Fluids & electrolytes
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  • Again, treatment goals are to ideally restore Na to their normal range – between 135 – 145. The most effective treatment, however, is prevention. Because thirst mechanism is oftentimes altered in ill clients, our role as providers of care is to help encourage appropriate hydration in the ill client. Early detection and treatment is necessary to help avoid serious consequences.

Fluids & electrolytes Presentation Transcript

  • 1. Nio Cruzada Noveno, RN, MAN, MSN Fluids & Electrolytes
  • 2. BODY FLUIDS
    • Functions of Fluids
        • Body fluids:
          • Facilitate in the transport
            • [nutrients, hormones proteins, & others…]
          • Aid in removal of cellular metabolic wastes
          • Provide medium for cellular metabolism
          • Regulate body temperature
          • Provide lubrication of musculoskeletal joints
          • Component in all body cavities
          • [parietal, pleural fluids]
    • Water is the principal body fluid & essential for life.
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 3. Renal Disorders [email_address] FLUIDS and ELECTROLYTES FLUIDS and ELECTROLYTES BODY FLUIDS ICF ECF 40% TBW 20% TBW P IS Distribution of Body Fluids: 50-70% of total body weight; infant [70-80%], elderly [45-50%] 60-kg man TBW = 0.6 x 60 kg = 3.6 L ICF = 0.4 x 60 kg = 24 L ECF =12 L 3L 9L
  • 4. BODY FLUIDS
    • Factors that Dictate Body Water Requirement
      • Amount needed to give the proper osmotic concentration
      • Amount needed to replace water lost excretion
    Normal Routes of water gain and loss Renal Disorders [email_address] FLUIDS and ELECTROLYTES INTAKE OUTPUT ml/day ml/day Fluid intake 1,500 Food 800 Metabolic water 300 TOTAL 2,600 Insensible loss 400 Sweat 600 Feces 100 Urine 1,500 TOTAL 2,600
  • 5. FLUID EXCHANGE BETWEEN BODY FLUID COMPARTMENTS Osmotic Pressure Gradient Oncotic P (Colloid osmotic P) Capillary P (Hydrostatic P) Renal Disorders [email_address] FLUIDS and ELECTROLYTES ICF ECF P ISF
  • 6. Control of Osmotic Pressure, Volume & Electrolyte Concentration
    • OBLIGATORY Reabsorption
        • occurs in the proximal tubules
        • 178 L/day of glomerular filtrate (80% reabsorbed)
        • 2  to solute reabsorption
        • independent of the water requirement
    • FACULTATIVE Reabsorption
        • occurs in the distal & collecting tubules
        • independent of the active solute transport
        • dependent of body’s need of water
        • under the control of ADH
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 7. DISTURBANCES IN FLUID BALANCE
    • EDEMA (Dropsy)
      •  in the interstitial fluid volume of about 2 L or more due to increase transudation of fluid from capillaries 2° to:
        • Increased HP [pregnancy, CHF]
        • Decreased OP
          • [malnutrition, end-stage liver disease, nephrotic syndrome]
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES FLUIDS and ELECTROLYTES
  • 8. DISTURBANCES IN FLUID BALANCE
    • CELL OVERHYDRATION
      • excess of water in the ECC w/ a normal amount of solute or a deficient amount of solute
      • occurs in prolonged and excessive diuresis, forcing hypotonic fluids to produce diuresis in the presence of renal impairment
      • fluid overload from  production of adrenal corticoid hormones [Cushing’s syndrome]
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 9. DISTURBANCES IN FLUID BALANCE
    • CELL OVERHYDRATION
      • Symptoms
        • Weight gain & edema
        • Cough, moist rales, dyspnea
        • [fluid congestion in lungs]
        • CVP, bounding pulse, neck vein engorgement [fluid excess in the vascular system]
        • Bulging fontanelles
        •  Hg and Hct
        • Nausea & vomiting
