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L&E Chapter 003 Lo
 

L&E Chapter 003 Lo

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  • Discuss the physical and chemical properties of water that make it an efficient medium for transport, heat regulation, maintenance of hydrogen ion balance, and for enzymatic action. Consider the water component of cells, tissues, organs, and systems. Describe the various fluid compartments.
  • Discuss the hormonal regulation of water. What is the function of the following: Anti-diuretic hormone Aldosterone Atrial natriuretic peptide What are the roles of osmoreceptors and baroreceptors?
  • Compare and contrast diffusion, osmosis, and filtration. What are the effects of hypotonic, isotonic, and hypertonic solutions on the red blood cells? What is the significance of osmotic and hydrostatic pressure in maintaining fluid balance?
  • List specific types of patients who demonstrate the risk factors. Identify specific age groups who are at risk for deficient fluid volume. What are the physiologic changes associated with aging that put the older adult at risk for deficient fluid volume? Explain the role of various hormones that regulate fluid balance.
  • Demonstrate how to elicit these signs of deficient fluid volume. List appropriate nursing interventions associated with these clinical findings. Describe abnormal BP and pulse associated with deficient fluid volume.
  • List appropriate nursing interventions for a patient with acute episodes of nausea and vomiting. What the likely causes of nausea and vomiting? Correlate nausea and vomiting with fluid loss.
  • Discuss the mechanism of action of the various medications used to alleviate nausea and vomiting. What are some common herbal remedies for nausea and vomiting? What is the role of carbonated drinks in alleviating nausea and vomiting?
  • What are the common causes of diarrhea? Compare and contrast diarrhea associated with various health conditions such as ulcerative colitis, irritable bowel syndrome, lactose intolerance, etc. Discuss the use of antidiarrheal medications.
  • List appropriate nursing diagnosis for a patient with diarrhea. Discuss appropriate nursing assessments for patients with abdominal pain associated with diarrhea. What other clinical data must the nurse consider when formulating a plan of care for a patient with diarrhea?
  • What is the rationale for the nursing interventions? What are the cultural considerations regarding these nursing interventions? Identify key points in patient teaching.
  • What is the mechanism of action of these various antidiarrheal medications? What are the key patient teaching instructions regarding antidiarrheal medications?
  • Describe specific nursing actions that: Provide physical and mental rest Prevent unnecessary loss of water and nutrients Protect the rectal mucosa Replace fluids What are some of the considerations when dealing with the older adult?
  • What are the common causes of excess fluid volume? Explain the pathophysiology of the changes in urine concentration associated with excess fluid volume. Correlate changes in urine concentration (urine specific gravity) with antidiuretic hormone, aldosterone, and circulating fluid volume.
  • Explain the pathophysiology of edema. Define “dependent edema.” What is "third spacing“? What are the common causes? What is the pathophysiology? It may occur with extensive trauma, burns, peritonitis, intestinal obstruction, nephrosis, sepsis, and cirrhosis of the liver where there is an increase in capillary hydrostatic pressure or increased capillary membrane permeability.
  • Describe the mechanism of action of various treatment options. What are key patient teaching instructions for a low-sodium diet? What are the rationales for these nursing interventions?
  • How can the nurse motivate the patient to take small amounts of liquids? What are nursing considerations for taking fluids? Describe specific patient teaching instructions regarding access to immediate care and fluid volume deficit.
  • Identify specific nursing considerations regarding daily weights. What are the critical teaching points regarding fluid excess? Describe how the nurse assesses edema.
  • Give examples of negatively charged ions and positively charged ions. Review the various fluid compartments of the body. What are the specific electrolytes responsible for nerve transmission, muscle contraction, and excretion of hormones.
  • Review the different fluid compartments of the body: extracellular fluid compartment and intracellular fluid compartment. Include other fluid compartments like intravascular volume, intercellular fluid compartment, and “third” spacing. What is the importance of serum osmolarity and urine osmolarity?
  • Review the functions of sodium and regulation of sodium balance. Correlate serum sodium with osmolarity and effect on the fluid balance. Discuss the pathophysiology of the signs and symptoms of hyponatremia.
  • Discuss the pathophysiology of the signs and symptoms of hypernatremia. Explain the physiologic responses to hypernatremia. Include hormonal feedback mechanisms. How does the nurse assess the specific signs and symptoms associated with hypernatremia?
  • Review the functions of the potassium ion. Discuss regulation of serum potassium levels. Correlate physiologic functions with the signs and symptoms associated with hypokalemia. Discuss how the nurse assesses these signs and symptoms.
