Fluids And Electrolytes

F L U I D SAND ELECTROLYTES

Water overview*Water comprises about 60% -70% of the total body weight *Varies with age weight gender

Factors that Determine the Amount of Water ContentAge – the older we get, water content is lesserSex/Gender – males have more water than femalesBody size/Weight– thin people have more water than chubby ones

Normal Composition in Average ManWhen a person loses more than 10% of his total body fluids,he can DIE!!!Functions of Water in the Body-Transportingnutrients to cells and wastes from cells -Transporting hormones, enzymes, blood platelets, and red and white blood cells-Facilitating cellular metabolism and proper cellular chemical functioning-Facilitating digestionand promoting elimination

-Acting as asolventfor electrolytes and non-electrolytes-Acting as a tissue lubricant and cushion

-Helping maintain normal body temperatureTwo Compartments of Fluid in the Body Intracellular fluid (ICF)(60-70%)- fluid within cells - K is the major component Extracellular fluid (ECF)(20-30%)- fluid outside cells - Na & Cl

Interstitial – between the cellsIntravascular – inside the blood vesselTranscellular – CSF, saliva, GIT secretions and tears

LOSS of WATERRoutes and daily body fluid excretion

SENSIBLE- An individual is aware of losing that water.

GIT / FecesWater loss through defecation/feces is 200cc

KIDNEYS / UrineWater loss through urination is 1,500ml

INSENSIBLE- An individual is unaware of losing that water.

SKIN / PerspirationWater loss through perspiration is 600ml

LUNGS / RespirationWater loss through respiration is about 300ml – 350ml

Causes of Increased Water LossCauses of Increased Water GainFever

Excess secretion of ADHElectrolytes

ElectrolytesAnelectrolyteis a substance, that when dissolved in water, gives a solution that can conduct electricity Ion -atom or molecule carrying an electrical charge cation –develop a positive charge ex. Na, K, Ca, Mg anions –develop a negative charge ex. Cl, HCO, PO4These charges are the basis of chemical interactions inThe body necessary for metabolism and other function

Functions of electrolytes-promotes neuromascular irritability-maintenance of body fluid osmolarity-regulation of water balance-distribution of body fluids between compartments-Conduct an electric current that transports energy thoughout the body

Effects of ElectrolytesThe loss of electrolytes in the body can lead to an unbalance of fluids in the body and the pH, and a damage of the electric potential between the nerve cells that transmit the nerve signals (Encarta)Major Electrolytes/Chief FunctionSodium- support muscle contraction and nerve impulse transmissionPotassium— chief regulator of cellular enzyme activity and water contentCalcium- formation of bones and teeth, nerve impulse, blood clotting, muscle contraction, B12 absorptionMagnesium— support bone mineralization, protein building, muscular contraction, nerve impulse t.Chloride — maintains osmotic pressure in blood, produces hydrochloric acidBicarbonate — body’s primary buffer systemPhosphate— involved in important chemical reactions in body, cell division and hereditary traits

Regulation of Body Fluid CompartmentsProcesses:Osmosisfluid move across a semi - permeable membrane from an area of low solute concentration to an area of high solute concentration until equilibrium is achieved.

Diffusion The movement of particles in all directions through a solution.

The process by which a solute (substance that is dissolved) may spread through a solution or solvent (solution in which the solute is dissolved).Active Transport

Physiologic pump that moves from an area of lower concentration to higher concentration with the use of ATP.

The sodium-potassium pump is an example of active transport.OsmolarityDescribes the concentration of solutes or dissolved particlesFiltrationis the movement of solutes and solvents by hydrostatic pressure. - the movement is from an area of greater pressure to an area of lesser pressure.Osmotic pressure is the amount of hydrostatic pressure needed to stop the flow of water by osmosis -pressure exerted by proteinsHydrostatic pressure pressure exerted by fluid on blood vessel wall

Types of IV SolutionsISOTONIC – balance osmotic pressure Solute concentration is equal to that of the serum Fluid doesn’t shift because they’re equally concentrated and already in balanceSolution has the same osmolality as the extracellular fluid. Examples: D5W ; Normal Saline* Doesn’t cause shrinking or swelling of the cell

HYPERTONIC SOLUTIONGreater pressure than that of the blood serumFluids tend to move out of the less concentrated solution into the more concentrated Solutions have a higher concentration of solute and are more concentrated than extracellular fluids. Net movement intracellular to extracellular Examples : 3% saline; 5% saline* Causes the cell to shrink

