| Fluid and Electrolyte Imbalance: Hyponatremia Posted: 14 Dec 2010 05:47 PM PST 
Hyponatremia - Sodium is essential to maintain osmotic pressure and acid-base balance chemically and to transmit nerve impulses.
- Sodium levels are obtained through venous blood extraction.
- It is a metabolic disorder wherein the level of sodium in the blood is lower than normal (< 135 mEq/L).
- It is a result of one of the following:
- Severe burns
- Congestive heart failure
- Excessive fluid loss such as severe diarrhea, vomiting
- Excessive IV induction of nonelectrolyte fluids such as glucose
- Addison’s disease
- Severe nephritis
- Pyloric obstruction
- Malabsorption syndrome
- Diabetic acidosis
- Drugs such as diuretics
- Edema
- Large amounts of water per orem
- Hypothyroidism
- Excessive ADH production
Symptoms: - altered mental status, restlessness
- convulsions
- fatigue, headache, irritability
- satiety
- muscle spasms or cramps
- muscle weakness
- nausea, vomiting
- restlessness
Treatment: - Correct underlying disorder associated with hyponatremia.
- Intravenous fluid administration.
- Give sodium tablets.
- Water restriction.
- When exercising, keep hydrated.
Nursing Considerations: - Strictly monitor fluid intake and output.
- Observe for dehydration. Accurately record state of hydration.
- Observe for neuromuscular changes such as declining levels of consciousness, fatigue and muscular weakness.
- Monitor for signs of edema and hypertension.
- Ensure adequate dietary sodium intake of 90 to 250 mEq/day.
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| Fluid and Electrolyte Imbalance: Hypokalemia Posted: 14 Dec 2010 05:44 PM PST 
Hypokalemia - Potassium plays an important role in nerve conduction, muscle function, acid-base balance and osmotic pressure.
- Potassium levels are obtained through venous blood extraction.
- It is a metabolic disorder wherein the level of potassium in the blood is lower than normal (< 3.5 mEq/L).
- It is associated with shifting of K+ into cells, K+ loss from GI and biliary tracts, renal K+ excretion and reduced K+ intake.
- It is a result of one of the following:
- Diarrhea, sweating, vomiting
- Starvation, malabsorption
- Bartter’s syndrome
- Draining wounds
- Cystic fibrosis
- Severe burns
- Primary aldosteronism
- Chronic alcoholism
- Osmotic hyperglycemia
- Respiratory alkalosis
- Renal tubular acidosis
- Diuretics, antibiotics and mineralocorticoid administration
- Barium chloride poisoning
Symptoms: - Arryrthmias, especially for persons with cardiovascular disease
- Breakdown of muscle fibers
- Constipation
- Fatigue
- Muscle weakness or spasms, paralysis
Treatment: - Correct underlying disorder associated with hypokalemia.
- Give potassium tablets.
- Have a diet rich in potassium such as bananas, apples, oranges, milk and tomatoes.
Nursing Considerations: - Record fluid intake and output.
- Check blood volume and venous pressure.
- Identify ECG changes such as depressed T waves, peaking P waves.
- Observe for dehydration. Accurately record state of hydration.
- Observe for neuromuscular changes such as fatigue and muscular weakness.
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| The Case Management Process (IMCI) Posted: 14 Dec 2010 05:41 PM PST 
- Relies on case detection using simple clinical signs and empirical treatment.
- The treatments are develop according to action-oriented classifications rather than exact diagnosis. They cover the most likely diseases represented by each classification.
- It can be used by doctors, nurses, and other health professionals who see sick infants and children aged one week to five years.
- It is a relevant process for a first-level facility such as a clinic, a health center, or the outpatient department of a hospital.
- It is presented in sequence of steps, with information on how to carry them out.
- It will also help and guide the user on how to interview caretakers, accurately recognize clinical signs, choose appropriate treatments, and provide counseling and preventive care.
Elements of Case Management Process - Assess the child or infant
- Assessing the child means taking down his or her history and doing a physical examination on him or her.
- Assess the child by checking first for danger signs such as convulsions, lethargy or unconsciousness, inability to drink or breastfeed, and vomiting, or possible bacterial infection in an infant, asking the mother questions about common conditions, examining the child, and checking his or her nutrition and immunization status.
- Classify the illness
- Classify the illness means making a decision as regards the severity of the illness.
- Classify a child's illness using a color-coded triage system. Since many children have more than one condition.
- Identify specific treatments for the child
- If a child requires urgent referral, give essential treatment before the patient is transferred.
- If a child needs treatment at home, develop an integrated treatment plan for the child and give the first dose of the drugs in the clinic.
- If a child should be immunized, give him or her immunization.
- Treat the child
- Treating the child means giving treatment in the health center.
- It includes teaching caregivers how to give fluids during illness and how to recognize signs indicating that the child should return immediately in the health care facility.
- Counsel the mother
- Counseling the mother includes assessing how the child is to be fed, and telling her about the foods and fluids to be given to the child, and when to bring the child back to the health center.
- Give follow up care
- When a child is brought back to the clinic, as requested, give follow-up care and, if necessary, reassess the child for new problems.
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