Alterations in Fluid and
Electrolyte balance
Undersupervision: Mr. Hossam.
Presented by: GA1
Scenario 1
Sylvia Burns is an 84-year-old widow whose
daughter brings her to the emergency room
with an alteration in mental status. – PMHx:
“heart failure, blood pressure, heart attack” –
Meds: “water pill and two heart pills – one for
my blood pressure” – Daughter states: “My
mother doesn’t want to get out of bed. She is
sleepy and she seems confused.” – What else
would you like to know?
Physical exam:
 Neurological: Lethargic, oriented to person and place not to time; slow to respond to questions, seems
confused about recent events, PERRL, equal strength in
all four extremities but with generalized weakness.
 Cardiovascular: Bp 92/64; HR 112 and irregular;
Peripheral pulses palpable but weak; EKG shows ST with
frequent PAC’s; skin warm/dry; neck veins flat.
 Respiratory: lungs clear to auscultation; respirations
12/min and shallow; SAO2 96% on RA – Integumentary:
Skin turgor poor; mucus membranes dry.
Labs & ABG’s
 Na+ 141 mEq/L
 K+ 2.5 mEq/L
 CL 85 mEq/L
 CO2 38 mEq/L
 BUN 42 mg/dl
 Hct 49%
 PH (7.52), PaCO2 (55 mm Hg) PaO2 (88 mm Hg) HCO3
(42 mEq/L)
What is your analysis?
What physical assessment findings support your
analysis? Confusion, tachycardia, irregular
What labs support your analysis? Hypokalmia,
increased PH, increased Hco3.
What is the most likely etiology of the fluid and
electrolyte imbalances? Burn in the emergent
phase.
Analyze the ABG’s
What is the etiology of the primary imbalance?
Burn, Diuretics medication
Is the body compensating?
There is compensated as the Paco2 increased
and there is shallow breathing.
Discuss the ECG changes.
What is the etiology?
What concerns do you have?
Develop a problem list.
Include potential complications.
cardiac arrhythmias.
acute respiratory failure.
Dehydration.
Contractures.
Hypovolemic shock.
More questions:
Why has Sylvia’s advanced age placed her at risk
for her fluid imbalance?
older adults are risk to dehydration and electrolyte
imbalances than younger adults as the kidneys may
lose some of their function with age. Older adults may
take multiple medications, such as diuretics, which
cause changes to the electrolyte levels. also, in the
older people their skin elasticity decreased and if the
pt. develop burns it will affect them.
Discuss the role of aldosterone in the regulation
of fluid and electrolyte balance.
How will changes in aldosterone affect Sylvia’s
fluid and electrolyte imbalances?
Aldosterone regulates the Na& K balance as it causes
sodium to be absorbed and potassium to be excreted as
when the aldosterone increase it will lead to increase the
sodium level and when the sodium increases, the
potassium will decrease in the kidney tubules.
Interventions:
What interprofessional therapeutic interventions
will you prepare for?
What type of fluids should she receive?
Isotonic solution
How will you administer them?
Intravenous.
What should be included in the nursing
management?
Assess patient for clinical manifestations of fluid
and electrolyte disturbances.
Determine whether ordered IV therapies are still
appropriate based on monitoring of patient
hydration and electrolyte levels.
 Choose and insert appropriate IV catheters and
infusion devices.
Administer IV fluids and medications to unstable
and critically ill patients.
Evaluate patient for clinical manifestations of
fluid overload or hypovolemia and initiate
appropriate changes in IV fluids.
Plan of care:
Develop a plan of care for Sylvia while she is in the
hospital.
What daily assessments should be included in this plan
of care?
Daily weight
I&O
S&S for fluid overload
Assess for edema
Mental status
Monitor urine output hourly
How will you evaluate your plan of care?