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 10.5mg/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
1.3 to 2.1 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?
Muscle twitches, Paraesthesia of fingers/lips, laryngospasm, Trousseau's sign, Chvostek's sign.
Who is at risk for developing hypokalemia?
Patient that is vomiting, diarrhea, undergoing NG suctioning, and overuse of diuretics.
What are the signs/symptoms of hypomagnesemia?
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
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.
Hand/finger spasms with sustained blood pressure cuff inflation.
Positive Trousseau's sign
What are the symptoms of hyponatremia?
Decreased DTRs, seizures, muscle weakness to the point of possible respiratory compromise.
What are the sign/symptoms of hypokalemia?
Dysrhythmias, 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 labs and signs/symptoms would you expect to see in a patient with dehydration?
increased urine specific gravity, low BP, rapid pulse, increased temperature, decreased urine output, skin tenting, dry skin and mucous membranes.
What are interventions for hypocalcemia
Give supplements. Respiratory services can be consulted for oxygen management. Consume foods high in calcium. Implement seizure precautions.
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).
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
Tapping on the facial nerve triggering facial twitching can indicate...?
Hypocalcemia
What are the signs/symptoms of hypernatremia?
Thirst, dry sticky mucous membranes, decrease in sweating and muscle twitching
What are the interventions for hyperkalemia?
Check for Muscle weakness, Monitor cardiac rhythm, promoted potassium restricted diet.
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