Nurs 100 Week 6: FLUID, ELECTROLYTE, & ACID-BASE

Osmolarity imbalances

disturbances of the concentration of body fluids hypernatremia and hyponatremia (alot of salt)

Isotonic

equal concentration

Rehydration Tubing changed _____

every 96 hours for continuous and 24 hours for intermittent

Extracellular fluid (ECF)

fluid outside cells 30% of total body water

Intracellular fluid (ICF)

fluid within cells *only can change this!!!* 70% of total body water

Hyperkalemia treatments

get the body to excrete it -*Diuretics, hemodialysis, resin medications (Kayexalate)*

Hypercalcemia S/S

greater than 10.5 -Decreased neuromuscular excitability -Lethargy and confusion, coma Anorexia, Constipation, abdominal pain Arrhythmias, thirst, polyuria if i forget to take chill pill im hyper (hyper): less than 9 ; Decreased neuromuscular excitability

Hypermagnesemia

greater than 2.1 -Decreases neuromuscular excitability (wouldnt move) -Excessive magnesium intake (antacids and laxatives) -Decreased deep tendon reflex (DTR) -Lethargy, blurred vision, headache, respiratory depression, bradycardia, arrhythmias, seizures, coma, cardiac arrest

Hyperkalemia

greater than 5.0 Decreased K+ output

Hypervolemia causes

heart failure, kidney failure, cirrhosis, pregnancy, too much IV fluid, H2O retention Bounding pulse, pitting edema, crackles in lungs (fluid), weight gain

fluid intake is affection

homeostasis

How to treat hypokalemia

how to treat it give potassium-rich food (bananas, avocados)

phlebitis

inflammation of a vein

Hypomagnesemia

less than 1.3 -Increases neuromuscular excitability (they would kick dramatic) -Nausea, vomiting, fatigue, arrhythmias -Muscle weakness, tremors, tetany, heart block, numbness, tingling *Hyperactive deep tendon reflex (DTR)*

blood transfusion reactions

low back pain, hypotension, tachycardia, fever, chills, chest pain, tachypnea, hemoglobinuria,

blood transfusion allergic reactions

mild: hives, pruritus, facial flushing severe: shortness of breath , bronchospasm, anxiety

autologous transfusion

occurs when a patient donates one's own blood for a transfusion

if you suspect cellulitis:

Stop, draw cultures, send tips for culture (we do this before to see specific what it is to treat it), antibiotics, antipyretics Asepsis and hand hygiene Replace catheter every 72-96 hours or per policy

Cellitus s/s

redness, warmth, swelling, pain, fever, chills, purulent discharge, edema, red streak

Hypocalcemia symptoms

-less than 9) -Increases neuromuscular excitability -Numbness and tinging around lips, fingers and toes -Muscle cramping, spasms, arrhythmias Confusion, personality changes, seizures if i take too much i'm chilled(hypo): greater than 10 ; Chvostek's (CHEEK) & Trousseau (TURN IN SPAMS) sign Hypocalcemia

Electrolyte imbalance

seriously disturbs vital body functions May occur separately or in combination: dehydration, over hydration

Discontinuing peripheral IV access importance

the patient's fluid volume has returned to baseline; the patient is being discharged from the facility; the IV catheter needs to be replaced; or the IV site has become unfavorable due to infection, infiltration, extravasation, or phlebitis.

Serum Osmolality

the ratio of water to solutes

dehyrdation example

think of McDonald with no water

Hypervolemia

too much fluids in my body the specific gravity would be lower than value (clear urine)

Total body water refers to the

total amount of water

The nurse is caring for a client with severe dehydration and a sodium level of 154 (high) mEq/L. Which of the following IV solutions should the nurse anticipate administering? Dextrose 5% in 0.45% normal saline Lactated ringers 0.45% normal saline Dextrose 5% in water

0.45% normal saline

The nurse is caring for a client with a sodium level of 122 (low) mEq/L. After assessing the client's neurologic status, which of the following IV solutions should the nurse anticipate administering? Dextrose 10% in Water Lactated ringers 0.45% normal saline Dextrose 5% in water

Dextrose 10% in Water

A client who had recent surgery has been vomiting and becomes dizzy when standing up to go to the bathroom. After assisting the client back to bed, the nurse notes that the blood pressure is 55/30 and the heart rate is 140. The nurse hangs which of the following IV fluids to correct this condition? D5 ½ NS at 50 mL/hr. 0.9% NS at an open rate D5W at 125 mL/hr. 0.45% NS at an open rate

0.9% NS at an open rate

Hypokalemia causes

Diarrhea, vomiting, furosemide (pee it out) Consider potassium-sparing diuretics (helps spare potassium)

Sodium levels

135-145

how long do you stay with paitent eith blood tranfusion?

