Chapter 6 fluid___electrolytes
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Chapter 6 fluid___electrolytes

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nursing electrolyte information

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Chapter 6 fluid___electrolytes Chapter 6 fluid___electrolytes Presentation Transcript

  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Chapter 6 Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Water in the Body  ½ of the human body’s weight is water  % of water balance decreases with age  Infant body 77% water, elderly body 45% water  Fatty tissue has less water that most others  To maintain a healthy body weight water % must be high  All life processes to take place in fluid-water  Majority of cells are fluid, where continuous exchange of glucose, oxygen, nutrients, and electrolytes  Functions of water in the Body:  Transports substances to and from the cells  Aid in heat regulation  Serve as a medium for enzymatic action  Assist in H+ ion balance Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Fluid Balance  Intracellular Fluid  Fluid within the cell  Extracellular Fluid  Fluid outside the cell  Interstitial Fluid-In the spaces surrounding  Intravascular Fluid-Within the blood  Transcellular Fluid-Aqueous humor, saliva, pleural, pericardial, and cerebrospinal fluids Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Control of Fluid Balance  Pressure Sensors  In the hypothalamus sense the intake of fluids (thirst mechanism)  Antidiuretic Hormone  Released by the posterior pituitary controls how much fluid leaves the body in urine and causes reabsorption of H2O  Aldosterone and Atrial natriuretic peptide (ANP)  Regualte the reabsorption of H2O and Na+ from the kidney tubules Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Movement of Fluids and Electrolytes  Active Transport  Requires cellular energy, ATP, to move molecules into cells despite the electrical charge or concentration  Movement of substances from are of lower concentration to an area of higher concentration  Passive Transport  Diffusion-Process in which molecules move back and forth across the cell membrane until there is equal distributation  Filtration-Movement of H20 and solutes through a semipermiable membrane due to pressure on one side of the membrane  Osmosis-Movement of liquid across a membrane Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Tonicity  Isotonic  Solution has the same concentration of particles and water  Hypertonic  Solution has a greater concentration of solutes than water  Hypotonic  Solution has a lesser concentration of solutes than water Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Fluid Gains and Losses  Gains  Losses  Food  Sensible  Fluid  Insensible Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Fluid Imbalances  Dehydration  Hypovolemia  Fluid Overload Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Dehydration Signs and Symptoms  Thirst  Rapid, Weak Pulse  Low Blood Pressure  Dry Skin and Mucous Membranes  Skin Tenting  Decreased Urine Output  Increased Temperature Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Deficient Fluid Volume  Monitor Daily Weight  Monitor Intake and Output  Increase Fluid Intake  Treat Underlying Cause  Use CAUTION with Elderly Patients Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Fluid Excess Signs and Symptoms  Bounding Pulse  Elevated Blood Pressure  Respiratory Changes  Edema  Increased Urine Output  Weight Gain  Heart Failure Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Excess Fluid Volume  Monitor Weight and Urine Output  Place in Fowler’s Position  Administer Oxygen  Administer Diuretics  Restrict Fluid and Sodium Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Electrolytes  Cations +  Anions - Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Sodium Imbalances  Hyponatremia  Hypernatremia Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Food Sources of Sodium  Pizza  Canned Vegetables  Canned Soups  Salty Snacks  Prepared Foods Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hyponatremia Signs and Symptoms  Sodium <135 mEq/L  Fluid Excess or Deficit  Mental Status Changes  Weakness  Nausea and Vomiting Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hyponatremia  Monitor Intake and Output  Monitor Weight  Restrict Fluids  Administer Diuretics/Steroids Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hypernatremia Signs and Symptoms  Sodium >145 mEq/L  Thirst  Mental Status Changes  Seizures  Muscle Weakness  Respiratory Compromise Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hypernatremia  Treat Fluid Imbalance First  Monitor Intake and Output  Monitor Weight  Administer Diuretics  Restrict Dietary Sodium  Treat Cause Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Potassium Imbalances  Hypokalemia  Hyperkalemia Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Food Sources of Potassium  Sweet Potato  Beet Greens  Potato  Yogurt  Prune Juice  Soybeans  Bananas Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hypokalemia Signs and Symptoms  K+ <3.5 mEq/L  Muscle Weakness  Shallow Respirations  Mental Status Changes  Cardiac Dysrhythmia and Arrest Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hypokalemia  Treat Underlying Cause  Offer Potassium-rich Foods  