Primary Nursing Diagnosis

Altered protection related to neuromuscular changes

OUTCOMES. Electrolyte and acid-base balance; Neurological status: Consciousness; Nutritional status; Fluid balance

INTERVENTIONS. Surveillance: Risk identification; Surveillance: Safety; Nutrition management; Teaching: Individual; Medication management; Fluid/electrolyte management

U PLANNING AND IMPLEMENTATION Collaborative

Treatment of hypochloremia involves treating the underlying cause and replacing the chloride. Careful monitoring of fluid and electrolyte status is critical. Monitor serum chloride levels and report any levels less than 95 mEq/L. Observe for decreases in serum potassium and sodium, and note any increase in serum bicarbonate, which indicates metabolic alkalosis. Maintain strict intake and output records, noting any excessive gastric secretion loss, emesis, and diarrhea. Weigh the patient at the same time each day.

In mild hypochloremia, replacement of chloride can be accomplished orally with salty broth. If the condition is severe, IV fluid replacement is necessary. If the patient is hypovolemic, administration of 0.9% sodium chloride increases fluid volume, as well as serum chloride levels. Ammonium chloride can also be given for replacement, and if metabolic alkalosis is present, potassium chloride is administered. Dietary changes are seldom necessary.

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