Fluid And Electrolytes Flashcards
Plan/implementation for volume deficit
Force fluids
Provide isotonic IV fluids, lacerated
Ringer or .9% nacl
I and O, hourly outputs, daily weights (1 L fluid= 1 kg or 2.2 lb)
Monitor vital signs
Check skin turgor
Assess urine specific gravity
Volume deficit
Assessment
Thirst (early sign) Temp increases Rapid and weak pulse Respirations increase Poor skin turgor- skin cool, moist Hypotension Emaciation, weight loss Dry eyes sockets, mouth and mucous membranes Anxiety Apprehension Exhaustion urine specific gravity greater than 1.030 Decreased urine output Increased hgb, hct Na+, serum osmolality Headache, lethargy, confusion, disorientation, weight loss
Volume overload
Assessment
No change in temp Pulse increases slightly and is bounding Resp increase, shortness of breath, dypnea, rales (crackles) Peripheral edema-bloated appearance, weight gain Hypertension May have muffled heart sounds Jugular vein distention Urine specific gravity less than 1.010 Apprehension Increased venous pressure Decreased hct, BUN Hgb, Na+, serum osmolality
Plan implementation for fluid volume overload
Administer diuretics Restrict fluids Sodium restricted diet Daily weight Asses breath sounds Check feet, ankle, sacral region for edema Semi-growlers position if dyspneic
Potassium
Hypokalemia
Assessment
Less than 3.5 meq/L Anorexia Nausea Vomiting Muscle weakness Paresthesias Dysrhythmias Increased sensitivity to digitalis
Hypokalemia
Diagnose and implementation
3.5-5
Causes vomiting, gastric suction, diarrhea, diuretics and steroids, inadequate intake
Implementation- administer oral potassium supplements
Dilute in juice to avoid gastric irritaion
Increase dietary intake- raisins, bananas, carrots, celery
Increased risk of digoxin toxicity
Hyperkalemia
Assessment
Greater then 5 meq/l EKG changes, dysrhythmias, Cardiac arrest Muscle weakness Paralysis Nausea Diarrhea
Hyperkalemia
Diagnose and implementation
Renal failure, use of pot supplements, burns, crushing injuries
Plan- restrict dietary potassium and pot contains meds kayexalate-cation resin
Calcium gluconate given IV, sodium bicarbonate give. IV, reg insulin and dextrose IV administration of reg insulin and dextrose shifts potassium into the cells
Peritoneal or hemodialysis
Diuretics
Hyponatremia
Less then 135
Nausea
Muscle cramps
Increased ICP, confusion, muscular twitching, convulsions
Caused by vomiting, diuretics, excessive administration of dextrose, and water IVs, prolonged low-sodium diet, excessive water intake
Plan- oral administration of sodium-rich foods- beef broth, tomato juice
IV lacerated ringer or .9 nacl
Water restriction
Hypernatremia
Greater then 145 Elevated temp Weakeness disorientation Delusions and hallucinations Thirst, dry swollen tongue, sticky mucous memebranes Postural hypotension with decreases ECF
Caused by hypertonic feedings without water, supplements, diarrhea, hyperventilation, diabetes insipidus, ingestion of OTC drugs such as alka-seltzer
Inhaling large amounts of salt water (near drowning)
Inadequate water ingestion
Plan- IV administration of hypotonic solution .3% nacl or .45 nacl
5% dextrose in water
Offer fluids at reg intervals
Decrease sodium in diet
Hypocalcemia
Assessment
Ionized serum calcium less than 4.5 or total serum calcium less than 8.6 mg/DL
Nervous system becomes increasingly excitable
Tetany trousseaus sign- inflate BP cuff on upper arm 20 mm Hh above sty systolic pressure; carpal spasms within
2-5 min indicate tetany
Chvosteks sign- tap facial nerve 2cm anterior to earlobe just below the zygomatic arch; twitching of facial muscles indicates tetany
Seizures
Confusion
Paresthesia
Irritability
Hypoglycemia diagnose
Calcium needed for blood clotting, skeletal muscle contraction
Normal ionized serum calcium less than 4.25 or total serum calcium less than 8.6
Regulated by parathyroid hormone and vit d, which facilitates reabsorption of calcium from bone and enhances absorption from the GI tract
Causes- hypoparathyoidism, pancreatitis, renal failure, steroids and loop diuretics, inadequate intake, post-thyroid surgery.
Hypercalcemia
Ionized serum calcium greater than 5.1 or total serum calcium 10.2
Sedative effect on Central and peripheral nervous system, muscle weakness, lack of coordination
Constipation, abdominal pain
