Question

Case Study, Chapter 16, Caring for Clients With Fluid, Eleetrolyte, and Acid-Base Imbalances 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. She states it is her normal to not produce any urine each day. A 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/L VN caring for the client reviewed the chart 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

a. ANS: Client nursing management related to the electrolyte imbalance:

Fluid restriction is important in this case and it can be done such that the patient gets fluids equivalent to previous day output plus daily maintenance

It would be important for the nurse to institute strict fluid input and output monitoring by charting

Daily weighing is an important tool of monitoring fluid retention

Dietary restriction of potassium rich foods and salt

Monitor for signs of electrolyte imbalance. For instance clinically hyperkalemia could cause arrhythmia and thus it is important for this patient to be on a cardiac monitor

Monitor vital signs

Monitor for signs of acidosis which often occurs concurrently with electrolyte anomalies especially hyperkalemia

Then since patient is on chronic dialysis it is important to institute good care of the dialysis catheter and site

b. ANS: client needed treatment:

The nurse should anticipate measures that are aimed at correcting the electrolyte imbalance which may include

An urgent dialysis due to the severe hyperkalemia

Shifting potassium by insulin or salbutamol treatment, potassium binding using kayxalate and dietary restriction

Renal dieting the patient with salt, potassium and fluid restriction