Fluid Balance
Interventions you would implement for a patient with fluid volume excess
What is:
Monitor daily weight (weight loss indicates successful intervention)
Administer diuretics and O2 as ordered
Fluid and sodium (Na) restrictions
Monitor I & O
24 hour urine
The normal range for serum calcium
8.5 to 10.5 mg/dL
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
Interventions you would implement for a patient with deficient fluid volume
What is:
Monitor daily weight (most accurate way to evaluate fluid balance)
Monitor I & O
Increase fluid intake (PO and IV if severe)
Treat underlying cause
Signs and symptoms of hypocalcemia
Spasms of face, lips, larynx (can cause stridor); tingling sensation around mouth (parathesia), mental status changes, Trousseau's sign, Chvostek's sign, bone pain and fragility, hypotension, arrythmias
Things that put a patient at risk for developing hyponatremia
What is:
Dehydration, diuretic use, GI loss (sweating, diarrhea, vomiting), adrenal insufficiency
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
Signs/symptoms you would expect to see in a patient with fluid volume excess
What are:
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.
The role of calcium in the body
What is:
the formation and function of bones and teeth, normal clotting, and regulation of neuromuscular irritability
Signs and symptoms of hyponatremia
What is thirst, dry mouth, orthostatic hypotension, tachycardia, azotemia (high blood urea nitrogen concentration), and oliguria.
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.
These area included in a fluid status 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
Signs and symptoms of hypercalcemia
Skeletal muscle weakness, constipation, severe fatigue, confusion, renal calculi
Signs/symptoms of hypernatremia
What is:
Fluid overload cause: weight gain, edema and hypertension
No fluid overload: thirst, irritability, tachycardia, flushed skin, dry mucous membranes, and oliguria.
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
Vital sign changes and signs/symptoms you would expect to see in a patient with dehydration
What are:
Hypotension, tachycardia, increased temperature, decreased urine output (oliguria), skin tenting, dry skin and mucous membranes.
Interventions for hypercalcemia
What is:
Close monitoring, IV fluids, diuretics to enhance urinary excretion, and meds that slow calcium movement from bones to the blood such as calcitonin, dialysis
The interventions for hypernatremia
What is: treating the underlying cause, providing fluids if dehydration is cause
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).