Lecture 2a
Download
1 / 97

Lecture 2A - PowerPoint PPT Presentation


  • 95 Views
  • Uploaded on

Lecture 2A. Fluid & electrolytes (Chapter 7) Integumentary System (chapters 44-46). Homeostasis. The body’s tendency to maintain a state of physiologic balance in constantly changing conditions. Body Fluids. Volume Electrolyte composition pH.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Lecture 2A' - hyacinth-everett


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Lecture 2a

Lecture 2A

Fluid & electrolytes (Chapter 7)

Integumentary System (chapters 44-46)


Homeostasis
Homeostasis

  • The body’s tendency to maintain a state of physiologic balance in constantly changing conditions.


Body fluids
Body Fluids

  • Volume

  • Electrolyte composition

  • pH


What is the primary component of body fluid
What is the primary component of body fluid?

  • Red blood cells

  • White blood cells

  • Electrolytes (i.e. sodium, potassium, calcium, etc.)

  • Water

  • Oxygen


Water
Water

  • 60% of body weight is water

  • Elderly 

  • 45 – 50% of body weight is water


Water in out
Water in & out

  • Water intake and output should be about equal.

  • Average daily intake/output

    • 2500 mL

  • Table 7-1 pg 101


Electrolytes
Electrolytes

  • Substances that dissociate in solution to form ions.

  • Ion =

    • Electrically charged particle


Function of electrolytes
Function of Electrolytes

  • Regulate water

  • Neuro-muscular activity


Key electrolytes
Key electrolytes

  • Sodium (Na)

    • 135-145 mEq/L

  • Potassium (K+)

    • 3.5 – 5.3 mEq/L

  • Calcium (Ca)

    • 4.5 – 5.5 mEq/L

  • Magnesium (Mg)

    • 1.5 – 2.4 mEq/L

  • Chloride (Cl-)

    • 95 – 105 mEq/L


Distribution of body fluid
Distribution of Body Fluid

  • Intracellular fluid (ICF)

    • Fluid inside the cells

    • 40% of body weight

  • Extracellular fluid (ECF)

    • Outside of cells

    • 20% body fluid

    • Where?

      • Interstitial fluid

        • Between the cells

      • Intravascular fluid

        • In the blood vessels

      • Transcellular

        • Body fluids


Body fluid movement
Body Fluid Movement

  • Compartments separated by selectively permeable membranes

  • 4 ways to move

    • Osmosis

    • Diffusion

    • Filtration

    • Active transport


Osmosis
Osmosis

  • Water moves from an area of lower solute concentration to an area of higher solute concentration


Osmosis1
Osmosis

  • Water moves towards a higher solute concentration


Isotonic solution
Isotonic solution

  • Have the same concentration of solutes as plasma


Hypertonic solution
Hypertonic solution

  • Have a great concentration of solutes than plasma


Hypotonic solution
Hypotonic solution

  • Have a lower concentration of solutes than plasma


Diffusion
Diffusion

  • Solutes move from an area of high solute concentration to an area of low solute concentration


Filtration
Filtration

  • Water & Solutes move across membranes driven by fluid pressure

  • Figure 7-6 pg 104


Active transport
Active transport

  • Allows molecules to move into areas of high solute concentration but requires cellular energy

    • Adenosine triphosphate or ATP


In osmosis what moves and how
In osmosis what moves, and how?

  • Water moves from an area of high solute concentration to an area of low solute concentration

  • Water moves from an area of low solute concentration to an area of high solute concentration

  • Solutes moves from an area of high solute concentration to an area of low solute concentration

  • Solute moves from an area of low solute concentration to an area of high solute concentration


In diffusion what moves and how
In Diffusion what moves, and how?

  • Water moves from an area of high solute concentration to an area of low solute concentration

  • Water moves from an area of low solute concentration to an area of high solute concentration

  • Solutes moves from an area of high solute concentration to an area of low solute concentration

  • Solute moves from an area of low solute concentration to an area of high solute concentration


Nrs dx fluid volume deficit
Nrs. Dx: Fluid Volume Deficit

  • AKA:

    • Dehydration


Common causes of fluid volume deficit
Common Causes of Fluid Volume Deficit

  • GI fluid loss

  • Excess urine output

  • Hemorrhaging

  • Inadequate fluid intake


S s of fluid volume deficit
S&S of Fluid Volume Deficit

  • Fatigue

  • Alt. mentation

  • BP?

    • Postural hypotension

  • Pulse?

    • Tachycardia

    • Weak

  • Weight?

