Deck 06_FLuids and Electrolytes

Question 1

Identify common aging-related causes of dehydration (dehydration rather than electrolyte imbalance)

Answer 1

• Decreased taste, smell, and thirst
• Numerous health issues
• May have a lack of financial resources for complex medication regimens that can influence appetite, food selection, and food absorption
• Older adults are at high risk for dehydration because they have less total body water then younger adults. They also may take drugs such as diuretics, antihypertensives, and laxatives that increase fluid excretion

Question 2

What are the signs and symptoms of dehydration?

Answer 2

• Assess patients who have sudden change in cognition for fluid and electrolyte imbalances
• Eye sinking
• Lower blood pressure (decreased volume)
• Loss of moisture in the mouth mucosa
• Decreased B/P
• Assess skin turgor for “tenting”, skin with normal turgor snaps rapidly back to its normal position (it doesn’t tent)
• Use daily weights to determine fluid gains or losses
• Ask patients about the use of drugs (ex. diuretics, laxatives, salt substitutes, and/or antihypertensives) that may alter fluid and electrolyte status.

Question 3

What is hypovolemia?

Answer 3

• Fluid volume deficit.
• Causes: Excessive loss of fluids, insufficient intake of fluid, or fluid shiftS, blood loss

Question 4

What electrolyte becomes imbalanced when a person is experiencing vomiting and diarrhea?

Answer 4

• Sodium
• POTASSIUM (worried about metabolic concerns)

Question 5

What are the interventions for the patient with a fluid volume deficit (i.e., dehydration)?

Answer 5

• Use a gait belt when assisting a patient with muscle weakness to walk or transfer
• PO fluids.
• Push/encourage fluids but provide IV fluids if not able to take fluids by mouth
• Offer or ensure that oral care is performed at least every 4 hrs for ps with dehydration
• Measure intake and output

Question 6

What are the signs and symptoms of fluid overload?

Answer 6

• Known as hypervolemia: fluid volume excess
• Causes: Disease processes or conditions that result in the retention of sodium and water include cirrhosis, heart failure, stress conditions causing a release of ADH and aldosterone, adrenal gland disorders, and use of corticosteroids
• Signs and symptoms: Weight gain, ascites, edema, and increased urinary output; also cardiac problems
• JVD
• Peripheral edema
• Crackles in the lungs (hydrostatic pressures altered)

Question 7

What are the interventions for the patient with a fluid volume excess?

Answer 7

• Fluid restriction
• Diuretics
• treating manifestations
• Hx, weight, i/o, physical assessment
• Strict intake and output measurement aimed at prevention, correcting/managing the underlying cause, and treating the clinical manifestations.
• Assessment of patients for fluid volume excess includes collecting a health history, performing a physical assessment, reviewing lab data, weight, and calculation of I&O.
• Collection of a health history focuses on the onset and duration of symptoms, and recent illness, previous health issues, and current medication use and compliance. Diuretics

Question 8

What electrolyte imbalances require cardiac monitoring?

Answer 8

• Hyperkalemia: has EKG changes
• Hypokalemia: EKG changes: nausea/vomiting, constipation
• Hypercalcemia: EKG changes
• Hypocalcemia
• Hypermagnesemia

Question 9

Compare and contrast venous access devices.

Answer 9

Infusion therapy is divided into 2 categories based on the location of the tip of the IVAD:

• Peripheral
  
  • Over-the-needle peripheral catheter: Superficial veins of the upper extremity: good for 3 days
  • Midline catheter: inserted in a peripheral vein in the upper extremities with tips that terminate distal to the should in either the basilica, cephalic, or brachial vein; expected to last between 1 and 4 weeks.
• Central:
  
  • Non-tunneled: Percutaneous central catheters: most commonly used for emergent or trauma situations, critical care, and surgery (short-term)
  • Peripheral inserted central catheters (PICCs) (weeks-12 months- average is 6 months)
  • Tunneled: Central catheters- portion lies in the subcutaneous tunnel; this separation is intended to prevent the organisms on the skin from reaching the bloodstream; used for frequent and long-term infusion therapy (months to years) ex. pts with cancer
  • Implanted ports: This type of device is chosen for pts who are expected to require IV therapy for more than a year

Question 10

What are some complications of peripheral IV therapy? ​

Answer 10

• Phlebitis: inflammation of the vein
• Infiltration: Occurs when solution or medication is inadvertently infused into the tissue surrounding the vein
• Other local complication of IV therapy:
  
  • Thrombosis (blood clot)
  • Thrombophebitis
  • Ecchymosis and hematoma
  • Site infection
  • Loss of patency or Occlusion
  • Occlusion that is nonthrombotic (medication precipitation)
  • Air embolism
  • Venous spasm
  • Nerve damage
  • Bottom line: Stop the infusion! Also don’t push if you feel resistance!

Question 11

Interpret an arterial blood gas used to determine: metabolic acidosis, metabolic alkalosis, respiratory acidosis or respiratory alkalosis.

Answer 11

Normal arterial blood= 7.35 to 7.45

R: Respiratory= O (opposite)-> high pH and low CO2; low pH and high CO2

M: (Metabolic)= E (Equal)-> High ph and high CO2; low pH and low CO2