Ch 06.pptx

Book cover for Understanding MedicalSurgical Nursing, Seventh Edition. Chapter 6 Nursing Care of Patients with Fluid, Electrolyte, and Acid–Base Imbalances Copyright ©2023 F.A. Davis Company Learning Outcomes  Identify the purposes of fluids and electrolytes in the body.  List the signs and symptoms of common fluid imbalances.  Predict patients who are at the highest risk for dehydration and fluid excess.  Identify data to collect in patients with fluid and electrolyte imbalances. Copyright ©2023 F.A. Davis Company Learning Outcomes (continued_1)  Describe therapeutic measures for patients with fluid and electrolyte imbalances.  Identify the education needs of patients with fluid imbalances.  Categorize common causes, signs and symptoms, and treatments for sodium, potassium, calcium, and magnesium imbalances. Copyright ©2023 F.A. Davis Company Learning Outcomes (continued_2)  Identify foods that have high sodium, potassium, and calcium contents.  Give examples of common causes of acidosis and alkalosis.  Compare how arterial blood gases change for each type of acid–base imbalance. Copyright ©2023 F.A. Davis Company Case Study With Concept Map Mrs. Hernandez is a 62-year-old postmenopausal patient who visits her health-care provider (HCP) and reports shortness of breath and bone pain. She came to the United States 10 years ago with her husband. She has her own housekeeping business but does not carry health insurance. She does not use harsh chemicals in her business. Spanish is her primary language. Copyright ©2023 F.A. Davis Company Case Study With Concept Map (continued_1) The patient felt a palpable mass with right breast pain 6 months ago but did not seek health care due to lack of insurance. She has never had any mammograms or breast cancer screening. Physical examination noted right breast skin peau d’orange effect (a thickened and pitting of the skin resembling orange peel). Mammogram and ultrasound were obtained, noting a 6-cm mass with enlarged lymph nodes. Stereotactic Copyright ©2023 F.A. Davis Company Case Study With Concept Map (continued_2) Mrs. Hernandez is visibly anxious and markedly short of breath. She has been nauseous and has a poor appetite. She has lost weight and her skin is dry and cracked. She is pale. You notice it is difficult for her to ambulate without holding on to the wall and she seems to grimace with pain. Copyright ©2023 F.A. Davis Company Case Study With Concept Map (continued_3) She had her visit with the medical and surgical oncologists and is scheduled for a bilateral mastectomy after which she will begin radiation and chemotherapy treatments. The oncologist recommended a lung biopsy and Mrs. Hernandez does not understand why she would need one. Copyright ©2023 F.A. Davis Company Case Study With Concept Map (continued_4) She does not understand English very well and it is difficult to communicate with her. You have an interpreter present for your data collection. You ask her if she has any questions related to her diagnosis. In addition, you discuss cultural concerns that may come into play during her course of treatment. Copyright ©2023 F.A. Davis Company Case Study With Concept Map: Activity  What nursing concepts would be used for Mrs. Hernandez’s care?  Can you see how the concepts in Mrs. Hernandez’s care are related?  Work with your group to create a concept map showing relationships between the concepts.  Continue the map to show patient cues, nursing interventions, and collaborative relationships. Copyright ©2023 F.A. Davis Company Mrs. Hernandez: Suggested Relationships Copyright ©2023 F.A. Davis Company Fluid Balance  Intracellular fluid  Extracellular fluid • Interstitial fluid • Intravascular fluid • Transcellular fluid Copyright ©2023 F.A. Davis Company Control of Fluid Balance  Pressure sensors  Antidiuretic hormone Copyright ©2023 F.A. Davis Company Movement of Fluids and Electrolytes  Active transport  Passive transport • Diffusion • Filtration • Osmosis Copyright ©2023 F.A. Davis Company Tonicity  Isotonic • Same osmolarity as blood  Hypertonic • Higher osmolarity than blood  Hypotonic • Lower osmolarity than blood Copyright ©2023 F.A. Davis Company Fluid Gains and Losses  Gains • Food • Fluid Copyright ©2023 F.A. Davis Company  Losses • Sensible • Insensible Fluid Imbalances  Dehydration • Hypovolemia  Fluid overload Copyright ©2023 F.A. Davis Company Dehydration Signs and Symptoms  Thirst  Rapid, weak pulse  Low blood pressure  Dry skin and mucous membranes  Skin tenting  Decreased urine output  Increased temperature Copyright ©2023 F.A. Davis Company Interventions for Deficient Fluid Volume  Monitor daily weight.  Monitor intake and output.  Increase fluid intake.  Treat underlying cause.  