By the end of the class, the student will be able to: 1. Examine the administration of sodium, potassium, calcium, and magnesium supplements and acid- base correction supplements as well as methods to correct deficiency and excess. 2. Plan nursing care for a patient receiving medication for hypokalemia, hyperkalemia, hyponatremia, hypernatremia, hypocalcemia, hypercalcemia, hypomagnesemia, hypermagnesemia, and acid-base imbalances.
Overview
This lecture reviews the nursing management of electrolyte imbalances (sodium, potassium, calcium, magnesium) and acid-base disturbances, focusing on causes, treatments, medication administration, and key nursing considerations.
Sodium Imbalances
- Hypernatremia (>145 mEq/L): usually caused by kidney disease, some medications (corticosteroids, lithium), or hypertonic saline.
- Symptoms: dehydration, thirst, fatigue, muscle convulsions, altered mental status.
- Mild treatment: low-sodium diet, increased fluids, stop offending meds; severe cases may need IV fluids or dialysis.
- Hyponatremia: often due to overhydration, hypotonic solutions, vomiting, diuretics; leads to confusion, lethargy, muscle twitching, and cramps.
- Treatment: diuretics for dilutional cause; sodium supplements/fluids for loss; encourage sodium-rich foods.
- Monitor for fluid overload, pulmonary edema, and neurological status during treatment.
Potassium Imbalances
- Hyperkalemia (>5 mEq/L): caused by supplements, potassium-sparing diuretics, kidney disease; symptoms include arrhythmias, paresthesia, muscle twitching.
- Treatments: restrict potassium intake; stop causative meds; insulin with glucose, calcium gluconate, sodium polystyrene to lower levels.
- Sodium polystyrene: exchanges sodium for potassium in the gut, causing diarrhea; monitor for constipation, electrolyte shifts.
- Hypokalemia: results from diuretics, vomiting, diarrhea; causes dysrhythmias, muscle weakness, cramps.
- Treat mild cases with increased dietary potassium; severe cases use potassium chloride (oral/IV).
- Never crush or chew oral tablets; never IV push potassium, max 10 mEq/hr; use large IV, monitor for burns, necrosis, and cardiac changes.
Acid-Base Disorders
- Acidosis = increased acid; alkalosis = increased base; both can be fatal if severe.
- Treat underlying cause; sodium bicarbonate is main therapy for acidosis (can cause alkalosis if overused).
- Monitor for alkalosis symptoms: confusion, irritability, slow respirations; avoid use with milk and in kidney disease.
- Alkalosis may require ammonium chloride or sodium/potassium chloride depending on severity.
Calcium Imbalances
- Hypocalcemia: due to vitamin D deficiency, parathyroid dysfunction; causes convulsions, muscle spasms.
- Hypercalcemia: from bone loss, parathyroid excess, certain cancers; treat underlying cause.
- Calcium supplements (carbonate/citrate): treat deficiency; adverse effects include hypercalcemia, GI upset, risk of kidney stones, and tissue necrosis if IV extravasation occurs.
- Calcitriol (vitamin D): used for hypocalcemia due to deficiency; avoid thiazide diuretics and certain supplements.
Magnesium Imbalances
- Essential for neuromuscular function; oral forms used as laxatives, IV for severe deficiency.
- Hypermagnesemia: causes decreased reflexes, sedation, potential for respiratory paralysis and circulatory collapse.
- Treat overdose with calcium gluconate.
- Avoid in renal disease, cardiac issues, intestinal obstructions; monitor cardiac, respiratory, and reflex status during IV use.
Key Terms & Definitions
- Hypernatremia — high sodium in blood (>145 mEq/L).
- Hyponatremia — low sodium in blood.
- Hyperkalemia — high potassium in blood (>5 mEq/L).
- Hypokalemia — low potassium in blood.
- Acidosis — excess acids, blood pH < 7.35.
- Alkalosis — excess bases, blood pH > 7.45.
- Hypocalcemia — low calcium in blood.
- Hypercalcemia — high calcium in blood.
- Hypomagnesemia — low magnesium in blood.
- Hypermagnesemia — high magnesium in blood.
Action Items / Next Steps
- Review relevant textbook sections (chapters 25, 43, 48 as assigned).
- Prepare for medication administration by memorizing monitoring strategies and contraindications.
- Complete any assigned readings or homework related to electrolyte and acid-base imbalances.