The nursing diagnosis Risk for Electrolyte Imbalance is defined as at risk for change in serum electrolyte levels that may compromise health.
Electrolytes regulate nerve and muscle function, hydrate the body, balance blood acidity and pressure, and further rebuild damaged tissue. Sodium, calcium, potassium, chloride, phosphate, and magnesium are all electrolytes. When these substances become imbalanced, it can lead to either muscle weakness or excessive contraction.
Electrolyte imbalance can occur due to several factors. Various disorders and their corresponding treatments may put the patient at risk for imbalances in serum electrolyte concentrations. Patients experiencing congestive heart failure frequently end up as rebound hospitalizations due to irregular sodium and potassium levels. Diabetes and hypertension may eventually place a patient in a calcium or magnesium imbalance. Electrolyte losses may occur from draining wounds and fistulas, particularly gastrointestinal fistulas. Irregularities in sodium and chloride concentrations happen frequently in situations associated with fluid imbalances, primarily gastrointestinal fluid losses such as vomiting, diarrhea, or suctioning.
Changes in the secretion of antidiuretic hormone and aldosterone can contribute to sodium imbalances. Patients receiving diuretics may be at risk for potassium imbalances. Thyroid and parathyroid problems place the patient at risk for calcium imbalances. Magnesium imbalances often occur in the same situations as calcium and potassium imbalances.
Electrolytes are vital for the normal functioning of the human body. A proper understanding of these imbalances is essential for current management and future prevention. This care plan and nurse study guide focus on sodium, potassium, calcium, and magnesium imbalances.
- Renal dysfunction
- Endocrine dysfunction
- Poor nutrition
- Severe dehydration
- Acid-base imbalance
- Fluid imbalance
- Congestive heart failure
- Cancer treatment
- Tissue trauma
- Wound drainage
- Significant burns
- Alcohol abuse
Goals and Outcomes
The following are the common goals and expected outcomes for Risk for Electrolyte Imbalance nursing diagnosis:
- Patient will sustain normal serum electrolyte balance as evidenced by: sodium level of 136 to 145 mEq/L; potassium level of 3.5 to 5.1 mEq/L; chloride level of 98 to 107 mEq/L; total calcium level of 9 to 10.5 mg/dL; ionized calcium of 4.6 to 5.1 mg/dL; and magnesium level of 1,8 to 3 mg/dL.
Nursing Assessment for Risk for Electrolyte Imbalance
The following are the subjective and objective data you need to assess for a patient with a nursing diagnosis of Risk for Electrolyte Imbalance:
|Monitor serum electrolyte levels.||The levels of electrolytes in the body can become too low or too high. Early detection of abnormality in serum electrolyte levels allows prompt initiation of measures to prevent further imbalances.|
|136 to 145 mEq/L|
|3.5 to 5.1 mEq/L|
|98 to 107 mEq/L|
|9 to 10.5 mg/dL|
|4.6 to 5.1 mg/dL|
|1.8 to 3 mg/dL|
|0.8 to 1.5 mEq/L|
|Identify any clinical conditions or situations that may be a factor for an imbalance in serum electrolytes.||Assessing a patient for electrolyte imbalance can give health care providers an insight into the homeostasis of the body and can serve as a marker for the presence of other illnesses. Prevention of electrolyte irregularities begins with the identification of situations that put the patient at risk for imbalance.|
|The patient’s fluid and food intake have a direct impact on the risk of electrolyte imbalance. A serum sodium level below 135 mEq/L is considered hyponatremia. This state can be due to low levels of sodium or to excess water in connection to the amount of sodium, referred to as dilutional hyponatremia.|
|For bowel to skin fistulas, the body fluid levels and electrolytes including levels of sodium, potassium, calcium, and magnesium in the blood will need to be monitored regularly and corrected to replace any losses. Extensive tissue injury may occur with trauma or burns may cause hyperkalemia, initially. Eventually, the patient may be at risk for hypokalemia and hyponatremia.|
|In this case, electrolyte imbalance can be caused by reduced renal excretion, excessive intake or leakage of potassium from the intracellular space. In addition to acute and chronic renal failure, hypoaldosteronism, and massive tissue breakdown as in rhabdomyolysis are common conditions influencing hyperkalemia.|
|Loop and thiazide diuretics increase sodium delivery to the distal segment of the distal tubule, this increases potassium loss and potentially causing hypokalemia because the increase in distal tubular sodium concentration stimulates the aldosterone-sensitive sodium pump to increase sodium reabsorption in exchange for potassium and hydrogen ion, which are lost to the urine. Thiazide diuretics also increase calcium reabsorption at the distal tubule causing hypercalcemia. Potassium-sparing diuretics may cause hyperkalemia. Hypokalemia may also be associated with prolonged use of corticosteroids.|