Use caution with elderly patients. Copyright ©2023 F.A. Davis Company Fluid Excess Signs and Symptoms  Bounding pulse  Elevated blood pressure  Respiratory changes  Edema  Increased urine output  Weight gain  Heart failure Copyright ©2023 F.A. Davis Company Interventions for Excess Fluid Volume  Monitor weight and urine output.  Place in Fowler position.  Administer oxygen.  Administer diuretics.  Restrict fluid and sodium. Copyright ©2023 F.A. Davis Company Electrolytes  Cations • Positive (+)  Anions • Negative (−) Copyright ©2023 F.A. Davis Company Sodium Imbalances  Hyponatremia • Sodium deficit  Hypernatremia • Sodium excess Copyright ©2023 F.A. Davis Company Food Sources of Sodium  Pizza  Canned vegetables  Canned soups  Salty snacks  Prepared foods Copyright ©2023 F.A. Davis Company Na+ Hyponatremia Signs and Symptoms  Sodium less than 135 milliequivalents per liter  Fluid excess or deficit  Mental status changes  Weakness  Nausea and vomiting Copyright ©2023 F.A. Davis Company Interventions for Hyponatremia  Monitor intake and output.  Monitor weight.  Restrict fluids.  Administer diuretics/steroids. Copyright ©2023 F.A. Davis Company Hypernatremia Signs and Symptoms  Sodium greater than 145 milliequivalents/liter  Thirst  Mental status changes  Seizures  Muscle weakness  Respiratory compromise Copyright ©2023 F.A. Davis Company Interventions for Hypernatremia  Treat fluid imbalance first.  Monitor intake and output.  Monitor weight.  Administer diuretics.  Restrict dietary sodium.  Treat cause. Copyright ©2023 F.A. Davis Company Potassium Imbalances  Hypokalemia • Potassium deficit  Hyperkalemia • Potassium excess Copyright ©2023 F.A. Davis Company Food Sources of Potassium         Sweet potatoes Beet greens Potatoes Yogurt Prune juice Bananas Orange juice Avocados Copyright ©2023 F.A. Davis Company K+ Hypokalemia Signs and Symptoms  Potassium (K+) lower than 3.5 milliequivalents per liter  Muscle weakness  Shallow respirations  Mental status changes  Cardiac arrhythmia and arrest Copyright ©2023 F.A. Davis Company Interventions for Hypokalemia  Treat underlying cause.  Offer potassium-rich foods.  Administer potassium replacement.  Teach patient • Signs and symptoms to report • Self-administration of supplement Copyright ©2023 F.A. Davis Company Practice Analysis Tip: Linking NCLEX-PN® to Practice The licensed practical nurse/licensed vocational nurse will  Monitor client intake and output.  Provide care for a client with a fluid and electrolyte imbalance. Copyright ©2023 F.A. Davis Company Activity: Cue Recognition 6.1 You are visiting Mr. Anand in his home after his discharge from the hospital following a heart failure exacerbation. You note the following meds: digoxin, hydrochlorothiazide, and warfarin. Today Mr. Anand is reporting weakness and “fuzzy” thinking. What action do you take? Copyright ©2023 F.A. Davis Company Cue Recognition 6.1: Answer Assess the patient for further signs of hypokalemia and collaborate with the case manager or HCP using SBAR. Copyright ©2023 F.A. Davis Company Cue Recognition 6.1: Answer Rationale  The patient is taking a medication (hydrochlorothiazide) that causes the excretion of potassium.  The patient is showing signs of low potassium (hypokalemia).  Hypokalemia can cause serious cardiac arrythmias, so the nurse should collaborate with the HCP or case manager. Copyright ©2023 F.A. Davis Company Hyperkalemia Signs and Symptoms  K+ greater than 5 milliequivalents per liter  Muscle twitching and cramps • Later muscle weakness  Diarrhea  Low blood pressure  Cardiac arrhythmia and arrest Copyright ©2023 F.A. Davis Company Interventions for Hyperkalemia  Limit dietary potassium.  Hold potassium supplements.  Administer medications as ordered. • Potassium-losing diuretic • Kayexalate • Insulin with glucose Copyright ©2023 F.A. Davis Company Calcium Imbalances  Hypocalcemia • Low calcium level  Hypercalcemia • High calcium level Copyright ©2023 F.A. Davis Company Food Sources of Calcium       Fortified cereals Canned salmon Spinach Yogurt Cheese Milk Copyright ©2023 F.A. Davis Company Ca++ Hypocalcemia Signs and Symptoms  Calcium (Ca++) less than 9 milligrams per deciliter or 4.5 milliequivalents per liter  Mental status changes  Hyperactive deep tendon reflexes  Diarrhea  Cardiac arrhythmia and arrest Copyright ©2023 F.A. Davis Company Hypocalcemia Signs and Symptoms (continued) Trousseau sign Copyright ©2023 F.A. Davis Company Chvostek sign Interventions for Hypocalcemia  Treat cause.  Increase dietary calcium.  Administer medications as ordered. • IV calcium gluconate • Oral calcium supplements • Aluminum hydroxide to bind phosphate Copyright ©2023 F.A. Davis Company Hypercalcemia Signs and Symptoms  Calcium greater than 11 milligrams per deciliter or 5.5 milliequivalents per liter  Increased heart rate and blood pressure  Skeletal muscle weakness  Decreased gastrointestinal motility Copyright ©2023 F.A. Davis Company Interventions for Hypercalcemia  Administer fluids.  