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Table of Contents
If not treated promptly and correctly, some imbalanced electrolytes have life-threatening consequences and can even lead to cardiac arrest.
When electrolytes become imbalanced, they can impair many of the body's critical functions, including blood acidity and pressure regulation, hydration levels, nerve and muscle coordination, and tissue repair. Losing body fluids caused by diarrhea, sweating, vomiting, medications, conditions, or extensive burns often lead to electrolyte imbalances that must be treated medically and with a nursing care plan for hands-on care and nursing interventions.
This article offers ten electrolyte imbalance nursing diagnoses and care plans to help you care for your patients. We'll focus on acid-base, sodium, calcium, magnesium, and potassium imbalances.
Signs and Symptoms of Electrolyte Imbalance
Different types of electrolyte imbalances cause various signs and symptoms. The signs depend on which electrolyte is affected, the severity of the imbalance, and the presence of comorbidities. However, there are common signs you might observe with most types of imbalances. Many patients experience no noticeable symptoms if the imbalance is mild or occurs gradually.
Common signs and symptoms of electrolyte imbalance include:
Assessment of Electrolyte Imbalance
The nursing assessment is vital to the identification of electrolyte imbalances. Registered nurses or practical nurses must take a comprehensive history and perform a physical exam, paying particular attention to the patient's skin turgor to assess for dehydration. In addition, you should ask about any recent changes in medication and inquire about the patient's dietary habits.
It is also vital to obtain laboratory tests for electrolytes such as sodium, potassium, chloride, and bicarbonate. Abnormal electrolyte levels should be promptly reported to the healthcare provider so treatment can begin.
Factors Affecting the Occurrence of Electrolyte Imbalance
Many factors can lead to electrolyte imbalance, including:
Causes of Electrolyte Imbalance
More than half of the body's weight consists of water. Blood and fluid in and around the cells hold most of the water found in the body. In addition, electrolytes move throughout the body due to the function of the liver, kidneys, and other organs. Because electrolytes are needed for overall health and wellness, many changes in the body or organ function can create imbalances that require treatment.
The most common causes of electrolyte imbalance include:
Treatments
However, if the imbalance is severe or related to an acute medical condition, surgery, or trauma, the patient may need hospitalization and treatment with IV fluids and other medications. In addition, patients with kidney failure or severe kidney damage may require hemodialysis to remove waste and fluids from the body to achieve electrolyte balance.
Complications
Untreated or significant electrolyte imbalances can be life-threatening and cause the following complications:
Nurse's Role Caring for a Patient with Electrolyte ImbalanceNurses are integral in caring for acutely ill patients experiencing an electrolyte imbalance. Thorough head-to-toe assessments to check for new or worsening signs of specific imbalances and monitoring and reporting any critical lab values ensure that changes in the patient's condition are addressed quickly.
In the home or outpatient setting, nurses perform similar assessments for signs and symptoms of electrolyte imbalances. In addition, medication and condition education is essential to the long-term management of any imbalances and the underlying conditions that cause them. Teaching patients self-care strategies can prevent acute exacerbations and hospitalizations.
Nursing Protocols for Electrolyte Imbalance
Nurses must know the protocols for electrolyte imbalance. They must recognize the signs of each type of imbalance, evaluate and monitor electrolyte levels, and create individualized nursing care plans to address their findings. They should also be familiar with treatments for electrolyte imbalances, like rehydration therapy and medications.
Each protocol starts with assessing the patient's symptoms with planned interventions and desired outcomes.
Nurses treating a patient for electrolyte imbalances will perform the following tasks to ensure the patient's safety and well-being:
Nursing Care Plans Related to Electrolyte ImbalanceNow, let's review some nursing care plans you can use when caring for patients with common electrolyte imbalances. The below nursing care plans are not exhaustive or individualized to a patient but can provide an overview of how to address these conditions.
