2-1

Sodium: 135- 145 Salt, soy sauce, pork,

cottage/ American cheese, spinach, Pickles
HYPO: HYPER:
A - Adrenal insuffIciency D - Dehydration
I - Intoxication of water I - IV Hypertonic Solution excess
D - Diuretics V - Vitamins “Sodium” Supplement
S - SIADH A - Amount of sodium intake excess
S/S: Tachycardia, Headache, Personality S/S: Irregular HR, Hyperactive BS, Thirst,
Change, Weakness,Hyperactive BS Restlessness, Dyspnea, Muscle Weakness.
Seizures. INTERVENTIONS:
INTERVENTIONS: M - Monitor sodium intake/ Labs
D - Diet, Cheese, Milk, Soy Sauce, Salt, Bacon, A - Alka-seltzer, Aspirin, and cough preps
Beef Broth shouldn’t be administered
R - Restrict fluids and NPO G - Gravity of urine monitoring
W - Weights daily I - I&O
A - Administer IV Hypertonic Solutions C - Cardiac monitoring
I- I&O
T - Thiazide Diuretics

Potassium: 3.5- 5.0 Avocados, Raisins, HYPER:

Cantaloupe, Bananas, Skim milk, Spinach M - Medications Ace, Spironolactone, NSAIDS
HYPO: A - Acidosis: metabolic and respiratory
G - GI loss (Vomiting) C - Cell destruction (burn, trauma, Injury)
O - Osmotic Diuresis H - Hypoaldosteronism
T - Thiazides and Loop diuretics I - Intake excess K+
S - Severe Acid Imbalance N - Nephrons/ renal failure
H - Hyperaldosteronism E - Excretion : impaired
O - Other meds such as Corticosteroids S/S: Bradydysrhythmias, Tall “T” waves on EKG,
T - Transcellular Shift Cardiac Arrest, ↑BS Diarrhea, Paresthesias.
S/S: Tachydysrhythmias, Ortho Hypotension, INTERVENTION:
Lethargy/Fatigue, BS, Constipation, Anorexia, M - Monitor EKG
Muscle Weakness, “U” waves on EKG. D - Diet, limit green leafy veggies and avocado
INTERVENTIONS: K - Kayexalate administration
A- Assess EKG and ABG I - IV Sodium Bicarb, Calcium Gluconate,
I - IV Potassium Chloride ***NEVER IV PUSH*** D - Dialysis
D - Diet: green leafy veggies, oj, raisins, bananas

Calcium: 9-11 Yogurt, cheese, milk, HYPER:

sardines, rhubarb H - Hyperparathyroidism
HYPO: A - Antacids
A - Antibiotics M - Malignancies cancer cells release excess
C - Corticosteroids ca+
I - Insulin S/S: Dysrhythmias, Pallor, HTN, ↓ LOC
D - Diuretics Disorientation, ↓ DTR, ↓ BS, Constipation.
S/S: Hypotension, Bradycardia, Tetany muscle INTERVENTIONS:
spasm, Laryngospasm/Stridor, ↑DTR, ↑ BS F - Sodium containing fluids
diarrhea, +Trousseau's sign, +Chvostek's sign. I - IV Phosphate
INTERVENTIONS: L - Lasix
D - Diuretics M -Monitor Labs and I&O
I - I&O
C - Calcium channel blockers /Calcium Gluconate

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2-2
Phosphorus: 2.5- 4.5 Tuna, beef liver,
pork, milk and yogurt.
HYPO:
● Alcohol withdrawal
● Thermal burns; Heat stroke,
● Respiratory alkalosis; Hyperventilation
● Hepatic encephalopathy
● Low mag, low potassium
● Use of diuretics and antacids
● Refeeding syndrome
S/S: Muscle pain & weakness, Bone Pain,
Confusion.
INTERVENTION:
● Oral or IV phosphate replacement.
● Encourage food high in phosphate,
gradually introduce calories to a
malnourished pt receiving parenteral
nutrition.
Chloride: 97- 107
HYPO:
● Hyponatremia, excess chloride loss from
vomiting, diarrhea or NG suction.
● Addison's disease, DKA, excess sweating,
fever, burns, metabolic alkalosis.
● Medications that cause hypochloremia:
diuretics (loop and thiazide) increase
excretion of chloride by the kidneys.
S/S: Dysrhythmia, Hypotension, Dyspnea,
Confusion, Coma, Seizure, Sodium Imbalance,
Tremor, Muscle Cramps.
INTERVENTION:
● Replace chloride with IV NS or 0.45% NS.
● Avoid free water, high chloride foods.
Magnesium: 1.3- 2.1 Spinach,
avocado, tuna, oatmeal and milk
HYPO:
A - Alcoholism
G - GI loss
E - Excretion, Impaired
D - DKA
S/S :Seizures, Tetany, Anorexia,
Tachycardia, HTN, Mood Changes.
INTERVENTIONS:
S - Safety r/t ability to swallow
I - IV mag sulfate
M - Monitor labs and reflexes
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HYPER:
● Excess vit D
● Hypoparathyroidism, symptoms associated with
hypocalcemia, decreased excretion by the
kidneys.
● Medications causing hyperphosphatemia:
Decreased excretion by the kidneys
● Increased phosphorus absorption
S/S: Circumoral and Peripheral Parenthesis, Muscle
Spasms, Tetany.
INTERVENTIONS:
● Give vit D preparations
● Calcium binding antacids, phosphate binding gels
● Loop diuretics
● IV, NS, Dialysis
● Avoid high phosphorus food
● Manage signs of hypocalcemia
● Teach about phosphate containing substances
HYPER:
● Hypernatremia
● Head injury, dehydration, severe
diarrhea, metabolic acidosis
● Hyperparathyroidism
● Respiratory alkalosis
S/S: Hypertension, Respiratory Alkalosis,
Tachypnea, ICP, Cognitive Changes, Diarrhea,
Dehydration, Lethargy, Weakness.
INTERVENTIONS:
● Restore electrolyte and fluid balance, LR,
Sodium Bicarbonate diuretics.
HYPER:
D: DKA
A: Antacids that contain mag and mag
supplements
R: Renal failure, kidneys cannot excrete mag
K: Potassium Hyperkalemia
S/S: DTR, N/V, Bradycardia, Hypotension,
Coma.
INTERVENTIONS:
H - Hemodialysis
I - IV calcium gluconate
M - Monitor labs and DTR’s
 2-3

