Transcript FLUID & ELECTROLYTES - Shelbye's CSON Notes Blog

Fluid and Electrolytes
CSON
Spring 2009
PREPARED BY CARLA HILTON, MSN, RN
PRESENTED AND REVISED BY REBECCA POWERS,
MSN, RN
15 questions from all of powers’ stuff…
Water Balance = Homeostasis
• Water in the body is used to or for:
•
Transporting nutrients & oxygen to cells
•
Removing waste from cells
•
Provides medium in which electrolyte chemical reactions
can occur
•
Regulation of body temperature
•
Lubricates joints and membranes
•
Provides medium for food digestion
• liter of water weighs 2.2 lbs
• The most accurate way to measure fluid status in a person is
daily weights, not I&O!!!
Water Distribution
• ICF: Intracellular fluid
• ECF: Extracellular fluid (lymph system, interstitial fluid,
intravascular fluid or plasma)
• TCF: Transcellular fluid (cerebral spinal fluid, fluid in joints, GI
tract, and peritoneal fluid)
• Third spacing: (a condition where fluid accumulates in a
pocket that isn’t really serving a purpose. Acieties (sp?)where fluid hangs out in your abd. The fluid is coming from
somewhere else.)
• More fluid in intracellular than anywhere else in the body!
Osmolarity / Osmolality
Osmole:
the
amount of substance that dissociates in solution
to form one mole of osmotically active particles
Concentration
of solution measured in osmoles
Osmolarity / Osmolality
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Osmolality is measured in milliOsmols/Kg (mOsm/Kg)
Osmolarity is measured in milliOsmols/L (mOsm/L)
Evaluates serum and urine in clinical practice
Normal: serum osmolality 275 – 295 mOsm/K
Lality= total volume will equal 1 L plus the amount of
volume taken up by the solids! The koolaid and water
equal a L
• Larity= volume is going to be less than 1 L. The koolaid
minus the water.
Concentrations of Solutions
• Isotonic: Same osmolarity as blood
plasma…no osmotic “pull”
• Hypotonic: Less concentration than blood
plasma…lower osmotic pressure
• Hypertonic: More concentration than blood
plasma….higher osmotic pressure
Movement of Water
• Intracellular & extracellular approximately
same osmolality
• Solvent (water) and solutes (electrolytes)
move across selectively permeable
membranes (compartments) in the body
(the bigger the particle, the slower they move,
and they may need a little boost…)
Review of Terms
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Osmosis
Diffusion
Active transport
Passive transport
Filtration
Hydrostatic pressure
Osmosis Review
• Movement of water only
• Speed of movement affected by:
• temperature of fluid
• concentration of fluid
• electrical charge of particles in solution
• The higher the solute concentration, the
greater the osmotic pressure is.
Other Mechanisms of Movement
• Diffusion: Solute (or gas) moves from area of higher
concentration to area of lower concentration
• Facilitated diffusion: Solute moves against
concentration gradient (passive transport)
• Active transport: Solute moved against
concentration gradient using ENERGY
Active Transport
• Na+/K+ pump: Maintains the higher
concentrations of extracellular Na+ and
intracellular K+
• In the cell, K is King. i.e. K is the major cation
of the cell, Na is outside the cell.
Continued
• Filtration: solutes & solvent move together in
response to fluid pressure; moves from area of high
pressure (hydrostatic pressure) to area of low
pressure
• Hydrostatic pressure: The force within a fluid
compartment (as in the vascular system) The
pressure that forces the fluid out of your capillaries.
• Colloidal Osmotic Pressure – pulls it back into the
capillaries.
Regulation of Body Fluids
• Intake: osmoreceptors sense osmolality of serum, signals the
hypothalamus, stimulates thirst
– Impact on intake: Age (decreases desire to drink),
conciousness, ability to take in fluids
• Output: kidneys, lungs, GI tract, skin
•
Sensible: measurable….urine output, excessive
perspiration, diarrhea, vomiting
•
Insensible: immeasurable…normal perspiration, normal
breathing
• Output for adults should be one mL/kg (of body weight) an
hour
Role of the Kidneys
• Filter approx 180 Liters of blood per day; GFR (glomerular
filtration rate)
• Produces urine between 1-2 Liters/day
• If loss of 1% to 2% of body water, will conserve water by
reabsorbing more water from filtrate; urine will be more
concentrated
• If gain of excess body water, will excrete more water from
filtrate; urine will be more diluted
Hormonal Control
• Antidiuretic hormone (ADH): Prevents diuresis;
“water saving”
• Question: Osmoreceptors sensing a/an increase in
osmolality will cause the release of ADH
• ADH acts on kidneys via the renal tubules. Makes
them more permeable to water. The water will move
from the tubes back into your body.
