Fluid and electrolytes are key elements in nursing care.

Imbalance of these two

values can result in harsh consequences for the patient's condition and subsequently

must be monitored and treated with foremost care. The most important of the

electrolytes to monitor is potassium.

Potassium imbalance is the deadliest electrolyte imbalance. With a narrow

normal lab value of 3.5-5.0 of meq/dL, the body is very sensitive to changes. A low

potassium level can lead to side effects such as muscle weakness and eventually

paralysis, drowsiness, lowered blood pressure, Dysrhythmias, abdominal cramping,

diarrhea, lower respiratory rate, and oliguria. As a result of the lower respiratory rate

the priority assessment is a respiratory one. To properly treat this, nurses may be

asked to give potassium through an I.V. or a central line.

An excess in potassium can be equally as, if not more dangerous then an a

deficit in potassium. A High potassium lab value can cause shallow respirations,

irritability, confusion, weakness, arrhythmias, lethargy, a thready pulse, lowered

intestinal motility, and bradycardia. As a result of the bradycardia, the priority

assessment for this patient is a cardiac one. Patients will likely be placed on insulin

along with d5w I.V. in order to drive blood potassium levels down. Another important

element that must be carefully monitored and treated is the fluid balance within the

body.

Excess fluid within the body is an important issue that must be properly

assessed, and treated in a timely matter. Symptoms of this condition may include

Tachycardia, Bounding peripheral pulses, possible edema, and shortness of breath. A

vital intervention that must be taken as soon as volume overload is assessed is to sit

the patient in a high fowlers position to facilitate healing. Patients may also be put on a

loop diuretic such as lasix which is the number one cause of hypokalemia. As a result

one must monitor potassium levels while lasix is being administered.

A fluid deficit, or dehydration is also a serious and common situation which

should be rectified as soon as possible. To recognize dehydration one must know the

signs and symptoms such as confusion, orthostatic hypotension, and tachycardia with a

weak and thready pulse. A common intervention to treat dehydration is to administer

normal saline I.V. While administering saline one should assess the I.V. site for any

infiltration and treat accordingly.

There are many risk factors associated with fluid and electrolyte imbalances

Elderly patients are more at risk for dehydration and hypokalemia as a result of nutrition

status. This stems from the fact that the geriatric patient is not as inclined to eat as the

younger client population. In addition the thirst drive is much lower in the older patient.

Many drugs such as loop diuretics and corticosteroids can cause potassium

imbalances. Any patient that is on a no oral intake diet must also be very carefully

monitored for signs of electrolyte imbalances. The prevalence of these risk factors

makes fluid and electrolytes a very important aspect of nursing care.