Hyponatremia

<135 serum Na.

Decrease in serum sodium:

assessment findings:

Vitals-hypothermia, tachycardia, thready pulse, hypotension, orthostatic hypotension.

Neuro- confusion, headache, lethargy, muscle weakness (possible resp. compromise) decreased deep tendon reflexes, fatigue.

GI- hyperactive BS, increased motility, nausea, abdominal cramping.

Could be excess or deficient fluid volume.

Interventions for hyponatremia:

Excess fluid- restric fluid intake.

Acute hyponatremia- encourage Na rich foods; administer hypertonic oral and IV fluids.

Return to normal ECF- isotonic IV (.9% NS, ringers lactate.)

I&O, weight.

Vitals, LOC. 

Hypernatremia

> 145

Excess sodium

Findings:

Vitals- hyperthermia, tachycardia, orthostatic hypotension.

restlessness, muscle twitching ( resp compromise) irritability, Increased DTR, seizures, coma

Thirst, dry mucous membranes, increased motility, hyperactive BS, nausea, abdominal cramping.

Edema, flushed warm skin, oliguria.

Decreased fluid volume.

Hypokalemia

< 3.5

Hyperthermia, weak irreg. pulse, hypotension, resp. distress, weakness (resp collaspe and paralysis), muscle cramping, decreased muscle tone, hypoactive reflexes, paresthesias, mental confusion.

PVC, bradycardia, blocks, ventricular tachycardia, inverted T waves, ST depression, decreased motility, abdominal distention, constipation, ileus, nausea, vomiting, anorexia, polyuria.

Hyperkalemia

>5.0

Irreg. pulse, hypotension.

Restlessness, irritability, weakness (flacid paralysis) paresthesias, ventricular fibrillation, peaked T waves, widening QRS, nausea, vomiting, increased motility, diarrhea, hyperactive BS, oligura.

Hypocalcemia

<9.0

Muscle twitches, tetany, frequent, painful muscle spasms, hyperactive DTR, + chvostek's sign, trosseau's sign, decreased myocardial contractility (decreased heart rate and hypotension) , prolonged QT interval, hyperactive BS, diarrhea, abdominal cramping.

Hypercalcemia

>10.5

fatigue, wealness, decreased DTR, headache, impaired concentration, memory defects, personality changes, confusion, leathargy, depression, polyuria, kidney stones, acute or chronic renal failure with decreasing urine concentration ability, anorexia, nausea/vomiting, pain, constipation, pancreatitis, cardiac dysrthmia, shortening QT interval, heart bloack, cardiac arrest, hypertension, weakness, arthritis, itching, bony cysts, conjunctivitis,

Hypomagnesmia

<1.2

Increased nerve impulse transmission, paresthesias, muscle tentant, chvosteks and trousseaus, hypoactive bowel sounds, constipation, abdominal distention, paralytic ileus.