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 10. DISTURBANCES IN FLUID BALANCE
    • CELL OVERHYDRATION
      • Management
        • Restrict fluids to lower fluid volume
        • Diuretics or hypertonic saline
        • Continuous assessments to prevent skin breakdown
        • Record daily weight to assess progress of treatment
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 11. DISTURBANCES IN FLUID BALANCE
    • CELL DEHYDRATION (DHN)
      • loss of body fluids, particularly from the extracellular fluid compartment
      • water loss > water intake
      • Causes
        • Fever
        • Insufficient water intake
        • Diarrhea, vomiting
        • Excess urine output [Diabetes insipidus, diuretics]
        • Excessive perspiration, burns
        • Hemorrhage, shock, metabolic acidosis
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 12. DISTURBANCES IN FLUID BALANCE
    • CELL DEHYDRATION (DHN)
      • Symptoms
        • Thirst, dry mucus membranes, sunken eyeballs
        • “ Doughy“ abdomen, dry skin w/ poor turgor
        •  temp, weight loss
        •  HR,  RR,  BP
        • Restlessness,irritability, disorientation, convulsion, coma [22-30% body H 2 0 loss]
      • Management
        • Fluid replacement therapy & continued fluid maintenance
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 13. Renal Disorders [email_address] FLUIDS and ELECTROLYTES Volume Disorders 2° Alteration in Sodium Balance Expansion Isotonic Inc N No net change Isotonic fluid ingestion Hypertonic Inc Dec ICF  ECF Sea water ingestion Hypotonic Inc Inc ECF  ICF Hypotonic IVF Contraction Isotonic Dec N No net change Diarrhea Hypertonic Dec Dec ICF  ECF Diabetes insipidus Hypotonic Dec Inc ECF  ICF Addison’s dse Volume ECF ICF Water Conditions Disorder Vol. Vol. Shift
  • 14.
    • ELECTROLYTES
      • salts or minerals in extracellular or intracellular body fluids
        • Sodium – major cation of ECF
        • Potassium – major cation of ICF
        • Chloride - major anion of ICF
        • Protein – in ICF > ISF
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 15. ELECTROLYTE Composition Electrolyte Conc Plasma (mEq/L) ISF ICF Sodium, Na + 142 141 10 Potassium, K + 5 4.1 150 Calcium, Ca ++ 5 4.1 - Magnesium, Mg ++ 3 3 40 (155) Chloride, Cl - 103 115 15 Bicarbonate, HCO 3 - 27 29 10 Biphosphate, HPO 4 - 2 2 100 Sulfate, SO 4 - 1 1 20 Protein 16 1 60 Organic foods 6 3.4 - (155) Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 16. ELECTROLYTES
    • Functions of Electrolytes
        • Contribute most of the osmotically active particles in body fluids
        • Provide buffer systems for pH regulation
        • Provide the proper ionic environment for normal neuromuscular irritability & tissue function
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 17.
    • Hyponatremia [Na + < 135 mEq/L; Normal = 135-145 mEq/L]
        • Causes
          •  Na + intake
          •  Na + excretion [diaphoresis, GI suctioning]
          • Adrenal insufficiency
        • Assessment
          • N & V, abdominal cramps, weight loss
          • Cold, clammy skin,  skin turgor
          • Apprehension, HA, convulsions, focal neurologic deficit, coma [cerebral edema]
          • Fatigue, postural hypotension
          • Rapid thready pulse
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES FLUIDS and ELECTROLYTES
  • 18. Hyponatremia Drugs that cause decreased sodium
    • Anti-convulsant:
    • Carbamazepine
    • Antidiabetics:
    • Chlorpropramide
    • Tolbutamide
    • Antipsychotics:
    • Fluphenazine
    • Thiozoridazine
    • Thiothixene
    • Antineoplastics:
    • Cyclophosphamide
    • Vincristine
    • Diuretics:
    • Bumetanide
    • Ethacrynic acid
    • Furosemide
    • Thiazides
    • Sedatives:
    • Barbiturates
    • Morphine
    Renal Disorders [email_address]
  • 19.
