Fluid Balance Pt I
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
The main intracellular cation?
Potassium
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?
Neuromuscular excitability: 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; Hypotension; Trousseau's sign, Chvostek's sign.
Who is at risk for developing hyponatremia?
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?
S/S are similar to low Ca and K levels. Tetany, Chvostek's sign, Trousseau's sign, tremors, muscle spasms, and cardiac arrythmias.
Alcoholics.
The main extracellular cation?
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?
S/S: Anorexia, cardiac arrhythmias, leg cramps, muscle fatigue, weakness, postural hypotension
ECG: prolonged PR interval, flattened T wave, and prominent U wave
What are factors that can lead to edema?
Increased blood volume = increased hydrostatic pressure
Lower albumin = reduced osmotic pressure
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?
Patient presentation depends on level of 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
What are the steps in the Renin-Angiotensin-Aldosterone System?
What initiates this system?
1.Renin released from kidneys: Converts angiotensinogen (from liver) to angiotensin I
2.Angiotensin I converted to angiotensin II: In lungs by angiotensin-converting enzyme (ACE)
3.Angiotensin II (vasoconstrictor): Activates adrenal cortex to release aldosterone
4.Aldosterone: Increases sodium and water reabsorption and potassium secretion by kidneys
Hypotension, hypovolemia, low cardiac output
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 causes for hypercalcemia?
•Elevated PTH
•Cancer (malignant cells causing bone destruction)
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
What is natriuresis?
Excretion of large amounts of sodium and water