10 Fluid And Electrolyte Imbalances Nursing Care Plans


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


Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia

Calcium (Ca) is a major cation that is regulated closely with magnesium and phosphorus. Calcium has a variety of functions: in bones, it contributes to bone and tooth rigidity and strength; it is also required for nerve, muscle, and cardiac conduction by its participation in the sodium-potassium pump, it is also required for hormonal secretion.

The normal serum calcium level ranges from 8.5 to 10.5 mg/dL.

  • Hypercalcemia is serum calcium levels above 10.5 mg/dL.
  • Hypocalcemia is serum calcium levels below 8.5 mg/dL.
Risk For Electrolyte Imbalance (Hypercalcemia)

May be related to

  • Hyperparathyroidism.
  • Hyperthyroidism.
  • Renal disease.
  • Treatment-related side effects of medications such as anticancer drugs, theophylline, lithium, thiazide diuretics.

Possibly evidenced by

  • [not applicable].

Desired Outcomes

  • Client will display heart rhythm, muscle strength, cognitive status, and laboratory results within the normal limit for the client.
Nursing InterventionsRationale
Assess the level of consciousness and neuromuscular status, including muscle tone, strength, and movement.Nerve and muscle activity is depressed. Lethargy and fatigue can progress to convulsions or coma.
Auscultate bowel sounds.Hypotonicity leads to constipation when the smooth muscle tone is inadequate to produce peristalsis.
Monitor cardiac rate and rhythm. Be aware that cardiac arrest can occur in a hypercalcemic crisis.Overstimulation of cardiac muscle occurs with resultant dysrhythmias and ineffective cardiac contraction. Sinus bradycardia, sinus dysrhythmias, wandering pacemaker, and atrioventricular (AV) block may be noted. Hypercalcemia creates a predisposition to cardiac arrest.
Monitor intake and output; calculate fluid balance.Efforts to correct the original condition may result in secondary imbalances and complications.
Review drug regimen, noting the use of calcium-elevating drugs, such as heparin, methicillin, phenytoin, and tetracycline.May affect drug choice or require a reduction in oral sources of calcium.
Strain urine if flank pain occurs.A large amount of calcium present in kidney parenchyma may lead to stone formation.
Provide safety measures, including gentle handling when moving client.Reduces the risk of injury and pathological fractures.
Identify and restrict sources of calcium intake such as dairy products, eggs, and spinach and calcium-containing antacids such as Dicarbosil, Tums, Titralac, if indicated.Foods or drugs containing calcium may need to be limited in chronic conditions causing hypercalcemia.
Maintain bulk in diet.Constipation may be a problem because of decreased GI tone.
Encourage fluid intake of 3 to 4 liters per day, including sodium-containing fluids (within cardiac tolerance) and use of acid-ash juices such as cranberry and prune, if kidney stones present or suspected.Reduces dehydration, encourages urinary flow and clearance of calcium and reduces the risk of stone formation.
Encourage frequent repositioning and range-of-motion (ROM) and/or muscle-setting exercises with caution. Promote ambulation as tolerated.Muscle activity may reduce calcium shifting from the bones that occur during immobilization.
Monitor laboratory studies such as calcium, magnesium, and phosphate.Evaluates therapy needs and effectiveness.
Administer medications, as indicated:
  • Calcitonin.
Promotes movement of serum calcium into bones, temporarily reducing serum calcium levels, especially in the presence of the increased parathyroid hormone.
  • Disodium edetate (EDTA).
Chelating action lowers the serum calcium level.
  • Diuretics, such as furosemide (Lasix).
Diuresis promotes renal excretion of calcium and reduces risks of fluid excess from an isotonic saline infusion.
  • Glucocorticoid therapy.
Inhibits intestinal absorption of calcium and reduces inflammation and the associated stress that mobilizes calcium from the bone.
  • Mithramycin (Mithracin).
A cytotoxic antibiotic that lowers serum calcium by inhibiting inappropriate bone resorption, typically seen in malignancies or hyperparathyroidism.
  • Neutra-Phos and Fleet Phospho-Soda.
These drugs bind calcium in the GI tract, promoting excretion.
  • Phosphate.
A rapid-acting agent that induces calcium excretion and inhibits bone resorption.
  • Sodium bicarbonate.
Induces alkalosis, thereby reducing the ionized calcium fraction.
Administer isotonic saline and sodium sulfate PO or IV.Emergency measures in severe hypercalcemia used to dilute extracellular calcium concentration and inhibit tubular reabsorption of calcium, thereby increasing urinary excretion.
Prepare for and assist with hemodialysis.Rapid reduction of serum calcium may be necessary to correct the life-threatening situation.
Risk For Electrolyte Imbalance (Hypocalcemia)

