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1. Who is at risk for inadequate fluid intake?
2. A client can go several weeks to months without food but how long can you go with out water?
A. 0.9% NaCl
B. 3% NaCl
C. 5% Dextrose in water (D5W)
D. 5% Dextrose in 0.225% NaCl
Watch KHAN video on tonicity
11.02 min long
An example of this type of imbalance is drowning.
1. Saltwater is _______ compared to the body. If its aspirated into the lungs it will draw fluid into the alveloli creating pulmonary edema, hypoxemia, hypovolemia, and hemoconcentration.
2.Freshwater is ______ compared to the body. If its aspirated into the lungs, it is absorbed into the bloodstream creating hemodilution, hypervolemia, and hemolysis.
HCT – blood concentration; HIGH in a deficit
Hgb – amount of oxygenated blood the body has
BUN – Norm - high in a deficit ;Tests kidney funtion If urea cant be removed from the blood normally, BUN ↑. HF, dehydration, ↑ in protein also ↑ BUN. Liver disease/damage can ↓ BUN.
Urine specific gravity – HIGH in deficit >1.030; - Normal value is 1.005-1.030.
Serum sodium, glucose – high
Fluids can only be replaced orally if the deficit is mild, thirst is intact and they can drink
*Adult 40kg/more needs at least 30mL/kg/day of free liquid intake (Gatorade/pedialyte & freezer pops;for fluid & electrolyte replacement)
*Avoid fruit juice & sodas (sugar) salt & caffeine. Too much solute can promote diarrhea
*BRAT or BRATTY diets (Bananas, rice, applesauce, toast, tea, yogurt) shortens the duration of GE
*MILK is not a good fluid replacement
Isotonic IV: isotonic deficit, replace with fluid that has the same concentration of solute to particles as another solution (blood transfusions)
*Cells surrounded by NS remain unchanged*
Hypotonic IV: a hypertonic deficit, add more water (a solution that is hypotonic) fluid will move out of the cell, so the cells shrink; shock, hydration, DKA
Hypertonic IV: When you have a hypotonic deficit, add more solute (a solution that is hypertonic) cell will swell for cell hydration
3. Monitor client during therapy...
4. Promote return to adequate oral intake.... explain HOW
3.VS- (resp. rate + overhydration can cause rales & rhonchi), change in mental status, I/O, change in urine concentration, daily weight, IV infusion rate especially with those who are prone to overload (infants, elderly, cardiac or renal dysfunction)
Treating the Cause .... GIVE SOME EXAMPLES
Hemorrhage↓ in fluid intakeExcessive GI lossExcessive diuresis
When someone is in shock they are past the point of dehydration, they are nearing code status, and they need to be treated Immediately!
Causes: Blood loss could be from trauma, ruptured ectopic pregnancy, placenta previa or abruption (massive bleeding); may not be immediately obvious (internal)
Vomiting, diarrhea, excessive NG drainage, draining wounds, and diaphoresis
1. What does blood do when shock occurs?
2. What will be the first organ to shut down?
3. Biggest SIGN a pt is going into shock?
4. What will the bodies extremities feel like?
5. What happens to the cap refill time?
1. In shock the body is going to send ALL its blood to ALL vital organs. Brain, heart, lungs & kidneys.
2. The Kidneys will shut down first; renal failure
3. Little to NO output (OUOP <30 mL/hr)
4. Cold extremities
5. increased cap refill time < 3 sec
LethargyTachycardiaCRT >3 sec.Hypotension1. Hypotension is a late sign.What will you see first?
1. Hypotension is a late sign. Orthostatics will appear first.
Equal amounts of solute and fluid are gained
1. Explain & Name some causes?
1. Isotonic Most common type of excess, b/c of ORGAN FAILURES fluid is gained in the ECF but ICF remains norm. Fluid & solute (primarily NA) are gained in=amts. Swelling & edema in tissue
Renal failure – kidneys cannot excrete properly
Heart failure – cannot pump it out (blood stasis)
Excess intake - IV fluids
Stress response;surgical pt., body increases aldosterone & retains fluid
More fluid is gained than solute
1. What is another name? Explain & causes?
2. Hypotonic also called "water intoxication"
cells will swell & burst; H2O dilutes electrolytes in the blood causing fluids to shift into the cells
Repeated Irrigation (enemas,NG tube, bladder)
Overuse of hypotonic IV fluids or infusing to fast
SIADH – Syndrome of Inappropriate Antidiuretic Hormone (opposite of Diabetes Insipidus)chronic disease states such as heart and kidney have trouble handling excess fluid administration
1. Why is age a risk factor for FVE?
2. Why does surgery put a pt at risk FVE?
3. Why does Cardio Vasc. disease put a pt at risk for FVE?
1.Edema follows gravity. Also be seen around the eyes.
