Chapter 18- Fluids
what is insensible loss?
- perspiration and expiration
What are the very young, the old, and obese most at risk for?
Dehydration This group of people has less fluid reserves, thus leading to fluid volume deficit that leads to dehydration
•Output includes
all fluids leaving the body. §Sensible loss - urine, diarrhea, vomitus, nasogastric suction, and chest tube drainage. •Also included is drainage from surgical wounds and drainage collected in surgical receptacles such as the Jackson-Pratt, Davol, or Hemovac systems. §Insensible loss - perspiration and expiration
•Calcium §Hypocalcemia nursing considerations
§Administer oral or IV Ca supplements oMonitor respirations and cardiovascular status §Initiate seizure precautions §Encourage foods high in calcium
expected findings for • §Hypomagnesemia
§Increased nerve impulse transmission, positive Chvostek / Trousseau's sign, tetany, seizures, tremors, cramping, paresthesia §Dysrhythmia, tachycardia, hypertension •Nursing considerations §d/c magnesium-losing medications §PO or IV magnesium sulfate §Encourage foods high in magnesium oWhole grains, dark green vegetables
dilute urine
§The kidneys react to fluid excesses by excreting a more _________________ to get rid of excess fluid and conserves electrolytes.
Active transport: •Magnesium
§The second most abundant cation in the intracellular fluid §Normal level is 1.5 to 2.4 mEq/L •ATI = 1.3 - 2.1 mEq/L §Although only small amounts are in the blood, it is important in maintaining normal body function §The majority is found in bone, muscle, and soft tissue §Dietary intake is usually 200 to 400 mg per day §It is commonly distributed in foods: whole grains, fruits, vegetables, meat, fish, legumes, and dairy products §The major route of excretion is the kidneys
•Metabolic Acidosis results from++++++++++++
§This can result from a gain of hydrogen ions or a loss of bicarbonate: retaining too many acids or losing too many bases §Without sufficient bases, the pH of the blood falls below normal; the bicarbonate level will also drop §The result is hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to lower the Pco2 level §Treatment is the administration of sodium bicarbonate
§Isotonic solutions
•A solution of same osmotic pressure •Expands the body's fluid volume without causing a fluid shift
•Question: The nurse assigns a certified nurse's assistant to document the fluid intake and output for a patient who had a lobectomy and splenectomy. The patient has been voiding per urinal, has a chest tube to low suction, and has a JP drain. The nurse answers the patient's call light and sees the JP has a lot of serosanguineous fluid. What should the nurse say to the assistant?
•Answer: First, the nurse should assess the assistant's level of knowledge regarding fluid intake and output. Then the nurse should demonstrate how to measure the chest tube drainage and how to measure and empty the JP. The nurse should inform the assistant that these are considered output measurements.
•Active Transport Potassium §HYPOkalemia
•Decrease in body's potassium to a level below 3.5 mEq/L •The major cause of loss is renal excretion •The kidneys do not conserve potassium and excrete it even when the body needs it •Potassium can be depleted due to excessive GI losses from gastric suctioning or vomiting and the use of diuretics •This can affect skeletal and cardiac function
•Metabolic Alkalosis §Results from
•Hypokalemia •Base excess (ingestion or antacids, sodium bicarb) •Acid deficit (nasogastric suction, prolonged vomiting) •Potassium depletion (thiazide diuretics) •Increased digoxin toxicity §Nursing considerations •For GI: antiemetics, replace fluids / electrolytes •For Potassium depletion: d/c cause (medications)
•Potassium §HYPERkalemia
•Increase in the body's serum potassium level above 5 mEq/L •Gained through intake and lost by excretion •The major cause of excess potassium is renal disease; severe tissue damage causes potassium to be released from the cell •Excessive increase in foods high in potassium can cause serum levels to increase •This can cause cardiac arrest •Kayexalate is an antidote
what is the largest of the two fluid compartments?
•Intracellular Fluid §Largest of the two compartments §Contains the fluid inside the billions of cells within the body
what are the fluid compartments?