Administer Potassium Replacement  Teach Patient  Signs and Symptoms to Report  Self-administration of Supplement Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hyperkalemia Signs and Symptoms  K+ >5 mEq/L  Muscle Twitching and Cramps  Later Muscle Weakness  Diarrhea  Low Blood Pressure  Cardiac Dysrhythmia and Arrest Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hyperkalemia  Limit Dietary Potassium  Hold Potassium Supplements  Administer Medications as Ordered  Potassium-losing Diuretic  Kayexalate  Insulin with Glucose Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Calcium Imbalances  Calcium most abundant ion in body  Normal adult calcium level 8.5-10.5 mg/dL  Obtained form dietary sources, only 20% absorbed for use, and excess excreted by renal system  Extracellular Ca important for:  supporting cell membrane  Regulating muscle contraction and relaxation  Maintain cardiac function  Blood clotting Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Calcium Imbalances  Hypocalcemia  Total serum Ca level is < 8.5 mg/dL  Decreased total Ca stores or low extracellular levels but normal amounts in bone  Shift of calcium of Ca into the bone  Caused by removal or injury of parathyroid glands during a thyroidectomy, chronic disease or insufficient intake and acute pancreatitis, postmenopausal women other electrolyte imbalances including hypomagnesemia, hyperphosphatemia, insufficient vitamin D, certain drugs including: loop diuretics, anticonvulants Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hypocalcemia Signs and Symptoms  Ca++ <9 mg/dL or 4.5 mEq/L  Mental Status Changes  Hyperactive Deep Tendon Reflexes  Diarrhea  Cardiac Dysrhythmia and Arrest  Hallmark signs:  Tetany (muscular spasms and convulsions) numbness and tingling around the mouth  Chvostek’s sign-facial muscle switching when face touching  Trousseau’s sign-palmar flexion during inflation of BP cuff Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hypocalcemia Signs and Symptoms (cont’d) Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Food Sources of Calcium  Fortified Cereals  Canned Salmon  Spinach  Yogurt  Cheese  Milk  Prevention: intake of at least 1000mg for adults and 1200mg for older adults Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hypocalcemia  Treat Cause  Increase Dietary Calcium  Administer Medications as Ordered  IV Calcium Gluconate given to prevent life-threatening problems such as airway obstruction  Can irritate the vein walls  PO Calcium Supplements  Aluminum Hydroxide to Bind Phosphate Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Calcium Imbalances  Hypercalcemia  Serum Ca value > 10.5 mg/dL  Increased resorption of Ca from bones or increased intestional absorption caused by antacids use, excessive intake, or thiazide diuretics  Common complication of cancer tumors, due to bone destruction or hormone-like substances  Caused by lengthy immobilization, when Ca is removed from the bones, excess Ca or Vitamin D intake Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hypercalcemia Signs and Symptoms  Ca++ >11 mg/dL or 5.5 mEq/L  Increased Heart Rate and Blood Pressure  Skeletal Muscle Weakness  Decreased GI Motility  Decreased Blood Clotting  Dysrhythmias, EKG changes, and HTN  Polyuria  Formation of kidney stones Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hypercalcemia  Administer Fluids  Administer Medications as Ordered  Furosemide (Lasix)  Pamidronate (Aredia):inhibit bone resorption with malignancies  Zoledronic Acid (Zometa)  Calcitonin  Hemodialysis Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Magnesium Imbalances  Only 1% of Mg found in body extracellular fluid, remainder found in bones  Normal serum Mg level ranges from 1.5 – 3.0 mg/dL  (1.3 – 2.1 mEq/L)  Vital to many intracellular reactions including:  Enzyme reactions  Protein and nucleic acid synthesis  Essential for neuromuscular transmissions, and cardiovascular function Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Magnesium Imbalances  Hypomagnesemia  Mg level < 1.5 mg/dL  Caused by deficient Mg intake  Most common cause chronic alcoholism  Increased neuromuscular excitability results in muscle weakness, tremors, and seizures  Decreased Mg elevates risk of cardiac dysrhythmias and sudden death  From excessive volume losses such:  GI fluids (diarrhea, ileostomy) Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Magnesium Imbalances  Hypermagnesemia  Serum Mg level > 3.0 mg/dL  Can develop in renal disease  Elevated levels can trigger CNS depression, cardiac compromise and respiratory depression Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Food Sources of Magnesium  Green vegetables  Grains  Nuts  Meats and seafood  Bananas  Chocolate  Refined sugar Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hypomagnesemia Signs and Symptoms  Mg++ <1.5 mEq/L  Positive Trousseau’s Sign  Positive Chvostek’s Sign  Cardiac Dysrhythmia and Arrest Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hypomagnesemia  Treat Underlying Cause  Administer Magnesium Replacement  Mg sulfate IV for several days  Encourage foods rich in Mg Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Hypermagnesemia Signs and Symptoms  Mg++ >3.0 mEq/L  Hypotension  Lethargy  Skeletal Muscle Weakness  Respiratory Failure  Cardiac Dysrhythmia and