Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 6 Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances

Understanding Medical Surgical Nursing, 4th Edition Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Fluid Balance  Intracellular Fluid  Extracellular Fluid  Interstitial Fluid  Intravascular Fluid  Transcellular Fluid

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Control of Fluid Balance  Pressure Sensors  Antidiuretic Hormone

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Movement of Fluids and Electrolytes  Active Transport  Passive Transport  Diffusion  Filtration  Osmosis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Tonicity  Isotonic  Hypertonic  Hypotonic

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Fluid Gains and Losses  Gains  Food  Fluid  Losses  Sensible  Insensible

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Fluid Imbalances  Dehydration  Hypovolemia  Fluid Overload

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Dehydration Signs and Symptoms  Thirst  Rapid, Weak Pulse  Low Blood Pressure  Dry Skin and Mucous Membranes  Skin Tenting  Decreased Urine Output  Increased Temperature

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Deficient Fluid Volume  Monitor Daily Weight  Monitor Intake and Output  Increase Fluid Intake  Treat Underlying Cause  Use CAUTION with Elderly Patients

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Fluid Excess Signs and Symptoms  Bounding Pulse  Elevated Blood Pressure  Respiratory Changes  Edema  Increased Urine Output  Weight Gain  Heart Failure

Understanding Medical Surgical Nursing, 4th Edition Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Interventions for Excess Fluid Volume  Monitor Weight and Urine Output  Place in Fowler’s Position  Administer Oxygen  Administer Diuretics  Restrict Fluid and Sodium

Understanding Medical Surgical Nursing, 4th Edition Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Electrolytes  Cations +  Anions -

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Sodium Imbalances  Hyponatremia  Hypernatremia

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Food Sources of Sodium  Pizza  Canned Vegetables  Canned Soups  Salty Snacks  Prepared Foods

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hyponatremia Signs and Symptoms  Sodium <135 mEq/L  Fluid Excess or Deficit  Mental Status Changes  Weakness  Nausea and Vomiting

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Hyponatremia  Monitor Intake and Output  Monitor Weight  Restrict Fluids  Administer Diuretics/Steroids

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypernatremia Signs and Symptoms  Sodium >145 mEq/L  Thirst  Mental Status Changes  Seizures  Muscle Weakness  Respiratory Compromise

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Hypernatremia  Treat Fluid Imbalance First  Monitor Intake and Output  Monitor Weight  Administer Diuretics  Restrict Dietary Sodium  Treat Cause

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Potassium Imbalances  Hypokalemia  Hyperkalemia

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Food Sources of Potassium  Sweet Potato  Beet Greens  Potato  Yogurt  Prune Juice  Soybeans  Bananas

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypokalemia Signs and Symptoms  K+ <3.5 mEq/L  Muscle Weakness  Shallow Respirations  Mental Status Changes  Cardiac Dysrhythmia and Arrest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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 © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hyperkalemia Signs and Symptoms  K+ >5 mEq/L  Muscle Twitching and Cramps  Later Muscle Weakness  Diarrhea  Low Blood Pressure  Cardiac Dysrhythmia and Arrest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Hyperkalemia  Limit Dietary Potassium  Hold Potassium Supplements  Administer Medications as Ordered  Potassium-losing Diuretic  Kayexalate  Insulin with Glucose

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Calcium Imbalances  Hypocalcemia  Hypercalcemia

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Food Sources of Calcium  Fortified Cereals  Canned Salmon  Spinach  Yogurt  Cheese  Milk

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypocalcemia Signs and Symptoms  Ca++ <9 mg/dL or 4.5 mEq/L  Mental Status Changes  Hyperactive Deep Tendon Reflexes  Diarrhea  Cardiac Dysrhythmia and Arrest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypocalcemia Signs and Symptoms (cont’d)

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Hypocalcemia  Treat Cause  Increase Dietary Calcium  Administer Medications as Ordered  IV Calcium Gluconate  PO Calcium Supplements  Aluminum Hydroxide to Bind Phosphate

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypercalcemia Signs and Symptoms  Ca++ >11 mg/dL or 5.5 mEq/L  Increased Heart Rate and Blood Pressure  Skeletal Muscle Weakness  Decreased GI Motility  Decreased Blood Clotting

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Hypercalcemia  Administer Fluids  Administer Medications as Ordered  Furosemide (Lasix)  Pamidronate (Aredia)  Zoledronic Acid (Zometa)  Calcitonin  Hemodialysis

Understanding Medical Surgical Nursing, 4th Edition Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Magnesium Imbalances  Hypomagnesemia  Hypermagnesemia

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypomagnesemia Signs and Symptoms  Mg++ <1.5 mEq/L  Positive Trousseau’s Sign  Positive Chvostek’s Sign  Cardiac Dysrhythmia and Arrest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Hypomagnesemia  Treat Underlying Cause  Administer Magnesium Replacement

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypermagnesemia Signs and Symptoms  Mg++ >2.5 mEq/L  Hypotension  Lethargy  Skeletal Muscle Weakness  Respiratory Failure  Cardiac Dysrhythmia and Arrest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Interventions for Hypermagnesemia  Administer IV Fluids  Administer Medications as Ordered  Loop Diuretics (Furosemide)  Dialysis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acid-Base Balance  Acid: Substance that Releases a Hydrogen Ion  Base (Alkali): Substance that Binds Hydrogen  Normal pH 7.35–7.45

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acid-Base Control  Cellular Buffers  Lungs  Kidneys

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acid-Base Imbalances  Acidosis  Respiratory  Metabolic  Alkalosis  Respiratory  Metabolic

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Arterial Blood Gas Values pHp CO 2 H CO 3 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition NCLEX QUESTION #1  A nurse is reading the physician’s progress notes in the client’s record and sees that the physician has documented “insensible fluid loss of approximately 800mL daily.” The nurse understands that this type of loss can occur through:  A. The skinC. Wound drainage  B. Urinary outputD. The GI tract

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Answer NCLEX Question #1  A (SKIN)

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition NCLEX QUESTION #2  A nurse is instructing a client on how to decrease the intake of potassium in the diet. The nurse tells the client that which food contains the least amount of potassium?  A. LettuceC. Apricots  B. PotatoesD. Avocados

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Answer NCLEX question #2  A (LETTUCE)