•Intracellular Fluid §Largest of the two compartments §Contains the fluid inside the billions of cells within the body •Extracellular Fluid §Contains any fluid outside the cell §Divided into interstitial and intravascular compartments
•Calcium §HYPERcalcemia
•It occurs when calcium levels exceed 5.6 mEq/L §ATI = GREATER THAN 10.5 mg/dL •It may occur when calcium stored in the bones enters the circulation; occurs with immobilization •An increased intake of calcium or vitamin D also may be a cause •Neuromuscular activity is depressed and renal calculi may develop
sodium: HYPOnatremia
•Less than normal concentration of sodium in the blood •Sodium level less than 136 mEq/L (ATI) •Can occur when there is a sodium loss or a water excess •Body attempts to compensate by decreasing water excretion •More water in ECF will force that water into the ICF resulting in swelling of cells
Hypophosphatemia VS §Hyperphosphatemia
•Phosphorus §Hypophosphatemia •Can occur from a dietary insufficiency, impaired kidney function, or maldistribution of phosphate •Muscle weakness possible •Treatment is to replace phosphorus via PO or IV §Hyperphosphatemia •Most commonly occurs as a result of renal insufficiency; also can occur with increased intake of phosphate or vitamin D •Signs and symptoms: tetany, numbness and tingling around the mouth, and muscle spasms •Treat underlying cause
•Respiratory Acidosis §Results from:
•Respiratory depression •Brain injuries, cerebral aneurysms, CVA •Inadequate chest expansion •Airway obstruction •COPD, asthma, PNA, cystic fibrosis §Nursing considerations: •Maintain airway •Oxygen therapy / enhance gas exchange
•Respiratory Alkalosis §Results from:
•Hyperventilation due to fever •Respiratory infections •Hypoxemia from asphyxiation •High altitudes §Nursing considerations •Oxygen therapy (rebreather mask) •Anxiety reduction •Rebreathing techniques
what plays an important role in fluid imbalance?
•The kidneys •If the kidneys are not functioning properly, the body has great difficulty in regulating fluid balance. •Glomerular Filtration Rate (GFR) §Nephrons filter blood at a rate of 125 mL per min, or about 180 L per day. §This leads to output of 1 to 2 L of urine per day.
intake & output
•The normal daily loss of fluids must be met by the normal daily intake. •Daily water intake and output is approximately 2500 mL. •Fluid leaves the body through the kidneys, lungs, skin, and GI tract. •Water loss is replenished by ingestion of liquids and foods and by metabolism of food and body tissues.
•Fluid volume deficit per ATI: ISOTONIC FVD
- Loss of water and electrolytes from the ECF = Hypovolemia §Dehydration - Loss of water from body without the loss of electrolytes •Causes §GI loss; vomiting, nasogastric suctioning, diarrhea §Diaphoresis §Impaired renal function / diabetes / DKA §Hemorrhage
The health care provider has ordered an arterial blood gas (ABG) test on your patient. The pH level on the test comes back as 7.29. What is this result considered?
Acidic The normal range for pH is 7.35 to 7.45. Anything above 7.45 is alkaline and anything below 7.35 is acidic.
The body is divided into fluid compartments. Which compartment is the largest and contains fluid inside the cells within the body?
Intracellular The body's largest fluid compartment is the intracellular, which contains fluid inside the cells. The extracellular compartment contains any fluid outside the cells. The interstitial and intravascular compartments are within the extracellular compartment.
A head injury patient has been admitted to ICU with dyspnea, tachycardia, tremors, lethargy, and disorientation. The results of an arterial blood gas showed pH = 7.28, PaCO2 = 60 mm Hg, HCO3 = 22 mEq/L. What condition is suspected?
Respiratory acidosis With respiratory acidosis, the pH is less than 7.35, PaCO2 is greater than 45 mm Hg and the HCO3 is normal. With respiratory alkalosis, the pH is greater than 7.45, PaCO2 is less than 35mm Hg and the HCO3 is normal. With metabolic acidosis, the pH is less than 7.35, PaCO2 is normal or less than 35mm Hg, and the HCO3 is below 22mEq/L. With metabolic alkalosis, the pH is greater than 7.45, PaCO2 is normal or greater than 45 mm Hg, and the HCO3 is greater than 26 mEq/L.
The body has systems that work to keep the pH in the narrow range of normal. What body systems work to keep the pH in the narrow range of normal? (Select all that apply.)
