lOMoAR cPSD| 36357603 lOMoAR cPSD| 36357603
NCLEX MEDSURG COMPREHENSIVE REVIEW
CHAPTER 6
Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances
• Key Points
Water is very important to the body for cellular metabolism, blood volume, body temperature
regulation, and solute transport.
• Electrolytes are chemicals that can conduct electricity when dissolved in water
• Positive electrical charge (cation)
• Negative electrical charge (anion)
o Electrolyte imbalances include either too much or too little of key electrolytes.
• Fluid deficit is the same as dehydration and occurs when there is not enough fluid in the body,
especially in the blood.
• Fluid excess, also called overhydration, occurs when there is too much fluid in the
bloodstream, causing dilution of electrolytes and red blood cells.
• Patients at high risk for fluid volume excess are those receiving IV therapy, irrigations,
and those with diseases that affect the kidneys or cause fluid retention.
• If the patient experiences an excess of an electrolyte, treatment focuses on getting rid of
the excess, often via the kidneys.
• Patients who are high risk for dehydration include
• older adults, infants, and children
• patients experiencing fluid loss through wounds, diseases, and suctioning.
Data collection for patients with fluid and electrolyte imbalances
• intake to output
• assessing weight gain or loss
• assessing for edema
• assessing lung sounds
• assessing skin turgor
• reviewing electrolyte levels on laboratory reports
Therapeutic measures for patients with fluid and electrolyte imbalances
• daily weights
• strict intake and output
• administering or withholding fluids as ordered
• determining and correcting the cause of the imbalances
Patient Education
, lOMoAR cPSD| 36357603
• Identifying and reporting early signs and symptoms of dehydration or fluid excess to the
healthcare practitioner
• Reporting elevated temperature that can lead to fluid loss
• Recognizing foods high in sodium
• Using diuretics and potassium supplements correctly
• Reporting any rapid weight gain
It is important to know the food sources of electrolytes to teach your patients with
imbalances what to eat or what to avoid
Sodium
• Highest in processed and packaged foods
o Frozen pizza
o Canned soups
o Salad dressings
Potassium
o Potatoes
o Baked potatoes
o Yogurt
o Milk
o Bananas
o Orange juice
Calcium
o Dairy products
o Fortified cereals
o Soy, greens
o Some fish
▪ Salmon and perch
Common causes of Acidosis include
• hypoventilation due to respiratory disease
• drugs
• neurological problems that depress breathing
• end-stage renal disease
• uncontrolled diabetes.
Common causes of Alkalosis
• Hyperventilation due to anxiety or fear
• Mechanical ventilation
• High altitudes
• Overuse of antacids or baking soda
• prolonged vomiting or gastric suction.
, lOMoAR cPSD| 36357603
The body strives to correct acidosis and alkalosis by making changes in respiration
and the elimination of acids or bases.
Arterial blood gases test for acidosis and alkalosis by measuring blood pH, carbon dioxide
levels, and bicarbonate levels.
NCLEX MEDSURG COMPREHENSIVE REVIEW
CHAPTER 6
Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances
• Key Points
Water is very important to the body for cellular metabolism, blood volume, body temperature
regulation, and solute transport.
• Electrolytes are chemicals that can conduct electricity when dissolved in water
• Positive electrical charge (cation)
• Negative electrical charge (anion)
o Electrolyte imbalances include either too much or too little of key electrolytes.
• Fluid deficit is the same as dehydration and occurs when there is not enough fluid in the body,
especially in the blood.
• Fluid excess, also called overhydration, occurs when there is too much fluid in the
bloodstream, causing dilution of electrolytes and red blood cells.
• Patients at high risk for fluid volume excess are those receiving IV therapy, irrigations,
and those with diseases that affect the kidneys or cause fluid retention.
• If the patient experiences an excess of an electrolyte, treatment focuses on getting rid of
the excess, often via the kidneys.
• Patients who are high risk for dehydration include
• older adults, infants, and children
• patients experiencing fluid loss through wounds, diseases, and suctioning.
Data collection for patients with fluid and electrolyte imbalances
• intake to output
• assessing weight gain or loss
• assessing for edema
• assessing lung sounds
• assessing skin turgor
• reviewing electrolyte levels on laboratory reports
Therapeutic measures for patients with fluid and electrolyte imbalances
• daily weights
• strict intake and output
• administering or withholding fluids as ordered
• determining and correcting the cause of the imbalances
Patient Education
, lOMoAR cPSD| 36357603
• Identifying and reporting early signs and symptoms of dehydration or fluid excess to the
healthcare practitioner
• Reporting elevated temperature that can lead to fluid loss
• Recognizing foods high in sodium
• Using diuretics and potassium supplements correctly
• Reporting any rapid weight gain
It is important to know the food sources of electrolytes to teach your patients with
imbalances what to eat or what to avoid
Sodium
• Highest in processed and packaged foods
o Frozen pizza
o Canned soups
o Salad dressings
Potassium
o Potatoes
o Baked potatoes
o Yogurt
o Milk
o Bananas
o Orange juice
Calcium
o Dairy products
o Fortified cereals
o Soy, greens
o Some fish
▪ Salmon and perch
Common causes of Acidosis include
• hypoventilation due to respiratory disease
• drugs
• neurological problems that depress breathing
• end-stage renal disease
• uncontrolled diabetes.
Common causes of Alkalosis
• Hyperventilation due to anxiety or fear
• Mechanical ventilation
• High altitudes
• Overuse of antacids or baking soda
• prolonged vomiting or gastric suction.
, lOMoAR cPSD| 36357603
The body strives to correct acidosis and alkalosis by making changes in respiration
and the elimination of acids or bases.
Arterial blood gases test for acidosis and alkalosis by measuring blood pH, carbon dioxide
levels, and bicarbonate levels.
