DSM Fluid & Electrolyte Imbalances

The nurse is instructing a group of patients on what to expect during pregnancy. Which information should the nurse include about hydration?

"A woman is most at risk for dehydration during the first trimester."

The nurse is caring for a patient with hypochloremia. Which dietary change should the nurse recommend to this patient?

"Add salt to your diet." Hypochloremia is a low serum chloride level. Interventions include adding more salt to the diet, addressing the cause of the hypochloremia, and adding chloride to IV fluids (if hospitalized).

Nursing interventions to address electrolyte imbalances are specific to the electrolyte that is out of balance, and usually involve replacing deficits or eliminating excess. General interventions include:

*Monitoring Na, K+, Cl, & Mg levels daily (monitoring more frequently if levels are significantly elevated or decreased). *Monitoring I&O as indicated by agency policy. *Observing for s/s of dehydration. *Observing for s/s of fluid & electrolyte excess or deficiency. *Providing nutritional teaching to maintain balance despite side effects of med therapy (e.g., foods high in K+ in pts receiving furosemide or thiazide diuretics). *Providing teaching for pts, teachers, coaches, and caregivers regarding early recognition of symptoms of dehydration & the need for ongoing fluid replacement. Including the need for water as well as electrolyte solutions. *Incorporating cultural or ethnic principles into nutritional teaching for patients who are at risk for fluid and electrolyte imbalance.

When caring for a patient with FVE, the nurse should be sure to include the following in the physical examination:

Checking for edema (no edema to severe pitting edema). Periorbital or scrotal edema (normal is no edema). Intake/output. Character of the pulse. Neck vein distention. Auscultation of the dependent lung fields (abnormal is crackles in the lower lobes). Accessory muscle use (normal is no accessory muscle use). Grading a pitting edema on a scale of 1 to 4, with 1 plus corresponding to 2 mm, 2 plus corresponding to 4 mm, 3 plus to 6 mm, and 4 plus to 8 mm.

An older adult patient with electrolyte imbalances is concerned about repeated episodes of dehydration. Which physiological change that contributes to electrolyte imbalances in older adult patients should the nurse explain?

Decreased thirst sensation. Older adult patients often experience a reduced sense of thirst, which makes it more likely for them to become dehydrated, because they may not drink as much water as needed. Older adult patients also tend to lose more insensible water in warm weather. *Older adults are at higher risk for electrolyte disturbances due to several physiological changes, including: Reduced glomerular filtration. Decreased ability to concentrate urine. Decreased total body water. Decreased thirst sensation. Greater insensible loss in warm weather. Reduced renin and aldosterone secretion. Increased atrial natriuretic peptide (ANP). Use of diuretics or other medications.

The nurse is caring for a patient with a fluid volume excess (FVE) secondary to heart failure. The nurse should request a collaborative therapy consult for which specialist?

Dietitian. Patients with FVE due to heart failure are advised to follow a low-sodium diet, and would benefit from a consultation with a dietitian or nutritionist to discuss the specifics. Social workers, exercise physiologists, and home care nurses are not typically required in the care of a patient with FVE

A patient with weakness and fatigue has hypotension. The patient reports having run a marathon the day before. Which health problem should the nurse suspect is occurring with this patient?

Fluid volume deficit. Fluid volume deficit is associated with lethargy, tachycardia, weakness, and tachypnea. Fluid volume excess causes rapid weight gain over a short amount of time, bounding pulse, distended neck veins, cough, and shortness of breath. *Symptoms of dehydration will vary depending on its severity. They may include: Thirst. Lethargy. Dry mucous membranes. Reduced or absent urine output. Weakness. Hypotension. Tachycardia. Tachypnea. Decreased cardiac output. If dehydration is not resolved, it will ultimately lead to coma and death.

The nurse is caring for a patient who is experiencing orthostatic hypotension secondary to fluid volume deficit (FVD). Which action by the patient requires immediate follow-up by the nurse?

Getting out of bed straight to standing. A pt c a FVD is at risk for orthostatic hypotension, dizziness, and falling. The nurse should teach the patient to get up and transition slowly from lying down to sitting to standing, instead of going straight to standing. Drinking at least 1500 mL each day, sitting in a recliner, and weighing themselves daily are all appropriate interventions for someone suffering from a FVD.

The nurse reviews information received during hand-off communication about a group of assigned patients. Which patient should the nurse closely monitor for signs of fluid volume deficit?

