LESSON ¹ 17
(PRACTICAL – 6 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.
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:
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.
The Head of
Assistant of Clinical Immunology,
Alergology and General Patients Care Department T.Yu.
Rybalka BSN, MSN