2.3 Nutrition, Fluid Balance, Electrolytes, Acid Base Imbalance Flashcards
Describe the nutritional assessments that identify the need for nutritional supplements
Anthropometric measurements: Height Weight Body Mass Index: -ideal 18.5-24.5 -healthy -overweight 25-30 -obese 30+
Explain the significance of the abnormal findings for TOTAL PROTEIN
If your total protein level is low, you may have a liver or kidney problem, or it may be that protein isn’t being digested or absorbed properly. A high total protein level could indicate dehydration or a certain type of cancer, such as multiple myeloma, that causes protein to accumulate abnormally
Explain the significance of the abnormal findings for ALBUMIN
Lower-than-normal level of serum albumin may be a sign of:
Kidney diseases
Liver disease (for example, hepatitis, or cirrhosis that may cause ascites)
Increased blood albumin may be due to:
Dehydration
High protein diet
Having a tourniquet on for a long time when giving a blood sample
Explain the significance of the abnormal findings for GLOBULIN
Low globulin levels can be a sign of liver or kidney disease.
High levels may indicate infection, inflammatory disease or immune disorders. However, abnormal results may be due to certain medications, dehydration, or other factors
Explain the significance of the abnormal findings for A/G RATIO
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Identify assessment findings used to determine the route of nutritional supplementation
Enteral Nutrition:
Used with patient’s who have a functional GI tract
Cancer, critical illness, neurological/muscular disorders, GI disorders, resp failure with prolonged intubation, inadequate oral intake.
Parenteral Nutrition:
Used with patient’s who has a non-functional GI tract
GI surgery, obstruction, extended bowel rest
Identify changes in bowel sounds that are expected with the stressed patient and nursing implications of changes in peristalsis
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Describe the procedure for changing a CVC dressing
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Describe the rationale for parenteral administration of lipids and nursing implications related to lipid administration
Fat emulsion (lipids) may be added Provides essential fatty acids and additional calories Monitor for fat overload syndrome -fever -elevated tri -clotting problems -multisystem failure
Identify solutions that may only be administered via central vein
TPN
Explain the guidelines for administration of parenteral fluids
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Compare the rational for the use of the major types of parenteral solutions and discuss the rate of administering fluids.
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Describe how to determine the caloric value of intravenous solutions
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Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
ALKALINE PHOSPHATASE
Alkaline Phosphatase:
Nursing:
Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
AST (SGOT)
AST (AGOT):
Nursing:
Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
BILIRUBINE, TOTAL
Total Bilirubin:
Nursing:
Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
BUN
BUN 5-20 mg/dl:
Indication of renal failure/insufficiency/injury
Low= malnourished, low in protein
High= dehydration
Nursing
Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
CREATININE
Creatinine 0.6-1.2 mg/dl:
Indication of renal failure/insufficiency/injury
Low= malnourished, low in protein
High= renal function
Nursing:
Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
GLUCOSE
Glucose 60-100 mg/dl:
Direct measurement of glucose, evaluation of DM pt’s
Low= starvation, hypothyroidism, hypopituitarism
High= DM, diuretic therapy, chronic renal failure
Nursing:
Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities POTASSIUM (K) SODIUM (NA) CHLORIDE CALCIUM
**SEE LEARNING PACKET PG 48-53
Identify the significance of abnormal findings for the following components of the Comprehensive Profile lab test including nursing responsibilities
TOTAL PROTEIN
Total Protein:
Measures total protein in blood including albumin and globulin
Keeps fluid within the vascular spaces due to osmotic pressure.
Low protein: fluid leaks out of vascular spaces into interstitial spaces causing edema.
Nursing:
Identify components of the “basic kidney profile” and explain the significance of abnormal findings for each of the components
Basic Kidney Profile:
Your kidney numbers include 2 tests: ACR (Albumin to Creatinine Ratio) and GFR (glomerular filtration rate). GFR is a measure of kidney function and is performed through a blood test. Your GFR will determine what stage of kidney disease you have
Review foods and substances high in sodium
Foods high in sodium:
Smoked, cured, salted or canned meat, fish or poultry including bacon, cold cuts, ham, frankfurters, sausage, sardines, caviar and anchovies.
Frozen breaded meats and dinners, such as burritos and pizza.
Canned entrees, such as ravioli, spam and chili.
Salted nuts.
Beans canned with salt added
Review foods and substances high in potassium
Foods high in potassium: Leafy greens, beans, nuts, dairy foods, and starchy vegetables like winter squash are rich sources. Dried fruits (raisins, apricots) Beans, lentils. Potatoes. Winter squash (acorn, butternut) Spinach, broccoli. Beet greens. Avocado. Bananas.
Review s/s and treatment for HYPO/HYPERNATREMIA HYPO/HYPERKALEMIA HYPO/HYPERCHLOREMIA HYPO/HYPERCALCEMIA HYPO/HYPER MAGNESIA
**SEE LEARNING PACKET PG 48-53
What should be taught to patients regarding electrolyte disturbances
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IV solutions and rates are appropriate. If not, identify the appropriate solution and rate.
Mrs. Golden, age 65, has a history of severe CHF and was admitted for treatment of
sepsis and dehydration. Her BP is 70/40; pulse 110, weak and thready. He orders
0.45% saline at 75 ml/hr
Mrs. Golden: 0.45 saline is a hypotonic solution and is not appropriate for this patient. The patient needs total volume replacement, which would require an isotonic solution instead. She needs volume resuscitation due to the sepsis and dehydration with low BP and tachycardia, but you would need to monitor closely as she is at risk for fluid volume overload if her heart function is poor. LR would not be the isotonic fluid of choice due to her potential for compromised liver (can’t metabolize the lactate) and kidney function (can’t have the K+ in the solution). You could expect 0.9 normal saline for the IV solution for this patient
IV solutions and rates are appropriate. If not, identify the appropriate solution and rate
Mrs. Kelly is a 35-year-old patient who recently underwent abdominal surgery. Her N.G.
is draining 1500 ml per shift, and her serum pH is 7.60. The Dr. order is Ringers Lactate
@ 150 ml/hr
Mrs. Kelly: Ringers Lactate at 150ml/hr is not appropriate for this patient. The lactate in the IV solution will cause further alkalosis because the liver converts lactate to bicarbonate. This patient needs a hypertonic IV solution in order to shift fluid out of the cells and into the ECF. She would likely need K+ replacement due to the large amount of drainage from the NG. You could expect D5.45 normal saline +KCL for this patient
