19.5: Summary

19.1 Fluid and Electrolytes

Homeostasis is necessary for proper body functioning. An adequate fluid balance gives shape and size to cells and tissues, allows blood to perfuse to cells and tissues, and is a catalyst for hundreds of biochemical processes that keep our bodies alive. Electrolyte levels are finely monitored by multiple mechanisms, including digestive absorption, in-body storage, and kidney and hormonal regulation. When the body systems function correctly and people consume adequate fluid and healthy foods, homeostasis in maintained. This section discussed why some systems fail to adequately regulate fluids and electrolytes and what manifestations will alert the nurse that a regulation system is not functioning correctly. The nurse’s role is to understand what normal fluid and regulation assessment indicators are, and to monitor for deviations. The nurse understands and, along with other healthcare team members, implements interventions to prevent and correct alterations in fluid and electrolyte balances.

19.2 Nursing Assessment for Fluid and Electrolytes

There are many factors the nurse must consider when assessing a patient’s fluid status. No lone indicator can determine a patient’s fluid volume status. The nurse, in collaboration with the healthcare team must evaluate all data including a patient’s history, physical assessment, I & O, weight changes, and laboratory values. The nurse contributes to the healthcare team with accurate and consistent assessment and documentation of skin, vital signs, I & O, weight and laboratory values and clearly communicates unexpected findings to the care team members.

19.3 Considerations for Fluid and Electrolyte Imbalances

The nurse plays a key role in modifying a patient’s fluid and electrolyte status. Nurses educate and encourage patients on how to follow prescribed dietary and fluid restriction limits. The knowledge and experience of the nurse can help the patient make the best choices for their health and for their enjoyment of eating. Nurses understand the implications of supplements and stress to patients that any vitamins and electrolytes supplements should be included on the patients list of current medications.

Intravenous fluids are fast way to influence fluid and electrolyte levels. The nurse must understand the rationale for an IVF infusion just as the nurse understands the rationale for any medication, and must monitor for unexpected side effects as with any medication.

19.4 Nursing Management of Elimination

Patients who experience special needs regarding urine creation and/or elimination require special attention from the nurse. Urine that is not able to be expelled from the bladder can back up and cause discomfort, and lead to kidney injury. Incontinence can lead to isolation and decreased quality of life, and is expensive. Both PD and HD are associated with a high risk for infection yet are lifesaving treatments that take the place of fully functioning kidneys. The nurse can provide intervention to prevent kidney, skin, and systemic complications for patients who experience these alterations in elimination.