FOUNDATIONS OF NURSING PRACTICUM

METHODICAL INSTRUCTION

FOR BSN STUDENTS

OF THE III COURSE

NURSING SCHOOL

LESSON ¹ 17 (PRACTICAL6 HOURS)

 

Theme: Fluid and Electrolyte Balance

Aim: To be able to perform nursing interventions according to nursing care plan and needs of the patient, to learn how properly evaluate the quality of care and outcomes for the patient. 

 

Professional orientation of students: Fluid, electrolyte balance within the body is necessary to maintain health and function in all body systems. This balance is maintained by the intake and output of water and electrolytes and regulation by the renal and pulmonary systems. Imbalances may result from many factors, including illnesses, altered fluid intake, or prolonged episodes of vomiting or diarrhea. Knowledge and understanding of the mechanisms that contribute to fluid, electrolyte is essential.

 

Methodology of Practical Class: 9:00-12:00

Algorithm of students’ communication with patients with pathology in subject (communication skills)

 

During examination of the patient students have to use such communicative algorithm.

 

Complaints and anamnesis taking in patients.

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Take complaints and anamnesis in a patient.

5. Explain to the patient results of his/her lab tests correctly and accessibly.

6. Explain to the patient your actions concerning him/her (the necessity of hospitalization, certain examinations and manipulations), which are planned in future.

7. Conversation accomplishment.

 

Objective examination:

Physical methods of examination of patients with internal diseases

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a patient, what examinations will be carried out and get his/her informed consent.

5. Find a contact with the patient and make an attempt to gain his/her trust.

6. Inform about the possibility of appearing of unpleasant feelings during the examination.

7. Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).

8. Examination (demonstration of clinical skill).

9. Explain to the patient results of his/her lab tests correctly and accessibly.

10. Conversation accomplishment.

 

Estimation of laboratory and instrumental investigations

Informing about the results of examination of patients with internal diseases

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a patient results of his/her lab tests correctly and clearly.

5. Involve the patient into the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly understood).

Planning and prognosis the results of the conservative treatment

Friendly facial expression and smile.

1. Gentle tone of speech.

2. Greeting and introducing.

3. Correct and clear explanation of necessary treatment directions.

4. Discuss with a patient the peculiarities of taking medicines, duration of their usage, possible side effects; find out whether your explanations are clear for him/her or not.

5. Conversation accomplishment.

 

Work 1. Master the next practical skills:

Practical Skill Preparing an IV Solution

Practical Skill  Starting an IV

Practical Skill Inserting a Butterfly Needle

Practical Skill Preparing the IV Bag and Tubing

Practical Skill Setting the IV Flow Rate

Practical Skill Assessing and Maintaining an IV Insertion Site

Practical Skill Changing the IV Solution

Practical Skill Discontinuing the IV and Changing to a Heparin Lock

Practical Skill Administering a Blood Transfusion

http://www.youtube.com/watch?v=1-6nATSEgCI

 

Work 2

Write a Nursing Care Map for a client with fluid and electrolyte imbalance

Bobby Warder, 54 years old, is being admitted with Congestive Heart Failure (CHF). Upon assessment, the nurse finds the following data: has gained five pounds in the last two days, a bounding pulse rate of 110 and blood pressure of 160/100, and distended neck veins. Upon auscultation, the nurse discovers his lungs have crackles (rales) in the bases. Develop a nursing care plan for Mr. Warder.

 

Seminar discussion of theoretical issues: 12:30-14:00

1.                 Identify the variables affecting normal fluid, electrolyte balances.

2.                 Discuss the clinical assessment for the client for fluid, electrolyte balances.

 

Individual Students Program

Test evaluation and situational tasks. 14:15-15:00

Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.

(the instructor has tests & situational tasks)

 

1.      Why do older adults generally have less total body water than younger adults?

A.   As functional cells die during the aging process, less water is needed.

B.   The muscle mass of older adults is smaller than the muscle mass of younger adults.

C.   Older adults have a smaller extracellular fluid to intracellular fluid ratio than younger adults.

D.   The plasma volume of older adults is decreased to reduce the risk for excess fluid volume and heart failure.

2.      Which clinical manifestation supports the concept that filtration is directly related to hydrostatic pressure?

A.   Capillary refill is faster in fingers than in toes.

B.   Central venous pressure is lowest in the right atrium.

C.   Pitting edema is usually detected first in dependent areas.

D.   Systolic blood pressure is higher than diastolic blood pressure.

3.      When evaluating the hydration status, the nurse observes tenting of the skin on the back of the 87-year-old client’s hand when testing the skin turgor. What is the nurse’s best action?

A.   Notify the physician.

B.   Examine dependent body areas.

C.   Assess turgor on the client's forehead.

D.   Document the finding as the only action.

4.      What effect would an infusion of 200 mL of albumin have on a healthy client's plasma osmotic and hydrostatic pressures?

