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Table 6-5

Disorder and Related Condition	Assessment		Analysis/Nursing Diagnosis	Nursing Care Plan/Implementation	Evaluation/Outcome Criteria
	Subjective Data	Objective Data
Hyponatremia
Addison’s disease Starvation GI suction Thiazide diuretics Excess water intake, enemas Fever Fluid shifts Ascites Burns Small bowel obstruction Profuse perspiration	Apathy, apprehension, mental confusion, delirium Fatigue Vertigo, headache Anorexia, nausea Abdominal and muscle cramps	Pulse: rapid and weak BP: postural hypotension Shock, coma GI: weight loss, diarrhea, loss through NG tubes Muscle weakness	Diarrhea Fluid volume excess Altered nutrition, less than body requirements Sensory/perceptual alteration (kinesthetic)	Obtain normal sodium level: identify cause of deficit, increase sodium intake PO (salty foods), IVs—hypertonic solutions Prevent further sodium loss: irrigate NG tubes with saline; hourly I&O to monitor kidney output Prevent injury related to shock, dizziness, decreased sensorium; dangle before ambulation Skin care	Na+ 135–145 mEq/L No complications of shock present Return of muscle strength Alert, oriented Limits intake of plain water
Hypernatremia
High sodium intake Low water intake Diarrhea High fever with rapid respirations Impaired renal functions Acute tracheobronchitis	Lethargy Restlessnes agitation Confusion	BP and temperature: elevated Neuromuscular: diminished reflexes Skin: flushed; firm turgor GI: mucous membrane dry, sticky GU: decreased output	Fluid volume deficit Fluid volume excess Altered nutrition, less than body requirements Sensory/perceptual alteration (kinesthetic)	Obtain normal sodium level: decrease sodium intake I&O to recognize signs and symptoms of complications (e.g., heart failure, pulmonary edema)	Na+ 135–145 mEq/L No complaint of thirst Alert, oriented Relaxed in appearance Identifies high-sodium foods to avoid K+ 3.5–5.0 mEq/L
Hypokalemia
Decreased intake: Poor potassium food intake Excessive dieting Nausea Alcoholism IV fluids without added potassium Increased loss: GI suctioning, vomiting, diarrhea Ulcerative colitis Drainage: ostomy, fistulas Medications: potassium-losing diuretics, digoxin, cathartics Increased aldosterone production Renal disorders	Apathy, lethargy, fatigue, weakness Irritability, mental confusion Anorexia, nausea Leg cramps	Muscles: weakness, paralysis, paresthesia, hyporeflexia Respirations: shallow to respiratory arrest Cardiac: decreased BP; elevated, weak, irregular pulse; arrhythmias ECG: low, flat T waves; prolonged ST segment; elevated U wave; potential arrest GI: vomiting, flatulence, constipation; decreased motility → distention → paralytic ileus GU: urine not concentrated; polyuria, nocturia; kidney damage Speech: slow	Decreased cardiac output Fatigue Altered cardiopulmonary tissue perfusion Ineffective breathing patterns Constipation Bathing/hygiene self-care deficit Impaired home maintenance management Sensory/perceptual alteration (gustatory)	Replace lost potassium: increase potassium in diet (see Chapter 9. Physiological Integrity: Basic Care and Comfort—Nutrition); liquid PO potassium medications—dilute in juice to aid taste; give potassium only if kidneys functioning Prevent injury to tissues: prevent infiltration, pain, tissue damage Prevent potassium loss: Irrigate NG tubes with saline, not water	Identifies cause of imbalance Lists foods to include in diet Lists signs and symptoms of imbalance Return of muscle strength No cardiac arrhythmias
Hyperkalemia
