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APPENDIX II: FLUID AND ELEcrROL YTE IMBALANCES

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affects fluid balance. Cellular functions that are reliant on proper

electrolyte balance include neuromuscular excitability, secretory

activity, and membrane permeabiliry.6 Clinical manifestations will

vary depending on the severity of the imbalance and can include

those noted in Fluid Imbalance. In extreme cases, muscle tetany and

coma can also occur. Common electrolyte imbalances are further

summarized in Table II-I.

Clinical Tip

Electrolyte levels are generally represented schematically

in the medical record in a sawhorse figure, as shown in

Figure II-I.

Medical management includes diagnosing and monitoring elecrrolyte imbalances via blood and urine tests. These tests include measuring levels of sodium, potassium, chloride, and calcium in

blood and urine; arterial blood gases; and serum and urine osmolality. Treatment involves managing the primary cause of the imbalance(s), along with providing supportive care with intravenous or oral fluids, electrolyte supplementation, and diet modifications.

Na

Cl

BUN

BS

K

Cr

Figure 11-1. Scbematic representation of electrolyte levels. (8 UN = blood urea

nitrogen; BS = blood sugar; CI = chloride; Cr = creatinine; HCOl = bicarbonate; K= potassium; Na = sodium.)

768 ACtrrE CARE HANDBOOK "'OR PHYSICAL THERAPISTS

Clinical Tip

•

Review the medical record closely for any fluid

restrictions that may be ordered for a patient with hypervolemia. These restrictions may also be posted at the

patient'S bedside.

• Conversely, ensure proper fluid intake before, during,

and after physical therapy intervention with patients who

are hypovolemic.

• Slight potassium imbalances can have significant effects

on cardiac rhythms; therefore, carefully monitor the

patient'S cardiac rhythm before, during, and after physical

therapy intervention. If the patient is nOt on a cardiac

monitor, then consult with the nurse or physician regarding the appropriateness of physical therapy intervention with a patient who has potassium imbalance.

•

Refer to Chapter 1 for more information on cardiac

arrhythmias.

•

Refer to Chapter 9 for more information on fluid and

electrolyte imbalances caused by renal dysfunction.

•

Refer to Chapter 11 for more information on fluid and

electrolyte imbalances caused by endocrine dysfunction.

References

I. Rose BD (ed). Clinical Physiology of Acid-Base and Elecrrolyre Disorders (2nd cd). New York: McGraw-Hill, 1984.

2. Corran RS, Kumar V, Robbins S, Schoes Fj (cds). Robbins Parhologic

Basis of Disease. Philadelphia: Saunders, 1994.

3. Kokko j, Tannen R (cds). Fluids and Elecrrolyres (2nd ed). Philadelphia:

Saunders, 1990.

4. McGee S, Abernethy WB III, Simei DL. Is rhis parienr hypovolemic?

JAMA 1999;281 (11):1022-1029.

5. Gorelick MH, Shaw KN, Murphy KO. Validiry and rcliabiliry of clinical

signs in rhe diagnosis of dehydrarion in children. Pediarrics 1997;99(5):

E6.

6. Marieb EN (ed). Human Anaromy and Physiology (2nd cd). Redwood

City, CA: Benjamin Cummings, 1992;911.

III-A

Medical-Surgical Equipment

in the Acute Care Setting

Eileen F. Lang

Introduction

The purpose of this appendix is to (1) describe the vatious types of medical-surgical equipment commonly used in the acute care sening, inc1llding oxygen (02) therapy and noninvasive and invasive monitoring and management devices, and (2) provide a framework for the safe use of

such equipment during physical therapy intervention.

Some equipment is used in all areas of the hospital, whereas other

type of equipment are u ed only in specialty areas, such as the intensive care unit (leU). The ICU is defined as "a place for the monitoring and care of patient with potentially severe physiological insrabiliry requiring technical andlor artificial life support." I The

presence of certain types of equipment in a patient's room can provide

the physical therapisr with a preliminary idea of the patient's general

medical condition and the appropriateness of therapeutic or prophylactic physical therapy intervention, or borh. The physical rherapist may initially be intimidated by rhe abundance of medical-surgical

equipment (especially in the ICU); however, a proper orientation to

sllch equipment allows the physical therapist to appropriately intervene wirh safety and confidence.

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