    • Hyponatremia [Na + < 135 mEq/L; Normal = 135-145 mEq/L]
      • Management
        • Provide foods high in sodium
        • Administer NSS IV
        • Assess blood pressure frequently
        • [measure lying down, sitting & standing]
        • High sodium foods
          • Celery
          • Cheeses
          • Condiments
          • Processed foods
          • Smoked meats
          • Snack foods
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 20. Treatment
    • Interventions
      • Mild
        • Water restriction if water retention problem
        • Increase Na in foods if loss of Na
      • Moderate
        • IV 0.9% NS, 0.45% NS, LR
      • Severe
        • 3% NS – short-term therapy in ICU setting
    Renal Disorders [email_address]
  • 21.
    • Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]
        • Causes
          • Excessive, rapid IV adm’n of NSS
          • Inadequate water intake
          • Kidney disease
        • Assessment
          • Dry, sticky mucus membranes
          • Flushed skin
          • Rough dry tongue, firm skin turgor
          • Intense thirst
          • Edema, oliguria to anuria
          • Restlessness, irritability [cerebral DHN]
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 22. Hypernatremia
    • S kin flushed
    • A gitation
    • L ow-grade fever
    • T hirst
    Renal Disorders [email_address]
  • 23.
    • Hypernatremia [Na+ >145 mEq/L; Normal = 135-145 mEq/L]
        • Nursing Intervention
          • Weigh daily
          • Assess degree of edema frequently
          • Measure I & O
          • Assess skin frequently & institute nursing measures to prevent breakdown
          • Encourage sodium-restricted diet
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 24.
    • Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]
        • Causes
          • Renal insufficiency
          • Adrenocortical insufficiency
          • Cellulose damage [burns]
          • Infection
          • Acidotic states
          • Rapid infusion of IV sol’n w/ potassium-conserving diuretics
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 25. Hyperkalemia Drugs that increase potassium
    • ACE inhibitors
    • Antibiotics
    • Beta blockers
    • NSAIDs
    • Spironolactone
    • Chemotherapeutics
    Renal Disorders [email_address]
  • 26.
    • Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]
        • Assessment
          • Thready, slow pulse
          • Shallow breathing
          • N & V, diarrhea, intestinal colic
          • Irritability
          • Muscle weakness, flaccid paralysis
          • Numbness, tingling
          • Difficulty w/ phonation, respiration
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 27.
    • Hyperkalemia [K+ > 5.5 mEq/L; Normal = 3.5-5.5 mEq/L]
        • Nursing Interventions
          • Administer kayexalate as ordered
          • Administer/monitor IV infusion of glucose & insulin
          • Control infection
          • Provide adequate calories & carbohydrates
          • Discontinue IV or oral sources of K +
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 28.
    • Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]
        • Causes
          • Renal tubule defects
          • Prolonged diuretic therapy
          • Prolonged vomiting, diarrhea, laxative use, NG suctioning, severe diaphoresis
          • Anorexia
          • Acute alcoholism
          • Hyperaldosteronism, excessive steroids
          • Metabolic alkalosis
          • Administration of potassium-deficient hyperalimentation sol’n, hypertonic glucose
          • Excessive amounts of insulin
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 29.
    • Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]
        • Assessment
          • Thready, rapid, weak pulse
          • Faint heart sounds
          •  BP
          • Skeletal muscle weakness
          •  or absent reflexes
          • Shallow respirations
          • Malaise, apathy, lethargy
          • Loss of orientation
          • Anorexia, vomiting, weight loss
          • Gaseous intestinal distention
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 30. Hypokalemia
        • S keletal muscle weakness
        • U -wave
        • C onstipation; ileus
        • T oxic effects of digoxin
        • I rregular, weak pulse
        • O rthostatic hypotension
        • N umbness [paresthesia]
    Renal Disorders [email_address]
  • 31. Hypokalemia Drugs that decrease potassium
    • Adrenergics:
    • Albuterol
    • Epinephrine
    • Antibiotics:
    • Amphotericin B
    • Carbenicillin
    • Gentamicin
    • Insulin
    • Cisplatin
    • Costicosteroids
    • Diuretics:
    • Furosemide
    • Thiazides
    • Laxatives [ excess use ]
    Renal Disorders [email_address]
  • 32.
    • Hypokalemia [K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L]
    • Nursing Interventions
      • Administer K + supplements to replace losses
      • Be cautious in administering drugs that are not potassium-sparing
      • Monitor acid-base balance
      • Monitor pulse, BP and ECG
      • High potassium foods
        • Avocados
        • Bananas
        • Dates
        • Oranges
        • Potatoes
        • Raisins
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 33.
    • Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]
        • Causes
          • Hyperparathyroidism
          • Immobility
          • Increased vitamin D intake
          • Osteoporosis & osteomalacia [early stages]
        • Assessment
          • N & V, anorexia, constipation
          • Headache, confusion
          • Lethargy, stupor
          • Decreased muscle tone
          • Deep bone/flank pain
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 34. Hypercalcemia Drugs that increase calcium
    • Calcium-containing antacids
    • Calcium preparations
    • Lithium
    • Thiazide diuretics
    • Vitamin A
    • Vitamin D
    Renal Disorders [email_address]
  • 35.
    • Hypercalcemia [Ca > 5.8 mEq/L; Normal = 4.5-5.8 mEq/L]
        • Nursing Interventions
          • Encourage mobilization
          • Limit vitamin D intake
          • Limit calcium intake
          • Normal saline
          • Administer diuretics
          • Calcitonin
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 36.
    • Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]
        • Causes
          • Acute pancreatitis
          • Diarrhea
          • Hypoparathyroidism
          • Lack of vitamin D in the diet
          • Long-term steroid therapy
        • Assessment
          • Painful tonic muscle & facial spasms
          • Fatigue, dyspnea
          • Laryngospasm, convulsions
          • (+) Trousseau’s and Chvostek’s signs
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 37.
    • Hypocalcemia [Ca < 4.5 mEq/L; Normal = 4.5-5.8 mEq/L]
        • Nursing Interventions
          • Administer oral Ca lactate or IV CaCl 2 or gluconate
          • Providing safety by padding side rails
          • Administer dietary sources of calcium
          • Vitamin D
          • Provide quiet environment
          • High calcium foods
            • Milk
            • Dairy products
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 38.
    • Hyermagnesemia [Mg > 3.0 mEq/L; Normal = 1.5-3.0 mEq/L]
      • Causes
        • Renal insufficiency, dehydration
        • Excessive use of Mg-containing antacids or laxatives
      • Assessment
        • Lethargy, somnolence, confusion
        • N & V
        • Muscle weakness, depressed reflexes
        •  pulse and respirations
      • Nursing Intervention
        • Withhold Mg-cont’g drugs/foods; Ca adm’n
        •  fluid intake, unless CI
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 39.
