Fluid Balance
What 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
What is the normal range for serum calcium?
9 to 11 mg/dL
What is the normal range for sodium (Na)?
135 to 145 mEq/L
What is the normal range for potassium?
What is the normal range for magnesium?
1.5 to 2.5 mEq/L
What are the normal values for pH, PCO2 and HCO3-?
Normal pH = 7.35 to 7.45
Normal PCO2 = 35 to 45
Normal HCO3- = 22-26
What 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
What are the signs and symptoms of hypocalcemia?
Spasms of face, lips, larynx (can cause stridor) tingling sensation around mouth, mental status changes, increased and irregular heart rate which can lead to cardiac arrest, Trousseau's sign, Chvostek's sign.
Who is at risk for developing hypocalcemia?
Patients with NPO status, use of diuretics, GI suctioning (especially continuous), decreased aldosterone, excess ingestion of hypotonic fluids
What are the signs/symptoms of hypomagnesemia?
What population is especially vulnerable to this?
Same as hypocalcemia: Positive Trousseau's sign and Chvostek's sign, increased and irregular heart rate, mental status changes, diarrhea and abdominal cramping, hyperactive deep tendon reflexes
Alcoholics.
What health problems put a patient at risk for respiratory acidosis?
Chronic lung diseases such as COPD
What 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.
Why is it important to monitor calcium levels following a thyroidectomy?
Parathyroid glands can be accidentally removed during a thyroidectomy causing hypocalcemia.
Parathyroid gland secretes parathyroid hormone which regulates calcium levels in the blood by increasing the levels when they are too low.
Should always have calcium gluconate available post operatively.
What are the symptoms of hyponatremia?
Can be vague and depends on if has a fluid imbalance as well. 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 in and around the brain.
What are the sign/symptoms of hypokalemia?
Muscle fatigue and cramping, mental status changes, shallow ineffective respirations due to diminished skeletal muscle activity, irregular and weak/thready pulse, dysrhythmias
What would be a nursing action for a patient experiencing a severe anxiety episode and respiratory alkalosis and why?
Have the patient breathe into a paper bag. Patient is hyperventilating causing patient to lose CO2 resulting in respiratory alkalosis. Rebreathing the air in the paper bag provides more CO2 to correct the respiratory alkalosis.
What is included in a 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
What are the signs and symptoms of hypercalcemia?
Increased BP and pulse, skeletal muscle weakness, decreased GI motility including diarrhea, severe fatigue, confusion.
What are the signs/symptoms of hypernatremia?
Thirst, mental status changes due to too little water in and around the brain, tremors, seizures, muscle weakness
What are the signs/symptoms of hyperkalemia?
Muscle twitching and cramps with muscle weakness, hypotension, slow and irregular heart rate with possible dysrhythmias and cardiac arrest.
What blood gas values would you expect to see with metabolic acidosis?
What blood gas values would you expect to see the respiratory acidosis?
What values would you expect with metabolic alkalosis?
What values would you expect with respiratory alkalosis?
*Metabolic acidosis: pH less than 7.35, PCO2 between 35-45, HCO3- of less than 22
*Respiratory acidosis: pH less than 7.35, PCO2 greater than 45, HCO3- between 22-26
*Metabolic alkalosis: pH greater than 7.35, PCO2 between 35-45, HCO3- greater than 26
*Respiratory alkalosis: pH greater than 7.45, PCO2 less than 35, HCO3- between 22-26
What labs and signs/symptoms would 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.
What are interventions for hypercalcemia?
Telemetry monitoring, IV fluids, medications including the diuretic Lasix, and meds that slow calcium movement from bones to the blood such as Aredia, Zometa, calcitonin.
What are the interventions for hypernatremia?
Monitor weight, monitor I & O, administer diuretics, restrict dietary sodium
What are food sources of potassium?
Potatoes, sweet potatoes, soybeans, banannas, tomato juice, dried apricots, kidney beans, orange juice, spinach
A patient is experiencing metabolic acidosis. How does the body compensate to correct the acidosis?
Patient develops Kussmaul respirations, which is a deep, labored breathing pattern. This allows the lungs to expel more acidic CO2 which is causing the acidosis. Seen in diabetic ketoacidosis (DKA).