Foundations: Fluid and Electrolyte Balance

The patient had 6 oz of ice chips. How many mL of intake should you record in the EMR?

90 mL

What counts as “intake” in a patient?

any fluid/food, any IV, GI feeding and flushes

When might someone experience drainage?

if they have wounds fistulas ulcers NG tubes chest tubes etc

intake and outage should be balanced after what time period?

2-3 days

What is the average fluid intake in adults in 24 hrs?

2500 - 2600 mL

What is the average fluid output in adults in 24 hrs?

15000 mL

When assessing fluid balance, what should you remember when weighing a patient?

their physical appearance (what they are wearing) should be the same each time they’re weighed

How much weight gain is notable when looking for fluid balance?

2+ lbs per day or 5+ lbs a week

A high blood pressure indicates fluid ________

excess

What does a high BUN lab indicate?

dehydration/deficit

A bulging fontanelle indicates fluid ________

excess

Tenting in the skin indicates fluid _________

deficit

Skin warmer than usual indicates fluid ______

deficit/dehydration

If a patient is dehydrated, what safety precautions should you put them on?

seizure precautions, hypovolemic shock, confusion

If a patient is in fluid overload, which organ problems take priority?

heart and lungs

Pulmonary edema leads to what in the lungs?

fluid build up in alveoli

If there is fluid in the lungs, what might you hear during auscultation?

crackles and rales

hyponatremia indicates fluid ________

excess

diabetic ketoacidosis indicates fluid ______

deficit

jugular vein distention indicates fluid ________

excess

increased heart risk indicates fluid __________

deficit

shortness of breath indicates fluid _________

excess

decreased urine specific gravity indicates fluid ________

deficit

potassium range

3.5-5

sodium range

136 to 145

calcium range

9-10.5

magnesium range

1.3 to 2.1

hypocalcemia can lead to…

muscle spasm/twitching

how can you test for hypocalcemia?

trousseau sign or chovstek’s sign

irregular calcium levels will cause problems in the ______ and ______

heart, muscles

neuromuscular sign and symptoms of calcium imbalance

numbness tingling muscular twitching cramping spasms

respiratory/cardiac s/s of calcium imbalance

chest pain and dysrhythmia

neuro s/s of calcium imbalance

depression dementia seizure

You should limit calcium supplements to ______ mg/day

600

You shouldn’t give more than 600 mg/ day of calcium because…

the body can’t absorb more than that in a day

What is a fasting glucose level?

glucose level of blood after not eating the whole night

what is considered a normal fasting blood sugar level?

99 mg/dL

what does the A1C test look for?

the amount of glucose that has been attached to a red blood cell during it’s lifetime (3-4 months)

what is a normal A1C test level?

below 5.7%

A diabetic A1C level is..

6.5% or above

T/F: You need to fast before an A1C hemoglobin test

False

What is a normal level in glucose tolerance test?

140 mg/dL or below

When is a glucose tolerance test most commonly used?

during pregnancy, to test for gestational diabetes

Which organ is most at risk during sodium imbalances?

brain

neuro s/s of hypernatremia

disorientation decreased LOC decreased DTRs muscle weakness fatigue seizure risk

A saline solution of 0.9% is considered…

isotonic

if your patient is hyponatremic, what % of saline do you give?

3% saline solution (hypertonic)

What is the normal amount of dextrose in a solution?

5%

What organ are you most concerned about during irregular potassium levels?

the heart

muscle aches dysrhythmias and heart failure are indicative of

hyperkalemia

How can you treat hyperkalemia?

• hemodialysis

• resin medication

• sodium polystyrene

• sulfonate calcium gluconate

• diuretics for the heart

what foods should you avoid if hyperkalemic?

• bananas

• salt substitutes

• sweet potatoes

• avocados

• spinach

• beets

• lentils

• dried fruits

What is infiltration?

fluid infuses into surrounding tissue instead of the vein

What should you do if infiltration occurs?

discontinue the IV, apply warm compress and elevate the arm

s/s of infiltration

swelling pallor pain cool to touch

what is phlebitis?

inflammation of vein

what is extravasation?

IV catheter becomes dislodged and medication goes into the tissues

What should you do when administering a blood transfusion?

stay with patient for 15 min to look for allergic reactions