15 mins

Transfusing blood procedure requires ________ checks

2 RN check

Every _____ pounds a person loses equates to 1 liter of fluid los

2.2

Initiating IV Therapy complications

Fluid overload Infiltration and extravasation Phlebitis Local infection Bleeding at IV insertion site

blood transfusion is given to

Hemoglobin 7-8 or below usually requires transfusion

Potassium normal range

3.5-5.0 mEq/L

normal range of calcium

9-10.5

Hypokalemia

-less than 3.5 Increased K+ output

A senior nurse delegates the task of intake and output to a new nursing assistant. The student will verify that the nursing assistant understands the task of I&O when the nursing assistant states: "I will record the amount of all voided urine" "I will not count liquid stools as output" "I will not record a café mocha as intake" I will notate perspiration and record it as a small or large amount"

"I will record the amount of all voided urine"

Isotonic IV FLUIDS

*Normal Saline (0.9% NaCl)* only give when changing the fluid the state hypoplovemic

Colliods

*plasma or volume expanders* Contain *larger* insoluble molecule Albumin, Hetastarch, Dextran 40

A patient is receiving an intravenous infusion of 0.9% normal saline. Which of the following assessment findings indicates that the patient has developed hypervolemia? (Select all that apply) Hypotension (expected) Crackles upon auscultation Jugular vein distention 3+ pitting edema in lower extremities Urine specific gravity of 1.036 (expected to be less)

-Crackles upon auscultation -Jugular vein distention -3+ pitting edema in lower extremities

blood transfusion 3 primary reasons to transfuse

-Increase blood volume -Increase the number of RBC's (hemoglobin levels) -Cellular component replacement (clotting factors, albumin, platelets, plasma, WBC)

A client who had recent surgery has been vomiting and becomes dizzy when standing up to go to the bathroom. After assisting the client back to bed, the nurse notes that the blood pressure is 55/30 and the heart rate is 140. The nurse hangs which of the following IV fluids to correct this condition? D5 ½ NS at 50 mL/hr.( hypertonic) 0.9% NS at an open rate D5W at 125 mL/hr. (too low dangerous) 0.45% NS at an open rate (hypotonic

0.9% NS at an open rate hypovolemia (only volume issues) (isotonic solution)

Magnesium normal range

1.3-2.1 mEq/L

Hypernatremia

Hypertonic Water deficit Cell shrinkage if I have water deficit my cell is shrinking

Air embolism S/S

Abrupt dyspnea, coughing, wheezing, hypotension, tachycardia, chest and shoulder pain.

A client is receiving an intravenous magnesium infusion to correct a serum level of 1.0 mEq/L. Which of the following assessment findings would alert the nurse to immediately stop the infusion? Absent patellar reflex Diarrhea Premature ventricular contractions Increase in blood pressure

Absent patellar reflex

Fluid Intake and Output

Assess 24-hr I&O (every fluid need to be reported)

Dehydration

Not enough water, increases salt concentration

blood transfusion can only be given with

Can only be given with *Normal Saline*

Initiating IV Therapy

Changing IV fluid containers, tubing, and dressings Assisting patient with ADLs

hypertonic

Concentrated (mom feels having nothing to live for anymore)

Osmolarity

Concentration or "pulling power"

VESCICANT FLUIDS EXTRAVASATION (if it happens) 3 C's

Cut off the infusion = STOP IT! Counteract = give an antidote(provider) (if available) Contain = elevate and apply a cool compress

overhyderation state

Hypervolemic, hyponatremic

Hyponatremia

Hypotonic Water intoxication Cell swelling too much water and cell swells

Dehydration state

Hypovolemic, hypernatremic state

Cellitus

Infection of skin cells

fluid overload s/s

JVD Elevated BP, HR, RR Crackles in the lungs Shortness of breath Edema Enlarged spleen or liver

Infiltration

Leakage of IV fluid or medication into the extravascular tissue

Infiltration s/s & interventions

Leakage of IV fluid or medication into the extravascular tissue Edema, pallor, cool temperature, pain, fluid leak Difficult to flush or infuse interventions: Elevate extremity D/C IV Apply warm compress, take iv out

VESCICANT FLUIDS prevention:

