Fluid and Electrolytes

Made
Fluid and Electrolytes Made INSANELY Easy! Without electrolytes, our bodies
Loretta Manning, MSN, RN, GNP
President, I CAN Publishing, Inc.
would be like a ship without light,
resulting in a crash!
Easy!
Without electrolytes, our bodies
NSNA, November 10, 2012
Loretta Manning, MSN, RN, GNP
would be like a ship without
President, I CAN Publishing, Inc.
Regional Director, Sylvia Rayfield & Associates
light, resulting in a crash!

Make mistakes
M
Ask dumb questions A
The most important thing
in nursing is not so much Collaborate C
to obtain more and
Have fun H
more facts, but to
TRANSFORM how we
THINK about them!
1 1
Loretta Manning, MSN, RN, GNP

2012 I Can Publishing, Inc.

Whos Here?
Red = Freshman and trying to figure out
just how to spell fluid and electrolytes.
What concerns me
Yellow = Sophomore but still feel insecure
is not the way things
with fluid and electrolytes.
are, but rather the way
Blue = Junior and starting to feel like I am people think things are.
just trying to remember F&E. Epictetus, Philosopher
Green =Senior and feel like I have so
much information in my brain that it is hard
to remember all of this! I keep wondering
when all of this is going to come together!

1
Trivialize

Tedious Learning is Directly

Proportional to the
Amount of FUN
You have.
Terrorize

1.
Grid puzzle 3.
2.Little figures

REMEMBER!!! Its
not what you
KNOW, but what 4. 5. 6.
you REMEMBER
that counts!
7. 8. 9.

CUSHY CARL
Grid solution

1994 I CAN

2
 What is the priority plan for a client with
Cushings syndrome?

Balancing Act for the Brain and

1. Prevent skin breakdown.
Kidneys:
Kidneys 2. Prevent dehydration.
3. Teach client about symptoms of
hypoglycemia.
4. Prevent fluid overload.

2012 I CAN Publishing, Inc.

FLUID SHIFTS 9 BRAIN RULES FOR THRIVING

VERSUS JUST SURVIVING
Exercise
Attention
Memory (repeat to remember)
Memory (remember to repeat)
Sleep
Stressed brains dont learn the same
1994 I CAN Sensory
Mary had a little lamb and everywhere Mary went the Vision trumps all other senses
lamb was sure to go.
Wiring

FLUID & ELECTROLYTE

IMBALANCE

What I hear, I forget;

What I see, I remember.
What I do, I understand.
Confusius, 451 B.C.

3
 Structure for Fluid & Electrolytes !
S ystem Specific Physiology, Assessments,
Labs / Diagnostic Procedures
A nalysis of Assessments, Nursing Diagnoses/
Concepts
F irst-prioritize Interventions / Pharmacology
Loss of 2% body weight, an increase
E xpected outcomes of ADH and a thirsty feeling are
T o Reduce Potential RISKS regulating fluid balance!
room assignments, recognize limitations of
staff, restraints, risk for falls, infection,
identification, skin breakdown, scope of
practice for delegation, know Standards of
Practice, safe equipment)
Y (Why?) Ask questions when you dont know
(Accuracy / Appropriateness of orders)!

2008 ICAN Publishing Inc.

2012 I CAN Publishing, Inc.

Fluid & Electrolytes

(Sung to the tune of Jingle Bells
Verse 1
Sodium, sodium is found outside the cells
Low levels come from pooping, puking, peeing!!
Verse 2
Sodium, sodium is found outside the cells
High levels come from too much salt and not drinking!
Verse 3
Potassium, potassium is found inside the cells
Low levels come from Lasix and laxatives.
Verse 4
Pot assium, pot assium is found inside t he cells
High levels come from some meds and renal failure!
Verse 5
Electrolytes, electrolytes like sodium and potassium
Dont have to be that hard when you sing our song!

Which of these would be an example of

ACTIVITY osmosis?

