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Na+ normal values
135 mEq/L to 145 mEq/L
Hyponatremia etiology
* Extracellular deficit (sweat,vomit,diarrhea)* Burns* Nasogastric suction* CHF, cirrhosis* Thiazide diuretics*Impaired renal function
Hyponatremia, clinical manifestation
* Dehydration* Weakness* Confusion* Orthostatic hypotension* Tachycardia* Crackles in lungs
Hyponatremia, nursing implications
* Na+ replacement as needed*Restrict Na+ until balance regained
Hypernatremia, etiology
* Decreased fluid intake*Physical or chemical restraint from H2O*Fever*Vomiting
Hypernatremia, clinical manifestation
* Anorexia, N&V*Restlessness*Muscle weakness*Skin: dry, flushed*Orthostatic hypotension*Tachycardia*S3 gallop
Hypernatremia, nursing implications
* Older patients at highest risk*Offer H2O & fluids hourly*Restrict high Na+ foods
Calcium, normal values
8.6 to 10 mEq/L
Hypocalemia, etiology
* Inadequate Ca intake*Vitamin D deficiency*Hypoparathyroidism*Increase serum protein (albumin)
Hypocalemia, clinical manifestation
* Neuromuscular irritability*Tetany*Positive Chvostek sign*Positive Trousseau's sign
Hypocalemia, nursing implications
* Monitor IV site
Hypercalemia, etiology
* Acidosis*Prolonged immobilization*Hyperparathyroidism*Hypoproteinemia
Hypercalemia, clinical manifestation
* Constipation*Dryness of mouth (thirst)*Muscle hypotonicity*Formation of ureteral or kidney stones
Hypercalemia, nursing implications
* Monitor ECG*Monitor serum calcium levels
Phosphate, normal values
1.2 to 3 mEq/L
Hypophosphatemia, etiology
*Long term lack of intake*Increased growth or tissue repair*Chronic respiratory alkalosis*Lead poisoning
Hypophosphatemia, clinical manifestation
Disruption of the ATP cycle*Decreased cardiac function*Decreased respiratory function*Fatigue*Brittle bones*Bone pain
Hypophosphatemia, nursing implications
Mild imbalance can be treated with diet
Hyperphosphatemia, etiology
Excessive intake of high-phosphate foods*Excess of Vitamin D*Impaired colonic motility*Addison's disease
Hyperphosphatemia, clinical manifestation
Potassium, normal values
3.5 tro 5 mEq/L
Hypokalemia, etiology
* Diarrhea, vomiting*Nasogastric suctioning*Diuresi*IV fluid without added potassium
Hypokalemia, clinical manifestation
* Prominent "U" wave*Weakness, paralysis*Constipation, ileus*Arrhythmias, and cardiac arrest
Hypokalemia, nursing implications
* Body does not conserve K+*Give K+ with glass of juice
Hyperkalemia, etiology
* Renal disease*Associated with metabolic acidosis*Transfusion with old donor blood*Crush injuries burns
Hyperkalemia, clinical manifestation
* Peaked "T" wave, flat "P" wave*Muscle weakness*Flaccid paralysis*Twitching*Ventricular fibrillation and cardiac arrest
Hyperkalemia, nursing implications
* Administer IV fluids as prescribed*Administer insulin (if ordered) to facilitate movement of K+ into cells
Magnesium, normal values
Critically ill*Alcoholics*Chronic malnutrition*Chrohn's or celiac disease*Prolonged IV or TPN without Mg replacement
Hypomagnesium, clinical manifestation
Myocardial irritability*Positive Chvostek's or Trousseau's sign*Tetany, convulsions*Vasospasms, leading to stroke
Hypomagnesium, nursing implications
Rare imbalance
Hypermagnesemia, etiology
Renal insufficiency*Use of Mg-containing antacids/laxatives*Administering of K+ sparing diuretics*Severe dehydration from ketoacidosis
Hypermagnesemia, clinical manifestation
Decreased muscle cell activity*Peripheral vessel dilation leading to hypotension*Severe muscle weakness*Loss of deep tendon reflexes*Respiratory paralysis
Fluid Excess, etiology
Excessive oral intake*Excessive IV infusion (hypotonic fluid)*Congestive Heart Failure (CHF)*Malnutrition
Fluid Excess, clinical manifestation
Edema*Moist rales*Slow, bounding pulse*Weight gain*Seizures, coma
Fluid Excess, nursing implications
Decrease serum electrolytes*Administer diuretics*Limit fluid intake
Fluid Deficit, etiology
Neglect of intake by self / caregiver*Overuse of diuretics*Loss through skin or lungs*Excessive sweating*Febrile states
Fluid Deficit, clinical manifestation
Postural hypotension*Dry skin and mucous membranes*Decreased urine output*Weight loss*Tacycardia
Fluid Deficit, nursing implications
Causes hyponatremia*Increased hematocrit*Increased BUN*Increased osmolarity
Respiratory Acidosis, Defining Signs
Hypoventilation*Increasing PaCO2*Decreasing pH
Respiratory Acidosis, Commonly Seen
Respiratory Acidosis, Signs of Severe Imbalance
Hypotension*Seizures*Muscle tremors
Respiratory Alkalosis, Defining Signs
Hyperventilation*Decreasing PaCO2*Increasing pH
Respiratory Alkalosis, Commonly Seen
Respiratory Alkalosis, Signs of Severe Imbalance
Dsyrhythmias*Muscle weakness*Chest pain
Metabolic Acidosis, Defining Signs
Hyperventilation*(Kussmaul's resp)*Decreasing HCO3*Decreasing pH
Metabolic Acidosis, Commonly Seen
Metabolic Acidosis, Signs of Severe Imbalance
Metabolic Alkalosis, Defining Signs
Hypoventilation*Increasing HCO3*Increasing pH
Metabolic Alkalosis, Commonly Seen
Confusion*Hypocalemia*Hypotension*Muscle cramping
Metabolic Alkalosis, Signs of Severe Imbalance

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