Chapter 13 And 15 Electrolyte Imbalance Part 1
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Transcript of Chapter 13 And 15 Electrolyte Imbalance Part 1
Electrolyte Electrolyte ImbalancesImbalances
Part IPart I
Peggy D. JohndrowPeggy D. Johndrow
20092009
SodiumSodium Major cation in extracellular fluidMajor cation in extracellular fluid Imbalances typically associated with parallel Imbalances typically associated with parallel
changes in osmolality changes in osmolality Sources: processed/preserved foods highest Sources: processed/preserved foods highest
sodium (ham, bacon, pickles, tomato juice, sodium (ham, bacon, pickles, tomato juice, canned soups), snacks often high (potatoes canned soups), snacks often high (potatoes chips)chips)
Sodium-Potassium PumpSodium-Potassium Pump
HypernatremiaHypernatremia
Elevated serum sodium occurring with Elevated serum sodium occurring with water loss or sodium gainwater loss or sodium gain
Causes hyperosmolality leading to Causes hyperosmolality leading to cellular dehydration cellular dehydration
Primary protection is thirst from Primary protection is thirst from hypothalamus hypothalamus
Hypernatremia ManifestationsHypernatremia Manifestations
Include thirst, lethargy, red/swollen Include thirst, lethargy, red/swollen tongue; agitation, seizures, and comatongue; agitation, seizures, and coma
If secondary to water deficiency, often If secondary to water deficiency, often results of impaired LOCresults of impaired LOC
Can be produced by clinical states such Can be produced by clinical states such as central or nephrogenic diabetes as central or nephrogenic diabetes insipidusinsipidus
Nursing DiagnosesNursing Diagnoses
IW Bullets p 186IW Bullets p 186 Risk for injury r/tRisk for injury r/t Risk for sensory/perceptional alterations Risk for sensory/perceptional alterations
r/tr/t Risk for fluid deficit r/tRisk for fluid deficit r/t Risk for altered mucous membranesRisk for altered mucous membranes
Nursing ActionsNursing Actions
Oral fluidsOral fluids IV fluids/ tube feedingsIV fluids/ tube feedings Assess changes in sensoruim, thirst, oral Assess changes in sensoruim, thirst, oral
mucous membrane temperaturemucous membrane temperature I&O, daily weightI&O, daily weight Oral careOral care Monitor foods & medications for Na+ contentMonitor foods & medications for Na+ content Assess changes in mental statusAssess changes in mental status Monitor serum Na+ & urine specific gravityMonitor serum Na+ & urine specific gravity
Hypernatremia ManagementHypernatremia Management
IncludesIncludes Treat underlying causeTreat underlying cause If oral fluids cannot be ingested, IV solution If oral fluids cannot be ingested, IV solution
of 5% dextrose in water or hypotonic salineof 5% dextrose in water or hypotonic saline Diuretics Diuretics
Serum sodium levels must be reduced Serum sodium levels must be reduced gradually to avoid cerebral edemagradually to avoid cerebral edema
HyponatremiaHyponatremia
Results from loss of sodium-containing Results from loss of sodium-containing fluids or from water excessfluids or from water excess
Clinical manifestations include confusion, Clinical manifestations include confusion, nausea, vomiting, seizures, and comanausea, vomiting, seizures, and coma
Hyponatremia ManagementHyponatremia Management
Cause water excess, fluid restriction neededCause water excess, fluid restriction needed Severe symptoms (seizures) occur, small Severe symptoms (seizures) occur, small
amount of intravenous hypertonic saline amount of intravenous hypertonic saline solution (3% NaCl) givensolution (3% NaCl) given
Associated with abnormal fluid loss, fluid Associated with abnormal fluid loss, fluid replacement with sodium-containing solution replacement with sodium-containing solution neededneeded
Nursing DiagnosesNursing Diagnoses
Risk for injuryRisk for injury Risk for fluid volume excessRisk for fluid volume excess Risk for sensory/perceptional alterationsRisk for sensory/perceptional alterations Risk for altered mucous membranesRisk for altered mucous membranes Altered thought processesAltered thought processes Risk for impaired skin integrityRisk for impaired skin integrity
Nursing ActionsNursing Actions Safety measuresSafety measures I&O (may be hourly), daily wtI&O (may be hourly), daily wt Assess for source of Na+ lossAssess for source of Na+ loss Monitor lab - Serum Na+, urine specific gravityMonitor lab - Serum Na+, urine specific gravity Assess for third space lossAssess for third space loss Give food & fluids high in Na+Give food & fluids high in Na+ Assess for fluid overload; lung sounds, respiratory Assess for fluid overload; lung sounds, respiratory
status, edemastatus, edema Care with cardiac & CV diseaseCare with cardiac & CV disease Assess mental statusAssess mental status Neuro checks/LOC/orientation (monitor for Neuro checks/LOC/orientation (monitor for
seizures& V/Sseizures& V/S