Dehydration/ Gastroenteritis
A common cause of dehydration in infants, children, and older adults.
What is gastroenteritis (nausea, vomiting, diarrhea)?
These symptoms may be present with hypovolemia in the elderly.
What is delirium and increased longitudinal furrows on the tongue?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 233, 236
These are the possible cause of hypervolemia.
What is heart failure, kidney dysfunction, liver cirrhosis, excessive aldosterone stimulation, or excessive consumption of sodium?
(Diminished function of fluid homeostatic mechanisms)
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 236
True or False: Sodium is the most abundant electrolyte in the ICF.
What is FALSE?
Sodium is the most abundant in the ECF.
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 239
This is the term for the type of relationship between Calcium and Phosphorus.
What is inverse relationship (meaning when one goes up, the other generally goes down)?
Lab values to expect with dehydration.
What are increased:
Serum sodium and osmolality
Urine osmolality and specific gravity
Hematocrit and BUN
Possibly creatinine
These are cues to assess and recognize for fluid volume deficit. (List at least 7.)
What are:
Assessment findings- Acute weight loss, flattened neck veins, tachycardia, hypotension (↓ MAP), ↓ skin turgor, thirst, dizziness, weakness, confusion, ↓ CVP, weak peripheral pulses, ↓ cap refill, oliguria (< 400mL/day output)
Lab values- ↑ hemoglobin and hematocrit, ↑ serum and urine osmolality and specific gravity, ↓ urine sodium, ↑ BUN and creatinine, ↑ urine specific gravity and osmolality
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 233
These are the patient education elements to minimize edema. (List at least 3.)
What is:
Take diuretics as prescribed.
Elevate legs when sitting down.
Apply TED hose (anti-embolic stockings) to promote venous return.
Restrict sodium to no more than 2grams/day.
Restrict oral fluid intake (amount per MD order).
Do NOT take any OTCs without talking to your doctor first.
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 238
This is the control mechanisms for serum sodium levels.
What are thirst, ADH, and the RAAS?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 239
Control mechanisms for serum phosphorus levels.
What are absorption and secretion in the GI tract, filtration and absorption in the kidneys, and shifting in and out of bone?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 254
Greater than 250mL/hr urinary output and urine specific gravity less than 1.005.
What is diabetes insipidus (DI)?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 1451
This is the priority monitoring and assessments for the patient with hypovolemia.
What are:
Assess skin turgor, pulse strength, skin temp
Monitor strict I/Os, neuro checks, vital signs, daily weights
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 236
These are cues to assess and recognize for fluid volume excess. (List at least 7.)
What are:
Assessment findings- Acute weight gain, distended neck veins (JVD), tachycardia, hypertension, ↑ CVP, bounding peripheral pulses, cough, crackles, SOB, peripheral edema, ascites, ↑ RR, ↑ UOPt, anasarca
Lab values- ↓ hemoglobin and hematocrit, ↓ serum and urine osmolality, ↓ urine sodium and specific gravity
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 234
These are the treatments for what condition? IV fluids, unrestricted free water intake, dietary sodium restriction, and desmopressin acetate.
What are treatments for Diabetes Insipidus (DI)?
Signs and symptoms and possible complications of low serum phosphorus levels (hypophosphatemia). (List at least 6.)
What are:
Cues: Paresthesia, apprehension, muscle weakness, bone pain and tenderness, chest pain secondary to poor oxygenation, confusion, nystagmus, memory loss
Complications: Cardiomyopathy and osteomalacia from chronic hypophosphatemia, tissue hypoxia, seizures, increased susceptibility to infection, respiratory failure d/t muscle weakness
Mild to moderate dehydration should be treated with this.
What is ORAL REHYDRATION SOLUTION (Pedialyte or Infalyte)?
Ricci, Susan, et al. Maternity and Pediatric Nursing. (4th Edition).
pg. 1521
The nursing intervention for this condition is the administration of Packed Red Blood Cells.
What is priority for a patient with hypovolemia from trauma or blood loss?
Two part:
Foods/drinks high in sodium. (List at least 5)
Amount for a mild sodium restriction.
What are:
Processed foods like cheese, pasta, meats (bacon, sausage, ham, lunch meats), pickles
Pre-packaged foods like frozen meals, chips and snacks, olives and canned veggies/fruits
Bottled drinks- Soda, tomato juice
Fast foods/restaurant foods
What is 2000mg/day of sodium for a mild restriction?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 237
These are the priority interventions for hyponatremia. (List at least 5)
What are:
Fluid (free water/tap water) restriction- no more than 1L/day
Strict I/O measurement
Daily weight
Seizure precautions
Neuro checks
Medications: NaCl tablets, ADH receptor antagonists (tolvaptan PO, conivaptan IV), hypertonic saline (3%NaCl); if low Na+ from SIADH, lithium or demeclocycline cause nephrogenic DI which excretes excess water but not sodium
**Remember that serum sodium levels should not be raised more than 12 mEq/L in 24h to avoid neurologic damage due to demyelination.
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 240
Essential patient education for calcium acetate.
What is take with all meals to bind with the phosphorus you eat?
Calcium acetate or calcium citrate or calcium carbonate are phosphorus binders that will help lower serum phosphorus levels.
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 256
Severe dehydration should receive this type of fluid initially.
What is isotonic (Normal Saline or Lactated Ringers)?
Ricci, Susan, et al. Maternity and Pediatric Nursing. (4th Edition).
pg. 1521
These are the components of Isotonic Lactated Ringers solution.
What are Na+, K+, Ca++, CL-, and lactate (which metabolizes to HCO3-)?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 235
These are methods to remove excess fluid and nitrogenous wastes, and balance the electrolyte/acid-base levels in the kidney injury patient or in the case of life-threatening fluid overload.
What are Hemodialysis and Continuous Renal Replacement Therapy (CRRT)?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 237
This is the safest IV fluid to reduce sodium levels in hypernatremia.
What is hypotonic fluid 1/2 NS (0.45%NaCl)?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 242
Foods high in phosphorus. (List at least 4.)
What are hard cheeses, nuts, cream, meats, dairy, whole grain cereals, dried fruits and vegetables, kidneys, and sardines?
Overbaugh, Janice L. Hinkle, Kerry H. Cheever, K. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (15th Edition)
pg. 256