Osmosis fluid moves 1. Water moves from an area of lower to

lower to higher higher particle concentration.
Diffusion higher to 2. Water moves from an area of higher to
lower lower particle concentration.
3. Fluid remains within the cell.
4. Fluid moves outside the cell due to
changes in protein.

4
Which of these would be an example of SAFETY::
diffusion? System Specific Physiology
FLUID VOLUME EXCESS: HYPERVOLEMIA

1. Water moves from an area of lower to ECF volume due to:

higher particle concentration.
2. Water moves from an area of higher to Heart or renal failure, cirrhosis
lower particle concentration. Na, excess IV fluids
3. Fluid remains within the cell. aldosterone secretion
4. Fluid moves outside the cell due to albumin,
changes in protein. Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)

SAFETY: SAFETY:
System Specific Assessment: System Specific Assessment
Labs & Diagnostic Procedures Fluid Volume EXCESS
FVE (hypervolemia) (Decreased values) Signs and Symptoms of Hypervolemia: in volume

pulse
temperature
blood pressure
Hct in edema
Serum Osmolality in ascites
in crackles in lungs
Serum Sodium (NA) swelling neck (jugular vein distention)

BUN in confusion, headache and seizures

2012 I CAN Publishing, Inc.

SAFETY: RESTRICT
SAFETY: FIRST - Priority Nursing Interventions

Analysis of Assessments /
Nursing Diagnosis / Concepts
Fluid Volume Excess
R educe IV flow rate
E valuate breath sounds and ABGs
S emi-Fowlers position
T reat with oxygen and diuretics as ordered
R educe fluid and sodium intake
I & O and weight
C irculation, color, and presence of edema
T urn and position at least every 2 hrs

5
 SAFETY SAFETY
Expected Outcomes System Specific Expected Outcomes System Specific
COMPARISON of initial assessment to expected COMPARISON of initial assessment to
outcome evaluation
expected outcome evaluation
System Specific Expected Outcome
Assessment FVE Fluid Balance
System Specific Expected Outcome
pulse Pulse within client norm - Assessment FVE Labs Fluid Balance of Labs
B/P B/P within client norm to normal range
weight Weight within client norm
Hct Hct
edema edema
ascites ascites Serum Osmolarity Serum Osmolarity
crackles in lungs crackles in lungs Serum Sodium (NA) Serum Sodium (NA)
dyspnea dyspnea BUN BUN
confusion confusion

SAFETY:
(Connecting NCLEX to Concept)
To Reduce Potential Risks Which clinical finding indicates the client
is experiencing potential fluid volume
excess?
R oom assignments, recognize limitations of
staff, restraint safety
I nfection, Identification, Identify TRENDS or a.B/P change from 108/78 to 140/90
Changes in Clinical Condition b.Decreased crackles in lower lung fields
S kin breakdown, Safe equipment, Scope of
Practice for delegation
c.Pulse increased from 72/min to 80/min
K now Standards of Practice, know how to d.Weight from 150 lbs to 142 lbs
document / report errors

Which nursing action would be appropriate

for a client with orthopnea, dyspnea, and
bibasilar crackles? SAFETY:
Why? Is there anything you
1. Elevate legs to promote venous return. want to ask?
2. Elevate the head of the bed, decrease the IV
fluids, and notify the provider of care. (Accuracy / appropriateness of orders)
3. Orient the client to time, place, and situation.
4. Prevent complications of immobility.

6
Which order should be questioned for a
client presenting with with orthopnea,
dyspnea, BP 150/92 with adventitious
breath sounds in bilateral lower lung
fields? Brain conducting Posterior
pituitary gland
a. Administer furosemide (Lasix) as ordered.
b. Daily weight every AM.
c. Increase IV fluids for 2 hours.
d. Position client in semi-Fowlers position.
Posterior
Pituitary Gland

2012 I CAN Publishing, Inc.

SOGGY SID
S-I-A-D-H
(Syndrome of Inappropriate Antidiuretic Hormone)
Lyrics (Sing to tune: BINGO) Darlene A. Franklin, RN MSN

Chorus
S-I-A-D-H, S-I-A-D-H, S-I-A-D-H,
This hormone stops the PeePee.
Verse 1
Brain tumors, trauma, and bad bugs
A complication might be
S-I-A-D-H, S-I-A-D-H, S-I-A-D-H,
This hormone stops the PeePee.
Verse 2
Low output, sodium; gained weight
And high S. gravity (specific gravity)
S-I-A-D-H, S-I-A-D-H, S-I-A-D-H,
This hormone stops the PeePee.
1994 I CAN PUBLISHING, INC.

