RNSG 1443 Complex Concepts of Adult Health

Nursing Care of the Patient with Fluid and Electrolyte Imbalances and Acid/Base Problems

Module Objectives: 
  1. Describe the mechanisms of fluid balance in the body.
    • Describe body flulid composition
    • Identify the major anions and cations in the fluid compartments of the body.
    • Identify the normal values for serum sodium, potassium, calcium, and magnesium.
    • Discuss the body fluid compartments
    • Define the mechanisms controlling fluid and electrolyte movement.
    • Describe the forces creating fluid movement in capillaries, especially osmotic pressure and its relationship to plasma proteins (especially albumin).
  2. Describe fluid movement between extracellular fluid and intracellular fluid.
  3. Identify the factors in the regulation of water balance.
  4. Discuss the pathophysiology and manifestations of fluid volume deficit and fluid volume excess
  5. Use the Nursing Process to plan care for the individual with fluid volume deficit and fluid volume excess.
    • Ineffective Tissue Perfusion
    • Risk for Injury
    • Home Care (Health Maintenance)
  6. Discuss the relationship of sodium and volume imbalances:
    • Discuss signs and symptoms exhibited by a patient experiencing gains and losses of sodium and volume.
    • For hypernatremia, which body system is primarily affected
    • Identify the effect of water gain or loss on Hgb & HCT and Specific gravity of urine.
  7. Discuss the major functions of potassium, sodium, magnesium, and calcium in the body.
  8. Discuss causes of hyper/hypo serum levels of potassium, sodium, magnesium, and calcium.
  9. Discuss signs and symptoms of hyper/hypo serum levels of potassium, sodium , magnesium, and calcium.
  10. Identify the diagnostic tests for each electrolyte (serum electrolyte levels, renal function, SG urine, EKG, digitalis level, CVP)
  11. Discuss nursing diagnoses for the individual experiencing imbalances of the major cations.
  12. Discuss collaborative care for for the individual experiencing imbalances of the major cations.
  13. Describe nursing implementation for the individual experiencing imbalances of the major cations.
  14. Identify the data needed to evaluate the outcomes of nursing interventions for the individual experiencing imbalances of the major cations.

Acid Base Balance

  1. Describe acid base regulation in the body.
  2. Define pH.
  3. Describe the mechanism of bicarbonate as a buffer.
  4. Describe the role of the respiratory system in acid-base balance.
  5. Describe the role of the renal system in acid base balance.
  6. Iidentify common causes, pathophysiology, and laboratory findings.
  7. Identify the mechanism causing four types of acid base imbalance.
  8. Interpret arterial blood gases to identify the four types of acid base imbalance.

Learning Activities: 

Review module objectives.

Read:  Lemone, P, Burke K., 2004. pp 77-119 ( electrolytes), pp 119- 134 (acid-base).

Watch this video to learn about interpreting Arterial Blood Gases

Link to this site to learn to use a stepwise approach (three steps) to determine the patient's acid-base status from arterial blood gases.

http://www.maagnursing.com/ABG/basic_questions.php/ Applying this approach, see Example ABG's

Review the terms on the vocabulary list.
Review handout on Laboratory Tests.

Use this summary table to help you review fluid and electrolyte imbalances

Do this fun exercise on fluid and electrolytes. Now try this one on acid/base exercise

Now try this fun exercise on FVE and FVD

Look at these flashcards to help you remember common lab values for the electrolytes.

Try this challenge board to test your knowledge of fluid and electrolytes.

Go to the PDS instructions in Blackboard and create a log in. They are under the "Course Information" tab. Once you have created a log in, proceed to the case studies below. You will only need to create a log in one time. These case studies may be used throughout your time in nursing school.

Go to the PDS module and click on Clinical Nursing Concepts: Fluid and Electrolyte Balance.

  • Do the module on Rusty Jackson who has fluid volume deficit and electrolye imbalances.
  • Do the module on Mary Richard who has water intoxication and hyponatremia.

Now go to Clinical Nursing Concepts: Acid-Base Balance.

  • Do the one of the modules on acidosis and one of the modules on alkalosis.

Read the case study. Compare your answers to the ones provided at the end of the case study.

Review module objectives and check for knowledge gaps.

Complete "Fluid Balance" quiz on Blackboard.

Complete "Acid-Base" quiz on Blackboard.