The nurse should monitor:- Vital signs,
- Fluid intake and output,
- Serum sodium levels,
- Dietary sodium intake,
- Breath sounds and signs of respiratory distress.
The nurse should educate the patient to:- Not drink excessive amounts of pure water on a hot day or after extreme
exercise. Fluid replacement should be an electrolyte solution such as
Gatorade or other commercial preparations that include sodium. - Monitor for signs and symptoms of hyponatremia if the patient is taking a
potent diuretic such as furosemide (Lasix) or a thiazide diuretic such as
hydrochlorothiazide (HydroDiuril). - Report any signs of respiratory distress to healthcare provider.
Calcium
Calcium is found in equal proportion in intracellular fluid and extracellular fluid.
It is combined with phosphate in bone and with protein (albumin) in the serum.
A patient receives calcium from ingesting calcium-containing food. Calcium
plays a critical role in transmission of nerve impulses, blood clotting, muscle
contraction, and the formation of teeth and bone. There is also growing evidence
that calcium can help with weight loss.
There are three forms of calcium in serum that can fluctuate among forms
depending on changes to the serum pH and/or serum protein (albumin) levels.
1.Free ionized form, which is the biologically active form. Half of the patient’s
total calcium is in the free ionized form.
2.Protein bound, which binds primarily with albumin.
3.Complex form, which is where calcium is combined with phosphate, cit-
rate, or carbonate.The normal serum calcium ranges between 8.5 mg/dL to 10.5 mg/dL. This
reflects the calcium level for all three forms of calcium. However, ionized cal-
cium (iC) levels are sometimes reported separately (4–5 mg/dL).
There is a balance between calcium and phosphorus. As serum calcium
increases, serum phosphorus decreases. Conversely, as serum calcium decreases,
CHAPTER 10 Fluid and Electrolyte Therapy^171