Evolve electrolyte and fluids

hypokalemia s/s

A SIC WALT Alkalosis Shallow respiration Irritability Confusion and drowsiness Weakness and fatigue Arrhythmias- irregular heart rate, tachycardia Lethargy Thready pulse decrease intestinal mobility, nausea and vomiting

Which client is at risk for the development of a potassium level of 5.5 mEq/L (5.5 mmol/L)? 1. The client with colitis 2. The client with Cushing's syndrome 3. The client who has been overusing laxatives 4. The client who has sustained a traumatic burn

A serum potassium level higher than 5.0 mEq/L (5.0 mmol/L) indicates hyperkalemia. Clients who experience cellular shifting of potassium in the early stages of massive cell destruction, such as with trauma, burns, sepsis, or metabolic or respiratory acidosis, are at risk for hyperkalemia. The client with Cushing's syndrome or colitis and the client who has been overusing laxatives are at risk for hypokalemia.

A client who has been experiencing clinical manifestations of hypermagnesemia. When evaluating the client, the nurse should determine that the client's status is returning to normal if which is no longer exhibited? 1. Tetany 2. Tremors 3. areflexia (loss of deep tendon reflexes) 4. Muscular excitability

Areflexia Signs and symptoms of hypermagnesemia include neurological depression, drowsiness and lethargy, loss of deep tendon reflexes (areflexia), respiratory paralysis, and loss of consciousness.

Hypercalcemia S/S

Bone pain Arrhythmias Cardiac arrest Kidney stones Muscle weakness Excessive urination

Hypocalcemia s/s

C.A.T.S. C - Convulsions A- Arrhythmias T - Tetany (involuntary contraction of muscles) S - Spasms and stridor

Hypercalcemia causes

Calcium supplements (too much) Hyperparathyroidism Immobilization Multiple meloma Parathyroid hyperplasia Alcohol Neoplasm

The priorities for nursing care of a client with hypokalemia

Ensuring adequate oxygenation, client safety for fall prevention and potassium administration, and monitoring for complications related to diuretic therapy and client response to therapy

Third spacing

Fluid that shifts into the interstitial spaces and remains there is referred to as third-space fluid. This fluid is physiologically useless because it does not circulate to provide nutrients for the cells. Common sites for third spacing include the pleural and peritoneal cavities and pericardial sac. Risk factors include older adults and those with liver or kidney disease, major trauma, burns, sepsis, major surgery, malignancy, gastrointestinal malabsorption, and malnutrition.

Deep tendon reflexes

Hypermagnesium and hyponatremia leads to a loss of deep tendon reflexes and hypercalcemia leads to hyperactive deep tendon reflexes.

Hyperkalemia s/s

M.U.R.D.E.R. M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

Hypernatremia s/s

Skin flushed Agitation Low grade fever Thirst

hyponatremia s/s

Stupor/coma Anorexia Lethargy Tendon reflexes (decreased) Limp muscles Orthostatic hypotension Seizures Stomach cramping

The nurse reviews a client's laboratory report and notes that the client's serum phosphorus (phosphate) level is 1.8 mg/dL (0.45 mmol/L). Which condition most likely caused this serum phosphorus level?

The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide-based or magnesium-based antacids.

Potassium

alKaLOsis: K is low acidosis: K is high

manifestations of hypocalcemia

are caused by overstimulation of the nerves and muscles; therefore, tetany and presence of Chvostek's sign would be expected. Calcium is needed by the heart for contraction. When the serum calcium level is decreased, cardiac contractility is decreased and the client will experience hypotension. A low serum calcium level could also lead to severe ventricular dysrhythmias and prolonged QT and ST intervals on the electrocardiogram.

what other factors besides tissue breakdown can cause high potassium levels?

blood transfusions, bleeding or hemorrhage, ingestion of potassium in medications, and failure to restrict dietary potassium

Which interventions should be included in the plan of care for Clients with hypokalemia

education about potassium-rich foods, all clients should maintain adequate hydration, Safety is also a priority because hypokalemia may cause muscle weakness, resulting in falls and injury. Monitoring for constipation.

Hypokalemia EKG changes

include shallow, flat, or inverted T waves; ST segment depression; and prominent U waves.

A client with dehydration is likely to be

lethargic or complain of a headache. The client would also exhibit weight loss, sunken eyes, poor skin turgor, flat neck and peripheral veins, tachycardia, and a low blood pressure. The client would not have bilateral crackles in the lungs because these are signs of fluid overload and an unrelated finding of dehydration.

LABS

little Maggie is 1.5-2.5 years old. (Mg) she ate 3.5-5 bananas (K) and drank 8.6-10.2oz of milk (Ca) she has a big brother Phil who is 2.5-4.5 years old. He took a 135-145 min nap.

The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client? 1. Twitching 2. Hypoactive bowel sounds 3. Negative Trousseau's sign 4. Hypoactive deep tendon reflexes

Twitching A serum calcium level lower than 8.6 mg/dL indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau's or Chvostek's sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.