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 (total)?
8.5 to 10.5 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?
3.5 to 5.0 mEq/L
1.8 to 3.0 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, muscle twitchingTrousseau's sign, Chvostek's sign.
Who is at risk for developing hypernatremia?
Patients with deficient ADH, inadequate water intake, dehydration, high sodium diets, enteral feedings
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, muscle cramping, hyperactive deep tendon reflexes
Chronic alcoholism patients
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 bone and kidney health with hypercalcemia?
Excess calcium gets deposited on bones (spurs) and can also create renal calculi
What are the symptoms of hyponatremia?
N/V/D and mental status changes such as confusion, disorientation and personality changes, headache, brain swelling, seizures, coma, herniation, death
What are the sign/symptoms of hypokalemia?
Increased excitability of cardiac cells = dysrhythmias, ectopic beats, arrest. Intestinal obstruction, ileus. Bilateral muscle weakness starting in arms/legs. Respiratory paralysis (hypoventilation).
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?
Hypoactive reflexes, muscle weakness, vomiting, renal calculi, dysrhythmias
What are the signs/symptoms of hypernatremia?
Thirst, mental status changes due to too little water in and around the brain, oliguria, seizures, coma, death
What are the signs/symptoms of hyperkalemia?
Lower extremity 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.
In hypocalcemia, PTH expression is upregulated or downregulated?
Upregulated (less production) because we need PTH to help release calcium from the bones
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).