Discussion: Disorders of Fluid and Electrolyte Balance

Discussion: Disorders of Fluid and Electrolyte Balance

Discussion: Disorders of Fluid and Electrolyte Balance

Disorders of Fluid and Electrolyte Balance
Fluid and electrolyte imbalances are crucial problems in nursing and healthcare. Nurses and other healthcare providers implement interventions that optimize organ functioning and minimize complications. Therefore, this essay examines pathophysiological changes in a 7-year-old boy that experienced 60% burns and issues of concern.
I would explain to the father that a burn causes a massive shift of fluid from the intravascular to extravascular space. The shift results in decreased body fluid volume level, hence, hypotension. Children also have a large surface area to volume ratio as compared to the adults. This implies that fluid loss due to burns is high among children as compared to adults. Severe fluid loss because of burns also affects vital organs. For example, kidney perfusion is lowered, resulting in complications such as acute kidney injury (Barrett et al., 2019). Therefore, maintain optimum fluid volume level is important for his son.

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I will inform the father that the accurate measure of fluid volume level is urinary output. He should monitor his son for any changes in urine output versus the input. A decline in the output will translate into the inadequate body fluid volume, hence, the need for interventions such as increasing oral intake and intravenous fluids. The other approach would be weighing his son same time, using the same weighing scale and clothes (Kim et al., 2019; Lang et al., 2019). This will enable the detection of potential fluid volume deficits or excess.
I would be most concerned about organ perfusion and functioning and patency of the airway. The boy might have suffered inhalation burns, which predisposes him to airway obstruction and impaired gaseous exchange. The burn percentage experienced is also extremely high. This places the boy at a risk of complications such as infections and organ failure (D’Abbondanza& Shahrokhi, 2021). Therefore, he should be managed in the intensive care unit.
In summary, the boy’s fluid level should be monitored closely due to severe losses from the burns. Urine output and weighing the boy are effective indicators of fluid volume level. Healthcare providers should be concerned of the boy’s risk of acquiring infections, experiencing organ failure, and airway collapse.
References
Barrett, L. W., Fear, V. S., Waithman, J. C., Wood, F. M., & Fear, M. W. (2019). Understanding acute burn injury as a chronic disease. Burns & Trauma, 7, s41038-019-0163–2. https://doi.org/10.1186/s41038-019-0163-2
D’Abbondanza, J. A., & Shahrokhi, S. (2021). Burn Infection and Burn Sepsis. Surgical Infections, 22(1), 58–64. https://doi.org/10.1089/sur.2020.102
Kim, H. Y., Kong, Y.-G., Park, J. H., & Kim, Y.-K. (2019). Acute kidney injury after burn surgery: Preoperative neutrophil/lymphocyte ratio as a predictive factor. Acta Anaesthesiologica Scandinavica, 63(2), 240–247. https://doi.org/10.1111/aas.13255
Lang, T. C., Zhao, R., Kim, A., Wijewardena, A., Vandervord, J., Xue, M., & Jackson, C. J. (2019). A Critical Update of the Assessment and Acute Management of Patients with Severe Burns. Advances in Wound Care, 8(12), 607–633. https://doi.org/10.1089/wound.2019.0963

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Introduction

A 7-year-old boy is a patient in your intensive care unit. He was on a camping trip with his family when he accidentally fell on the campfire, causing severe second– and third-degree burns over 60% of his body. The clinical care team tells his parents that it will be critical to maintain their son’s airway and keep his fluid levels high.

Discussion Guidelines

Initial Post

In your initial post, answer the following questions:

The father is confused and asks you why his son’s fluid level is important after a burn. How would you explain this to him?

After your explanation, the father nods that he understands. He then asks how you will measure his son’s fluid levels. How would you respond?

As a clinician with knowledge of physiology, which aspects of this boy’s condition would you be most concerned about?

Response Post(s)

Reply to at least two classmates’ initial posts by Sunday.

Submission

Post your initial and follow up responses and review full grading criteria on the Discussion 13.1: Disorders of Fluid and Electrolyte Balance page.

