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.
Attention: This nursing diagnosis has been renamed.
Nursing diagnoses are revised, added, or retired by the NANDA International Diagnosis Development Committee (DDC) to coincide with shifts in language standardization. “Risk for Electrolyte Imbalance” has been replaced with “Risk for Impaired Water-Electrolyte Balance”. Students and seasoned nurses alike may be unfamiliar with this change, and thus we have chosen to continue to use the diagnostic label “Risk for Electrolyte Imbalance” in this article until the recent relabeling receives wider adoption.
In this article:
- Risk Factors (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Risk Factors (Related to)
Several factors can contribute to electrolyte abnormalities. Some of the potential risk factors and causes include:
- Vomiting
- Diarrhea
- Excessive or insufficient fluid volume
- Other medical conditions (i.e. renal failure, congestive heart failure, hypothyroidism)
- Medications (i.e. diuretics)
- Malnutrition
- Surgery
- Chemotherapy
Signs and Symptoms (As evidenced by)
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.
Hyperkalemia
- Muscle weakness
- Nausea
- Life threatening cardiac dysrhythmias
Hypokalemia
- Muscle weakness and muscle spasms
- Tingling, numbness
- Fatigue
- Light-headedness
- Palpitations
- Constipation
- Severe cases can cause cardiac arrest
Read more on hyperkalemia & hypokalemia.
Hypercalcemia
- Thirst
- Renal stones
- Anorexia
- Urinary frequency
- Confusion
- Abdominal pain
- Fatigue
- Lethargy
- Nausea and vomiting
Hypocalcemia (can be very mild to severe)
- Muscle pains
- Paresthesias
- Seizures
- Bronchospasm
- Life threatening cardiac arrhythmias
Read more on hypercalcemia & hypocalcemia.
Hypermagnesemia
- Nausea and vomiting
- Respiratory distress
- Muscle weakness
- Cardiac arrhythmias
- Headache
- Flushing
- Constipation
- Hypotension
Hypomagnesemia
- Muscle weakness and spasms
- Cramps
- Tetany
- Tremor
- Fatigue
Hyperphosphatemia
- Muscle spasms and cramping
- Weakness
- Itching
Hypophosphatemia
- Cardiac arrhythmias
- Muscle and bone pain
- Numbness
- Seizures
- Respiratory distress
- Irritability
- Confusion
Hyperchloremia
- Thirst
- Pitting edema
- Dehydration
- Vomiting and/or diarrhea
- Respiratory distress
- Confusion
Hypochloremia
- Dehydration
- Hyponatremia
- Nausea and vomiting
- Respiratory distress
- Muscle weakness
- Diaphoresis
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for risk for electrolyte imbalance:
- Patient will maintain normal electrolyte levels (serum potassium, sodium, calcium, magnesium, and phosphorus).
- Patient will maintain normal fluid balance.
- Patient will maintain adequate hydration.
- Patient will maintain normal kidney function.
- Patient will maintain normal sinus rhythm.
- Patient will have decrease/absent edema.
- Patient will verbalize understanding of nutritional status and ways to maintain normal electrolyte levels.
Nursing Assessment
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
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
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.
Care Plan #1
Diagnostic statement:
Risk for electrolyte imbalance as evidenced by renal dysfunction.
Expected outcomes:
- Patient will show laboratory results within the normal range.
- Patient will engage in lifestyle modifications to prevent complications of renal dysfunction.
Assessment:
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.
Interventions:
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.
Care Plan #2
Diagnostic statement:
Risk for electrolyte imbalance as evidenced by multiple drains.
Expected outcomes:
- Patient will display normal serum electrolyte results.
- Patient will be free of complications caused by electrolyte disturbances.
Assessment:
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.
Interventions:
1. Teach patients about the care of multiple drains.
The following strategies help to prevent infection and dehiscences:
- Make sure the drain is always compressed.
- Clip the drain to your clothing to avoid pulling on the drain stitches.
- Milk the tubes at least three times a day to keep the tubes from clumping. Start at the end closest to your body and bring your fingers toward the drain.
- Empty the drain once a day or as needed. Don’t forget to wash your hands first before measuring the drain output. Touch the outside of the spout.
- Shower daily and gently clean the skin around the drain.
- Check the skin for redness, swelling, pain, or a pus-like discharge around the tube. Call your doctor right away if you notice any of these signs.
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:
- Nausea or vomiting
- Headache, confusion, or fatigue
- Low blood pressure
- Muscle weakness or cramps
- Lethargy
- Confusion
Signs and symptoms of hypokalemia:
- Weakness
- Feeling tired
- Muscle cramps
- Confusion
- Constipation
- Dysrhythmia
- Tingling or numbness
Signs and symptoms of hypomagnesemia:
- Hyperactive reflexes
- Nausea
- Tremors
- Tetany
- Abnormal eye movements
- Fatigue and weakness
Care Plan #3
Diagnostic statement:
Risk for electrolyte imbalance as evidenced by diuretic use.
Expected outcomes:
- Patient will exhibit normal results of serum electrolytes.
- Patient will demonstrate proper diuretic use.
Assessment:
1. Evaluate the use of diuretics.
Assessing how the patient takes the diuretics will determine the practices that need to be corrected.
2. Review medications.
The type of diuretics will give information on the electrolyte imbalance the patient is at risk for. Potassium-sparing diuretics can cause hyperkalemia. Loop diuretics an cause hyponatremia, hypokalemia, hypochloremia, hypomagnesemia.
3. Monitor laboratory results for abnormal findings.
Laboratory findings of serum electrolytes guide therapy.
Interventions:
1. Administer balanced electrolyte IV solutions as prescribed.
Lactated Ringer’s solution electrolyte content mimics to that of the extracellular environment. Extended use of isotonic saline may contribute to hypernatremia. Excessive use of sodium-free IV solutions puts the patient at risk for hyponatremia.
2. Administer electrolyte replacements as ordered.
Oral or IV administration of electrolytes may be administered to maintain electrolyte balance for electrolyte imbalances are present.
3. Teach the patient about dietary sources of electrolytes.
A balanced diet provides the patient with good sources of electrolytes.
4. Teach the patient about any medications prescribed.
Medication teaching includes the drug name, its purpose, administration instructions, such as taking it with or without food, and any side effects to be aware of. Diuretic use remains a primary cause of low serum potassium levels, especially if not taken cautiously as instructed.
5. Teach about the signs of electrolyte disturbances and the risk factors.
Understanding risk factors such as improper use of diuretics will help prevent electrolyte imbalances. Early detection leads to prompt treatment.
References
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- American Heart Association. (2005). Part 10.1: Life-threatening electrolyte abnormalities. Circulation 112 (24). https://doi.org/10.1161/CIRCULATIONAHA.105.166563
- Bindroo, S., Quintanilla-Rodriguez, B.S.,& Challa, H.J. (2022). Renal failure. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK519012/
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- Cleveland Clinic. (2018). Surgical drain care instructions. https://my.clevelandclinic.org/health/treatments/15199-surgical-drain-care-instructions
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- Murdeshwar, H.N.& Anjum, F. (2023). Hemodialysis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK563296/
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