Verse 3 What would be the highest priority of care for a

But, Diabetes Insipidus client with syndrome of inappropriate anti-
The opposite youll see diuretic hormone (SIADH)?
Pee, PeeGive IVs
Pee PeeGive IVs 1. Instruct the UAP to encourage the client to
Pee, PeeGive IVs drink fluids.
Vas-o-pressin they need!
Verse 4
2. Advise client to report large amounts of urine
High output, sodium; pounds lost, output.
And low S. gravity (specific gravity) 3. Evaluate for signs and symptoms of
Pee, PeeGive IVs dehydration.
Pee PeeGive IVs 4. Instruct the LPN to report a weight gain of 2.5
Pee, PeeGive IVs pounds.
Vas-o-pressin they need!

ht t p:/ / www.marvist avet .com/ asset s/ images/ dog

_ IV.gif

7
CALLING THE SHOTS IN ACID VS. BASE
1994 I CAN
SAFETY:
System Specific Assessment
Fluid Volume DEFICIT
Decrease in weight
Decreased skin turgor
Dry mucous membranes
Decreased urine output
Decrease in Blood Pressure
Decrease in warmth to extremities
Decrease fluid to pump so pulse is
Decrease strength in pulse (weak)
SAFETY:
Analysis of Assessments /
Nursing Diagnosis / Concepts
Fluid Volume Deficit
SAFETY::
System Specific Physiology
FLUID VOLUME DEFICIT: Dehydration-Big Time
Deficit = Shock
Loss of fluids from anywhere: vomiting,
diarrhea, hemorrhage, thoracentesis,
paracentesis, diabetes insipidus.
Third spacing When fluid is in a place
that does you no good.
SAFETY:
System Specific Assessment:
Labs & Diagnostic Procedures
Dehydration (increased values)
Hct (more that 3x Hgb)
BUN > 20
Specific Gravity > 1.030 (except
diabetes insipidus
Osmolality > 295mOsm/kg water
Serum Na > 145 mEq/L
SAFETY: FLUIDS
FIRST - Priority Nursing
Interventions
F luid (po), Isotonic fluids, Blood
L evel of consciousness, look at weight
U rine < 30 ml / hr report or trending
I V fluids as ordered, I & O
D ocument vital signs and watch trends
(hypotension and weak pulses)
S hock position (back with legs ); skin
8
 Expected Outcomes
COMPARISON of initial assessment to expected outcome
What would be the priority nursing evaluation
intervention for a client with a B/P change
from 140/88 to 86/62? System Specific Expected Outcome
Assessment of FVD Evaluation of clients
response
a. Put client in supine position with legs
elevated. Decrease in weight Weight - clients norm
Decrease in BP BP- clients norm
b. Notify provider of care.
Decrease fluid = pulse Pulse within clients norm
c. Put client in Fowlers position. Dry mucous membranes Moist mucous membranes
d. Evaluate characteristics of mucous Decreased urine output Urine output 30 cc/hr
membranes. Decrease in warmth to Extremities warm to touch
extremities

Expected Outcomes LABS

COMPARISON of initial assessment to expected outcome Which assessment best indicates proper
evaluation rehydration?
System Specific Expected Outcome
Assessment of FVD Labs Evaluation of clients Labs
1. 400 cc of po intake.
to normal range
Hct (more that 3x Hgb) Hct (3x Hgb) 2. Heart rate of 105 beats per min.
BUN > 20 BUN 10 -20 3. Respiratory rate of 32 per min.
Specific Gravity > Specific Gravity 1.005
1.030 1.030
4. Urine output of 100 cc per hour.
Osmolality > Osmolarity 285 -
295mOsm/kg water 295mOsm/kg water
Serum Na > 145 Serum Na 135 145mEq/L
mEq/L

SAFETY:
(Connecting NCLEX to Concept) Which system specific assessment
To Reduce Potential Risks findings would the client present with
who has been vomiting for 24 hours
R oom assignments, recognize limitations indicating a need for further
of staff, restraint safety intervention?
I nfection, Identification, Identify TRENDS
or Changes in Clinical Condition
a.B/P increase from 110/70 to 130/80.
S kin breakdown, Safe equipment, Scope
b.Urine output decrease from 95cc/hr to
of Practice for delegation
75cc/hr.
K now Standards of Practice, know how
c.BUN -15.
to document / report errors
d.Pulse increased from 68/min to 118/min.

9
 SAFETY: Which of these orders would be most
Why? Is there anything you important for the nurse to question for a client
want to ask? who is in hypovolemic shock?

(Accuracy / appropriateness of orders) 1. Administer dopamine and digitalis.

2. Infuse 0.9 Normal Saline 500 cc bolus.
3. Administer a blood transfusion as ordered.
4. Foley catheter to a straight drain.

DIABETES INSIPIDUS

Brain conducting Posterior D ry

pituitary gland I + O, daily weight
L ow specific gravity
U rinates lots
T reat = pituitary hormone
Posterior
Pituitary Gland
r E hydrate 1994 Adapted from
Creative Educators
2012 I CAN Publishing, Inc.

SAFETY::
NO WATER, NO SALT System Specific Physiology
Sodium Deficit (Hyponatremia)
Na < 135 mEq / L

Electrolyte imbalance that may result in

disturbances involving these systems:
No Water, No Salt Neurological
Cardiac
Endocrine
From: GI sct., Diarrhea, inadequate salt
intake, diuretics, vomiting, Fluid shift from ICF to
ECF
2012 I CAN Publishing, Inc.

10
 SAFETY: SAFETY:
System Specific Assessment System Specific Assessment:
Sodium Deficit (Hyponatremia) Lab & Diagnostic Procedures
Na < 135 mEq / L Sodium Deficit (Hyponatremia)
Na < 135 mEq / L
B/P Labs (Decreased values)
Muscle Strength
Deep Muscle Reflexes (DTR) Serum Sodium (NA)
Serum Osmolality
Pulse (bounding) Specific Gravity <1.010
Apprehension
Confusion & lethargy
Seizures

SAFETY:
Analysis of Assessments /
Nursing Diagnosis / Concepts
Sodium Deficit (Hyponatremia)
Na < 135 mEq / L
Electrolyte Imbalance Sodium Deficit
SAFETY: SODIUM
FIRST - Priority Nursing Interventions
HYPONATREMIA
(Na) < 135 mEq / L
S odium intake , Seizure precaution
O verloadrestrict water intake
D aily weight
I ntake & Output
U se isotonic fluids to restore
ECF
M onitor posturial hypotension, HR,
decrease CVP, dry mucous membranes / LOC
2012 I CAN Publishing, Inc.

NURSING MANAGEMENT SAFETY

OF HYPONATREMIA Expected Outcomes
COMPARISON of initial assessment to expected outcome evaluation

Diet IV f luids System Specific Expected Outcome

Assessment of Sodium Evaluation of clients
Deficit (Hyponatremia) response
Within clients norm
B/P
B/P
Muscle Strength
Muscle Strength normal
Deep Muscle Reflexes
Deep Muscle Reflexes
(DTR)
(DTR) return
Elect rolyt es Medicat ions Pulse
Pulse

Hyponat remia needs t o be f ixed wit h a DIME: Diet ,

IV f luids, Medicat ions, Elect rolyt e replacement
2012 I CAN Publishing, Inc.