What am i ? Interventions:
Serum potassium level below 3.5 AID
mEq/L. Most common cation in the ECF. ❖ A- Assess EKG and
Obtained through diet; Absorbed in the ABG’s
small intestine; Excreted in the kidneys. ❖ I - IV Potassium
Chloride
Patho ❖ D - Diet: green leafy
veggies
Nerve impulse induction; Essential
Fun Fact
for normal electrical conduction in
In a relationship with salty
the heart; Important for, skeletal
sodium.
muscle contraction. Hypokalemia
Never push Potassium!
occurs when serum potassium levels
Alterations in acid base
fall below 3.5 mEq/ L. balance/low K alkalosis “your

Nursing Assessment battery is low.”

Causes Heart- Life threatening

dysrhythmias; Prominent “U”
Education:
GOT SHOT
waves and flat T waves; Weak
❖ G- GI loss (Vomiting;
pulses.
Diarrhea) ❖ Educate the client to
Lungs- Respiratory alkalosis;
❖ O- Osmotic Diuresis (ex: eat potassium rich
Kussmaul respirations; Slow
DKA) foods: Avocado,
shallow breath.
T- Thiazide and loop bananas, cantaloupes,
Neuro- Loc changes; Altered
diuretics carrots, fish,
mental status Lethargy; Anxiety.
mushrooms, oranges,
Gi- Constipation; Nausea;
❖ S- Severe Acid Imbalance potatoes, pork, beef,
Vomiting; Paralytic ileus.
( alkalosis) veal, raisins, spinach,
Musculoskeletal- Weakness
❖ H- Hyperaldosteronism strawberries, tomatoes.
and cramps; Decreased DTR;
❖ O- Other meds such as ❖ Intake and output
General weakness.
Corticosteroids Monitoring.
❖ T- Transcellular Shift (Using ❖ Daily weights if
insulin to treat DKA) indicated.
❖ Prevention of future
episodes of
hypokalemia.
❖ The need for a
high-potassium diet,
including foods that
Treatment are good sources of
potassium.
❖ Oral potassium
❖ Warning signs and
❖ IV potassium
❖ Potassium sparing symptoms of
diuretics hyperkalemia and
hypokalemia to report

Labs & Diagnostics

to a healthcare
practitioner.
❖ Serum electrolytes: ❖ The importance of
potassium less than 3.5 adhering to
mEq/L. scheduled follow-up
❖ EKG: ST depression, visits and laboratory
shallow, flat or inverted T
testing to evaluate
wave and prominent U
wave. the condition and the
effectiveness of
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treatment.
 2-4

What am i ?
Serum potassium level greater than
5 mEq/L . Most common cation in the
ECF.
Obtained through diet; Absorbed in
the small intestine; Excreted in the
kidneys.
Facilitates: Nerve impulse induction:
Essential for normal electrical
conduction in the heart: Important for
skeletal muscle contraction.
Regulated:
By the sodium/potassium pump and
the kidneys.
patho
Hyperkalemia is a result of serum
potassium levels rising above 5.0 mEq/L.
Occurs from deficient intake of
potassium, increased excretion of
potassium, or a shift of potassium from
extracellular to intracellular space.
Potassium imbalance can lead to muscle
weakness and flaccid paralysis because
of an ionic imbalance in neuromuscular
tissue excitability.
Causes
❖ M - Medications Ace
Assessment
Heart- Life threatening
dysrhythmias; elevated T Waves Labs & Diagnostics
could cause V-fib; wide QRS EKG: Tall peaked T waves, flat P
complex. waves, widened QRS complex,
Lungs- Could lead to your prolonged PR intervals.
respiratory failure.
Neuro- LOC, AMS.
Serum Potassium : > 5.0 mEq/ L
GI - Hyperactive bowel sounds.
Musculoskeletal- Hyperreflexia;
Tingling; Burning and
Numbness.
Interventions
❖ Monitor cardiovascular, renal,
neuromuscular, and respiratory
status.
❖ D/C IV potassium , hold oral
potassium supplements.
❖ Administer potassium excreting
diuretics.
❖ Prepare to administer sodium
polystyrene sulfonate ( kayexalate).
❖ Ready the client for dialysis.
❖ Ready IV calcium for administration.
❖ Prepare to administer IV hypertonic
solution with regular insulin to move
K+ back into the cell.

