Primary Nursing Diagnosis

Risk for injury related to muscle weakness, unstable gait

OUTCOMES. Cardiac pump effectiveness; Circulation status; Electrolyte and acid-base balance; Knowledge: Medication; Respiratory status: Ventilation and gas exchange

INTERVENTIONS. Electrolyte management: Hypomagnesemia; Intravenous therapy; Cardiac care: Acute; Emergency care; Medication administration; Medication management

H PLANNING AND IMPLEMENTATION Collaborative

If the levels are severely low, the patient needs intravenous (IV) or intramuscular magnesium replacement with magnesium sulfate (MgSO4). Calcium gluconate may be administered with IV magnesium replacement therapy to reduce the risk of sudden reversal to hypermagnesemia. If the patient does not suffer from chronic malabsorption requiring total parenteral nutrition, an increase in dietary intake of magnesium is prescribed. Foods high in magnesium include bananas, chocolate, green leafy vegetables, grapefruit, oranges, nuts, seafood, soy flour, and wheat bran.

Monitor for signs of hypermagnesemia during IV infusions. These symptoms include hypotension, labored respirations, and diminished or absent patellar reflex (knee jerk). If any of these symptoms occurs, stop the infusion and notify the physician immediately. If hypokalemia occurs simultaneously with hypomagnesemia, the magnesium level should be corrected first because magnesium is necessary for the movement of potassium into the cell. Be aware that hypomagnesemia may precipitate digitalis toxicity by enhancing the effects of digitalis, which places the patient at increased risk for digitalis-induced atrial and ventricular dysrhythmias and Mobitz type I atrioventricular (AV) block (Wenckebach). Alkalosis should be avoided or corrected because this condition may precipitate tetany.

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