11
 SAFETY: The priority nursing intervention with a
(Connecting NCLEX to Concept) client with a serum sodium level
To Reduce Potential Risks 128mEq/L?
R oom assignments, recognize limitations of
staff, restraint safety a. Have suction at the bedside
I nfection, Identification, Identify TRENDS or b. Encourage water intake to 2000cc/day
Changes in Clinical Condition c. Question order for IV for Normal Saline
S kin breakdown, Safe equipment, Scope of
Practice for delegation
d. Restrict cheese and condiments
K now Standards of Practice, know how to
document / report errors

A client with a sodium level of 133 mEq / L has

SAFETY: an order to push po fluids. What would be the
Why? Is there anything you
priority of care?

want to ask? 1. Review the plan with the UAP.

2. Develop a plan for UAP to give 60 cc / hr.
(Accuracy / appropriateness of orders) 3. Notify the provider of care and verify order.
4. Review the importance of recording weight
every 48 hours.

ANEMIC ADAM

Why am I so
BRONZE?
Balancing Act for the Brain and
Kidneys:
Kidneys

SALT

2012 I CAN Publishing, Inc. 1994 I CAN

12
 SAFETY::
System Specific Physiology
Sodium Excesst (Hypernatremia)
Na > 135 mEq / L
Electrolyte imbalance that may result in
disturbances involving these systems:
Neurological
Cardiac
Endocrine
SAFETY:
System Specific Assessment
Sodium Excess (Hypernatremia)
Na > 135 mEq / L
Pulse
Muscle irritability & twitching
Deep Muscle Reflexes (DTR)
Thirst (may be depressed in elderly)
Restlessness progressing to confusion
SAFETY:
System Specific Assessment:
Labs & Diagnostic Procedures
Sodium Excess (Hypernatremia)
Na > 135 mEq / L
Labs (Increased values)
Serum Sodium (NA)
Serum Osmolality
HYPERNATREMIA
LODES OF EXTRA SODIUM
L ow H2 O int ake
O smot ic Diuret ics
D iabet es Insipidus
E xcessive H2 O loss
S odium int ake t oo much
f rom meds and meals
2012 I CAN Publishing, Inc.
HYPERNATREMIA
You feel DRIED out from too MUCH sodium!
D ecreased urine out put , DRY
mout h
R est less ( irrit able) ;
progressing to
conf usion
I ncreased f luid ret ent ion
E dema ( peripheral and
pit t ing)
D eep muscle ref lexes
2012 I CAN Publishing, Inc.
increased
SAFETY:
Analysis of Assessments /
Nursing Diagnosis / Concepts
Sodium Excess (Hypernatremia)
Na > 135 mEq / L
Electrolyte Imbalance Sodium Excess
13
 SAFETY: SODIUM SAFETY
FIRST - Priority Nursing Interventions Expected Outcomes
COMPARISON of initial assessment to expected outcome evaluation
HYPERNATREMIA
(Na) > 135 mEq / L System Specific Expected Outcome
Assessment of Sodium Evaluation of Clients
S odium intake Excess (Hypernatremia) Response
Within clients norm
O ral hygiene Deep Muscle Reflexes Deep Muscle Reflexes
D iuretic (I.e., Loop Diuretics) (DTR) (DTR)
Pulse Pulse
I ncrease water intake, I&O Thirst Thirst
U se hypotonic or isotonic fluids Muscle irritability & twitching No Muscle irritability &
M onitor for inadequate renal output twitching

SAFETY
Expected Outcomes SAFETY:
COMPARISON of initial assessment to expected outcome evaluation (Connecting NCLEX to Concept)
To Reduce Potential Risks
System Specific Assessment Expected Outcome
Sodium Excess Labs Evaluation of clients Labs R Room assignments, recognize
limitations of staff, restraint safety
to normal range
I Infection, Identification, Identify TRENDS
Serum Na > 145mEq/L Serum Na (135-145mEq/L)
or Changes in Clinical Condition
Osmolality > 300mOsm/L Osmolality
(270-300mOsm/L) S Skin breakdown, Safe equipment
Scope of Practice for delegation
K Know Standards of Practice, know how to
document / report errors