Education
inhibitors,
Spironolactone,
NSAIDS. ❖ Teach the client to avoid
❖ A - Acidosis: foods high in potassium.
metabolic ❖ Teach the client to avoid the
❖ and respiratory. use of salt substitutes as they
❖ C - Cell destruction: contain potassium.
burn, trauma, ❖ Teach the client signs and
Injury. symptoms of hyperkalemia
❖ H - Hypoaldosterone,
Hemolysis.
❖ I - Intake of exces
K+.
❖ N - Nephron
destruction/ renal
failure. Treatments
❖ E - Excretion:
❖ Dialysis
impaired.
❖ IV calcium
❖ Regular insulin
❖ Potassium excreting diuretics
❖ Kayexelate

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 2-5

Nursing Assessment Labs & Diagnostics

What am i ?
Serum calcium value lower than 8.6
mg/dL. Most abundant cation in the Human
body. 99% stored in the bones. Primary
source is in the bones. You need Vitamin D to
Heart- EKG prolonged QT interval and ❖ Chvostek's and
ST segment. Abnormal clotting, Trousseau's
Bradycardia in later stages. Diminished ❖ Serum calcium
Peripheral Pulses, Hypotension. levels
Lungs- Dyspnea; Laryngospasm; Stridor,

Interventions
aid in absorption, this is obtained via diet and Respiratory Arrest.
absorbed in the small intestine and excreted Neuro- Seizure
by the kidneys. GI- Diarrhea; Intestinal Cramping ❖ Monitor cardiac,
Function: Assists in building bones and Hyperactive bowel sounds respiratory and
teeth, facilitates blood clotting, essential for Musculoskeletal- muscle and nerve neuromuscular status.
nerve impulses. Plays a key role in skeletal excitability, tetany, muscle spasms of the ❖ Administer calcium
muscle contraction and relaxation, important face, hand, and feet, Circumoral orally or IV( warm the
for normal heart and muscle function. numbness( numbness around the mouth) solution to body
Regulated: Paraesthesia ( numbness and tingling) , temp).
1. Parathyroid hormone: excreted by the Hyperactive DTR, positive Trousseau's ❖ Observe for
parathyroid gland increase Ca+ concentration sign, positive Chvostek's sign. infiltration.
in the blood. ❖ Provide a quiet
2. Calcitriol: hormonally active Vit D. H - Hyperactive bowel sounds environment.
Increases Ca+ by aiding in absorption in the E - EKG changes ❖ Move the client
small intestine ,decreases renal transfer from carefully to prevent
the blood to the kidneys. Increases the T - Tetany pathological fracture.
release of calcium from the bones into the W - Wink ( chvostek's ) ❖ Keep 10% calcium
blood. I - Increased hr , followed by decreased gluconate ready for
3. Calcitonin: produced by the thyroid HR acute hypocalemia.
gland, decreases blood Ca+ and increases T - Trousseau’s sign ❖ Instruct the client to
reabsorption into the bones. C - Circumoral numbness consume calcium rich
H - Hyperactive deep tendon reflexes foods.
E - Excitability ( neuromuscular) ❖ Initiate seizure

Patho
S - Seizures precautions.

A reduction in total serum calcium can

result from a decrease in albumin
secondary to liver disease, nephrotic Education
syndrome, or malnutrition. Hypocalcemia ❖ Consume calcium rich
causes neuromuscular irritability and foods: cheese, collard
tetany. greens, milk, soymilk,
rhubarb, sardines,

Causes
spinach, tofu, yogurt.
❖ Educate the client on
❖ Body's inability to absorb signs and symptoms of
calcium low calcium.
❖ Decreased calcium intake ❖ Instruct the client to take a
❖ Vit D deficient calcium supplement.
❖ Lactose intolerance ❖ Educate the client on the
❖ Crohn's disease medications you are
❖ End stage kidney disease administering--some take
❖ Diarrhea, steatorrhea 2 hrs apart (beta-blockers)
❖
❖
Wound drainage
Hyperproteinemia
Treatments
❖ Aluminum hydroxide: reduces phosphorus
❖ Alkalosis
levels.
❖ Chelating agents or calcium
❖ Vitamin D: Aids in calcium absorption.
binders
❖ Acute pancreatitis
❖ Removal or damaged
parathyroid
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❖ Immobility
❖ Hyperphosphatemia
2-6

