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Running head: FLUID AND ELECTROLYTES
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Fluid and Electrolyte Worksheet
Wynter Galway-Severtson
Nurs 220 DH
Karen Boyer
January 26, 2014
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NURS220 Health and Illness I - Concept 7 Fluid & Electrolyte Balance
Case Study and Worksheets
1. Describe the basic components of heart failure. (Do not use the mechanisms cited in
the case study. Use your own resources that may include nursing or medical web-based sites.)
According to Copstead and Banasik (2014), “Heart failure refers to the inability of the
heart to maintain sufficient cardiac output to optimally meet metabolic demands of tissues and
organs, and is the end stage of most cardiac diseases.” (pp. 409). Heart failure may be caused by
weakened cardiac muscle, ischemia, atherosclerosis, or fluid overload. Due to either of these
mechanisms, the heart is no longer pumping blood out of the chambers sufficiently which means
that blood will be backing up into the space from which it came if it cannot move forward. In
right sided heart failure (failure of the right ventricle to move un-oxygenated blood forward into
pulmonary circulation sufficiently) blood will back up into the systemic circulation which often
causes hypoxia because the blood is not getting oxygen, and acidosis because the CO2 is not
being released. These side effects may cause cyanosis. Other side effects of right sided heart
failure include edema and liver damage. In left sided heart failure (failure of the left ventricle to
move oxygenated blood forward into the body sufficiently) blood will back up into the
pulmonary circulation causing respiratory symptoms. If left sided heart failure is severe enough
it may back up as far as the right side of the heart and into the systemic circulation and ultimately
cause right sided heart failure as well.
2. What do you think was occurring at the elementary school where she volunteered that
resulted in her vomiting and diarrhea? Cite the mode of transmission.
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There are many possible causes of Mrs. Malone’s symptoms including viral
gastroenteritis, also known as the stomach flu. Viral gastroenteritis is an inflammation of the
gastric lining in the stomach and or intestines due to a viral infection of many different kinds.
According to the centers of Disease Control and Prevention (2011), “The viruses that cause
gastroenteritis are spread through close contact with infected persons.” (pp. 1).
3. Using your own words, describe the mechanisms that occur with orthostatic
hypotension. Include effect of the blood pressure and heart rate.
Orthostatic hypotension is a drop in blood pressure upon changing from a lying or sitting
position to a standing position. The drop in blood pressure causes a lack of blood flow to the
brain which leads to the typical symptoms of lightheadedness and fainting. Orthostatic
hypotension may occur due to low ECV, low cardiac output, increased blood viscosity, diabetes,
and other factors. When the blood pressure suddenly drops, the heart beats faster in an attempt to
perfuse un-perfused tissues like the brain causing the heart rate to rise. The objective signs of
orthostatic hypotension include a reduction of 20mmHg systolic, and or a reduction of 10mmHg
diastolic pressure upon position change, and an increased heart rate.
4. What electrolyte imbalance was occurring when Mrs. Malone began to drink more
water? Keep in mind that her diarrhea persisted and dietary intake was reduced during this time.
Drinking water would replace fluid volume but not replace the sodium and potassium that
was lost which would cause a hypotonic imbalance in the body.
5. What electrolyte imbalance was occurring when Mrs. Malone stopped taking her
KCL? Were there other factors contributing to this electrolyte imbalance?
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Mrs. Malone was taking the KCL because she is on potassium wasting diuretics so the
discontinuation of this medication along with the electrolyte loss from vomiting and diarrhea
would cause her potassium levels to drop.
6. Why did the NP recommend Mrs. Malone drink broth with salt and orange juice?
Salt is needed to replace the sodium that was lost through the combination of the
diuretics, low sodium diet, and vomiting and diarrhea. Orange juice would aid in replacing fluids
and other electrolytes including potassium.
7. What is the relationship between Mrs. Malone’s electrolyte imbalance and “weak
legs”? What other recommendations should have been made at this time by the nurse?
