10 Electrolyte Imbalance Nursing Diagnosis & Care Plans

Melissa Mills, BSN

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:

Fatigue
Muscle weakness, cramps, or spasms
Confusion and irritability
Cardiac dysrhythmias
Tachycardia
Nausea and vomiting
Diarrhea or constipation
Dyspnea
Headaches
Dizziness
Delirium
Numbness of limbs, fingers, and toes

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:

Dehydration - may be caused by excessive sweating, vomiting, diarrhea, or inadequate fluid intake
Kidney disease - impaired kidney function affects the regulation of electrolyte levels in the body
Diabetes - many diabetic patients have imbalances in sodium and potassium
Dietary changes - inadequate or excessive intake of electrolyte-containing foods such as dairy and fruits can lead to an imbalance, and a high protein diet may lead to hypernatremia
Parenteral nutrition - may cause loss of electrolytes
Medications - certain medications, such as diuretics and laxatives, can interfere with electrolyte levels
Trauma - physical trauma or injury can disrupt electrolyte balance
Hypertension - can cause too much sodium and potassium in the body
Diuretics -promote the release of sodium through the urine, which may lead to a decrease in electrolyte levels
High aldosterone levels - can cause hypernatremia or hypokalemia
Heart disease - can cause an imbalance in electrolytes, specifically potassium, and sodium
Excessive vomiting or diarrhea - can cause loss of electrolytes
Congestive heart failure - may cause irregular sodium and potassium levels
Surgery - can cause post-operative imbalances due to fluid volume changes (hypovolemia/hypervolemia), blood transfusion, the body's stress response related to the procedures, or an underlying condition or disease

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:

Electrolyte Poor Diets
Vomiting or Diarrhea
Medications (example: diuretics and laxatives)
Medical Conditions (example: diabetes, kidney disease, congestive heart failure)
Hypovolemia or Hypervolemia

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:

Seizures
Coma
Cardiac arrest
Death

Nurse's Role Caring for a Patient with Electrolyte Imbalance

Nurses 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:

Monitor electrolyte levels in the patient and adjust treatment plans accordingly
Teach the patient and family about electrolyte imbalances, potential complications, and treatment options
Provide education on lifestyle changes that can help maintain balanced electrolytes
Administer IV fluids, oral medications, and supplements as ordered
Weigh the patient daily and review any changes in body weight, if indicated
Provide emotional support to the patient and their family
Refer the patient to other healthcare professionals as needed
Record and document all treatments, medications, and patient condition changes
Administer oxygen therapy and other treatments as needed
Monitor the patient for dehydration, shock, or any other complications associated with electrolyte imbalance

Nursing Care Plans Related to Electrolyte Imbalance

Now, 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 Plan

Hypernatremia 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

Dehydration
Severe diarrhea
Fever
Vomiting
Poorly controlled diabetes
Certain medications
Kidney disease
Diabetes insipidus
Extensive burns

Evidenced By

Extreme thirst
Fatigue
Headache
Nausea
Lethargy
Confusion
Muscle twitching or spasms
Seizures
Coma

Desired Outcomes

The patient will maintain a normal fluid balance
The patient will maintain normal serum sodium and intravascular volume levels.
The patient will maintain normal electrolyte levels.
The patient's heart rate and blood pressure will be within normal limits.
The patient will verbalize an understanding of the cause of hypernatremia and how to self-manage the condition.
The patient will be free of neuromuscular irritability.

Risk for Hypernatremia Nursing Assessment

Assess sodium levels.
Ask the patient if they have extreme thirst.
Assess mental status for new-onset confusion.
Monitor fluid intake and output.

Risk for Hypernatremia Nursing Interventions and Rationales

Increase the patient's fluid intake or provide free water to patients receiving enteral feedings.
Rationale: May prevent hypernatremia if the patient cannot perceive or respond to thirst.
Encourage increased oral and IV fluid intake.
Rationale: Gradually restores the balance of sodium and water.
Educate patients to avoid foods high in sodium, such as processed foods or canned vegetables and vegetable juice.
Rationale: Minimizes the risk of too much sodium intake through diet and reduces the risk of heart disease and heart failure.
Provide regular oral care and avoid mouthwashes containing alcohol.
Rationale: Prevents further drying and promotes comfort.
Restrict a diet high in sodium and administer diuretics as ordered.
Rationale: Decreases sodium levels while there is extracellular fluid excess.
Monitor laboratory values for electrolyte levels as ordered.
Rationale: Detects changes in the patient's fluid and electrolyte balance. Administer intravenous fluids as ordered.
Provide seizure precautions such as lowering the height of the bed and using padding on side rails.
Rationale: Protects against injury during seizures.

Risk for Hyponatremia Care Plan

Hyponatremia 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

Water intoxication
Vomiting
Diarrhea
Side effects of gastric suctioning, medication, or electrolyte-free IV fluids
Kidney dysfunction

Evidenced By

Confusion
Nausea and vomiting
Drowsiness or fatigue
Restlessness
Muscle weakness or spasms
Seizures
Coma

Desired Outcomes

The patient will maintain a normal heart rate and blood pressure.
The patient will maintain normal serum sodium levels.

Risk for Hyponatremia Nursing Assessment

Monitor fluid intake and output.
Evaluate sodium levels.
Assess the patient's neurological and neuromuscular status.
Monitor urine and serum osmolality and electrolytes.

Risk for Hyponatremia Nursing Interventions and Rationales

Provide seizure precautions such as lowering the height of the bed and using padding on side rails.
Rationale: Protects against injury during seizures.
Irrigate nasogastric tubes with normal saline.
Rationale: Isotonic solutions reduce electrolyte loss in gastrointestinal fluids.
Encourage foods and fluids high in sodium, such as eggs, milk, and meat.
Rationale: Provides a slow replacement of dietary sodium.

Risk for Hypercalcemia Care Plan

Hypercalcemia 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

Kidney problems
Hyperparathyroidism
Hyperthyroidism
Side effects of certain medications, such as theophylline, thiazide diuretics, and antineoplastics

Evidenced By

Nausea and vomiting
Constipation
Excessive thirst
Frequent urination
Bone pain and muscle weakness
Cardiac dysrhythmias
Confusion
Lethargy
Depression

Desired Outcomes

The patient will be free of ECG changes, such as tachycardia and bradycardia.
The patient will maintain normal calcium levels.
The patient will maintain a normal cognitive status.

Risk for Hypercalcemia Nursing Assessment

Monitor blood calcium, phosphate, and magnesium levels.
Assess the patient's level of consciousness and neuromuscular status.
Assess bowel sounds.
Monitor cardiac rhythm and rate.
Review the medication regimen for drugs that can elevate calcium levels, such as phenytoin and heparin.

Risk for Hypercalcemia Nursing Interventions and Rationales

Increase the use of safety measures when moving the patient.
Rationale: Decreases the risk of injury, including pathological fractures related to weakened bones.
Promote a diet high in bulk.
Rationale: Decreases the risk of constipation related to impaired gastrointestinal tone.
Assess for urinary stones by straining the urine.
Rationale: High calcium levels increase the risk of stone formation.
Encourage up to four liters of fluid intake daily and include fluids containing sodium if signs of cardiac tolerance are present.
Rationale: Increases urinary flow and removal of calcium to minimize the risk of stone formation and improves hydration.
Administer sodium sulfate and isotonic saline as ordered.
Rationale: Increases urinary excretion by diluting extracellular calcium concentrations and reducing tubular reabsorption of calcium.

Risk for Hypocalcemia Care Plan

Hypocalcemia 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

Diarrhea
Chronic laxative use
Renal failure
Side effects of certain medications, such as anticonvulsants, diuretics, and antibiotics

Evidenced By

Muscle twitches, cramps
Dry, scaly skin
Brittle nails
Depression
Confusion
Irritability
Hallucinations
Muscle aches
Laryngospasms
Tetany
Seizures
Cardiac arrhythmias
Congestive heart failure

Desired Outcomes

The patient will maintain cardiac rhythms within normal limits.
The patient will maintain serum calcium levels within normal limits.
The patient will be free of respiratory distress.
The patient will be free of neuromuscular irritability.

Risk for Hypocalcemia Nursing Assessment

Monitor laboratory results.
Monitor the patient's respiratory status, including rate, rhythm, and signs of dyspnea.
Monitor heart rate and rhythm.
Assess for petechiae and ecchymosis, and other signs of bleeding.
Perform a medication regimen review.