    • loss

  • Skin

    • Dry

    • Poor turgor

  • Urine output

    • Decreased

    • Dark


Lab test for fluid volume deficit
Lab Test for Fluid Volume Deficit

  • Serum osmolality

    • h

  • Hematocrit

    • h

  • Urine specific gravity

    • h


Nursing plan fluid volume deficit
Nursing Plan: Fluid Volume Deficit

  • I&O

    • <30 mL / hr REPORT!

  • Vital Signs

    • BP

      • i

    • Pulse rate

      • h

    • Pulse strength

      • i


Nursing plan fluid volume deficit1
Nursing Plan: Fluid Volume Deficit

  • Assess urine

    • Color

      • Dark

    • Specific gravity

      • Weight of urine compared to a drop of distilled water

      • h = FVD


Nursing plan fluid volume deficit2
Nursing Plan: Fluid Volume Deficit

  • Daily weight

    • Same…

      • Time

      • Scale

      • Clothing

    • FVD 

      • i wt


Nursing plan fluid volume deficit3
Nursing Plan: Fluid Volume Deficit

  • Assess mental status & breath sounds

  • Assess skin

    • Dry

    • Turgor

    • Warm

  • Assess mucus membranes

    • Moist


Nursing plan fluid volume deficit4
Nursing Plan: Fluid Volume Deficit

  • PUSH FLUIDS!!!

    • #1 water

    • Variety

    • Available

    • Appealing

    • Intravenous fluids (I.V.)


Nursing plan fluid volume deficit5
Nursing Plan: Fluid Volume Deficit

  • Educate

    • I&O

    • Avoid sun/heat

    • Vomiting 

      • Small frequent sips

      • Tea, ginger ale, flat cola

    • Caffeine & sugar 

      • urination

    • If diarrhea 

      • drink fruit juice or bouillon not just water


Nrs dx fluid volume excess
Nrs. Dx: Fluid Volume Excess

  • Usually due to sodium & water retention

  • AKA

    • Hypervolemia


Common causes of fluid volume excess
Common causes of Fluid Volume Excess

  • Renal failure

  • Heart failure

  • Too much water intake

  • Too much sodium intake

  • Medications


S s of fluid volume excess
S&S of Fluid Volume Excess

  • BP

    • h

    • Hypertension

  • Pulse rate

    • h

    • Tachycardia

  • Pulse strength

    • Full bounding pulse


S s of fluid volume excess1
S&S of Fluid Volume Excess

  • Respiratory

    • Rate

      • h

    • Cough

    • Dyspnea

  • Weight

    • h

  • Edema

    • Excess fluid in the body tissues


Lab tests for fluid volume excess
Lab tests for Fluid Volume Excess

  • Serum osmolarity

    • i

  • Hematocrit

    • i

  • Specific gravity of urine

    • i


Interdisciplinary care for fluid volume excess
Interdisciplinary Care for Fluid Volume Excess

  • Medications

    • Diuretics

  • Fluid restriction

    • Rx by MD

  • Sodium restriction

  • Action:

    • Increase water excretion

    • “Water pills”


Nursing plan fluid volume excess
Nursing Plan: Fluid Volume Excess

  • Baseline weight

  • Baseline vital signs

  • Monitor

    • I&O

    • VS

    • Skin turgor

    • Edema


Nursing plan fluid volume excess1
Nursing Plan: Fluid Volume Excess

  • Report

    • Dizziness

    • Orthostatic hypotension

    • Tachycardia

    • Muscle cramping


Nursing plan fluid volume excess2
Nursing Plan: Fluid Volume Excess

  • Monitor labs

    • K*

    • Glucose

    • Notify MD for abnormal


Nursing plan fluid volume excess3
Nursing Plan: Fluid Volume Excess

  • Administer meds per MD order

  • Fluid restrictions

  • Sodium restrictions


Nursing plan fluid volume excess4
Nursing Plan: Fluid Volume Excess

  • Provide

    • Oral hygiene

    • Rest

    • Elevate feet

    • Semi-fowler position


Nursing plan fluid volume excess5
Nursing Plan: Fluid Volume Excess

  • Educate (about diuretics)

    • Increase urine

    • Take in AM

    • Change position slowly

    • Weight daily

    • Decrease salt

    • h potassium

    • Report to MD


With fluid volume deficit you would expect the blood pressure to be what
With fluid Volume deficit you would expect the blood pressure to be what?

  • Increased (hypertension)

  • Decreased (hypotension)


Why are respiratory problems common with fluid volume deficit
Why are respiratory problems common with Fluid Volume deficit?

  • The blood flows to the feet

  • There is no blood to circulate the oxygen

  • Increased respiratory rate causes a decreases in effective breathing

  • It is not common with fluid volume deficit, it is common with fluid volume excess


Why are respiratory problems common with fluid volume excess
Why are respiratory problems common with Fluid Volume excess?