May be related to

  • Chronic laxative abuse.
  • Diarrhea.
  • Renal failure.
  • Treatment-related side effects of medications such as antibiotics, anticonvulsants, corticosteroids, diuretics.

Possibly evidenced by

  • [not applicable].

Desired Outcomes

  • Client will display heart rhythm and laboratory results within normal limit and absence of neuromuscular irritability and respiratory impairment.
Nursing InterventionsRationale
Monitor respiratory rate, effort, and rhythm. Place tracheostomy set at the bedside.Hypocalcemia may result in laryngeal stridor leading to respiratory arrest.
Monitor heart rate and rhythm.Heart muscle may contract irregularly with calcium and magnesium deficit.
Assess for areas of possible bleeding. Observe for petechiae and ecchymosis.Severe hypocalcemia is associated with depressed circulatory function and alterations in coagulation.
Discuss the use of antacids and laxatives.Those containing phosphate may negatively affect the metabolism of calcium.
Assess neuromuscular strength, tone, movement, and reflexes; observe for Trousseau’s and Chvostek’s sign.Hypocalcemia directly increases peripheral neuromuscular irritability resulting in muscle spasm.
Maintain a safe, quiet environment and seizure precaution.Reduces CNS stimulation and protects the client from injury.
Stress importance of meeting calcium needs.Adverse effects of long-term deficiency include cataracts, eczema, osteoporosis, and tooth decay.
Encourage relaxation and stress-reduction measures such as deep-breathing exercise, guided imagery, and visualizations.Hypocalcemic tetany can be potentiated by stress and hyperventilation.
Encourage use of calcium-containing antacids if needed, such as Dicarbosil, Titralac, and Tums.Possible sources for an oral replacement to help maintain calcium levels, especially in clients at risk for osteoporosis.
Review client’s medication regimen such as digoxin, insulin use, mithramycin (Mithracin), and parathyroid injection.These drugs can decrease magnesium levels, affecting calcium level. The effect of digoxin is enhanced by calcium, and, in clients receiving calcium, digoxin intoxication may develop.
Encourage to eat foods high in calcium such as dark leafy greens, cheese, low-fat milk, yogurt, eggs, oranges, green beans, and sardines. Avoid intake of phosphorus-rich foods such as bran, chocolates, nuts, whole wheat, and barley.Vitamin D aids in the absorption of calcium from the intestinal tract. Phosphorus competes with calcium for intestinal absorption.
Review dietary intake of vitamins and fat.Vitamin D and fat insufficiency impair calcium absorption.
Monitor laboratory studies.Evaluates therapy needs and effectiveness.
Administer medication as indicated:
  • Calcium gluconate, gluceptate, or chloride intravenously (IV)
Provides rapid treatment in acute calcium deficit, especially in the presence of tetany or convulsions.
  • Calcium carbonate/lactate PO
Oral preparations are useful in correcting subacute deficiencies.
  • Vitamin D supplement
May be used in combination with calcium therapy to enhance calcium absorption once concomitant phosphate deficiency is corrected.
  • Magnesium sulfate IV or PO
Hypomagnesemia is a precipitating factor in calcium deficit.

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