NR 324 Week 1 Altered Fluid and Electrolyte Balance

NR 324 Week 1 Altered Fluid and Electrolyte Balance

Student Name

Chamberlain University

NR-324 Adult Health I

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Date

Altered Fluid and Electrolyte Balance in Nursing Care

Nursing Management for Altered Fluid Balance

A client presenting with heart failure was admitted to the emergency department with shortness of breath. Upon assessment, the nurse identified clinical indicators suggestive of fluid overload. Based on these findings, several nursing diagnoses were established, including ineffective breathing pattern, ineffective coping, powerlessness, decreased cardiac output, and fluid volume excess. Interventions were tailored to address these specific needs. For managing fluid overload, furosemide—a potent loop diuretic—is typically administered to facilitate fluid excretion and minimize complications related to excess fluid volume.

Pharmacological Impacts on Fluid Volume

The control of fluid volume excess frequently involves diuretic therapy. Furosemide is particularly effective in stimulating diuresis to eliminate accumulated fluids. Other medications such as tamsulosin, metoprolol, and verapamil may be used concurrently to manage related cardiovascular conditions, but they do not directly address fluid overload. Diagnostic evaluations, including serum osmolality, CMP, and CBC, are instrumental in assessing fluid balance and guiding treatment decisions.

Role of Diagnostic Testing in Fluid Imbalance

Evaluating a patient’s fluid status requires comprehensive diagnostic assessments. Key tests include CBC, CMP, echocardiography, and chest X-rays. These tools help determine the extent of fluid retention and guide ongoing management. Notably, clinical signs such as pulmonary crackles must be monitored vigilantly, as they may indicate worsening fluid accumulation. Furthermore, potassium levels should be checked regularly, especially in patients on diuretics, due to the risk of hypokalemia.

Table 1: Nursing Interventions for Altered Fluid Balance

Table 2: Diagnostic Tests for Fluid Imbalance

Table 3: Key Findings in Fluid Volume Overload

Therapeutic Interventions for Electrolyte and Fluid Excess

Pharmacologic and Nursing Actions

Albumin is administered to draw fluid into the vascular space from the interstitial compartment, thereby improving circulation and promoting diuresis when used with diuretics. Conditions like liver cirrhosis and heart failure commonly involve fluid overload, and medications such as Bumetanide are used to augment urinary output. These interventions help manage symptoms like ascites and pulmonary congestion.

Scenario: Dyspnea and Peripheral Edema

A patient presents with shortness of breath and leg swelling, persisting for two weeks. The spouse reports a decline in the patient’s mobility. Upon arrival, the client is disoriented and diaphoretic. Given the vital signs—tachycardia, tachypnea, hypertension, and O2 saturation at 88%—immediate measures include halting hypertonic saline infusions, initiating respiratory support, and contacting the physician.

Clinical Decision-Making and Delegation

In another example, a client with hepatic cirrhosis and increasing abdominal girth experiences respiratory distress. Vital signs show low oxygen saturation and tachycardia. The RN should administer IV albumin and Bumetanide, initiate oxygen, and track daily weight and abdominal girth. Skin turgor must also be assessed to identify dehydration.

Table: Delegated Nursing Tasks

Pathophysiology and Presentations of Fluid Volume Excess

Conditions Contributing to Volume Overload

Several health issues can cause fluid volume overload, such as SIADH, hyperaldosteronism, and excessive IV fluid administration. Nurses must monitor at-risk patients closely, particularly those with cardiac, renal, or hepatic dysfunction.

Table: Clinical Signs and Management

Delegation and Electrolyte Disturbances

Mary’s potassium level of 5.7 mEq/L requires specific interventions. Tasks like administering spironolactone and sodium polystyrene sulfonate can be delegated to an LPN. However, critical interventions—such as ECG analysis or potassium chloride administration—should remain with the RN.

Client Education and Medication Interactions

When educating clients like Mary, misconceptions about salt substitutes must be corrected. Since spironolactone is potassium-sparing, using potassium-containing salt substitutes could raise potassium levels dangerously high.

Risk Diagnosis for Potassium Imbalance

For a client such as Arthur, who has abnormal potassium levels, the highest priority diagnosis is the risk for decreased cardiac output. Given potassium’s role in cardiac rhythm, continuous monitoring is essential.

Monitoring and Treating Hypokalemia

Clients with low potassium receiving digoxin should be observed for signs of toxicity. Symptoms like bradycardia and visual disturbances necessitate urgent intervention. Oral potassium should be given with water, avoiding crushing unless indicated.

Delegated Responsibilities

Magnesium Imbalance and Electrolyte Interactions

Clients at risk for hypomagnesemia, including those with malabsorption syndromes, may exhibit positive Chvostek’s signs and bradycardia. Nurses should monitor both potassium and calcium levels due to their interrelated dynamics. Administering potassium with water aids absorption, and agitation from imbalances should be addressed with reassurance and safety precautions.

Clinical Deterioration and Prioritization

In a report from UAP, Ms. Smyth shows confusion, tachycardia, and discomfort. The RN should prioritize assessing lower extremity circulation, evaluating pain, and reorienting the client to prevent further deterioration.

Respiratory Alkalosis: Assessment and Management

Anxiety-induced hyperventilation can cause respiratory alkalosis. In clients like Liam, with elevated pH and low CO2, anxiety is the primary trigger. Nurses should teach breathing control and coping strategies.

Respiratory Acidosis in Chronic Illness

Damien, a COPD patient with pneumonia, exhibits respiratory acidosis, shown by high CO2 and low SaO2. Interventions include ABG monitoring, incentive spirometry, and respiratory assessments.

Interpreting ABGs and Alkalosis

A patient with a pH of 7.35, PaCO2 of 72, and HCO3 of 38 has fully compensated respiratory acidosis. ABG interpretation helps differentiate from other acid-base imbalances and guide treatment.

Case Review: Carole and Metabolic Alkalosis

Carole presents with weakness and cramping due to excessive diuretic use. ABG results confirm metabolic alkalosis. Interventions focus on potassium replacement and lab monitoring.

Table: Causes of Metabolic Alkalosis

Prioritized Actions

Carole’s care requires prioritizing potassium replacement and continuous monitoring of ABGs and electrolyte levels to correct alkalosis and prevent cardiac complications.

References

American Association of Critical-Care Nurses (AACN). (2020). Arterial blood gas (ABG) analysis for critical care nurses.

American Heart Association (AHA). (2021). Metabolic alkalosis: Causes, symptoms, diagnosis, and treatment.

Smith, J., & Johnson, L. (2022). Understanding acid-base imbalances: A clinical guide. Nursing Journal, 36(2), 23–29.

NR 324 Week 1 Altered Fluid and Electrolyte Balance

NR 324 Week 1 Altered Fluid and Electrolyte Balance.