___________________________________________________________ Chapter 14 Fluids and Electrolytes 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 39
• The severity of the symptoms in fluid volume excess depends on how quickly the
Fluid Imbalances (cont.)
• Excess fluid volume
• An increase in body water
• Extracellular fluid excess
TALKING POINTS:
9
Age-Related Changes Affecting Fluid Balance
• Aging kidney slower to adjust to changes in acid-base, fluid, and electrolyte balances
Age-Related Changes Affecting Fluid Balance (cont.)
• Older person has limited reserves to maintain fluid balance when abnormal losses occur
• Antihypertensives, diuretics, and antacids can also contribute to imbalances
TALKING POINTS:
• What symptoms may occur in the older adult with fluid imbalances?
• Chronic conditions that affect mobility or mental status may interfere with adequate fluid
intake.
6
&
8
Slide 42
• Disorders that put the patient at risk for hyponatremia include congestive heart failure,
Hyponatremia
• Lower than normal sodium in the blood serum
• Can be actual deficiency of sodium or increase in body water that dilutes the sodium
excessively
• Assessment
• Symptoms: headache, muscle weakness, fatigue, apathy, confusion, abdominal
TALKING POINTS:
18 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 43
Hyponatremia (cont.)
• Medical treatment
• The usual treatment is restriction of fluids while the kidneys excrete excess water
• Diuretic: furosemide (Lasix)
TALKING POINTS:
Hypernatremia
• Higher than normal concentration of sodium in the blood
• Very serious imbalance; can lead to death if not corrected
TALKING POINTS:
• What are some causes of hypernatremia?
Slide 45
Hypernatremia (cont.)
• Medical treatment
• Oral or IV replacement of water to restore balance
• A low-sodium diet often prescribed
TALKING POINTS:
• What foods should be avoided for a patient on a low-sodium diet?
Slide 46
Hypokalemia
• Low serum potassium
• May result in gastrointestinal, renal, cardiovascular, and neurologic disturbances
• Can cause abnormal, potentially fatal, heart rhythm
• Signs and symptoms
TALKING POINTS:
___________________________________________________________ Chapter 14 Fluids and Electrolytes 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 47
Hypokalemia (cont.)
• Medical treatment
• Potassium replacement by the IV or oral route
• Nursing care
• Monitoring at-risk patients for decreased bowel sounds, a weak and irregular pulse,
decreased reflexes, and decreased muscle tone
Slide 48
Hypokalemia (cont.)
• High serum potassium
• Patients at risk: decreased renal function, in metabolic acidosis, taking potassium
supplements
TALKING POINTS:
• Potassium is plentiful in common foods, so it is easy for people on normal diets to take in
adequate amounts.
• How can traumatic injuries cause hyperkalemia?
Slide 49
Hypokalemia (cont.)
• Medical treatment
• Correct the underlying cause
• Restrict potassium intake
• Polystyrene sulfonate (Kayexalate)
TALKING POINTS:
• Temporary effects may be obtained by the intravenous administration of insulin and
Slide 50
Chloride Imbalance
• Usually bound to other electrolytes; therefore, chloride imbalances accompany other
electrolyte imbalances
• Hyperchloremia
20 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 51
Calcium Imbalance
• Regulated by the parathyroid glands
• Hypocalcemia results from diarrhea, inadequate dietary intake of calcium or vitamin D,
and multiple blood transfusions (banked blood contains citrates that bind to calcium), in
Magnesium Imbalance
• Hypomagnesemia: decreased gastrointestinal absorption or excessive gastrointestinal
10,
11,
&
Slide 53
Respiratory Acidosis
• Respiratory system fails to eliminate the appropriate amount of carbon dioxide to
maintain the normal acid-base balance
TALKING POINTS:
Respiratory Acidosis (cont.)
• Nursing care
• Assess PaCO2 levels in the arterial blood
TALKING POINTS:
• PaCO2 directly reflects the degree of respiratory dysfunction.
