Fluid and electrolytes Flashcards
Magnesium
a) lab rate
b) Where is most abundant?
c) Modifies what?
a) 1.3-2.1 mEq/L
b) Second most abundant ICF
c) Modifies nerve impulse transmission
Skeletal muscle response
Osmosis
Water move from low solute to high solute
Isotonic solution IV?
- *Increase fluid volume**
- due to blood loss, surgery, or dehydration
0.9% Sodium shloride
(normal saline)
Lactated ringers
Dextrose 5%(D5W)
Hypertonic solution IV?
Severe hyponatremia and cerebral edema (for cell under hypotonic condition)
Anything higher than 0.9% NACL
3% NACL
10% Dextrose
50% Dextrose
Hypotonic solution IV?
- *Cell is dehydrated and fluids need to be put back intracellularly**
- *Cell is shrink=hydration**
Anything less than 0.9% NACL
- 45% NACL(1/2 noramal saline)
- 25% NACL
Flush IV site every ???? hours when not in use
8-12 hr
Chang IV site usually every ??? hours
72 hr
IV solution overload
Clinical sing?
(Fluid overload)
Distended neck veins
Increased BP
Tachycardia
Shortness of breath
Crackles in the lungs
Edema
IV solution overload
Treatment
(Fluid overload)
Raise the head of the bed
Check vital sing(O2 as well)
Ajust the rate after correcting fluid overload Administer diuretics (water pills)
Diuretics?
Water pills
Help rid your body of salt (sodium) and water
Cellulitis?
Serious bacterial skin infection
Pain
Warmth
Edema
Fever
Cellulitis treatment
Discontinue and remove IV
Elevate the extremity
Apply warm compresses 3 to 4 time/day
Administer antibiotics, analgesics
Catheter embolus?
Missing catheter tip on removal
Catheter embolus
Treatment
Place a tourniquet(band) high on the extremity to limit venous flow
Prepare for removal under X ray or surgery
Save the catheter after removal to determine the cause
DO NOT use vein in the antecubital fossa.
Why?
Because it will limit the mobility of the pt’s arm
Fluid volume deficit?
Hypovolemia
Isotonic dehydration
A lack of both water and electrolytes
Causing a decrease in circulating blood volume
Cause of dehydration?
Prolonged fever
Diabetic ketoacidosis
Hyperventilation(low CO2)
Excessive hypertonic IV fluid
Hypovolemia
When the amount of fluid in the intravascular system is too low
Causes of hypovolemia?
Vomiting, diarrhea
Renal disfunction
Burns
Hemorrhage
Altered intake
-nausea
-anorexia
-NPO
Hypovolemia
Assessment
Hypotension
Tachycardia
Every lab values increase!!
Oliguria
Rapid weight loss
syncope
Oliguria
Urine output below normal 30-50mL
less than 30mL emergency condition!!
Hypovolemia
Interventions
Oral rehydration
Isotonic water 0.9% NS
Oral hygiene Q2
Frequent skin assessment (turgor)
Hypervolemia
Causes?
Chronic kidney failure
High sodium foods
Enteral tube feeding
Excess isotonic IV fluid
SIADH
Hypervolemia
Assessment
Hypertension
Tachycardia
Decreased all lab values!!
Chest X-ray fluid in lung
Hypervolemia
interventions
Observe breath sounds
Auscultate breath sounds(edema)
Dyspnea
Elevate HOB
devises to reduce pressure
Syncope
A temporary loss of consciousness usually related to insufficient blood flow to the brain
Polydipsia?
Excess thirst
Hyponatremia
Expecting finds (Heat to toe)
Confusion
Orthostatic hypotension
Nausea, vomiting
abdominal cramps
Weight gain, Edema
Muscle spasms けいれん
Hyponatremia
Expecting finds (Heat to toe)
Confusion
Seizures
Coma
Orthostatic hypotension
Nausea, vomiting
abdominal cramps
Weight gain, Edema
Muscle spasms けいれん
Decease serum osmolality
Hyponatremia
Causse
Heart and renal failure
Vomiting
Burns
Hyperglycemia
Medication s such as antidiabetics, diuretics
Hyponatremia
Interventions
Restrict fluid intake
Seizure precautions
Administer isotonic I.V. fluids
Monitor pt’s conciseness
Arterial Blood Gases (ABGs)
Normal rang
a) pH
b) pCO2
c) HCO3
d) PO2
e) SaO2
a) 7.35-7.45
b) 35-45 mmHg
c) 22-26 mEq/L
d) 80-100 mmHg
e) (95-100%)
Mean Arterial Pressure (MAP)
Definition
What is the normal range
Pressure necessary to adequately perfuse organs
normal range is 70-100
How to calculate MAP
Map caculation
a) 120/60?
b) 140/80?