Hormonal Control
• RAA (Renin-angiotensin-aldosterone): cascade initiated
by decrease in renal perfusion or low Na+
•
If extracellular volume is decreased
renal
perfusion decreases
renin secreted by kidneys
renin acts to produce angiotensin I which then
converts to angiotensin II
results in massive
vasoconstriction
increases renal arterial
perfusion and causes increased thirst, a release of
aldosterone (causes the retention of Na and Water)
Hormonal Control
• Aldosterone:
• Angiotensin II causes the adrenal gland to release
aldosterone
• Aldosterone causes the kidneys to retain Na+ and
water
• Volume regulator….released if Na+ is low and K+ is
high; increases reabsorption of Na+ (where salt goes,
water follows) and the excretion of K+
ANP
• Atrial Natriuretic Peptide: (ANP): secreted
from atrial cells of heart (in response to too
much volume in the blood)
•
acts as diuretic
•
inhibits thirst mechanism
•
suppresses the RAA cascade
Thirst Mechanism
• Regulated by the hypothalamus
• Stimulates thirst:
•
increased osmolality of ECF
•
decreased ECF
•
dry mucous membranes
• Causes: eating salty foods, inadequate intake,
excessive water loss
Pressure Sensors
Baroreceptors: Nerve receptors that sense pressure in blood
vessels (think barometer measures pressure in the
atmosphere, this measures pressure in the blood vessels)
•
Low pressure: sensors in the cardiac atria; stimulate
SNS (sympathetic nervous system) & inhibits PSNS
(parasympathetic nervous system) (sns will increase heart rate
and BP)
•
High pressure: sensors in the aortic arch, carotid sinus,
and the juxtaglomerular apparatus in the kidney; stimulates
PSNS and inhibits the SNS (psns will decrease your heart rate
and lower BP)
Pressure Sensors
• Osmorecptors: Sense Na+ concentration
• Positioned on surface of hypothalamus
• Increase in Na+ concentration: stimulates
release of ADH
• Decrease in Na+ concentration: inhibits
release of ADH
ELECTROLYTES and OTHER LABS
RELATED TO FLUID VOLUME
STATUS
Electrolytes
• Minerals and salts: electrolytes
• Cations: Positively charged; sodium, potassium,
calcium, magnesium
•
Major cation in ECF is sodium
• Anions: Negatively charged; chloride, bicarbonate,
sulfate
•
Major cation in ICF is potassium
Hyponatremia
Usually loss of Na w/o loss of fluid
• Causes
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Salt wasting fr. Kidney
Adrenal insufficiency
GI losses
Profuse sweating
Diuretics
SIADH
• Syndrome of inappropriate
Anti-Diruetic Hormone
– Inadequate Na intake
• Physical Exam
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Apprehension
Personality change
Postural hypotension
Tachycardia
Convulsions/coma
NV&D
Anorexia
Hyponatremia cont’d
• Labs
– Serum Na+ below 135
mEq/L
– Serum Osmolality below
280 mOsm/kg
– Urine specific gravity
below 1.010
• Treatment
• Restrict water
• Sodium replacement
Hypernatremia
• Causes
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 ingestion of salt
Iatrogenic (we caused it)
 aldosterone
Water deprivation
• Signs & Sxms
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Thirst, sticky tongue
Dry, flushed skin
Fever
Convulsions, irritability
Hypernatremia cont’d
• Labs
– Serum Na+ above 145
mEq/L
– Serum Osmolality above
295 mOsm/kg
– Urine specific gravity
above 1.030
• Treatment
• Hypotonic IV solution
•
or D5W
Urine Na+ Studies
• Urine Na+
– Assesses volume status
– Aids in diagnosing hyponatremia & acute renal
failure
• Random normal range = 50 -130 mEq/L
• 24 hour = 75-200 mEq/L
Hypokalemia
• Causes
– Diuretics that “waste”
potassium
– D, V, & gastric suction
–  aldosterone
– Polyuria, sweating
– Iatrogenic – K+ poor
solutions
• Signs & Sxms
– Weakness, fatigue
–  muscle tone
– Hypoactive bowel
sounds and distention
– Weak, irregular pulse
– Paresthesias
– SOMETHING ABOUT
CARDIAC FUNCTION
Hypokalemia cont’d
• Labs
– K+ below 3.5 mEq/L
– ECG abnormalities
• Treatment
• Oral K+ or IV solution
w/K+
• Increased dietary K+
Hyperkalemia
• Causes
– Renal failure
– Fluid vol. deficit
– Massive cellular injury
(trauma/burns)
– Iatrogenic
– Potassium “sparing”
diuretics
– Addison’s disease
• Signs & Sxms
– Anxiety
– Dysrrhythmias
– Paresthesia (numbness,
pins & needles feeling)
– Weakness
– Diarrhea
Hyperkalemia cont’d
• Labs
– Serum K+ above 5.0
mEq/L.
