Fluids and Albumin

Antibiotics Causing Electrolyte Imbalances

• Certain antibiotics, like vancomycin, can cause hyperkalemia (high potassium).
• Zosyn (piperacillin/tazobactam) may lead to hypernatremia (high sodium).

Nursing Assessment of Electrolyte Imbalances

Assessment

• Monitor intake and output
• Hypo or Hypervolemia (Hypo=Too little volume; Hyper=To much volume)
• Daily weights. Monitor daily weight

Fluid Compartments

• Body fluid is divided into intracellular fluid (ICF) and extracellular fluid (ECF).
• Intracellular fluid is inside cells, about two-thirds of total body.
• Extracellular fluid is outside cells, about one-third of total body water.
• The extracellular fluid is interstitial fluid that's between cells but not inside blood vessels, intravascular fluid or blood plasma, and transcellular fluids in epithelial-lined cavities like cerebrospinal, synovial, pleural, and peritoneal fluids.
• The distribution and composition of these fluid compartments is regulated in order to maintain function, transport nutrients, remove wastes, and provide the optimal internal environment.

Third Spacing

• Third spacing is when fluid shifts from intravascular space into interstitial space or body cavities.
• This can occur in conditions such as ascites, pleural effusions, intestinal obstructions, and severe burns. Trapped fluid outside of the vascular system leads to a relative decrease in intravascular volume that can result in hypovolemic shock.
• Clinically presents as edema or fluid accumulation in areas like the abdomen or extremities.

Electrolytes and Their Abnormal Signs and Symptoms

Sodium (Normal range: 135-145 mEq/L)

• Hyponatremia (<135 mEq/L) symptoms - Nausea, confusion, fatigue, muscle cramps, seizures.
• Hypernatremia (>145 mEq/L) symptoms - Extreme thirst, confusion, muscle twitches, seizures

Calcium (Normal range: 8.5-10.2 mg/dL)

• Hypocalcemia (<8.5 mg/dL) symptoms - Muscle cramps, numbness, seizures, arrhythmias.
• Hypercalcemia (>10.2 mg/dL) symptoms - Nausea, vomiting, confusion, kidney stones.

Potassium (Normal range: 3.5-5.0 mEq/L)

• Hypokalemia (<3.5 mEq/L) symptoms - Muscle weakness, cramping, arrhythmias.
• Hyperkalemia (>5.0 mEq/L) symptoms - Muscle paralysis, Peaked T-waves on ECG, arrhythmias.

Magnesium (Normal range: 1.8-2.4 mg/dL)

• Hypomagnesemia (<1.8 mg/dL) symptoms - Muscle cramps, tremors, arrhythmias, seizures.
• Hypermagnesemia (>2.4 mg/dL) symptoms - Nausea, vomiting, lethargy, respiratory depression.

Bicarbonate (Normal range: 22-28 mEq/L)

• Low levels symptoms - Metabolic acidosis - nausea, fatigue, Kussmaul respirations.
• High levels symptoms - Metabolic alkalosis - confusion, arrhythmias, muscle twitching.

Albumin (Normal range: 3.5-5.0 g/dL)

• Hypoalbuminemia (<3.5 g/dL) symptoms - Edema, ascites, poor wound healing.
• Hyperalbuminemia (>5.0 g/dL) symptoms - Dehydration, rarely symptomatic.

Isotonic, Hypertonic, and Hypotonic Solutions

• Isotonic solutions have the same osmotic pressure as blood plasma and cells and cause no fluid shift between compartments. Examples 0.9% normal saline and 5% dextrose in water (D5W), and LR.
• Hypertonic solutions have higher osmotic pressure than blood plasma and cells and pull water out of cells, causing them to dehydrate and shrink. Examples are 3-5% saline solution, D10W, D5 in 0.9% NS, DD5 in 0.45% NS, D5 in LR.
• Hypotonic solutions have lower osmotic pressure than blood plasma and cells which causes water to move into cells, leading to cellular swelling and potentially rupture if severe. Examples are 0.45% saline and LR.