A.   Increased osmotic pressure, increased hydrostatic pressure

B.   Increased osmotic pressure, decreased hydrostatic pressure

C.   Decreased osmotic pressure, increased hydrostatic pressure

D.   Decreased osmotic pressure, increased hydrostatic pressure

5.      Why does pulmonary edema form in a client who has left-sided heart failure?

A.   Increased blood volume in pulmonary vessels, increased blood osmotic pressure

B.   Increased blood volume in pulmonary vessels, decreased blood osmotic pressure

C.   Increased blood volume in pulmonary vessels, increased blood hydrostatic pressure

D.   Increased blood volume in pulmonary vessels, decreased blood hydrostatic pressure

6.      What is the expected action when capillary pores increase in size?

A.   Increased filtration, increased plasma volume

B.   Increased filtration, decreased plasma volume

C.   Decreased filtration, increased plasma volume

D.   Decreased filtration, decreased plasma volume

7.      Which condition is most likely to cause formation of edema?

A.   Increased plasma osmotic pressure, increased plasma hydrostatic pressure

B.   Increased plasma osmotic pressure, decreased plasma hydrostatic pressure

C.   Decreased plasma osmotic pressure, increased plasma hydrostatic pressure

D.   Decreased plasma osmotic pressure, decreased plasma hydrostatic pressure

8.      Which assessment technique would be the best for the nurse to use to determine the adequacy of circulation in a client whose blood osmolarity is 250 mOsm/L?

A.   Checking urine output

B.   Measuring abdominal girth

C.   Monitoring fluid intake

D.   Comparing the radial pulse with the apical pulse

9.      Which community-dwelling healthy person has the greatest risk for dehydration when exposed to a hot, dry environment for several hours?

A.   50-year-old man

B.   50-year-old woman

C.   80-year-old man

D.   80-year-old woman

10.    How is the process of active transport beneficial to human living systems?

A.   Active transport moves substances against a concentration gradient, allowing fluid compartment volume ionic differences to be maintained.

B.   Active transport allows the fluid lost at the capillary–interstitial compartment interface to be returned by lymph flow to the systemic circulation.

C.   When diffusion is limited by membrane impermeability, active transport maintains homeostasis of osmolarity across all body fluid compartments.

D.   When osmosis cannot occur during periods of anoxia, active transport facilitates movement of glucose across cell membranes so that energy production is not disrupted.

 

Student should know:

  1. The function, distribution, and regulation of fluids and electrolytes.
  2. Factors affecting normal body fluids, electrolytes, balance.
  3. Clinical manifestation of fluid and electrolyte Imbalance.
  4. Main steps for performing IV infusion set.

 

Student should be able to:

1.     Discuss the function, distribution, movement, and regulation of fluids and electrolytes in the body.

2.     Identify factors affecting normal body fluid, electrolyte balance.

3.     Discuss the risk factors for and the causes and effects of fluid, electrolyte imbalance.

4.     Collect assessment data related to the client’s fluid, electrolyte balance.

5.     Identify examples of nursing diagnoses, outcomes, and interventions for clients with altered fluid, electrolyte balance.

6.     Teach clients measures to maintain fluid and electrolyte balance.

7.     Implement measures to correct imbalances of fluids and electrolytes such as enteral or parenteral replacements and blood transfusions.

8.     Evaluate the effect of nursing and collaborative interventions on the client’s fluid, electrolyte.

Correct answers of test evaluations and situational tasks:

1.      B

2.     C

3.     C

4.     A

5.     C

6.     B

7.     C

8.     A

9.     D

10.           A

References:

Basic: .   

1.     Ternopil State Medical University http://intranet.tdmu.edu.ua/data/kafedra/internal/i_nurse/classes_stud/en/BSN-%284y%29/3%20year/1%20sem/Foundations%20of%20Nursing%20Practicum/17.%20Fluid%20%20and%20Electrolyte%20Balance.htm

2.     Potter & Perry, Chapter 38, pp. 959-999.

3.     Study Guide: Chapter 38Altman G. Delmar’s fundamental and advanced nursing skills book, pp. 121-234.

4.     Kozier & Erb's Fundamentals Of Nursing: Concepts, Process, And Practice Eighth Edition Audrey Berman, Shirlee Snyder, Barbara Kozier, Glenora Erb,

 

Additional:

1.     Potter and Perry. Fundamentals of Nursing. – 6th edition. – Mosby, Inc.

2.     Study Guide and Skills Performance Checklist to Accompany Potter and Perry’s Fundamentals of Nursing. – 6th edition. – Mosby, Inc.

3.     Altman G. Delmar’s fundamental and advanced nursing skills book / G.Altman, P. Buschel, V.Coxon. – Thomson Learning ©

 

WEB RESOURCES

National Health Information Center http://nhic-nt.health.org

American Nurses Association http://www.nursingworld.org

Certification Board of Infection Control and Epidemiology www.cbic.org

HealthCare Report Cards www.healthcarereportcards.com

Hospital Infections Program, Centres for Disease Control and Prevention www.cdc.gov

 

Methodical instruction has been worked out by: T. Yu. Rybalka

 

Methodical instruction was discussed and adopted at the Department sitting            11 June 2012.  Minute ¹ 13

Methodical instruction was adopted and reviewed at the Department sitting              12 June 2013. Minute ¹ 13

 

The Head of Clinical Immunology,

 Alergology and General Patients Care Department         Prof. I. Ya. Hospodarsky, MD, D.M.

 

The Head of Institute Of Nursing                                    As. Prof. S.O. Yastremska, Ph.D, MSN

 

Assistant of Clinical Immunology,

 Alergology and General Patients Care Department                            T.Yu. Rybalka BSN, MSN