Fluid Balance Pt I
Interventions would you implement for a patient with fluid volume excess
Monitor daily weight (weight loss indicates successful intervention)
Administer diuretics and O2 as ordered
Fluid and sodium (Na) restrictions
Monitor I & O and put in Fowler's position
Normal range for serum calcium
9.0–11 mg/dL
Normal range for sodium (Na+)
135 to 145 mEq/L
Normal range for potassium & magnesium
3.5 to 5.0 mEq/L
1.3 to 2.1 mEq/L
Causes of Respiratory acidosis
COPD, emphysema, asthma, pneumonia, airway obstruction, CNS depression
Interventions would you implement for a patient with deficient fluid volume
Monitor daily weight (most accurate way to evaluate fluid balance)
Monitor I & O
Increase fluid intake (PO and IV if severe)
Treat underlying cause
Signs and symptoms of hypocalcemia
Neuromuscular excitability: Spasms of face, lips, larynx (can cause stridor); Tingling sensation around the mouth; Mental status changes; Increased and irregular heart rate which can lead to cardiac arrest; Hypotension; Trousseau's sign, Chvostek's sign.
Patient's at risk for developing hyponatremia
Patients with NPO status, use of diuretics, GI suctioning (especially continuous), decreased aldosterone, excess ingestion of hypotonic fluids.
Signs/symptoms of hypomagnesemia and the population that is especially vulnerable
S/S are similar to low Ca+ and K+ levels. Tetany, Chvostek's sign, Trousseau's sign, tremors, muscle spasms, and cardiac arrhythmias.
Alcoholics are especially vulnerable.
Signs and symptoms of Metabolic acidosis
Rapid breathing, confusion, drowsiness, shock, death
Signs/symptoms would you expect to see in a patient with fluid volume excess
Bounding pulse, increased BP, weight gain, increased and dilute urine output, increased and shallow respirations. May see neck vein distention, pitting edema of lower extremities, crackles in the lungs.
Reason it is important to monitor calcium levels following a thyroidectomy
Parathyroid glands can be accidentally removed during a thyroidectomy causing hypocalcemia.
The parathyroid gland secretes a parathyroid hormone that regulates calcium levels in the blood by increasing the levels when they are too low.
Staff should always have calcium gluconate available post-operatively.
Signs and symptoms of hyponatremia
Severe hyponatremia presents with weakness, N/V/D, and mental status changes such as confusion, disorientation, and personality changes due to low sodium and osmolarity, which causes more water to collect around the brain.
Signs/symptoms of hypokalemia
S/S: Anorexia, cardiac arrhythmias, leg cramps, muscle fatigue, weakness, postural hypotension
ECG: prolonged PR interval, flattened T wave, and prominent U wave
Hyperventilation
Cause of respiratory alkalosis
Components of hydration assessment of a patient
Monitor daily weights.
Assess for skin tenting (forehead or sternum)
Assess mucous membranes and tongue for moisture and furrows
Assess for thirst and urine output
Signs and symptoms of hypercalcemia
Increased BP and pulse, skeletal muscle weakness, decreased GI motility including diarrhea, severe fatigue, confusion.
Signs/symptoms of hypernatremia
Thirst, mental status changes due to too little water in and around the brain, tremors, seizures, muscle weakness
Signs/symptoms of hyperkalemia
Patient presentation depends on K+ elevation and if chronic or acute elevation.
Early symptoms: numbness, muscle cramps, diarrhea; ECG: wide QRS, tall and peaked T waves, bradycardia; Can lead to cardiac arrest.
Normal values of pH, PCO2, HCO3
7.35-7.45, 35-45, 22-26
Labs and signs/symptoms you expect to see in a patient with dehydration
Increased Hct and BUN, increased urine specific gravity, low BP, rapid pulse, increased temperature, decreased urine output, skin tenting, dry skin, and mucous membranes.
Causes for hypercalcemia
•Elevated PTH
•Cancer (malignant cells causing bone destruction)
Interventions for hypernatremia
Monitor weight, monitor I & O, administer diuretics, restrict dietary sodium
Food sources of potassium
Potatoes, sweet potatoes, soybeans, bananas, tomato juice, dried apricots, kidney beans, orange juice, and spinach.
Metabolic alkalosis