Fluid Electrolyte & Acid Base Balance #7 Med Surg

Hyponatremia can occur with

- not enough sodium in diet; - excessive sweating; - diarrhea; - fluid excess; excessive ingestion of fluids - decreased aldosterone;

BUN

6-20 mg

Sodium daily intake (from chart on pg 76)

Adults up to age 49: 1.5 g per day Age 50-70: 1.3 g per day Age 71 & older: 1.2 g per day Upper tolerable limit for daily intake is 2.3 g (slightly more than a tsp of salt)

What should the nurse keep at the bedside to prepare for the possibility of magnesium sulfate toxicity?

Calcium gluconate; The antagonist of magnesium sulfate is calcium gluconate

Which is an independent nursing action that should be included in the plan of care for a client after an episode of ketoacidosis?

During treatment for acidosis, hypoglycemia may develop; careful observation for this complication should be made by the nurse.

Majority of Calcium is

Extracellular

Majority of Sodium is

Extracellular

A client's intravenous (IV) infusion infiltrates. The nurse concludes that what is most likely the cause of the infiltration?

Failure to secure the catheter adequately

A nurse evaluates that a client understands the side effects of hydrochlorothiazide (HCTZ) therapy when the client states, "I should call my health care provider if I develop:

Generalized weakness; Generalized weakness is a symptom of significant hypokalemia, which may be a result of diuretic therapy

A nurse is caring for a toddler with severe dehydration and its associated acid-base imbalance. What compensatory mechanism within the body is activated to counteract the effects of the child's acid-base imbalance?

Increased respiratory rate b/c the child has metabolic acidosis; the lungs compensate by blowing off excess carbonic acid in the form of carbon dioxide.

Majority of Magnesium is

Intracellular

Majority of Potassium is

Intracellular

Sodium Imbalances

Major cation; normal is 135-145 mEq/L; helps maintain serum osmolarity; important for cell function (esp CNS) Mostly in intravascular space Daily intake 2300 mg Daily intake for AfAm 1500 mg

While assessing a patient, the nurse finds the patient has increased intracranial pressure. Which medications would the nurse anticipate administering to the patient?

Mannitol infusion; is administered intravenously to treat increased intracranial pressure. Mannitol reduces the intracranial pressure by causing osmotic diuresis. It eliminates the water by pulling it from the interstitial spaces into the intravascular space.

Nursing process for Hyponatremia

Monitor I&O; Daily Weight at same time (a.m.), in same clothes; IV saline, if no fluid excess (restrict fluids for fluid excess); Administer Diuretics to reduce fluids; Administer Steroids to decrease brain swelling Evaluate for mental changes such as confusion/safety

S&S of Hypernatremia

Na+ greater than 145 mEq Thirst Mental Status changes Seizures Muscle Weakness Respiratory Compromise Severe Hypernatremia - can lead to coma and respiratory arrest Serum Osmolality will be increased

Interventions for hypervolemia

Place in HIGH fowlers for lung expansion, administer oxygen, administer diuretics, restrict fluid and sodium, monitor weight and urine output (at least 30 mL per hr); teach S&S of hypervolemia; teach to reduce sodium intake to 1-2 g per day

Hyperkalemia is sometimes treated with:

Polystyrene sulfonate (Kayexalate) is used to treat hyperkalemia. Polystyrene sulfonate (Kayexalate) binds with potassium and stimulates potassium elimination through stools.

A nurse is caring for a client after abdominal surgery and encourages the client to turn from side to side and to engage in deep-breathing exercises. What complication is the nurse trying to prevent?

Respiratory acidosis; (Shallow respirations, bronchial tree obstruction, and atelectasis compromise gas exchange in the lungs; an increased carbon dioxide level leads to respiratory acidosis.)

Excessive vomiting causes

an increased loss of hydrogen ions (hydrochloric acid), leading to *metabolic alkalosis*, an excess of base bicarbonate.

Signs and Symptoms of Hypervolemia

bounding pulse, elevated blood pressure, shallow/increased respirations, distended neck veins, pitting edema, pale/cool skin, increased urine output, dilute urine, weight gain, heart failure; possible renal failure if urinary output is not increased; *decreased BUN, decreased hematocrit & low urine specific gravity*

Low Sodium Very Low Sodium Sodium Free

less than 140 mg per serving less than 35 mg per serving less than 5 mg per serving

Nursing Process for hypervolemia

monitor I&O, check for edema (monitor), listen to lungs for crackles, check for weight gain

Hypervolemia (fluid excess)

overhydration, too much fluid in the body; kidneys will attempt to compensate by increasing urinary output; can be caused by IV fluids on a pump; aggressive irrigation of wounds, aggressive bladder irrigation, heart failure, renal failure, ADH syndrome

S&S of Hyponatremia

sodium less than 135; fluid excess or deficit; mental status changes such as confusion; nausea and vomiting; when dehydrated - also have elevated pulse, decreased BP, concentrated urine, elevated BUN when overhydrated - bounding pulse, tonicity of fluid, respiratory arrest (excess fluid in lungs), brain cells can swell

Nursing Process for Hypernatremia

treat fluid imbalance first - if dehydrated, replace fluid w/o sodium; Monitor I&O; monitor weight administer diuretics (if not excreting sodium through kidneys) Restrict dietary sodium (if too much in diet) May need dialysis Teach pt to read labels, not add salt to food and reduce intake of processed foods with high sodium