How do you care for someone with electrolyte imbalance?

Use this nursing diagnosis guide to help you create nursing interventions and care plan for patients with electrolyte imbalance risk.

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Nursing Interventions for Risk for Electrolyte Imbalance
Recommended Resources
How would you care for a patient with fluid and electrolyte imbalance?
How do you treat electrolyte imbalance at home?
What is the best way to balance electrolytes?
What are 4 signs of an electrolyte imbalance?

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.

Nursing Assessment for Risk for Electrolyte Imbalance
Nursing Interventions for Risk for Electrolyte Imbalance
Recommended Resources
See also

The following are the subjective and objective data you need to assess for a patient with a nursing diagnosis of Risk for Electrolyte Imbalance:

Assessment	Rationale
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.
Sodium	136 to 145 mEq/L
Potassium	3.5 to 5.1 mEq/L
Chloride	98 to 107 mEq/L
Total calcium	9 to 10.5 mg/dL
Ionized calcium	4.6 to 5.1 mg/dL
Magnesium	1.8 to 3 mg/dL
Phosphate	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.
Dietary consumption	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.
Tissue trauma and wound drainage	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.
Renal dysfunction	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.
Drug therapy	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 fluid losses	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.
Endocrine dysfunction	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.
Cancer	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:

Nursing Interventions	Rationale
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.
Sodium	dill pickles tomato juices, sauces, and soups table salt
Potassium	potatoes with skin plain yogurt banana
Calcium	yogurt milk ricotta collard greens spinach kale sardines
Chloride	tomato juices, sauces, and soups lettuce olives table salt
Magnesium	halibut pumpkin seeds spinach
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.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.

How do you care for someone with electrolyte imbalance?

Nursing Interventions for Risk for Electrolyte Imbalance

Recommended Resources

See also

How would you care for a patient with fluid and electrolyte imbalance?

How do you treat electrolyte imbalance at home?

What is the best way to balance electrolytes?

What are 4 signs of an electrolyte imbalance?

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