Risk for Hypocalcemia Nursing Interventions and Rationales

Educate the patient on the chronic and excessive use of laxatives and antacids.
Rationale: Medications containing phosphorous can reduce serum calcium levels.
Encourage the patient to use antacids containing calcium, such as Tums, if needed.
Rationale: Assists with oral replacement of calcium levels.
Educate the patient on the importance of meeting dietary calcium needs.
Rationale: Diets including calcium-rich foods reduce the risk of tooth decay, osteoporosis, and eczema.
Administer medications as ordered.
Rationale: Certain medications can increase serum calcium levels.

Risk for Hypermagnesemia Care Plan

Magnesium 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

Chronic diarrhea
Renal dysfunction
Diabetic ketoacidosis
Side effects of medications containing magnesium
Diuretic overuse or abuse

Evidenced By

Nausea
Mental impairment
Headache
Vomiting
Flushing
Hypotension
Respiratory depression
Decreased or absent reflex response

Desired Outcomes

The patient will maintain normal serum magnesium levels.
The patient will maintain normal blood pressure values.
The patient will maintain respiratory functions within normal limits.

Risk for Hypermagnesemia Nursing Assessment

Assess renal function. Renal impairment can affect the body's ability to regulate magnesium levels.
Check serum Magnesium levels. Use a corrected magnesium level to get an accurate reading.
Assess respiratory rate and rhythm.
Monitor heart rate and rhythm.
Monitor blood pressure.
Monitor urinary output and 24-hour fluid balance.
Assess the level of consciousness and neuromuscular status, including muscle tone, strength, and reflexes.

Risk for Hypermagnesemia Nursing Interventions and Rationales

Encourage bed rest and use safety precautions during movement.
Rationale: Promotes safety if the patient experiences neurological depression or muscle weakness.
Encourage increased fluid intake.
Rationale: Promotes excretion of magnesium through the kidneys.
Educate on avoiding antacids with magnesium, such as Mylanta or Maaylox.
Rationale: Minimizes risk of hypermagnesemia related to increased oral intake.
Administer diuretics and IV fluids.
Rationale: Promotes excretion of magnesium through the kidneys.
Administer calcium gluconate or 10% calcium chloride.
Rationale: Reverses symptoms of too much magnesium in the blood.
Prepare and educate the patient on dialysis.
Rationale: Lowers magnesium levels quickly.

Risk for Hypomagnesemia Care Plan

Hypomagnesemia 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

Gastrointestinal losses
Renal disease
Diabetic ketoacidosis
Hyperaldonsteonism
Malnutrition
Side effects of certain medications, including chemotherapeutics and diuretics

Evidenced By

Weakness
Irritability
Torsades de pointes
Tetany
Cardiac dysrhythmias
Hypertension
Hyperreflexia
Nausea
Involuntary movements
Decreased GI function, including mobility and bowel sounds
Death

Desired Outcomes

The patient will maintain normal serum magnesium levels.
The patient will display normal cardiac function.
The patient will display normal mental and neuromuscular function.

Risk for Hypomagnesemia Nursing Assessment

Assess for the presence of slowed GI mobility, such as reduced bowel sounds or the presence of an ileus.
Assess for laryngeal stridor and dysphagia.
Monitor cardiac function, including heart rate, rhythm, and ECG changes.
Assess the level of consciousness and neuromuscular tone, movement, and reflexes.
Observe for signs of digoxin toxicity if part of the patient's medication regimen, including vomiting, nausea, blurred vision, and heart block.
Assess magnesium, phosphate, and calcium levels.
Assess renal function, which can affect the body's ability to regulate magnesium levels.

Risk for Hypomagnesemia Nursing Interventions and Rationales

Educate on the proper use of laxatives and diuretics.
Rationale: Overuse or abuse can lower magnesium levels.
Provide seizure and safety precautions.
Rationale: Protects against injury related to seizure or changes in mental status.
Utilize a cradle or footboard on the hospital bed.
Rationale: Keeping linens off of feet and legs may reduce muscle spasms.
Keep the environment calm, quiet, and dim.
Rationale: Promotes rest and minimizes stimulation.
Encourage ROM exercises.
Rationale: Minimizes effects of muscle changes, including spasticity and weakness.
Increase magnesium-rich foods, including dairy, green leafy vegetables, and meat.
Rationale: Promotes replacement of magnesium through the diet for mild electrolyte imbalance.
Administer oral or IV magnesium supplements as indicated.
Rationale: Replaces magnesium for moderate to severe hypomagnesemia.