The blood buffers respiratory systems, and kidneys are the body's three lines of defense that are constantly working to maintain a normal pH. The GI and nervous system are not a part of this.
•Intake includes
all fluids entering the body. §Fluids can be liquids taken orally or consumed in food, including foods that assume a liquid consistency at room temperature. §This also includes tube feedings and parenteral intake such as intravenous fluids, blood components, and total parenteral nutrition.
§Hypotonic solutions
•A solution of fewer concentration electrolytes than body •Has more water vs your cell •Moves fluids into the cell, causing them to enlarge
§Hypertonic solutions
•A solution of higher concentration of electrolytes than body •Has less water vs your cell •Pulls fluid from the cells
Acid base balance: is what kind of relationship
•An inverse relationship exists between hydrogen ion concentration and the pH level: As the numbers of hydrogen ion increase, the acidity of the solution increases, and the pH decreases. increase in H = decrease in pH •The opposite happens with alkalinity; the number of hydrogen ions decreases and the pH increases decrease in H = increase in pH
what is sensible loss?
- urine, diarrhea, vomitus, nasogastric suction, and chest tube drainage. •Also included is drainage from surgical wounds and drainage collected in surgical receptacles such as the Jackson-Pratt, Davol, or Hemovac systems.
NORMAL VALUES ATI MUST MEMORIZE
1.pH = 7.35-7.45 2.PaCO2 = 35-45 3.HCO3 = 21-28mEq/L
how to set up chart
1.pH = 7.35-7.45 2.PaCO2 = 35-45 3.HCO3 = 21-28mEq/L ● pH: Acidosis 7.35 - 7.45 Alkalosis PaCO2: Acidosis 45 - 35 Alkalosis HCO3: Acidosis 21 - 28 Alkalosis
Of all the electrolyte disorders, which disorder is considered the most dangerous and potentially fatal?
ANSWER: Hyperkalemia is an elevated level of potassium and is considered the most dangerous. It can lead to serious arrhythmias or cardiac arrest. Hypernatremia causes cellular dehydration and an interruption in cellular processes, but it is not the most dangerous of the disorders listed. Hypercalcemia can depress neuromuscular activity and lead to the development of renal calculi, but it is not the most dangerous of the disorders listed. Hypermagnesemia restricts nerve and muscle activity but is not the most dangerous of the disorders listed.
What is the process that requires energy to move fluids, electrolytes, and other solutes across the semipermeable membrane that surrounds the cells?
Active transport Active transport requires energy to move substances from low concentration to high concentration. Diffusion, osmosis, and filtration are parts of passive transport and require no energy.
A patient is admitted with a diagnosis of dehydration. Which type of IV fluid might the nurse expect the health care provider to order to expand the body's fluid volume?
Isotonic solution Isotonic solution is a solution of the same osmotic pressure that expands the body's fluid volume without causing a fluid shift from one compartment to another. Hypertonic solution is a solution of higher osmotic pressure that pulls fluid from the cells. Hypotonic solution is a solution of lower osmotic pressure that moves fluid into the cells, causing them to enlarge. Pretonic solution is not a type of solution used to expand fluid volume.
concentrated urine
Loss of fluid will result in kidneys trying to conserve fluid by reabsorbing water, therefore more __________
What is/are the primary excretion route(s) for the electrolytes sodium and potassium?
The kidneys are the primary route of excretion and affect how much is retained and how much is excreted.
The nurse is caring for a patient with a history of fluid retention. What is the best way to monitor the water balance in the body of this patient?
Weigh daily after the morning shower. By weighing daily, a sudden change in weight will show an increase in fluid retention. Weighing needs to be the same time each day since there are fluctuations in weight throughout the day.
what is the percentage of body weight that water depends on?
depends on several factors. §Age •Premature infant: 90% •Newborn: 70% to 80% •Twelve years to adult: 50% to 60% •Older adults: 45% to 55%
•Acid-base balance
means homeostasis of the hydrogen ion concentration in the body fluids. •The hydrogen ion concentration is determined by the ratio of carbonic acid to bicarbonate in the extracellular fluid. •The ratio needed for homeostasis is 1 part carbonic acid to 20 parts bicarbonate. •The symbol used to indicate hydrogen ion balance is pH. •Arterial blood gases determine whether a solution is acid, neutral, or alkaline; the more hydrogen ions in a solution, the more acid is the solution, and the fewer hydrogen ions, the more alkaline is the solution.