Use of Hypertonic, Isotonic, and Hypotonic Solutions as Treatment

• Isotonic solutions like 0.9% normal saline are used to replace fluid losses and maintain intravascular volume.
• Hypertonic solutions like 3% saline are used to treat severe hyponatremia by raising the sodium concentration in the extracellular fluid while pulling water out of cells.
• Hypotonic solutions like 0.45% saline are used to treat hypernatremia by diluting the extracellular fluid and allowing water to move into cells.

Colloids and Crystalloids

• Colloids contain larger insoluble molecules like proteins or starches suspended in a crystalloid solution. They are used when plasma volume expansion is needed, such as in hypovolemic shock, burns, or during surgery. Examples are albumin, dextran, and hydroxyethyl starches. Colloids pull fluid into the vascular space from the interstitial space due to their higher oncotic pressure.
• Colloid-Albumin is hyper-oncotic and it expands the plasma volume by about four times its volume.
• Crystalloids are aqueous solutions of electrolytes or other water-soluble molecules and are given for fluid resuscitation in conditions like dehydration, hypovolemia, and shock. Examples include normal saline, Ringer's lactate, and dextrose solutions

How Albumin Affects Blood Pressure, Pulmonary Edema and Urination

• Albumin increases blood pressure by expanding the plasma volume (the increased blood volume leads to increased venous return to the heart, increasing cardiac output and blood pressure) when administered intravenously.
• Albumin administration can potentially cause pulmonary (if too much fluid enters the pulmonary vasculature, increasing hydrostatic pressure and leading to fluid leakage into the lung interstitium and alveoli) edema.
• Albumin shifts fluid from of the interstitial spaces into the vascular space due to its oncotic properties and is shift can increase renal perfusion and glomerular filtration rate, resulting in increased urination.

Signs and Symptoms of Fluid Volume Deficit

• Thirst and dry mucous membranes.
• Decreased skin turgor and dry skin.
• Sunken eyeballs.
• Orthostatic hypotension (dizziness upon standing).
• Oliguria (decreased urine output).
• Tachycardia (rapid heart rate).
• Fatigue and weakness, headache, muscle cramps.
• Concentrated urine with high specific gravity.
• Elevated BUN and hematocrit levels.
• Weight loss.
• Severe cases can progress to hypovolemic shock with cool, clammy skin, altered mental status, oliguria or anuria, and hypotension.

Signs and Symptoms of Fluid Volume Excess

• Weight gain.
• Edema (swelling) in the legs, feet, hands
• Distended neck veins.
• Shortness of breath
• Crackles or wheezing in the lungs.Ascites (fluid accumulation in the abdomen)
• Increased blood pressure
• Decreased hematocrit and plasma protein levels.
• Oliguria (decreased urine output).
• Fluid can accumulate in the lungs causing pulmonary edema with pink and frothy sputum and lead to congestive heart failure.

Edema and Its Types

• Edema is the accumulation of excessive fluid in the interstitial spaces between cells or body tissues.
• Types-Localized Edema, generalized edema, pitting Edema, non-pitting edema, peripheral edema, pulmonary edema, cerebral Edema.

Hormonal Regulators of Fluid Intake

• ADH stored in posterior pituitary gland, release in response to changes in blood osmolarity.
• Aldosterone (released by adrenal cortex) is a sodium conserver.
• RAA system is to combat hypovolemia.
• Atrial natriuretic peptide (ANP) released by the heart.

