The Patient with Fluid and Electrolyte Imbalance 1

THE PATIENT WITH FLUID AND ELECTROLYTE IMBALANCE

List the adult normal values for the following electrolytes:

1. Sodium (Na+) =

2. Potassium (K+) =

3. Chloride (Cl–) =

4. Calcium (Ca2+) =

5. Phosphate (PO4–) =

6. Magnesium (Mg2+) =

Case Study: A 36-year-old client was admitted with gastroenteritis. He has been vomiting and havingsevere diarrhea for 2 days. He is very weak. The current laboratory results are: Na+ 128 mEq/L,K+ 2.8 mEq/L, Cl– 90 mEq/L. The physician orders: IV of 0.9% NS at 100 cc/hr, NPO and I & O.

From Castillo, S.L.M. (2003): Strategies, Techniques and Approaches to Thinking (2nd ed.). Philadelphia: WB Saunders.

Pertinent Terminology Definition

Sodium (Na+)

Potassium (K+)

Chloride (Cl–)

Calcium (Ca2+)

Phosphate (PO4–)

Magnesium (Mg2+)

Third space syndrome

Edema

Pitting edema

Write in the appropriate medical terminologyfor the serum laboratory values below:

Mg2+ 3.5 mg/dl =

K+ 2.5 mEq/L =

Cl– 90 mEq/L =

Na+ 132 mEq/L =

Ca2+ 8.5 mg/dl =

PO4– 5.1 mg/dl =

2 Strategies, Techniques, and Approaches to Thinking

From the case study, identify the abnormal laboratory results. List the major clinical signs or symp-toms that you would assess with each abnormal value:

∗ =

∗ =

∗ =

Follow-up case study: The client’s vomiting and diarrhea has begun to subside in the evening and the MD has ordered a clear liquid diet. The client’s 24-hour I & O for the day is charted below:

24-Hour Intake/Output Record

IV = 2400 Emesis = 950 Oral = 120 Diarrhea = 900

Urine = 750

2520 cc 2600 cc

Based on the case study and Intake and Output Record select the most appropriate NANDA Nursing Diagnoses for the client:

Excess fluid volume Deficient fluid volume Diarrhea Impaired skin integrity Imbalanced nutrition: Less than Risk for injury body requirements

Interactive Activity: With a partner, read the case study below and write a rationale for each of thenursing interventions listed:

Case Study Nursing Interventions Rationale

Ms. M was admitted with heartfailure. The nursing diagnosis of“Fluid volume excess r/t noncompliance to dietary Na+

restriction” is listed in her NCP. Digoxin 0.25 mg qd po,Furosemide 40 mg qd po, and K-dur10 mEq po tid are her medications.

Weigh daily

Monitor I & O

Take apical pulse

Assess skin

Assess lungs

Neck veins

From Castillo, S.L.M. (2003): Strategies, Techniques and Approaches to Thinking (2nd ed.). Philadelphia: WB Saunders.