Marco, Carmela Dawn M.

HYPONATREMIA
Causes: 4D 2S FHILV Diarrhea Diuretics Deficiency in Aldosterone Dilutional Hyponatremia Sweating SIADH Fistulas Hyperglycemia Increased Water Intake Low Salt Diet Vomiting Signs and Symptoms: DO2 PHASC Dry mucosal membrane Decreased Saliva Production Obtundation Orthostatic hypotension Poor skin turgor Headache Altered mental status Status Epilepticus Coma Management: MEDICAL MANAGEMENT: 3R SI Restrict Na+ if edema Restrict H2O with normal or excess fluid volume Restrict Na+ and H2O if edema and hyponatremia Sodium replacement by mouth, NGT or parenteral ICU setting: administer 3 or 5% NaCL NURSING MANAGEMENT: 2MW Monitor I & O Monitor daily weight Watch out for changes in nervous system Water Supplement restrict in SIADH patient

HYPERNATREMIA
Causes: DEFHIMN Diabetes Insipidus Excessive Use of Sodium Bicarbonate Fluid Depreviation Heat Stroke IV administration of hypertonic solution Malfunction in dialysis Near- drowning in the sea Signs and Symptoms: 3DS 2P FIT Delusion Dehydration Dry swollen tongue Sticky mucous membrane Severe Hypernatremia Slight elevated body temperature Postural hypotension Peripheral & Pulmonary Edema Flushed Skin Increased muscle tone and DTRs Thirst Management: MEDICAL MANAGEMENT: ADD Administration of Hypotonic Solution Diuretics Desmopressin Acetate (VASOPRESSIN) NURSING MANAGEMENT: MO2R Monitor I & O Monitor changes in behaviour Obtain medical history Offer fluids at regular interval Regulate IV fluids and monitor patient response

Marco, Carmela Dawn M.

HYPOKALEMIA
Causes: 2PM DGHV Poor Dietary Intake Persistent Insulin Hypersecretion Metabolic alkalosis Magnesium depletion Diuretics Gastric Suctioning Hyperaldosteronism Vomiting Signs and Symptoms: 4D 2P FAGVL Decreased bowel motility Dysrhythmias Decreased DTRs Digitalis Sensitivity Paresthesia Polyuria Fatigue Anorexia Glucose Intolerance Vomiting Leg Cramps Diagnostic: MFED Metabolic Alkalosis Flat T wave Elevate U wave Depress ST segments Management: MEDICAL MANAGEMENT: DO Dietary Intake Increases Oral or IV Replacement Therapy NURSING MANAGEMENT: DM Diet- Potassium rich foods Monitor ECG and blood pH

HYPERKALEMIA
Causes: ALTU Addisons Disease Leukocytosis Thrombocytosis Untreated Renal Failure Signs and Symptoms: PDIN Paralysis of respiratory and speech muscles Diarrhea Intermittent Intestinal Colic Nausea Diagnostic: 3P SM Peak, narrow T wave Prolong PR followed by disappearance of P wave Prolonged QRS complex Shortened QT interval Metabolic Acidosis Management: MEDICAL MANAGEMENT:BISCK Beta 2 Agonist Immediate ECG Sodium Bicarbonatr Calcium Gluconatte Kayexelate Cat-ion Exchange Resins NURSING MANAGEMENT: RM Restrict Potassium Monitor ECG and pH

Marco, Carmela Dawn M.

HYPOCALCEMIA
Causes: 3MA Massive admin. of citrated blood Magnesium deficiency Medullary Thyroid Carcinoma After radical neck dissection Alkalosis Alcohol Abuse Signs and Symptoms: 2TC DIS Tetany Trousseaus Sign (+) Chvosteks Sign (+) Confusion Depression Impaired memory Spasms in the extremities and face Diagnostic: IDP Increased pH= Total serum calcium Decreased pH= Ionized Calcium Prolonged QT interval Management: MEDICAL MANAGEMENT: Calcium Gluconate NURSING MANAGEMENT: ISSA Institute Vitamin D Seizures Precaution Slow IV infusion through infusion pump Avoid excess use of laxatives and antacids (< Ca2+ absorption)

HYPERCALCEMIA
Causes: MAHAV Malignancy After severe or multiple fracture Hyperparathyroidism Administration of Thiazide Diuretics Vitamin A and D intoxication Signs and Symptoms: PACAC Polyuria Anorexia Constipation Abdominal Pain Coma Diagnostic: SSS Shortened QTinterval Shortened ST segments Sulkowitch Urine Test Management: MEDICAL MANAGEMENT: BCM2N Biphosphonates Corticosteroids Mithramycin Mobilizing the patient 0.9 % NaCl NURSING MANAGEMENT: MAEI Monitor cardiac rate and rhythm Adequate fiber in the diet Encourage Fluid Intake Instruct to ambulate

Marco, Carmela Dawn M.

HYPOMAGNESEMIA
Causes: NWABLD NGT Suctioning Withdrawal from alcohol Administration of tube feedings and parenteral nutrition Burns Low Serum Albumin Diarrhea Signs and Symptoms: 3T CAL Tremors Tetany Trousseaus Sign (+) Chvosteks Sign Athetoid movement Laryngeal Stridor Diagnostic: 3P 2D FW Prolonged PR interval Prolonged QT interval Prominent U wave Depress ST segments Decrease Urine magnesium Flattened T wave Widened QRS complex Management: MEDICAL MANAGEMENT: DM2 Diet Magnesium Salts (P.O.) Magnesium in IV NURSING MANAGEMENT: ASM2 Assess and grade DTRs Seizure precaution Monitor vital signs, cardiac rate Monitor UO

HYPERMAGNESEMIA
Causes: RUELAA Renal Failure Untreated Diabetic Ketoacidosis Excessive administration of MgSO4 Lithium Intoxication Addisons disease Adenocortical Insufficiency Signs and Symptoms: 5D CAP Delayed thrombin formation Depressed CNS Decreased BP Difficulty in speaking Drowsiness Coma Atrioventricular heart block Platelet Clumping Diagnostic: 2P DTAW Prolonged PR interval Prolonged QT interval Decreased Creatinine Clearance Tall T wave Atrioventricular block Widened QRS Complex Management: MEDICAL MANAGEMENT: HAVA Hemodialysis with Mg free dialysate Avoid administration of Mg Ventilator Support Administration of Loop Diuretics and NaCl NURSING MANAGEMENT: MO Monitor Vital Signs Observe patellar reflex and changes in LOC