HYPOTONIC SOLUTIONLesser pressure than that of the blood serumFluid shifts from the hypotonic solution into the more concentrated compartment to equalize the concentrationsSolutions have a lower concentration of solutes and is more dilute than extracellular fluid . Net movement extracellular to intracellular Examples : 1/2 Normal Saline; 1/3 Normal Saline* Causes the cell to swell

WATER BALANCETHIRST – hypothalamusHormones a. ADH – posterior pituitary gland - reabsorption of water b. Aldosterone – adrenal gland - Na retention, H2O retention

ADHHypothalamus senses low blood volume  pituitary gland secretes ADH into the bloodstream  ADH causes the kidney to retain water  water retention boosts blood volume

ALDOSTERONEProduced as a result of the renin-angiotensin mechanismActs to regulate fluid volumeAngiotensin II stimulate the adrenal gland to release aldosterone

Aldosterone causes the kidneys to retain Na and water

Increases fluid volume and sodium levelsRenin - angiotensinsystem BP decreased  renin  angiotensinogenangiotensin 1angiotensin 2

Renin – angiotensinsystemAngiotensin 2aldosterone peripheral vasoconstriction increase Na reabsorptionincrease water reabsorptionIncrease plasma volume increase blood pressure

Description:Dehydration in which the body’s intake is not sufficient to meet the body’s fluid needs.The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit.

CAUSESDiabetes insipidusFeverDiarrheaRenal failureLack of fluid intakeMalnutritionVomitingDiaphoresis

Poor skin turgorSunken fontanelsDry mouthScanty urineNo perspirationSunken eyeballsWeight lossNo tearsWeakLethargyDizziness Extreme thirstDry skinSIGNS AND SYMPTOMS

Encourage increase oral fluid intakeAdminister IVF (LR or NSS)Monitor I & OReplace fluid loss gradually over 48 hoursMonitor Na levels, urine specific gravityMANAGEMENT

FLUID VOLUME EXCESSIncrease waterCAUSESExcess fluid or sodium intake a. IV administration of NSS or LR b. High intake of dietary NaFluid and Na retentionFluid shift into the intravascular space a. Burn b. use of plasma CHON or albumin

EdemaIncrease in weigHtPuffy eyelidsPoor skin turgorTachypneaDyspneaSigns and symptoms

MANAGEMENTMonitor I & OLimit waterSkin careTurn patient every 2 hoursO2Limit NaMonitor electrolyte values

SODIUM (Na+)  135-145 mEq/L-principal cation in ECF-average daily requirements 2-4 grms/day-responsible for: -serum osmolality -water retention -neuromuscular activity “Na pump action” -acid- base balance-foods high in Na -salted foods ex. ham, corned beef, cheese etc.-regulated by the kidneys-influenced by hormone aldosterone-Chloride frequently appears in combination with Na+ion.

Hyponatremia:serum sodium level falls below 135 mEq/L. Cells become swollen.Etiology:a. loss of Nab. gains of waterc. Disease states associated with ADH (Vasopressin)

Clinical manifestations(Hyponatremia) <135mEq/LCNS changesLethargy, headachesConfusionSeizuresComanausea/vomitingHemiparesisDiarrhea, abdominal crampsPale dry skin

Nursing Intervention1.Evaluate precipitating cause is corrected2.monitor Na serum level3.Evaluate clinical manifestations of Na loss4.Maintain pts. safety5.Administer prescribed treatment, IV therapy

Hypernatremia:Serum sodium is more than 150 mEq/L.Cells shrink. Etiology:Water deprivationExcessive salt ingestionIncreased insensible lossWater loss diarrheaProlong fever or diaphoresis w/o water replacementNa containing parenteral solutions, corticosteroids, some antibioticsNear salt water drowningDiabetes insipidus- polyuria, polydipsia

Clinical manifestations (hypernatremia)Serum Na+>145 mEq/LThirstNausea and vomitingFlushed, dry skinFeverDry sticky membranesRough, dry, swollen tongueCNS effectsRestlessness, agitationMuscular twitching, tremor, hyper-reflexiaDisorientation, hallucinationsStupor, coma

Nursing Interventions1.Evalute precipitating cause and correct2.Monitor serum Na level3.Evaluate clinical manifestations of hypernatremia4.Administer prescribed treatment5.Report abnormal findings to MD6.Patient education for future prevention