  • Excess fluid pools into the lungs

  • The blood does not circulate as well

  • Oxygen can not be carried in watery blood

  • Peripheral edema causes their feet to swell


Kidney failure usually leads to which of the following nursing diagnosis
Kidney failure usually leads to which of the following nursing diagnosis?

  • Fluid volume deficit

  • Fluid volume excess


Sodium imbalance
Sodium Imbalance nursing diagnosis?

  • What is the chemical sign for sodium?

    • So

    • Sa

    • S

    • N

    • Na


What is the normal serum sodium level
What is the normal serum sodium level nursing diagnosis?

  • 135 – 145 mEq/L

  • 13 – 15 mEq/L

  • 3.5 – 5.3 mEq/L

  • 35 – 45 mEq/L

  • Uh, what??


Sodium imbalance1
Sodium imbalance nursing diagnosis?

  • Sodium and fluid volume frequently go together.


Hyponatremia
Hyponatremia nursing diagnosis?

  • Low serum sodium level

    • < 135 mEq/L


Common causes of hyponatremia
Common causes of hyponatremia nursing diagnosis?

  • Water retention

    • Kidney disease

    • Heart disease

    • Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

  • Sodium loss

    • Vomiting

    • Diarrhea

    • diuretics


S s of hyponatremia
S&S of Hyponatremia nursing diagnosis?

  • Anorexia

    • N/V

    • Diarrhea

  • H/A

  • Mental changes

  • Convulsions

  • Coma


Lab tests hyponatremia
Lab Tests: hyponatremia nursing diagnosis?

  • Serum electrolyte levels

    • < 135 mEq/L


If a client has hyponatremia what do they need
If a client has hyponatremia, what do they need? nursing diagnosis?

  • More Sodium

    • Foods high in sodium

    • IV fluids

  • Less water

    • diuretics


Hypernatremia
Hypernatremia nursing diagnosis?

  • High serum sodium levels

    • > 145 mEq/L


Common causes of hypernatremia
Common Causes of Hypernatremia nursing diagnosis?

  • Water loss

    • Not drinking

    • Sweating

    • Diarrhea

    • Diabetes

  • Sodium retention

    • Tube feedings without water

    • IV with Na


S s of hypernatremia
S&S of hypernatremia nursing diagnosis?

  • Thirst

  • Alt. mental status

  • Dry mucous membranes

  • Postural hypotension

  • Skin

    • Hot, dry


Interdisciplinary care hypernatremia
Interdisciplinary Care: nursing diagnosis?Hypernatremia

  • Increase water

    • Push fluids

    • IV

    • SLOWLY!


Potassium imbalance
Potassium imbalance nursing diagnosis?

  • What is the chemical sign for potassium?

    • Pt

    • P

    • Po

    • K

    • Sa


What is the normal serum potassium level
What is the normal serum potassium level? nursing diagnosis?

  • 1.5 – 5.1 mEq/L

  • 2.5 – 5.2 mEq/L

  • 3.5 – 5.3 mEq/L

  • 4.5 – 5.4 mEq/L

  • None of the above


Lab tests for hypokalemia
Lab tests for Hypokalemia nursing diagnosis?

  • Serum electrolytes

    • K+


Hypokalemia
Hypokalemia nursing diagnosis?

  • Low potassium levels

    • < 3.5 mEq/L


Common causes of hypokalemia
Common Causes of nursing diagnosis?Hypokalemia

  • GI loss

    • Vomiting

    • Diarrhea

    • Diuretics

    • NPO


S s of hypokalemia
S&S of Hypokalemia nursing diagnosis?

  • N&V

  • Anorexia

  • Muscle weakness

  • Dysrhythmias


If a client has hypokalemia what do they need
If a client has Hypokalemia, what do they need? nursing diagnosis?

  • POTASSIUM REPLACEMENT!!

    • Potassium replacement medications


Natural sources of k
Natural sources of K nursing diagnosis?+

  • Fruits

    • Banana

    • Oranges

    • Cantaloupe

  • Vegetables

    • Carrots

    • Cauliflower

    • Potato


What is hyperkalemia
What is Hyperkalemia? nursing diagnosis?

  • Increased sodium levels

  • Decreased sodium levels

  • Increased potassium levels

  • Decreased potassium levels

  • I have no idea!


Hyperkalemia
Hyperkalemia nursing diagnosis?

  • High potassium levels

    • > 5.3 mEq/L


Common causes of hyperkalemia
Common causes of Hyperkalemia nursing diagnosis?

  • #1 Renal failure


S s of hyperkalemia
S&S of Hyperkalemia nursing diagnosis?

