chapter 6: nursing care of pts w/ fluid, electrolyte and acid base imbalances Flashcards
fluid balance
intracellular fluid
extracellular fluid: interstitial fluid, intravascular fluid, transcellular fluid
control of fluid balance
pressure sensors
antidiuretic hormone
movement of fluids and electrolytes
active transport
passive transport: diffusion, filtration, osmosis
tonicity
isotonic: same osmolarity as blood
hypertonic: lower osmolarity than blood
hypotonic: greater osmolarity than blood
fluid gains and losses
gains: food and fluid
losses: sensible, insensible
fluid imbalances
dehydration: hypovolemia
fluid overload
dehydration signs and symptoms
- thirst
- rapid, weak pulse
- low blood pressure
- dry skin and mucous membranes
- skin tenting
- decreased urine output
- increased temp
interventions for deficient fluid volume
- monitor daily weight
- monitor intake and output
- increase fluid intake
- treat underlying cause
- use caution w/ elderly patients
fluid excess signs and symptoms
- bounding pulse
- elevated bp
- respiratory changes
- edema
- increased urine output
- weight gain
- heart failure
interventions for excess fluid volume
- monitor weight and urine output
- place in Fowlers
- administer oxygen
- administer diuretics
- restrict fluid and sodium
electrolytes
cations: positive
anions: negative
sodium imbalances
hyponatremia: sodium deficit
hypernatremia: sodium excess
food sources of sodium
pizza
canned vegetables
canned soups
salty snacks
prepared foods
hyponatremia signs and symptoms
- sodium < 135 mEq/L
- fluid excess or deficit
- mental status changes
- weakness
- nausea and vomiting
interventions for hyponatremia
- monitor I & Os
- monitor weight
- restrict fluids
- administer diuretics/steroids
hypernatremia signs and symptoms
- sodium > 135 mEq/L
- thirst
- mental status changes
- seizures
- muscle weakness
- respiratory compromise
interventions for hypernatremia
- treat fluid imbalance FIRST
- monitor I & Os
- monitor weight
- administer diuretics
- restrict dietary sodium
- treat cause
potassium imbalances
hypokalemia: potassium deficit
hyperkalemia: potassium excess
food sources of potassium
sweet potatoes
beet greens
potatoes
yogurt
prune juice
bananas
orange juice
hypokalemia signs and symptoms
- potassium < 3.5 mEq/L
- muscle weakness
- shallow respirations
- mental status changes
- cardiac arrhythmia and arrest
interventions for hypokalemia
- treat underlying cause
- offer potassium rich foods
- administer potassium replacement
- teach pts: signs and symptoms to report, self administration of supplement
hyperkalemia signs and symptoms
- K+ > 5 mEq/L
- muscle twitching and cramps: later muscle weakness
- diarrhea
- low bp
- cardiac arrhythmia and arrest
interventions for hyperkalemia
- limit dietary potassium
- hold potassium supplements
- administer medications as ordered: potassium losing diuretic, kayexalate, insulin w/ glucose
calcium imbalances
hypocalcemia: low calcium level
hypercalcemia: high calcium level
food sources of calcium
fortified cereals
canned salmon
spinach
yogurt
cheese
milk
hypocalcemia signs and symptoms
- calcium < 4.5 mEq/L
- mental status changes
- hyperactive deep tendon reflexes
- diarrhea
- cardiac arrhythmia and arrest
interventions for hypocalcemia
- treat cause
- increase dietary calcium
- administer medications as ordered: IV calcium gluconate, oral calcium supplements, aluminum hydroxide to bind phosphate
hypercalcemia signs and symptoms
- calcium > 5.5 mEq/L
- increased heart rate and bp
- skeletal muscle weakness
- decreased GI motility
interventions for hypercalcemia
- administer fluids
- administer medications as ordered: Furosemide, pamidronate, Zoledronic acid, Calcitonin
- hemodialysis
magnesium imbalances
hypomagnesemia: low magnesium level
hypermagenesemia: high magnesium level
hypomagnesemia signs and symptoms
- magnesium < 1.5 mEq/L
- positive Troussea sign
- Positive Chvostek sign
- cardiac arrhythmia and arrest
interventions for hypomagnesemia
- treat underlying cause
- administer magnesium replacement
hypermagnesemia signs and symptoms
- magnesium > 2.5 mEq/L
- hypotension
- lethargy
- skeletal muscle weakness
- respiratory failure
- cardiac arrhythmia and arrest
interventions for hypermagnesemia
- administer IV fluids
- administer medications as ordered: loop diuretics (Furosemide), dialysis
acid-base imbalance
acid: substance that releases a hydrogen ion
base (alkali): substance that binds hydrogen
normal H 7.35-7.45
acid-base control
cellular buffers
lungs
kidneys
types of acidosis
respiratory
metabolic
types of alkalosis
respiratory
metabolic
respiratory acidosis has low ____, high ____, neutral ____
ph, PCO, HCO
respiratory alkalosis has high ____, low ____, neutral _____
ph, PCO, HCO
metabolic acidosis has low ____, neutral ____, low ____
ph, PCO, HCO
metabolic alkalosis has high ___, neutral ____, high ____
ph, PCO, HCO
