Fluid and electro. chart quiz 7
Fluid Volume
Variable Fluid Volume
Deficit
Description
Occurs when the body loses water and electrolytes isotonically; that is, the same proportion as exists in the normal body fluid.
Serum electrolyte levels remain normal.
Dehydration: State in which the body loses water, and serum sodium levels increase.
Excess
Occurs when the body retains water and electrolytes isotonically.
Water intoxication: State in which the body retains water and serum sodium levels decrease.
Causes of Fluid Volume Deficit
Vomiting
Diarrhea
Sweating
Inadequate fluid intake
Massive edema, as in the initial stage of major burns
Ascites
Elderly forgetting to drink
Heart failure
Renal failure
Cirrhosis, liver failure
Excessive ingestion of table salt
Over-hydration with sodium-concentrating fluids
Poorly controlled IV therapy, especially in young and old clients.
Symptoms of Fluid Volume Deficit
Weight loss (1 pint of fluid loss is equal to 1 pound of weight loss!)
Decreased skin turgor
Oliguria (concentrated urine)
Dry and sticky mucous membranes
Postural hypotension or weak, rapid pulse
Peripheral edema
Increased bounding pulse
Elevated blood pressure
Distended neck and hand veins
Dyspnea; moist crackles heard when lungs auscultated
Attention loss, confusion, aphasia
Altered level of consciousness
Lab Findings in Fluid Volume Deficit
Elevated BUN (Blood Urea Nitrogen) and creatinine
Increased serum osmolality
Increased urine osmolality and specific gravity
Elevated Hemoglobin (Hgb) and Hematocrit (Hct)
Decreased BUN
Decreased Hgb and Hct
Decreased serum osmolality
Decreased urine osmolality and specific gravity
Treatment and Nursing Care for Fluid Volume Deficit
Strict Intake and Output (I&O) monitoring
Diuretics
Fluid restriction
Replacement of fluids isotonically, preferably orally
Water is considered hypotonic
If IV hydration is needed, isotonic fluids are used.
Sodium-restricted diet
Weight daily
Monitor potassium (K+) levels
Electrolyte Imbalances
Hyponatremia
Definition: Sodium (Na+) level < 135 mEq/l
Common Causes
Diuretics
GI fluid loss
Hypotonic tube feedings
D5W or hypotonic fluids
Diaphoresis
Signs and Symptoms
Anorexia, nausea, vomiting
Weakness
Lethargy
Confusion
Muscle cramps, twitching
Seizures
Treatment
Restrict fluids (safest approach)
If IV saline solutions are prescribed, administer slowly; use if fluid restriction is not effective.
Hypernatremia
Definition: Sodium (Na+) level > 145 mEq/l
Common Causes
Water deprivation
Hypertonic tube feedings
Diabetes insipidus
Heatstroke
Hyperventilation
Watery diarrhea
Renal failure
Cushing syndrome
Signs and Symptoms
Thirst
Hyperpyrexia
Sticky mucous membranes
Dry mouth
Hallucinations
Lethargy
Irritability
Seizures
Treatment
Restrict sodium in the diet
Beware of hidden sodium in foods and medications
Increase water intake
Hypokalemia
Definition: Potassium (K+) level < 3.5 mEq/l
Common Causes
Diuretics
Diarrhea
Vomiting
Gastric suction
Steroid administration
Hyperaldosteronism
Amphotericin B
Bulimia
Cushing syndrome
Signs and Symptoms
Fatigue
Anorexia
Nausea and vomiting
Muscle weakness
Decreased GI motility
Dysrhythmias
Paresthesia
Flat T waves on ECG
Treatment
Administer K+ supplements orally or IV
Oral forms of K+ are unpleasant tasting and are irritating to the GI tract (do NOT give on empty stomach; dilute)
NEVER give IV bolus; must be well diluted
Assess renal state (i.e., urinary output) prior to administering
Encourage foods high in K+, such as bananas, oranges, cantaloupe, avocado, spinach, and potatoes
Hyperkalemia
Definition: Potassium (K+) level > 5 mEq/l
Common Causes
Hemolyzed serum sample produces pseudohyperkalemia
Oliguria
Acidosis
Renal failure
Addison’s disease
Multiple blood transfusions
Signs and Symptoms
Muscle weakness
Bradycardia
Dysrhythmias
Flaccid paralysis
Intestinal colic
Tall T waves on ECG
Treatment
Eliminate parenteral potassium from IV infusions and medications
Administer D50 with regular insulin
Administer cation exchange resin (Kaexalate)
Monitor ECG
Administer calcium gluconate to protect heart
IV loop diuretics may be prescribed
Renal dialysis may be required.