Week 13: Renal System Physiology and Dysfunction

Welcome to Week 13. This week is about renal system physiology and dysfunction. The first set of material, which does not linearly follow that presented in the textbook, covers renal structure and function (Chapter 32 in your textbook). You should be aware of the key morphological structures, including the nephron and its components, the cortex and medullary areas, the juxtaglomerular apparatus, the afferent and efferent arterioles, the glomerular capillaries, and the vasa recta. You should be able to describe the three fundamental processes in the kidney: filtration, reabsorption, and secretion. You should also be able to describe the role of the kidneys in controlling blood volume and pressure. Renal diseases, and how they are diagnosed, are also covered in this material. You should know about abnormal urine constituents, diuretic drugs, and dialysis. Finally, you should be able to describe and discuss renal disorders and renal failure.

The second set of material is about water balance, electrolyte maintenance (including sodium, chloride, potassium, and calcium regulation), and acid-base balance. (This material is in Chapter 8 in your textbook). You should be able to differentiate between isotonic, hypertonic, and hypotonic alterations or abnormalities and understand the conditions that lead to these alterations. In order to function properly, pH is tightly controlled in our bodies. You will need to be able to understand the anion gap as a diagnostic tool and the key buffer systems in the body. You should also be able to use the Henderson-Hasselbalch equation to understand the four acid-base disturbances and the mechanisms that are used during acid-base compensation.

The final set of content is from Chapter 33 in your textbook. This set of material provides additional information on renal disorders, with some of it redundant from the first set of content.

Lesson 1: Structure and Function of the Renal System; Disorders of Acid-Base Balance and Renal Function

The materials for this lesson are covered in two presentations: Renal Physiology and Water Balance, Electrolyte Maintenance, and Acid-Base Balance. These materials do not follow linearly from the several book chapters on this content; however, the lesson’s learning outcomes are derived directly from the presentations. The first presentation provides information on normal renal physiology, as well as providing coverage of various renal diseases (some of that material is reinforced in Lesson 2 for the week). The second presentation provides information on maintenance of water, electrolyte, and acid-base balance and describes dysfunction associated with each.

Learning Outcomes

At the end of this lesson, you will be able to:

Renal Structure and Function

Describe the functions of the kidney

Explain why the kidney receives such a large percentage of the cardiac output and describe the mechanisms for regulating renal blood flow

Understand the concept of renal clearance

Describe the structure and function of the glomerulus and tubular components of the nephron in terms of regulating the composition of the extracellular fluid compartment

Explain the concept of the glomerular filtration rate

Define the terms reabsorption and secretion

Describe how the kidney produces concentrated or dilute urine

Renal Diseases

Understand the tests for renal diseases and what are abnormal urine constituents

Compare and contrast hemodialysis and peritoneal dialysis

Describe the causative factors of urinary tract infections (UTIs), and why UTIs can lead to pyelonephritis and cystitis

Understand the development of glomerulonephritis and nephrotic syndrome

Describe the causative factors of renal stone formation that lead to urinary tract obstructions

Compare and contrast acute and chronic renal failure

Water and Electrolyte Balance

Describe water balance in the body, and how the percentage of body water is affected by gender and the amount of body fat

Understand how edema occurs

Describe the mechanisms for regulating water and salt in the body

List conditions that result in isotonic, hypotonic, and hypertonic alterations to extracellular fluid volume

Describe conditions that lead to hypokalemia or hyperkalemia

Acid-Base Balance

Understand how blood pH is regulated, and how pH is calculated with the Henderson-Hasselbalch equation

Describe how metabolic and respiratory alkalosis and acidosis can occur, and the body’s compensatory responses to the acid-base disturbances

Before attempting to complete your learning activities for this week, review the following learning materials:

Learning Materials

Read the following in your Porth’s Pathophysiology: Concepts of Altered Health States textbook:

Chapter 32, “Structure and Function of the Kidney”

Chapter 8, “Disorders of Fluid, Electrolytes, and Acid–Based Balance”