POTASSIUM (K+): 3.5-5.0 mEq/L-Principal cation in ICF, 97%-Cannot be measured in the cells-Acute abnormal levels are life threatening1. K+<2.5 or>7.0-cardiac arrest 2. K+<3.5-hypokalemia 3. K+>5.5-hyperkalemia-Responsible for:Conduction of nerve impulses

Skeletal and cardiac muscle activity

Enzyme action for cellular metabolism POTASSIUM (K+): 3.5-5.0 mEq/L-80-90% excreted in the GIT in urine-10-20% excreted in by GIT in feces-Poorly stored in the body-Daily intake is essential (40-60mEq/L)-Foods high in K+Green vegetablesDry fruitsNutsMeatCocoa, brewed coffee

Hypokalemia:<3 mEq/LEtiologyGI lossDiarrhea, GI suction, vomiting, laxativesRenal lossK loss diuretics, aldosterone, steroidsGlucocorticoids, sweat, some antibioticShift into cellsInsulin, alkalosis,TPNPoor intakeAnorexia, alcoholism, debilitation, neglect

Clinical manifestations ( hypokalemia)Fatigue, weaknessCramps, restless legsDecreased reflexesQuadra-paralysisRespiratory muscle-RenalImpaired conc. Of urineDilute frequent urinationResistance to ADH, kidney exchange Na for K-CVSensitivity to digoxinDecreased BP

Cont.Clinical manifestation (hypokalemia)-ECG changesFlat T wavesU waveArrhythmias/cardiac arrest-GIDecreased motility, paralytic ileusAnorexia, nausea, vomiting

Nursing interventionsBe aware of pt.at risk for K excessAssess pt.taking K+P.O. for GI upsetBe aware that there are many forms of K+ supplements available. Check physicians order carefullyAssess and educate pt.concerning nutrition for adequate K+ intake

Hyperkalemia: serum value of >6 mEq/LEtiology:Pseudo hyperkalemiaExcess K+ intakeRenal excretionDrugsShift of K+ out of cells

Clinical manifestations (hyperkalemia)-ABD cramping, nausea, diarrhea-Lower extremities muscle weakness-Irritability-Paresthesias of face, tongue, feet and hands-Flaccid muscle paralysis-Bradycardia, irregular heart rate, cardiac standstill-ECG changesTall, peaked T waves, prolonged PRWidened QSR

Hyperkalemia: serum value of >6 mEq/L

Nursing InterventionsMonitor serum K+ report value >5.3Caution hyperkalemiapts.to avoid foods high in K+ like:Chocolates, coffee, tea, dried fruits and beans, meat and eggs, bananasMonitor for U/OAdminister fresh blood as orderedRegulate IV w/ K+ carefullyUtilized good phlebotomy techniques

CALCIUM :8.5-10.5 mg/dl or 4.5-5.8 mEq/LFunctions:Formation of bone and teeth

Contraction of muscle, relaxation, activation and excitation

Maintaining cardiac contraction

Cellular strength and permeability

Blocks sodium transport into the cell

Transmission of nerve impulsesCalcium ImbalancesEtiologyHypocalcemia<4.5/9 mg/dlDietChronic renal failureMal absorption syndromesAlcoholismAcute pancreatitisLoop diureticsCitrated bloodalkalosisHypercalcemia>5.5/11 mg/dl98%HyperparathyroidismThiazide diuretics malignancyImmobilityVit.A & D overdoseCa cont. antacidsRenal dysfunctionSteroidacidosis

Clinical manifestations (hypocalcemia)IrritabilityDecreased memoryDelusions, hallucinationsHyperreflexiaParasthesias+ Chvostek’s sign+ Trousseau’s signLaryngeal spasm, resp.arrestTetany, seizuresAbd’l. crampsECGProlonged QT interval

Nursing InterventionsMonitor serum Ca, VS, ECGGive PO Ca supp.30 mins.before eatingBe aware of safe administration of IV CaTeach clients to eat food high in Ca, Vit.D, proteinTake necessary precautions for confusion, seizureAssess for prolong bleeding

Clinical manifestation (Hypercalcemia)Headache, confusionDecreased memoryPsychosis, stupor, comaMuscle weaknesses, fatigueDepressed reflexesAnorexia, N/VBone pain, fracturesPolyuria, dehydrationNephrolithiasis ( kidney stones)ECGShortened QT interval

Nursing InterventionsMonitor serum Ca, VS, ECGMobilization and wt. bearing activityDiet low in CaDilute urine to prevent renal calculi formationHydrate w/ isotonic solutionsPromote excretion w/loop diureticWatch for digitalis toxicity

Dehydration: Definitiondefined as "the excessive loss of water and electrolytes from the body“Dehydration can be caused by losing too much fluid, not drinking enough water or fluids, or both.