What am i ? Labs & Diagnostics

Serum calcium value greater than 10.2 Assessment ❖ Serum calcium
Heart- Ekg: heart block, short levels
mg/dL Most abundant cation in the Human
QT, wide T waves, spastic ❖ Parathyroid
body. 99% stored in the bones. Primary
contraction of heart muscles. hormone levels
source is in the bones. Need vit D for
Lungs- SOB; Weak respiration. ❖ Imaging to check
absorption. Obtained via diet, absorbed in
Neuro- LOC; AMS; Decreased bones density
small intestine, excreted by the kidneys.
Function: Assists in building bones and DTR w/o parenthesis.
teeth, facilitates blood clotting, essential GI/ GU- Polyuria; Decreased
for nerve impulses, plays a key role in motility; Constipation; Renal
skeletal muscle contraction and relaxation, Calculi.
Important for normal heart and muscle fx. Musculoskeletal- Severe
Regulated: muscle weakness; Decreased
1. Parathyroid hormone: Excreted by the excitability of muscle and
parathyroid gland increase Ca++ nerve; Bone pain.
concentration in the blood.

Interventions
2. Calcitriol: Hormonally active Vit D.
Increases Ca+ by aiding in absorption in the
small intestine, decreases renal transfer Slim Fast
from the blood to the kidneys. Increases ❖ S - Safety - from falls.
the release of calcium from the bones into ❖ L - Lasix - Will excrete
the blood. electrolytes, mainly
Education
3. Calcitonin: Produced by the thyroid potassium but also
gland, decreases blood CA and increases
Calcium as well.
reabsorption into the bone. ❖ Increase fluid intake.
❖ I - IV Phosphate - ❖ Greatly limit or stop your
Remember, Friendly Fatty intake of milk, cheese, cottage

Patho Phosphate will repel cheese, yogurt, pudding, and

ice cream.
Calcium from the blood ❖ Avoid antacid medicines.
Hypercalcemia is reported as elevation of
total plasma calcium levels rather than stream. ❖ Don’t limit your salt intake.
ionized calcium levels. Acidosis decreases ❖ M- Monitor EKG, I&O, ❖ Exercise.
❖ Resume your normal activities
the amount of calcium bound to albumin, Kidney Stones.
as directed by your healthcare
whereas alkalosis increases the bound provider.
fraction of calcium. A small amount of ❖ F - Fluids: Like Normal ❖ Take your medicines as
calcium (about 6%) is complexed to anions Saline (decrease chance directed.
such as citrate and sulfate. The remainder ❖ Tell your healthcare provider
of renal stone formation). about any other medicines you
is ionized calcium that is biologically active.
❖ A - Avoid HIGH Calcium are taking, including
The most common causes of
Foods. over-the-counter or herbal
hypercalcemia, affecting 90% of all
medicines and supplements.
patients, are primary hyperparathyroidism ❖ S - Serious Case =
❖ Keep all appointments for lab
(HPT) and malignancy. dialysis. work and follow-up.
❖ T - Treat with calcium
reabsorption inhibitors:
Causes Calcitonin, Treatments
HAM Bisphosphonates, ❖ IV phosphorus
❖ H - Hyperparathyroidism prostaglandin synthesis ❖ Calcitonin
❖ A - Antacids containing calcium inhibitors (ASA, NSAIDS). ❖ Bisphosphonates
❖ M - Malignancies cancer cells ❖ Prostaglandin inhibitors
release excess Ca+

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 2-7

What am I ?
Below-normal serum magnesium Assessment Labs & Diagnostics
concentration 1.3 mg/dL. Second most ❖ Serum magnesium
Heart- Torsades de pointes;
abundant cation in the body. 50- 65% found in levels
Tachycardia; Hypertension;
bone, the rest is in ICF and intravascular
Dysrhythmias. ❖ Deep tendon reflexes
system primary source is diet, absorbed in the
Lung- Shallow respiration.
ileus, excreted in stool and urine.
Neuro- Apathy; Confusion;
Interventions
Function :
Agitation; Ataxia “poor
❖ Maintains normal muscle function
coordination“; Hyperactive deep
❖ Nerve function ❖ Increase dietary intake of
tendon reflexes.
❖ Heart rhythm magnesium.
GI/GU- Diarrhea.
Required for calcium and Vitamin B absorption,
Musculoskeletal- ❖ Monitor cardiac rhythm.
stimulates parathyroid hormone which
Hyperexcitability; Chvostek’s ❖ Monitor reflexes.
regulates ICF calcium levels. Fights tooth ❖ Monitor serum electrolytes.
and Trousseau’s signs.
decay by binding calcium to tooth enamel. Has ❖ Keeps breathing bag, and O2
a sedative effect of the neuromuscular system at bedside in case of
causing decrease ach release causing smooth respiratory distress.
muscle relaxation. ❖ Calcium preps may be given
Regulated: Kidneys to counteract cardiac
dysfunction related to
Patho magnesium intoxication from
rapid infusion.
Hypomagnesemia is caused by
❖ Seizure precautions.
impaired intestinal absorption of
❖ Monitor for digoxin toxicity.
magnesium and is accompanied by
❖ Keep the client safe.
renal magnesium wasting which is a
❖ Assess ability to swallow
result of a reabsorption defect in the
before giving po fluids or
distal convoluted tubule.
meds.