  • Review the role of potassium in the cardiac conduction system. Discuss the role of potassium in muscle contraction and nerve transmission. Correlate the importance of checking potassium levels when giving intravenous solutions containing potassium.
  • Review the function of calcium. Discuss the regulation of calcium. Include vitamin D and parathyroid hormone. Demonstrate Trousseau and Chvostek signs.
  • Discuss the pathophysiology of the signs and symptoms of hypercalcemia. Discuss common causes of hypercalcemia. Correlate cardiac dysrhythmias with calcium levels.
  • Review the function of magnesium. Include its effect on other electrolytes. Discuss the pathophysiology of hypomagnesemia in relation to the various disease processes. Correlate diuretic use with hypomagnesemia.
  • Correlate hypermagnesemia with renal failure. Give examples magnesium-containing antacids and cathartics. Describe how these medications can cause hypermagnesemia.
  • Define “anions” and “cations.” Review the functions of these anions: chloride, phosphate, and bicarbonate. Discuss the physiologic control of chloride.
  • Correlate the anion imbalances with the cation imbalances. Discuss how vitamin D deficiency and hyperparathyroidism affect bicarbonate levels. Correlate hyperphosphatemia with renal failure.
  • What is the importance of buffer systems? What are some of the diagnostic tests that measure buffer systems? Explain the importance of compensatory mechanisms.
  • Give examples of clinical conditions that could potentially cause these acid base imbalances. Discuss physical assessments to determine acid-base imbalances. Review the regulation of acid-base balance.
  • Emphasize the importance of distinguishing between oxygenation and acid-base balance when interpreting arterial blood gases. Review the functions of hydrogen ions and bicarbonate-carbonic acid buffer systems. Compare and contrast oxygen saturation and partial pressure oxygen
  • Give examples of the common disorders that cause respiratory acidosis. Explain how an increase in carbon dioxide could cause increased difficulty in breathing and other signs and symptoms. How does the nurse assess the changes in mental alertness?
  • What is the rationale for these interventions? Demonstrate postural drainage and deep breathing exercises. Explain how respiratory depressants treat respiratory acidosis.
  • Explain how diabetic ketoacidosis causes metabolic acidosis. Correlate renal failure with metabolic acidosis.
  • Explain the pathophysiology of symptoms of metabolic acidosis. Distinguish between confusion and stupor. Explain the pathophysiology of fruity odor and ketone bodies.
  • What is the mechanism of action of insulin? What is the role of dialysis in treating metabolic acidosis? What is the role of the LVN/LPN in the administration of IV bicarbonate or lactate?
  • Explain how anxiety, high fever, and aspirin overdose can cause respiratory alkalosis? What is the underlying cause of respiratory alkalosis? Explain the role of carbon dioxide in respiratory alkalosis.
  • What is the rationale for these interventions? What is the role of the LVN/LPN in implementing these nursing measures? Give specific patient instructions regarding breathing into a paper sack.
  • Explain how vomiting, extensive GI suction, and excessive consumption of antacids with bicarbonate cause metabolic alkalosis. How does steroid therapy cause metabolic alkalosis? Review the mechanism of action of diuretics and how these could potentially cause metabolic alkalosis.
  • How does the nurse assess disorientation and irritability? Explain how metabolic alkalosis causes tetany, seizures, and coma? What are the symptoms of calcium and potassium depletion?
  • What is the role of the LVN/LPN in fluid and electrolytes replacement? What is the mechanism of action of ammonium chloride in the treatment of metabolic acidosis?
  • List critical patient teaching instructions. How does the nurse assess the learning needs of the patient/family? Discuss nursing interventions that promote sodium restriction.
  • What is the role of the LVN/LPN in intravenous therapy? List the responsibilities of the nurse in administering intravenous fluids. What specific intravenous fluids can be administered by the LVN/LPN?
  • What are the emerging roles and responsibilities of the LVN/LPN in intravenous therapy? What is the National Patient Safety Goals and how do these affect nursing practice? What are the roles and responsibilities of the LVN/LPN in caring for vascular access devices and intraosseous infusion?

L&E Chapter 003 Lo L&E Chapter 003 Lo Presentation Transcript

  • Lesson 3.1 Chapter 3
    • Fluids, Electrolytes, Acid-Base Balance, and Intravenous Therapy
  • Learning Objectives
    • Theory
    • 1. Recall the various functions fluid performs in the body.
