Chapter 10 Fluid & Electrolytes Page 233 Hypovolemia How can it develop? Clinical Manifestations : Assessment Findings Lab studies findings Table 10-4 Fluid Volume Disturbances Imbalance Fluid volume deficit ( hypovolemia ) Contributing factors Signs/symptoms Laboratory findings Chapter 10 Fluid & Electrolytes Fluid volume excess (hypervolemia) Medical management for fluid volume deficit : If not severe – how are fluids given If severe how are fluids given What type of fluids are given ? What is assessed? What to do if patient is oliguric? Nursing Management How does the nurse assess for FVD? Chapter 10 Fluid & Electrolytes Quality & Safety Nursing The nurse observes for a week rapid and orthostatic hypotension ( a decrease in SBP exceeding 20mmHg when the patient moves from lying to sitting . It is useful to monitor daily body weight when monitoring fluid volume ; an acute loss of 0.5 kg (1.1 lb) represents a fluid loss of approximately 500mL. one liter (100mL) of fluid weighs approximately 1 kg, or 2.2 lb. A weight loss or gain of 1-2 lb/day is mainly to water loss or gain . How can it be prevented ? Hypervolemia Causes Clinical Manifestations Assessment Diagnostic findings Medical management Chapter 10 Fluid & Electrolytes Pharmacologic therapy What is used if sodium restriction is not enough? Dialysis Nutritional Therapy Nursing management What is assessed? What is monitored ? Quality & Safety Nursing Alert An acute weight gain of 1 kg ( 2.2lb) is equivalent to a gain of approximately 1 L of fluid. How can you prevent hypervolemia? Electrolyte Imbalances Sodium Normal range : Table 10-6 sodium imbalances Imbalance Contributing factors Sodium deficit Hyponatremia <135 Signs/symptoms Lab findings Chapter 10 Fluid & Electrolytes Sodium excess Hypernatremia >145 What is the medical management for hyponatremia ? page 240 Sodium replacement Water restriction Quality & safety nursing alert In patients with hyponatremia , highly hypertonic sodium’s solutions (2-23% sodium chloride ) should be administered slowly . the patient needs close monitoring , because only small volumes are needed to elevate the serum sodium concentration , Pharmacologic therapy nursing management Chapter 10 Fluid & Electrolytes What does the nurse monitor Note the importance early detect issues ( page 241) Quality & safety nursing alert When administering fluids to patients with cardiovascular disease, the nurse assesses for hemodynamic signs of circulatory overload ( example- cough, dyspnea, JVD, dependent edema , 1-2 lb. weight gain in 24 hours ) the lungs should be auscultated for crackles as this can indicate pulmonary edema . Your patient is on Lithium – what do you need to do ? Hypernatremia Medical management nursing management How to prevent hypernatremia ? How to correct hypernatremia ? Potassium imbalances Table 10-7 Imbalance Potassium deficit Hypokalemia Serum K < 3.5 Contributing factors Signs/ symptoms Medical management Nursing management Chapter 10 Fluid & Electrolytes Potassium excess Hyperkalemia Serum potassium >5.0 Quality & safety nursing alert Hypokalemia increases sensitivity to digitalis , predisposing the patient to digitalis toxicity at lower digitalis levels . Orla potassium supplements can produce small bowel lesions ; therefore , the patient must be assessed for and cautioned about abdominal distention , pain , or GI bleeding . Page 245 Administering IV potassium Quality & safety nursing alert Potassium is never given IV push or intramuscularly to avoid preplacing potassium too quickly . potassium is extremely irritating to tissues. IV potassium must be given using an infusion pump. Hyperkalemia Quality & safety Nursing alert Potassium supplements are extremely dangerous for patients who have impaired renal function and thus decreased ability to excrete potassium. Even more dangerous is the IV administration of potassium to such patients , because serum levels can rise quickly. It is possible to exceed the Chapter 10 Fluid & Electrolytes renal tolerance of any patient with rapid IV potassium administration , as well as when large amount of oral potassium supplements are ingested. what is the emergency pharmacologic therapy for hyperkalemia ? Calcium Imbalances Table 10-8 Imbalance Contributing factors Calcium deficit Hypocalcemia <8.8 Calcium excess Hypercalcemia >10.4 Signs/symptoms and lab findings Medical management Nursing management Chapter 10 Fluid & Electrolytes Quality & safety Nursing alert Page 249 Too rapid IV administration of calcium can cause _________________________, preceded by ___________________. Therefore , ________________________________________________ Magnesium Imbalances Table 10-9 Imbalance Magnesium deficit Hypomagnesemia Serum magnesium < 1.8 Magnesium excess Hypermagnesemia >2.6 Contributing factors Signs/symptoms Medical management Nursing management Chapter 10 Fluid & Electrolytes Page 253 Quality & safety Nursing alert Phosphorus Imbalances Imbalances Contributing factors Phosphorus deficit Hypophosphatemia Serum phosphorus <2.7 Phosphorus excess Hyperphosphatemia Serum phosphorus >4.5 Signs/symptoms Medical management Nursing management Chapter 10 Fluid & Electrolytes Chloride imbalances Table 10-11 page 257 Imbalance Contributing factors Chloride deficit Hypochloremia Serum chloride <96 Chloride excess Hyperchloremia Serum chloride >108 Signs/symptoms Medical management Nursing management Chapter 10 Fluid & Electrolytes DO NOT READ ACID BASE DISTURBANCES MANAGING SYSTEMIC COMPLCATIONS OF IV THERPAHY PAGE 266 FLIUD OVELLOAD AIR EMBOLISM INFECTION MANAGING LOCAL COMPLICATIONS Phlebitis Infiltration and extravasation Thrombophlebitis Hematoma Clotting and obstruction
