ࡱ> tws !bjbjWW 4>55x#ppppp8<<~b4 !v-"$Q"$~&~&~&~&~&~&~$JJ~pe"!!e"e"J~pp _~{${${$e"Zp p $~{$e"$~{${$rJz ࡵ#vtL~u~0~u85$FJzJzRp{te"e"{$e"e"e"e"e"J~J~{$e"e"e"~e"e"e"e"e"e"e"e"e"e"e"e"e" 6: RNSG 2572 Health Care Concepts 2 Concept FLUID AND ELECTROLYTE BALANCE Concept Definition The process of regulating the extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes. Exemplars Dehydration Gastroenteritis Elderly, Extracellular Fluid Volume Excess, Hypokalemia Hyperkalemia - Chronic Renal Failure, Hyponatremia - Syndrome of antidiuretic Hormone (SIADH), Hypernatremia Diabetes Insipidus (DI), Hypophosphatemia, Hyperphosphatemia Hypomagnesaemia, Hypermagnesemia Objectives Explain the correlation between Dehydration Gastroenteritis Elderly, Extracellular Fluid Volume Excess, Hypokalemia, Hyperkalemia - Chronic Renal Failure, Hyponatremia - Syndrome of antidiuretic Hormone (SIADH), Hypernatremia Diabetes Insipidus (DI), Hypophosphatemia, Hyperphosphatemia, Hypomagnesaemia, and/or Hypermagnesemia to the concept of Fluid and Electrolyte Balance (including compromised antecedents, deficit measurement in attributes, a list of negative consequences, and the interrelated concepts which may be involved). Identify conditions that place an individual at risk for imbalance leading to a compromised concept(s) resulting in Dehydration Gastroenteritis Elderly, Extracellular Fluid Volume Excess, Hypokalemia, Hyperkalemia - Chronic Renal Failure, Hyponatremia - Syndrome of antidiuretic Hormone (SIADH), Hypernatremia Diabetes Insipidus (DI), Hypophosphatemia, Hyperphosphatemia, Hypomagnesaemia, and/or Hypermagnesemia . Apply the nursing process with collaborative interventions for individuals experiencing Dehydration Gastroenteritis Elderly, Extracellular Fluid Volume Excess, Hypokalemia, Hyperkalemia - Chronic Renal Failure, Hyponatremia - Syndrome of antidiuretic Hormone (SIADH), Hypernatremia Diabetes Insipidus (DI), Hypophosphatemia, Hyperphosphatemia, Hypomagnesaemia, and/or Hypermagnesemia. Concept Analysis Diagram Note: Diagram on separate page. Explanation of Fluid and Electrolyte Diagram: If the antecedents are met then fluid and electrolyte balance occurs as indicated by the attributes. If an individual experiences normal intake and absorption of fluid and electrolytes, and the individual experiences sufficient cardiac output, normal rennin-angiotensin-aldosterone system function, normal thyroid, parathyroid, and pituitary gland function, and normal regulation of body fluid compartments through osmosis-diffusion-active transport, the individual will experience a balance of fluid and electrolytes. The balance of fluid and electrolytes in an individual occurs when intake and output are equal, and serum values fall within the of the following ranges: Potassium 3.5-5.0 mEq/L; Sodium 135-145 mEq/L; Total Calcium 8.6-10.2 mg/dL; Magnesium 1.3-2.3 mg/dL; Phosphorus 2.5-4.5 mg/dL; Serum osmolality 280-300 mOsm/Kg; CVP 2 to 6 mm Hg. If there is an alteration in the antecedents, the negative consequences occur resulting in the need for intervention. To help determine the appropriate interventions, the negative consequence must be traced back to which antecedent is ineffective. The interrelated concepts are affected by both positive and negative consequences. Assignments Prior to class: 1. Review definitions of inter-rated concepts on concept analysis diagram. 2. Review concept analysis diagram. 3. Assigned reading: Berman, A. & Snyder, S. (2012). Kozier & Erbs Fundamentals of Nursing. Boston: Pearson. Chapter 52: Fluid, Electrolyte, and Acid-Base Balance Giddens, J.F. (2013). Concepts for nursing practice. St. Louis. MO: Mosby Elsevier. Chapter 7: Fluid and Electrolyte Balance Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., OBrien, P.G., & Bucher, L. (2011). Medical surgical nursing (8th ed). St. Louis: Mosby Elsevier. Chapter 43: Lower Gastrointestinal Problems; Gastroenteritis; pg. 1022 Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances; pg. 307-320 Chapter 50: Endocrine Problems; SIADH and Diabetes Insipidus; pg. 1259-1261 4. Internet resources to review: Information on gastroenteritis:  HYPERLINK "http://www.ehow.com/about_5100736_nursing-care-plan-acute- gastroenteritis.html#page=1" http://www.ehow.com/about_5100736_nursing-care-plan-acute- gastroenteritis.html#page=1 Gastroenteritis  HYPERLINK "http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm" http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm Sample Nursing Care Plan for FVD  HYPERLINK "http://www.reference.com/motif/Society/nursing-care-plan-for-acute-gastroenteritis" http://www.reference.com/motif/Society/nursing-care-plan-for-acute-gastroenteritis Chronic Renal Failure  HYPERLINK "http://www.kidney.org/index.cfm" http://www.kidney.org/index.cfm Diabetes Insipidus  HYPERLINK "http://kidney.niddk.nih.gov/kudiseases/pubs/insipidus/" http://kidney.niddk.nih.gov/kudiseases/pubs/insipidus/ DI and SIADH  HYPERLINK "http://youtu.be/SE5IbNdTJfg" http://youtu.be/SE5IbNdTJfg Fluid and Electrolyte Imbalance  HYPERLINK "http://www.livestrong.com/article/288507-signs-of-a-fluid-electrolyte-imbalance/" http://www.livestrong.com/article/288507-signs-of-a-fluid-electrolyte-imbalance/ Sample Nursing Care Plan for FVE  HYPERLINK "http://pterrywave.com/Nursing/Care%20Plans/13.aspx" http://pterrywave.com/Nursing/Care%20Plans/13.aspx 5. Review the following Nursing Diagnoses: Fluid Volume, deficient Fluid Volume, excess Electrolyte Imbalance, risk for Imbalanced Nutrition, less than body requirements Risk for impaired skin integrity Decreased Cardiac Output Concept content outline: Concept: Fluid and Electrolytes Sub Concepts: Hyper/Hypovolemia Vulnerable Demographics Regulation Imbalances Risk Factors: Related to each exemplar Assessment: Comprehensive history Physical assessment Physical and psychological clinical manifestations Diagnostic tests Positive Outcomes: Normal cardiac rhythm Clear mentation Good skin turgor Negative Outcomes: Physiological Psychological Clinical Management: Nursing interventions Collaborative interventions Pharmacological therapy Non Pharmacological therapy Diagnostic studies Exemplars: Dehydration Gastroenteritis Elderly, Extracellular Fluid Volume Excess, Hypokalemia Hyperkalemia - Chronic Renal Failure, Hyponatremia - Syndrome of antidiuretic Hormone (SIADH), Hypernatremia Diabetes Insipidus (DI), Hypophosphatemia, Hyperphosphatemia Hypomagnesaemia, Hypermagnesemia     FLUID & ELECTROLYTES !"-IK]^_    7 8 o p = ? 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