    • Hypomagnesemia [Mg < 1.50 mEq/L; Normal = 1.5-3.0 mEq/L]
      • Causes
        • Low intake of Mg in the diet
        • Prolonged diarrhea
        • Massive diuresis
        • Hypoparathyroidism
      • Assessment
        • Paresthesias, muscle spasm
        • Confusion, hallucination, convulsions
        • Ataxia, tremors, hyperactive deep reflexes
        • Flushing of the face, diaphoresis
      • Nursing Intervention
        • Provide good dietary sources of Mg
    ELECTROLYTES Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 40. Hypomagnesemia Drugs that decrease magnesium
    • Aminoglycoside:
      • Amikacin, gentamicin, streptomycin, tobramycin
    • Amphotericin B
    • Cisplatin
    • Cyclosporine
    • Insulin
    • Laxative
    • Loop diuretics
    • Pentamidine isethionate
    Renal Disorders [email_address]
  • 41. Hypomagnesemia
        • S eizures
        • T etany
        • A norexia & arrhythmias
        • R apid heart rate
        • V omiting
        • E motional lability
        • D eep tendon reflexes increased
        • [tremors, twitching, tetany]
    Renal Disorders [email_address]
  • 42. Dietary sources
    • Chocolates
    • Dry beans and peas
    • Green, leafy vegetables
    • Meats
    • Nuts
    • Seafood
    • Whole grains
    Renal Disorders [email_address]
  • 43. IV FLUID REPLACEMENT THERAPY
    • Indications
      • Replacement of abnormal fluid & electrolyte losses [surgery, trauma, burns, GI bleeding]
      • Maintenance of daily fluid & electrolyte needs
      • Correction of fluid disorders
      • Correction of electrolyte disorders
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 44. IV FLUID REPLACEMENT THERAPY
    • Types of Solutions
      • Isotonic
        • 0.9% sodium chloride (NSS)
        • Lactated Ringer’s sol’n
      • Hypotonic
        • 5% dextrose and water (D5W)
        • 0.45% sodium chloride
        • 0.33% sodium chloride
      • Hypertonic
        • 3% NaCl
        • Protein sol’ns
      • Colloids
        • Salt poor albumin Plasmanate, Dextran
    Renal Disorders [email_address] FLUIDS and ELECTROLYTES
  • 45. BURNS
    • wounds caused by excessive exposure to the following agents or causes:
    • Causes of Burns:
      • Thermal [moist or dry heat]
      • Electrical
      • Chemical [strong acids and strong alkali]
      • Radiation [UV, x-rays, radium, sunburns]
    Renal Disorders [email_address] B U R N S
  • 46.
    • CLASSIFICATION OF BURNS
    • Superficial Partial thickness (1 st degree)
      • Outer layer of dermis
      • Erythema, pain up to 48 hrs
      • Healing 1-2 wks [sunburn]
    • Deep Partial thickness (2 nd degree)
      • Epidermis & dermis
      • Blisters & edema, frequently quite painful
      • Healing 14-21 days
    • Full thickness (3 rd degree)
      • Epidermis, dermis, subcutaneous fat
      • Dry, pearly white or charred in appearance
      • Not painful
      • Eschar must be removed; may need grafting
    Renal Disorders [email_address] B U R N S
  • 47.
    • STAGES OF BURNS
    • 1 st : Shock/Fluid Accumulation Phase
        • 1 st 48 hrs
        • IVC  ISC
        • Generalized DHN [fluid shifting]
        • Hypovolemia [plasma loss],  BP,  C.O.
        • Hemoconcentration,  Hct [liquid blood component  ISC]
        • Oliguria [  renal perfusion], ADH release & aldosterone
        • HyperK, hypoNa
        • Metabolic acidosis
    Renal Disorders [email_address] B U R N S
  • 48.
    • STAGES OF BURNS
    • 2 nd : Diuretic/Fluid Remobilization Phase
        • After 48 hrs
        • ISC  IVC
        • Hypervolemia,
        • Hemodilution,  Hct
        • Diuresis [  renal perfusion],  ADH & aldosterone secretion
        • HypoK, hypoNa [K moves back into the cells, Na+ still trapped in the edema fluids
        • Metabolic acidosis
    Renal Disorders [email_address] B U R N S
  • 49.
    • STAGES OF BURNS
    • 3 rd : Recovery Phase
        • 5 th day onwards
        • Hypocalcemia
          • Ca is lost on the exudates
          • Ca is utilized in the granulation tissue formation
        • Negative nitrogen balance
          • Due to stress response
          •  protein catabolism
          • Protein intake is lesser than the demand
        • HypoK
    Renal Disorders [email_address] B U R N S
  • 50.
