Primary Nursing Diagnosis

Fluid volume deficit related to water loss and dehydration

OUTCOMES. Fluid balance; Electrolyte and acid-base balance; Hydration; Nutritional status: Food and fluid intake; Knowledge: Treatment regimen; Knowledge: Medication

INTERVENTIONS. Electrolyte management; Intravenous therapy; Electrolyte monitoring; Surveillance; Venous access device maintenance; Medication management; Nutrition management

H PLANNING AND IMPLEMENTATION Collaborative

Report any serum chloride levels greater than 108 mEq/L, and observe the patient for increases in serum potassium and sodium levels. Note any decrease in serum bicarbonate level, which indicates metabolic acidosis.

Severe hyperchloremia secondary to hypernatremia because of dehydration may require an intravenous (IV) solution of hypotonic saline, such as 0.45% sodium chloride (one-half normal saline). Infuse the solution cautiously because rapid infusion can cause a rapid shift of water into the cerebral cells, creating cerebral edema and the risk of death. Patients with hyperchloremia from metabolic acidosis may receive IV sodium bicarbonate; monitor them closely for overcor-rection (metabolic alkalosis and respiratory depression). Dietary changes are seldom necessary;

however, for severe conditions, a low-sodium diet prevents further accumulation of chloride and sodium.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Sodium bicarbonate

IV 2-5 mEq/kg over 4-8 hr

Alkalinizing agent

Corrects metabolic acidosis;

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