Organs Releasing Hormonal Regulators

• Hypothalamus produces antidiuretic hormone (ADH), increased by the kidneys.
• Kidneys release renin, which initiates the renin-angiotensin-aldosterone system (RAAS).
• Adrenal Cortex releases aldosterone and increasing blood levels.
• Heart Atria produces atrial natriuretic peptide (ANP) and reduces blood volume

Fluid and Electrolyte Evaluation

• Serum electrolytes, hematocrit, hemoglobin, BUN, Creatinine.
• Compare Serum electrolyte tests with:Measure sodium, potassium, chloride, and bicarbonate levels. Hemoglobin

Causes of Acidosis and Alkalosis

• Acidosis can be caused by:
  • Metabolic causes: Diabetic ketoacidosis, lactic acidosis due to poor perfusion, renal failure leading to acid retention, ingestion of acidic substances.
  • Respiratory causes: Hypoventilation and carbon dioxide retention.
• Alkalosis cause:
  • Vomiting and loss of hydrochloric acid.
  • Diuretic use, hypokalemia.
  • Excessive bicarbonate intake.
  • Respiratory causes:Hyperventilation and excessive carbon dioxide loss.

Nursing Monitor: Fluid/Electrolyte Assessment/Labs

• Monitor Intake and output
• Hypo or Hypervolemia (Hypo=Too little volume; Hyper=To much volume)
• Hematocrit
• Monitor Laboratory Test:BUN, Creatinine, Urine Specific gravity
• Monitor Serum sodium, Serum osmolality daily weight
• Monitor:Assess Communication,
• Asses:Thermoregulation,Elimination-Monitor Intake of Sodium
• Fluids/Foods

Causes of Acidosis and Alkalosis

• Acidosis can be caused by:
  • Metabolic causes: Diabetic ketoacidosis, lactic acidosis due to poor perfusion, renal failure leading to acid retention, ingestion of acidic substances.
  • Respiratory causes: Hypoventilation and carbon dioxide retention.
• Alkalosis cause:
  • Vomiting and loss of hydrochloric acid.
  • Diuretic use, hypokalemia.
  • Excessive bicarbonate intake.
  • Respiratory causes:Hyperventilation and excessive carbon dioxide loss

Signs and Symptoms of Acidosis

• Headache, lethargy, confusion, coma, Kussmaul respirations (rapid, deep breathing),
• Anorexia, nausea, vomiting, diarrhea, abdominal discomfort, Dysrhythmias, hypotension, muscle weakness, cramping, fatigue, restlessness.

Signs and Symptoms of Alkalosis

• Dizziness, headache, confusion, seizures, tetany (muscle twitching/cramping), Shallow, slow breathing, arrhythmias, hypotension, nausea, vomiting, muscle cramps, weakness, hyperreflexia, paresthesias (numbness/tingling around mouth and extremities).

Arterial Blood Gases

• Compensated acidosis: pH is normal (7.35-7.45), PaCO2 and HCO3¯ are BOTH abnormal and the respiratory system has compensated for the metabolic acidosis by lowering PaCO2.
• Compensated alkalosis: pH is normal (7.35-7.45), PaCO2 and HCO3¯ are BOTH abnormal and the respiratory system has compensated for the metabolic alkalosis by raising PaCO2.
• Partially compensated acidosis: pH is abnormal as well as both PaCO2 and HCO3¯ are abnormal, partial respiratory compensation.
• Partially compensated alkalosis: pH is abnormal as well as both PaCO2 and HCO3,¯ are abnormal, partial respiratory compensation.
• Uncompensated acidosis: pH is abnormal (acidic < 7.35 or alkaline > 7.45) and only one system (PaCO2 or HCO3) is abnormal.
• Uncompensated alkalosis: pH is abnormal (acidic < 7.35 or alkaline > 7.45) and only one system (PaCO2 or HCO3) is abnormal.
• Uncompensated acidosis:
  • PACO2 abnormal, HCO3- normal, Only one system abnormal
  • Respiratory: Compensation and tachypnea or hyperventilation.

