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?