MAP = (SBP + 2DBP) ÷ 3
a) (120 +120) /3= 80 MAP
b) (140+160)/3= 100 MAP
A high MAP means?
A lot of pressure in the arteries
Eventually lead to blood clots or damage to the heart muscle
What is a low MAP?
Blood may not be reach to the major organs
Without blood and nutrients, the tissue of these organs begins to die
Use of Incentive Spirometry
a) Use a_______ method
b) Put mouth on mouthpiece and make?
c) Inhale or exhale? slowly and deeply
d) When the pt cannot c any more
remove the mouthpiece.
Hold breathe for how long?
then slowly inheal or exheale?
Repeat and when finish make cough
Set up position
Prevent pnemonia
a) teach-back method
b) seal
c) Inhale
d) 3 sec
Slowly exhale
Hypoventilation?
Too shallow or too slow to meet the needs of the body
Low O2, more CO2
COPD
Hyperventilation?
Rapid or deep breathing
Usually caused by anxiety or panic
Diabetic ketoacidosis
Respiratory alkalosis
Hyperventilation
Intervention?
Monitor RR, depth, breath sounds
Monitor Level of Consciousness
Monitor SpO2, ABG
Assessment – possible anxiety and cause
Assess need for & provide supplemental O2 as ordered
Hypoventilation
Intervention?
Monitor RR, depth, breath sounds
Monitor LOC
Monitor SpO2, ABG
Assess need for and provide supplemental O2 as ordered
Hypo and hyper/ventilation
Nursing DX
Problem-focused vs. risk focused nursing dx:
Ineffective airway clearance
Ineffective breathing pattern
Impaired gas exchange
Activity intolerance
Fatigue
Acute confusion
Risk for aspiration
Risk for infection
Risk for falls
Non-productive cough meaning?
Dry cough
Exposure to smoke or dust
Viral illnesses
Irritation of the airway
Allergies
Medication
Asthma
Mobilizing secretions
Frequent repositioning
Deep breathing and coughing
Hypernatremia
Causes
Water loss Inadequate water intake Excessive sodium intake Diabetes Insipidus (DI)
Cell shrink
HyPERnatremia
S/S
Thirst
Dry sticky mucous membranes
Restlessness
disorientation
Muscle weakness and irritability
HyPERnatremia
Nursing Intervention
Maintain urine output of 0.5 to 1.5 mL/kg/hr
Maintain normal blood pressure
Provide low sodium, no salt added diet
Seizure precautions
Administer hypotonic and non-sodium containing isotonic fluids
D5W at first
arouse
awaken (someone) from sleep
Potassium
a) range
b) Ragulate what?
c) Can affect what rate
a) 3.5 - 5.0 mEq/L
b) Cell excitability
Nerve impulse conduction
c) Cardiac rate rythem
HyPOkalemia
Excessive K+ output
Why?
(<3.5 mEq/L)
GI losses from diarrhea
Prolonged gastric suctioning
Prolonged vomiting
HyPOkalemia
S/S
Confuse
Depression
Cardiac arrest
Fatigue
Muscle weakness
HyPOkalemia
Intervention
Assess the patient’s diet for a lack of potassium
Encourage intake of high-potassium foods
IV must given very slowly
HyPERkalemia
Causes
Why excessive K+ intake?
Oral supplements
Salt substitutes
(>5.0 mEq/L)
HyPERkalemia
S/S
Arrhythmias HR mess up
Decreased strength of contraction
Cardiac arrest
Nausea, vomiting diarrhea
Decreased bowel sounds
Abdominal distention
HyPERkalemia
Intervention
Apply and monitor ECG
Restrict K+ intake
Administer oral meds for K+ excertion
Calcium
Function
Muscles must have Ca+ to contract
Calcination shifts into bone
8.5- 10.2 mg/dL
(including heart)
HyPOcalcemia
Excessive losses why?
Chronic diarrhea
Shit into bone
Acute pancreatitis
Vitamin D deficiency
Hypocalcemia