This article provides an in-depth overview of hypermagnesemia and hypomagnesemia nursing care plans and nursing diagnosis. Learn about the causes, symptoms, nursing interventions and management options for magnesium imbalances.
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.
- Hypomagnesemia is serum magnesium levels below 1.3 mEq/L.
Nursing Care Plans
Magnesium imbalances, including hypermagnesemia and hypomagnesemia, require careful management to prevent potentially serious complications. The nursing care plan goals for patients with magnesium imbalances are focused on restoring magnesium levels to a safe range and managing associated symptoms and complications.
Here are two nursing diagnosis for patients with magnesium imbalances: hypermagnesemia & hypomagnesemia nursing care plans:
Hypermagnesemia: Risk For Electrolyte Imbalance
Hypermagnesemia, an elevated level of magnesium in the blood, can lead to a risk of electrolyte imbalance, as it may affect the normal functioning of cells and organs, including the heart and nervous system. This can occur due to various reasons, including excessive intake of magnesium-containing supplements, medications or antacids, and medical conditions affecting the kidneys or hormonal regulation of magnesium balance. Symptoms of hypermagnesemia may include weakness, confusion, respiratory and cardiac distress, and coma.
Nursing Diagnosis
- Risk for Electrolyte Imbalance
May be related to
- Chronic diarrhea
- Diabetic ketoacidosis
- Renal dysfunction
- Treatment-related side effects such as medications containing magnesium, dialysis with hard water, diuretic abuse
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Desired Outcomes
- The client will display heart rhythm, muscular strength, cognitive status, and laboratory results within the normal limit for the client and the absence of respiratory impairment.
Nursing Assessment and Rationales
Nursing assessment is a crucial aspect of managing hypermagnesemia, an electrolyte imbalance characterized by serum magnesium levels greater than 2.1 mg/dL. A thorough nursing assessment of clinical presentation, medical history, and diagnostic tests is necessary to prevent complications associated with hypermagnesemia.
1. 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.
2. Monitor blood pressure.
Hypotension unexplained by other causes is an early sign of magnesium toxicity. Hypermagnesemia can cause vasodilation, which can lead to a drop in blood pressure, and potentially cause cardiovascular collapse. As a result, blood pressure monitoring is necessary to detect any fluctuations and to initiate prompt interventions to prevent adverse outcomes.
3. Monitor heart rate and rhythm.
Bradycardia and heart block may develop, progressing to cardiac arrest as a direct result of hypermagnesemia in cardiac muscle.
4. 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.
5. 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.
6. Check patellar reflexes regularly.
The absence of these reflexes indicates magnesium levels of about 7 mEq/L or greater. If untreated, cardiac and respiratory arrest can occur.
7. Monitor laboratory results as indicated.
Evaluate therapy needs and effectiveness.
Nursing Interventions and Rationales
1. Encourage bed rest; assist with personal activities, as needed.
Flaccid paralysis, lethargy, and decreased mentation can reduce activity tolerance and ability.
2. Encourage increased fluid intake, if appropriate.
Increased hydration promotes the excretion of magnesium, however, fluid intake must be cautious in the event of cardiac or renal failure.
3. Instruct the avoidance of magnesium-containing antacids such as Maalox, Mylanta, Riopan, and Getusil, in a client with renal disease. Caution for clients with renal diseases to avoid over-the-counter drug use without discussing it with the health care provider.
Limits oral intake to help avoid increased magnesium.
4. Administer medications as indicated:
- 4.1. Thiazide diuretics and IV fluids
Promotes renal clearance of magnesium if kidney function is normal.
- 4.2. 10% Calcium chloride or calcium gluconate
Antagonize action and reverses symptoms of magnesium toxicity to improve neuromuscular function.
5. Prepare, and assist with dialysis, as needed.
Dialysis may be indicated to lower magnesium levels, in case of the presence of renal failure.
