10 Fluid And Electrolyte Imbalances Nursing Care Plans

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Human body cells are immersed in fluids both inside and outside the cell. The water that is inside accounts for about one-half to two-thirds of an average person’s weight.

Fluid inside the cells is called intracellular fluid (ICF), and fluid outside the cells is called extracellular fluid (ECF). Intracellular fluid contains water and dissolved solutes and proteins. The solutes are electrolytes, which plays an important role in physiologic body functions.

An imbalance in fluids and electrolytes can result in excessive amounts of fluids in the body or dehydration. This can happen as a result of an alteration in body systems, chronic disease, certain medications, or an underlying illness.

Nursing Care Plans

Nursing care plan and goals for fluid and electrolyte imbalances include: maintaining fluid volume at a functional level, patient exhibits normal laboratory values, demonstrates appropriate changes in lifestyle and behaviors including eating patterns and food quantity/quality, re-establishing and maintaining normal pattern and GI functioning.

Here are ten (10) nursing care plans (NCP) and nursing diagnosis for fluid and electrolyte imbalances, more specifically:

1. Fluid Balance: Hypervolemia & Hypovolemia

2. Potassium (K) Imbalances: Hyperkalemia and Hypokalemia

3. Sodium (Na) Imbalances: Hypernatremia and Hyponatremia

4. Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia

5. Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia

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Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia


Magnesium (Mg) is the second most abundant cation in the intracellular fluid. Magnesium functions by exerting its effects on the myoneural junction, affecting neuromuscular irritability. It also plays an important role in the contraction of cardiac and skeletal muscles cells; contributes to vasodilation and through this effect, changes blood pressure and cardiac output; activates intracellular enzymes to participate in carbohydrate and protein metabolism, and influences intracellular calcium levels through its effect on parathyroid hormone secretion.

The normal serum magnesium concentration ranges from 1.3 to 2.1 mEq/L.

  • Hypermagnesemia is serum magnesium levels above 2.1 mEq/L.
  • Hypomagnesium is serum magnesium levels below 1.3 mEq/L.
Risk For Electrolyte Imbalance (Hypermagnesemia)

May be related to

  • Chronic diarrhea.
  • Diabetic ketoacidosis.
  • Renal dysfunction.
  • Treatment-related side effects of such as medications containing magnesium, dialysis with hard water, diuretic abuse.

Possibly evidenced by

  • [not applicable].

Desired Outcomes

  • Client will display heart rhythm, muscular strength, cognitive status and laboratory results within the normal limit for client and absence of respiratory impairment.
Nursing InterventionsRationale
Monitor respiratory rate and depth. Encourage deep breathing and coughing exercise. Elevate the head of the bed.Neuromuscular transmissions are blocked by excess magnesium, resulting in respiratory muscular weakness, and hypoventilation, which may proceed to apnea.
Monitor blood pressure.Hypotension unexplained by other causes is an early sign of magnesium toxicity.
Monitor heart rate and rhythm.Bradycardia and heart block may develop, progressing to cardiac arrest as a direct result of hypermagnesemia on cardiac muscle.
Monitor urinary output and 24-hour fluid balance.Renal failure is the primary contributing factor in hypermagnesemia, and if it is present, a fluid excess can easily occur.
Assess the level of consciousness and neuromuscular status, including reflexes, muscle movement, tone, and strength.CNS and neuromuscular depression can cause a decreasing level of alertness, progressing to coma, and depressed muscular response, progressing to flaccid paralysis.
Check patellar reflexes regularly.Absence of these reflexes indicates magnesium levels about 7 mEq/L or greater. If untreated, cardiac and respiratory arrest can occur.
Encourage bed rest; assist with personal activities, as needed.Flaccid paralysis, lethargy, and decreased mentation can reduce activity tolerance and ability.
Encourage increased fluid intake, if appropriate.Increased hydration promotes excretion of magnesium, however, fluid intake must be cautious in the event of cardiac or renal failure.
Instruct the avoidance of magnesium-containing antacids such as Maalox, Mylanta, Riopan, and Getusil, in a client with renal disease. Caution clients with renal diseases to avoid over-the-counter drug use without discussing with the health care provider.Limits oral intake to help avoid increased magnesium.
Monitor laboratory results as indicated.Evaluate therapy needs and effectiveness.
Administer medications as indicated:
  • Thiazide diuretics and IV fluids.
Promotes renal clearance of magnesium if kidney function is normal.
  • 10% Calcium chloride or calcium gluconate.
Antagonize action and reverses symptoms of magnesium toxicity to improve neuromuscular function.
Prepare, and assist for dialysis, as needed.Dialysis may be indicated to lower magnesium levels, in case of a presence of renal failure.
Risk For Electrolyte Imbalance (Hypomagnesemia)