Risk for Hyperkalemia Care Plan

Potassium 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

Renal disease
Certain medications, including NSAIDs, diuretics, and cytotoxic drugs
Large transfusion with banked blood
Too much potassium in the diet
Rhabdomyolysis
Burns, tissue injuries, or trauma

Evidenced By

Heart palpitations
Abnormal heart rhythms
Nausea

Desired Outcomes

The patient will not experience life-threatening cardiac conduction or neuromuscular disturbance.
The patient will maintain normal serum potassium levels.
The patient will remain free of signs and symptoms of hyperkalemia.

Risk for Hyperkalemia Nursing Assessment

Assess urine and serum electrolytes.

Use a 12-lead ECG to identify signs of cardiac conduction abnormality.
Monitor cardiac status, including heart rate and rhythm.
Monitor respiratory status, including rate and depth.
Assess the level of consciousness and neuromuscular function, including movement and strength.
Monitor serum potassium levels.
Monitor urinary output.

Risk for Hyperkalemia Nursing Interventions and Rationales

Administer diuretics as indicated.
Rationale: Promotes potassium excretion and renal clearance.
Instruct on needed dietary changes, such as increasing the intake of fats and low-potassium foods.
Rationale: Reduces dietary sources of potassium.
Educate on limiting salt or salt substitutes containing potassium.
Rationale: Reduces dietary sources of potassium.
Educate on the use of potassium supplements, if indicated.
Rationale: Correct administration can reduce the risk of misuse or overuse.
Perform a medication review for medications containing potassium or those that affect potassium excretion.
Rationale: Indicates the need for regular monitoring of potassium levels and may require the healthcare provider to consider alternate drug therapies.
Monitor BUN and creatinine levels.
Rationale: Indicates patients at high risk of kidney problems, which may affect potassium excretion.
Encourage frequent rest and the need to participate in ROM exercises as tolerated.
Rationale: Reduces muscle weakness and cramping and improves muscle tone.

Risk for Hypokalemia Care Plan

Hypokalemia 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

Severe diarrhea or vomiting
Diets high in sodium
Profuse sweating
Diabetic acidosis
Renal failure
Side effects of some diuretics and antibiotics

Evidenced By

Lightheadedness
Excessive urination and thirst
Hypotension
Muscle twitches and cramps
Muscle weakness
Tingling and numbness
Heart palpitations
Constipation
Fatigue

Desired Outcomes

The patient will maintain potassium levels within normal limits.
The patient will maintain a normal heart rhythm.
The patient will maintain normal cognitive and neuromuscular function.

Risk for Hypokalemia Care Plan Nursing Assessment

Assess for excessive wound, gastric, or urinary output.
Monitor heart rate and rhythm.
Assess for signs of metabolic alkalosis, including cardiac dysrhythmias, tachycardia, tetany, and changes in mental status.
Auscultate bowel sounds for changes in motility.
Monitor serum potassium levels and arterial blood gases as indicated.

Risk for Hypokalemia Care Plan Nursing Interventions and Rationales

Educate on the use of laxatives and the importance of avoiding overuse.
Rationale: Prevent the recurrence of potassium depletion due to laxative use.
Carefully administer IV potassium using an infusion pump or micro drip set.
Rationale: Ensures safe administration and safeguards against overdose.
Observe for signs of hyperkalemia when administering potassium supplements.
Rationale: Promotes safe usage of potassium supplements.
Monitor blood pressure and electrocardiogram.
Rationale: Detects early signs of the condition.
Perform a medication review to assess for potassium-wasting drugs, such as Lasix or gentamicin.
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

Severe vomiting
NG tube drainage without electrolyte replacement
Fistulas
Steroid or diuretic use
Excessive intake of baking soda or milk (alkali)
Excessive use of antacids

Evidenced By

Dry skin
Altered skin turgor
Dry mucous membranes
Hypotension
Tachycardia
Fever
Decreased urine output
Concentrated urine
Confusion
Thirst
Weakness
Dehydration

Desired Outcomes

The patient will maintain a normal acid-base balance.
The patient will be free of signs of dehydration.
The patient's vital signs will remain within normal ranges.
The patient's fluid loss will be corrected.

Risk for Alkalosis Nursing Assessment

Assess for signs of dehydration.
Determine the cause of fluid loss.
Ask the patient about excessive antacid use.
Monitor serum pH and bicarbonate levels.
Monitor urine pH.
Monitor intake and output.