    • 2. Identify the body’s mechanisms for fluid regulation.
    • 3. Review three ways in which body fluids are continually being distributed among the fluid compartments.
    • 4. Distinguish the signs and symptoms of various electrolyte imbalances.
    • 5. Discuss why the elderly have more problems with fluid and electrolyte imbalances.
    • 6. Recognize the disorders that cause specific fluid and electrolyte imbalances.
    • 7. Compare the major causes of acid-base imbalances.
    • 8. State correct interventions to correct an acid-base imbalance.
    • 9. Discuss the steps in managing an intravenous infusion.
    • 10. Describe the measures used to prevent the complications of intravenous therapy.
    • 11. Identify intravenous fluids that are isotonic.
    • 12. Discuss the principles of intravenous therapy.
    • Clinical Practice
    • 1. Assess patients for signs of dehydration.
    • 2. Correctly assess for and identify edema and signs of overhydration.
    • 3. Apply knowledge of normal laboratory values in order to recognize electrolyte imbalances.
    • 4. Carry out interventions to correct an electrolyte imbalance.
    • 5. Determine if a patient has an acid-base imbalance.
    • 6. Carry out measures to prevent the complications of Intravenous therapy.
    • 7. Compare interventions for the care of a patient receiving total parenteral nutrition with one undergoing intravenous therapy.
  • Functions of Water
    • Transportation
    • Heat regulation
    • Maintenance of hydrogen (H + ) balance
    • Medium for the enzymatic action of digestion
  • Control of Fluid Balance
    • Thirst mechanism and osmoreceptors
    • Antidiuretic hormone (ADH)
    • Aldosterone and atrial natriuretic peptide (ANP)
    • Baroreceptors in the carotid sinus and aortic arch and the sympathetic/parasympathetic nervous system
  • Movement of Fluid and Electrolytes
    • Passive transport:
      • Diffusion
      • Osmosis
      • Isotonic, hypertonic, and hypotonic
      • Osmotic pressure
      • Filtration and hydrostatic pressure
    • Active transport:
      • Sodium pump and ATP  
  • Fluid Imbalances: Deficient Fluid Volume
    • Risk factors
    • Inability to take in sufficient quantities of fluid because of impaired swallowing, extreme weakness, disorientation or coma, or the unavailability of water
    • Loss of excessive amounts of fluid through prolonged vomiting, diarrhea, hemorrhage, diaphoresis (sweating), excessive wound drainage, or diuretic therapy
  • Assessment (Data Collection)
    • Turgor
    • Furrowed, dry tongue
    • Blood pressure
    • Pulse
  • Nausea and Vomiting
    • “ Sick to my stomach"
    • Pallor, mild diaphoresis, cold clammy skin, excessive salivation, and attempts to remain quiet and motionless
    • Vomitus odor, color, contents (e.g., undigested food), and amount
  • Medical Treatment
    • Antihistamines, sedative-hypnotics, anticholinergics, and phenothiazines
    • Complementary and alternative therapy
    • NPO, then progressing slowly to a regular diet
    • Carbonated drinks
  • Diarrhea
    • Frequent watery bowel movements, abdominal cramping, and general weakness
    • Watery stools often contain mucus and are blood‑streaked; frequency could be as high as 15 to 20 liquid stools.