It's also important to note that lab values are not included in these nursing care plans as each laboratory establishes normal and abnormal values. Therefore, always refer to your institution's laboratory value norms and protocols when determining when to report electrolyte imbalance values to the healthcare provider.
Risk for Hypernatremia Care PlanHypernatremia occurs when the level of sodium in the body is abnormally high. It can cause serious problems, such as seizures and confusion.
Nursing Diagnosis: Risk for Hypernatremia
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Hypernatremia Nursing Assessment
Risk for Hypernatremia Nursing Interventions and Rationales
Rationale: May prevent hypernatremia if the patient cannot perceive or respond to thirst.
Rationale: Gradually restores the balance of sodium and water.
Rationale: Minimizes the risk of too much sodium intake through diet and reduces the risk of heart disease and heart failure.
Rationale: Prevents further drying and promotes comfort.
Rationale: Decreases sodium levels while there is extracellular fluid excess.
Rationale: Detects changes in the patient's fluid and electrolyte balance. Administer intravenous fluids as ordered.
Rationale: Protects against injury during seizures.
Risk for Hyponatremia Care PlanHyponatremia occurs when the level of sodium in the body becomes abnormally low. In this case, excessive water excretes in the kidneys. It can cause seizures and confusion.
Nursing Diagnosis: Risk for Hyponatremia
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Hyponatremia Nursing Assessment
Risk for Hyponatremia Nursing Interventions and Rationales
Rationale: Protects against injury during seizures.
Rationale: Isotonic solutions reduce electrolyte loss in gastrointestinal fluids.
Rationale: Provides a slow replacement of dietary sodium.
Risk for Hypercalcemia Care PlanHypercalcemia occurs when the level of calcium in the body is abnormally high. It can cause serious problems, such as an increased risk of cardiac arrest, confusion, muscle weakness, and pain.
Nursing Diagnosis: Risk for Hypercalcemia
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Hypercalcemia Nursing Assessment
Risk for Hypercalcemia Nursing Interventions and Rationales
Rationale: Decreases the risk of injury, including pathological fractures related to weakened bones.
Rationale: Decreases the risk of constipation related to impaired gastrointestinal tone.
Rationale: High calcium levels increase the risk of stone formation.
Rationale: Increases urinary flow and removal of calcium to minimize the risk of stone formation and improves hydration.
Rationale: Increases urinary excretion by diluting extracellular calcium concentrations and reducing tubular reabsorption of calcium.
Risk for Hypocalcemia Care PlanHypocalcemia occurs when calcium levels in the blood are abnormally low. Chronic laxative use, diarrhea, and certain medications can cause hypocalcemia. Low calcium levels can disrupt the body's magnesium and phosphorous levels, causing an electrolyte imbalance.
Nursing Diagnosis: Risk for Hypocalcemia
Potentially Related to
Evidenced By
Desired Outcomes
Risk for Hypocalcemia Nursing Assessment
Risk for Hypocalcemia Nursing Interventions and Rationales
Rationale: Medications containing phosphorous can reduce serum calcium levels.
Rationale: Assists with oral replacement of calcium levels.
Rationale: Diets including calcium-rich foods reduce the risk of tooth decay, osteoporosis, and eczema.
Rationale: Certain medications can increase serum calcium levels.
Risk for Hypermagnesemia Care PlanMagnesium regulation happens in the renal and gastrointestinal systems. The nutrient is absorbed in the GI tract and excreted through urine. If an excess of magnesium exists, it's stored in the bones.
Hypermagnesemia happens when magnesium levels in the blood are abnormally high. Magnesium is a vital nutrient in the body and is needed to maintain nerve and muscle function, blood pressure, and blood glucose levels.
Nursing Diagnosis: Risk for Hypermagnesemia
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Hypermagnesemia Nursing Assessment
Risk for Hypermagnesemia Nursing Interventions and Rationales
Rationale: Promotes safety if the patient experiences neurological depression or muscle weakness.
Rationale: Promotes excretion of magnesium through the kidneys.
