Question

4.Identify the causes of each type of electrolyte imbalance. Discuss the major symptoms associated with each type of electrolyte imbalance, stating the nursing considerations related to each condition. 5.Differentiate among the four major types of acid–base imbalances: respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis.

Answer 1

Electrolytes
There are many chemicals in your blood stream that regulate important functions of our bodies. These chemicals are called electrolytes.
When dissolved in water, electrolytes separate into positively and negatively charged ions. Human body's nerve reactions and muscle function are dependent upon the proper exchange of these electrolyte ions outside and inside cells.
Examples of electrolytes are calcium, magnesium, potassium, and sodium. Electrolyte Imbalance can cause a variety of symptoms.
Normal Adult Values
Calcium:   4.5-5.5 mEq/L
Chloride:   97-107 mEq/L
Potassium:   3.5-5.3 mEq/L
Magnesium:   1.5-2.5 mEq/L
Sodium:   136-145 mEq/L
* Note: Normal values may vary from laboratory to laboratory.
Electrolyte Imbalance
CAUSES
Causes may include the following factors
Loss of body fluids from prolonged vomiting, diarrhea, sweating or high fever
Inadequate diet and lack of vitamins from food
Malabsorption - your body may be unable to absorb these electrolytes due to a variety of stomach disorders, medications, or may be how food is taken in
Hormonal or endocrine disorders
Kidney disease
A complication of chemotherapy is tumor lysis syndrome. This occurs when your body breaks down tumor cells rapidly after chemotherapy, causing a low blood calcium level, high blood potassium levels, and other electrolyte abnormalities.
Certain medications may cause an electrolyte imbalance such as:

Chemotherapy drugs (cisplatin)
Diuretics (furosemide[Lasix] or bumetanide [Bumex])
Antibiotics (amphotericin B)
Corticosteroids (hydrocortisone)
Symptoms of Electrolyte Imbalance:
As described, an electrolyte imbalance may create a number of symptoms.
The symptoms of electrolyte imbalance are based on which of the electrolyte levels are affected.
If blood test results indicate an altered potassium, magnesium, sodium, or calcium levels, the patient may experience muscle spasm, weakness, twitching, or convulsions.
Blood test results showing low levels may lead to: irregular heartbeat, confusion, blood pressure changes, nervous system or bone disorders.
Blood test results showing high levels may lead to: weakness or twitching of the muscles, numbness, fatigue, irregular heartbeat and blood pressure changes.
SYMPTOMS BASED ON TYPES OF ELECTROLITE IMBALANCE
Symptoms of Hypercalcemia
Loss of appetite
Nausea and vomiting
Constipation and abdominal (belly) pain
The need to drink more fluids and urinate more
Tiredness, weakness, or muscle pain
Confusion, disorientation, and difficulty thinking
Headaches
Depression
Serious symptoms can include:
Seizure
Irregular heartbeat
Heart attack
Loss of consciousnes
Coma
Symptoms of Hypocalcemia
Paresthesia
Muscle spasms
Cramps
Tetany
Circumoral numbness
Seizures
Laryngospasm
Neuromuscular irritability
Cognitive impairment
Personality disturbances
Prolonged QT intervals
Electrocardiographic changes that mimic myocardial infarction, or heart failure
Symptoms of Hyperchloremia
Dehydration, fluid loss, or high levels of blood sodium may be noted.
Patient may be experiencing other forms of fluid loss, such as diarrhea, or vomiting.
I f the patient diabetic, and have poor control over your blood sugar levels (they may be very high).
Symptoms of Hypochloremia
Dehydration
Fluid loss or high levels of blood sodium may be noted.
Patientr may be experiencing other forms of fluid loss, such as diarrhea, or vomiting.
Symptoms of Hypermagnesemia
The may not have any symptoms, unless blood magnesium levels are significantly elevated.
Some symptoms like
Muscle weakness
Confusion
Decreased reflexes
Blood test results show severely high blood magnesium levels.
Symptoms of Hypomagnesemia
Some patients are asymptomatic.
Clinical manifestations include anorexia, nausea, vomiting, lethargy, weakness, personality change, tetany (eg, positive Trousseau or Chvostek sign or spontaneous carpopedal spasm, hyperreflexia), and tremor and muscle fasciculations.
Trousseau sign is the precipitation of carpal spasm by reduction of the blood supply to the hand with a tourniquet or blood pressure cuff inflated to 20 mm Hg above systolic blood pressure applied to the forearm for 3 minutes.
Chvostek sign is an involuntary twitching of the facial muscles elicited by a light tapping of the facial nerve just anterior to the exterior auditory meatus.
The neurologic signs, particularly tetany, correlate with development of concomitant hypocalcemia, hypokalemia, or both. Myopathic potentials are found on electromyography but are also compatible with hypocalcemia or hypokalemia.
Severe hypomagnesemia may cause generalized tonic-clonic seizures, especially in children.
Symptoms of Hyperphosphatemia
Muscle cramps
Tetany
Perioral numbness or tingling
Other symptoms include bone and joint pain, pruritus, and rash
Symptoms of Hypophosphatemia
Muscle weakness
Fatigue
Bone pain
Bone fractures
Appetite loss
Irritability
Numbness
Confusion
Symptoms of Hyperkalemia
Muscle weakness
Numbness
Tingling
Nausea
Other unusual feelings.
Symptoms of Hypokalemia
Constipation
Feeling of skipped heart beats or palpitations
Fatigue
Muscle damage
Muscle weakness or spasms
Tingling or numbness
Symptoms of Hypernatremia
Thirst
Brain dysfunction
Confusion
Muscle twitching
Seizures
Coma
Death
Symptoms of Hyponatremia
Nausea and vomiting
Headache
Confusion
Loss of energy, drowsiness and fatigue
Restlessness and irritability
Muscle weakness, spasms or cramps
Seizures
Coma

