V Most abundant electrolyte in the ECF

V 135 to 145 mEq/L

V Has a major role in controlling water

distribution throughout the body

V Regulated by ADH, thirst and the renin-

angiotensin-aldosterone system
V ˜rimary regulator of ECF volume

V Also functions in establishing the

electrochemical state necessary for muscle
contraction and the transmission of nerve
impulses
V utter, bacon, canned food, cheese, ketchup,
frankfurters, processed food, soy sauce, table
salt
V jerum sodium level lower than 135 mEq/L

V Causes include: increased sodium excretion

(excessive diaphoresis, diuretics, vomiting,
diarrhea, wound drainage, decreased
secretion of aldosterone); inadequate sodium
intake; dilution of serum sodium (freshwater
drowning, j ADH)
V Rapid pulse rate
V Generalized skeletal muscle weakness
V Headache
V Diminished deep tendon reflexes
V Confusion
V jeizures
V Nausea
V Decreased urinary specific gravity
V ncreased urine output
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V f hyponatremia is accompanied by a fluid

deficit,
sodium chloride infusions are
administered

V f hyponatremia is accompanied by a fluid

excess, osmotic diuretics are administered
V nstruct client to increase oral sodium intake
and inform the client about the foods to
include in the diet

V f the client is taking lithium, monitor the

lithium level, because hyponatremia can
cause diminished lithium excretion, resulting
in toxicity
V s a serum sodium level that exceeds 145
mEq/L

V Causes include: decreased sodium excretion,

increased sodium intake, decreased water
intake, increased water loss
V Heart rate and ˜ that respond to vascular
volume status
V ˜ulmonary edema if hypervolemia is present
V jpontaneous muscle twitches, irregular
muscle contractions (early)
V jkeletal muscle weakness (late)
V Altered cerebral function is the most
common manifestation
V ncreased urinary specific gravity; decreased
urine output
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V f the cause is fluid loss, prepare to administer

infusions

V f the cause is inadequate renal excretion of

sodium, prepare to administer diuretics

V Restrict sodium as prescribed

V s the major intracellular electrolyte

V Ranges from 3.5 to 5.1mEq/L

V 98% of the bodyǯs potassium is inside the

cells, the remaining 2% is in the ECF that is
important in neuromuscular function

V nfluences both skeletal and cardiac muscle

activity
V Avocado, banana, cantaloupe, carrots, fish,
mushroom, oranges, potatoes, raisins,
spinach, strawberries, tomatoes, pork, beef
V s a serum potassium level lower than 3.5meq/L

V ˜otassium deficit is potentially life-threatening

because every body system is affected

V Causes include: excessive use of medications

such as diuretics, vomiting, diarrhea, inadequate
potassium intake, hyperinsulinism
V 'eak peripheral pulses
V à
 flattened T wave, U wave, jT segment
depression in ECG
V jhallow respirations, anxiety, lethargy,
confusion
V jkeletal muscle weakness
V Deep tendon hyporeflexia
V Hypoactive to absent bowel sounds
V Nausea and vomiting
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V Monitor electrolyte values

V Administer potassium supplements orally or

intravenously
V èral potassium supplements may cause
nausea and vomiting and they should not be
taken on an empty stomach

V Liquid potassium chloride has an unpleasant

taste and should be taken with juice or
another liquid

V ˜otassium is never given by
push or by the

M or j route
V After adding potassium to an
solution, rotate
and invert the bag to ensure that the potassium
is distributed evenly

V Label
bag containing potassium properly

V ˜otassium infusion can cause phlebitis; thus the

nurse should assess the
site frequently

V Monitor renal function and è before

administering potassium
V nstitute safety measures for the client
experiencing muscle weakness

V ˜otassium sparing diuretic may be prescribed

instead

V nstruct the client about foods that are high in

potassium content
V s a serum potassium level that exceeds
5.1mEq/L

V s caused by: excessive potassium intake,

decreased potassium excretion, tissue
damage, hypercatabolism
V jlow, weak, irregular heart rate
V Decreased ˜
V -
à  Tall peaked T waves, widened Rj
complexes, flat ˜ waves, widened Rj
complexes
V Muscle twitches, cramps (early)
V ˜rofound weakness (late)
V Diarrhea
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V Discontinue
potassium and hold oral

potassium supplements

V nitiate a potassium-restricted diet

V ˜repare to administer potassium-excreting

diuretics if renal function is not impaired
V ˜repare to administer sodium polysterene
sulfonate (Kayexalate), cation exchange resin
that promotes G sodium absorption and
potassium excretion
V ˜repare the client for dialysis if potassium levels
are critically high
V ˜repare for the
administration of hypertonic
glucose with regular insulin to move excess
potassium into the cells
V Monitor renal function

V 'hen blood transfusions are prescribed for a

client with a potassium imbalance the client
should receive fresh blood

V Teach the client to avoid foods high in potassium

V nstruct the client to avoid the use of salt

substitutes
V Major component of bones and teeth

V ˜lays a major role in transmitting nerve

impulses and helps regulate muscle
contraction and relaxation, including cardiac
muscle, also plays a role in blood coagulation

V 8.6 to 10mg/dL
V The serum calcium level is controlled by
parathyroid hormone and calcitonin

