Fluid and Electrolytes - Disrupted Homeostasis (Student Copy) PDF

Disrupted Paucek and Lage Homeostasis (Fluid and Electrolytes) Chapter 10 Enterprise RiskBy: Debbie Management Coleman, PhD, RN Visit Our Website reallygreatsite.com  Body Fluid Compartments...

Disrupted Paucek and Lage Homeostasis (Fluid and Electrolytes) Chapter 10 Enterprise RiskBy: Debbie Management Coleman, PhD, RN Visit Our Website reallygreatsite.com  Body Fluid Compartments Extracellular fluids Extracellular (fluid outside cells) Plasma (5%) aka intravascular Interstitial (15%) Intracellular (fluid within cells) 2/3 of body fluid  Fluid Regulation Regulation Osmolality (serum) Concentration of Thirst  blood volume solute (particles) Indicates water  Water loss balance  serum osmolality (# of particles) Kidneys < 275 = water  Renin-Angiotensin- excess Aldosterone (RAAS) >higher The 290 = the number, water Antidiuretic Hormone the greater pulling deficit (ADH) power for water  Released from pituitary to retain fluid  Fluid Volume Deficit GI Vomiting suctioning and Renal , Diuretics disorders diarrhea intestinal fistulas Hot Endocrine Hemorrha Third environm disorders ge spacing ent With burn patients, fluid moves Burns out of the intravascular space causing hypovolemia  What Does the Patient Look Like? Manifestations Weight Decreased cardiac outputloss output Thirst Tachypnea Concentrated urine Low grade fever Low urine volume Mental status Dry skin / ↓ turgor changes Acute weight loss Sunken eyeballs Sunken or depressed fontanels Hypotension  Knowing What To Do Fluid Volume Deficit Assessment Daily Weights VS, peripheral pulse Weigh daily volume q 4 hr. at least under standard (hypotension, tachycardia, conditions (time low CVP and weak, easily of day, clothing, obliterated peripheral scale) pulses indicate. hypovolemia) Fluids Monitor Labs Check patient preferences Hematocrit increased BUN increased Monitor for overhydration Sodium increased Monitor for fluid overload Serum osmolality increased (dyspnea, tachypnea, tachycardia, increased CVP, jugular vein distention and edema)  Fluid Volume Excess Adrenal Heart or Corticoster Cirrhosis gland renal failure oids disorders Excessive Medication Stress sodium side SIADH conditions intake effects  What Does the Patient Look Like? Manifestations Crackles Peripheral output edema Tachycardia High CVP Shortness of breath Pulmonary edema Wheezing Acute rapid weight gain Altered urine output/concentrati on Distended neck veins  Knowing What To Do (Fluid Volume Excess) Assessment Medications Health history, weights, Loop diuretics VS, lungs, urine output, Thiazide mental status diuretics Potassium- Overall Care sparing diuretics. Fluid/dietary management Monitor Labs Check renal and liver Electrolytes, BNP, function CBC, LFT Sodium/fluid restriction Osmolality Prevent falls Education  Tests Ordered to Review Chest X-ray  Pulmonary congestion?  Compare to baseline daily  Determine if treatment effective in ineffective Other Tests  Echocardiogram  ECG  CBC, electrolytes, LFT  ABG’s  Types of IV Fluids Isotonic – 0.9 NS; LR Enters cells evenly Hypotonic – 0.45 NaCl; 0.225% NaCl From intravascular to cellular Hypertonic – D5NS; D5LR; D10; D50; 3% and 5% NaCl; albumin From cellular to intravascular  Intravascula r Isotonic S L L LY I F N Interstitial Fluid does not shift E – just “fills the E V tank evenly” D. Coleman Cells  Intravascula r Hypotonic Interstitial Moves from intravascular and interstitial space INTO CELLS Cells  Intravascula r Hypertonic Interstitial Moves FROM cells TO interstitial and intravascular space Cells  Hyponatremia –Na 145 Sodium Manifestatio Possible ns thirst Excessive  Water DeprivationCauses  Hyperglycemia Dry, swollen tongue  Excess water loss  Hypertonic solution Sticky mucosa  Diabetes insipidus  