Fluid and Electrolyte Management Quiz

Care for the Person with Basic Fluid and Electrolyte Needs

• Basic Fluid & Electrolyte Health Needs: This is a topic about caring for patients with basic fluid and electrolyte needs.
• Exemplars and NCLEX Client Needs: Exemplars for fluids include fluid volume deficit, fluid excess, and electrolyte imbalances like hypo/hyper-sodium, chloride, and potassium. These are categorized under physiological integrity, physiological adaptation, basic care, and comfort. Other categories include potential pharmacological and parenteral therapies, safe and effective care environment, management of care, safety and infection control, health promotion, and psychosocial integrity.
• Curriculum Threads: Clinical judgment, communication, quality improvement, health outcomes, legal/ethical collaboration, evidence-based practice, nursing process, and informatics are key curriculum threads.
• Course Outcomes: Four main outcomes include applying clinical reasoning for patient-centered care, applying interprofessional collaboration, implementing the nursing process to achieve patient outcomes, and demonstrating professional core values.
• Homeostasis: Kidneys maintain fluid and electrolyte balance, retaining and excreting liquids and electrolytes in response to hormones like aldosterone and ADH. Cardiovascular system circulates blood to kidneys, producing urine. Lungs maintain balance through insensible fluid loss and regulating CO2 affecting acid-base. Pituitary regulates fluids and electrolytes via ADH, increasing reabsorption for fluid retention.
• Pathophysiology of Fluid Imbalance: Key aspects are osmosis—fluid movement from low concentration to high, osmolality—osmotic pressure relating to solute/kg solvent, and osmolarity—osmotic pressure relating to solute/L of solvent.
• Tonicity: The ability of a solution to cause osmotic water movement. Hypotonic solutions cause movement into cells, while hypertonic solutions cause it out. Isotonic solutions have similar concentrations, causing no net movement.
• Fluid Volume Deficit (FVD): Causes include inadequate replacement, poor oral intake, certain medical conditions (CVA, dementia), inadequate IV fluids, and excessive losses (GI, vomiting, diarrhea, or other situations).
• Nursing Process & Clinical Judgment: The student must learn how to assess patients, discover clues regarding the patient's condition, analyze their findings to formulate a hypothesis, and how to then develop a conclusion based on the gathered evidence.
• Assessment for FVD: Blood pressure (orthostatic), heart rate (rapid thread pulse), respirations, urine output and specific gravity are important. Also important is assessment of mental status, skin color and turgor, capillary refill, weight, input and output, serum electrolytes, increased thirst, and cool clammy skin. General Considerations for geriatric patients include that skin turgor and thirst drive are not reliable indicators for older adults over 65.
• Nursing Diagnosis & Planning: PES format (problem, etiology, signs/symptoms) is used to formulate the plan of care related to type of dehydration and required safety measures to achieve health outcomes.
• Implementation and Taking Action for FVD: Minimize fluid loss, use oral/IV fluids, and monitor complications. Important considerations include the tonicity of fluids provided (isotonic, hypotonic, hypertonic). The use of various fluids should also consider collaboration with healthcare providers to determine appropriate treatment for patients.
• Evaluation of Outcomes: Monitor fluid intake and output, vital signs (BP, HR, RR), physical assessment findings (edema, lung sounds, mental status), electrolyte levels, and complications.
• Fluid Volume Excess (FVE): Causes include impaired regulatory mechanisms, renal failure, heart/liver failure, high sodium intake (oral or IV), increased cortisol, prolonged steroid therapy, severe stress, and hyperaldosteronism.
• Assessment for FVE: Important features include vital signs (BP, HR, RR), physical assessment (edema, lung sounds, weight), laboratory tests (electrolytes, ABG), and ongoing monitoring of potential complications.
• Sodium and Chloride Imbalance: Sodium range is 135-145 mEq/L. Chloride range is 96-106 mEq/L. This section addresses the control, causes, and treatment for imbalances of these electrolytes.
• Potassium Imbalance: Potassium is a major intracellular electrolyte (98% inside cells) and thus crucial for neuromuscular and cardiac function. It is regulated by the sodium-potassium pump. Minor imbalances can impact health. Considerations include signs, causing factors (medications and other issues), and assessment methods to evaluate these imbalances.
• Hypokalemia and Hyperkalemia: The causes and symptoms of low and high potassium are addressed with emphasis on their detrimental effects on other body systems.
• Nursing Management: Understanding and managing fluid and electrolyte imbalances in the clinical setting is a key topic. The role of safety and potential psychosocial implications that may affect care are also addressed.
• Diverse client needs and considerations in care: How diversity affects care for the person is a key topic.
• Evaluation of outcomes: The evaluation of outcomes for fluid, electrolytes, and their related imbalances are explained. This includes monitoring serum electrolytes, ABGs, input and output, vital signs, and assessing for neurologic issues, always maintaining safety of the patient.

Additional Topics (from fragmented text)

• Nursing Diagnosis, Planning, Implementation, Evaluation, and Generate Solutions are highlighted as important parts of patient care