Primary Nursing Diagnosis

Risk for injury related to neurosensory alterations secondary to hypermagnesemia

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

INTERVENTIONS. Artificial airway management; Circulation status; Electrolyte management: Hypermagnesemia; Cardiac care: Acute; Code management; Emergency care; Oxygen therapy; Medication administration; Medication management

H PLANNING AND IMPLEMENTATION Collaborative

The physician discontinues all medications that contain magnesium. The patient may be given calcium gluconate in emergencies to antagonize the effects of magnesium. If the patient does not have severe renal failure, 1000 mL of 0.9% saline with 2 g of calcium gluconate may be infused to increase magnesium excretion at a rate of 150 to 200 mL per hour. In patients with inadequate renal function, the physician may prescribe dialysis with magnesium-free dialysate. Prompt supportive therapy is essential, such as mechanical ventilation if the patient has respiratory failure or a temporary pacemaker if the patient has symptomatic bradycardia.

During treatment, monitor the serum magnesium in patients at risk for hypermagnesemia. Monitor vital signs, urine output, and the neuromuscular status, including level of consciousness, orientation, and muscle strength and function. Assess the patellar (knee-jerk) reflex in patients with a magnesium level above 5 mEq/L: With the patient lying flat or sitting on the side of the bed, support the knee and tap the patellar tendon firmly just below the patella. A normal response is extension of the knee. An absent reflex may indicate a magnesium level greater than 7 mEq/L and should be reported to the physician.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Calcium gluconate

10-20 mL IV (1-2 g)

Electrolyte replace

Antagonizes the effects of

10%

over 10 min

ment; nutritional

magnesium and counteracts

0 0

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