Deficient Fluid Volume
Fluid Volume Excess
Electrolyte Levels
ABG Values
Acid-Base Imbalances
100

Causes of deficient fluid volume

What is N/V/D, excessive diaphoresis (sweating), poor intake (who is at risk?  What GI issue can this lead too?), hemorrhage, use of diuretics?

100

Causes of fluid volume excess

What is overhydration (i.e. receiving IV fluid too fast); impaired ability to eliminate excess fluids (i.e. patients with heart failure, renal failure)
100

Sodium 

What is 135 - 145 mEq/L?

100

pH

What is 7.35 to 7.45?

100

What patients are at risk for respiratory acidosis?  Hint -- think anyone who retains CO2.

What is patients with any type of obstructive lung disease, acute (i.e. asthma, chest injury) or chronic (COPD -- emphysema, chronic bronchitis).  Patients with decreased RR (i.e. sedation from medications)

ANYTHING THAT CAUSES THE RETENTION OF COIN THE LUNGS CAN LEAD TO RESPIRATORY ACIDOSIS!!

200

Subjective s/s of deficient fluid volume -- what the patient may feel.

What is thirsty, dizzy, weak?  What safety concern would you have?

200

Signs and symptoms of overhydration

What is weight gain (DAILY WEIGHTS ARE GREAT INDICATOR OF FLUID STATUS!!); bounding pulse, BP up, possible edema; possible pulmonary edema (listen to those lungs for crackles!!); JVD; decreased hematocrit, urine specific gravity, blood sodium levels (EVERYTHING IS DILUTED!! 

200

Potassium 

What is 3.5 - 5.0 mEq/L

200

Paco(Partial Pressure of Carbon Dioxide [CO2])

What is 35 to 45 mm Hg?

200

What patients are at risk for respiratory alkalosis? Hint -- think of anyone who blows off too much CO2

What is patients who are hyperventilating?  They are blowing off too much CO2

This could be r/t anxiety, panic, pain, fever, etc. -- whatever the cause of the hyperventilation it can lead to respiratory alkalosis

300

Objective s/s of deficient fluid volume -- what you may see when evaluating the patient.

What is tenting when checking skin turgor, weight loss (d/t decrease fluid volume), orthostatic hypotension (BP decreases with position changes -- THINK FALLS!), reduced urine that is concentrated, dry oral mucosa with thick saliva, dry skin.  VS changes -- HR up, Temp up (decreased ability to sweat d/t lack of fluid which is how we cool off!).  

300

Most accurate measure of fluid gain or loss?

What is DAILY WEIGHT!! Gain or loss of 2.2 pounds (1 kg) in 24 hours indicates a gain or loss of 1 Liter of fluid

300

Calcium 

What is 8.4 - 10.6 mg/dL?

300

HCO3- (Bicarbonate)

What is 22 to 26 mEq/L?

300

What patients are at risk for metabolic alkalosis?  Hint -- think of patients who are losing stomach acid

What is excessive vomiting, GI suctioning, too many antiacids with bicarbonate

Acid is reduced, leaving patient in alkalosis

Low potassium can lead to alkalosis too (kidneys retain K and release hydrochloric acid)

400

Why the hematocrit (amount of RBCs) and urine specific gravity (measures concentration of urine) increase?  

What is LESS FLUID -- MORE CONCENTRATED!!

400

Treatments that may be ordered by the provider for fluid volume excess

Diuretic medications; low sodium diet; patient may be ordered to be placed on a fluid restriction; elastic stockings for lower extremity edema

400

Magnesium 

What is 1.3 - 2.1 mg/dL?

400

pH greater than 7.45 

What is alkalosis?

400

What patients are at risk for metabolic acidosis?  

Excessive diarrhea -- loss bicarb through stool -- leads to acidosis

Diabetes mellitus -- too little insulin, body can't use glucose for energy.  Breaks down fat, byproduct of fat breakdown is acidic

Renal failure -- unable to get rid of excess acids, can't make enough bicarb

Hyperkalemia 

500

Nursing interventions for fluid volume deficit

Increase PO fluid intake -- avoid fluids that have diuretic--like effect (i.e. caffeine); IV fluids as ordered if unable to take PO fluids; administer antiemetics (N/V) or antidiarrheals as ordered if indicated; I+O; daily weights (BEST INDICATOR OF FLUID STATUS!!); watch those electrolytes; provide mouth care! Don't forget about SAFETY - FALL PRECAUTIONS!

500

Nursing interventions for fluid volume excess

Daily weights (same time, same scale, same type of clothing); I+O (especially of your patient receives diuretics); diet/fluids/medications as ordered; MAKE SURE TO MONITOR LUNG SOUNDS -- PULMONARY EDEMA (THINK ABCs!)

500

Phosphate 

What is 3.0 - 4.5 mg/dL?

500

pH less than 7.35 

What is acidosis?  

500
Patients with metabolic acidosis may have deep, rapid respirations called Kussmaul respirations -- why?

What is an effort to remove COfrom the blood?

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