(Assessment Findings: Fluid Volume Deficit)
Fluid Volume Deficit
Cardiovascular
o Thready, increased pulse rate
o Decreased blood pressure and
orthostatic (postural)
hypotension
o Flat neck and hand veins in
dependent positions
o Diminished peripheral pulses
o Decreased central venous
pressure
o Dysrhythmias
Respiratory
o Increased rate and depth of
respirations
o Dyspnea
Neuromuscular
o Decreased central nervous
system activity, from lethargy
to coma
o Fever, depending on the
amount of fluid loss
o Skeletal muscle weakness
Renal
o Decreased urine output
Integumentary
o Dry skin
o Poor turgor, tenting
o Dry mouth
Gastrointestinal
o Decreased motility and
diminished bowel sounds
o Constipation
o Thirst
o Decreased body weight
Laboratory findings
Fluid Volume Excess
o Bounding, increased pulse rate
o Elevated blood pressure
o Distended neck and hand veins
o Elevated central venous
pressure
o Dysrhythmias
o Increased respiratory rate
(shallow respirations)
o Dyspnea
o Moist crackles on auscultation
o Altered level of consciousness
o Headache
o Visual disturbances
o Skeletal muscle weakness
o Paresthesias
o Increased urine output if
kidneys can compensate;
decreased urine output if
kidney damage is the cause
o Pitting edema in dependent
areas
o Pale, cool skin
o Increased motility in the
gastrointestinal tract
o Diarrhea
o Increased body weight
o Liver enlargement
o Ascites
o Increased serum osmolality o Decreased serum osmolality
o Increased hematocrit o Decreased hematocrit
o Increased blood urea nitrogen o Decreased BUN level
(BUN) level o Decreased serum sodium level
o Increased serum sodium level o Decreased urine specific gravity
o Increased urinary specific
gravity
(Sodium)
Normal value Common food sources
135-145 mEq/L o Bacon
o Butter
o Canned food
o Cheese
o Frankfurters
o Ketchup
o Lunch meat
o Milk
o Mustard
o Processed food
o Snack food
o Soy sauce
o Table salt
o White and whole-wheat bread
(Assessment Findings: Hyponatremia and Hypernatremia)
Hyponatremia Hypernatremia
Cardiovascular
o Symptoms vary with changes in Heart rate and blood pressure
vascular volume respond to vascular volume
 Normovolemic: Rapid pulse status
rate; normal blood pressure
 Hypovolemic: Thready, weak,
rapid pulse rate; hypotension;
flat neck veins; normal or low
central venous pressure
 Hypervolemic: Rapid,
bounding pulse; blood
pressure normal or elevated;
normal or elevated central
venous pressure
Respiratory
Shallow, ineffective respiratory movement is a Pulmonary edema if
late manifestation related to skeletal muscle hypervolemia is present
weakness
Neuromuscular
o Generalized skeletal muscle weakness o Early: Spontaneous
that is worse in the extremities muscle twitches;
o Diminished deep tendon reflexes irregular muscle
contractions
o Late: Skeletal muscle
weakness; deep tendon
reflexes diminished or
absent
Central nervous system
o Headache o Altered cerebral
o Personality changes function is the most
o Confusion common manifestation
o Seizures of hypernatremia
o Coma o Normovolemia or
hypovolemia: Agitation,
confusion, seizures
o Hypervolemia:
Lethargy, stupor, coma
Gastrointestinal
o Increased motility and hyperactive o Extreme thirst
bowel sounds
o Nausea
o Abdominal cramping and diarrhea
Renal
Increased urinary output Decreased urinary output
Integumentary
Dry mucous membranes o Dry and flushed skin
o Dry and sticky tongue
and mucous
membranes
o Presence or absence of
edema, depending on
fluid volume changes
Laboratory findings
o Serum sodium level less than 135 o Serum sodium level
mEq/L that exceeds 145
o Decreased urinary specific gravity mEq/L
o Increased urinary
specific gravity
(Potassium)
Normal value
3.5-5.0 mEq/L
(Assessment Findings: Hypokalemia and Hyperkalemia)
Hypokalemia
Cardiovascular
o Thready, weak, irregular pulse
o Weak peripheral pulses
o Orthostatic hypotension
Respiratory
o Shallow, ineffective
respirations that result from
profound weakness of the
skeletal muscles of respiration
o Diminished breath sounds
Neuromuscular
o Anxiety, lethargy, confusion,
coma
o Skeletal muscle weakness,
eventual flaccid paralysis
o Loss of tactile discrimination
o Paresthesias
o Deep tendon hyporeflexia
Common food sources
o Avocado
o Bananas
o Cantaloupe
o Carrots
o Fish
o Mushrooms
o Oranges
o Potatoes
o Pork, beef, veal
o Raisins
o Spinach
o Strawberries
o Tomatoes
Hyperkalemia
o Slow, weak, irregular heart rate
o Decreased blood pressure
Profound weakness of the skeletal
muscles leading to respiratory failure
o Early: Muscle twitches cramps,
paresthesias (tingling and
burning followed by numbness
in the hands and feet and
around the mouth)
o Late: Profound weakness,
ascending flaccid paralysis in the
arms and legs (trunk, head, and
respiratory muscles become
affected when the serum
potassium level reaches a lethal
level)
Gastrointestinal
o Decreased motility, hypoactive o Increased motility, hyperactive (Assessment Findings: Hypocalcemia and Hypercalcemia)
to absent bowel sounds bowel sounds Hypocalcemia Hypercalcemia
o Nausea, vomiting, o Diarrhea Cardiovascular
constipation, abdominal o Decreased heart rate o Increased heart rate in the
distention o Hypotension early phase; bradycardia that
o Paralytic ileus o Diminished peripheral pulses can lead to cardiac arrest in
Laboratory findings late phases
o Serum potassium level lower o Serum potassium level that o Increased blood pressure
than 3.5 mEq/L exceeds 5.0 mEq/L o Bounding, full peripheral pulses
o Electrocardiogram changes: ST o Electrocardiographic changes: Respiratory
depression; shallow, flat, or Tall peaked T waves, flat P Not directly affected; however, Ineffective respiratory movement as a
inverted T wave; and waves, widened QRS complexes, respiratory failure or arrest can result result of profound skeletal muscle
prominent U wave and prolonged PR intervals from decreased respiratory movement weakness
because of muscle tetany or seizures
(Electrocardiographic Changes in Electrolyte Imbalances) Neuromuscular
Electrolyte Imbalance Electrocardiographic Changes o Irritable skeletal muscles: o Profound muscle weakness
Hypocalcemia o Prolonged ST segment Twitches, cramps, tetany, o Diminished or absent deep
o Prolonged QT interval seizures tendon reflexes
Hypercalcemia o Shortened ST segment o Painful muscle spasms in the o Disorientation, lethargy, coma
o Widened T wave calf or foot during periods of
Hypokalemia o ST depression inactivity
o Shallow, flat, or inverted T wave o Paresthesias followed by
o Prominent U wave numbness that may affect the
Hyperkalemia o Tall peaked T waves lips, nose, and ears in addition
o Flat P waves to the limbs
o Widened QRS complex o Positive Trousseau’s and
o Prolonged PR interval Chvostek’s signs
Hypomagnesemia o Tall T waves o Hyperactive deep tendon
o Depressed ST segment reflexes
Hypermagnesemia o Prolonged PR interval o Anxiety, irritability
o Widened QRS complexes Renal
Urinary output varies depending on the o Urinary output varies
(Calcium) cause depending on the cause
Normal value Common food sources o Formation of renal calculi; flank
8.6-10 mg/dL o Cheese pain
o Collard greens Gastrointestinal
o Milk and soy milk o Increased gastric motility; o Decreased motility and
o Rhubarb hyperactive bowel sounds hypoactive bowel sounds
o Sardines o Cramping, diarrhea o Anorexia, nausea, abdominal
o Spinach distention, constipation
o Tofu Laboratory findings
o Yogurt o Serum calcium level less than o Serum calcium level that
 8.6 mg/dL exceeds 10 mg/dL o Electrocardiographic changes: o Electrocardiographic changes:
o Electrocardiographic changes: o Electrocardiographic changes: Tall T waves, depressed ST Prolonged PR interval, widened
Prolonged ST interval, Shortened ST segment, segments QRS complexes
prolonged QT interval widened T wave