Burns Crushing injuries Kidney disease Excessive infusion or ingestion of K+ Adrenal insufficiency Mercurial poisoning	Irritability Weakness, muscle cramps Nausea, intestinal cramps	Muscles: paresthesia, flaccid muscle paralysis (later) Cardiac; irregular pulse; arrhythmias; bradycardia → asystole ECG: high T waves; depressed ST segment; widened QRS complex; diminished or absent P waves; ventricular fibrillation GI: explosive diarrhea; hyperactive bowel sounds Kidney: scanty to no urine	Decreased cardiac output Altered urinary elimination Activity intolerance Ineffective breathing patterns Diarrhea Impaired home maintenance management	Decrease amount of potassium in body; identify and treat cause of imbalance; give foods low in K+; avoid drugs or IV fluids containing K+ If kidney failure present, may need to prepare for dialysis	K+ 3.5–5.0 mEq/L No complications (e.g., arrhythmias, acidosis, respiratory failure)
Hypocalcemia
Acute pancreatitis Diarrhea Peritonitis Damage to parathyroid during thyroidectomy Hypothyroidism Burns Pregnancy and lactation Low vitamin D intake Multiple blood transfusions Renal disorders Massive infection	Fatigue Tingling/numbness; fingers and circumoral Abdominal cramps Palpitations Dyspnea	Muscle spasms: tonic muscles, carpopedal, laryngeal Neuromuscular: grimacing, hyperirritable facial nerves Tetany → convulsions Orthopedic: osteoporosis → fractures Cardiac: arrhythmias → arrest GI: diarrhea	Pain Diarrhea Altered nutrition, less than body requirements Risk for injury Sensory/perceptual alteration (gustatory)	Prevent tetany (medical emergency): calcium gluconate IV, 2.5–5.0 mL 10% solution; repeated q10 min to maximum dose of 30 mL Prevent tissue injury due to hypoxia and sloughing; administer slowly; avoid infiltration Prevent injury related to medication administration. Caution: drug interaction with carbonate, phosphate, digitalis; avoid hypercalcemia In less acute condition: increase calcium intake—calcium gluconate or lactate	Ca++ 4.5–5.5 mEq/L No signs of tetany Absent Trousseau‘s and Chvostek‘s signs Lists foods high in vitamin D and calcium
Hypercalcemia
Parathyroid glands: overactive, tumor Increased immobility Decreased renal function Bone cancer Increased vitamin D and calcium intake Milk-alkali syndrome—self-administration of antacids; increased milk in diet to relieve GI symptoms	Pain: flank, deep bone, shin splints Muscle weakness, fatigue Anorexia, nausea Headache Thirst → polyuria	Muscles: relaxed GU: kidney stones GI: increased milk intake, constipation, dehydration Neurological: stupor → coma	Decreased cardiac output Constipation Activity intolerance Altered urinary elimination Pain	Reduce calcium intake: decrease foods high in calcium; identify cause of imbalance; give steroids, diuretics as ordered; isotonic saline IV Prevent injury: prevent pathological fractures (e.g., advanced cancer); prevent renal calculi by increasing fluid intake	Ca++ 4.5–5.5 mEq/L No pain reported No fractures/calculi seen on x-ray examination
Hypomagnesemia
Impaired GI absorption Prolonged malnutrition or starvation Alcoholism Excess loss of magnesium through kidneys, related to increased aldosterone production Prolonged diarrhea Draining GI fistulas	Agitation Depression Confusion Paresthesia	Muscles: irritable, tremors, spasticity, tetany → convulsions Cardiac: arrhythmias, tachycardia	Risk for injury related to seizure activity Decreased cardiac output	Provide safety: prevent injury to client who is disoriented; administer magnesium salts PO or IV Health teaching: prevention; diet—high-magnesium foods: fruits, green vegetables, whole-grain cereals, milk, meats, nuts	Mg++ 1.5–2.5 mEq/L
Hypermagnesemia
Renal failure Diabetic ketoacidosis Severe dehydration Antacid therapy	Drowsiness, lethargy	Neuromuscular: loss of deep tendon reflexes Respiratory: depression Cardiac: arrest, hypotension	Ineffective breathing pattern Decreased cardiac output Fluid volume deficit Fluid volume excess Altered cardiopulmonary tissue perfusion	Obtain normal magnesium level: IV calcium, fluids; possible dialysis	Mg++ 1.5–2.5 mEq/L No complications (e.g., respiratory depression, arrhythmias) Identifies magnesium-based antacids (e.g., Gelusil) Deep tendon reflexes 2+