Fluids n Electrolytes
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Transcript of Fluids n Electrolytes
1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Chapter 14
Fluids and Electrolytes
2Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Electrolyte Imbalances
3Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HyponatremiaLower than normal sodium in the blood serum Can be actual deficiency of sodium or
increase in body water that dilutes the sodium excessively
AssessmentSymptoms: headache, muscle weakness,
fatigue, apathy, confusion, abdominal cramps, and orthostatic hypotension
Take blood pressures with the patient lying or sitting and then standing to determine if a significant drop
4Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HyponatremiaMedical treatment
The usual treatment is restriction of fluids while the kidneys excrete excess water
Diuretic: furosemide (Lasix) Sodium replacement therapy
Nursing careAdminister prescribed medications and IV
fluidsMeasure fluid intake and output and assess
mental status
5Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HypernatremiaHigher than normal concentration of
sodium in the bloodVery serious imbalance; can lead to death if
not correctedOccurs when excessive loss of water or
excessive retention of sodiumSigns and symptoms
Thirst, flushed skin, dry mucous membranes, low urine output, restlessness, increased heart rate, convulsions, and postural hypotension
6Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HypernatremiaMedical treatment
Oral or IV replacement of water to restore balance
A low-sodium diet often prescribed Nursing care
Encourage patients with hypernatremia to drink water
Closely monitor the infusion of IV fluidsTeach patient to track daily I&O and to
recognize the signs and symptoms of fluid retention or depletion
7Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HypokalemiaLow serum potassium
May result in gastrointestinal, renal, cardiovascular, and neurologic disturbances
Can cause abnormal, potentially fatal, heart rhythm
Signs and symptoms Anorexia, abdominal distention, vomiting,
diarrhea, muscle cramps, weakness, dysrhythmias (abnormal cardiac rhythms), postural hypotension, dyspnea, shallow respirations, confusion, depression, polyuria (excessive urination), and nocturia
8Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HypokalemiaMedical treatment
Potassium replacement by the IV or oral route Nursing care
Monitoring at-risk patients for decreased bowel sounds, a weak and irregular pulse, decreased reflexes, and decreased muscle tone
Cardiac monitors may be used to detect dysrhythmias
Administer oral or IV potassiumUrine output should be no less than 30 ml/hr
9Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HyperkalemiaHigh serum potassium
Patients at risk: decreased renal function, in metabolic acidosis, taking potassium supplements
A serious imbalance because of the potential for life-threatening dysrhythmias
Signs and symptoms Explosive diarrhea and vomiting; muscle cramps
and weakness, paresthesia, irritability, anxiety, abdominal cramps, and decreased urine output
10Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
HyperkalemiaMedical treatment
Correct the underlying causeRestrict potassium intake Polystyrene sulfonate (Kayexalate)Intravenous calcium gluconate
Nursing carePatients with low urine output or those taking
potassium-sparing diuretics must be monitored carefully for signs and symptoms
Carefully monitor flow rate of IV fluids, which should not exceed 10 mEq/hr through peripheral veins
Screen the results of laboratory studies
11Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Chloride ImbalanceUsually bound to other electrolytes;
therefore, chloride imbalances accompany other electrolyte imbalancesHyperchloremia
Usually associated with metabolic acidosis Hypochloremia
Usually occurs when sodium is lost because chloride most frequently bound with sodium
12Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Calcium ImbalanceRegulated by the parathyroid glandsHypocalcemia results from diarrhea, inadequate
dietary intake of calcium or vitamin D, and multiple blood transfusions (banked blood contains citrates that bind to calcium), in addition to some diseases, including hypoparathyroidism
Hypercalcemia results from a high calcium or vitamin D intake, hyperparathyroidism, and immobility that causes stores of calcium in the bones to enter the bloodstream
13Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Magnesium ImbalanceHypomagnesemia: decreased
gastrointestinal absorption or excessive gastrointestinal loss, usually from vomiting and diarrhea, or increased urinary loss
Hypermagnesemia occurs most often with excessive use of magnesium-containing medications or intravenous solutions in patients with renal failure or preeclampsia of pregnancy
14Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Acid-Base Disturbances
15Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Respiratory AcidosisRespiratory system fails to eliminate the
appropriate amount of carbon dioxide to maintain the normal acid-base balance
Caused by pneumonia, drug overdose, head injury, chest wall injury, obesity, asphyxiation, drowning, or acute respiratory failure
Medical treatmentImprove ventilation, which restores partial
pressure of carbon dioxide in arterial blood (Paco2) to normal
16Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Respiratory AcidosisNursing care
Assess Paco2 levels in the arterial bloodObserve for signs of respiratory distress:
restlessness, anxiety, confusion, tachycardiaIntervention
Encourage fluid intake Position patients with head elevated 30
degrees
17Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Respiratory AlkalosisLow Paco2 with a resultant rise in pH
Most common cause of respiratory alkalosis is hyperventilation
Medical treatment Major goal of therapy: treat underlying cause of
condition; sedation may be ordered for the anxious patient
18Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Respiratory AlkalosisNursing care
Intervention In addition to giving sedatives as ordered,
reassure the patient to relieve anxiety Encourage patient to breathe slowly, which will
retain carbon dioxide in the body
19Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Metabolic AcidosisBody retains too many hydrogen ions or loses
too many bicarbonate ions; with too much acid and too little base, blood pH falls
Causes are starvation, dehydration, diarrhea, shock, renal failure, and diabetic ketoacidosis
Signs and symptoms: changing levels of consciousness, headache, vomiting and diarrhea, anorexia, muscle weakness, cardiac dysrhythmias
Medical treatment: treat the underlying disorder
20Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Metabolic AcidosisNursing care
Assessment of the patient in metabolic acidosis should focus on vital signs, mental status, and neurologic status
Emergency measures to restore acid-base balance. Administer drugs and intravenous fluids as prescribed. Reassure and orient confused patients
21Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Metabolic AlkalosisIncrease in bicarbonate levels or a loss of
hydrogen ions Loss of hydrogen ions may be from prolonged
nasogastric suctioning, excessive vomiting, diuretics, and electrolyte disturbances
Signs and symptoms: headache; irritability; lethargy; changes in level of consciousness; confusion; changes in heart rate; slow, shallow respirations with periods of apnea; nausea and vomiting; hyperactive reflexes; and numbness of the extremities
22Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Metabolic AlkalosisMedical treatment
Depends on the underlying cause and severity of the condition
23Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Metabolic AlkalosisNursing care
Assessment Take vital signs and daily weight; monitor heart
rate, respirations, and fluid gains and losses Keep accurate intake and output records,
including the amount of fluid removed by suction Assess motor function and sensation in the
extremities; monitor laboratory values, especially pH and serum bicarbonate levels
24Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Metabolic AlkalosisIntervention
To prevent metabolic alkalosis, use isotonic saline solutions rather than water for irrigating nasogastric tubes because the use of water for irrigation can result in a loss of electrolytes
Provide reassurance and comfort measures to promote safety and well-being