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Ch. 12 Fluid & Electrolytes
Terms in this set (37)
What is the minimum amount of urine per day needed to excrete toxic waste products?
In a healthy adult, how much water loss is insensible water loss?
How much does 1L of water weight?
1 kg (2.2 lbs)
What is isotonic dehydration?
Water & electrolytes are lost in equal proportions.
What is hypertonic dehydration?
Water loss is greater than electrolyte loss.
What is hypotonic dehydration?
Electrolyte loss is greater than water loss.
What kind of solution will you use to treat hypertonic dehydration?
Hypotonic solution. Hypertonic dehydration causes hypernatremia, the cells are dehydrated. The hypotonic solution will shift fluid out of vessels and back into cells.
What kind of solution will you use to treat hypotonic dehydration?
Hypertonic solution. Hypotonic dehdration causes hyponatremia, the cells are swollen with water. The hypertonic solution shifts water out of cells and back into circulation.
Clinical manifestations of dehydration
Tachycardia, poor skin turgor, dry skin/mucous membranes, decreased blood pressure, vasoconstriction, orthostatic hypotension, urine specific gravity greater than 1.030.
Nursing interventions for dehydration
Fluid replacement, fall prevention, monitor pulse rate, observe for fluid overload, monitor I&O and urine quality, control the causes of dehydration, offer fluids hourly.
Patient teaching for dehydration
Increase fluids, do not double your dose of diuretics, recognize early signs & symptoms.
Causes for dehydration
Diuretics, vomiting & diarrhea, laxatives, polyuria (diabetes), burns, severe wounds
Clinical manifestations of fluid overload
Pulmonary edema, increased blood pressure, increased respirations, moist crackles. SOB, decreased Na+ and K+ levels, distended neck/hand veins, urine specific gravity below 1.005
Nursing interventions for fluid overload
Loop diuretics (Lasix), turn every 2 hours, monitor I&O, daily weight, pressure reducing devices, no added salt
Patient teaching for fluid overload
2-4 g/day of sodium, daily weights, monitor I&O
Causes for fluid overload
SIADH, CHF, kidney failure, increased fluid intake
Urine specific gravity
Clinical manifestations of Hypokalemia
Muscle weakness, respiratory insufficiency, confusion, irritability, anxiety, alkalosis
Nursing interventions for hypokalemia
*ASSESS respirations, K+ replacement PO or IV. Never IM or SubQ. Never rapid push. Must be diluted 1 mEq/L to 10 mL by pharmacist. 5-10 mEq/hr, never to exceed 20. Discontine K+ wasting diuretics, fall precautions,
Causes for hypokalemia
Diarrhea & vomiting, Cushing's syndrome, inappropriate use of diuretics, digitalis and corticosteroids, alkalosis, TPN, NG suctioning, increased secretion of aldosterone
Clinical manifestations of hyperkalemia
Muscle weakness, oliguria, decreased contractility, bradycardia, hypotension, ventricular fibrillation, flaccid paralysis
Nursing interventions for hyperkalemia
*Monitor HEART RATE, eliminate extra K+ by administering thiazide & loop diuretics. Kayexalate may also be administered to patient's with kidney problems, fall precautions, compare ECG's.
Causes of hyperkalemia
Acidosis, potassium-sparing diuretics, kidney failure, transfusions of whole blood, over-ingestion of potassium.
Clinical manifestations of hypocalcemia
Positive Trousseau's & Chvostek's signs, tetany, hypotension, diarrhea, tingling and numbness
Nursing interventions for hypocalcemia
Calcium supplements, high calcium diet, fracture prevention (pt. may have brittle bones), reduce stimulation
Causes of hypocalcemia
Inadequate oral intake of calcium and/or vitamin D, lactose intolerance, malabsorption syndromes, diarrhea, alkalosis
Clinical manifestations of hypercalcemia
Confused & lethargic, severe muscle weakness, increased blood pressure & heart rate, constipation, blood clotting
Nursing interventions for hypercalcemia
Preventing increase in calcium, fluid replacement (0.9% NS), high-ceiling loop diuretics
Clinical manifestations in hypophosphatemia
Weak contractility, decreased stroke volume, decreased cardiac output, muscle weakness, irritability followed by coma. Hypercalcemia problems also occur.
Nursing interventions for hypophosphatemia
Increase phosphorous rich foods, oral replacement of phosphorous & vitamin D. IV phosphorus is given when levels fall below 1 mg/dL
Clinical manifestations in hyperphosphatemia
Problems that occur are because of hypocalcemia. Management of hyperphosphatemia is the same for hypocalcemia.
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