Assessment and Care of Patients with Fluid and Electrolyte Imbalances

1. Assessment and Care of Patients with Fluid and Electrolyte Imbalances

2. Sodium (135 to 145 mEq/L) • Sodium level is vital for skeletal muscle contraction, cardiac contraction, nerve impulse transmission, and normal osmolality and volume of the ECF.

3. Hypernatremia • Serum sodium level over 145 mEq/L • Nervous system changes • Skeletal muscle changes • Cardiovascular changes

4. Hypernatremia Interventions • Priorities for nursing care of the patient with hypernatremia include monitoring the patient's response to therapy and preventing hyponatremia and dehydration. • Drug therapy. • Nutrition therapy.

5. Hyponatremia • Sodium level below 135 mEq/L • Cerebral changes • Neuromuscular changes • Intestinal changes • Cardiovascular changes

6. Hyponatremia Interventions • The priority for nursing care of the patient with hyponatremia is monitoring the patient’s response to therapy and preventing hypernatremia and fluid overload. • Drug therapy. • Nutrition therapy.

7. Potassium (3.5 to 5.0 mEq/L) • Depolarization and generation of action potentials, as well as regulating protein synthesis and glucose use and storage

8. Hyperkalemia • Serum potassium greater than 5.0 mEq/L. • Cardiovascular changes are the most severe problems from hyperkalemia and are the most common cause of death in patients with hyperkalemia. • Neuromuscular changes. • Intestinal changes.

9. Hyperkalemia Interventions • Drug therapy—Kayexalate, insulin • Cardiac monitoring • Health teaching

10. Hypokalemia • Serum potassium level below 3.5 mEq/L • Can be life threatening because every body system is affected • Respiratory changes • Musculoskeletal changes • Cardiovascular changes • Neurologic changes • Intestinal changes

11. Hypokalemia Interventions • The priorities for nursing care of the patient with hypokalemia are ensuring adequate oxygenation and patient safety for falls prevention, preventing injury from potassium administration, and monitoring the patent's response to therapy. • Drug therapy. • Nutrition therapy. • Safety measures. • Respiratory monitoring.

12. Dehydration • Fluid intake is less than what is needed to meet the body’s fluid needs, resulting in a fluid volume deficit. • Consideration for older adults.

13. Collaborative Care—Dehydration • Assessment • History • Physical assessment/clinical manifestations: • Cardiovascular changes • Respiratory changes • Skin changes • Neurologic changes • Renal changes

14. Dehydration: Interventions • Patient safety • Fluid replacement • Drug therapy

15. Intravenous Solutions • Normal plasma osmolality for adults are 275 to 295 mOsm/kg: • Parenteral solutions are isotonic within that range. • Fluids greater than 295 mOsm/kg are hypertonic. • Fluids less than 275 mOsm/kg are hypotonic.

16. Hypotonic Infusate • Move water into the cells and expand them.

17. Isotonic Infusate • Water does not move into or out of the body’s cells. • Patients receiving isotonic solutions are at risk for fluid overload, especially older adults.

18. Hypertonic Infusate • Used to correct fluid, electrolyte, and acid-base imbalances by moving water out of the body’s cells and into the bloodstream. • Parenteral nutrition is an example of hypertonic infusions.

19. Administering IV Medications • Medication safety • Rapid therapeutic effect • Never assume that IV administration is the same as giving that drug by other routes • Prescribing infusion therapy

20. Local Complications of Intravenous Therapy (Peripheral) • Infiltration • Extravasation • Phlebitis and post-infusion phlebitis • Thrombosis • Thrombophlebitis • Ecchymosis and hematoma • Site infection • Venous spasm • Nerve damage

21. Potential Complications of CVADS • Catheter embolism • Catheter occlusion • Catheter-related infection • Pneumothorax • Catheter migration