WK 3 Fluid and Lytes, Student PDF

NUPD 701: Module 3 Fluid & Electrolytes Empirical Way of Knowing  Discuss Discuss the composition and indications of common intravenous fluid solutions. Apply Apply the nursing process Respiratory acidosis...

NUPD 701: Module 3 Fluid & Electrolytes Empirical Way of Knowing  Discuss Discuss the composition and indications of common intravenous fluid solutions. Apply Apply the nursing process Respiratory acidosis to a patient with the Respiratory alkalosis following: Metabolic acidosis Metabolic alkalosis Discuss Discuss and apply the hypo/hypervolemia (hypovolemic Objective shock), clinical manifestations, and nursing and collaborative hypo/hypernatremia apply management of the hypo/hyperkalemia following: s Explore Explore how empirical knowing influences nurses and nursing practice. Apply Apply empirical pattern of knowing to fluid/electrolyte & acid base imbalance Reflect Reflect and explore your personal values and beliefs and in relation to the explore metalanguage (metaparadigms) of nursing. Fluid & Electrolytes Review  Osmolality The normal osmolality for plasma and other body fluids is 270 to 300 mOsm/L. tinicty or amount of solute in fluid Increased Osmolality means = more solutes than fluid Dehydrations, less fluid Elevated NA levels Decreased urine output Decreased osmolality means = more fluid than solutes Edema Cardiac irregularities Hyponatremia Decreased LOC , seziures, increase in ICP What is Osmosis – movement of water to move from an area of high concentration to an area of low concentration to make equilibrium. Fluids & Electrolytes How do we know where the water or fluid is needed - Lab values ( NA, K+, serum osmolaility) - Vital signs Know: What IV fluid is required, indication, volume, rate & duration What complications may occur- effects on body, adverse reactions.  Intravenous fluid replacement solutions fall into tow broad categories Crystalloids (isotonic, hypotonic, Types of hypertonic) These solutions flow easily from inside the bloodstream to cells and tissues Fluid Colloids (always hypertonic) Expands intravascular volume, draw Solutions fluid from interstitial to intravascular Increase circulatory volume without doing it quickly Examples: albumin, plasma, protein fraction and whole blood Composition & Indication Crystalloids: Isotonic: same osmolality as plasma; replaces extracellular fluid 0.9 NaCl, D5W, Ringer’s lactate (electrolyes, surgery and burnt patients) Hypotonic: correct cellular dehydration & hypernatremia; maintain daily fluid requirements 0.45 NaCl, 0.2nacl, 0.33nacl, 2.5%dextrose Problem with use: hypotension, increased ICP, 3 rd spacing ( pressure, headache) Circulating volume goes down Uses: dilute sodium in blood (hypernatremia) Hypertonic: pull water back into circulation; severe hyponatremia 3% NaCl, 5%NaCl, D5W/0.45%nacl, D5W/0.9%NaCl Problem with use: bring up blood pressure, monitor electrolytes, monitor patients co morbities ( lead to CHF) Colloids: Expand intravascular volume, draw fluid from interstitial intravascular Albumin, Dextran Know what you are hanging  Isotonic Solutions Isotonic Solutions have same osmolality as plasma & are administered to increase Extracellular Fluid Volume due to dehydration, blood loss, and surgery 9% Normal Saline NaCl: mixture of salt and water Contains the electrolytes sodium and chloride Lactated Ringers Contains the electrolyte sodium, potassium, calcium, and chloride Contains Lactate which is converted to sodium bicarbonate by the liver 5% Dextrose in Water (D5W) while inside the bag Dextrose metabolizes quickly. The body metabolizes the glucose molecules and acts like a hypotonic solution leaving water behind Wont stay in a vascular space  Hypotonic Solutions Hypotonic solutions have fewer dissolved particles (such as e-lytes) than found inside the cell Hypotonic solutions are given cautiously because fluid moves from the extracellular space into the cells causing swelling Hippo – large and swollen Hypotonic sol’s cells will swell Hypotonic Solutions.45% Normal Saline (1/2 NS).25% Normal Saline (1/4 NS).33 % Normal Saline (1/3 NS) Hypotonic solutions are administered when cells are dehydrated and fluids are