chapter 52 Fluid Electrolyte balance

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chapter 52 Fluid Electrolyte balance
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  1. •Causes–GI losses (N/V, diarrhea, GI suction)–Renal loss: kidney disease, diuretics–Skin loss: excessive perspiration, burns–Inappropriate ADH
    Hyponatremia
  2. •S/S

    –Personality∆,
    postural hypotension- dry
    mucus membrane


    –Abdominal cramping

    –N/V, diarrhea, dry mucous membranes

    –Tachycardia-fast

    –Convulsions------ coma

    –Na+ <135 mEq/L

    –Urine sp. Gravity < 1.010
    hyponatremia
  3. Water
    moves from the blood into the cells

    Swelling:
    most dangerous consequence: swelling in the legs, abdomen, and BRAIN

    Fatigue,
    seizure, coma, confusion, death
    hyponatremia
  4. kidney
    disease

    heart disease

    liver cirrhosis

    thyroid disorder

    Addisons
    disease

    brain disorder

    cancer
    hyponatremia
  5. May
    be caused by antidiuretics, too much water
    intake , SIADH syndrome of anti-diuretic hormone secretion
    hyponatremia
  6. the
    pee is dark concentrated because vasopressin hormone made the kidneys “think”
    that they should keep water in, therefore elevating water in body, decreasing
    sodium level.
    hyponatremia
  7. from
    DRINKING TOO MUCH WATER.
    hyponatremia
  8. Nursing
    intervention: fluid restriction
    hyponatremia
  9. –Na+ <135 mEq/L
    hyponatremia
  10. –Personality∆,
    postural hypotension- dry
    mucus membrane


    –Abdominal cramping

    –N/V, diarrhea, dry mucous membranes

    –Tachycardia-fast

    –Convulsions------ coma
    hyponatremia
  11. Diarrhea

    Diuretic
    medication

    Excessive
    salt intake

    Excessive
    vomiting

    Heavy
    respiration (e.g., exercise, exertion)

    Severe
    burn

    Sweating
    hypernatremia
  12. Body tries to even out decreased
    level of salt by pushing water out of cells. As a result, the cells become
    dehydrated.
    hypernatremia
  13. Thirst mechanism: the body is
    stimulated to drink water which helps correct:
    hypernatremia
  14. Intervention- encourage fluids as
    ordered

    Restrict intake of foods high in sodium
    hypernatremia
  15. •Causes

    –↑ salt intake, too much salt, too little water

    –↑ aldosterone secretion

    –Diabetes Insipidus


    –↑ water loss

    –Water deprivation

    –Loss of water, gain of sodium
    hypernatremia
  16. –Na+ >145mEq/L
    hypernatremia
  17. •S/S

    –c/o extreme
    thirst

    –Dry/flushed
    skin

    –Dry
    mucous membranes

    –Postural hypotension

    –Fever, agitation

    –Convulsions, restlessness

    –Irritable
    hypernatremia
  18. ventricles may become irritable, possibly
    causing ventricular arrhythmias and even cardiac arrest
    hypokalemia
  19. You'll be on the lookout for the
    following:

    * skeletal muscle weakness, usually in
    the legs, that may lead to flaccid paralysis

    * muscle weakness spreading from legs to
    trunk and involving respiratory muscles

    * smooth-muscle hyperactivity,
    particularly in the GI tract, resulting in nausea, abdominal cramping, and
    diarrhea

    * restlessness and tingling in the lips and fingers
    hypokalemia
  20. * eliminating the cause of serum
    potassium loss

    * replacing lost potassium.

    The patient's health care provider will order oral and/or
    I.V. administration of potassium chloride to reverse hypokalemia. Potassium chloride comes in tablet and
    liquid forms and is usually administered after a patient has eaten to limit GI
    distress
    hypokalemia
  21. •Causes

    –K+ wasting diuretics- lasixs


    –Diarrhea, vomiting, GI losses

    –Alkalosis

    –↑ aldosterone secretion

    –Polyuria-excessive peeing!

    Extreme sweating
    hypokalemia
  22. K+ < 3.5 mEq/L
    hypokalemia
  23. •S/S

    –Weakness & fatigue

    –N/V, intestinal distention

    –↓ bowel sounds

    –↓ deep tendon reflexes

    –Ventricular dysrhythmias-life
    threatening

    –Paresthesia &
    weak irregular pulse
    hypokalemia
  24. –ECG abnormalities
    hyperkalemia
  25. –K+ >5.0 mEq/L
    hyperkalemia
  26. •Causes

    –Renal failure

    –FVD

    –Massive cellular damage

    –↑ amounts of IV fluids with K+

    –Adrenal insufficiency

    –Acidosis- diabetic ketoacidosis


    –K+ sparing diuretics

    –K+ salt substitutes
    hyperkalemia
  27. •S/S

    –Anxiety

    –Dysrhythmias


    –Paresthesia-tingling

    –Weakness

    –Abdominal cramps

    –Diarrhea
    hyperkalemia
  28. common cause of _______ is metabolic acidosis (excessive acid in
    body fluids).
    hyperkalemia
  29. can occur when a patient ingests more potassium than his
    body can handle. This can happen if a patient's taking potassium supplements,
    or if he's eating foods rich in potassium, like potatoes, bananas, and oranges.
    Most salt substitutes are made with potassium chloride as well, so patients who
    use them may inadvertently overdo the potassium
    hyperkalemia
  30. Causes:* burns, severe infection, trauma, crush injury, or
    intravascular hemolysis, which injure
    cells and may cause potassium to leave the cells
    hyperkalemia
  31. the heart's conduction system becomes
    sluggish and the impulses that keep the heart beating slow down. Arrhythmia and
    cardiac arrest can occur quickly.
    hyperkalemia
  32. decreased heart rate

