chapter 52 Fluid Electrolyte balance

•Causes–GI losses (N/V, diarrhea, GI suction)–Renal loss: kidney disease, diuretics–Skin loss: excessive perspiration, burns–Inappropriate ADH

•S/S

–Personality∆,
postural hypotension- dry
mucus membrane


–Abdominal cramping

–N/V, diarrhea, dry mucous membranes

–Tachycardia-fast

–Convulsions------ coma

–Na+ <135 mEq/L

–Urine sp. Gravity < 1.010

Water
moves from the blood into the cells

Swelling:
most dangerous consequence: swelling in the legs, abdomen, and BRAIN

Fatigue,
seizure, coma, confusion, death

kidney
disease

heart disease

liver cirrhosis

thyroid disorder

Addisons
disease

brain disorder

cancer

May
be caused by antidiuretics, too much water
intake , SIADH syndrome of anti-diuretic hormone secretion

the
pee is dark concentrated because vasopressin hormone made the kidneys “think”
that they should keep water in, therefore elevating water in body, decreasing
sodium level.

from
DRINKING TOO MUCH WATER.

Nursing
intervention: fluid restriction

–Na+ <135 mEq/L

–Personality∆,
postural hypotension- dry
mucus membrane


–Abdominal cramping

–N/V, diarrhea, dry mucous membranes

–Tachycardia-fast

–Convulsions------ coma

Diarrhea

Diuretic
medication

Excessive
salt intake

Excessive
vomiting

Heavy
respiration (e.g., exercise, exertion)

Severe
burn

Sweating

Body tries to even out decreased
level of salt by pushing water out of cells. As a result, the cells become
dehydrated.

Thirst mechanism: the body is
stimulated to drink water which helps correct:

Intervention- encourage fluids as
ordered

Restrict intake of foods high in sodium

•Causes

–↑ salt intake, too much salt, too little water

–↑ aldosterone secretion

–Diabetes Insipidus


–↑ water loss

–Water deprivation

–Loss of water, gain of sodium

–Na+ >145mEq/L

•S/S

–c/o extreme
thirst

–Dry/flushed
skin

–Dry
mucous membranes

–Postural hypotension

–Fever, agitation

–Convulsions, restlessness

–Irritable

ventricles may become irritable, possibly
causing ventricular arrhythmias and even cardiac arrest

You'll be on the lookout for the
following:

* skeletal muscle weakness, usually in
the legs, that may lead to flaccid paralysis

* muscle weakness spreading from legs to
trunk and involving respiratory muscles

* smooth-muscle hyperactivity,
particularly in the GI tract, resulting in nausea, abdominal cramping, and
diarrhea

* restlessness and tingling in the lips and fingers

* eliminating the cause of serum
potassium loss

* replacing lost potassium.

The patient's health care provider will order oral and/or
I.V. administration of potassium chloride to reverse hypokalemia. Potassium chloride comes in tablet and
liquid forms and is usually administered after a patient has eaten to limit GI
distress

•Causes

–K+ wasting diuretics- lasixs


–Diarrhea, vomiting, GI losses

–Alkalosis

–↑ aldosterone secretion

–Polyuria-excessive peeing!

Extreme sweating

K+ < 3.5 mEq/L

•S/S

–Weakness & fatigue

–N/V, intestinal distention

–↓ bowel sounds

–↓ deep tendon reflexes

–Ventricular dysrhythmias-life
threatening

–Paresthesia &
weak irregular pulse

–ECG abnormalities

–K+ >5.0 mEq/L

•Causes

–Renal failure

–FVD

–Massive cellular damage

–↑ amounts of IV fluids with K+

–Adrenal insufficiency

–Acidosis- diabetic ketoacidosis


–K+ sparing diuretics

–K+ salt substitutes

•S/S

–Anxiety

–Dysrhythmias


–Paresthesia-tingling

–Weakness

–Abdominal cramps

–Diarrhea

common cause of _______ is metabolic acidosis (excessive acid in
body fluids).

