Magnum Magnesium!
Normal value for magnesium
1.3-2.1
Normal value for sodium
135-145
Normal value for potassium
3.5-5
Normal value for calcium
8.5-10.5
Normal value for phosphate
1.7-2.6
Food sources for mg
cashews, halibut, swiss chard and other green leafy vegetables, tofu, wheat germ, dried fruit
food sources for sodium
breads, cereals, chips, cheese, processed meats such as lunch meats, hot dogs, bacon, ham, commercially canned food and table salt
Food sources for K+
fish (except for shellfish), whole grains, nuts, broccoli, cabbage, carrots, celery, cucumbers, potatoes with skins, spinach, tomatoes, apricots, bananas, cantaloupe, nectarines, oranges, tangerines
Food sources for calcium
cheese, ice cream, milk, yogurt, rhubarb, spinach, tofu
Normal value for chloride
95-105
Why would a patient present with hyperactive DTR's, irritable nerves and muscles, and tachyarrhythmias
Because the patient has low levels of magnesium (hypomagnesemia)
(Magnesium is the law enforcement electrolyte in the body. If there is not enough Mg, the muscles are having a party and going crazy. This explains why hypomagnesemia can be caused by Chron's disease or ulcerative colitis)
How does the secretion of anti-diuretic hormone have an affect on sodium levels?
SIADH cause hyponatremia because the kidneys are not allowing water to escape in the urine. This is causing fluid overload and is diluting the sodium, resulting in low levels of sodium in the blood
What is an appropriate way to administer potassium?
Running as a piggy back along with a primary (normal saline) solution.
NEVER IV BOLUS/IV PUSH POTASSIUM!!!
How would a vitamin D deficiency affect calcium levels?
A Vt.D deficiency can cause hypocalcemia. Without vit.d, calcium cannot be absorbed.
Calcium NEEDS vitamin D to be absorbed!!
Wherever sodium goes ______ goes
CHLORIDE!
(they have the same function- regulate pH and fluid in the body)
What are signs of hypermagnesemia?
Warm, flushed appearance
Nausea, vomiting
Drowsiness, lethargy
**Decreased muscle strength**
**Generalized weakness**
**Decreased deep tendon reflexes**
Hypotension
**Dysrhythmias, especially bradycardia and heart block**
**Slow, shallow respirations; respiratory arrest**
Too much= slows down/stops muscle contractions
You just assessed your patient and noticed that they are presenting with weakness, complaints of thirst and elevated temp. What interventions will you implement?
Monitor vital signs.
Monitor level of consciousness.
Monitor intake and output.
Monitor laboratory results, especially serum sodium and serum osmolarity.
Limit salt intake and foods high in sodium.
Increase water intake.
Administer hypotonic IV solutions as ordered.
What are a few causes of hyperkalemia?
Renal failure (Kidneys cannot excrete potassium, leaving high levels in the blood)
Massive trauma, crushing injuries, burns (this is because dying cells will release potassium into the bloodstream)
Hemolysis
IV potassium
Potassium-sparing diuretics
Acidosis, especially diabetic ketoacidosis
How can prolonged bed rest and osteoporosis cause hypercalcemia?
If a patient is on prolonged bed rest or has osteoporosis, they may not get much physical activity. This can cause increased levels in calcium.
ROM exercises decrease calcium levels. Increasing the patients activity is a good nursing intervention with someone who has high levels of calcium.
Why would you see a positive Chvostek and Trousseau signs in hyperphosphatemia?
Positive Chvostek and Trousseau signs are indicative of hypocalcemia.
Whenever calcium is low, phosphate rises (vice versa)
(They are enemies! When one goes down, the other comes up!)
Nursing interventions for hypomagnesemia
Assess vital signs, especially heart rate and rhythm.
Monitor cardiac rhythm with ECG.
Assess mental status, changes in level of consciousness.
Monitor laboratory results, including potassium and calcium levels.
Assess swallowing before administering medications, food, or fluid.
Institute seizure precautions.
Administer oral or IV supplements as ordered.
Signs of hypervolemia
Lethargy, confusion, weakness
Muscle cramping
Seizures
Anorexia, nausea, vomiting
Serum osmolarity <280 mOsm/kg
Your patient has a potassium level of 2.9
What signs and symptoms are they most likely presenting with?
Weak, irregular pulse
Fatigue, lethargy
Anorexia, nausea, vomiting
Muscle weakness and cramping
Decreased peristalsis, hypoactive bowel sounds
Paresthesia
Cardiac dysrhythmias
Increased risk of digitalis toxicity
What are these signs and symptoms indicative of?
Lethargy, stupor, coma
Decreased muscle strength and tone
Pathologic fractures
Dysrhythmias
Renal calculi
Hypercalcemia
What are some signs and symptoms of hypophosphatemia?
Weak pulse
Shallow respirations
Hypotension
Decreased cardiac output
Hemolytic anemia
*Bleeding, increased bruising*
*Muscle weakness*
*Decreased deep tendon reflexes*
Tremors
*Bone pain*
Anorexia
Increased risk of infection
(remember, low levels of phosphate mean that levels in calcium will be high)