active transport: sodium
§A cation + §Most abundant electrolyte in the body §Normal level: 135 to145mEq/L •ATI 136 - 145 mEq/L §Major source is from the diet; frequently must be limited §Functions of sodium: regulates water balance, controls extracellular fluid volume, increases cell membrane permeability, stimulates conduction of nerve impulses and helps maintain neuromuscular irritability, controls contractility of muscles
active transport:•Bicarbonate
§A main anion of the extracellular fluid §Normal level is 22 to 24 mEq/L •ATI = 21 - 28 mEq/L (ATI Med Surg, pg 255) §It is an alkaline electrolyte whose major function is the regulation of the acid-base balance. §It acts as a buffer to neutralize acids in the body and maintain the 20:1 bicarbonate/carbonic acid ratio needed to keep the body in homeostasis. §The kidneys selectively regulate the amount of bicarbonate retained or excreted.
active transport: calcium
§A positively charged ion §Normal level is 4.5 mEq/L-5.6 mEq/L •ATI = 9 - 10.5 mg/dL §Of calcium in the body, 99% is concentrated in the bones and teeth. §Calcium is deposited in the bones and mobilized as needed to help keep the blood level constant during any period of insufficient intake. §Vitamin D, calcitonin, and parathyroid hormone are necessary for absorption and utilization of calcium. §The best food sources are milk and cheese.
•Nursing Diagnoses
§Actual or risk for deficient fluid volume §Imbalanced nutrition, less than body requirements §Fluid volume excess §Impaired or risk for impaired skin integrity §Impaired tissue integrity §Impaired oral mucous membrane §Ineffective tissue perfusion §Decreased cardiac output §Impaired gas exchange §Ineffective breathing pattern
active transport: •Chloride
§An extracellular anion §Normal level is 96 to 106 mEq/L §It is the chief anion in interstitial and intravascular fluid §It has the ability to diffuse quickly between the intracellular and extracellular compartments and combines easily with sodium to form sodium chloride or with potassium to form potassium chloride §Daily requirement is equal to that of sodium §The main route of excretion is the kidneys
• what are the three systems the body work to keep the pH in the narrow range of normal
§Blood buffers: Buffers circulate throughout the body in pairs, neutralizing excess acids or bases by contributing or accepting hydrogen ions §Lungs: By speeding up or slowing down respirations, the lungs can increase or decrease the amount of carbon dioxide in the blood §Kidneys: They excrete varying amounts of acid or base •The three systems work closely together to maintain a normal hydrogen ion concentration
Active Transport: phosphorus
§Chiefly an intracellular anion §Normal level is 2.4 to 4.1 mEq/L. §Phosphorus and calcium have an inverse relationship in the body; an increase in one causes a decrease in the other. §The majority is found in bones and teeth combined with calcium. §Dietary intake is usually 800 to 1500 mg per day. §An adequate intake of vitamin D is necessary for the absorption of both calcium and phosphorus.
•Calcium §Hypercalcemia •Expected findings
§Decreased reflexes, bone pain, flank pain r/t renal calculi §Dysrhythmia, confusion, weakness, lethargy oShortened QT intervals •Nursing considerations §Encourage fluid intake to promote excretion oAlso to decrease risk for renal calculi §Encourage fiber to promote bowel elimination §Limit dietary calcium §Monitor for blood clots
§Hypermagnesemia •Expected findings
§Diminished deep tendon reflexes (DTRs) §Muscle paralysis §Shallow, decreased respirations §Bradycardia, dysrhythmia, hypotension, cardiac arrest §Lethargy •Nursing considerations §Frequent focused assessments §Monitor respirations and cardiac status •Treatment §Loop diuretics and magnesium free IV fluids ONLY if GFR allows §Calcium for severe cardiac changes
§HYPERnatremia •Expected findings
§Disorientation, muscle weakness, seizures, thirst, dry and mucous membranes, edema, oliguria •Nursing considerations §Monitor I&O §Monitor LOC §Provide oral hygiene and other comfort measures to decrease thirst •Treatment §Hypotonic solutions (0.225% sodium chloride)
Active Transport: •Potassium
§Dominant intracellular cation + §Normal level is 3.5 to 5 mEq/L §Promotes transmission of nerve impulses and skeletal muscle function •K+ imbalance = dysrhythmia §The routes of potassium excretion are the kidneys, in the feces, and through perspiration §The kidneys control the excretion of potassium §The main function is regulation of water and electrolyte content within the cel
active transport: electrolytes
§Electrolytes develop tiny electrical charges when they dissolve in water and break up into particles known as ions. §Ions develop either a positive or negative electrical charge. •Cations have a positive charge. •Anions have negative charge. §A balance exists between the electrolytes; for each positively charged cation, there must be a negatively charged anion.