Risk for Alkalosis Nursing Interventions and Rationales

Educate on the use of laxatives and the importance of avoiding overuse.
Rationale: Prevent the recurrence of potassium depletion due to laxative use.
Carefully administer IV potassium using an infusion pump or micro drip set.
Rationale: Ensures safe administration and safeguards against overdose.
Observe for signs of hyperkalemia when administering potassium supplements.
Rationale: Promotes safe usage of potassium supplements.
Encourage increased intake of potassium-rich foods, such as bananas, oranges, and potatoes.
Rationale: Promotes management of the condition through dietary sources.
Monitor blood pressure and electrocardiogram.
Rationale: Detects early signs of the condition.
Perform a medication review to assess for potassium-wasting drugs, such as Lasix or gentamicin.
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

Severe vomiting
NG tube drainage without electrolyte replacement
Fistulas
Steroid or diuretic use
Excessive intake of baking soda or milk (alkali)
Excessive use of antacids

Evidenced By

Dry skin
Altered skin turgor
Dry mucous membranes
Hypotension
Tachycardia
Fever
Decreased urine output
Concentrated urine
Confusion
Thirst
Weakness
Dehydration

Desired Outcomes

The patient will maintain a normal acid-base balance.
The patient will be free of signs of dehydration.
The patient's vital signs will remain within normal ranges.
The patient's fluid loss will be corrected.

Risk for Alkalosis Nursing Assessment

Assess for signs of dehydration.
Determine the cause of fluid loss.
Ask the patient about excessive antacid use.
Monitor serum pH and bicarbonate levels.
Monitor urine pH.
Monitor intake and output.

Risk for Alkalosis Nursing Interventions and Rationales

Administer oral or IV fluid replacement therapy.
Rationale: Replaces the fluid loss and restores normal electrolyte levels.
Evaluate electrolyte levels.
Rationale: Establishes causes of alkalosis, such as hypokalemia and hypochloremia, to allow for treatment.
Administer medications to treat symptoms of alkalosis, including antiemetics or antidiarrheals.
Rationale: Treats the underlying cause of hypovolemia, including vomiting or
diarrhea.

Risk for Acidosis Care Plan

Metabolic 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:

Chronic kidney problems
Bone disease
Delayed growth
Renal stones

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

Poorly controlled diabetes
Loss of bicarbonate
Chronic alcohol use
Heart disease
Liver disease
Cancer
Low blood sugar
Prolonged oxygen deprivation
Poor kidney function

Evidenced By

Tachycardia
Tachypnea
Drowsiness
Confusion
Weakness
Loss of appetite
Nausea and vomiting
Sweet or fruity-smelling breath

Desired Outcomes

The patient will maintain normal serum electrolyte and bicarbonate levels.
The patient will no longer experience confusion.
The patient's vital signs will be within normal limits.
The patient will not exhibit complications of metabolic acidosis.

Risk for Acidosis Nursing Assessment

Monitor skin temperature.
Assess skin turgor, color, and capillary refill.
Assess the patient's neurological status and level of consciousness.
Assess for underlying conditions, such as kidney failure or diabetes.
Assess for hypotension.
Assess for altered respiratory status.
Listen to bowel sounds.
Monitor intake and output.
Evaluate serum and blood pH.

Risk for Acidosis Nursing Interventions and Rationales

Provide oral hygiene with sodium bicarbonate mouthwashes or lemon glycerin swabs.
Rationale: Protectively lubricates the mouth and neutralizes acids.
Administer oral or IV fluids as indicated.
Rationale: Helps to treat the underlying cause of acidosis.
Implement seizure and coma precautions, like placing the bed in a low position or using side rail padding.
Rationale: Promotes safety and minimizes injury from advanced neurological
Complications.
Administer sodium bicarbonate, lactate, or saline IV as indicated.
Rationale: Corrects the bicarbonate deficiency.
Educate on a low-protein, high-carbohydrate diet.
Rationale: Helps to correct acid-base imbalances.

More Electrolyte Imbalance Nursing Diagnosis

Below are more nursing diagnoses for electrolyte imbalances:

Hypervolemia
Hypovolemia
Hyperphosphatemia
Hypophosphatemia
Hyperchloremia
Hypochloremia

Electrolyte Imbalance NCLEX Test Questions

As 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 Resources

Need more information about electrolyte imbalances? AllNurses has you covered! Check out these other articles below:

Wrapping Up Electrolyte Imbalance Nursing Care Plans

Electrolytes 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.