Clinical Case: Impaired Fluid and Electrolyte Balance

Running head: CLINICAL CASE 1
CLINICAL CASE
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CLINICAL CASE
Introduction
Developmental and chronological gender, age, support, life experiences, and health
status impacts on an individual response to illness. The chosen priority problem for this essay
is impaired fluid and electrolyte balance. In relation to impaired fluid and electrolyte balance,
the essay will focus on both case studies of Anna, 4years old and Mc Adams, 85 years old.
The essay will identify relevant data in relation to the priority problem and give its
interpretation in relation to the underlying pathophysiology of the problem. The paper will
highlight the developmental differences and similarities in signs and symptoms expressed by
both patients in the cases. The paper will define a goal for care and nursing interventions
(nurse-initiated and collaborative) for the chosen priority problem. Lastly, the paper will
discuss the evaluation of the implemented nursing interventions in each case highlighting the
physical changes that would indicate the effectiveness of the nursing interventions.
Impaired Fluid and Electrolyte Balance
From both case studies, both Anna and Mc Adams had a history of diarrhea and
vomiting for two days. They were unable to tolerate any oral fluids given. They both had
three episodes of watery bowel motions and vomited up the small amount of water given
shortly after consumption. On assessment, Anna’s body temperature is 38.20C, body weight
is 16kg, respiratory rate 22, blood pressure is 88/50 mmHg, heart rate is 118. For McAdams,
temperature is 38.20C, respiratory rate is 22, blood pressure is 105/60, and heart rate of 108
which is irregular. In both cases, there is nil urine output within 8 hours.
The fluids and electrolyte balance in the body must be in total maintenance to keep
the brain, muscles, and nerves in proper function. Fluid and electrolyte imbalance can be due
to hypovolemia hypervolemia and normovolemia with poor fluid dissemination. One of the

CLINICAL CASE
most common causes of hypovolemia is trauma which presents with profuse loss of blood
(Noda, & Sakuta, 2013).
Dehydration is another common cause which entails loss of plasma and not whole
blood. The end results of hypovolemia constitute of reduction in the volume of blood in
circulation, decreased venous blood return into the heart, and arterial hypotension in majority
of cases. Failure of heart muscles can result from high myocardial oxygen demand in parallel
with the reduced perfusion of the tissues such as the brain which results into the feeling of
light headedness as for Mr. George McAdams (El-Sharkawy, Sahota, Maughan, & Lobo,
2014)
Anaerobic respiration takes place which may result into metabolic and respiratory
acidosis and, in combination with dysfunction of myocardium may conclude into multi
systemic and multi-organ failure. The organs which are susceptible to the extreme effects of
hypovolemic shock and hypotension include the splanchnic organs such as the kidneys.
Depending on the severity and duration of the effects, they may be irreversible despite the
restoration of normal fluid volume through fluid therapy (Balci et al., 2013).
Excessive fluid therapy may result into fluid overload and associated pulmonary
function impairment. However, fluid entry into the lungs may be facilitated by increased
permeability of blood vessels in some disease condition such as endotoxemia and blood
sepsis even in absence of increased hydrostatic pressure. The main aim of fluid management
should be to facilitate sufficient delivery of oxygen by balancing oxygenation of blood, the
volume in circulation, and the perfusion pressure (El-Sharkawy et al., 2014)
Dehydration, which is attributed to excessive loss of body water through conditions
such as sweating, vomiting, urination and diarrhea. It has numerous impacts on the kidney
which resuts into urinary concentration due to activation of vasopresssin occurring as a result