Rationale: Minimizes risk of hypermagnesemia related to increased oral intake.
Rationale: Promotes excretion of magnesium through the kidneys.
Rationale: Reverses symptoms of too much magnesium in the blood.
Rationale: Lowers magnesium levels quickly.
Risk for Hypomagnesemia Care PlanHypomagnesemia occurs when the magnesium levels in the blood are abnormally low. Magnesium is found in the intracellular fluid. The body needs magnesium for normal nerve and muscle function, protein synthesis, contraction of skeletal and cardiac muscles, and blood pressure regulation.
Nursing Diagnosis: Risk for Hypomagnesemia
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Hypomagnesemia Nursing Assessment
Risk for Hypomagnesemia Nursing Interventions and Rationales
Rationale: Overuse or abuse can lower magnesium levels.
Rationale: Protects against injury related to seizure or changes in mental status.
Rationale: Keeping linens off of feet and legs may reduce muscle spasms.
Rationale: Promotes rest and minimizes stimulation.
Rationale: Minimizes effects of muscle changes, including spasticity and weakness.
Rationale: Promotes replacement of magnesium through the diet for mild electrolyte imbalance.
Rationale: Replaces magnesium for moderate to severe hypomagnesemia.
Risk for Hyperkalemia Care PlanPotassium is critical to normal body function, including the operation of the heart, kidneys, muscles, and nervous system. In addition, this essential macromineral regulates the osmolarity of extracellular fluid by exchanging it with sodium. It also helps to keep the transmembrane electrical potential between the intracellular and extracellular fluid within normal limits.
Hyperkalemia happens when the potassium levels in the blood are abnormally high. This condition is common in patients with abnormal kidney function affecting the ability to remove potassium from the body, such as in patients with renal disease. In addition, other treatment modalities can affect the potassium levels in the body and place the patient at an elevated risk of hyperkalemia.
Nursing Diagnosis: Risk for Hyperkalemia
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Hyperkalemia Nursing Assessment
Assess urine and serum electrolytes.
Risk for Hyperkalemia Nursing Interventions and Rationales
Rationale: Promotes potassium excretion and renal clearance.
Rationale: Reduces dietary sources of potassium.
Rationale: Reduces dietary sources of potassium.
Rationale: Correct administration can reduce the risk of misuse or overuse.
Rationale: Indicates the need for regular monitoring of potassium levels and may require the healthcare provider to consider alternate drug therapies.
Rationale: Indicates patients at high risk of kidney problems, which may affect potassium excretion.
Rationale: Reduces muscle weakness and cramping and improves muscle tone.
Risk for Hypokalemia Care PlanHypokalemia is when the potassium levels in the blood are abnormally low, which can cause serious problems such as muscle weakness, paralysis, and cardiac arrest. This condition may happen due to inadequate potassium intake or absorption, too much potassium loss, or potassium shifting into the cells from the extracellular fluid.
Nursing Diagnosis: Risk for Hypokalemia
Potentially Related to
Evidenced By
Desired Outcomes
Risk for Hypokalemia Care Plan Nursing Assessment
Risk for Hypokalemia Care Plan Nursing Interventions and Rationales
Rationale: Prevent the recurrence of potassium depletion due to laxative use.
Rationale: Ensures safe administration and safeguards against overdose.
Rationale: Promotes safe usage of potassium supplements.
Rationale: Detects early signs of the condition.
Rationale: Identifies patients at increased risk of the condition.
Risk for Alkalosis Care Plan
Metabolic Alkalosis is an acid-base imbalance always related to an underlying condition. Alkalosis happens when there is either too much bicarbonate or too little acid in the body. Symptoms of the disease are seen in the respiratory, metabolic, and renal systems.
If left untreated, metabolic alkalosis can be life-threatening and progress to coma or seizures.
Nursing Diagnosis: Risk for Alkalosis
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Alkalosis Nursing Assessment
Risk for Alkalosis Nursing Interventions and Rationales
Rationale: Prevent the recurrence of potassium depletion due to laxative use.