2.soft spot on babies head bulged
3. r/t lungs may cause high BP; Low Pulse Ox
4. FVE in the lungs;Wet congestive cough
5. JVD when head of bed is elevated to 45•/higher,
6. Weight gain of 3 lbs./ more over 2 to 5 days
7. Polyuria; homeostasis by ↑ urine output
3.CXR: fluid building up in the lungs (pleural effusions) Will sound very wet
*ONLY TIME THIS WOULD NOT APPLY is if there are renal or heart failures !
1. r/t excessive fluid or sodium intake and/or retention
2. r/t hypervolemia
3. r/t signs & symptoms of fluid excess
4. r/t edema
5. r/t risk factors & therapeutic interventions
2. Fluid restrictions /weigh daily at the same time
3. May be limited to 1000-1500 cc/day. Includes med administration! Mouth care to ↓ thirst, ice counts as fluid. Cold fluids b/c Hot ↑ thirst!!
4. mild (4-5gm), mod (2gms/day) NA follows water !
5. Saline lock; monitor s/s of fluid overload q 2 hr
6. measure I/O -Loop;Lasix (furosemide), K+ sparing Aldactone (spirinolactone), & thiazide (Diuril)
7. Natrecor helps pull fluids off pts w/ CHF
What else is important to monitor for with FVE ....
1. Pt with FVE & edema are at risk for what? Name some preventions?
2. If pulmonary edema / HF are problems & there are moist crackles on auscultation & condition is worsening... what 2 things should you watch for?
3. What is a LATE sign that is BAD?
*Nerve impulse conduction
*Makes protein using amino acids
*Electroconductivity of heart
*Muscle contraction – skeletal, cardiac and smooth
*Higher in the ICF (in cells) than ECF (outside cells)
Everything SLOWS down
*Thready weak pulse ; HR and rythym will be irregular skipping beats ; could be tachycardic to make up for slow HR
*Constipation/Ileus .... SLOW itestinal Motility
*Why can this be life threatening?
Diet ... explain
Oral (3.0-3.5 mEq/L) Supplement1. There are pills and liquid ... What should you ALWAYS do to the liquid K+?
IV is always diluted bc it will FRY their veins
IV sites need changed every couple of days bc it burns their veins even after diluted2. Never give potassium supplements via route these 3 routes?
Eat bananas and other food that contain K+
STAY AWAY FROM BLACK LIQUIRICE
1. Excessive intake... explain2. Decreased excretion...explain3. Massive tissue trauma...explain“Relative” YOU DIDN’T DO ANYTHING TO CAUSE IT – secondary conditionMetabolic acidosisGI bleedDigoxin use (used to treat CHF & slow HR)OverdoseInsulin deficiency
If K+ is greater than 6.0 that is an EMERGENCY !!!!
In this situation EVERYTHING speeds ↑ ….
*Muscles twitch, cramp … & can develop paralysis
*Heart EKG changes
*Diarrhea bc of acessive abdominal activity
Risk for InjuryRisk for Decreased Cardiac OutputAltered NutritionDiarrhea
Dietary intakeMedication therapy
Dietary intake (MILD)
* 5-5.1 level … ask about SALT subs & canned foods
Oral – MILD - can be oral but most commonly given as an enema; Kayexalte ; it exchanges sodium for K+ & excretes in stool ; looks very tarry and gets everywhere
Parenteral 6.5 emergency
Calcium Gluconate – given in code situations bc it makes the K+ mad antagonizes it and stops what it should be doing. Very short term to save the heart dysrhythmia then follow up with regular insulin via IV will cause K+ to shift back into the cell (still short term) or Sodium BiCarb will also shift K+ back into the cell … then a diuretic (long term) you have got to excrete it (pee it out). Lasix (LOOP) diuretic is most common
What does CALCIUM (Ca++) do ?
*Cardiac muscle contraction
*Nerve impulse transmission
1. Calcium Loss –
it is stored but still needs to be replaced
Phosphorus works opposite of calcium
Low calcium – high phosphorus and vice versa
secondary to renal failure ; renal increase phosphorus so there will be a decrease in Ca++
*Transfusions … citrate in blood bags … binds to calcium & makes it inactive … people who are anemic / trauma pt & have had a lot of transfusions are low in Ca++ b/c citrate binds to the Ca++ depleting it
How do you know someone is HYPOcalcemic? Everything speeds up (opposite of HYPOkalemia K+)
*Trousseaus – While taking BP the hand will have a palmer spasm
*Chvostek sign – tap on facial nerve just in front of the ear their face will twitch (like a tic)
*Increased deep tendon reflexes (hyperactive)
Cardiovascular – irregular HR and pulse could go into cardiac arrest
Respiratory- lorengio spasm – airway closes off …
Renal – failures
GI – diarreahea
Musculoskeletal – complaints of bone pain/hurt and may have bone fractures due to loss of the minerals
Bleeding AND bruising
Brittle hair and nails
Have had their thyroid removed … the parathyroid activates calcitonin and vitD. THYROID ectomy pts need to watched carefully bc it can cause lorengi spasm
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