NURSING CONSIDERATIONS

Identify signs and symptoms of client fluid and/or electrolyte imbalance
Apply knowledge of pathophysiology when caring for the client with fluid and electrolyte imbalances
Manage the care of the client with a fluid and electrolyte imbalance
Evaluate the client's response to interventions to correct fluid or electrolyte imbalance

Perform initial/routine assessments, assessfor neurologicalmanifestationsindicating electrolyteimbalance. Reportfindings to clinician(MD, PA, NP)promptly.
Implement the rapeuticactions (i.e.,appropriate diet,administer replacementelectrolytes—sodiumbicarb, mag sulfate,etc., as ordered)
Assess/monitor serumlevels of electrolytes;report finding to MDpromptly
Monitor for associated complications
Assess/monitor cardiac rhythm
Educate patient on disease process and s/s of complications of electrolyte imbalances
Assessment of changes in fluid volume
Implementation of therapeutic actions (i.e., administer/restrictfluids, as ordered)
Monitor for associated complications
Educate patient on disease process and s/s of complications of fluid imbalance
DIFFERENTIATE BASED ON THE SYMPTOMS

RESPIRATORY ACIDOSIS

Respiratory acidosis can be acute or chronic; the chronic form is asymptomatic, but the acute, or worsening, form causes headache, confusion, and drowsiness. Signs include tremor, myoclonic jerks, and asterixis. Diagnosis is clinical and with arterial blood gas and serum electrolyte measurements. The cause is treated; oxygen (O₂) and mechanical ventilation are often required.

RESPIRATORY ALKALOSIS

• dizziness.
• bloating.
• feeling lightheaded.
• numbness or muscle spasms in the hands and feet.
• discomfort in the chest area.
• confusion.
• dry mouth.
• tingling in the arms.

METABOLIC ALKALOSIS

• Confusion (can progress to stupor or coma)
• Hand tremor.
• Lightheadedness.
• Muscle twitching.
• Nausea, vomiting.
• Numbness or tingling in the face, hands, or feet.
• Prolonged muscle spasms (tetany)

METABOLIC ACIDISIS

• rapid and shallow breathing.
• confusion.
• fatigue.
• headache.
• sleepiness.
• lack of appetite.
• jaundice.
• increased heart rate.