Rationale: Ensures safe administration and safeguards against overdose.
Rationale: Promotes safe usage of potassium supplements.
Rationale: Promotes management of the condition through dietary sources.
Rationale: Detects early signs of the condition.
Rationale: Identifies patients at increased risk of the condition.
Risk for Alkalosis Care PlanMetabolic Alkalosis is an acid-base imbalance always related to an underlying condition. Alkalosis happens when there is either too much bicarbonate or too little acid in the body. Symptoms of the disease are seen in the respiratory, metabolic, and renal systems.
If left untreated, metabolic alkalosis can be life-threatening and progress to coma or seizures.
Nursing Diagnosis: Risk for Alkalosis
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Alkalosis Nursing Assessment
Risk for Alkalosis Nursing Interventions and Rationales
Rationale: Replaces the fluid loss and restores normal electrolyte levels.
Rationale: Establishes causes of alkalosis, such as hypokalemia and hypochloremia, to allow for treatment.
Rationale: Treats the underlying cause of hypovolemia, including vomiting or
diarrhea.
Risk for Acidosis Care PlanMetabolic acidosis is when the blood pH is abnormally low, resulting in an electrolyte imbalance. As a result, bicarbonate levels are so low that the body's acid-base balance is affected, leading to various symptoms such as nausea, confusion, and drowsiness.
If left untreated metabolic acidosis may lead to the following complications:
It's vital to understand that metabolic acidosis is almost always due to an underlying condition that must be treated to reduce morbidity and mortality in the patient.
Nursing Diagnosis: Risk for Acidosis
Potentially Related To
Evidenced By
Desired Outcomes
Risk for Acidosis Nursing Assessment
Risk for Acidosis Nursing Interventions and Rationales
Rationale: Protectively lubricates the mouth and neutralizes acids.
Rationale: Helps to treat the underlying cause of acidosis.
Rationale: Promotes safety and minimizes injury from advanced neurological
Complications.
Rationale: Corrects the bicarbonate deficiency.
Rationale: Helps to correct acid-base imbalances.
More Electrolyte Imbalance Nursing DiagnosisBelow are more nursing diagnoses for electrolyte imbalances:
Electrolyte Imbalance NCLEX Test QuestionsAs a nursing student, you must study for the NCLEX-RN or NCLEX-PN. Therefore, you may encounter questions about electrolyte imbalances. Below are sample test questions and answers to help registered nurse students pass the exam. Let's test your knowledge.
Q. What is the cause of hypochloremia?
A. Hypochloremia can be caused by loss of fluids from vomiting, diarrhea, and sweating.
Q. What are the signs and symptoms of hypervolemia?
A. The signs and symptoms of hypervolemia are edema, weight gain, shortness of breath, rapid heart rate, confusion, and fatigue.
Q: How can dehydration lead to an electrolyte imbalance?
A: Dehydration can lead to an electrolyte imbalance due to a decreased concentration of ions in the blood, which disrupts normal bodily functions.
Q: How is hypophosphatemia treated?
A: Treatment for hypophosphatemia includes oral supplements, intravenous phosphate, and dietary changes.
Additional Readings and ResourcesNeed more information about electrolyte imbalances? AllNurses has you covered! Check out these other articles below:
Wrapping Up Electrolyte Imbalance Nursing Care PlansElectrolytes perform vital body functions. An imbalance can cause systemic symptoms that require prompt assessment and treatment. Nurses are essential to the care, treatment, and resolution of all types of electrolyte imbalances and must be skilled in their care.
These nursing diagnoses and care plans provide a solid basis of understanding and can be referenced when creating individualized care plans for patients. If you have other questions or suggestions for other assessments or interventions, please comment below to begin the conversation and receive further support from the AllNurses community.
CitationsAbout Melissa Mills, BSN
Melissa is a nurse with over two decades of experience in leadership and workforce development. She loves to help other healthcare professionals advance their careers.
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