how much water does fat contain?
§Fat contains relatively little water. §The female has proportionately more body fat than the male, which means that the female has less body fluid. §The more obese an individual, the lesser the percentage of body water. •Extracellular fluid is lost from the body more rapidly than intracellular fluid.
•Expected findings: HYPOnatremia
§Headache, confusion, lethargy, muscle weakness, fatigue, seizures, coma •Nursing considerations §Monitor I&O §Weight §Monitor for ALOC, report irregular findings §Encourage pt to change positions slowly §Follow fluid restriction per order §Monitor muscle weakness •Treatment §Hypertonic solution; 3% Sodium Chloride
Osmosis Hypertonic Hypotonic Isotonic
§Hypertonic solutions •A solution of higher concentration of electrolytes than body •Has less water vs your cell •Pulls fluid from the cells §Hypotonic solutions •A solution of fewer concentration electrolytes than body •Has more water vs your cell •Moves fluids into the cell, causing them to enlarge §Isotonic solutions •A solution of same osmotic pressure •Expands the body's fluid volume without causing a fluid shift
•Chloride HYPOchloremia vs HYPERchloremia
§Hypochloremia •It usually occurs when sodium is lost, because sodium and chloride are frequently paired •The most common causes of hypochloremia are vomiting and prolonged nasogastric or fistula drainage §Hyperchloremia •It rarely occurs but may be seen when bicarbonate levels fall.
Fluid Volume Deficit per ATI expected findings
§Hypotension / orthostatic hypotension §Tachycardia with thready pulse §Tachypnea §Dizziness, syncope, confusion, fatigue §Thirst, dry mucous membranes, acute weight loss §Oliguria §Diminished capillary refill §Decreased skin turgor §Urine specific gravity greater than 1.030 §Serum osmolarity greater than 295 mOsm/kg
•Expected findings: ISOTONIC FVD
§Hypotension / orthostatic hypotension §Tachycardia with thready pulse §Tachypnea §Dizziness, syncope, confusion, fatigue §Thirst, dry mucous membranes, acute weight loss §Oliguria §Diminished capillary refill §Decreased skin turgor §Urine specific gravity greater than 1.030 §Serum osmolarity greater than 295 mOsm/kg
what are the 2 parts divided of extracellular fluid called?
§Interstitial fluid •Between the cells or in the tissue •Accounts for approximately 27% of the fluid in the body •Examples: lymph, cerebrospinal fluid, and gastrointestinal secretions §Intravascular fluid •Plasma within the vessels •Makes up 7% of fluid volume
Fluid Volume Deficit per ATI
§Isotonic FVD - Loss of water and electrolytes from the ECF = Hypovolemia §Dehydration - Loss of water from body without the loss of electrolytes •Causes §GI loss; vomiting, nasogastric suctioning, diarrhea §Diaphoresis §Impaired renal function / diabetes / DKA §Hemorrhage
•Fluid volume excess per ATI
§Isotonic retention of water and sodium in high proportions •Hypervolemia = increased blood volume §Overhydration •aka Hypoosmolar fluid imbalance •Retention of more water than electrolytes §Severe fluid volume excess can lead to pulmonary edema and heart failure
what are the methods by the body to move fluids , electrolytes, solutes, or dissolved substances IN AND OUT of cells?
§Passive transport processes •No cellular energy is required to move substances from a high concentration to a low concentration. §Active transport processes •Cellular energy is required to move substances from a low concentration to a high concentration.
