Fluid Imbalance
Too much fluid is the body from excessive intake of ineffective removal from the body
What is Overhydration. (278)
Examples: Fluid overload-excess fluid or water. Includes hemodilution making amount of blood components seem lower.
Hypervolemia (FVE) - excess of water and electrolytes so that the 2 are still in the right proportion
Water deprivation (NPO)
Diabetes Insipidus
Heat stroke
Burns
Excessive sweating
What are conditions that cause relative sodium excess?
Inadequate chest expansion secondary to muscle weakness, respiratory depression due to opioids, poison, anesthetics. inadequate ventilation
What are risk factors for respiratory acidosis?
Elevated Hct, BUN, Urine specific gravity, Sodium and blood osmolality
What are lab results for dehydrated clients?
What are nursing interventions for Fluid volume excess?
A shift of water from the plasma to the interstitial space.
What is relative dehydration. (277)
Actual dehydration- lack of fluid in the body
Isotonic dehydration (hypovolemia/FVD)- lack of both water and electrolytes causing a decrease in circulating blood volume.
Excessive sweating
diuretics use
kidney disease
low sodium diet routines
NG tube suction of isotonic gastric contents
What are risk factors for Hyponatremia
Tachypneic
inability to concentrate, numbness, tingling, tinnitus
tachycardia, atrial dysrhythmias
rapid, deep respirations
What are manifestations of Respiratory alkalosis?
Decreased Hgb/Hct, blood osmolarity, Sodium, urine specific gravity, BUN
What are lab results for fluid volume excess clients?
Daily weights
Encourage foods and fluids such as beef broth, tomato juice
Administer LR or normal saline
What are interventions for hyponatremia?
Thready, fast pulse
hypotension
tachypnea
decreased CVP
dizziness
thirst
oliguria
cool, clammy skin
poor skin turgor
flattened neck veins
What are manifestations of hypovolemia?
Results from and increased loss from the body such as vomiting, diarrhea, prolonged nasogastric suctioning, and excessive laxative use.
Results in decreased HCO3 and decreased pH
What is metabolic acidosis?
Blood level less than 3.5 mEq
What is hypokalemia?
What are nursing interventions for fluid volume deficit (dehydration)
Weigh yourself daily. Notify provider if 1-2lb gain in 24 hrs, and 3lb gain in 1 week
Encourage low sodium diet
Adhere to fluid restrictions
What is Hypervolemic client education?
Peaked T waves, wide QRS, and PR, ST depression
What are ECG changes of hyperkalemia.
Results from base excess such as antacids, venous administration of bases (blood transfusion, TPN, or sodium bicarb)
What is metabolic alkalosis?
Blood level less than 9 mg/dL
What is calcium level for hypocalcemia?
Loop diuretics
Cation exchange resin
Beta-2 agonists
What are medications that increase potassium excretion?
Administer O2, Monitor VS, Administration of Colloids or crystalloids, administration of vasoconstrictors and agents that increase myocardial contractibility and perfusion.
What are nursing interventions for hypovolemic shock?
Inadequate Vitamin D intake, ESKD, lactulose intolerance, malabsorption issues
What are risk factors of hypocalcemia?
The pH, CO3, and PaCO2 are outside of the expected reference range,
What is Partial Compensation?
Blood level greater than 5.0 mEq, Hgb /Hct increased with dehydration and decreased with kidney failure, BUN and creatinine increased with kidney failure, metabolic acidosis with kidney failure.
What are lab results for hyperkalemia?
Treat the underlying cause
Education can vary in relation to client's condition
What is nursing care for acid-base imbalances?