Which nursing intervention would be

Which of these assessment findings would be
most important to report to the provider for a
client with a serum sodium 147 mEq/L?
most appropriate to delegate to the UAP
(unlicensed personnel or CNA) for a
client with a serum sodium of 148mEq/L?

a. Dry mucous membranes. a.Restrict PO water intake

b. Complaints of being thirsty. b.Evaluate effectiveness of diuretic
c. Urine output drop from 80 cc/hr to 45 cc/hr. c.Provide oral hygiene every 2-4 hours
d. Skin warm to touch. d.Provide a snack of crackers and
cheese

14
 Which of these orders should the nurse question?
SAFETY:
Why? Is there anything you
want to ask? 1. Administer IV fluids 0.9 % Sodium Chloride
as ordered.
2. Place suction at the bedside.
(Accuracy / appropriateness of orders)
3. Monitor I&O.
4. Limit water intake.

CUSHY CARL

Balancing Act for the Brain and

Kidneys:
Kidneys

1994 I CAN
2012 I CAN Publishing, Inc.

SAFETY:
SAFETY:: System Specific Assessment
System Specific Physiology Potassium Deficit (Hypokalemia)
Potassium Deficit (Hypokalemia)
(K+) < 3.5 mEq / L (K+) < 3.5 mEq / L

Electrolyte imbalance that may result in disturbances involving

these systems: Hypoactive reflexes
GI Losses: vomiting, nasal gastric suctioning, diarrhea, laxative
use
Muscle cramping
Renal loses: diuretics (Lasix), use of corticoids steroids Weak & irregular Pulse
Skin loses: diaphoresis and wounds
Insufficient potassium: dietary or prolonged non-electrolyte IV EKG changes: Inverted T waves
solutions ie. D5W
Intracellular shift: Tissue repair (burns, starvation, trauma)
Bowel sounds (hypoactive),
* Older adults risk because of laxatives & diuretics constipation

15
 SAFETY: CRAMP
System Specific Assessment SAFETY:
Potassium Deficit (Hypokalemia) System Specific Assessment:
(K+) < 3.5 mEq / L Labs & Diagnostic Procedures
Potassium Deficit (Hypokalemia)
C onstipation, i bowel (K+) < 3.5 mEq / L

sounds
R eflexes i Serum Potassium < 3.5mEq/L
Arterial Blood Gases
A rrhythmias, inverted T waves
Metabolic alkalosis: pH > 7.45
M uscle cramps EKG changes: Inverted T waves, V-Tach
P ulseirregular and weak depressed ST segment

2012 I CAN Publishing, Inc.

SAFETY: POTASSIUM
SAFETY: FIRST - Priority Nursing Interventions
Analysis of Assessments / HYPOKALEMIA
Nursing Diagnosis / Concepts (K+) < 3.5 mEq / L
Potassium Deficit (Hypokalemia)
P otatoes, avacados, broccoli, etc, (K+)
(K+) < 3.5 mEq / L
O ral potassiom suppliments (with diuretics)
T waves depressed (flattened)monitor
Electrolyte Imbalance: Potassium deficit A rrhythmiasmonitor
S hallow ineffective respirationsmonitor
S ounds of breathing diminishedmonitor
I V supplement in NEVER an IV push!!!
U rine outputmonitor (must be 0.5 mL/kg per hr)
M uscle cramping, motility (GI) i
2012 I CAN Publishing, Inc.

SAFETY:
SAFETY
Expected Outcomes
COMPARISON of initial assessment to expected outcome evaluation (Connecting NCLEX to Concept)
System Specific Expected Outcome To Reduce Potential Risks
Assessment of Potassium Evaluation of Clients
Deficit (Hypokalemia) Response
R Room assignments, recognize
Within clients norm
limitations of staff, restraint safety
Hypoactive reflexes Normal Muscle Reflexes
Muscle cramping No muscle cramping
I Infection, Identification, Identify TRENDS
Weak & irregular Pulse Pulse within clients norm
or Changes in Clinical Condition
EKG changes: Inverted T No EKG changes S Skin breakdown, Safe equipment
waves Bowel sounds within clients Scope of Practice for delegation
Bowel sounds (hypoactive) normal K Know Standards of Practice, know how to
document / report errors

16
 Which documentation indicates the nurse
SAFETY:
understands how to provide safe care for a client Why? Is there anything you
with a serum potassium of 3.3 mEq/L? want to ask?
a. Potassium Chloride administered IV push.
(Accuracy / appropriateness of orders)
b. Oral potassium supplement held due to level.
c. Discussed eating oranges, broccoli, bananas.
d. Administered Lasix as ordered.

