Fluid and Electrolyte Imbalances
(Resource: Nursing Notes, ATI Pink Book, MedSurg Textbook)
1. Fluid Imbalances
a. Hypovolemia (Dehydration)
● Nursing Interventions:
○ Monitor Vital Signs: Regularly check blood pressure, heart rate, and respiratory
rate.
○ Administer Fluids: Administer IV fluids as prescribed (e.g., isotonic solutions
like normal saline or lactated Ringer’s).
○ Assess Urine Output: Monitor urine output for changes and report decreased
output.
○ Evaluate Daily Weights: Track weight changes to gauge fluid loss or gain.
○ Educate Patient: Teach about signs of dehydration and the importance of fluid
intake.
● NCLEX Tips:
○ Look for Key Symptoms: Dry mucous membranes, decreased skin turgor, and
low blood pressure are key indicators.
○ Prioritize Fluid Resuscitation: Focus on prompt fluid replacement and
monitoring.
b. Hypervolemia (Fluid Overload)
● Nursing Interventions:
○ Monitor Vital Signs: Watch for hypertension and increased respiratory rate.
○ Restrict Fluid Intake: Follow fluid restriction orders and monitor adherence.
○ Administer Diuretics: Administer diuretics as prescribed to remove excess fluid.
○ Monitor Weight: Daily weights can help track fluid retention.
○ Elevate Legs: Elevate the patient’s legs to reduce peripheral edema.
● NCLEX Tips:
○ Identify Signs of Overload: Look for edema, crackles in the lungs, and sudden
weight gain.
○ Assess for Respiratory Issues: Be vigilant about signs of pulmonary edema.
2. Electrolyte Imbalances
a. Sodium Imbalances
● Hyponatremia (Low Sodium)
○ Nursing Interventions:
■ Monitor Neurological Status: Check for confusion or seizures.
■ Administer Hypertonic Solutions: Use saline solutions (e.g., 3% NaCl)
as prescribed.
■ Restrict Fluid Intake: Manage fluid intake to prevent dilutional
hyponatremia.
■ Assess Sodium Levels: Regularly monitor serum sodium levels.
○ NCLEX Tips:
■ Focus on Neurological Symptoms: Watch for confusion and seizures.
■ Avoid Rapid Correction: Correct sodium levels gradually to prevent
central pontine myelinolysis.
■ Risk with hypertonic solutions - cerebral edema
● Hypernatremia (High Sodium)
○ Nursing Interventions:
■ Monitor for Dehydration: Check for signs of dehydration and fluid loss.
■ Administer Hypotonic Solutions: Use solutions like 0.45% NaCl to
dilute sodium levels.
■ Encourage Fluid Intake: Promote adequate fluid intake.
■ Monitor Sodium Levels: Regularly check serum sodium levels.
○ NCLEX Tips:
■ Identify Dehydration: Look for symptoms such as dry mucous
membranes and thirst.
■ Balance Fluid Intake: Ensure proper hydration and monitor sodium
levels closely.
b. Potassium Imbalances
● Hypokalemia (Low Potassium)
○ Nursing Interventions:
■ Monitor EKG: Watch for changes such as flattened T waves.
■ Administer Potassium Supplements: Provide oral or IV potassium as
prescribed.
■ Assess Muscle Strength: Monitor for muscle weakness and cramps.
■ Encourage Dietary Intake: Promote potassium-rich foods like bananas
and oranges.
○ NCLEX Tips:
■ Be Aware of Cardiac Changes: Pay attention to EKG changes and
cardiac symptoms.
■ Administer Potassium Safely: IV potassium should be administered
slowly and never as a bolus, must dilute.
■ NO P = NO K (client is not urinating, do NOT administer potassium)
● Hyperkalemia (High Potassium)
○ Nursing Interventions:
■ Monitor EKG: Look for peaked T waves and arrhythmias.
■ Administer Calcium Gluconate: To stabilize cardiac membranes.
■ Administer Insulin: To shift potassium into cells.
■ Educate on Dietary Restrictions: Advise limiting potassium-rich foods.
■ Monitor bowel sounds.
○ NCLEX Tips:
■ Focus on Cardiac Symptoms: Monitor for arrhythmias and EKG
changes.
■ Use Multiple Interventions: Combine calcium gluconate, insulin, and
diuretics if necessary.
c. Calcium Imbalances
● Hypocalcemia (Low Calcium)
○ Nursing Interventions:
■ Monitor for Tetany: Watch for signs such as muscle cramps and seizures.
■ Administer Calcium Supplements: Provide oral or IV calcium
gluconate.
■ Use Safety Precautions: Implement safety measures to prevent injury
from seizures.
■ Monitor Serum Calcium Levels: Regularly check calcium levels.
■ Monitor for orthostatic hypertension
○ NCLEX Tips:
■ Use Clinical Signs: Chvostek’s and Trousseau’s signs can indicate
hypocalcemia.
