The Patient with Fluid and Electrolyte Imbalance 1

THE PATIENT WITH FLUID AND ELECTROLYTE IMBALANCE

List the adult normal values for the following Write in the appropriate medical terminology
electrolytes: for the serum laboratory values below:
1. Sodium (Na+) =
Mg2+ 3.5 mg/dl =
2. Potassium (K+) =
3. Chloride (Cl–) = K+ 2.5 mEq/L =
4. Calcium (Ca2+) = Cl– 90 mEq/L =
5. Phosphate (PO4 –) =
Na+ 132 mEq/L =
6. Magnesium (Mg2+) =
Ca2+ 8.5 mg/dl =

PO4– 5.1 mg/dl =

Case Study: A 36-year-old client was admitted with gastroenteritis. He has been vomiting and having
severe diarrhea for 2 days. He is very weak. The current laboratory results are: Na+ 128 mEq/L,
K+ 2.8 mEq/L, Cl– 90 mEq/L. The physician orders: IV of 0.9% NS at 100 cc/hr, NPO and I & O.

Pertinent Terminology Definition

Sodium (Na+)

Potassium (K+)

Chloride (Cl–)

Calcium (Ca2+)

Phosphate (PO4–)

Magnesium (Mg2+)

Third space
syndrome

Edema

Pitting edema

From Castillo, S.L.M. (2003): Strategies, Techniques and Approaches to Thinking (2nd ed.). Philadelphia: WB Saunders.
2 Strategies, Techniques, and Approaches to Thinking

From the case study, identify the abnormal laboratory results. List the major clinical signs or symp-
toms that you would assess with each abnormal value:

∗ =

∗ =

∗ =

Follow-up case study: The client’s vomiting and diarrhea has begun to subside in the evening
and the MD has ordered a clear liquid diet. The client’s 24-hour I & O for the day is charted
below:
24-Hour Intake/Output Record

IV = 2400 Emesis = 950

Oral = 120 Diarrhea = 900
Urine = 750

2520 cc 2600 cc

Based on the case study and Intake and Output Record select the most appropriate NANDA
Nursing Diagnoses for the client:

Excess fluid volume Deficient fluid volume

Diarrhea Impaired skin integrity
Imbalanced nutrition: Less than Risk for injury
body requirements

Interactive Activity: With a partner, read the case study below and write a rationale for each of the
nursing interventions listed:

Case Study Nursing Interventions Rationale

Ms. M was admitted with heart Weigh daily

failure. The nursing diagnosis of
Monitor I & O
“Fluid volume excess r/t
noncompliance to dietary Na+ Take apical pulse
restriction” is listed in her NCP.
Assess skin
Digoxin 0.25 mg qd po,
Furosemide 40 mg qd po, and K-dur Assess lungs
10 mEq po tid are her medications. Neck veins

From Castillo, S.L.M. (2003): Strategies, Techniques and Approaches to Thinking (2nd ed.). Philadelphia: WB Saunders.