Question

Case Study, Chapter 16, Caring for Clients With Fluid, Eleetrolyte, and Acid-Base Imhalances Ms. Sallie James, a 56-year-old female client, is admitted to the hospital on Thursday with chronic renal failure (CRF). She reports a 3-lb weight gain from yesterday. She is on a fluid restriction of 1,000 ml/day. client in CRF may not produce any urine once being dialyzed because the kidneys are functioning very minimal and the hemodialysis process removes the excess fluids and accumulated nitrogenous wastes and excess electrolytes. She is on a renal diet, which restricts protein, potassium, sodium, and phosphorous. She receives hemodialysis three times a week on Mondays, Wednesdays, and Fridays. The LPN/LVN caring for the client reviewed the chart She states it is her normal to not produce any urine each day. A noting the following abnormal electrolytes and must determine the needed nursing management. Sodium, 130 mEq/L Potassium, 6.5 mEq/L (Learning Objective 16) a. What nursing management related to the electrolyte imbalances is necessary for the client? b. What treatments should the nurse anticipate will be needed for the client and why?

Answer 1

Kidney is not only a organ it is an important part of our body that remove wastes and extra waste from the blood to form urine.The main functions of the kidneys are :

*regulation of extracellular fluid volume

*regulation of osmolarity

*regulation of ion concentrations

*regulation of pH

*excretion of wastes and toxins

*production of hormones

Chronic renal failure is a condition characterized by a gradual loss of kidney function over time that leads to fluid,electrolyte and acid-base imbalances.

For an healthy person with an healthy kidneys removes excess fluid from the body,and in the case when the kidneys do not work well,they dont have the adequate production of urine to remove the extra fluid from the body,causing the fluid weight gain.

a.The nurse is the main care giver who is managing the patient for 24 hours a day.She has to assess each and every symptoms of a patient carefully to manage in a easiest way and and to avoid complications and thus the patient can lead a burden free life further.

*Assess the risk for patient fluid-electrolyte and acid base imbalance

*Assess the fluid intake and output of the patient carefully

*Restrict the fluid intake and sodium intake as per physician orders.

*Carefully monitor the patient Blood pressure and pulse rate frequently

*Advice the patient to avoid the foods that contain phosphorous

*Prepare the patient for dialysis when ever needed

*Assess for any signs of dehydration

*Monitor the reasons for weight gaining,check the weight of the patient each day in a same weighing machine

*Assess for any breathing difficulty,there may be a chance due to pulmonary edema

*Reveiw the blood reports of the patient

*Reveiw the fluid balance of the patient

*Assess for the skin elasticity/turgor to know the fluid status

*Assess for any signs of edema

*Prepare a menu plan with timing chart according to the dietecians order (the diet that restricts protein,pottasium,sodium,and phosphorous)

*Assess the maental status of the patient also know any magnesium alterations also.

b.The main aim of treatment of patient who is having chronic reanl failure is to manange the symptoms,any way we can manange the case by dialysis (filtering by using a dialysis/external machine).

If the patient is showing any difficulties or symptoms we have to manage it symptomaticallyby a doctors order,other than that no other medications are needed.

Some times the doctors may prescribe vitamin,calcium reducer and some other dietary supplement according to the patient blood charts.