THE PATIENT WITH FLUID AND ELECTROLYTE IMBALANCE

List the adult normal values for the following electrolytes:

1. Sodium (Na+) = ___________________________

2. Potassium (K+) =__________________________

3. Chloride (Cl−) =___________________________

4. Calcium (Ca++) =__________________________

5. Phosphate (PO4−) =________________________

6. Magnesium (Mg++) =_______________________

Case Study: A 36-year-old client was admitted with gastroenteritis. He has been vomiting and having severe diarrhea for 2 days. He is very weak.
The current laboratory results are Na+ 128 mEq/L, K+ 2.8 mEq/L, Cl− 90 mEq/L. The physician orders IV of 0.9% normal saline solution at 100
mL/hr, NPO, and I & O.

Pertinent Terminology: Define these terms

Sodium (Na+) ___________________________________________________________________________________________________________

Potassium (K+) __________________________________________________________________________________________________________

Chloride (Cl−) ___________________________________________________________________________________________________________

Calcium (Ca++) __________________________________________________________________________________________________________

Phosphate (PO4−) ________________________________________________________________________________________________________

Magnesium (Mg++) _______________________________________________________________________________________________________

Third space syndrome ____________________________________________________________________________________________________

Edema _________________________________________________________________________________________________________________

Pitting edema ___________________________________________________________________________________________________________

From the case study, identify the abnormal laboratory results. List the major clinical signs or symptoms that you would assess with each
abnormal value:

Follow-up case study: The client's vomiting and diarrhea has begun to subside in the evening and the MD has ordered a clear liquid diet. The client's
24-hour I & O for the day is charted below: 24-Hour Intake/Output Record
On the basis of the case study and Intake and Output Record, select the most appropriate NANDA nursing diagnoses for the client:

_____ Excess fluid volume

_____ Deficient fluid volume
_____ Diarrhea
_____ Impaired skin integrity
_____ Imbalanced nutrition: Less than body requirements
_____ Risk for injury

Interactive Activity: With a partner, read the case study below and write a rationale for each of the nursing interventions listed:

Case Study Nursing Interventions Rationale

Ms. M was admitted with heart failure.
The nursing diagnosis of “Fluid volume Weigh daily
excess r/t noncompliance to dietary Na+
restriction” is listed in her NCP.
Digoxin 0.25 mg qAM po, furosemide Monitor I & O
40 mg qAM po, and K-dur 10 mEq po
tid are her medications.
Take apical pulse

Assess skin

Assess lungs

✓ Neck veins