Causes
cray
❖ C - Consumption of alcohol in
excess - inhibits absorption of
Mg+ in the GI tract.
❖ R - Really large fluid loss, NG
suction, Vomiting, Diarrhea or
Diuretics! Bc where fluids flow,
Electrolytes GO!!!
❖ A - Antibiotics - Aminoglycoside
- Fully explained in the FULL

Education
video.
❖ Y - Young mothers - are HIGH

Treatment
RISK for malnutrition.
❖ IV Mg+ Sulfate
❖ Increase oral intake of
Magnesium
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❖ Increase intake of dietary
magnesium: green veggies,
chocolate, nuts bananas,
oranges, peanut butter.
❖ Prepare the client for IV Mg+
infusion, let them know that it will
burn going in. You can slow down
the infusion for client comfort.
❖ Educate the client on signs and
symptoms of low magnesium.
 2-8

What am i ?
Serum magnesium level higher than 2.3 Labs & Diagnostics
mg/dL. Second most abundant cation in
the body. 50- 65% found in bone, the rest ❖ Serum magnesium
is in ICF and intravascular system primary levels.
source is diet, absorbed in the ileus,
❖ Neuromuscular status
excreted in stool and urine.
Function : Maintains normal muscle fx, checks.
nerve fx, and heart rhythm, required for
calcium and vit b absorption, stimulates
parathyroid hormone which regulates ICF
calcium levels. Fights tooth decay by
binding calcium to tooth enamel. Has a
sedative effect of the neuromuscular

Interventions
system causing decrease ach release
causing smooth muscle relaxation.
Regulated: Kidneys
Assessment HIM
Heart- Bradycardia, cardiac. ❖ H - Hemodialysis
arrest, dysrhythmias, ❖ I - IV calcium gluconate
hypotension. ❖ M - Monitor labs and
DTR’s
Lung- Depressed
Discontinue oral IV Mg+
respirations. Monitor respiratory status.
Neuro- Diminished or absent
Patho deep tendon reflexes;

Education
Magnesium excess affects the CNS, Drowsiness and lethargy that
neuromuscular, and cardiac organ progresses to coma.
systems. It most commonly is GI/GU- Hypoactive bowel. ❖ Educate client on signs
observed in renal insufficiency and in Musculoskeletal- Skeletal and symptoms of
patients receiving intravenous (IV) muscle weakness. hypermagnesemia.
magnesium for treatment of a medical ❖ Educate the client to
condition. avoid magnesium
containing antacids and
other OTC medications
that contain magnesium.

Causes
DARK
❖
❖
D- DKA.
A- Antacids that contain Mg+
Treatment
and Mg+ supplements.
❖ R- Renal failure, kidneys cannot ❖ Discontinue IV Mg+
excrete Mg+ ❖ Discontinue oral Mg+
❖ K- Potassium hyperkalemia. ❖ Administer IV Calcium
Gluconate
❖ Support ventilation

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 8-9
What am I
Hypophosphatemia is
indicated by a value below 2.5
mg/dL . Major anion in the ICF.
-phosphorus is found in the
body in combination with 02
approx. 85 % is bound with
calcium in teeth. Obtained via
diet. Absorbed in intestines
excreted by urine and stool.
Function:
Essential for bone and teeth
formation. Helps regulate
calcium. Assists in muscle
contraction, maintenance of
heart rhythm, and kidney fx.
Regulated: Parathyroid and
calcitriol.
patho
Hypophosphatemia is most
often caused by long-term,
relatively low phosphate intake
in the setting of a sudden
increase in intracellular
phosphate requirements such
as occurs with refeeding.
Intestinal malabsorption can
contribute to inadequate
phosphate intake, especially if
coupled with a poor diet.
Causes
❖ Alcohol withdrawal
❖ Thermal burns; Heat stroke
❖ Respiratory alkalosis,
Hyperventilation
❖ Hepatic encephalopathy
❖ Low mag, low potassium
❖ Use of diuretics and antacids
Labs & Diagnostics
Assessment
Serum electrolyte levels
Heart- Dysrhythmias;
Slowed peripheral
pulses.
Lung- Respiratory
alkalosis;
Hyperventilation; Shallow Interventions
respiration. ❖ Oral or IV phosphate
Neuro- AMS, altered. replacement.
LOC; CNS depression. ❖ Encourage food high in
GI/GU- K+ excretion. phosphate, gradually introduce
Musculoskeletal- calories to a malnourished pt
Decreased deep tendon receiving parenteral nutrition.
reflexes.
Education
❖
Eat more foods that contain
phosphorus.
❖ Increase your intake of milk,
cream, cheese, cottage cheese,
yogurt, puddings, custard, and ice
cream. Add powdered milk to
foods.
❖ Eat meat, fish, poultry, eggs, and
peanuts and other nuts and
seeds. Also eat beans, lentils,
peas, and soy products.
❖ Eat bran cereal, granola, oatmeal,
and wheat germ.
Treatment
Hypophosphatemia (serum phosphate 1-2 mg/dL),
providing oral phosphate replacement may be
desirable. It is recommended that oral phosphate
replacement be used in patients who are
symptomatic and have phosphate levels between
1.0-1.9 mg/dL.
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2-10