    * irregular pulse

    * decreased cardiac output

    * hypotension.
    hyperkalemia
  33. Intervention:

    Stabilize
    cardiac membrane potential

    Move
    potassium from ECS to ICS

    Remove extra
    potassium from the body
    hyperkalemia
  34. –Ca+ < 4.5 mEq/L
    hypokalcemia
  35. •Causes

    –Vitamin D deficiency

    –Pancreatitis

    –Alkalosis

    –Chronic Renal Failure

    –Chronic alcoholism
    hypocalcemia
  36. •S/S

    –Numbness, tingling

    –Hyperactive reflexes

    –Tetany


    –Muscle cramps

    Pathological fractures
    hypokalcemia
  37. High
    K= high H ions or acids= high Calcium



    While




    Low K= low H ions or acids= low Calcium
  38. ph
    7.35-7.45
  39. PaCO2
    : 35 to 45 mm Hg
  40. HCO3
    22-26 mEq
  41. PaO2
    80 to 100 mm Hg
  42. Respiratory acidosis
    • between pH<735 paCO2> 45 (HCO3 normal or
    • slightly elevated)
  43. Respiratory alkalosis
    • (higher ph)- ph >745 PaCO2<35 (HCO3 normal
    • or slightly lower)
  44. Metabolic acidosis
    ph<735 HCO3 <22
  45. Metabolic alkalosis
    ph<745 HCO3>26
  46. (males):
    4.7 – 6.1 million

    (females):
    4.2-5.4 million
    • The number of red blood
    • cells per cubic millimeter of blood
  47. Adults:
    (males):
    14 - 18 g/dl

    (Females):
    12 – 16g/dl
    Hemoglobin levels
  48. Adults:

    (males): 42 – 52%


    (females): 37-47%
    Hematocrit levels
  49. Adults: 5,000 -10,000 mm3
    Total number of WBC’s
  50. Also called THROMBOCYTES

    Adults: 150,000 – 400,000 mm3
    Platelets
  51. Critical
    values < 50,000 mm3 or > 1,000,000 mm3
    Platelets
  52. Adults: 10 –20 mg/dl
    BUN Blood urea nitrogen
  53. Men 0.6 – 1.2 mg/dl

    Women 0.5 – 1.1 mg/dl
    Serum Creatinine
  54. Adults: 70-110 mg/dl Fasting

    <140 mg/dl 2 hours after a meal
    Blood glucose levels
  55. PT Normal 11-12.5

    INR 0.8-1.1
  56. thirst, restlessness, headaches, inability to concentrate, postural hypotension
    first signs on dehydration
  57. cyanosis, cold clammy skin, weak thready pulse,confusion, oliguria
    late signs of dehydration
  58. vital sign changes associated with fluid volume deficit:
    tachycardia, hypotension
  59. dehydration causes:
    vomiting, diarhhea, type 2 diabetes
  60. intervention: hydrate the client with IV solution as prescribed to treat:
    hypovolemia/ dehydration
  61. intervention for _____:notifying the physician of urine output of less than 30ml/hr
    hypovolemia/dehydration
  62. intervention for _____: elevate the legs to enhance venous return, thus contributing to cardiac output
    hypovolemia
  63. shock, multiple organ failure or death may result from:
    hypovolemia/ dehydration
  64. lower blood pressure and higher BUN / creatinine ration may be a sign of __________ among elderly
    hypovolemia
  65. providing a restricted sodium diet is an intervention for:
    excess fluid volume
  66. administer prescribed diuretics as appropriate is an intervention for _______
    excess fluid volume, hypervolemia
  67. ph < 7.35
    CO2 is > 45 mm Hg
    Patient breathing slowly (hypoventilation)
    Hyperkalemia
    Respiratory Acidosis
  68. ph < 7.35
    HCO3 is less than 22 meQ/L
    patient breating rapidly (Kussmaul)
    Hyperkalemia
    Metabolic Acidosis
  69. ph > 7.45
    CO2 is less than 35 mm Hg
    patient breathing RAPIDLY
    Hypokalemia
    Respiratory Acidosis
  70. ph> 7.45
    HCO3 is greater than 26 mEq/L
    patient breathing slowly
    Hypokalemia
    Metabolic Alkalosis
  71. low bp
    dyspnea
    headache
    hyperkalemia
    increase K, dysrythmia
    disorientation
    muscle weakness
    in COPD, atelacsis
    Respiratory Acidosis
  72. treatment:
    bronchodilators
    maintain hydration of 2-3 L of fluid per day
    Respiratory acidosis
  73. Intervention:
    Monitor I and O, LOC
    administer IV sodium bicarbonate
    Metabolic acidosis
  74. Hyperkalemia
    low bp
    cardica arrest
    numbness, tingling
    nausea, vomiting
    headache
    renal failure, shock
    Metabolic acidosis
  75. seizure
    tachycardia
    low bp
    hypokalemia
    numbness, tingling
    nausea, vomiting
    Respiratory Alkalosis
  76. treatment:
    assist client to breath in paper bag to inhale CO2
    Respiratory Alkalosis
  77. Hypokalemia
    restlessness, lethargy
    tachycardia
    confusion
    nausea, vomiting
    muscle cramping, tremors
    use of diuretics
    Metabolic Alkalosis
  78. treatment:
    monitor I and O closely
    monitor resp., LOC
    Administer ordered IV fluids

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