Near-drowning in sea water Oliguria (r/t kidney  Osmotic diuretic  Older adult has inability to fx)  Excess sodium recognize thirst Lightheaded/ intake Weakness Seizures / coma Irritability Assess mental/neuro status Altered LOC Labs – sodium, Encourage fluids osmolality H20 via tube feeding REMEMBER Oral rehydration Administer hypotonic fluids Safety Hypotonic solution Give hypotonic fluids slowly SLOWLY Sodium restriction to prevent cerebral Teach about low sodium edema foods or seizures Potassium Hypokalemia – K < 3.5 Manifestatio Possible ns ECG changes  GI losses Causes Muscle weakness  Medications  Poor dietary intake N/V  Medications  Metabolic alkalosis Abdominal (potassium-wasting) distention  Sweat Muscle cramps Impaired renal fx Constipation Potassium replacement Cardiac monitoring Analyze ABGs (IV or PO) Potassium replacement Higher acuity setting for REMEMBER therapy IV potassium Monitor IV site Monitor Cardiac replacement Eliminate cause (e.g. Monitor kidney fx Teach about high potassium meds) ABGs food Potassium Hyperkalemia – K > 5.3 Manifestatio Possible ns ECG changes  Impaired renalCauses fx  Metabolic Acidosis Chest  High potassium  Potassium-sparing pain/palpitations intake diuretics Muscle weakness  Dehydration  Type 1 diabetes Muscle cramping  Medications Diarrhea Anxiety (jittery) Paresthesia GI manifestations Serial serum potassium Monitor ECG Kayexalate / Diuretics Monitor meds Calcium gluconate Educate on foods high in Limit potassium potassium REMEMBER IV dextrose + insulin Monitor Dialysis Cardiac Check renal fx  Hypomagnesemia - Magnesium < 1.8 Manifestatio Possible ns Neuromuscular  Loss of GI fluids Causes  Citrated blood excitability  Alcoholism  Diabetic ketoacidosis Chvostek  Decreased  Trousseau Decreased GFR absorption Seizures  Medications HTN/tachycardia Dysrhythmias Change in MgSO4 IV Assessment (neuro, personality Oral magnesium respiratory & cardiovascular) Diet (increase Monitor labs REMEMBER magnesium) Ensure safety Monitor Labs – BMP (calcium IV site care Patient teaching r/t diet, cardiac and magnesium) medications, ETOH Neuromuscul ar excitability  Hypermagnesemia – Mg > 3 Magnesium Manifestatio Possible ns CNS depression  Renal failure Causes Lethargy/  Excessive use of drowsiness laxatives/antacids Confusion/  Renal decline with age dizziness Decreased DTR Decreased respiration IV calcium chloride Assessment (DTR, Dysrhythmias IV calcium gluconate respiratory rate) Loop diuretics Patient safety REMEMBER Isotonic fluids Teach about foods/meds high Monitor Hemodialysis in magnesium Cardiac Neuro depression Fall risk Calcium Hypocalcemia - Calcium < 9 Manifestatio Possible ns Tetany (spasms)  Hypoparathyroidism Causes  Decreased calcium Seizures  Osteoporosis consumption Circumoral  Kidney failure  Decreased Vit D numbness  Bariatric surgery  Medications Muscle spasms  Malabsorption  Alcoholism Chvostek sign Trousseau sign Increased DTRs Dysrhythmias IV calcium chloride (if Assessment emergent) Medication administration Calcium gluconate Teach about weight-bearing Oral calcium / Vit D exercises REMEMBER Labs – Calcium, Mg, Teach about foods high in Safety / risk for calcium fall Phos, Vit D Seizure precautions Calcium Hypercalcemia – Ca > 11 Manifestatio Possible ns Muscle weakness Causes  Hyperparathyroidism  Renal failure Fatigue  Malignancies  Excess Vit D GI manifestations  Lack of weight Decreased muscle bearing  Medications  Immobilization  Hypophosphatemia tone Dysrhythmias Bone pain Kidney stones Depression Phosphates Assessment Biphosphonates Encourage ambulation Calcitonin Increase fluids / monitor UO REMEMBER Labs (Ionized calcium Teach about fiber Monitor level) Teach about limitation of Cardiac Isotonic solution Encourage fluids foods high in calcium Check current meds & ambulation