A 37-year-old patient with chronic diarrhea. Fluid volume deficit, or dehydration, can occur when excessive amounts of fluids are lost through diarrhea or vomiting. Kidney failure causes water retention, leading to fluid volume excess, not deficit. Water intoxication results from excessive fluid intake and also leads to fluid volume excess. Fluid volume excess can result in HTN. Excessive fluid loss from diarrhea or vomiting ar most common causes of dehydration, other causes of fluid loss include: Excessive renal loss of water and sodium.Diuretics.Renal disorders.Endocrine disorders. Water and sodium loss from sweating.Heavy exercise. Hot outdoor temp. Hemorrhage. Chronic abuse of laxatives or enemas.

The nurse is reviewing patient assignment data to begin planning care for the day. Which patient should the nurse identify as being at the greatest risk for developing fluid volume excess?

A patient w/ cirrhosis. A patient with liver cirrhosis is at greatest risk for developing fluid volume excess. Patients with nausea and vomiting, overuse of laxatives, or oral surgery are not at risk for developing fluid volume excess. Risk factors associated c excess fluid volume include: Preeclampsia in pregnancy. Heart disease. Kidney dysfunction. Diabetes and peripheral vascular disease. Hypertension. IV therapy if infusion rate and solution are not carefully monitored.

A patient in the 28th week of pregnancy is suspected of developing preeclampsia. Which potential complication should the nurse anticipate when planning care for this patient?

Heart failure. Preeclampsia during pregnancy puts a woman at risk for fluid volume excess. Without prompt tx & resolution of fluid imbalance, is at risk for developing HF due to increased workload associated c pumping excess blood volume. Fluid volume excess is not associated c dehydration, cirrhosis, or sodium imbalance. Fluid volume excess is associated with: Heart failure. Pulmonary edema. Cerebral edema. Plasma dilution causing a decreased hematocrit and BUN. Ascites. Edema and anasarca.

A patient with confusion and hyperreflexia has a serum sodium level of 162 mEq/L. The nurse should plan this patient's care based on which health problem?

Hypernatremia. The normal range of serum sodium level is from 135-145 mEq/L. A high value indicates hypernatremia. Hyponatremia is a low serum sodium level. There is insufficient information to diagnose either FVE or FVD.

The nurse is planning care for a patient with a new diagnosis of right-sided heart failure. Which teaching should the nurse make a priority for this patient?

Importance of a low-sodium diet. Sodium retention is one of the dietary-related causes of fluid volume excess (FVE) & HF. A low-Na diet is often prescribed to help manage symptoms & prevent worsening HF. Calcium & vita D supplementation do not have an effect on FVE. Fluid restriction, not an increase in intake, is usually prescribed for FVE. The importance of gentle exercise is not a priority teaching point for a patient with FVE.

Fluid replacement is necessary for children with dehydration due to diarrhea or vomiting, and is not as simple as just giving them a glass of water.

Oral rehydration solutions (ORS) such as Pedialyte are ideal. Water does not contain needed electrolytes that may be lost during diarrhea. Do not give full-strength apple juice or soda due to the risk of worsening diarrhea. Diet ORS do not contain sugar, which is necessary to promote sodium reabsorption. Start with a tablespoon of liquid at a time and progress to greater amounts as tolerated. If oral fluid replacement is not successful at replacing lost fluids and electrolytes, intravenous fluids may be necessary.

Sodium and fluid restrictions are required for a patient with FVE. This may include:

Placing allowed amounts of fluid in a small glass instead of a large one. Offering ice chips. Being aware of the water content in some fruits, vegetables, and foods (such as soup). Providing frequent mouth and oral care. Using sugarless gum to reduce thirst. Watching out for salt in nonprescription drugs (analgesics, cough medicines, antacids), toothpastes, and mouthwashes. Using salt substitutes sparingly. Using herbs, spices, lemon juice, vinegar, and wine for flavoring instead of salt. Being aware that processed foods are often high in salt.

Teaching points for a patient with fluid volume excess include:

Proper administration of prescribed meds. Fluid and sodium restrictions. Importance of following up with the healthcare provider as ordered. Sitting in the Fowler position to promote comfort and ventilation. use of diuretics. Taking daily weight. Signs that the patient needs to call the healthcare provider or go to the emergency department.

The nurse observes a new graduate nurse provide care to a patient with an elevated sodium level. For which action performed by the graduate nurse should the nurse preceptor intervene?