(Magnesium) (Phosphorus)
Normal value Common food sources Normal value Common food sources
1.6-2.6 mg/dL Avocado 2.7-4.5 mg/dL o Fish
Canned white tuna o Pumpkin, squash
Cauliflower o Nuts
Green leafy vegetables, such as spinach o Pork, beef, chicken, organ meats
and broccoli o Whole-grain breads and cereals
Milk o Dairy products
Oatmeal, wheat bran
Peanut butter, almonds
Peas
Pork, beef, chicken, soy beans
Potatoes
Raisins
Yogurt

(Assessment Findings: Hypomagnesemia and Hypermagnesemia)

Hypomagnesemia Hypermagnesemia
Cardiovascular
o Tachycardia o Bradycardia, dysrhythmias
o Hypertension o Hypotension
Respiratory
Shallow respirations Respiratory insufficiency when the
skeletal muscles of respiration are
involved
Neuromuscular
o Twitches; paresthesias o Diminished or absent deep
o Positive Trousseau’s and tendon reflexes
Chvostek’s signs o Skeletal muscle weakness
o Hyperreflexia
o Tetany, seizures
Central nervous system
o Irritability Drowsiness and lethargy that progresses
o Confusion to coma
Laboratory findings
o Serum magnesium level less o Serum magnesium level that
than 1.6 mg/dL exceeds 2.6 mg/dL