  • Dysrhythmias  cardiac arrest

  • N&V / diarrhea

  • Muscle weakness


Remember
REMEMBER!!! nursing diagnosis?

  • Both hypokalemia and hyperkalemia affect cardiac function and can result in serious, even fatal dysrhythmias


Lab tests hyperkalemia
Lab Tests: Hyperkalemia nursing diagnosis?

  • Serum electrolytes

    • K+

  • ECG

    • Electrocardiogram

  • Renal function

    • BUN

      • Blood Urea Nitrate


Hyperkalemia interdisciplinary care
HyperKalemia nursing diagnosis?: Interdisciplinary Care

  • Medications

    • Treat the cause

    • Loop diuretics

      • Lasix


Nursing plan at risk for injury
Nursing Plan nursing diagnosis?At risk for injury

  • Monitor

    • K+ levels

    • S&S of K+ imbalance

      • Weakness


Nursing plan decreased cardiac output
Nursing Plan: nursing diagnosis?Decreased Cardiac output

  • Monitor

    • Vital signs

    • Apical pulse

  • Place on cardiac monitor


Calcium c a
Calcium (C nursing diagnosis?a)

  • Hypocalcemia

    • Low serum calcium levels

  • Hypercalcemia

    • High serum calcium levels


Common causes of hypocalcemia
Common causes of nursing diagnosis?hYPOCALCEMIA

  • Parathyroidectomy

  • iDietary intake

  • Lack of sun exposure

  • Alcoholics


What s so bad about not having calcium why do we need it anyway
What’s so bad about not having calcium? Why do we need it anyway?

  • Healthy bones

  • Muscle contraction & relaxation


S s of hypocalcemia
S&S of hypocalcemia anyway?

  • Tetany

    • Group of symptoms that are caused by hypocalcemia

    • Paresthesia

    • Muscle spasms


S s of hypocalcemia1
S&S of Hypocalcemia anyway?

  • + Chvostek’ssign

    • Tap facial nerve 

    • Facial spasm


S s of hypocalcemia2
S&S of Hypocalcemia anyway?

  • + Trousseau’s sign

    • Occlusion of brachial artery > 3 min.

    • Carpal spasm


S s of hypocalcemia3
S&S of Hypocalcemia anyway?

  • Dysrhythmias

  • Cardiac output

    • i

  • BP

    • i


Interdisciplinary care hypocalcemia
Interdisciplinary Care: Hypocalcemia anyway?

  • Diagnostic tests

    • Serum Calcium level

    • PTH

      • Parathyroid Hormone levels


Interdisciplinary care hypocalcemia1
Interdisciplinary Care: Hypocalcemia anyway?

  • If a client has a diagnosis of hypocalcemia – what do they need?

  • Calcium replacement!

    • Oral calcium replacement


Natural courses of calcium
Natural courses of Calcium anyway?

  • Milk

  • Milk products


Hypercalcemia
HYPERCALCEMIA anyway?

  • Increased serum calcium levels


Common causes of hypercalcemia
Common causes of Hypercalcemia anyway?

  • Hyperparathyroidism

  • Some cancers

  • Immobilization

  • Renal failure


What endocrine gland controls the serum calcium level
What endocrine gland controls the serum calcium level anyway?

  • Parathyroid

  • Pituitary

  • Adrenal

  • Ovaries

  • Testis


S s of hypercalcemia
S&S of Hypercalcemia anyway?

  • Muscle weakness

  • i reflexes

  • Confusion

  • Dysrhythmias

  • BP

    • h

  • Urine output

    • h


Remember calcium has a sedative effect on neuromuscular transmission
REMEMBER: Calcium has a sedative effect on neuromuscular transmission

  • HYPERcalcemia decreased neuromuscular excitability, muscle weakness and fatigue

  • HYPOcalcemia increased neuromuscular excitability, muscle twitching, spasms and tetany


Interdisciplinary care hypercalcemia
Interdisciplinary care transmissionHypercalcemia

  • Lab tests:

    • Serum Calcium levels

    • PTH

    • ECG


Interdisciplinary care hypercalcemia1
Interdisciplinary care transmissionHypercalcemia

  • Medications

    • Diuretics


Magnesium imbalance
Magnesium Imbalance transmission

  • Mg


Hypomagnesemia
Hypomagnesemia transmission

  • Low serum magnesium levels


Common causes of hypomagnesemia
Common Causes of transmissionHypomagnesemia

  • #1 Alcoholism


S s of hypomagnesemia
S&S of transmissionHypomagnesemia

  • Muscle weakness

  • Tetany

    • + Chvostek’s

    • + Troussseau’s

  • Dysrhythmias

    • ECG changes

  • Seizures


ad