About Me Labs & Diagnostics

❖ Serum sodium levels
Serum phosphorus level that ❖ Serum phosphate
exceeds 4.5 mg/dL. Major anion in levels
the ICF. -phosphorus is found in the Assessment ❖ Neuromuscular
body in combination with 02 approx.
Heart- Prolonged ST assessments
85 % is bound with calcium in teeth.
interval; Prolonged QT
obtained via diet. Absorbed in
interval; Diminished
intestines excreted by urine and
peripheral pulses.
stool.
Lungs- Soft tissue
Function:
calcification in lungs.
Essential for bone and teeth
Neuro- Altered LOC, AMS;
formation. Helps regulate calcium.
Hyperactive reflexes.
Assists in muscle contraction,
GI/GU- Nausea/Vomiting.
maintenance of heart rhythm, and
Musculoskeletal- Muscle
kidney fx.
weakness.
Regulated:
Parathyroid and calcitriol.
Interventions
❖ Give vit D preparations.
❖ Calcium binding antacids, phosphate binding
gels.
❖ Loop diuretics.
Patho ❖
❖
IV, NS, Dialysis.
Avoid high phosphorus food.
The most common cause of ❖ Manage signs of hypocalcemia.
hyperphosphatemia in renal failure. ❖ Teach about phosphate containing
Other, less common causes are, substances.
increased phosphate intake,
decreased phosphate output, or a
shift of phosphate from the
intracellular to the extracellular
space. Decreased sodium levels will
also cause a decrease in phosphate
levels. Education
❖ Client education will be identical to client
education for a client with a Sodium

Causes
imbalance .