Monitor every 15 minutes during infusion

Hypertonic IV fluids

More solutes than in the cells Causes a shift of fluid into the cells *3% Sodium Chloride, D51/2 NS, D5NS, D5LR, D10W* Used to treat hyponatremia and cerebral edema fluid is coming out (hypo state uses hypernatuic state)

Hyperkalemia Clinical manifestations

Muscle weakness Peaked T wave

Hypokalemia Clinical manifestations

Muscle weakness (shallow respirations, fatigue) -Dysrhythmias - Prominent U waves

Intake

Oral, intravenous

A client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented? Encourage fluids orally Administer 10% NS IV piggyback Administer antidiuretic hormone intranasally Place on seizure precautions

Place on seizure precautions

The nurse is caring for a client who is on diuretic therapy. The client begins to complain of leg cramping and fatigue. Which lab value is consistent with this finding? Calcium 8.0 mg/dL Potassium 3.1 mEq/L Magnesium 1.9 mEq/L Sodium 139 mEq/L

Potassium 3.1 mEq/L

ADPIE: PLANNING & IMPLEMENTATION

Prevent or correct fluid, electrolyte and acid-base imbalances

Water and body fluids functions

Primary body fluid Transports nutrients and waste Transports hormones, enzymes, blood products Facilitate cellular metabolism Acts as a solvent Maintains body temperature Digestion and elimination

phlebitis S&S and intervention

Redness, Heat, Pain, Swelling D/C (discontinue) IV interventions: Apply a moist warm compress, take it out and start again

Hyperkalemia causes

Renal failure, dehydration, diabetes, getting or eating too much potassium,

fluid overload preventions:

Review the history for cardiac and renal problems Use a pump Assess frequently Accurate I & O Daily weights

if fluid overload happens:

STOP the infusion Assess the ABC's, take vitals Elevate HOB Plan for diuretics and modify fluid intake

The nurse is evaluating lab values on four clients. Which lab value is a priority for the nurse to report to the provider? Calcium 10.0 mg/dL Magnesium 1.8 mEq/L Potassium 3.8 mEq/L Sodium 149 mEq/L

Sodium 149 mEq/L

Crystalloids

Solutions of salts, water, and variable electrolyte composition

Air embolism treatment

Stop the infusion, clamp the line, place on side with with head down *Trendelenburg*, call a code or Rapid Response, provide O2 if needed Prime the line, burp the bag, monitor patient

The nurse reviews the electrolyte results of a client and notes that the potassium is 5.4 mEq/L. Which of the following would the nurse expect to note on the electrocardiogram as a result of the laboratory value? ST depression Inverted T wave Prominent U wave Tall peaked T waves

Tall peaked T waves *greater than 5*

air embolism

The presence of air in the veins, which can lead to cardiac arrest if it enters the heart.

Output

Urine, feces, vomitus, gastric secretions, wound drainage

fluid overload

a condition in which the body cannot eliminate the fluid consumed

CATHETER EMBOLISM

a small portion of the catheter breaks off and enters vascular system considered medical emergency

Osmosis

diffusion of water across a selectively permeable membrane

if hanging magnesium you need _________

another nurse

Hypotonic

dilute everyone around the mom and she exposes (too much water not enough solutes)

Hypovolemia causes

blood loss, GI loss, severe burns, third spacing, excessive sweating and urination Weak pulse, hypotension, poor skin turgor, flat neck veins tachycardia, weight loss

Hypolemia

body is working harder to get the fluid, does not have enough water urine color: dark would be above urine specific gravity

Volume imbalances

disturbances of the amount of fluid in the extracellular compartment hypovolemia, hypervolemia

Hypotonic IV FLUIDS

cause a shifting fluid in the cell (hypernatremic state to hypotonic solution) (anything less than *0.9* is hypotonic *Sodium Chloride .45%, .33% or .225% (1/2 NS, 1/3 NS, ¼ NS)* Treats hypernatremia and diabetic ketoacidosis

overhyderation & Hyponatremia

cerebral edema: lethargy, confusion, HA, restlessness, irritability, seizures, coma

dehydration and hypernatremia

confusion, lethargy, irritability, muscle twitching, *seizures*

t/f We need Vitamin D for absorption of Calcium

true (besties need to be together)

t/f We do not push Potassium

true , hang it and give pills (2-4 hours)

catheter embolism interventions

utlrasound and need to fix immediately

Laboratory Studies

we need to make sure we ask because it can get lower. so assess

physical assessment Consistent conditions:

weight them in same clothes,, voiding, before eating , same time daily (Consistent conditions)

blood transfusion

whole blood or cells are taken from a donor and infused into a patient

Overhydration example

whole bunch of water not enough fries but whole drink