•Potassium §HYPERkalemia •Expected findings
§Slow irregular pulse, hypotension, irritability, confusion, paresthesia, lack of reflexes §V-fib, peaked T waves, widening QRS •Nursing consideration §Monitor cardiac rhythm (EKG) §Maintain / monitor IV access oPrep for dialysis as needed •Treatment §Antidote Kayexalate §Decrease K+ intake; stop infusion, withhold oral K+ supplement, potassium-restricted diet §Dialysis
Fluid Volume Excess per ATI expected findings
§Tachycardia §Hypertension §Tachypnea §Confusion §Muscle weakness §Weight gain, ascities §Dypsnea, crackles in the lungs §Edema, JVD §Urine specific gravity less than 1.010 §Serum osmolarity less than 280 mOsm/kg
•Calcium §Hypocalcemia •Expected findings
§Tetany oNumbness / tingling around face and mouth oFrequent, painful muscle spasms oPositive Trousseau's sign oPositive Chvostek's sign §Weak, thready pulse, oCardiac dysrhythmia; Prolonged QT intervals and ST segments §Seizures
What is respiratory acidosis?
§This is caused by any condition that impairs normal ventilation §A retention of carbon dioxide occurs with a resultant increase of carbonic acid in the blood §As the pH falls, the Pco2 level increases §Shallow respirations result because of the retained carbon dioxide §Treatment is aimed at improving ventilation and correcting the primary condition responsible for the imbalance
•Respiratory Alkalosis is caused by
§This is caused by hyperventilation. §Respirations that increase in rate, depth, or both can result in loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood. §The pH rises because of the decrease in carbonic acid being blown off with each exhalation. §Treatment is sedation and reassurance; breathing into a paper bag will cause rebreathing of the exhaled carbon dioxide.
PASSIVE TRANSPORT: DIFFUSION
§This is the movement of particles in all directions through a solution or gas. §Solutes move from an area of higher concentration to an area of lower concentration, which eventually results in an equal distribution of solutes within the two areas.
PASSIVE TRANSPORT: OSMOSIS
§This is the movement of water from an area of lower concentration to an area of higher concentration. §It equalizes the concentration of ions or molecules on both sides of the membrane. §The flow of water will continue until the number of ions or molecules on both sides are equal. §This is all happening through a semipermeable membrane
Passive transport: •Filtration
§This is the transfer of water and dissolved substances from an area of higher pressure to an area of lower pressure. §A force behind filtration is called hydrostatic pressure, or the force pressing outward on a vessel wall. §The pumping action of the heart is responsible for the amount of force of the hydrostatic pressure that causes water and electrolytes to move from the capillaries to the interstitial fluid.
•Metabolic Alkalosis results
§This results when a significant amount of acid is lost from the body or an increase in the bicarbonate level occurs §The most common cause is vomiting gastric content, normally high in acid §It can also occur in patients who ingest excessive amounts of alkaline agents, such as bicarbonate-containing antacids §The central nervous system is depressed §Treatment is aimed at the cause
•Question: The nurse is assessing a heart failure patient who has 2 + peripheral edema. The nurse knows this means there is fluid in which space?
•Answer: Edema indicates there is extracellular fluid. The fluid is not in the cells; it is in the interstitial spaces.
what is §Hypermagnesemia
•Develops when blood levels exceed 2.5 mEq/L §ATI = GREATER THAN 2.1 mEq/L •It rarely occurs when kidney function is normal •Major causes are impaired renal function, excess magnesium administration, and diabetic ketoacidosis when there is severe water loss •An excess of magnesium severely restricts nerve and muscle activity
what is §Hypomagnesemia?
•Develops when blood levels fall below 1.5 mEq/L §ATI = LESS THAN 1.3 mEq/L •A decreased level often parallels decreased potassium. •Signs and symptoms: increased neuromuscular irritability similar to those observed with hypocalcemia •Major causes are increased excretion by the kidneys, impaired absorption from the GI tract, and prolonged malnutrition.