Provided bouillon and crackers for an afternoon snack. Administration of bouillon and crackers is not appropriate for the pt's health problem because these food items are high in sodium. Involving the pt in meal planning, teaching the pt to avoid falls secondary to dizziness, and administering IV fluids using an infusion pump are important interventions when caring for a patient with an electrolyte imbalance.

The nurse is planning care for a patient with heart failure (HF). Which physiological change should the nurse identify as causing this patient to be at risk for fluid retention?

Retention of water & sodium. Fluid volume excess results from conditions that cause retention of water & sodium. Impaired renal excretion of potassium is not related to fluid volume excess. There will be an increase in antidiuretic hormone (ADH) and aldosterone when the stress response is activated with fluid volume excess. An increase in serum osmolality, not a low serum osmolality, stimulates the thirst center, which could affect fluid volume. Fluid volume excess usually results from conditions that cause retention of sodium and water. These conditions include: Heart failure. Cirrhosis of liver. Renal failure. Adrenal gland disorders. Administration of corticosteroids. Stress conditions causing a release of ADH and aldosterone. Excessive intake of sodium-rich foods. Medications that cause sodium retention. Administration of IV fluids that contain sodium.

A young child with increasing lethargy and sleepiness is suspected of having a fluid volume deficit. Which microorganism should the nurse suspect is causing this patient's symptoms?

Rotavirus. One of the primary causes of gastroenteritis in young children is rotavirus. Children are at greater risk for developing fluid volume deficit for several reasons, including: Diarrhea due to gastroenteritis. Increased respiratory rate that causes insensible water loss. Higher risk of fever, which increases metabolic rate and water demand. Excess exercise and activity. Lack of feelings of thirst.

The mother of a 2-month-old infant is concerned that the baby is becoming dehydrated because of the number of wet diapers. Which recommendation should the nurse make to this mother?

"Continue with breast milk or formula only; it provides all of the hydration that an infant needs." Breast milk or formula should be only source of fluids for young infant. Newborns & young infants are at risk for fluid volume excess (FVE) due to immature kidneys & filtering mechanism. Extra water, even in mixed formula, or oral rehydration solutions are not necessary for an infant. A few teaching points when infants suffer from fluid loss or dehydration include the following: Water should be given slowly, sparingly, and only during extremely hot weather. Symptoms of FVE include a change in behavior and drowsiness. FVE can also be associated with serious injury or illness; it tends to occur in the pediatric intensive care unit because intervention includes the use of fluids, and balancing intake is difficult. Treatment includes limiting fluid intake and use of diuretics if the FVE is severe.

The nurse provides teaching to a patient with excess fluid volume. Which patient statement indicates the need for further teaching

"I should read food labels to note fiber content." For a pt c fluid volume excess, pt should understand importance of monitoring fluid intake to stay within fluid restrictions, monitoring weight daily & reporting significant increases to healthcare provider, and elevating the legs and feet to reduce dependent edema. The patient should read labels on food products for sodium content. Caffeinated drinks produce a diuretic effect and would not need to be reduced.

A patient with altered renal function has an elevated potassium level. Which prescription should the nurse question before administering to this patient?

Administration of a diuretic. With normal renal function, diuretics are sometimes used to treat hyperkalemia. However, they cannot be used when a pt has abnormal renal excretion. Routine electrocardiograms (ECGs) & serum electrolytes are important to monitor for worsening hyperkalemia or cardiac dysrhythmias.. Management of hyperkalemia includes: Admin of sodium polystyrene sulfonate orally or by enema. Calcium gluconate. Insulin and glucose. Diuretics in case of normal renal excretion.

The nurse is providing patient care for a young adult who presented with acute dehydration. Which assessment finding indicates poor perfusion?

Cyanosis of the nail beds. A pt with a decreased perfusion would have cyanosis of the nail beds, which indicates poor oxygenation from blood not reaching extremities. Decreased urine output & strong sense of thirst are signs of dehydration & do not necessarily indicate decreased perfusion.

The nurse is caring for a patient with severe diarrhea. Which assessment data should indicate to the nurse that additional intervention is required for this patient?

Elevated hematocrit level. An elevated hematocrit indicates dehydration caused by intravascular volume loss and hemoconcentration. When caring for a pt c dehydration, the nurse must evaluate the pt's progress toward meeting the desired outcomes. Expected outcomes include: The patient has water and electrolytes that are in balance as measured by serum electrolytes, hematocrit, and assessment findings. Urinary output is within normal limits. Fluid intake is adequate to meet maintenance needs. Vital signs are within normal limits.