Hypomagnesemia: Risk For Electrolyte Imbalance
Hypomagnesemia, a low level of magnesium in the blood, can lead to a risk of electrolyte imbalance, as magnesium is required for many essential cellular functions, including muscle and nerve function, protein synthesis, and DNA synthesis. This can occur due to various reasons, including inadequate intake, malabsorption, excessive losses from the body, and medical conditions affecting the kidneys or hormonal regulation of magnesium balance. Symptoms of hypomagnesemia may include muscle weakness, tremors, seizures, cardiac arrhythmias, and mental status changes.
Nursing Diagnosis
- Risk for Electrolyte Imbalance
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. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Desired Outcomes
- The client will display heart rate, rhythm, muscle strength, cognitive status, and laboratory results within normal limits for the client and the absence of neuromuscular irritability.
Nursing Assessment and Rationales
Nursing assessment is crucial for identifying patients with hypomagnesemia, an electrolyte imbalance characterized by serum magnesium levels less than 1.3 mg/dL. A thorough nursing assessment of clinical presentation, medical history, and diagnostic tests is necessary for prompt recognition, treatment, and prevention of complications associated with hypomagnesemia.
1. Auscultate bowel sounds.
Decrease peristalsis and bowel function can occur as a result of muscle weakness. Auscultation of bowel sounds is a critical component of nursing care plans for patients with hypomagnesemia. Hypomagnesemia can cause decreased intestinal motility and ileus, which can result in abdominal distention, nausea, and vomiting. As a result, regular auscultation of bowel sounds is necessary to detect any changes in motility and initiate prompt interventions to prevent complications such as bowel obstruction.
2. Assess the client’s airway and swallowing.
Moderate to severe hypomagnesemia can lead to dysphagia and laryngeal stridor. Hypomagnesemia can cause muscle weakness, including the muscles involved in breathing and swallowing. Therefore, a thorough assessment of the airway and swallowing is necessary to detect any signs of respiratory distress or dysphagia and to initiate prompt interventions to prevent aspiration or respiratory failure.
3. Monitor heart rate and rhythm; Monitor ECG changes.
Magnesium regulates sodium and potassium transport across the cell and affects the excitability of cardiac tissues.
4. Assess the level of consciousness and neuromuscular strength, tone, movement, and reflexes; observe Trousseau’s and Chvostek’s signs.
Psychosis, irritability, and confusion may occur. But, more common manifestations are muscular including hyperactive deep tendon reflexes, spasticity, generalized tetany, or muscle tremors.
5. Observe for signs of digoxin toxicity when used: reports of blurred vision, vomiting, nausea, increasing atrial dysrhythmias, and heart block.
Low magnesium may precipitate digoxin toxicity.
6. Note for signs of magnesium toxicity during administration such as weakness or lethargy
flushing, hypotension, respiratory depression, abnormal heart rhythms, absence of patellar reflex, and loss of consciousness or coma.
Rapid, excessive administration of magnesium, may result in toxicity and life-threatening complications.
7. Monitor laboratory studies such as serum magnesium, potassium, and calcium levels.
Evaluates therapy needs and effectiveness.
Nursing Interventions and Rationales
1. Encourage range-of-motion (ROM) exercises, as tolerated.
Decreases deleterious effects of muscle weakness and spasticity.
2. Teach the client the proper use of diuretics and laxatives.
The abuse of these drugs may result in a magnesium deficit.
3. Provide safety and seizure precautions as indicated.
Changes in mentation or the development of seizure activity in severe low magnesium increase the risk of client injury.
4. Place the footboard or cradle on the bed.
Elevation of linens may reduce spasms.
5. Provide a quiet environment and subdued lighting.
Reduces extraneous stimuli; promotes rest.
6. 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.
7. Administer magnesium, as indicated:
- 7.1. Magnesium-based antacids such as Gelusil, Maalox, Mylanta, and Riopan
Can supplement dietary replacement.
- 7.2. 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.
- 7.3. 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.
Recommended Resources
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See also
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