Administer medications as ordered. • • • • Furosemide (Lasix) Pamidronate (Aredia) Zoledronic acid (Zometa) Calcitonin  Hemodialysis Copyright ©2023 F.A. Davis Company Magnesium Imbalances  Hypomagnesemia • Low magnesium level  Hypermagnesemia • High magnesium level Copyright ©2023 F.A. Davis Company Mg+ Hypomagnesemia Signs and Symptoms  Magnesium (Mg++) less than 1.5 milliequivalents per liter  Positive Trousseau sign  Positive Chvostek sign  Cardiac arrhythmia and arrest Copyright ©2023 F.A. Davis Company Interventions for Hypomagnesemia  Treat underlying cause.  Administer magnesium replacement. Copyright ©2023 F.A. Davis Company Hypermagnesemia Signs and Symptoms  Magnesium greater than 2.5 milliequivalents per liter  Hypotension  Lethargy  Skeletal muscle weakness  Respiratory failure  Cardiac arrhythmia and arrest Copyright ©2023 F.A. Davis Company Interventions for Hypermagnesemia  Administer IV fluids.  Administer medications as ordered. • Loop diuretics (Furosemide) • Dialysis Copyright ©2023 F.A. Davis Company Acid–Base Balance  Acid • Substance that releases a hydrogen ion  Base (Alkali) • Substance that binds hydrogen  Normal pH 7.35 to 7.45 Copyright ©2023 F.A. Davis Company Acid–Base Control  Cellular buffers  Lungs  Kidneys Copyright ©2023 F.A. Davis Company Acid–Base Imbalances Acidosis Alkalosis  Respiratory  Metabolic  Respiratory  Metabolic Copyright ©2023 F.A. Davis Company Arterial Blood Gas Values: ROME pH Respirato ry Acidosis Respirato ry Alkalosis Metabolic Acidosis Metabolic Alkalosis Copyright ©2023 F.A. Davis Company Down arrow pCO2 HCO3 Up arrow Horizontal line Up arrow Down arrow Horizontal line Down arrow Horizontal line Down arrow Up arrow Horizontal line Up arrow Case Study for SBAR Hand-Off Report  Mrs. Rodriquez is a 38-year-old female who is brought to the emergency department after collapsing while running in a marathon.  She began to experience muscle cramps, weakness, nausea, and some confusion prior to collapsing.  Her temperature is 100.4°F (38°C); BP 86/52; HR 110, regular; RR 24. Skin is warm, dry, and flushed. Copyright ©2023 F.A. Davis Company Case Study for SBAR Hand-Off Report (continued)  She is receiving an IV solution of normal saline and may have clear liquids as tolerated. Copyright ©2023 F.A. Davis Company Activity: SBAR Hand-Off Report  You are preparing to give a hand-off report at the end of your shift to the oncoming nurse.  Think about the information you should include in the hand-off report.  Now turn to your neighbor and communicate a hand-off report using SBAR.  Afterwards, review suggested SBAR report on next slide. Copyright ©2023 F.A. Davis Company SBAR Hand-Off Report: Suggested Answers Situation: Mrs. Rodriquez is a 38year-old female, collapsed while running in a marathon Background: Reported muscle cramps, weakness, nausea, and some confusion Assessment of Situation: Temperature is 100.4°F (38°C); BP 86/52; HR 110, regular; RR 24. Skin is warm, dry, and flushed. Currently receiving IV fluids for dehydration. Copyright ©2023 F.A. Davis Company SBAR Hand-Off Report: Suggested Answers (continued) Recommendation: Continue with IV infusion; monitor vital signs. Reinforce adequate fluid intake at discharge. Copyright ©2023 F.A. Davis Company Review Question #1 Where are most body fluids found? 1. Intracellular 2. Interstitial 3. Intravascular 4. Transcellular Copyright ©2023 F.A. Davis Company Review Question #1 Answer Correct Answer: 1 Copyright ©2023 F.A. Davis Company Review Question #2 A 76-year-old patient with skin tenting and decreased urine output is most likely experiencing which fluid or electrolyte disorder? 1. Hypernatremia 2. Hypocalcemia 3. Fluid excess 4. Dehydration Copyright ©2023 F.A. Davis Company Review Question #2 Answer Correct Answer: 4 Copyright ©2023 F.A. Davis Company Review Question #3 Which electrolyte is most critical to healthy cardiac rhythm? 1. 2. 3. 4. Calcium Sodium Potassium Magnesium Copyright ©2023 F.A. Davis Company Review Question #3 Answer Correct Answer: 3 Copyright ©2023 F.A. Davis Company Review Question #4 Which interventions should the nurse initiate for a patient with fluid excess? Select all that apply. weight. 1. Monitor 2. 3. 4. 5. Place in Fowler position. Administer IV fluids. Encourage ambulation. Restrict fluid and sodium. Copyright ©2023 F.A. Davis Company Review Question #4 Answer Correct Answer: 1, 2, 5 Copyright ©2023 F.A. Davis Company Review Question #5 What are good food sources of calcium? Select all that apply. 1. Canned tuna 2. Canned salmon 3. Spinach 4. Yogurt 5. Whole grains Copyright ©2023 F.A. Davis Company Review Question #5 Answer Correct Answer: 2, 3, 4 Copyright ©2023 F.A. Davis Company

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