Dehydration: DefinitionInfants and children are more susceptible to dehydration than adults because of their smaller body weights and higher turnover of water and electrolytes. So are the elderly and those with illnesses

Causes of Dehydrationwhen losses are not replaced adequately, a deficit of water and electrolytes develop.vomiting or diarrheaacute illness where there is loss of appetite and vomitingExcessive urine output ex. diabetes or diuretic use Excessive sweating (sports)Burns

Since diarrhea and vomiting are the most common causes of dehydration in children, the volume of fluid loss may vary from 5 ml/kg (normal) to 200 ml/kgConcentration of electrolytes lost also variesNaCl and K are the most common electrolytes lost through stools

Dehydration:Checking the main symptomsHistory taking and do a thorough physical examination classify type of dehydration depending on the amount of water and electrolytes lostThese are reflected by the signs and symptoms the child will present

Dehydration: ClassificationDehydration is classified as no dehydration, some dehydration, or severe dehydration based on how much of the body's fluid is lost or not replenished. When severe, dehydration is a life-threatening emergencyDEATH

WHO Treatment Plan AThree rules of home treatment:give extra fluidscontinue feedingadvise when to return to the doctor(if the child develops blood in the stool, drinks poorly, becomes sicker, or is not better in three days).

WHO Treatment Plan BORS(ml) the mother slowly gives the recommended amount of ORS by spoonfuls or sipsNote: If the child is breastfed, breast-feeding should continue.After 4 hours, reassess and reclassify dehydration, and begin feeding to provide required amounts of potassium and glucose. Wt kg x 75 for 4h

WHO Treatment Plan BIf there are no more signs of dehydration, do Plan A. If there is still some dehydration, repeatPlan B.If the child now has severe dehydration, do Plan C.

WHO Treatment Plan C-Give IV infusion-If IV infusion is not possible, fluids should be given by nasogastric tube. -If none of these are possible and the child can drink, ORS must be given by mouth. Note: In areas where cholera cannot be excluded for patients less than 2 years old with severe dehydration, antibiotics are recommended. Start Cotrimoxazole.

WHO Treatment Plan C100 ml/kg of PLRNormal saline does not correct acidosis or replace potassium losses, but can be used. Plain glucose or dextrose solutions are not acceptable for the treatment of severe dehydration.

REMEMBER:Do not give:Very sweet tea, soft drinks, and sweetened fruit drinks. (These are often hyperosmolar (high sugar content).Can cause osmotic diarrhea, worsening dehydration and hyponatremia. Also to be avoided are fluids with purgative action and stimulants (e.g., coffee, some medicinal teas or infusions).

Assessment of DehydrationGraded according to the signs and symptoms that reflect the amount of fluid lost.There are usually no signs or symptoms in the early stagesAs dehydration increases, signs and symptoms develop. Initially, thirst, restlessness, irritability, decreased skin turgor, sunken eyes and sunken fontanelles.As more losses occur, these effects become more pronounced.

Signs of hypovolemic shock (SEQUELAE)diminished sensorium (lethargy)Lack of urine outputCool moist extremitiesA rapid and feeble pulseDecreased BPPeripheral cyanosisDEATH.

Summary of Management According to Degree of Dehydration

Calculating Administration RatesOne must know two key components before using the formula:Drop factor of the IV administration set

Amount of solution to be infused over one hourRate Calculations Macrodrip Set10 drops = 1 ml

20 drops = 1 mlMicrodrip Set60 drops = 1 mlBlood Set10 drops = 1 mlCalibrated in drops per ml-this calibration is needed in calculating flow rates.

Macrodrip set is used for routine adult IV administration, depending on the manufacturer and the type of tubing.

10/15, 15/60, 20/60, commonly drop factor.

A macrodrip set is used when more exact measurements are needed, such as in pediatric units.FORMULADrip Rate (gtts or mgtts/min) =Total no. of ml x Drip Factor Total no. of min.

Total number of mlqtts/min= × drop factor Total number of hours 1000ml = × 20gtts/ml 8hours = 41-42gtts/minDoctor’s Order: Start D5LR 1L to infuse over 8 hours the drop factor is 20qtts/ml,compute for the drops/minute.