    • ASSESSMENT
      • Assess extent of body surface burned
        • Greater morbidity & mortality for burns affecting face, hands & perineum
        • Assess for dyspnea, stridor, hoarseness
      • Assess extent of burn injury
        • Rule of nine – immediate appraisal
        • Lund-Browder chart – more accurate
        • Berkow’s method – based on client’s age & changes that occur in proportion of head & legs to the rest of the body as one grows
    Renal Disorders [email_address] B U R N S
  • 51. ASSESSMENT Burn Evaluation Chart Renal Disorders [email_address] B U R N S 9% 9% 9% Front= 18% Back= 18% 18% 18% 1%
  • 52.
    • ASSESSMENT
      • 3. Assess depth of burn
        • Major burns – 2 nd degree over 30% of body
        • Hospitalization - eyes, face, neck, hands, perineum, genitalia
      • 4. Assess unique contributing factors
        • Age of client
        • Health history
          • Diabetes, preexisting ulcers
          • Tetanus immunization
    Renal Disorders [email_address] B U R N S
  • 53.
    • EMERGENCY MANAGEMENT
      • Stop the burning process
        • Remove patient from source of injury
        • Advise client to roll on the ground if clothing is in flame [STOP-DROP-ROLL]
        • Throw a blanket over the client to smother the flame
        • Remove clothing only if hot or for scald burn
        • Immerse affected part in cold water [10 min]
        • Irrigate copiuosly w/ large amount of running water w/ chemical burns [except w/ phosphorus]
        • Interrupt power source w/ electrical burn
    Renal Disorders [email_address] B U R N S
  • 54.
    • MANAGEMENT
      • Maintenance of adequate airway
      • Promoting comfort: relieve pain
      • Promoting fluid-electrolyte, acid-base balance
      • Preventing infection
      • Maintaining adequate nutrition
      • Wound care
    Renal Disorders [email_address] B U R N S
  • 55.
    • METHODS OF TREATING BURNS
      • Open method or Exposure method
        • Face, neck, perineum, trunk
        • Allowing exudate to dry in 3 days
      • Occlusive
        • Less pain, absorption of secretion, comfort, transportability, accelerated debridement
        • Aesthetic considerations
      • Semi-open method
        • Covering of wound w/ topical antimicrobials:
          • Silver sulfadiazine 1% (Flamazine)
          • Silver nitrate 0.5% sol’n
          • Mafenide acetate (sulfamylon acetate)
    Renal Disorders [email_address] B U R N S
  • 56.
    • BIOLOGIC DRESSING (Skin Graft)
      • Allograft
        • Skin taken from other person [cadaver]
      • Autograft
        • Same person
      • Heterograft
        • Different species
        • Xenograft
        • [segment of skin from animal such as pig or dog]
    Renal Disorders [email_address] B U R N S
  • 57.
    • FLUID REPLACEMENT
    • Types of fluids:
        • Colloids
          • Blood
          • Plasma & plasma expanders
        • Electrolytes
          • Lactated Ringers
        • Non-electrolyte
          • D 5 W
    Renal Disorders [email_address] B U R N S
  • 58.
    • FLUID REPLACEMENT
    • EVAN’S Formula:
        • C – 1ml x % burns x kg BW
        • E - 1ml x % burns x kg BW
        • G lucose 5% for insensible loss – 2,000ml D5W
      • Administer sol’n 1 st 24 hrs – ½ [1 st 8hrs], ½ [16hrs]
    • BROOKE Formula: [Administer as in Evan’s]
        • C – 0.5ml x % burn x kg BW
        • E - 1.5ml x % burn x kg BW
        • Water – 1000ml D5W
    Renal Disorders [email_address] B U R N S
  • 59.