    • Acute diarrhea and local irritation
    • Chronic and prolonged diarrhea in ulcerative colitis, irritable bowel syndrome, allergies, lactose intolerance, and nontropical sprue
  • Diarrhea
    • Dehydration, malnutrition, and anemia
    • Bowel sounds likely to be loud gurgling and tinkling sounds that come in waves and are hyperactive
    • Note and record the number of stools during the shift and the characteristics of each stool and associated pain
  • Acute Diarrhea
    • Limit the intake of food
    • Progress to clear, bland liquids and to solids with increased calories and high‑protein, high‑carbohydrate content
    • Give rehydrating solutions containing glucose and electrolytes
    • Avoid iced fluids, carbonated drinks, whole milk, roughage, raw fruits, and highly seasoned foods
  • Medications for Diarrhea
    • Cause of the disorder and the length of time the condition Mild cases:
      • Kaolin and bismuth preparations, (e.g., Kaopectate)
    • Antispasmodic drugs such as belladonna or paregoric
    • Bismuth and "traveler's diarrhea"
    • Codeine, diphenoxylate (Lomotil), or loperamide (Imodium)
    • Drugs and causative organisms
    • Metabolic acidosis and buffer solutions
  • Nursing Management
    • Provide physical and mental rest, prevent unnecessary loss of water and nutrients, protect the rectal mucosa, and replace fluids
    • Maintain a calm and dignified manner, accept and understand the patient's behavior, and provide privacy and a restful environment
  • Excess Fluid Volume
    • Hematocrit:
      • 35% to 54%, depending on age and sex
    • Urine concentration:
      • Specific gravity: 1.003 to 1.030 (average range is 1.010 to 1.025)
  • Edema
    • Localized edema and generalized edema
    • General causes of edema:
      • An increase in capillary hydrostatic pressure
      • A loss of plasma proteins
      • An obstruction of lymphatic circulation
      • An increase in capillary permeability
    • Dependent edema
  • Treatment
    • Correct the underlying cause
    • Assist the body to rebalance fluid content
    • Restrict fluids
    • Give diuretic drugs
    • Allow bed rest
    • Provide low-sodium diet
    • Use elastic stockings or sequential compression devices
  • Home Care: Fluid Volume Deficit
    • Log of intake and output
    • Small amounts of liquid every hour while awake
    • Emergency department and intravenous fluids
  • Home Care: Fluid Excess
    • Weigh daily
    • Assess edema
    • Know when to notify physician
  • Electrolytes
    • Ions:
      • Negatively charged anions
      • Positively charged cations
    • Creation of an electrical impulse:
      • Transmission of nerve impulses
      • Contraction of muscles
      • Excretion of hormones and other substances from glandular cells
  • Osmolality
    • Concentration of the solution determined by the number of solutes
    • Osmolality controls water movement and the body fluid distribution in the intracellular and extracellular compartments
    • Intracellular fluid and potassium
    • Extracellular fluid and sodium
    • Normal osmolality: 280 to 294 milliosmoles per kilogram
  • Sodium Imbalances
    • Hyponatremia (below 135 mEq/L)
    • Signs and symptoms:
      • Fatigue, lethargy, muscle weakness
      • Muscle cramps
      • Abdominal cramps and nausea and vomiting
      • Headache, confusion, seizures
      • Decreased blood pressure
  • Sodium Imbalances
    • Hypernatremia (above 145 mEq/L)
    • Signs and symptoms:
      • Decreased urine output if compensatory ADH is being secreted
      • Increased thirst with dry mucous membranes
      • Weakness and agitation
      • Good tissue turgor and firm subcutaneous tissues
  • Potassium Imbalances
    • Hypokalemia (below 3.5 mEq/L)
    • Signs and symptoms:
      • Cardiac dysrhythmias and ECG changes
      • Muscle weakness and decreased reflexes
      • Urinary retention and increased urine pH
      • Abdominal pain, gaseous distention, and paralytic ileus
      • Lethargy and confusion
  • Potassium Imbalances
    • Hyperkalemia (above 5.0 mEq/L)
    • Signs and symptoms:
      • ECG changes and cardiac dysrhythmias that may progress to cardiac arrest
      • Paresthesias and muscle weakness progressing to paralysis
      • Fatigue and nausea
  • Calcium Imbalances
    • Hypocalcemia (below 8.4 mg/dL)
    • Signs and symptoms:
      • Paresthesia and abdominal cramps
      • Muscle twitching, carpopedal spasm, Trousseau sign, and hyperactive reflexes
      • Chvostek sign
      • Tetany
      • Weak heart contractions
      • Laryngospasm
  • Calcium Imbalances
    • Hypercalcemia (above 10.6 mg/dL)
    • Signs and symptoms:
      • Muscle weakness, lethargy, stupor, and personality change
      • Anorexia and nausea
      • Polyuria
      • Dysrhythmias and cardiac arrest
      • Decreased bone density