needed for intracellular spaces Hypernatremia Diabetic Ketoacidosis HHS – Hyperosmolar hyperglycemic state Contraindications for Hypotonic Solution Increased Intracranial Pressure (ICP) from fluid shifting in the brain Change in level of consciousness, motor sensory deficits, and changes in the size/shape/response to light of pupils Liver disease, burn, or trauma patients Patients already suffering from abnormal fluid shifts into the interstitial space or the body cavities (hypervolemia) Hypertonic Solutions Hypertonic solutions have more dissolved particles than what is found inside the cell Draws fluid out of the intracellular space causing the cell to shrink and the extracellular space to expand Cells exposed to hypertonic solutions tend to shrink in its presence (think of a lean runner) Some Hypertonic Solutions: 3%NS; 5% NS; 10% Dextrose (D10W); Hypertonic Solutions Indications and Contraindications Indications: Contraindications: Heat related disorders Cardiac and renal disease Hypotonic dehydration Patient at risk for cellular Fresh water drowning dehydrations (DKA)  Do you know what is hanging and why? 0.9% Na Cl? > 250 mOsm/L (more water than solute) Action: expands extracellular fluid space (plasma), electrolyte replacement (sodium and chloride) Nursing Considerations: May cause fluid overload generalized edema hemodilution electrolyte imbalance, etc.  Do you know what is hanging and why? Lactated Ringers? > 250 mOsm/L (more water than solute) Action: expands extracellular fluid space (plasma), electrolyte replacement (sodium, chloride, lactate, potassium, calcium) Nursing Considerations: May cause fluid overload, generalized edema, hemodilution, electrolyte imbalance, pro- inflammatory in large doses. IV Solutions 0.45 NaCl, D5W,? 375 mOsm/L (more solute than water) Action: Shifts fluid from intracellular to extracellular (plasma) Vascular expansion Electrolyte replacement Nursing Considerations Irritates veins May cause fluid overload, hypernatremia, hyperchloremia, etc. Sodium Imbalances typically associated with parallel changes in osmolality Plays a major role in ECF volume and concentration Generation and transmission of nerve impulses Acid-base balance Na leaves the body through urine, sweat and feces Kidneys are the primary regulator of sodium balance Hypernatremia Elevated serum sodium occurring with water loss or sodium gain Causes hyperosmolality leading to cellular dehydration *** first reponse to hypernatremia: Primary protection is thirst from hypothalamus. Can be the result of impaired level of consciousness or an inability to obtain fluids Possible Causes: Impaired LOC Produced by clinical states : Central or nephrogenic diabetes insipidus Manifestations Thirst, lethargy, agitation, seizures and coma  Hyponatremia Results from fluid excess or loss Manifestations of sodium containing fluids Confusion, nausea, vomiting, muscle spasms, seizures and coma Potassium Major ICF cation Necessary for Transmission and conduction of nerve and muscle impulses Cellular growth Maintenance of cardiac rhythms Acid-base balance Hyperkalemia High serum potassium caused by Massive intake Impaired renal excretion Shift from ICF to ECF Common complication in renal failure Certain drugs, such as potassium-sparing diuretics (e.g., spironolactone [Aldactone], triamterene [Dyrenium]) and angiotensin-converting enzyme (ACE) inhibitors (e.g., enalapril [Vasotec], lisinopril [Prinivil]), may contribute to the development of hyperkalemia Hypokalemia Low serum potassium caused by Abnormal losses of K+ via the kidneys or GI tract Metabolic alkalosis Manifestations Most serious are cardiac. Skeletal muscle weakness (legs) Weakness of respiratory muscles Decreased gastrointestinal motility Impaired regulation of arteriolar blood flow Calcium Hypercalcemia: Thirst CNS deterioration Increased interstitial fluid Hypocalcemia Tetany (muscle spasms) Muscle twitching Chvostek’s, Trousseau’s sign Empirical Way of Knowing References Edwards, S. L. (2008). Pathophysiology of acid base balance: The theory practice relationship. Intensive and Critical Care Nursing, 24, 28-40. Kim, D. (2007). IV fluids: Do you know what’s hanging and why? RN, 70 (10), 35-41.