According to Ignatavicius and Workman (2014), “Low serum potassium levels increase
the difference in the amount of potassium between the fluid inside the cells (ICF) and the fluid
outside the cells (ECF). This increased difference reduces the excitability of cells.” (pp. 184).
The reduced excitability of the cells would cause weak muscles. Low sodium levels have a
similar effect in reducing the excitability of cell membranes causing a weakness in muscle
contraction. The NP also should have recommended some fall precautions due to the weakened
muscles, these could have included suggestions like: removing rugs around the house, standing
slowly while keeping grip on something solid and immobile, and wearing a fall alert bracelet.
8. As the nurse consultant, what time frame would you want her electrolytes to be
rechecked?
In approx. 3 days which would allow Mrs. Malone enough time to recuperate from her
illness and feel up to the task.
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9. Are there any other health care providers that should be considered in planning care
for Mrs. Malone? Cite a minimum of three and their role in her care.
Mrs. Malone would benefit from a nutrition specialist who could help her better
understand her fluid and electrolyte balance, a home care nurse for the duration of the illness that
she is suffering, and a social worker to help Mrs. Malone with future planning including
decisions involving moving into a long term care facility.
10. Describe one provision of Medicare that supports Mrs. Malone in accessing primary
care.
Medicare provision part B covers services that are medically necessary, and services that
will prevent illness and injury. These provisions of Medicare cover the needs of Mrs. Malone in
her long-term treatment and prevention measures. These provisions also allow Mrs. Malone to
access the primary care of her physician, as well as any specialists she may require. Medicare
also offers low co-payment plans for easier access to the medications Mrs. Malone needs.
11. If Mrs. Malone were eligible for home care, what five objective data would the RN
ask the health care team to make? (There is an assumption here that the RN will not always be
making the home visit and according to our state Nurse Practice Act, only RNs can assess.
Answer this question as if you were providing instruction to a CNA. )
Mr. Smith, upon arriving at Mrs. Malone’s residence please assess and monitor her heart
rate, blood pressure, intake and output, level of consciousness, and daily weight.
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12. If Mrs. Malone had refused to restart her KCL, what ethical principle would she be
asserting? Does Mrs. Malone have the right to refuse this treatment? (This information may be
found in your Cherry text, chap. 9 or any resource addressing client rights).
According to Simpson (2011), “Competent adults have the right to refuse treatment,
regardless of the reasons they give for refusal and even if the refusal will result in death;
clinicians must respect their decision.” (pp. 1). Mrs. Malone would be well within her rights to
refuse to restart her KCL. Mrs. Malone would be asserting the ethical principle of autonomy,
which according to Cherry and Jacob (2014) is the “Personal freedom and the right to make
choices.” (pp. 167).
13. What have you learned completing this case study? Equally as important, what do
you think you need to know more about to be a competent nurse managing Na+ and K+
imbalances?
I have learned that even though fluid and electrolyte balance may be clear and obvious to
us, it may not be to the patient whom may require in-depth education on the subject before
starting diuretics or supplementation. I think that experience with F&E case studies and
situations is the best way to become a competent nurse in the area of Na+ and K+ and to better
understand each electrolyte’s effects on the body.
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References
Centers for Disease Control and Prevention. (2011). Viral Gastroenteritis. Retrieved January 24,
2014, from http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm
Cherry, B., Jacob, S. (2014). Contemporary Nursing: Issues, Trends, & Management, (6th Ed).
Mosby. St. Louis, MO: Saunders.
Copstead, L., Banasik, J. (2013). Pathophysiology, (5th Ed). Mosby. St. Louis, MO: Saunders.
Ignatavicius, D., Workman, L. (2014). Medical Surgical Nursing: Patient Centered
Collaborative Care, (7th Ed). Mosby. St. Louis, MO: Saunders.
Simpson, O. (2011). Consent and assessment of capacity to decide or refuse treatment. British
Journal of Nursing, 20(8), 510-513.