Deficient Fluid Volume
Causes of deficient fluid volume
What is N/V/D, excessive diaphoresis (sweating), poor intake (who is at risk? What GI issue can this lead too?), hemorrhage, use of diuretics?
Causes of fluid volume excess
Sodium
What is 135 - 145 mEq/L?
pH
What is 7.35 to 7.45?
What patients are at risk for respiratory acidosis? Hint -- think anyone who retains CO2.
What is patients with any type of obstructive lung disease, acute (i.e. asthma, chest injury) or chronic (COPD -- emphysema, chronic bronchitis). Patients with decreased RR (i.e. sedation from medications)
ANYTHING THAT CAUSES THE RETENTION OF CO2 IN THE LUNGS CAN LEAD TO RESPIRATORY ACIDOSIS!!
Subjective s/s of deficient fluid volume -- what the patient may feel.
What is thirsty, dizzy, weak? What safety concern would you have?
Signs and symptoms of overhydration
What is weight gain (DAILY WEIGHTS ARE GREAT INDICATOR OF FLUID STATUS!!); bounding pulse, BP up, possible edema; possible pulmonary edema (listen to those lungs for crackles!!); JVD; decreased hematocrit, urine specific gravity, blood sodium levels (EVERYTHING IS DILUTED!!
Potassium
What is 3.5 - 5.0 mEq/L
Paco2 (Partial Pressure of Carbon Dioxide [CO2])
What is 35 to 45 mm Hg?
What patients are at risk for respiratory alkalosis? Hint -- think of anyone who blows off too much CO2
What is patients who are hyperventilating? They are blowing off too much CO2
This could be r/t anxiety, panic, pain, fever, etc. -- whatever the cause of the hyperventilation it can lead to respiratory alkalosis
Objective s/s of deficient fluid volume -- what you may see when evaluating the patient.
What is tenting when checking skin turgor, weight loss (d/t decrease fluid volume), orthostatic hypotension (BP decreases with position changes -- THINK FALLS!), reduced urine that is concentrated, dry oral mucosa with thick saliva, dry skin. VS changes -- HR up, Temp up (decreased ability to sweat d/t lack of fluid which is how we cool off!).
Most accurate measure of fluid gain or loss?
What is DAILY WEIGHT!! Gain or loss of 2.2 pounds (1 kg) in 24 hours indicates a gain or loss of 1 Liter of fluid
Calcium
What is 8.4 - 10.6 mg/dL?
HCO3- (Bicarbonate)
What is 22 to 26 mEq/L?
What patients are at risk for metabolic alkalosis? Hint -- think of patients who are losing stomach acid
What is excessive vomiting, GI suctioning, too many antiacids with bicarbonate
Acid is reduced, leaving patient in alkalosis
Low potassium can lead to alkalosis too (kidneys retain K and release hydrochloric acid)
Why the hematocrit (amount of RBCs) and urine specific gravity (measures concentration of urine) increase?
What is LESS FLUID -- MORE CONCENTRATED!!
Treatments that may be ordered by the provider for fluid volume excess
Diuretic medications; low sodium diet; patient may be ordered to be placed on a fluid restriction; elastic stockings for lower extremity edema
Magnesium
What is 1.3 - 2.1 mg/dL?
pH greater than 7.45
What is alkalosis?
What patients are at risk for metabolic acidosis?
Excessive diarrhea -- loss bicarb through stool -- leads to acidosis
Diabetes mellitus -- too little insulin, body can't use glucose for energy. Breaks down fat, byproduct of fat breakdown is acidic
Renal failure -- unable to get rid of excess acids, can't make enough bicarb
Hyperkalemia
Nursing interventions for fluid volume deficit
Increase PO fluid intake -- avoid fluids that have diuretic--like effect (i.e. caffeine); IV fluids as ordered if unable to take PO fluids; administer antiemetics (N/V) or antidiarrheals as ordered if indicated; I+O; daily weights (BEST INDICATOR OF FLUID STATUS!!); watch those electrolytes; provide mouth care! Don't forget about SAFETY - FALL PRECAUTIONS!
Nursing interventions for fluid volume excess
Daily weights (same time, same scale, same type of clothing); I+O (especially of your patient receives diuretics); diet/fluids/medications as ordered; MAKE SURE TO MONITOR LUNG SOUNDS -- PULMONARY EDEMA (THINK ABCs!)
Phosphate
What is 3.0 - 4.5 mg/dL?
pH less than 7.35
What is acidosis?
What is an effort to remove CO2 from the blood?