Fluid Balance Pt I
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?
9.0–10.5 mg/dL
What is the normal range for sodium (Na+)?
135 to 145 mEq/L
What is the normal range for potassium?
What is the normal range for magnesium?
3.5 to 5.0 mEq/L
1.3 to 2.1 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)
Treat underlying cause
What are the signs and symptoms of hypocalcemia?
Neuromuscular excitability: Spasms of face, lips, larynx (can cause stridor); Tingling sensation around the mouth; Mental status changes; Increased and irregular heart rate which can lead to cardiac arrest; Hypotension; Trousseau's sign, Chvostek's sign.
Who is at risk for developing hyponatremia?
Patients with NPO status, use of diuretics, GI suctioning (especially continuous), decreased aldosterone, excess ingestion of hypotonic fluids.
What are the signs/symptoms of hypomagnesemia?
What population is especially vulnerable to this?
S/S are similar to low Ca+ and K+ levels. Tetany, Chvostek's sign, Trousseau's sign, tremors, muscle spasms, and cardiac arrhythmias.
Alcoholics are especially vulnerable.
The main extracellular cation?
Sodium (Na+)
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.
Why is it important to monitor calcium levels following a thyroidectomy?
Parathyroid glands can be accidentally removed during a thyroidectomy causing hypocalcemia.
The parathyroid gland secretes a parathyroid hormone that regulates calcium levels in the blood by increasing the levels when they are too low.
Staff should always have calcium gluconate available post-operatively.
What are the symptoms of hyponatremia?
It can be vague and depends on whether it has a fluid imbalance. Severe hyponatremia presents with weakness, N/V/D, and mental status changes such as confusion, disorientation, and personality changes due to low sodium and osmolarity, which causes more water to collect around the brain.
What are the signs/symptoms of hypokalemia?
S/S: Anorexia, cardiac arrhythmias, leg cramps, muscle fatigue, weakness, postural hypotension
ECG: prolonged PR interval, flattened T wave, and prominent U wave
What factors can lead to edema?
Increased blood volume = increased hydrostatic pressure
Lower albumin = reduced osmotic pressure
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 the signs and symptoms of hypercalcemia?
Increased BP and pulse, skeletal muscle weakness, decreased GI motility including diarrhea, severe fatigue, confusion.
What are the signs/symptoms of hypernatremia?
Thirst, mental status changes due to too little water in and around the brain, tremors, seizures, muscle weakness
What are the signs/symptoms of hyperkalemia?
Patient presentation depends on K+ elevation and if chronic or acute elevation.
Early symptoms: numbness, muscle cramps, diarrhea; ECG: wide QRS, tall and peaked T waves, bradycardia; Can lead to cardiac arrest.
What are the steps in the Renin-Angiotensin-Aldosterone System?
What initiates this system?
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 (vasoconstrictor): Activates adrenal cortex to release aldosterone
4. Aldosterone: Increases sodium and water reabsorption and potassium secretion by kidneys
Hypotension, hypovolemia, low cardiac output.
What labs and signs/symptoms would you expect to see in a patient with dehydration?
Increased Hct and BUN, increased urine specific gravity, low BP, rapid pulse, increased temperature, decreased urine output, skin tenting, dry skin, and mucous membranes.
What are the causes for hypercalcemia?
•Elevated PTH
•Cancer (malignant cells causing bone destruction)
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, bananas, tomato juice, dried apricots, kidney beans, orange juice, and spinach.
This is the most abundant glucocorticoid. In large doses, it has both glucocorticoid (glucose-elevating and antiinflammatory) and mineralocorticoid (sodium-retention) effects.
What is cortisol?