A patient seeks medical attention for symptoms that are occurring since drinking large amounts of water after running a marathon. Which assessment should the nurse make a priority for this patient?

Level of consciousness. pt c water intoxication is experiencing a fluid volume excess and likely low electrolyte levels. Measuring BP, auscultating lung sounds, & assessing LOC are all priority assessments for nurse to perform. Reflexes and skin turgor are important to evaluate, because they can give information about electrolyte and fluid levels, but they are not the priority assessment. Palpating the area around the eyes, not testing for accommodation, is a priority for this patient. When treating a pt for acute fluid overload, the nurse should be prepared for interventions that include: Administering diuretics. Elevating the head of the bed. Monitoring vital signs and oxygen saturation. Administering oxygen as needed. Measuring daily weights. Accurate measuring of I&O. Instituting temporary fluid restrictions.

A patient presents with noticeable lower extremity swelling and periorbital edema. Which collaborative thearpy should the nurse anticipate?

Loop diuretic. Significant edema and periorbital edema signifies that the patient may be suffering from fluid volume excess (FVE). The nurse should anticipate the healthcare provider ordering a diuretic to help reduce extra fluid. The patient may be placed on a sodium-restricted diet, not given sodium replacement therapy. Performing an electrocardiogram (ECG) is not likely indicated except for a severe imbalance or concurrent electrolyte imbalances. Elevating the head of the bed is an independent nursing intervention, not a healthcare provider order.

The healthcare provider prescribes a patient a diuretic that inhibits sodium and chloride reabsorption in the ascending loop of Henle. For which class of diuretic should the nurse prepare teaching for this patient?

Loop. Loop diuretics inhibit Na & Cl reabsorption in ascending loop of Henle. Thiazide diuretics promote excretion of Na, Cl, K+, & water by decreasing absorption in the distal tubule. Potassium-sparing diuretics promote excretion of Na & water by inhibiting sodium-potassium exchange in distal tubule.

When taking a health history of a patient with a suspected FVD, the nurse should be sure to include:

Meds. Acute/chronic renal disease. Endocrine disorders. Drinking habits. Hot weather. Extensive exercise. Recent illness (especially accompanied by fever, vomiting & diarrhea). Onset & duration of symptoms.

The nurse is assigned to care for a patient with excess fluid volume. Which intervention in the patient's plan of care should the nurse question?

Orthostatic hypotension precautions. A pt c a fluid volume excess requires oral hygiene at least every 2 hours and measures to reduce friction or shearing to the skin. The nurse should also administer prescribed diuretics and monitor the patient's response to therapy. Orthostatic hypotension precautions are not appropriate for this patient. Nursing interventions for the pt with fluid volume excess (FVE) vary depending on the pt's specific needs and tx. However, interventions generally include: *Weighing the patient daily. *Maintaining I&O records. *Administering oral fluids carefully. *Performing oral hygiene at least every 2 hours. *Teaching the patient and significant others about a sodium-restricted diet. *Administering prescribed diuretics and monitoring the patient's response to therapy. *Reporting significant changes in serum electrolytes or osmolality.

A young child has been experiencing vomiting and diarrhea for several days. Which rehydration solution should the nurse recommend to this patient's mother?

Pedialyte. Pedialyte is an oral rehydration solution that contains both fluids and electrolytes in the correct proportions. A child who has been vomiting with diarrhea for several days needs replacement of both fluid and electrolytes. Water does not contain necessary electrolytes.

Nursing interventions for the patient with fluid volume excess (FVE) vary depending on the patient's specific needs and treatment. However, interventions generally include:

Weighing the patient daily. Maintaining I&O records. Administering oral fluids carefully. Performing oral hygiene at least every 2 hours. Teaching the patient and significant others about a sodium-restricted diet. Administering prescribed diuretics and monitoring the patient's response to therapy. Reporting significant changes in serum electrolytes or osmolality.

The nurse is providing discharge teaching for an older adult patient with a new diagnosis of heart failure. Which symptom should the nurse instruct the patient to immediately report to the healthcare provider?

Weight gain of 5 lb in a week. weight gain of 5 lb in a wk indicates that the pt is retaining fluid or experiencing fluid volume excess. This can indicate worsening cardiac function. Dry mouth and dizziness when standing are signs of dehydration, not fluid volume excess. Urine output of 320 mL per 8 hours is within the normal range.