Fluid and Electrolytes

cracklingkraken, ASN, RN · Nov 2, 2015

Absolutely. Well, you said that your patient has frequent, watery diarrhea. How does diarrhea unbalance your F&E?

203bravo, MSN, APRN · Nov 2, 2015

is there any dehydration? how could dehydration alter electrolytes? also how could the current meds effect electrolytes?

AceOfHearts<3 · Nov 2, 2015

I recommend going to youtube and searching "simple nursing fluid and electrolytes". You'll get some good short videos that will explain this stuff in a way that is easy to remember (imo). The ABG videos are really good too. Post back with some more thoughts and we'll let you know if you are on the right path :)

Trauma Columnist · Nov 2, 2015

Moved to Nursing Student Assistance.

nursej22, MSN, RN · Nov 3, 2015

I would examine each lab value, and determine if each is high or low. You described his creatinine of 8 as low. Either you are missing a decimal point, or you need to look up normal creatinine levels.

I think you are on the right track with fluid volume deficit, what IV fluid(s) are used for fluid replacement?

And definitely, look up iso/hypo/hypertonic, and review osmosis.

CelticGoddess, BSN, RN · Nov 3, 2015

A creat of 8 is NOT low, it is very high. Look at what normal creatinine levels are and what a high level can indicate.

IVRUS, BSN, RN · Nov 3, 2015

My pt has stomach virus with fatigue, persistent nausea and frequent, watery diarrhea.

Pt is on metoprolol 50 mg b.i.d. and hydrochlorothiazide 25 mg daily for hypertension.

Pt has a pulse of 130, B/P of 78/50, respirations of 26, creatinine of 8, potassium of 2.8 and sodium of 150. Arterial blood gases revealed a pH of 7.28, PCO2 of 45, and HCO3 of 20.

My nsg diagnosis would be Fluid volume deficit r/t nausea and diarrhea

I would monitor intake and output, and assess vital signs, and monitor for signs / symptoms of dehydration.
I need to figure out what factors contributed to his altered vital signs and abnormal lab values, (not sure why creatinine is so low) and what type of IV therapy might be used to restore this patient's fluid and electrolyte balance, I want to say Normal saline, but I feel like that is not enough and I am not sure the difference between Isotonic, hypo/hypertonic solutions.

Can someone help me please?

I would hold the HCTZ, and then address the hyokalemia immediately! Is the patient a dialysis patient? Do they need to be dialyzed? A creatinine of 8 tells me that there is little kidney function left. This is a very HIGH level. The patient appears dry as their pulse has increased to take what little circulating volume that they have around and the BP, being a measurement of the force of the blood against the walls of the vessels is low, as there probably is not enough volume secondary to the dehydration process. Na has jumped in response to this too. Yes, the patient needs to by hydrated, but be careful, because if they are Anuric, fluids won't be urinated out.

Studentnurse365 · Nov 3, 2015

First what is wrong with the patient? What s/s are not normal?

What are the patients vitals signs? Are they within normal limits? If they aren't what might be causing them to be out of whack?

What are the lab values? Are they within normal limits? What does each lab mean when it is high or low? What caused the lab values to be out of range?

Abgs: same as lab values. What is normal, what does it mean when a value is higher or lower, and what caused it?

Think about the entire picture.

The patient may have fluid volume deficit r/t diarrhea but think about how it affects the pathophysiology of these body.

Lots of research needed. Use your text book, come back with some normal values, the difference between isotonic, hypotonic and hypertonic, as well as some thoughts on the pathophysiology of what's going on in the body.

Lev, MSN, RN, NP · Nov 3, 2015

My pt has stomach virus with fatigue, persistent nausea and frequent, watery diarrhea.

Pt is on metoprolol 50 mg b.i.d. and hydrochlorothiazide 25 mg daily for hypertension.

Pt has a pulse of 130, B/P of 78/50, respirations of 26, creatinine of 8, potassium of 2.8 and sodium of 150. Arterial blood gases revealed a pH of 7.28, PCO2 of 45, and HCO3 of 20.

My nsg diagnosis would be Fluid volume deficit r/t nausea and diarrhea

I would monitor intake and output, and assess vital signs, and monitor for signs / symptoms of dehydration.
I need to figure out what factors contributed to his altered vital signs and abnormal lab values, (not sure why creatinine is so low) and what type of IV therapy might be used to restore this patient's fluid and electrolyte balance, I want to say Normal saline, but I feel like that is not enough and I am not sure the difference between Isotonic, hypo/hypertonic solutions.

Can someone help me please?

Your patient is ICU level sick. They are severely hypovolemic as evidenced by the low BP and heading into a shock state. Why do you think the heart is pumping faster?

Look at your sodium level to help decide what type of IV fluid to use. If the patient does not respond to IV fluids, what do you think is the next choice?

Think about how potassium is excreted from the body. Hint: what symptom is your patient having?

What happens when the kidney doesn't get enough blood flow? What can that cause? Hint: take a look at the ABG..

RescueNinjaKy · Nov 3, 2015

What's the temp on the patient? Be careful of sepsis. Increases hr, decreased bp, elevated rr. Septic shock and hypovolemic Shock can occur. Add that low potassium in and you can have dysrhythmias