Question about the nursing diagnosis: Risk for fluid electrolyte imbalance

[namaB, ADN]

Hey there, I have a question about the Nanda nursing diagnosis Risk for Electrolyte Imbalance. Nanada defines it as, "Susceptible to changes in serum electrolyte levels, which may compromise health. Risk factors: diarrhea, excessive fluid volume, insufficient fluid volume, insufficient knowledge of modifiable factors, vomiting. Associated conditions: compromised regulatory mechanism, endocrine regulatory dysfunction, renal dysfunction, treatment regimen," (Herdman & Kamitsuru, 2018, p.182).

My question is: does this diagnosis apply to someone who has an electrolyte imbalance?

On our last exam we had a question about an anorexic patient who weighed 88lbs and was 5'6 and had a serum potassium of 3.0. There were a few other specifics in the question but that was all of the relevant data given. The question was asking what her priority diagnosis is and of the four choices one was risk for fluid electrolyte imbalance and another was imbalanced nutrition: less than body requirements. The other two were basically just distractors. The answer was: risk for fluid electrolyte imbalance.

***note: it has been established in our class/ program that risk for diagnoses can be priority in certain situations. It has also been established in other unrelated scenarios that you can't have a risk for diagnosis if what you say they are at risk for is already an actual problem. The accepted value for serum potassium that we use is 3.5-5.0.

So, my reasoning is that it isn't risk for fluid electrolyte imbalance because she already actually has an electrolyte imbalance (potassium of 3.0). Is she at risk for further imbalance and for experiencing the effects of hypokalemia and other imbalances... yes. Is/Are that/those a big deal for this patient... yes. But, since she has the imbalance already, it is an actual and not a risk for. Therefore, that diagnosis does not apply and the answer should be (out of the four provided) imbalanced nutrition.

Our professor defended the answer with the rationale of: her potassium is low but it does not say in the question that she is experiencing symptoms of hypokalemia. Therefore it is a risk and not an actual problem. She went on to defend the rationale with some patients will perpetually have low values for potassium or Hbg (she gave those as examples) just naturally.

So, what then is the definition of having an electrolyte imbalance if not, you know, electrolytes outside of the normal accepted range? Is it only an electrolyte imbalance if you are symptomatic? Do you have to have multiple electrolytes imbalanced?

Basically: what am I missing here? It felt like I was the only one with an issue with this question.

Works Cited

Herdman, T. H., & Kamitsuru, S. (2018). Nanda International, Inc. nursing diagnoses: definitions & classification 2018-2020 (11th ed.). New York: Thieme.

[JKL33]

So I wrote out a reply yesterday and erased it because while writing it out I realized that this could be justified both ways (according to your thinking and your instructor's thinking). It doesn't immediately strike one as being correct to use a risk dx for an actual situation, and if reading the question as you posted it, I probably would have justified the same answer you gave, the same way you did. But that is sort of the lay person's way of thinking. Because...

It appears that the only nursing diagnoses directly related to electrolyte imbalances are the risk diagnoses. That tells me that if the patient is not symptomatic, you are to use these dx to address their electrolyte abnormalities. If the patient is symptomatic, then you would add on whatever more specific diagnoses are related to the ensuing problem. For instance if your patient then develops a symptomatic arrhythmia you might have a dx of altered tissue perfusion.

Anyone feel free to jump in and correct me. I haven't cracked a NANDA book in awhile, certainly not an up-to-date one. I'm basically replying because I think this is a thoughtful question that deserves some kind of discussion and I don't find the instructor's answer completely satisfying.