|Gastrointestinal losses from diarrhea, vomiting, or nasogastric suctioning also are typical causes of hypokalemia. Vomiting leads to hypokalemia via complex pathogenesis. Gastric fluid holds little potassium, around 10 mEq/L. Nevertheless, vomiting produces volume depletion and metabolic alkalosis, which are accompanied by increased renal potassium excretion.|
|Variations in the secretion of antidiuretic hormone from the posterior pituitary gland place the patient at risk for sodium imbalances. Changes in the thyroid gland and parathyroid gland increase the patient’s risk for calcium imbalances. Disorders linked with changes in cortisol and aldosterone secretion from the adrenal cortex put the patient at risk for imbalance in potassium and sodium.|
|The most dangerous forms of electrolyte imbalance in cancer patients is hypercalcemia or a disorder called tumor lysis syndrome that results in electrolyte imbalance from the killing of cancer cells. Both of these can be life-threatening if not managed appropriately.|
Nursing Interventions for Risk for Electrolyte Imbalance
The following are the therapeutic nursing interventions you can use for your care plan for Risk for Electrolyte Imbalance nursing diagnosis:
|Supply balanced electrolyte IV solutions as directed.||Lactated Ringer’s solution has an electrolyte concentration similar to that of extracellular fluid. Isotonic saline (0.9% sodium chloride) may contribute to hypernatremia if used in a long period of time. Extreme use of sodium free IV solutions (e.g., D5W) puts the patient at risk for hyponatremia.|
|Administer electrolyte replacements as prescribed.||Oral or IV administration of electrolytes may be prescribed to keep electrolyte balance for patients at risk for imbalances.|
|Consider measures to reduce excess electrolytes.||Hyperkalemia is common in patients with end-stage renal disease and may result in serious electrocardiographic abnormalities. Dialysis is the definitive treatment of hyperkalemia in these patients. Intravenous calcium is used to stabilize the myocardium. Kayexalate may be indicated to patients at risk for electrolyte excesses such as potassium.|
|Irrigate nasogastric tubes with isotonic saline, as prescribed.||Irrigation of nasogastric tubes with plain water produces electrolyte losses. Plain water attracts electrolytes from mucosal tissue into the stomach, where they are eliminated with suctioning.|
|Educate the patient about dietary sources of electrolytes.||Electrolytes are salts and minerals, like sodium, potassium, calcium, magnesium, and chloride, in the body that maintain fluid balance and blood pressure. A balanced diet provides the patient with sources of electrolytes to prevent imbalances. Milk, yogurt, dark green, leafy vegetables, and legumes are excellent sources of electrolyte calcium. Whole grains, nuts, fruits, and vegetables are good sources for magnesium and potassium. Bananas are known to be the king of all potassium containing fruits and veggies. Vitamin D is needed for the absorption of calcium from the intestines.|
tomato juices, sauces, and soups
|potatoes with skin|
|tomato juices, sauces, and soups|
|Educate the patient about dietary sources of sodium and the use of salt substitutes.||Patients need to learn to read labels to identify all sources of sodium in foods. Changing from table salt to a potassium-based salt substitute is another way to shift your sodium-potassium balance, and some preliminary study implies that making this switch may have benefits for the heart. But these potassium-based salt substitutes are not for everyone: Excess potassium can be fatal for people who have kidney disease or who are taking medications that can increase potassium levels in the bloodstream.|
|Educate the patient using potassium-wasting about potassium replacements.||To prevent hypokalemia, the patient needs to understand the importance of potassium replacements that include dietary sources and prescribed oral replacements such as potassium chloride (KCl).|
|Educate the patient about limiting the use of over-the-counter antacids and laxatives.||Excessive use of antacids that contain magnesium has a laxative effect that may cause diarrhea, and in patients with renal failure, they may cause increased magnesium levels in the blood, because of the reduced ability of the kidneys to eliminate magnesium from the body in the urine.|
References and Sources
Additional references and further reading about Risk for Electrolyte Imbalance nursing diagnosis:
- Metheny, N. (2011). Fluid and electrolyte balance. Jones & Bartlett Publishers. [Link]
- Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins. [Link]
- Williams, L. S., & Hopper, P. D. (2015). Understanding medical surgical nursing. FA Davis.