Chapter 29- Fluids, Electrolytes and Intro to acid base balance

When you care for patients with fluid volume deficit whether due to hemorrhage or dehydration---actions are

- Replace fluids orally and by IV as ordered by the health care provider -Monitor electrolyte levels closely -Administer antiemetic medications ordered for nausea or vomiting or antidiarrheal medication for loose stools - Monitor vital signs for low blood pressure, elevated pulse rate and elevated temperature (AS A LPN-LOOK OUT FOR FIRST!!) -Measure and monitor intake and output for balance, Normally the output total should be equal to or within 300 to 500 mL of the total intake. (PERSISTANT URINARY OUTPUT BELOW 30 ML PER HOUR MAY INDICATE RENAL FAILURE) -Assess each patient to be sure that he or she has voided at least every 8 hours and notify the health care provider if this does not occur -Administer IV fluids at the rate ordered -Assess the patient's oral mucous membranes for dryness and provide mouth care as needed.

Nursing actions for hypercalcemia

-Encouraging fluids and monitoring IV infusions as ordered, to help lower the calcium levels -Monitoring the patient for bradycardia, digestive complaints and visual disturbances if also on digitalis (Lanoxin) because high calcium can cause digitalis toxicity.

Signs and Symptoms of fluid volume deficit

-Patient report or little or no fluid intake or urine output - Patient report of frequent vomiting or diarrhea -Flushed, pale, hot, dry skin with nonelastic turgor -Complaints of thirst or nausea -Dry, cracked tongue and lips -Elevated heart rate -Weak pulse -Fever (FIRST SIGN TO SHOW) -Low Blood pressure -In newborns, sunked or depressed fontanels -decreased level of consciousness (severe fluid volume deficit) -Confusion (Severe fluid volume deficit)

Magnesium (Mg2+)

1.6-2.2 mg/dl

Sodium (NA+)

135-145 mEq/L

Phosphorus (PO43-)

2.5-4.5mg/dl

Potassium (K+)

3.5-5.3mEq/L

Chloride (Cl-)

97-107 mEq/L

An increase of acids in the blood and pH is below 7.35

Acidosis

An increase in blood alkalinity and moves the pH to above 7.45

Alkalosis

Encourage patients to eat foods high in potassium ---which foods?? and to provide 500 mg of potassium each.

Bananas, Yellow and orange fruits such as oranges, apricots, avocados and sweet potatoes and baked potatoes, yogurt, white bean and halibut.

Approximately 80% of the volume of water entering the first section of the large intestine the _______________, is absorbed there. The water molecules must cross through the intestinal wall and capillary wall to enter the bloodstream

Cecum

The other one third of the body's fluid is located outside the cells and is known as

Extracellular Fluid (ECF)

Results when the patient loses both fluid and the electrolytes contained in that fluid. The most common cause for this is the loss of a large amount of blood through hemorrhage.

Hypovolemia (fluid volume deficit)

Approximately two-thirds of body fluids resides inside individual cells. Fluid within the cells are called

Intracellular Fluid (ICF)

Function of water in the body---- Water helps to lubricate joints such as knees and elbows, reducing friction and allowing smoother movement.

Lubricating the joints and digestive tract

Function of water in the body------Water helps maintain body temperature, whether warm or cold. Because it takes longer for the temperature of liquid to change than it does for solid matter, the body's water protects from extreme changes

Maintaining Temperature

Hypokalemia

Potassium deficit- Weak , rapid or irregular pulse, Decreased BP, anorexia, nausea, vomiting, decreased deep tendon reflexes, fatigue, muscular weakness and cramps, numbness, abdominal distention, decreased peristalsis, ileus; may complain of seeing yellow haloes around objects if hypokalemia is caused by digoxin toxicity.

Function of water in the body------- Water as a component of spinal fluid, acts as a cushion for organs such as the brain and spinal cord, protecting these organs from damage from the outside forces.

Protecting the brain and spinal cord

Body fluids are found in one of two water compartments

The intracellular space and the Extracellular space

Calcium (Ca2+)

Total Ca2+ 8.2-10.2 mg/dl

Function of water in the body-------Water transport electrolytes such as sodium and potassium; an electrolyte is a salt that transmits electrical impulses when it is dissolved in water. Water transmits minerals such as zinc and copper and vitamins such as vitamin C and B-complex vitamins to all the individual cells throughout the body. Water transport waste products from the cells to the blood so that they can be eliminated in the urine

Transporting electrolytes, minerals, vitamins and waste products

Administering oral calcium tablets or IV calcium along with vitamin D as ordered by the health care provider for hypocalcemia

True

Administering supplemental potassium chloride as ordered in oral tablets, liquids, powders, or IV formulation. If the patient routinely takes certain diuretics be certain to administer potassium as ordered by the health care provider to prevent hypokalemia

True

An adult male's body weight is made up of 60% to 65% water, while for an older adult this is only 50% to 55%

True

Another cause of fluid deficit is abnormal fluid losses. Losses can be due to bleeding, prolonged tachypnea, excessive sweating, fever, diarrhea, vomiting or excessive urination due to diuresis.

True

Assessing for imbalance in potassium and calcium as well as magnesium; restoring the magnesium level will also require restoring the balance of potassium and calcium

True

Calcium is the most common mineral in our bodies: 99% of it is combined with phosphorus and located in the bones and teeth with the remaining 1 % located outside the skeletal system in the blood.

True

Magnesium is some times used by patients who experience twitching and controlled movements of their legs while trying to sleep. The magnesium works at the neuromuscular junctions, producing somewhat of a sedative effect reducing the twitching of the muscles

True

Some types of diuretics such as loop diuretics cause the patients to lose potassium and sodium. Furosemide (Lasix) a common loop diuretic can also cause magnesium and calcium losses. Thiazide diuretics such as hydrochlorothiazide also cause potassium loss.

True

The American Heart Association recommends that healthy adults consume no more than 2,300 mg per day. This is about 1 teaspoon of table salt. For the people with hypertension, those over the age of 40 and African American it is recommended that they consume no more than 1,500 mg per day because of their risk factors for cardiovascular diease

True

The Institute of medicine recommends a dietary intake of 4.7 g of potassium per day to help decrease long term health problems

True

Water normally accounts for 50% to 70% of the body's total weight and serves as the liquid in which the body's solid components are dissolved

True

Normal pH

between 7.35 and 7.45

When patients loses only fluids the remaining electrolytes become more concentrated called

dehydration

When you drink a glass of water, the water you swallow passes through the esophagus and into the stomach. The bloodstream absorbs some of the water from the stomach and small intestine, but most of the water is not absorbed until it reaches the

large intestine

Used to measure the acidity or alkalinity of a substance. The number on the pH scale corresponds to the parts of hydrogen in the substances. The scale ranges from 0 to 14. The number 7 on the scale is neutral.

pH scale