May be related to

  • Diabetic ketoacidosis, hyperaldosteronism.
  • Excessive losses.
  • Malnutrition.
  • Renal disease.
  • Treatment-related side effects of medications such as antifungals, aminoglycosides, chemotherapy agents, diuretics.

Possibly evidenced by

  • [not applicable].

Desired Outcomes

  • Client will display heart rate, rhythm, muscle strength, cognitive status, and laboratory results within normal limits for client and absence of neuromuscular irritability.
Nursing InterventionsRationale
Auscultate bowel sounds,Decrease peristalsis and bowel function can occur as a result of muscle weakness.
Assess the client’s airway and swallowing.Moderate to severe hypomagnesemia can lead to dysphagia and laryngeal stridor.
Monitor heart rate and rhythm; Monitor ECG changes.Magnesium regulates sodium and potassium transport across the cell and affects the excitability of cardiac tissues.
Assess level of consciousness and neuromuscular strength, tone, movement, and reflexes; observe for Trousseau’s and Chvostek’s sign.Psychosis, irritability, and confusion may occur. But, more common manifestations are muscular including hyperactive deep tendon reflexes, spasticity, generalized tetany, or muscle tremors.
Observe for signs of digoxin toxicity when used: reports if blurred vision, vomiting, nausea, increasing atrial dysrhythmias, and heart block.Low magnesium may precipitate digoxin toxicity.
Note for signs of magnesium toxicity during administration:

  • Absence of patellar reflex.
  • Anxiety.
  • Diaphoresis.
  • Drowsiness.
  • Hot flushes.
  • Hypotension.
  • Increased muscular irritability.
  • Thirst.
Rapid, excessive administration of magnesium, may result in toxicity and life-threatening complications.
Encourage range-of-motion (ROM) exercises, as tolerated.Decreases deleterious effects of muscle weakness and spasticity.
Teach the client on the proper use of diuretics and laxatives.The abuse of these drugs may result in magnesium deficit.
Provide safety and seizure precaution as indicated:

  • Bed in a low position.
  • Frequent observation.
  • Use of padded side rails.
 Changes in mentation or the development of seizure activity in severe low magnesium increase the risk of client injury.
Place footboard or cradle on the bed.Elevation of linens may reduce spasms.
Provide a quiet environment and subdued lightingReduces extraneous stimuli; promotes rest.
Encourage intake of dairy products, meat, fish, green leafy vegetables, and whole grains.Provides an oral replacement for mild magnesium deficits; may prevent a recurrence.
Monitor laboratory studies such as serum magnesium, potassium, and calcium levels.Evaluates therapy needs and effectiveness.
Administer magnesium, as indicated:
  • Magnesium-based antacids such as Gelusil, Maalox, Mylanta, and Riopan.
Can supplement dietary replacement.
  • Magnesium chloride IV or Magnesium sulfate.
IV replacement is preferred in severe deficit because the absorption of magnesium from the intestinal tract varies inversely with calcium absorption. However, a potential for drug interaction with digitalis preparations may lead to increased cardiac dysrhythmias or heart block.
  • Magnesium sulfate IM or magnesium hydroxide PO (Amphojel and milk of magnesia)
May be given for mild deficit or in nonemergent situations. Injections should be deep IM to decrease local tissue reactions.
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