HYPERKALEMIA
A client is scheduled for a cardiac catheterization at 0900. (K+) > 5.0 mEq / L
On admission 3 days ago lab work was: K 3.1 mEq/L and
Na 147 mEq/L. She is currently complaining of muscle
cramps and weakness. Which nursing intervention is a
priority at this time?
S top infusion of IV
potassium, Salt
substitutes avoid
a. Hold 0700 dose of spironolactone (Aldactone). T all T waves (peaked)
b. Call the provider to recommend a stat K level. O rders: Kayexalate or dextrose with
c. Recommend eating a banana for breakfast. regular insulin
d. Observe EKG for spiked T waves. P rovide potassium restricted foods,
Potassium-losing diuretics (Lasix)

Which of these medications should be

HYPOCALCEMIA
questioned for a client with a potassium level
5.2mEq/L? CA - 8.5-11 mg/dL
Risk factors:
a. Furosemide (Lasix). P Parathyroid (hypo)
b. Hdrochlorothiazide (HCTZ). E End-stage renal disease
c. Kayexalate. T Thyroidectomy
d. Lisinopril (Prinivil). S Steroids

17
 HYPOCALCEMIA: Assessments NURSING CARE

T rousseaus sign (hand/finger

spasms)
W atch for arrhythmias S eizure precautions
( pulse, ST - ECG A dminister calcium supplements
I ncrease in bowel sounds
F oods high in calcium,(I.e. dairy, green)
diarrhea
T etany E mergency equipment on standby
C hvosteks sign (facial twitching)
H ypotension, Hyperactive DTR

Which foods would the nurse encourage

The client is admitted with hypoparathyroidism. the client with hypoparathyroidism to eat?
What is mot important to have at the bedside for
this client? a. High calcium
b. High potassium
c. Low sodium
a. Cardiac monitor
d. Low potassium
b. IV Pump
c. Heating Pad
d. Tracheostomy set

The nurse is preparing to discharge a client who

has a calcium level of 9 mg / dL, but had been
HYPERCALCEMIA
admitted with a low calcium level. Which
CA . >11 mg/dL
statement indicates a need for additional
Risk Factors:
teaching?
Immobility
Malignant tumors
a. I will call my provider if I have any twitching. Hyperparathyroidism
b. I will take my calcium every AM. Thiazide diuretics
c. I will avoid broccoli, spinach, and milk.
d. I will take my vitamin D with my calcium.
Excess calcium or vitamin D supplements

18
 HYPERCALCEMIA: HYPERCALCEMIA:
Assessments Assessments

Constipation Constipation
Flank pain (Calcium in urine ) Flank pain (Calcium in urine )
Deep bone pain Deep bone pain
reflexes reflexes

Nursing Care:
The 4 Fs) What is most important to include in a teaching
plan for an elderly client with
hyperparathyroidism?
Fluids
Fiber a. To decrease physical activity.
Fluids (IV) that are ordered b. To increase fluid intake.
Furosemide c. To stop taking furosemide (Lasix).
d. To report any twitching of the fingers.

KEY TO SUCCESS

R REVIEW, REFLECT

SAFETY E ENGAGE WHILE STUDYING

L LEARN TO PRIORITIZE AND THINK!

A APPLICATION

X X OUT NEGATIVE THINKING!

19
Fluid and Electrolytes
Made The secret of joy in
work is contained in
one word-EXCELLENCE.
To know how to do
Easy! something well is to
enjoy it.
You CAN do it!!!
We wish you much SUCCESS! Pearl Buck

20