can occur when a patient ingests more potassium than his
body can handle. This can happen if a patient's taking potassium supplements,
or if he's eating foods rich in potassium, like potatoes, bananas, and oranges.
Most salt substitutes are made with potassium chloride as well, so patients who
use them may inadvertently overdo the potassium

Causes:* burns, severe infection, trauma, crush injury, or
intravascular hemolysis, which injure
cells and may cause potassium to leave the cells

the heart's conduction system becomes
sluggish and the impulses that keep the heart beating slow down. Arrhythmia and
cardiac arrest can occur quickly.

decreased heart rate

* irregular pulse

* decreased cardiac output

* hypotension.

Intervention:

Stabilize
cardiac membrane potential

Move
potassium from ECS to ICS

Remove extra
potassium from the body

–Ca+ < 4.5 mEq/L

•Causes

–Vitamin D deficiency

–Pancreatitis

–Alkalosis

–Chronic Renal Failure

–Chronic alcoholism

•S/S

–Numbness, tingling

–Hyperactive reflexes

–Tetany


–Muscle cramps

Pathological fractures

High
K= high H ions or acids= high Calcium



While




Low K= low H ions or acids= low Calcium

ph

PaCO2

HCO3

PaO2

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

(males):
4.7 – 6.1 million

(females):
4.2-5.4 million

Adults:
(males):
14 - 18 g/dl

(Females):
12 – 16g/dl

Adults:

(males): 42 – 52%


(females): 37-47%

Adults: 5,000 -10,000 mm3

Also called THROMBOCYTES

Adults: 150,000 – 400,000 mm3

Critical
values < 50,000 mm3 or > 1,000,000 mm3

Adults: 10 –20 mg/dl

Men 0.6 – 1.2 mg/dl

Women 0.5 – 1.1 mg/dl

Adults: 70-110 mg/dl Fasting

<140 mg/dl 2 hours after a meal

PT Normal 11-12.5

INR 0.8-1.1

thirst, restlessness, headaches, inability to concentrate, postural hypotension

cyanosis, cold clammy skin, weak thready pulse,confusion, oliguria

vital sign changes associated with fluid volume deficit:

dehydration causes:

intervention: hydrate the client with IV solution as prescribed to treat:

intervention for _____:notifying the physician of urine output of less than 30ml/hr

intervention for _____: elevate the legs to enhance venous return, thus contributing to cardiac output

shock, multiple organ failure or death may result from:

lower blood pressure and higher BUN / creatinine ration may be a sign of __________ among elderly

providing a restricted sodium diet is an intervention for:

administer prescribed diuretics as appropriate is an intervention for _______

ph < 7.35
CO2 is > 45 mm Hg
Patient breathing slowly (hypoventilation)
Hyperkalemia

ph < 7.35
HCO3 is less than 22 meQ/L
patient breating rapidly (Kussmaul)
Hyperkalemia

ph > 7.45
CO2 is less than 35 mm Hg
patient breathing RAPIDLY
Hypokalemia

ph> 7.45
HCO3 is greater than 26 mEq/L
patient breathing slowly
Hypokalemia

low bp
dyspnea
headache
hyperkalemia
increase K, dysrythmia
disorientation
muscle weakness
in COPD, atelacsis

treatment:
bronchodilators
maintain hydration of 2-3 L of fluid per day

Intervention:
Monitor I and O, LOC
administer IV sodium bicarbonate

Hyperkalemia
low bp
cardica arrest
numbness, tingling
nausea, vomiting
headache
renal failure, shock

seizure
tachycardia
low bp
hypokalemia
numbness, tingling
nausea, vomiting

treatment:
assist client to breath in paper bag to inhale CO2

Hypokalemia
restlessness, lethargy
tachycardia
confusion
nausea, vomiting
muscle cramping, tremors
use of diuretics

treatment:
monitor I and O closely
monitor resp., LOC
Administer ordered IV fluids