Ex. gtts/min. Doctor’s order: Start 500ml of NS to infuse over 300 minutes. The drop factor is 10 gtts/ml. compute for the gtts/min.?Gtts/min = total no. of ml X drop factor total no. of hour = 500ml X 10gtts/ml 300mins. = 16.66 gtts/min

Ex. gtts/min. Doctor’s order: Start 500ml of NS to infuse over 300 minutes. The drop factor is 10 gtts/ml. compute for the gtts/min.?Gtts/min = total no. of ml X drop factor total no. of hour = 500ml X 10gtts/ml 5 hours 60 = 16.66 gtts/min

FORMULAml per hour =Total no. of ml Total no of hours

total number of ml Cc /hr= total number of hours 1000ml = 80ml/hour = 12.5hourDoctor’s Order: 1000ml of D5NM to infuse at a rate of 80cc/hour. A nurse determine that it will take, how many hours for 1L to infuse?total number of mlCc/hour =c

Start D5LR 1L to run for 10 hours. Compute for cc/hour? total number of mlcc/hour= total number of hour 1000cc = 10hours = 100cc/hour

Ex. Gtts/min D5NM 1L has been ordered by Dr. Dy for his post-mastectomy patient to be infused at rate of 20gtts/minute. In how many hours will the said IVF last?Gtts/min = _____total no. of ml_____ X drop factor total no. of hour = __1,000ml__ X 15 20 gtts/min 60 = 15,000 1,200 = 12.5 hours

Other factors affecting Flow Rate:Gauge of the catheterViscosity of the infusateHeight of the IV standCondition of the veinsCondition of the patient

COMPLICATIONSCirculatory Overloadcan occur if an IV is not regulated and IV fluids infuse to rapidly for the patient’s body to handle. Signs of fluid over load:TachycardiaIncrease Blood pressureHeadacheAnxietyWheezing or signs of respiratory distressDiaphoresisRestlessnessDistended neck veinsChest pain

- If an IV is running behind schedule-colaborate with the physician to determine the patients ability to tolerate an increased flow rate particularly patients with cardiac, pulmonary and renal problem.A nurse should never arbitrarily speed up an IV to catch up if the IV is running behind the schedule.Whenever an IV rate is increased the nurse should assess the patient for increased heart rate, increase respiration or lung congestion-indication of fluid overload.

AFTERCARERegulating IV fluids is an ongoing process from the time that an IV is started until it is completed. Hourly checks of an IV should include assessing the pt’s response to the IV, the rate of an IV flow, how much fluid has infused, how much fluid remains to be infused, and the condition of the IV insertion site. Adjust the rate if the IV is not flowing at the rate that was ordered.

If IV fluid is flowing in slowly, the nurse should check for a kink in the tubing or a position of problem. If an IV is flowing to rapidly, it may be leaking out around the IV insertion site. The whole system from the insertion site to the IV bag should be examined.

Thank you very much for listening

MAINTENANCE REQUIREMENTSHOLIDAY-SEGAR METHODBODY SURFACE AREA METHOD

HOLIDAY-SEGAR METHODEstimates caloric expenditure in fixed weight categoriesAssumption100 cal metabolized : 100 mL waterNot suitable for neonates < 14 daysOverestimates fluid needs

EXAMPLEWhat is the maintenance fluid rate for a an 8 year old child weighing 25 kg using the Holiday-Segar Method?

100 x 10 = 1000 ml+ 50 x 10 = 500 ml+ 20 x 5 = 100 ml 1600 ml/day

4 x 10 = 40 ml+ 2 x 10 = 20 ml+ 1 x 5 = 5 ml 65 ml/hr

EXERCISEUsing the Holiday-Segar Method, what is the full maintenance requirement and rate for a 10 year old patient who weighs 37 kg?

BODY SURFACE AREA METHODAssumption: caloric expenditure is related to BSANot used in children < 10 kg

BSA METHODSTANDARD VALUES FOR USE IN BODY SURFACE AREA METHOD

BSA FormulaSurface area (m2) = ht (cm) x wt (kg) 3600

EXAMPLEUsing the BSA method, what is the maintenance requirement of an 8 year old who weighs 25 kg and is 132 cm tall?

BSA Formula 0.92 m2 = 132 cm x 25 kg 3600

Water = 1500ml/0.92/day = 1630 mlNa+ = 40 mEq/0.92/day = 43.5 mEqK+ = 30 mEq/0.92/day = 32.6 mEq

EXERCISEUsing the BSA Method, what is the maintenance requirement of a 12 year old boy who weighs 37 kg and is 142 cm tall?