  • Magnesium Imbalances
    • Hypomagnesemia (below 1.3 mEq/L)
    • Causes:
      • Diuretic use
      • Diabetic ketoacidosis
      • Hyperparathyroidism
      • Hyperaldosteronism
  • Magnesium Imbalances
    • Hypermagnesemia (above 2.1 mEq/L)
    • Causes:
      • Renal failure
      • Overuse of magnesium-containing antacids and cathartics
  • Anion Imbalances
    • Imbalances of chloride, phosphate, and bicarbonate accompany cation imbalances:
    • Hypochloremia (below 95 mEq/L) and hyponatremia
    • Hyperchloremia (above 103 mEq/L) with hypernatremia and metabolic acidosis
  • Anion Imbalances
    • Imbalances of chloride, phosphate, and bicarbonate accompany cation imbalances
    • Hypophosphatemia (below 3.0 mg/dL):
      • Aluminum-containing antacids that bind phosphate
      • Vitamin D deficiency
      • Hyperparathyroidism
    • Hyperphosphatemia (above 4.5 mg/dL) and renal failure
  • Control Mechanisms and pH
    • Buffer pairs
      • Bicarbonate–carbonic acid buffer system
      • Phosphate system
      • Hemoglobin system
      • Protein system
    • Respiratory system
      • Carbon dioxide
      • Carbonic acid
    • Kidneys
      • Bicarbonate ion
  • Acid–Base Imbalances
    • Respiratory acidosis
    • Respiratory alkalosis
    • Metabolic acidosis
    • Metabolic alkalosis
  • Arterial Blood Gas Analysis
    • Partial pressure exerted by oxygen (PaO 2 ) 80 to 100 mm Hg
    • Partial pressure of carbon dioxide (PaCO 2 ) 35 to 45 mm Hg
    • pH 7.35 to 7.45
    • SaO 2 (also abbreviated O 2 Sat) 94% to 100%
    • HCO 3 22 to 26 mEq/L
    • Base excess or deficit measured in "+" or " − "
  • Respiratory Acidosis
    • An increase in carbon dioxide levels occurs in a variety of disorders
    • Signs and symptoms:
      • Complaints of increasing difficulty in breathing
      • History of respiratory obstruction (acute or chronic)
      • Dyspnea, weakness, dizziness, restlessness, sleepiness, and change in mental alertness
  • Respiratory Acidosis Treatment
    • Airway:
    • Tracheostomy and endotracheal tube
    • Oxygen administration
    • Mechanical ventilation
    • Postural drainage, deep‑breathing exercises, bronchodilators, and antibiotics
    • Narcotics, hypnotics, and tranquilizers as respiratory depressants
  • Metabolic Acidosis
    • An excessive loss of bicarbonate ions or an increased production or retention of hydrogen ions
    • Causes:
      • Excessive loss of bicarbonate ions from diarrhea
      • Renal failure
      • Diabetic ketoacidosis
      • Hyperkalemia
  • Symptoms of Metabolic Acidosis
    • Weakness, lethargy, headache, and confusion
    • Stupor, unconsciousness, coma, and death
    • Fruity odor and ketone bodies (ketoacidosis)
    • Vomiting and diarrhea
  • Metabolic Acidosis Treatment
    • Insulin and diabetic ketoacidosis
    • Dialysis and kidney failure
    • Severe metabolic acidosis and administration of IV bicarbonate or lactate
  • Respiratory Alkalosis
    • Causes of
    • hyperventilation
      • Anxiety
      • High fever
      • Aspirin overdose
    • Symptoms
      • Deep, rapid breathing
      • Tingling of the fingers
      • Pallor around the mouth
      • Dizziness
      • Spasms of the muscles of the hands
  • Treatment for Hyperventilation
    • Treat the underlying disorder
    • Have patient use re-breather mask
    • Calm patient’s hysteria and prevent further hyperventilation
    • Administer sedatives to calm the patient
    • Have patient breathe into a paper sack
  • Causes of Metabolic Alkalosis
    • Vomiting
    • Extensive gastrointestinal suction
    • Hypokalemia
    • Excessive consumption of antacids with bicarbonate
    • Other causes
      • Drainage from intestinal fistula
      • Diuresis
      • Steroid therapy
  • Signs and Symptoms of Metabolic Alkalosis
    • Irritability, disorientation, lethargy, muscle twitching, tingling and numbness of the fingers, and convulsions
    • Slow shallow respirations, decreased chest movements, and cyanosis
    • Symptoms of potassium and calcium depletion
    • Tetany, seizures, and coma
  • Treatment of Metabolic Alkalosis
    • Correcting underlying cause
    • Fluid and electrolyte replacement
    • Administration of an acidifying solution such as ammonium chloride
  • Home Care
    • Fluid intake or restriction
    • Sodium restriction
    • Controlling underlying disorder
    • Arterial blood gases
    • Oxygen and electrolytes
  • Intravenous Therapy
    • Total parenteral nutrition
    • Isotonic, hypotonic, and hypertonic
    • Blood‑related fluids
    • Plasma expanders
  • Nursing Responsibilities: Administering IV Fluids
    • Venipuncture
    • National Patient Safety Goal
    • Central intravenous lines
    • Subcutaneous infusion and hypodermoclysis
    • Intraosseous infusion
    • Epidural infusion