    • FLUID REPLACEMENT
    • MOORES BURN BUDGET:
        • 75 ml of plasma, 75 ml of electrolyte-cont’g fluid for q 1% TBSA plus 2000 D 5 W
    • HYPERTONIC RESUSCITATION Formula:
        • Hypertonic salt containing 300 mEq of Na + , 100 mEq of Cl - , 200mEq lactate
        • Administered to maintain urinary output of 30-40 ml/hr
    Renal Disorders [email_address] B U R N S
  • 60. ACID-BASE DISORDERS Renal Disorders [email_address] Disorder Clinical manifestation Compensation Respiratory acidosis ↑ Paco 2 , ↑ or normal HCO 3 - , ↓ pH Kidneys eliminate H + and retain HCO 3 - Respiratory alkalosis ↓ Paco 2 , ↓ or normal HCO 3 - , ↑ pH Kidneys conserve H + and eliminate HCO 3 - Metabolic acidosis ↓ or normal Paco 2 , ↓HCO 3 - , ↓ pH Lungs eliminate CO 2 and conserve HCO 3 - Metabolic alkalosis ↑ or normal Paco 2 , ↑HCO 3 - , ↑ pH Lungs hypoventilate to ↑ Paco 2 , kidneys conserve H + excrete HCO 3 -
  • 61. Causes of Acid-Base Disorders
    • Metabolic acidosis
    • Causes :
    • DKA, uremia, starvation, diarrhea, severe infections
    • Manifestations:
    • Headache, nausea and vomiting
    • Signs of hyperkalemia
    • Seizures, coma, hyperventilation
    • Nursing management:
    • Administer sodium bicarbonate
    • Monitor for signs of hyperkalemia
    • Provide alkaline mouthwash
    • Lubricate lips to prevent dryness
    • I & O
    • Institute seizure precaution
    • Monitor ABG & electrolyte losses
    Renal Disorders [email_address]
  • 62. Causes of Acid-Base Disorders
    • Metabolic alkalosis
    • Causes:
    • Severe vomiting, NGT suctioning, diuretic therapy, excessive ingestion of NaHCO 3 , biliary drainage
    • Manifestations:
    • Nausea and vomiting
    • Signs and symptoms of hypokalemia
    • Nursing management:
    • Decreased respirations
    • Replace fluids nad electrolytes losses
    • I & O
    • Assess for signs of hypokalemia
    • Monitor ABG & electrolytes
    Renal Disorders [email_address]
  • 63. Causes of Acid-Base Disorders
    • Respiratory acidosis
    • Causes:
    • Hypoventilation: COPD, barbiturate or sedative overdose, acute airway obstruction, neuromuscular disorders
    • Manifestations:
    • Headache, weakness, visual disturbances, rapid respirations, confusion, drowsiness, tachycardia, coma
    • Nursing management:
    • Semi-Fowler’s
    • Patent airway
    • Turn, cough, deep-breath
    • Administer fluids
    • O 2 therapy
    • Monitor ABG
    Renal Disorders [email_address]
  • 64. Causes of Acid-Base Disorders
    • Respiratory alkalosis
    • Causes:
    • Hyperventilation, mechanical overventilation, encephalitis
    • Manifestations:
    • Numbness and tingling of mouth and extremities
    • Inability to concentrate
    • Rapid respirations, dry mouth, coma
    • Nursing management:
    • Offer reassurance
    • Encourage breathing into a paper bag
    • Provide sedation as ordered
    • Monitor mechanical ventilation and ABG
    Renal Disorders [email_address]
  • 65. Interpretation Renal Disorders [email_address] UC PC FC pH ↓ or ↑ ↓ or ↑ normal HCO 3 - ↓ or ↑ normal ↓ or ↑ ↓ or ↑ Paco 2 ↓ or ↑ normal ↓ or ↑ ↓ or ↑
  • 66. Nio Cruzada Noveno, RN, MAN, MSN Fluids & Electrolytes