Excess and Deficit
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
Monitor breath sounds
Sit up in fowlers position
What is the normal range for serum calcium?
9.0–10.5 mg/dL
What is the normal range for sodium (Na+)?
135 to 145 mEq/L
What is the normal range for potassium?
3.5 to 5.0 mEq/L
The main intracellular cation?
Potassium (K+)
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)
What are 2 signs and symptoms of hypocalcemia?
Neuromuscular excitability: Spasms of face, lips, larynx (can cause stridor); Tingling sensation around the mouth; Mental status changes; dysrhythmias; Hypotension; Positive Trousseau's sign, Positive Chvostek's sign.
What are 2 causes of hyponatremia
Hypovolemic hyponatremia (NPO)
Diuretics
GI fluid loss (vomiting, diarrhea)
Water intoxication
Prolonged hypotonic IV fluid use
SIADH
What should never be done when replacing potassium?
The main extracellular cation?
Sodium (Na+)
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 2 signs and symptoms of hypercalcemia?
lethargy, stupor, coma
decreased muscle strength and tone
anorexia, nausea, and vomiting
constipation
pathologic fractures
dysrhythmias
renal calculi
What are 3 signs/symptoms of hypernatremia?
Thirst, dry and sticky mucous membranes
weakness
elevated temperature
Confusion, irritability, decreased LOC, hallucinations, seizures
What are 2 signs/symptoms of hyperkalemia?
Anxiety, irritability, confusion
Dysrhythmias (bradycardia, heart block, cardiac arrest)
muscle weakness, flaccid paralysis
Paresthesia
Abdominal cramping
What happens when the Renin-angiotensin system is activated?
1. Renin released from kidneys: Converts angiotensinogen (from the liver) to angiotensin I
2. Angiotensin I converted to angiotensin II: In lungs by angiotensin-converting enzyme (ACE)
3. Angiotensin II : Activates the adrenal cortex to release aldosterone and cause vasoconstriction
4. Aldosterone: Increases sodium and water reabsorption and potassium secretion by kidneys
List 4 signs/symptoms would you expect to see in a patient with fluid volume excess?
Weight gain, edema, bounding pulses, hypertension, JVD, dyspnea, cough, crackles
If Na+ is low, also decreased LOC, coma, seizures
What are 2 causes of hypocalcemia
Hypoparathyroidism
Pancreatitis
Vitamin D deficiency
Inadequate intake of Ca
Hyperphosphatemia
Chronic Alcoholism
What are 3 symptoms of hyponatremia?
lethargy, confusion
weakness, muscle cramping
seizures
anorexia, nausea, vomiting
What are 2 signs/symptoms of hypokalemia?
Weak, irregular pulse; Dysrhythmias
fatigue, lethargy
anorexia, nausea, vomiting
muscle weakness and cramping
decreased peristalsis, hypoactive bowel sounds
paresthesia
What is one factor that can lead to edema?
Increase in hydrostatic pressure due to fluid overload
Decrease in plasma proteins (colloids)
obstruction of lymphatic drainage
increased capillary permeability due to tissue damage
List 1 abnormal lab would you might see in a patient with fluid volume deficit?
Increased hematocrit
Increased BUN
Increased creatinine
Increased urine specific gravity
Increased sodium
Increased serum osmolality
What are 2 causes for hypercalcemia?
Prolonged bed rest
hyperparathyroidism
bone malignancy
osteoporosis
What is an intervention for hypernatremia (NOT monitoring)?
Limit salt intake
Increase water intake
Administer hypotonic IV solution
What are 2 causes of hyperkalemia?
Renal failure
massive trauma, crush injury, burns
hemolysis
IV potassium
Acidosis (DKA)
What is the process by which fluid and solutes move together from an area of higher pressure to lower pressure?
Filtration