Hospitalized patients are at an increased risk of electrolyte imbalance, meaning they are more susceptible to changes in their electrolyte levels that could potentially compromise their health. Electrolytes are a vital part of normal body function. The electrolytes help maintain electrical neutrality in cells. Likewise, they help to generate and conduct action potentials in the body’s nerves and muscles. When these levels are abnormal, patients may experience abnormal bodily functions, and these abnormalities may cause life-threatening complications.
In this article:
Several factors can contribute to electrolyte abnormalities. Some of the potential risk factors and causes include:
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
The following sections contain common signs and symptoms of different types of electrolyte imbalances.
The following are common nursing care planning goals and expected outcomes for risk for electrolyte imbalance:
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to risk for electrolyte imbalance.
1. Auscultate heart sounds.
Patients with electrolyte imbalances are more likely to develop cardiac abnormalities, specifically cardiac arrhythmias.
2. Assess cardiac rhythm.
Cardiac dysrhythmias are common when electrolyte abnormalities are present.
3. Assess vital signs routinely.
Electrolyte abnormalities can lead to arrhythmias and respiratory failure.
4. Assess mental status.
Severe electrolyte abnormalities can cause a change in mentation and confusion.
5. Monitor intake and output.
Excessive fluid intake or insufficient fluid intake can cause abnormalities in electrolytes.
6. Assess respiratory status and auscultate breath sounds.
Severe electrolyte abnormalities can cause respiratory distress and lead to respiratory failure.
7. Assess laboratory values.
Patients at risk of electrolyte imbalances should have routine lab work completed to monitor for any changes so that treatment and supplements are not delayed.
8. Assess the patient’s overall medical history.
This will help the nurse to potentially pinpoint the cause of any imbalances or what condition may put the patient most at risk of an electrolyte imbalance.
9. Assess pain level.
Electrolyte abnormalities can cause discomfort (i.e. muscles cramps/abdominal cramping).
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with a risk for electrolyte imbalance.
1. Weigh the patient daily.
Regular monitoring of the patient’s weight will indicate if there is fluid volume excess, which could cause changes in electrolyte levels.
2. Administer pain medication as appropriate.
Electrolyte abnormalities may cause discomfort, and patients may need treatment for pain.
3. Provide intravenous or oral hydration as needed.
Patients are more prone to electrolyte imbalances when experiencing vomiting and/or diarrhea. It is important that the nurse ensures the patient is maintaining appropriate hydration status.
4. Supplement electrolyte levels as appropriate as ordered by the healthcare provider.
If patients’ electrolyte levels are low, additional supplements may be needed orally or intravenously to maintain appropriate levels. The nurse will administer these as ordered by the healthcare provider.
5. Administer oxygen as needed.
Electrolyte imbalances can cause respiratory distress/failure. The nurse should monitor closely and if needed, supply supplemental oxygen therapy.
6. Educate patient and family on signs and symptoms of electrolyte abnormalities.
This will help to provide the patient with more independence at home in managing their care and preventing further complications or episodes of electrolyte abnormalities.
7. Educate the patient and family members on the importance of a balanced diet and the importance of hydration.
This will help patients to understand how their nutritional status affects their electrolyte levels.
8. Educate the patient and family members on the importance of taking medications as prescribed and what their specific medications are used for.
Understanding their individualized medication regimen will help the patient to develop more independence in their care. Adherence to medication regimens will also reduce the chances of electrolyte imbalances precipitated by worsening disease.
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for risk for aspiration.
Risk for electrolyte imbalance as evidenced by renal dysfunction.
1. Assess renal disease-related symptoms.
Electrolyte imbalances are due to the impairment in renal filtration and tubular reabsorption. Assessing the associated renal symptoms provides information on the severity of the condition and helps determine appropriate management.
2. Assess fluid intake and output.
Fluid imbalance occurs along with electrolyte disturbances in renal dysfunction. The information will determine the required fluid management and provide a treatment response.
3. Monitor signs and symptoms of associated electrolyte imbalances.
Signs and symptoms will provide information on the affected electrolytes. Due to poor renal filtration, patients are at increased risk of many electrolyte imbalances.
4. Monitor laboratory findings (i.e., serum sodium, potassium, calcium, chloride, and magnesium).
These electrolytes are essential in regulating bodily functions such as fluid balance, nerve conduction, muscle contraction, blood clotting, and pH balance. Changes in the values outside of the normal range can cause systemic disturbances.
1. Provide electrolyte replacement as ordered.
Depending on the severity of the electrolyte imbalance, replacement electrolytes may be ordered.
2. Provide balanced nutrition in collaboration with a dietitian or nutritionist, using the best route for feeding.
Obtaining and utilizing electrolytes and other minerals depends on the patient regularly receiving them in readily available form.
3. Anticipate the need for dialysis.
Dialysis is performed to manage fluid overload and severe hyperkalemia in patients with advanced kidney diseases.
4. Teach the patient and family to take or administer drugs that support renal function as prescribed— especially diuretics, antihypertensives, and cardiac drugs.
Knowledge about proper intake of these medications will reduce the potential of complications associated with medication-induced electrolyte imbalances.
Risk for electrolyte imbalance as evidenced by multiple drains.
1. Evaluate the care provided for drains by the patient or family.
Improper drain care will not put the patient at increased risk for electrolyte imbalances but also for infection. Gathering information on drain care will identify areas for correction during health teaching sessions.
2. Review laboratory results (i.e., sodium, potassium, and magnesium).
Ostomy output or fistula drainage can lead to hypokalemia and hypomagnesemia. Large-volume drainage can lead to sodium and water depletion.
3. Monitor drain output.
Drain output monitoring is an essential component of postoperative care, which serves as a guide for the surgical management of the condition.
1. Teach patients about the care of multiple drains.
The following strategies help to prevent infection and dehiscences:
2. Teach the patient about dietary sources of electrolytes.
A balanced diet provides the patient with good sources of necessary electrolytes.
3. Teach the patient and family the signs of affected electrolytes (i.e., sodium, potassium, magnesium).
Knowing and recognizing the following signs might help the family know when to notify a doctor:
Signs and symptoms of hyponatremia:
Signs and symptoms of hypokalemia:
Signs and symptoms of hypomagnesemia: