1. Linda S. Williams / Paula D. Hopper Copyright © 2011. F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 6 Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances

2. Understanding Medical Surgical Nursing, 4th Edition Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Fluid Balance  Intracellular Fluid  Extracellular Fluid  Interstitial Fluid  Intravascular Fluid  Transcellular Fluid

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Control of Fluid Balance  Pressure Sensors  Antidiuretic Hormone

4. Copyright © 2011. 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

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Tonicity  Isotonic  Hypertonic  Hypotonic

6. Copyright © 2011. 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

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Fluid Imbalances  Dehydration  Hypovolemia  Fluid Overload

8. Copyright © 2011. 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

9. Copyright © 2011. 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

10. Copyright © 2011. 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

11. Understanding Medical Surgical Nursing, 4th Edition Copyright © 2011. 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

12. Understanding Medical Surgical Nursing, 4th Edition Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Electrolytes  Cations +  Anions -

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Sodium Imbalances  Hyponatremia  Hypernatremia

14. Copyright © 2011. 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

15. Copyright © 2011. 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

16. Copyright © 2011. 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

17. Copyright © 2011. 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

18. Copyright © 2011. 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

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Potassium Imbalances  Hypokalemia  Hyperkalemia

20. Copyright © 2011. 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

21. Copyright © 2011. 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

22. Copyright © 2011. 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

23. Copyright © 2011. 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

24. Copyright © 2011. 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

25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Calcium Imbalances  Hypocalcemia  Hypercalcemia

26. Copyright © 2011. 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

27. Copyright © 2011. 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

28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypocalcemia Signs and Symptoms (cont’d)

29. Copyright © 2011. 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

30. Copyright © 2011. 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

31. Copyright © 2011. 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

32. Understanding Medical Surgical Nursing, 4th Edition Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Magnesium Imbalances  Hypomagnesemia  Hypermagnesemia

33. Copyright © 2011. 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

34. Copyright © 2011. 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

35. Copyright © 2011. 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

36. Copyright © 2011. 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

37. Copyright © 2011. 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

38. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acid-Base Control  Cellular Buffers  Lungs  Kidneys

39. Copyright © 2011. 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

40. Copyright © 2011. 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