•Calcium §Hypocalcemia
•Develops when the serum level is below 4.5 mEq/L (ATI = LESS THAN 9 mg/dL) •A deficiency may be caused by infusion of excess amounts of citrated blood, excessive loss through diarrhea, inadequate dietary intake, surgical removal of parathyroid, pancreatic disease, or small bowel disease
•Metabolic Acidosis §Results from:
•Excess production of hydrogen ions •Diabetic ketoacidosis (DKA) •Starvation •Hyperkalemia •Liver / kidney disease •Diarrhea (excess elimination of bicarb) §Nursing considerations: •For DKA: insulin •For GI loss: rehydration and antidiarrheals •For low bicarb: IV sodium bicarbonate prn
•Potassium §HYPOkalemia •Expected findings
•Expected findings §Weak irregular pulse, hypotension, respiratory distress, muscle cramping, hypoactive reflexes, mental confusion §PVC, brady/tachycardia, flattening T waves, ST depression •Nursing considerations §Monitor for shallow ineffective respirations §Monitor LOC §Monitor I&O •Treatment §Replace K+ / food or supplements §K rider - 10mEq of KCL in 100 mL of NS
what is the function of water?
•Functions §Provides an extracellular transportation route to deliver nutrients to the cells and carry waste products from the cells §Provides a medium in which chemical reactions, or metabolism, can occur within the cell §Acts as a lubricant for tissues §Aids in the maintenance of acid-base balance §Assists in heat regulation via evaporation
•Sodium :HYPERnatremia
•Greater than normal concentration of sodium in the blood •Sodium level greater than 145 mEq/L •Can occur when there is a sodium excess or a water loss •Body attempts to correct the imbalance by conserving water through renal reabsorption •Causes fluid to shift from the cells to the interstitial spaces, resulting in cellular dehydration
•A nurse is caring for a male patient who has been diagnosed with hypercalcemia. The patient admits to taking several calcium supplements at home. The patient has developed renal calculi and is having pain. Upon entering the room, the nurse notes the patient's respiratory rate is 40, he has cyanosis of his lips, and he is lethargic. She calls the doctor, who orders ABGs stat, which reveal the patient is in respiratory alkalosis. How does the nurse manage this patient?
•Guidelines: In respiratory alkalosis, the patient is losing too much carbon dioxide or hyperventilating. The best action for the nurse would be to provide a paper bag for the patient to place around his mouth and breathe in and out through his mouth. This will cause the patient to inhale exhaled carbon dioxide, therefore increasing the patient's carbon dioxide levels.
active transport
•Requires energy •Process of moving molecules against pressure through a membrane with the use of "carriers" and energy from the cell •Force that moves molecules into cells without regard for their positive or negative charge and against concentration factors that would prevent entry via diffusion •Substances actively transported through the cell membrane: sodium, potassium, calcium, iron, hydrogen, amino acids, and glucose.
Steps 1-4
•STEP 1 : §IF pH below 7.35 = acidosis §IF pH above 7.45 = alkalosis •Keep in mind 7.40 is the mid point •STEP 2: §PaCO2 less than 35 or greater than 45 = respiratory §HCO3 less than 21 or greater than 28 = metabolic •STEP 3: §Combine step 1 and step 2 finding •STEP 4: §IF PaO2 and SaO2 are below expected range = hypoxic
Step 5
•STEP 5: Determine compensation • §Uncompensated = pH AND either HCO3 or PaCO2 is outside range (pH + one or the other) § §Partially compensated = pH, HCO3, PaCO2 all outside range § §Fully compensated = pH within range, PaCO2 and HCO3 outside range
Movement of Fluid and Electrolytes
•Substances entering the body begin their journey in the extracellular fluid. •To carry out their functions, they must cross the semipermeable membrane surrounding each body cell to enter the cell. §This is accomplished through active and passive transport
how much should the kidneys excrete per hour?
•must excrete a minimum of 30 mL/hour of urine to eliminate waste products from the body. §Loss of fluid will result in kidneys trying to conserve fluid by reabsorbing water, therefore more concentrated urine §The kidneys react to fluid excesses by excreting a more dilute urine to get rid of excess fluid and conserves electrolytes. •A simple and accurate method of determining water balance is to weigh the patient under exact conditions. §1 L of fluid equals 1 kg (2.2 lb); a weight change of 1 kg will reflect a loss or gain of 1 L of body fluid.