■ Ensure Safe Environment: Protect the patient from potential injury due
to tetany or seizures.
■ IV calcium must be administered slowly.
● Hypercalcemia (High Calcium)
○ Nursing Interventions:
■ Hydrate Patient: Increase fluid intake to facilitate calcium excretion.
■ Administer Diuretics: Use loop diuretics to promote calcium excretion.
■ Monitor for Kidney Stones: Watch for signs of renal calculi.
■ Educate on Symptoms: Inform about symptoms like bone pain and
constipation.
○ NCLEX Tips:
■ Recognize Symptoms: Monitor for bone pain, constipation, and
confusion.
■ Monitor Fluid Balance: Ensure adequate hydration and monitor renal
function.
d. Magnesium Imbalances
● Hypomagnesemia (Low Magnesium)
○ Nursing Interventions:
■ Monitor for Neuromuscular Symptoms: Watch for tremors and seizures.
■ Administer Magnesium Sulfate: Provide oral or IV magnesium as
prescribed.
■ Monitor Reflexes: Assess for changes in reflexes and muscle strength.
■ Educate on Dietary Intake: Encourage foods rich in magnesium like nuts
and green leafy vegetables.
○ NCLEX Tips:
■ Observe for Neuromuscular Changes: Look for tremors and seizures.
■ Administer Magnesium Safely: Monitor for signs of overdose or
toxicity. Magnesium toxicity with IV replacement and treat with calcium
gluconate.
● Hypermagnesemia (High Magnesium)
○ Nursing Interventions:
■ Monitor Vital Signs: Watch for hypotension and respiratory depression.
■ Administer Calcium Gluconate: To counteract the effects of high
magnesium.
■ Monitor Reflexes: Watch for decreased reflexes and muscle weakness.
■ Ensure Adequate Hydration: Facilitate magnesium excretion through
hydration.
○ NCLEX Tips:
■ Focus on Vital Signs: Pay attention to changes in blood pressure and
respiratory rate.
■ Use Calcium Gluconate: Administer calcium gluconate if indicated.
■ Magnesium should not be administered to clients in renal failure.
ABG Gas Interpretation
1. Understanding ABGs
● pH: 7.35-7.45
● PaCO2: 35-45 mmHg
● HCO3-: 22-26 mEq/L
2. Interpreting ABG Results: USE ROME (Respiratory Opposite, Metabolic Equal)
● Respiratory Acidosis:
○ pH: < 7.35
○ PaCO2: > 45 mmHg
○ HCO3-: Normal or slightly increased
○ Risk factors: respiratory depression, pneumothorax, airway obstruction,
inadequate ventilation
○ Nursing Interventions:
■ Improve Ventilation: Provide respiratory support if needed.
■ Monitor for Complications: Check for signs of respiratory failure.
■ Assess for Underlying Conditions: Address causes like COPD.
● Respiratory Alkalosis:
○ pH: > 7.45
○ PaCO2: < 35 mmHg
○ HCO3-: Normal or slightly decreased
○ Risk Factors: hyperventilation, hypoxemia, altitude sickness, asthma, pneumonia,
asphyxiation.
○ Nursing Interventions:
■ Reassure Patient: Provide anxiety management and education.
■ Monitor Respiratory Rate: Address hyperventilation issues.
■ Provide Support: Offer breathing exercises or paper bag breathing if
appropriate.
■ Regulate oxygen therapy.
● Metabolic Acidosis:
○ pH: < 7.35
○ PaCO2: Normal or slightly decreased
○ HCO3-: < 22 mEq/L
○ Risk Factors: DKA, dehydration, seizures, starvation, renal failure, diarrhea, fever
○ Nursing Interventions:
■ Identify Underlying Cause: Manage conditions like diabetic
ketoacidosis.
■ Administer Bicarbonate: Provide sodium bicarbonate if ordered.
■ Monitor Electrolytes: Check for concurrent electrolyte imbalances.
● Metabolic Alkalosis:
○
○
○
○
pH: > 7.45
PaCO2: Normal or slightly increased
HCO3-: > 26 mEq/L
Risk Factors: hypokalemia, GI suction, TPN, blood transfusion, prolonged
vomiting, ingestion of antacids.
○ Nursing Interventions:
■ Address Cause: Manage issues like vomiting or excessive antacid use.
■ Administer Electrolytes: Provide potassium or chloride supplements if
necessary.
■ Monitor for Symptoms: Watch for signs of hypocalcemia and
hypokalemia.
NCLEX Tips and Mnemonics
1. NCLEX Tips
● Understand the Question: Read each question carefully and identify keywords.
● Eliminate Clearly Wrong Answers: Use the process of elimination to narrow down
options.
● Prioritize Patient Safety: Focus on interventions that prioritize patient safety and
life-threatening conditions