___________________________________________________________ Chapter 14 Fluids and Electrolytes 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 55
Respiratory Alkalosis
• Low PaCO2 with a resultant rise in pH
• Most common cause of respiratory alkalosis is hyperventilation
• Medical treatment
TALKING POINTS:
• What aspect of the respirations is a key observation for a patient with respiratory
alkalosis?
Respiratory Alkalosis (cont.)
• Nursing care
• Intervention
• Encourage patient to breathe slowly, which will retain carbon dioxide in the body
Slide 57
• Medical treatment: treat the underlying disorder
Metabolic Acidosis
• Body retains too many hydrogen ions or loses too many bicarbonate ions; with too much
acid and too little base, blood pH falls
• Causes are starvation, dehydration, diarrhea, shock, renal failure, and diabetic
ketoacidosis
TALKING POINTS:
• Signs and symptoms vary according to the underlying cause and the severity of the acid-
base disturbance.
• Mechanical ventilation may be necessary, especially in patients who are comatose.
Slide 58
Metabolic Acidosis (cont.)
• Nursing care
• Assessment of the patient in metabolic acidosis should focus on vital signs, mental
status, and neurologic status.
Metabolic Alkalosis
• Increase in bicarbonate levels or a loss of hydrogen ions
• Loss of hydrogen ions may be from prolonged nasogastric suctioning, excessive
Slide 60
Metabolic Alkalosis (cont.)
• Medical treatment
• Depends on the underlying cause and severity of the condition
22 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Slide 61
Metabolic Alkalosis (cont.)
• Nursing care
• Assessment
• Take vital signs and daily weight; monitor heart rate, respirations, and fluid gains
and losses
Metabolic Alkalosis (cont.)
• Intervention
• To prevent metabolic alkalosis, use isotonic saline solutions rather than water for
Slide 63
Question 1
• Which of the following is a true statement?
A. Approximately 60% to 70% of the human body is composed of water.
B. When the body does not maintain homeostasis, the cells can still function properly.
C. Most of the body’s fluids are found outside the cell.
D. Extracellular fluid is mainly responsible for the transport of nutrients and wastes
throughout the body.
TALKING POINTS:
Slide 64
Question 2
• ______________ is the transfer of water and solutes through a membrane from an area
of high pressure to an area of low pressure.
A. Active transport
B. Filtration
C. Facilitated diffusion
D. Osmosis
TALKING POINTS:
___________________________________________________________ Chapter 14 Fluids and Electrolytes 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Activities
Classroom Choose from below to make 30 minutes
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss homeostasis. Note that all body
organs and structures are involved in the
maintenance of homeostasis.
2
DISCUSS
• Discuss composition of body fluids and the
factors that affect the percentage of body
weight that is water.
24 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
3
DISCUSS
• Discuss membranes, highlighting their
functions.
• Discuss transport processes. Describe the
differences among diffusion, active transport,
filtration, and osmosis.
• Divide the class into four groups. Assign each
group one of the following hormones: renin,
aldosterone, antidiuretic hormone (ADH),
atrial natriuretic factor (ANF). Have each
4
DISCUSS
• Discuss fluid volume deficits and review the
etiology, assessment findings, treatment,
and nursing care for both hypovolemia and
dehydration.
• Divide the class into four groups and assign
each group a fluid imbalance:
• Hypovolemia
• Dehydration
___________________________________________________________ Chapter 14 Fluids and Electrolytes 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
5
DISCUSS
• Discuss electrolytes. List common
electrolytes and their roles in the body.
• Discuss nonelectrolytes. Offer examples of
nonelectrolytes and define how they differ
6
DISCUSS
• Discuss electrolyte imbalances and highlight
the differences between hyponatremia and
hypernatremia and how to assess for each.
• Divide the class into groups. Assign each
group one or more of the following
electrolyte imbalances:
information with the class.
26 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
7
DISCUSS
• Discuss assessment of fluid and electrolyte
balance. Outline the components of a
thorough assessment of fluid and electrolyte
balance, and discuss why each is important.
• Divide the class into small groups and
assign each group one or more assessment
criteria, such as health history, vital signs,
8
DISCUSS
• Discuss the medical treatment and nursing
care required for hyperkalemia.
