AM - GALEN 170 EXAM 1
(PERIOPERATIVE, COMFORT, ANEMIA)
20-30 (FLUID & ELECTROLYTES, ACID
BASE) 20-30 COMPLETE DETAILED
CASE STUDY
y Best indicator for fluid volume overload? - Weight
Assessment for FVO - - Bounding + increase pulse
- High BP
- Dyspnea, crackles, edema
- Decreased hematocrit, serum sodium, and urine specific gravity
Causes of FVO - - ESRD, CHF, water intoxication, SIADH, corticosteroid therapy, rapid fluid replacement
Treatment for FVO - - Diuretics
- Fluid Restriction
- Salt restriction
- Monitor I&O's
intracellular fluid - fluid within cells; 66%; 25 L
Extracellular fluid - - Fluid outside the cell; 33%; 15L
- Most important for homeostasis
Homeostasis - - Proper functioning of all body systems
,- Extracellular (intravascular and interstitial fluid)
Fluid balance - - 2 to 3 liters a day
- urine output 400-600 ml per day
- increases during stress, fever and tachy
Fluid Volume Deficit (FVD) (dehydration) - - Increased HR; decreased B/P
- Lethargy; decreased UOP; dry mucous membranes; constipation; thirst
- Increased hemoconcentration; BUN; sodium; urine specific gravity
Causes of FVD - vomiting, diarrhea, ileostomy, laxitives, burns, fever, diuretics, GI suctioning and NPO
Interventions of FVD - - Halt OTC
- Outdoor activity
- Weight gain/loss
- Diet habits
BUN and Creatinine are? - Kidney markers and are sensitive to decreased blood flow.
Normal BUN levels - 10-20 mg/dL
Normal creatinine levels - 0.6-1.2
BUN and creatinine rise when - - Nitrogenous wastes are found in the blood indicating kidney
impairment.
- Also dehydration
Hypernatremia - - Due to sodium loss, water gain, or inadequate intake
- Diuretics, Anticonvulsants, SSRI's
, - Water Gain: CHF, SIADH, polydipsia
- Dehydration
- Common: Restlessness or agitation, anorexia, N/V, weakness, lethargy, confusion, crave water
- Worst case scenario: Decreased LOC, seizures, coma
- Treatment: Fluids! PO/IV; what type of IVF?- - Nursing implications: Frequent VS, Monitor neurologic
status, Seizure/fall precautions, strict I/O's, assess skin/MM, oral care, monitor labs
Hypokalemia - - Not enough in: Inadequate K+ intake
- Too much out: GI fluid losses
- Depleting drugs: Diuretics, corticosteroids, insulin, excessive laxative use, albuterol
- Black licorice?
- Common: Cardiac arrhythmias, leg cramps (hallmark), muscle weakness, decreased GI motility
(decreased BS, constipation, N/V), decreased DTR's, muscle weakness, alkalosis
- Worst case scenario: Life threatening cardiac arrhythmias/Cardiac arrest!
- **Hypokalemia may potentiate dig toxicity**
- Treatment: Increase dietary intake of potassium, K supplementation. Give IV potassium SLOWLY!!!
- Nursing implications: Frequent VS, cardiac monitoring, patent IV, monitor labs (recheck after
supplementation), NEVER give potassium IVP or bolus!
Hyperkalemia - - Too much intake: Increased dietary intake, salt substitutes, potassium supplements
- Donated blood
- Drugs: K-sparing diuretics, -- ACE-I's, ARBS, NSAIDS
- Not enough excreted: Renal failure
- Crush injury: Intracellular K released
- Common: Cardiac arrhythmias, Muscle weakness (which may lead to flaccid paralysis), increased GI
motility, decreased DTR's, acidosis
- Worst case scenario: Life threatening cardiac arrhythmias/cardiac arrest
- Treatment: Potassium restricted diet; if critical/symptomatic will require drug therapy (such as?)
- Nursing implications: Cardiac monitoring, frequent labs, VS, monitor for hypoglycemia if insulin IVP
given