Question

Case Study, Chapter 16, Caring for Clients With Fluid, Electrolyte, 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/LVN caring for the client reviewed the chart noting the following abnormal electrolytes and must determine the needed nursing management. Sodium, 130 mEą/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, Nursing management of electrolyte imbalances for this patient.

               * Patient electrolyte levels indicate

                                 * Hyonatremia. (low sodium level in the blood)

                                 * Hyperkalemia.

              So nursing management include,

                                 * Maintain the fluid and electrolyte level in balance to prevent low blood

                                   sodium level.

                                 * Maintain pottasium level by IV administration of calcium,glucose

                                   and insulin to lower the potassium level.

                                 * Give psychological support to reduce the stress level of patient related to

                                    symptoms of electrolyte imbalances like muscle cramps,fatigue,restlessness

                                    palpitations,tingling etc.

b, Treatment needed for this patient.

                     * Treatment measures for this client include correction of electrolyte imbalances because

changes in electrolyte levels produce life threatning systemic complications in patient

with kidney failure.

* Therapeutic measures include,

         * Management of hyponatremia through IV administration of hypertonic

                                   sodium chloride solution.

                                * Hemodialysis with use of low sodium replacement fluid to maintain normal

                                  sodium level.

                                * IV administration of calcium can prevent heart and muscle problems occurs

                                  due to hyperkalemia.

                                * Both glucose and insulin administration enhance the movement of pottasium

                                   from extracellular space into the cells of the body and maintain normal pottasium

                                  level.