1. MODULE 11 Fluids / Electrolytes Balance Care of the Patient with Fluid & Electrolyte imbalances

2. FLUID & ELECTROLYTE IMBALANCE MANAGEMENT

3. REVIEW OF CONCEPTS  FLUID VOLUME IMBALANCES  Deficient / Excess Fluid Volume  ELECTROLYTE IMBALANCES  Hyper/hyponatremia (sodium)  Hyper/hypokalemia (potassium)  Hyper/hypocalcemia (calcium)

4. NAME THE FLUID IMBALANCE IMBALANCE #1  Hypertension  Bounding pulse  Third spacing  Decreased H&H  Moist crackles, dyspnea  EXCESS FLUID IMBALANCE #2  Decreased urine output  Weak, thready pulse  Postural hypotension  Increased H&H  Elevated urine specific gravity  DEFICIENT FLUID

5. NAME THE ELECTROLYTE IMBALANCE EXCESS  Muscle weakness  Dysrhythmias  Flaccid paralysis  Intestinal colic  HYPERKALEMIA DEFICIENCY  Muscle weakness  Dysrhythmias  Anorexia, nausea & vomiting  Increased sensitivity to digitalis  HYPOKALEMIA

6. NAME THE ELECTROLYTE IMBALANCE EXCESS  Muscle weakness  Hypo-reflexia  Bradycardia  Decreased BP  Kidney stones  Polyuria  HYPERCALCEMIA DEFICIENCY  Numbness/tingling of extremities  Hyper-reflexia/muscle cramps  Tetany / seizures  Laryngospasm  Cardiac irritability  (+) Trousseau’s & Chovostek’s  HYPOCALCEMIA

7. NAME THE ELECTROLYTE IMBALANCE EXCESS  Thirst  Dry mouth, sticky MMs  Elevated temperature  Severe: irritability, lethargy, seizures, hallucinations  HYPERNATREMIA DEFICIENCY  Weakness  Lethargy  Confusion  Muscle cramps/twitching  Seizures  HYPONATREMIA

8. A client is admitted to the hospital with a decreased serum osmolality and a serum sodium of 126 mEq/L In further assessing the client, which of the following assessments would indicate that the client has excess fluid volume? a. Distended hand and neck veins b. Decreased urine output c. Decreased capillary refill d. Increased rate and depth of respirations

9. A client with a history of severe diarrhea presents with a rapid pulse, orthostatic hypotension, urine output of 20 mL/hr, pale skin, & increased respiratory rate. In evaluating the client’s laboratory values, you would expect to see which abnormality? a. Decreased urine specific gravity b. Increased potassium c. Decreased BUN d. Increased hematocrit

10. A client with a history of severe diarrhea presents with a rapid pulse, orthostatic hypotension, urine output of 20 mL/hr, pale skin, & increased respiratory rate. Immediate interventions to correct this fluid volume imbalance includes a. Re-hydration b. Administration of a diuretic c. Administration of an anti-diarrheal d. Replacement of glucose

11. A client with a history of severe diarrhea presents with a rapid pulse, orthostatic hypotension, urine output of 20 mL/hr, cool pale skin, & increased respiratory rate. Which of the following would indicate that the client has had a negative response to fluid resuscitation? a. Increased blood pressure b. Urinary output of 40 mL/hr c. Crackles auscultated in the lung fields d. Decreased urine specific gravity

12. PUTTING IT ALL TOGETHER WHAT IS THE NURSING DIAGNOSIS/PROBLEM? WHAT IS THE ETIOLOGY OF THE PROBLEM (R/T)? WHAT ARE THE SIGNS/SYMPTOMS OF THE PROBLEM (AMB)?

13. WRITE A CLIENT OUTCOME -ACTION? -PERFORMANCE CRITERIA? - TARGET TIME?

14. NURSING INTERVENTIONS -PATIENT FOCUSED? -APPROPRIATE FOR THIS PATIENT? -HELPS TO MEET CLIENT OUTCOME? -

15. Recommended Daily Allowances - http://www.lenntech.com/recommended- daily-intake.htmhttp://www.lenntech.com/recommended- daily-intake.htm Low Sodium Foods: http://www.livestrong.com/low-sodium-foods/ High Sodium Foods: http://www.livestrong.com/article/261439-foods-high-in-sodium/ High Potassium Foods http://www.livestrong.com/article/251145-foods-that-are-high-low-in- potassium/ Low Potassium Foods http://www.livestrong.com/low-potassium-foods/

16. Low Calcium Foods http://www.livestrong.com/article/232814-low-calcium-foods / High Calcium Foods http://www.livestrong.com/foods-high-in-calcium/ Nutritional Value of Foods www.nutritionvalue.org Recommended Values Sodium: < 2300mg/day Potassium: 3500mg/day Calcium: 1000mg/day