DEFICIT THERAPYCalculated AssessmentClinical Assessment

CALCULATED ASSESSMENTFluid deficit (L) = preillness weight (kg) – illness weight (kg)% Dehydration = (preillness weight – illness weight)/preillness weight x 100%

ICF & ECF COMPARTMENTSIn dehydration, there are variable losses from the extracellular and intracellular compartmentsPercentage of deficit is based on total duration of illness

DECIMALSAll figures to the left of the decimal point are whole numbersAll figures to the right of the decimal point are decimal fractions. 385 = . 3 8 5tenths.385 = 385 1000hundredthsthousandths.38 = 38 100.3 = 3 10

CHANGING FRACTIONS TO DECIMALS:Fractions can be changed to decimals by dividing the numerator and the denominator¾ = 3 ÷ 4 = 0.75

PERCENTAGEPercentage ( % ) means hundredthsPercent ( % ) is the same as a fraction with denomination as 100. 3% = 31004510045% =

CHANGING PERCENT TO A DECIMAL & CHANGING DECIMAL TO PERCENTTo change percent to a decimal, remove the percent sign and divide the number by 100 or move the decimal point two places to the left. 4% = 4/100 = .04 or 0.04To change a decimal to a percent, multiply by 100 or move the decimal point two places to the right and place % sign. 0.04 X 100 = 4% or 0.04 = 4%

RATIOA Ratio consists of two numbers as separated by a colon ( : ) e.g. 1 : 4 A ratio indicates that there is a relationship between the two numbers.A ratio is an indicated fraction. e.g. ¼ = 1 : 4The numbers in ratio must be expressed in the same terms. e.g. 3 inches : 2 feet = 3 : 24 (feet changes to inches)

PROPORTIONIt is a statement showing that the two ratios have equivalent values 1 : 50 = 2 : 100If one value is not known, it can be solved by using the term X. 1 : X = 2 : 100 or meansextremes1 2X 100~

THE METRIC SYSTEMIt is the international decimal system of weights and measures¤ In the metric system, fractions are expressed as decimals ¤ In the decimal system, the fraction ½ is written as 0.5METRIC SYSTEMLiter = vol. of fluids milli = one thousandths Gram = weights of solids centi = one hundredths Meter = measure of length deci = one tenth mcg = one thousandths

RULE OF CONVERSIONWhen converting from a larger unit of measure to a smaller unit, multiply the larger unit by (1000, 100, 10) or move the decimal to the right.When converting a smaller unit of measure to a larger unit, divide the smaller unit by (1000, 100, 10) or move the decimal to the left.e.g. 2.5 grams = ___________ mg.

APOTHECARIES SYSTEMGrain (gr) Dram Ounce Minims PoundsApproximate Equivalent Value: 1 gr = 60 mg 1 ml = 15 minims (16 minims) 1 ounce = 30 ml 1 ounce = 30 Gm 1 kg = 2.2 pounds e.g. 60 gr = _________ mg. 4 oz = _________ ml.

HOUSEHOLD MEASURES 1 teaspoon (tsp) = 4 – 5 ml 1 Tablespoon (Tbsp) = 3 teaspoons (tsp) 1 Tablespoon = 15 ml 1 milliliter = 15 drops (gtts) e.g. 5 ml = ______

CONVERSION OF TEMPERATURENormal Temperature = 37°C = 98°F Conversion of Centigrade (Celsius) to Fahrenheit: Conversion of Fahrenheit to Centigrade (Celsius):°C = 5 ( °F ) – 32 9°F = 9 ( °C ) + 32 5

Interpretation of Doctor’s Order for DrugsThe nurse must understand the order perfectly before acting on it > The Drug> The Dose> The Route> The FrequencyIf any of the above are unclear or open for interpretations, it is the Responsibility of the nurse to clarify the order with the physician.

Example: The order reads : Inderal 2 x4 a. What is the Drug? b. What is the Dose? c. What is the Route? d. What is the Frequency? e. Does this order need clarification?The order reads : Lasix 10 mg IV 1 ml O.D. a. What is the Drug? b. What is the Dose? c. What is the Route? d. What is the Frequency? e. Does this order need clarification?

DECIMALSAll figures to the left of the decimal point are whole numbersAll figures to the right of the decimal point are decimal fractions. 385 = . 3 8 5.385 = 385 1000tenths.38 = 38 100thousandthshundredths.3 = 3 10

Fluids And Electrolytes

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