Fluid and Electrolyte Imbalance Factors

• Excessive fluid losses (Vomiting, diarrhea, high output fistulas or drains, excessive sweating, burns, or polyuria can lead to dehydration and electrolyte deficits)
• Impaired ability due to kidney function (kidney disease)
• Endocrine (diabetes insipidus, SIADH, Addison's disease) severe illnesses
• Medications like diuretics, chemotherapy, steroids
• Severe injuries
• Gastro intestinal losses
• Liver functions

Nurse Procedures for Determining Fluid Balance

• Measure and record accurate intake and output (I&O), which includes oral, IV and tube feeding, as well as urine output, vomiting, diarrhea, and drainage from tubes/wounds.
• Weigh patient, daily and at the same time using the the same equipment. Use ABGs
• Assess skin/turgor
• ABGs
• Inspect Edemas

Fluid and Electrolyte Balance in Older Adults

• Dehydration, and higher kidney risk. impaired
• hyponatremia and kidney issues, can result and seizures
• Edemas, and causes liver conditions
• Older adults are at high risk for fluid/electrolyte imbalances from age-related physiological changes. Health Outcomes:, hypernatremia, hypokalemia, and fluid overload

Reasons for Developing Fluid Deficits/Excesses

• Older adults
• High Risk/Drive is a side affect
• immobility is a contributing

Explain which system compensates the fastest for altered arterial blood gases.

• The kidneys take the longest time.
• The RESPIRATORY SYSTEM compensates the fastest for altered arterial blood gases. Changes in the rate and depth of breathing can rapidly adjust the partial pressure of carbon dioxide (PaCO2) to compensate for acid-base disturbances.

Types of Lung Sounds

• Vesicular breath sounds are the normal soft, breezy sounds heard over lung fields during inhalation and exhalation, which indicate air is moving freely through the airways.
• Crackles (rales) are discontinuous, non-musical, interrupted sounds that can be fine or coarse. Fine crackles (hair rubbing together) may suggest airway secretions or abnormal opening of small airways. Rhonchi are caused by mucus may suggest plugging

Causes, Interventions for Pneumothorax, Tension Thorax, and Hemothorax

• Tension pneumothorax occurs when air enters pleural space but cannot escape, increasing pressure and shifting mediastinum, emergent needle throcosomy

Signs and Symptoms of asthma

• Wheezing • Dyspnea

• SOB elevated heart rate

Nursing Education for Asthma.

Teaching:

• includes educate on proper inhaler technique for bronchodilators and coriticosteroids- Expain what is involved on adjustings .
• Triggers for avoidance includes identify allergens, irritants, viral infections, stress, and other personal asthma triggers. Enviromental/regular testing

Medication used to treat asthma (Classification, side effects patient teaching):

• Steriods-Prednisone the patients must to stop abruplty
• bronchodilators-albuterol should not exeed
• Achlinerig Better rinsh after a use
• Long time

Oxygenation Complications of COPD

Pulmonary hypertension: Increased blood pressure in the pulmonary arteries from chronic hypoxemia and destruction of lung vasculature.

Tuberculosis

• Teaching about what to expect
• To social distance.
• Remind the patient to avoid exposure.

Managing Pneumonia

• Proper nutrtion
• Sputtm
• Lung functions

Medications for Pneumonia

• (zirhomycin ), allergies Educate the family

Calculate MAP

• The Mean Arterial Pressure average vitals with brian heart and kidneys

Teach blood transfusion to Family

What does it mean for blood types

What Does Transfuson Means.

Alloegenic- for the body

Transfuson Reatctions (EXPALINING)

1. Family will be with a actions

• Hypoallegeric
• Reactions
• (Trall, acitiutes

111. Educate Familys what signs to look for - Clincial fatigue- shortness, low blood cells

• Taught Family
• Avoid / prevent crisis

This lesson covers the different types of fluids in the body, including interstitial and intravascular fluid. It also discusses albumin, its uses, and when it is administered to patients. The content helps to understand fluid dynamics and related medical treatments.