❖ Excess vit D.
❖ Hypoparathyroidism,
symptoms associated with
hypocalcemia, decreased
excretion by the kidneys. Treatment
❖ Medications that may cause ❖ Oral replacement therapy (1000
hyperphosphatemia: mg/d) Mild hypophosphatemia
decreased excretion by the should be managed with oral
kidneys. replacement therapy (1000 mg/d).
❖ Increased phosphorus
absorption.
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 2-11
What am I ?
Hypochloremia is a serum chloride level
below 97 mEq/L . Major ANION in the
ECF, functions primarily with sodium and
chloride to maintain a balance between
intra and extracellular fluid. When sodium
is retained so is chloride. Chloride is
retained continuously in the intestines
along with sodium, kidneys are responsible
for reabsorption and excretion of sodium
and chloride.
Function: Combines with hydrogen in the
stomach to produce hydrochloric acid;
Works with magnesium and calcium to
maintain nerve transmission and normal
muscle contraction/relaxation; Imbalance
never occurs alone, always check
bicarbonate, K+ , and sodium as well.
Regulation
Primarily by the kidneys.
Patho
Hypochloremia occurs in the
presence of other abnormalities. It’s
often associated with hypoventilation
and can be associated with chronic
respiratory acidosis. If it occurs
together with metabolic alkalosis
(decreased blood acidity) it is often
due to vomiting. It is usually the
result of hyponatremia or elevated
bicarbonate concentration. It occurs
often in cystic fibrosis.
Causes
❖ Hyponatremia, excess
chloride loss from
vomiting, diarrhea or NG
suction.
❖ Addison's disease, DKA,
excess sweating, fever,
burns, metabolic
alkalosis.
❖ Medications that cause
hypochloremia: diuretics
(loop and thiazide)
increase excretion of
chloride by the kidneys.
Assessment
Heart- Dysrhythmia,
hypotension
Lung- Dyspnea; SOB
Neuro- Agitation; Irritability;
Seizure; Coma; Confusion
GI/GU- Sodium imbalance
Musculoskeletal- Tremor;
Muscle cramps
Complications
❖ Respiratory arrest
❖ Seizures
❖ Coma
Treatments
❖ Treatment of underlying
condition.
❖ Treatment of associated
metabolic alkalosis or
electrolyte imbalances.
❖ Fluid resuscitation with
normal saline I.V.
solution.
❖ Electrolyte replacement
therapy, including
potassium chloride and
sodium chloride.
❖ Nonsteroidal
anti-inflammatory drugs
(NSAIDs) such as
indomethacin.
❖ Carbonic anhydrase
inhibitors such as
acetazolamide.
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Labs & Diagnostics
❖ Serum chloride level is less
than 97 mEq/L.
❖ Serum sodium level is less
than 135 mEq/L.
❖ Metabolic alkalosis.
❖ Serum pH is greater than
7.45.
❖ Serum carbon dioxide level
is less than 35 mEq/L.
Interventions
❖ Replace chloride with IV
NS or 0.45% NS.
❖ Avoid free water, high
chloride foods.
Education
❖ Signs and symptoms of electrolyte
imbalances, including hyperchloremia
and hypochloremia, hyponatremia
and hypernatremia, and hypokalemia
and hyperkalemia.
❖ Signs and symptoms of metabolic
alkalosis and metabolic acidosis.
❖ Use of dietary supplements and
appropriate food choices; food
sources for chloride.
❖ Prescribed drugs, including drug
names, dosages, rationales for use,
and schedule of administration.
❖ Possible adverse effects of NSAIDs (if
ordered), such as GI upset and
increased risk of bleeding.
❖ Importance of adequate fluid intake
to maintain hydration status.
❖ Signs and symptoms of dehydration
and the need to notify a practitioner if
any occur.
❖ Importance of continued follow-up
and laboratory testing to evaluate the
condition and effectiveness of
therapy.
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What am I ?
Hyperchloremia exists when the
serum level of chloride exceeds 107
mEq/L . Major ANION in the ECF,
functions primarily with sodium and
chloride to maintain a balance
between intra and extracellular fluid.
When sodium is retained so is
chloride. Chloride is retained
continuously in the intestines along
with sodium, kidneys are responsible
for reabsorption and excretion of
sodium and chloride.
Function: combines with hydrogen in
the stomach to produce hydrochloric
acid; Works with magnesium and
calcium to maintain nerve transmission
and normal muscle
contraction/relaxation; Imbalance
never occurs alone, always check
bicarbonate, K+ , and sodium as well.
Regulation
Primarily by the kidneys.
Patho
Chloride is secreted by stomach
mucosa as hydrochloric acid; it
provides an acid medium that aids
digestion and activation of enzymes.
Chloride helps to maintain acid-base
and body water balances, influences
the osmolality or tonicity of
extracellular fluid, plays a role in the
exchange of oxygen and carbon
dioxide in red blood cells, and helps
activate salivary amylase (which, in
turn, activates the digestive process).
An inverse relationship exists between
chloride and bicarbonate. When the
level of one goes up, the level of the
other goes down.
Causes
❖ Hypernatremia
❖ Head injury, dehydration,
severe diarrhea, metabolic
acidosis
❖ Hyperparathyroidism
❖ Respiratory alkalosis
❖ Loss of pancreatic secretion
Assessment Labs & Diagnostics
Heart - Hypertension ❖ Serum chloride level is
Lungs - Respiratory greater than 107 mEq/L.
alkalosis ,rapid deep ❖ With metabolic acidosis,
respirations, tachypnea serum pH is less than
Neuro - ICP, cognitive 7.35, serum HCO3 level is
changes. less than 22 mEq/L, and
GI/GU - Diarrhea, diuresis, the anion gap is normal.
dehydration ❖ Serum sodium level is
Musculoskeletal - lethargy, greater than 145 mEq/L.
weakness
Interventions
❖ Auscultate heart and lung
sounds for changes.
Continuous cardiac
monitoring.
❖ Evaluate muscle strength and
adjust activity level.
❖ Assess neurologic status
closely. Reorient the patient as
❖
necessary.
Assess for signs and
Education
❖ Signs and symptoms
symptoms of metabolic
alkalosis. associated with
❖ Serum electrolyte levels,
especially sodium, chloride,
complications, including
recurrence of elevated
and potassium levels. chloride levels.
❖ Monitor ❖ Dietary or fluid restrictions,
❖ Respiratory status. as indicated.
❖ Signs of metabolic alkalosis. ❖ Prescribed medications,
❖ Intake and output. including drug names,
❖ Daily weight. dosages, schedule of
❖ Location and extent of edema. administration, and possible
adverse effects.
❖ Neurologic status.
❖ Recommendations for
❖ Cardiopulmonary status,
including cardiac rhythm. follow-up evaluation,
❖ Arterial blood gas (ABG) including laboratory testing
levels. for electrolyte levels.
Treatments
❖ Treatment of underlying cause.
❖ Restoring fluid, electrolyte, and
acid-base balance.
❖ Treatment-Diet: Restricted sodium
and chloride intake.
❖ Treatment-Activity: As tolerated.
❖ Treatment-Medications: Sodium
bicarbonate IV.
❖ IV fluid therapy with lactated Ringer's
solution.
❖ Loop diuretics to address fluid
overload.
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 2-13
What am i ?
Hyponatremia refers to a serum
sodium level that is less than 135
mEq/L. Major cation in the ECF,
obtained via diet and absorbed in
the small intestines excreted via
kidneys.
Function: maintains blood volume
and blood pressure. Regulated by
aldosterone: conserves sodium.
Regulation
ADH: thru dilution or retention of
h20 NA+ K+ PUMP: moves in and
out of cells via active transport.
Patho
Hyponatremia can result from
improper blood collection,
excessively high water intake, or,
most commonly, an inability of the
kidneys to excrete free water.
Sodium is regulated through the
sodium potassium pump and dilution
or concentration of sodium can be
altered by ADH and aldosterone
imbalances.
Causes
❖ S - SIADH
❖
I - intoxication of water -
Hemodilution leading to
LOW sodium!
❖ A - adrenal insufficiency
like Adrenal Crisis with
Addison's Patients wastes
sodium from the body.
❖ D - diuretics - Thiazides and
loop diuretics Generic
names are
(hydrochlorothiazide and
furosemide), Excretes that
sodium.
❖ H - Heat Exhaustion or HIGH
fever Causes massive
sweating called
“Diaphoresis.”
Labs & Diagnostics
Assessment
Heart- Cardiac ❖ Serum sodium <135
Dysrhythmias; Weight gain mEq/L
Lungs- SOB; Dyspnea ❖ - Critical value <120
Neuro- Restlessness, mEq/L
confusion, seizures, coma ❖ - Serum osmolality
GI/GU- Nausea/Vomiting; <280 mOsm/kg
Abdominal cramping
Musculoskeletal- General
Interventions
weakness
❖ A - Administer IV Saline
solutions.
❖ D - Diuretics Or Dialysis.
Treatments ❖ D - daily weights.
❖ Replace deficit with NS over
6-12 hours until signs of ECF
❖ S - Safet: orthostatic
hypotension.
deficit are stable. ❖ A - Airway protection!
❖ Rate of 10-12 mEq/L in 24 ❖ L - Limit Water Intake -
hrs or 18 mEq/L in 48 hrs. for patients with HYPER
❖ Water restriction. volemia.
❖ Diuretic therapy. ❖ T - Teach Foods HIGH
❖ Increased Na+ intake. in salt.
❖ SLOW correction <12
mEq/L/day If too rapid, it
may cause acute decrease in
brain cell volume, which may
lead to demyelination =
permanent brain injury.
Education
❖ Deficit causes
❖ Prevention
❖ Treatment regimen: Medication, Nutrition
❖ Foods High in Sodium: Foods High in Added Sodium
❖ Processed Meats & Fish (bacon, sausage, smoked fish)
❖ Dairy Products (cheeses, cottage cheese, ice cream)
❖ Canned Goods (meats, soups, vegetables)
❖ Processed Grains (dry cereals, graham crackers)
❖ Condiments & Food Additives (barbecue sauce,
ketchup, pickles, salad dressings)
❖ Snack Foods (gelatin desserts, nuts, potato chips)
❖ Foods High in Sodium: Foods Naturally High in
Sodium
❖ Carrots, clams, crab, dried fruits, lobster, oysters,
shrimp, spinach
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 2-14