• Divide the class into groups. Assign each
group an electrolyte imbalance (preferably
one they have not worked on in a previous
activity). Have each group develop a list of
medical treatments and nursing interventions
that would be appropriate when caring for a
patient who is experiencing that electrolyte
imbalance, as well as the rationale for those
interventions. Then have each group share its
list of interventions with the class.
9
DISCUSS
• Discuss age-related changes affecting fluid
balance. Outline the factors that place an
older person at risk for fluid and electrolyte
imbalances.
• Lead a class discussion with the students
regarding fluid and electrolyte balance in
___________________________________________________________ Chapter 14 Fluids and Electrolytes 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
10
DISCUSS
• Discuss acid-base balance and why it is
important to the normal functioning of the
body.
• Discuss how to assess a patient’s acid-base
status.
• Divide the class into groups. Assign each
group one of the four acid-base imbalances.
Have each group develop an explanation of
how the acid-base imbalance occurs. Then
have each group present its findings.
11
DISCUSS
• Discuss respiratory acidosis and respiratory
alkalosis and describe the major causes of
each.
• Discuss metabolic acidosis and metabolic
alkalosis and describe the major causes of
each.
12
DISCUSS
• Discuss respiratory acidosis and respiratory
alkalosis and describe the medical treatment
and nursing care associated with each.
• Divide the class into small groups and
28 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 14.1
Critical Thinking Question
A 75-year-old man is admitted to the medical-surgical unit for treatment of acute, severe
pneumonia. He has a history of hypertension and congestive heart failure for which he takes
medication, including a diuretic. Why is this patient at increased risk for fluid and electrolyte
imbalances?
Discussion Guidelines: This patient is a risk for fluid and electrolyte imbalances because of his
infection.
Instructor Notes/Student Feedback
___________________________________________________________ Chapter 14 Fluids and Electrolytes 29
Introduction to Medical-Surgical Nursing, 6th ed.
14
Assessments for
Fluids and Electrolytes
CHAPTER OBJECTIVES
Lesson 14.1:
2. Describe the composition of the extracellular and intracellular body fluid compartments.
4. Discuss the mechanisms of fluid transport and fluid balance.
6. List data to be collected in assessing fluid and electrolyte status.
8. Identify the causes, signs and symptoms, and treatments of electrolyte imbalances.
10. List the four types of acid-base imbalances.
12. Explain the management of acid-base imbalances.
Assessments by Lesson & Objective
Lesson 14.1
1
Study Guide
• Part IA: 1-4 (p. 73)
Evolve Instructor Resources
• Test Bank: 11, 22
2
Study Guide
• Part IIG: 1-3 (p. 75)
Evolve Instructor Resources
• Test Bank: 3, 11
3
Study Guide
• Part IC: 1, 2 (p. 74)
Evolve Instructor Resources
• Test Bank: 6-8, 23
4
Study Guide
• Part IE: 1, 2 (p. 74)
Evolve Instructor Resources
• Test Bank: 4, 19, 20
Evolve Student Resources
• NCLEX Review: 4
30 Chapter 14 Fluids and Electrolytes ___________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
5
Study Guide
• Part IB: 1 (p. 74)
• Part IIG: 36, 37 (p. 76)
Evolve Instructor Resources
Evolve Instructor Resources
• Part IA: 5, 6 (p. 73)
• Part IIG: 14-27, 42, 44, 45 (pp. 75-78)
• Part IIIH: 1, 9, 14 (pp. 78-79)
Evolve Instructor Resources
• Test Bank: 10
9
Evolve Instructor Resources
• Test Bank: 18
10
Study Guide
• Part IF: Blood Gas Values (p. 74)
• Part IIG: 31, 32 (p. 76)
Introduction to Medical-Surgical Nursing, 6th ed.
11
• Part IIG: 35 (p. 76)
• Part IIG: 34, 40 (p. 76)
12
Study Guide
Instructor’s Notes/Student Feedback
Study Guide