Hypocalcemia
Definition: Calcium (Ca++) level < 8.5 mEq/l
Common Causes
Renal failure
Hypoparathyroidism
Malabsorption
Pancreatitis
Alkalosis
Diarrhea
Signs and Symptoms
Numbness
Tingling of extremities
Convulsions
Positive Trousseau sign
Positive Chvostek’s sign
At risk for tetany
Treatment
Administer calcium supplements orally 30 minutes before meals
Administer calcium IV slowly, as infiltration can cause necrosis
Increase Ca++ intake, such as dairy products and greens.
Hypercalcemia
Definition: Calcium (Ca++) level > 10.5 mEq/l
Common Causes
Hyperparathyroidism
Malignant bone disease
Prolonged immobilization
Excess calcium supplements
Signs and Symptoms
Muscle weakness
Constipation
Anorexia
Nausea, vomiting
Polyuria
Polydipsia
Neurosis
Dysrhythmias
Treatment
Eliminate parental calcium
Administer agents to reduce calcium such as calcitonin
Avoid calcium-based antacids
Renal dialysis may be required
Hypomagnesemia
Definition: Magnesium (Mg) level < 1.5 mEq/l
Common Causes
Alcoholism
Malabsorption
Diabetic ketoacidosis
Prolonged gastric suction
Diuretics
Signs and Symptoms
Anorexia
Distention
Neuromuscular irritability
Depression
Disorientation
Treatment
Administer MgSO4 IV
Encourage foods high in magnesium, such as meats, nuts, legumes, fish, and vegetables
Hypermagnesia
Definition: Magnesium (Mg) level > 2.5 mEq/l
Common Causes
Renal failure
Adrenal insufficiency
Excessive replacement
Signs and Symptoms
Flushing
Hypotension
Drowsiness, lethargy
Hypoactive reflexes
Depressed respirations
Bradycardia
Treatment
Avoid magnesium-based antacids and laxatives
Restrict dietary intake of foods high in magnesium
Hypophosphatemia
Definition: Phosphorus (P) level < 2 mEq/l
Common Causes
Refeeding after starvation
Alcohol withdrawal
Diabetic ketoacidosis
Respiratory alkalosis
Signs and Symptoms
Paresthesias
Muscle weakness
Muscle pain
Mental changes
Cardiomyopathy
Respiratory failure
Treatment
Correct underlying cause
Administer oral replacement of phosphates with vitamin D
Hyperphosphatemia
Definition: Phosphorus (P) level > 4.5 mEq/L
Common Causes
Renal failure
Excess intake of phosphorus
Signs and Symptoms
Short term: Tetany
Long term: Phosphorus precipitation in non-osseous sites
Treatment
Administer aluminum hydroxide with meals to bind with phosphorus
Dialysis may be required if renal failure is the underlying cause
Types of IV Solutions
Isotonic Solutions
Osmolality close to the extracellular fluid (ECF)
Do not cause red blood cells to swell or shrink
Indicated for intravascular dehydration (e.g., dehydration caused from running, labor, fever, etc.)
Common isotonic solutions:
Normal Saline (NS) - 0.9% NaCl
Lactated Ringer's (LR)
D5W (caution: isotonic in bag, but hypotonic in person!)
Hypotonic Solutions
Osmolality lower than ECF
Cause fluid to shift from ECF into intracellular fluid (ICF)
Indicated for cellular dehydration (e.g., from prolonged dehydration; not common)
Common hypotonic solutions:
0.45%-0.5% NaCl
D2.5/0.45% NaCl
Hypertonic Solutions
Osmolality higher than ECF
Indicated for intravascular dehydration with interstitial or cellular overhydration
To be used with extreme caution
Some may contain high concentrations of dextrose (TPN) and must be infused into a central vein for rapid dilution.
Used to treat intravascular dehydration with hypotonic conditions!
Flow Rate Calculation
Figure Out ML/HR:
Total ml fluid to be given divided by total hours to be administered = ml/hr (set pump)
Figure Out GTT/MIN:
Total ml fluid to be given divided by total min to be administered, multiplied by gtts/min (gravity drip). Most tubing will have a drip factor of 10, 12, 15 (macrodrip), or 60 (microdrip).