Human body cells are immersed in fluids both inside and outside the cell. The water that is inside accounts for about one-half to two-thirds of an average person’s weight. Fluid inside the cells is called intracellular fluid (ICF), and fluid outside the cells is called extracellular fluid (ECF). Intracellular fluid contains water and dissolved solutes
and proteins. The solutes are electrolytes, which plays an important role in physiologic body functions. An imbalance in fluids and electrolytes can result in excessive amounts of fluids in the body or dehydration. This can happen as a result of an alteration in body systems, chronic disease, certain medications, or an underlying illness. Nursing care plan and goals for fluid and electrolyte imbalances include: maintaining fluid volume at a functional level, patient exhibits normal laboratory values, demonstrates appropriate changes in lifestyle and behaviors including eating patterns and food quantity/quality, re-establishing and maintaining normal pattern and GI functioning. Here are ten (10) nursing care plans (NCP) and nursing diagnosis for fluid and electrolyte imbalances, more specifically: 1. Fluid Balance: Hypervolemia & Hypovolemia 2. Potassium (K) Imbalances:
Hyperkalemia and HypokalemiaNursing Care
Plans
- Risk For Electrolyte Imbalance (Hyperkalemia)
- Risk For Electrolyte Imbalance (Hypokalemia)
3. Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- Risk For Electrolyte Imbalance (Hypernatremia)
- Risk For Electrolyte Imbalance (Hyponatremia)
4. Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- Risk For Electrolyte Imbalance (Hypermagnesemia)
- Risk For Electrolyte Imbalance (Hypomagnesemia)
5. Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Risk For Electrolyte Imbalance (Hypercalcemia)
- Risk For Electrolyte Imbalance (Hypocalcemia)
4. Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
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.
- Hypomagnesium is serum magnesium levels below 1.3 mEq/L.
May be related to
- Chronic diarrhea.
- Diabetic ketoacidosis.
- Renal dysfunction.
- Treatment-related side effects of such as medications containing magnesium, dialysis with hard water, diuretic abuse.
Possibly evidenced by
- [not applicable].
Desired Outcomes
- Client will display heart rhythm, muscular strength, cognitive status and laboratory results within the normal limit for client and absence of respiratory impairment.
| 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. |
| Monitor blood pressure. | Hypotension unexplained by other causes is an early sign of magnesium toxicity. |
| Monitor heart rate and rhythm. | Bradycardia and heart block may develop, progressing to cardiac arrest as a direct result of hypermagnesemia on cardiac muscle. |
| 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. |
| 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. |
| Check patellar reflexes regularly. | Absence of these reflexes indicates magnesium levels about 7 mEq/L or greater. If untreated, cardiac and respiratory arrest can occur. |
| Encourage bed rest; assist with personal activities, as needed. | Flaccid paralysis, lethargy, and decreased mentation can reduce activity tolerance and ability. |
| Encourage increased fluid intake, if appropriate. | Increased hydration promotes excretion of magnesium, however, fluid intake must be cautious in the event of cardiac or renal failure. |
| Instruct the avoidance of magnesium-containing antacids such as Maalox, Mylanta, Riopan, and Getusil, in a client with renal disease. Caution clients with renal diseases to avoid over-the-counter drug use without discussing with the health care provider. | Limits oral intake to help avoid increased magnesium. |
| Monitor laboratory results as indicated. | Evaluate therapy needs and effectiveness. |
| Administer medications as indicated: | |
| Promotes renal clearance of magnesium if kidney function is normal. |
| Antagonize action and reverses symptoms of magnesium toxicity to improve neuromuscular function. |
| Prepare, and assist for dialysis, as needed. | Dialysis may be indicated to lower magnesium levels, in case of a presence of renal failure. |
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].
Desired Outcomes
- Client will display heart rate, rhythm, muscle strength, cognitive status, and laboratory results within normal limits for client and absence of neuromuscular irritability.
| Auscultate bowel sounds, | Decrease peristalsis and bowel function can occur as a result of muscle weakness. |
| Assess the client’s airway and swallowing. | Moderate to severe hypomagnesemia can lead to dysphagia and laryngeal stridor. |
| Monitor heart rate and rhythm; Monitor ECG changes. | Magnesium regulates sodium and potassium transport across the cell and affects the excitability of cardiac tissues. |
| Assess level of consciousness and neuromuscular strength, tone, movement, and reflexes; observe for Trousseau’s and Chvostek’s sign. | Psychosis, irritability, and confusion may occur. But, more common manifestations are muscular including hyperactive deep tendon reflexes, spasticity, generalized tetany, or muscle tremors. |
| Observe for signs of digoxin toxicity when used: reports if blurred vision, vomiting, nausea, increasing atrial dysrhythmias, and heart block. | Low magnesium may precipitate digoxin toxicity. |
Note for signs of magnesium toxicity during administration:
| Rapid, excessive administration of magnesium, may result in toxicity and life-threatening complications. |
| Encourage range-of-motion (ROM) exercises, as tolerated. | Decreases deleterious effects of muscle weakness and spasticity. |
| Teach the client on the proper use of diuretics and laxatives. | The abuse of these drugs may result in magnesium deficit. |
Provide safety and seizure precaution as indicated:
| Changes in mentation or the development of seizure activity in severe low magnesium increase the risk of client injury. |
| Place footboard or cradle on the bed. | Elevation of linens may reduce spasms. |
| Provide a quiet environment and subdued lighting | Reduces extraneous stimuli; promotes rest. |
| 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. |
| Monitor laboratory studies such as serum magnesium, potassium, and calcium levels. | Evaluates therapy needs and effectiveness. |
| Administer magnesium, as indicated: | |
| Can supplement dietary replacement. |
| 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. |
| May be given for mild deficit or in nonemergent situations. Injections should be deep IM to decrease local tissue reactions. |
4. Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.
- 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.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to endocrine system and metabolism disorders:
- Acid-Base Balance
- – Respiratory Acidosis Nursing Care Plan
- – Respiratory Alkalosis Nursing Care Plan
- – Metabolic Acidosis Nursing Care Plan
- – Metabolic Alkalosis Nursing Care Plan
- Addison’s Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 17 Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- – Fluid Balance: Hypervolemia & Hypovolemia
- – Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- – Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- – Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- – Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans
Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.