Arrest Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Interventions for Hypermagnesemia  Administer IV Fluids  Administer Medications as Ordered  Loop Diuretics (Furosemide)  Dialysis Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Acid-Base Balance  Acid: Substance that Releases a Hydrogen Ion  Base (Alkali): Substance that Binds Hydrogen  Normal pH 7.35–7.45  Normal cell function depends on regulating hydrogen ion (H+) in solution  H+ production increases, pH falls  Modulation of serum pH interdependent systems  Chemical buffering in blood plasma and cells  Excretion of acids (CO2) by lungs  Excretion of acid or regeneration of base (HCO3) by kidney  CO2 lowers, pH rises Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Acid-Base Control  Cellular Buffers  Lungs  CO2 produced by cells as by-product of energy production  CO2 diffuses into blood and mixes with H2O to produce H2CO3 which then separates into H+ and HCO3 (bicarbonate)  Lungs help expel or retain CO2  Kidneys  Regulation of fixed acids and bicarbonate by the kidneys  Regulate pH by secreting H+ into urine or by regenerating HCO3 for reabsorption into the blood  Regulation works until pH <4.5 Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Acid-Base Control  Acid-base compensation  pH normalized by lungs (within minutes) and kidneys (within hours)  Acid-base correction  Occurs when problem is resolved  Analysis of arterial blood gases  Determines type of imbalance  Evaluates degree of compensation  Interpreting ABG results (see Critical Monitoring box pg 84) Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Analysis of Arterial Blood Gases  Classify the pH: norm: 7.35 to 7.45  Acidosis: <7.35  Alkalosis: >7.45  Assess PaCO2: norm: 35 to 45 mm Hg  Respiratory acidosis: >45 mm Hg  Respiratory alkalosis: <35 mm Hg  Assess HCO3: norm 22 to 26 mEq/L  Metabolic acidosis: <22 mEq/L  Metabolic alkalosis: >26 mEq/L  Determine if compensated  CO2 and HCO3 are abnormal in opposite directions (one is acidic and one isCopyright © 2011. F.A. Davis Company alkalotic)
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Analysis of Arterial Blood Gases, cont’d  Identify primary disorder  The acid-base component most consistent with the pH disturbance  Classify degree of compensation  Simple compensation  Complex compensation Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Disorders of Acid-Base Balance  Acidosis  Pathologic process causing excess acid  Alkalosis  Pathologic process causing excess base Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Acid-Base Imbalances  Acidosis  Alkalosis  Respiratory  Respiratory  Metabolic  Metabolic Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Respiratory Alkalosis  Etiology  Hyperventilatory states  CO2 eliminated  Some causes  Pulmonary disorders (pneumonia, embolism)  Acute anxiety  Stimulant drugs (epinephrine)  Neural disorders (stroke, intracranial lesions)  Pathophysiology  pH is elevated and PaCO2 is decreased Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Respiratory Alkalosis  Clinical manifestations  Hyperventilation  Paresthesias, lightheadedness, confusion  High pH, low PaCO2, HCO3 levels fall with compensation  Outcome management  Treatment of underlying disorder  Respiratory support  O2 therapy  Rebreathing Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Respiratory Acidosis  Etiology: hypoventilatory states  Some causes  COPD, infections, cardiac diseases, Guillain-Barré syndrome, obesity, inadequate mechanical ventilation  Pathophysiology  CO2 retained and pH decreased  Clinical manifestations  Hypoventilation, hypoxemia  Tremors, seizures, lethargy  Low pH and high PaCO2 Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Respiratory Acidosis  Outcome management  Treat underlying cause  Respiratory support  Mechanical ventilation  Cautious O2 administration to CO2 retention  Administer exogenous alkali  Sodium bicarbonate Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Metabolic Alkalosis  Etiology  Loss of acid or gain of base  Some causes  Vomiting, long-term gastric suctioning, administration of NaHCO3, overuse of diuretics  Pathophysiology  High pH and high HCO3  Clinical manifestations  Adaptive hypoventilation  Lethargy, confusion, seizures  High pH and high HCO3 Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Metabolic Alkalosis  Outcome management  Treat the underlying disorder  Promote loss of bicarbonate  Acetazolamide sodium (Diamox)  Administer exogenous acid Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Metabolic Acidosis  Etiology  Accumulation of acid or loss of base  Anion gap (Nl 12 ± 4)  Some causes  Lactic acidosis, diabetic ketoacidosis, azotemic renal failure, diarrhea  Pathophysiology  pH decreases and HCO3 decreases Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Metabolic Acidosis  Clinical manifestations  Compensatory hyperventilation  Low pH and low HCO3  Outcome management  Treatment of underlying disorder  Respiratory support  Mechanical ventilation  Administration of exogenous alkali  Sodium bicarbonate Copyright © 2011. F.A. Davis Company
  • Understanding Medical Surgical Nursing, 4th EditionLinda S. Williams / Paula D. Hopper Arterial Blood Gas Values pH pCO2 HCO3 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis Copyright © 2011. F.A. Davis Company