Assessment Labs & Diagnostics

What am I ? Heart: Hypertension
Lungs : Respiratory alkalosis, ❖ Serum >145 mEq/L
Hypernatremia refers to a serum rapid deep respirations, ❖ Increased osm in plasma.
tachypnea ❖ Decreased osm in urine,
sodium level that is greater than 145
Neuro : ICP, cognitive changes increased Hematocrit.
mEq/L. Major cation in the ECF, ❖ Dry mucous membrane.
obtained via diet and absorbed in the GI/GU:Diarrhea, diuresis,
dehydration
small intestines excreted via kidneys.
Musculoskeletal: lethargy,
Function: Maintains blood volume and
Interventions
weakness
blood pressure. Regulated by
aldosterone: conserves sodium ❖ M - monitor sodium
Regulation intake and labs.
ADH: thru dilution or retention of h20 ❖ A- Alka-seltzer, Aspirin,
NA+ K+ PUMP: moves in and out of cells and cough preps should
via active transport. not be administered.
NURSING ACTION: ❖ G- gravity of urine should
❖ Cerebral cells are be monitored.
highly sensitive to ❖ I- I&O strict monitoring.
changes in sodium ❖ C- Cardiac monitoring.
Patho
level and fluid volume.
Brain cells swell in Monitor response to therapy
Sodium concentration in serum is more cases of hyponatremia prevent hyponatremia and
than 145 mEq/L. Hypertonicity of ECF = and shrink in cases of dehydration.
cellular dehydration.hypernatremia hypernatremia. These
occurs when there is a large decrease changes may lead to
Seizures, coma, and
in fluid volume and brain volume which
death.
is caused by an an osmotic shift of free ❖ - DO NOT INCREASE
water out of the cells. SODIUM TOO FAST,
IT MAY CAUSE
NEUROLOGICAL
Causes SYMPTOMS
❖ D- Dehydration.
❖ I - IV hypertonic
solution excess.
Education
❖ V - Vitamins “sodium”
❖
Treatment
Limit all foods that are high in
supplements. sodium.
❖ A - amount of sodium ❖ Drink more fluids.
❖ With hypovolemia: restore fluid balance.
intake in excess. ❖ Have your sodium levels checked.
❖ Hypotonic (0.225% NaCl) IV infusions.
❖ With poor renal excretion of Na+: diuretics ❖ Replace your body fluids after
such as furosemide/Lasix or vomiting or diarrhea.
bumetanide/Bumex. ❖ Take all medicine as directed.
❖ Assess hourly for excessive fluid loss, Na
loss, K+ loss.
❖ Nutrition interventions. Call your hcp if you have
❖ For mild hypernatremia. ❖ Muscle twitching, spasms, or cramps
❖ Ensure adequate water intake, esp. w/ ❖ Fatigue
older adults. ❖ Confusion
❖ Dietary Na restriction w/ kidney problems.
❖ Seizures
❖ Fluid restrictions often necessary.
❖ Collaborate w/ dietician for patient ❖ Loss of consciousness or fainting
education. ❖ Dizziness or lightheadedness

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