Patients With Fluid/Electrolyte Imbalance

Question 1

Causes of Fluid Volume Deficit

Answer 1

Hemorrhage
Vomiting
Diarrhea
Fluid Leakage: fistulas
Ileostomy
Burns
Severe wounds
NPO
Diuretic therapy
GI suction
Diabetes Insipidus
Difficulty swallowing
Fever

Question 2

Causes of FVE

Answer 2

IV fluids: too much or too fast
Blood transfusion
Failure to excrete fluids (kidney failure)
Heart failure
Obstructed lymph system
Long-term corticosteroid therapy
SIADH (syndrome of inappropriate antidiuretic hormone)

Question 3

FVD Assessment

Answer 3

Weight:
- loss
Cardiovascular:
- tachycardic
- pulses weak
- hypotension
- dizzy/lightheaded
- veins flat
Respiratory:
- RR increase
- O2 hunger
Skin:
- poor tutor and tenting
- mucous membranes dry and cracky
Neurological:
-confusion
Organs:
- kidney: urine specific grav (>1.03), dark, odor, output <500mL/day

Question 4

FVE assessment

Answer 4

Weight:
- gain
Cardiovascular:
- tachycardic
- pulse bounding
- BP elevated
- pulse pressure decreased
- central venous pressure elevated
- veins distended and engorged
Respiratory:
- RR increased
- shallow, SOB, Crackles
Skin:
- pitting edema
- pale and cool to touch
Neurological:
- altered LOC
- headache and visual changes
- muscle weakness
Organs:
- GI: increased motility
- enlarged liver

Question 5

FVD lab values

Answer 5

Elevated

Question 6

FVE lab values

Answer 6

Decreased

Question 7

FVD implementation/planning

Answer 7

Goal: prevent further fluid loss, return fluid vol to normal, and prevent complications from FVD
Replacements:
- begin within oral fluids
- IV fluids
- do not withhold fluid for incontinence
- meds: antiemetic, anti diarrheal, antipyretics, antibiotics
- monitor VS, I/Os, weights

Patient safety
- fall risks

Question 8

FVE planning/implementation

Answer 8

Restore normal fluid balance, prevent complications of FVE, and prevent future fluid overload
CRITICAL: Pulmonary edema can occur quickly and lead to death!

Priority: Patient safety
- monitor VS, lung sounds, I/Os

Drug therapy
- loop diuretics
Nutrition therapy
- restrict water and sodium
Weight
- call GCP if gain: 3lbs/week or 2lbs/day
Assess Respiratory status, CV status, and skin breakdown

Question 9

Electrolyte Values

Answer 9

Sodium (136-145)
Potassium (3.5-5)
Calcium (9-10.5)

Question 10

Common manifestations of electrolyte imbalances

Answer 10

Decreased respiratory muscle function
Changes in cardiac function
Changes in neurological function
Changes in GI motility
Decreased skeletal muscle function

Question 11

Nursing diagnosis for electrolyte imbalances

Answer 11

Sodium:
- Risk for Seizure (hypo)
- Risk for Imbalanced Fluid Volume
Potassium:
- impaired gas exchange (hypo)
Potassium and Calcium:
- Dec cardiac output (hyperkalemia and hypercalcemia)

Question 12

Hyponatremia

Answer 12

Increase sodium intake slowly
Restrict free water
If FVE: admin diuretics
If severe: admin 3% saline
If diuretics promoting sodium loss, decrease dose
SEIZURE PRECAUTIONS

Question 13

Hypernatremia

Answer 13

Provide IV fluids if caused by fluid loss
Limit sodium intake and/or increase fluid intake
Read food labels
Use salt substitutes

Question 14

Hypokalemia

Answer 14

Ask about meds (diuretics and digoxin)
Monitor respiratory status
Mild: potassium oral supplements (with food)
Severe: IV replacement, 20mEq/hr, tissue irritant

Question 15

Hyperkalemia

Answer 15

Avoid salt substitutes
Eat low potassium foods
Use K+ wasting diuretics
Give IV insulin for uptake of K+ into cells
CARDIAC MONITOR

Question 16

Hypocalcemia

Answer 16

Calcium replacement IV
Oral replacement: may interfere with absorption of other meds
High calcium diet
Injury prevention measures

Question 17

Hypercalcemia

Answer 17

Stop meds that contain or increase calcium
Encourage fluids for excretion of calcium
Diuretics such as furosemide excrete calcium
CARDIAC MONITOR