Discharge And Home Healthcare Guidelines

PREVENTION. To prevent a recurrence of hypermagnesemia, teach the patient to avoid sources of magnesium such as laxatives, antacids, and vitamin-mineral supplements and to consult with the pharmacist or physician before using any over-the-counter medications. The patient should also be taught the signs and symptoms of hypermagnesemia (changes in level of consciousness, neuromuscular weakness, nausea and vomiting) and instructed to notify the physician if these return.

COMPLICATIONS OF NEUROMUSCULAR WEAKNESS. If the patient suffered from prolonged neuromuscular symptoms, he or she may have developed muscle weakness as a result of disease. Teach safety measures to the patient and significant others, including the use of any assistive devices (cane or walker) and seeking assistance when ambulating. The patient should also be taught muscle-strengthening exercises and may need a home care evaluation before being discharged.

Hypernatremia DRG Category: 296

Mean LOS: 5.4 days Description: MEDICAL: Nutritional and

Miscellaneous Metabolic Disorders, Age > 17 with CC

I I ypernatremia is a condition in which the serum sodium concentration is greater than 145 mEq/L (normal range is 136 to 145 mEq/L). Sodium is the most abundant cation in the body; a 70-kg person has approximately 4200 mEq of sodium. About 30% of the total body sodium, called silent sodium, is bound with bone and other tissues; the remaining 70%, called the exchangeable sodium, is dissolved in the extracellular fluid (ECF) compartment or in the compartments in communication with the ECF compartment. Sodium has five essential functions: It maintains the osmolality of the ECF; it maintains ECF volume and water distribution; it affects the concentration, excretion, and absorption of other electrolytes, particularly potassium and chloride; it combines with other ions to maintain acid-base balance; and it is essential for impulse transmission of nerve and muscle fibers.

Hypernatremia is a fairly rare electrolyte imbalance that occurs in less than 1% of all hospital admissions and is unusual in patients who are awake, are alert, and have an intact thirst response. When it does occur, mortality may be as high as 50%. Hypernatremia usually occurs when there is an excess of sodium in relation to water in the ECF compartment, resulting in hyperosmolarity of the ECF, which produces a shift in water from the cells to the ECF. The result is cellular dehydration. Three different manifestations of hypernatremia have been described,

TABLE 5 Types and Causes of Hypernatremia

Constipation Prescription

Constipation Prescription

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