We hang fluids with varying concentrations of electrolytes in response to specific lab results, but how much do we actually remember what is going to happen physiologically?

Revisiting the fundamentals of fluid and electrolyte balance.

I remember first learning about fluids and electrolytes in undergraduate physiology, and then again all throughout medical-surgical nursing courses. When I was in orientation for my first position as an ED nurse, it was included in the critical care course. Sounds like that should have been enough—but it wasn’t.

Understanding the underlying science matters.

The basic concepts underlying the body’s mechanisms for keeping systems functioning are complex processes involving the ebb and flow of fluid and molecules controlled by several systems. It’s a delicate balance and one that we all learn in basic nursing education, but then usually recall little of it when we practice.

We hang fluids with varying concentrations of electrolytes in response to specific lab results, but how much do we actually remember what is going to happen physiologically? We know the protocol of what to infuse when, but we’re hard-pressed to explain the science underlying our practice. This is a concern because nurses are usually the first ones to review laboratory results and need to understand the implications of abnormal results and what might be an urgent concern requiring immediate action. Patients may also ask why—and we should know the answer.

A series focusing on nursing basics.

We’re happy to announce the beginning of a new series of articles, Back to Basics, which is “devoted to improving acute care nurses’ understanding of the physiological abnormalities underlying many disorders and applying that understanding to enhance physical assessment techniques and refine the nursing plan of care.”

In addition to reviewing the science, articles will include clinical scenarios to illustrate nursing implications and actions. The first article, “Concentration and Volume: Understanding Sodium and Water in the Body,” is in the January issue (free until February 7, it’s currently the most-emailed article and the 4th-most-viewed article trending on our website, www.ajnonline.com.)

The author of the series, Lydia A. Bertschi, DNP, APRN, ACNP-BC, is an assistant professor at Illinois Wesleyan University School of Nursing in Bloomington, Illinois. The next column will focus on disorders involving the basic metabolic panel, including potassium, chloride, blood urea nitrogen, and creatinine. And in the near future, look for a Back to Basics collection on our website (see here for a listing of current article collections).

As author Bertschi notes:

“Understanding the etiology guides the nurse’s understanding of the treatment approach and maximizes the role of the nurse in correcting, managing, and preventing disorders of sodium and water balance.”

We agree.