V Cheese, milk, soy milk, sardines, spinach,

tofu, yogurt
V s a serum calcium level lower than 8.6 mg/dL

V Causes include: inadequate oral intake of

calcium, lactose intolerance, inadequate
intake of vitamin D, diarrhea, steatorrhea,
hyperphosphatemia, , acute pancreatitis,
removal or destruction of the parathyroid
glands
V Decreased heart rate
V Hypotension
V Diminsihed peripheral pulses
V ˜rolonged jT interval, prolonged T interval
V Twitches, cramps
V ˜ainful muscle spasms during periods of
inactivity
V 

 - 
 

V nflate a blood pressure cuff around the
clientǯs upper arm for 1 to 4 minutes above
the systolic pressure

V n a client with hypocalcemia, the hand and

fingers become spastic and go into palmar
flexion
V Tap the face just below and in front of the ear

V Facial twitching on that side of the face

indicates a positive test
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V Administer calcium supplements orally or

calcium intravenously

V 'hen administering calcium
, warm the

injection solution to body temperature
before administration and administer slowly
V Monitor for ECG changes, observe for
infiltration, and monitor for hypercalcemia
during therapy

V Administer medications that increase calcium

absorption (aluminum hydroxide, vitamin D)

V ˜rovide a quiet environment to reduce stimuli

V nitiate seizure precautions

V Move the client carefully, and monitor for

signs of a fracture

V Keep 10% calcium gluconate available for

treatment of acute calcium deficit

V nstruct client to consume foods high in

calcium
V s a serum calcium level that exceeds
10mg/dL

V Causes include: increased calcium

absorption, decreased calcium excretion (use
of thiazide diuretics), hyperparathyroidism,
malignancy, immobility
V ncreased heart rate in early phase,
bradycardia that can lead to cardiac arrest in
late phases
V ncreased ˜
V jhortened jT segment, widened T wave
V ˜rofound muscle weakness
V ncreased urinary output
V Formation of renal calculi
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V Discontinue
infusions of solutions

containing calcium and oral medications
containing calcium or vitamin D

V Discontinue thiazide diuretics and replace

with diuretics that enhance the excretion of
calcium
V ˜repare client with severe hypercalcemia for
dialysis
V Move client carefully and monitor for signs of
fracture
V Monitor for flank or abdominal pain, and strain
the urine to check for the presence of urinary
stones
V nstruct client to avoid calcium rich foods
V Acts as an activator for many intracellular
enzyme systems and plays a role in both
carbohydrate and protein metabolism

V Acts peripherally to produce vasodilation

V Affect neuromuscular irritability and

contractility
V 1.6 to 2.6 mg/dL

V Avocado, canned white tuna, cauliflower,

milk, green leafy vegetables, oatmeal, peanut
butter, peas, pork, beef, chicken, potatoes,
raisins, yogurt
V s a serum magnesium level lower than 1.6
mg/dL

V Causes include: insufficient magnesium

intake, chronic alcoholism, malnutrition and
starvation, insulin administration
V Tall T waves, depressed jT segments
V Tachycardia
V Twitches
V Hyperreflexia
V jeizures
V rritability
V Confusion
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V Monitor serum magnesium levels frequently

V nitiate seizure precautions

V nstruct client to increase intake of foods that

contain magnesium
V s a serum magnesium level that exceeds 2.6
mg/dL

V Causes include: increased magnesium intake,

decreased renal excretion of magnesium
V radycardia
V Hypotension
V ˜rolonged ˜R interval, widened Rj
complexes
V jkeletal muscle weakness
V Drowsiness and lethargy
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V Diuretics are prescribed to increase renal

excretion

V nstruct client to restrict dietary intake of

magnesium-containing foods
V ntravenously administered calcium chloride
or calcium gluconate may be prescribed to
reverse the effects of magnesium on cardiac
muscle

V nstruct the client to avoid the use of laxatives

and antacids containing magnesium
V Essential to the function of muscle and red
blood cells, formation of AT˜, maintenance of
acid base balance

V ˜rovides structural support to bones and

teeth

V 2.7 to 4.5 mg/dL

V Fish, organ meats, nuts, pork, beef, chicken,
whole grain breads and cereals
V s a serum phosphorus level lower than
2.7mg/dL

V A decrease in the serum phosphorus level is

accompanied by an increase in the serum
calcium level

V Causes include: insufficient intake,

malnutrition, starvation,
hyperparathyroidism
V Decreased contractility and cardiac output
V 'eakness
V Decreased bone density
V rritability
V Confusion
V seizures
V Monitor cardiovascular, respiratory,
neuromuscular, cerebral, renal, and G status

V Administer phosphorus orally along with

vitamin D supplement

V ˜repare to administer phosphorus

V Assess renal system before administering

phosphorus
V Move client carefully, and monitor for signs of
fracture

V nstruct client to increase intake of

phosphorus containing foods while
decreasing the intake of calcium-containing
foods
V jerum phosphorus level that exceeds
4.5mg/dL

V ncrease in serum phosphorus is accompanied

by a decrease in serum calcium

V Causes include: decreased renal excretion,

increased intake of phosphorus,
hypoparathyroidsm
V jame as assessment of hypocalcemia
V Entails management of hypocalcemia

V nstruct client to avoid phosphate containing

medications

V nstruct client to decrease the intake of food

that