine output Signs and symptoms to report

71. Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Surgical Nursing: Preparation for Practice Kathleen S. Osborn | Annita Watson | Cheryl E. Wraa Discharge Teaching for Electrolyte Imbalances Causes Treatment Prevention of recurrences Knowledge of food sources