– ECG abnormalities – can
lead to arrest (if too high
or too low)
• Treatment
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Kayexalate
IV Na+ bicarb
IV Ca+ gluconate
Regular insulin and
hypertonic dextrose IV
• Limit via diet
• Possible dialysis
Hypocalcemia
• Causes
– Rapid admin of blood w
citrate
– Hypoalbuminemia
– Hypoparathyroidism
– Vit. D deficiency
– Pancreatitis
– Stuff that relates back to
preexisting conditions
• Signs & Sxms
– Numbness, tingling of
fingers & mouth
– Hyperactive reflexes
– Tetany- a muscle
contraction that stays
contracted
– Muscle cramps
– Pathological fractures
Hypocalcemia cont’d
• Labs
– Serum Ca++ below 4.5
mEq/L
– ECG abnormalities
• Treatment
• Increase dietary intake
• IV calcium gluconate
• Ca+ & vit D supplements
Hypercalcemia
• Causes
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Hyperparathyroidism
Osteometastasis
Paget’s disease
Osteoporosis
Prolonged
immobilization
• Signs & Sxms
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Anorexia, N & V
Weakness, lethargy
Low back pain (stones)
Decreased LOC
Personality changes
Cardiac arrest
Hypercalcemia cont’d
• Labs
– Serum Ca++ above 5.5
mEq/L
– X-rays showing
osteoporosis
– Stones &  BUN /
creatinine fr. FVD or
renal damage
• Treatment
• Lasix (diuretic)
• Increased fluids
Hypomagnesemia
• Causes
– Inadequate intake
• Alcohol, Malnutrition
– Inadequate absorption
• V&D, Gastric aspirate
• Fistulas, Sm. Bowel
– Loss fr. Diuretics
– Polyuria
• Signs & Sxms
– Tremors
– Hyperactive deep
tendon reflexes
– Confusion
– Dysrhythmias
Hypomagnesemia cont’d
• Labs
– Serum Mg++ below 1.5
mEq/L
• Treatment
• Mag sulfate IV
• Oral replacement
• Increase dietary intake
Hypermagnesemia
• Causes
– Renal failure
– Excess intake of
magnesium
• Signs & Sxms
– Most frequently seen in acute
– Hypoactive deep tendon
reflexes & drowsiness
– Decreased depth and rate of
resp.
– Hypotension
– flushing
Hypermagnesemia cont’d
• Labs
– Serum Mg++ levels above
2.5 mEq/L
• Treatment
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IV calcium gluconate
Loop diuretics
NS or LR IV solutions
Dialysis
Additional Lab Data
• Hematocrit
– Measures the volume % of RBC’s in whole blood
• Normal: M = 40-50%; F = 37-47%
– Increases with dehydration (hemoconcentration)
– Decreases with overhydration (hemodilution)
Hematocrit & Fluid Volume Status
From “Fluids & Electrolytes Made Incredibly Easy” 4th ed.
Fluids & Electrolytes Made Incredibly Easy
Lab Data (cont’d)
• Blood urea nitrogen (BUN)
– Measures kidney function
– Normal range: 7-20mg/dL
– Varies with protein intake, fever, dehydration,
GI bleeding, liver failure, etc.
Lab Data (cont’d)
• Creatinine
– End product of muscle metabolism
– Better indicator of renal function than BUN
• Doesn’t vary w protein intake or metabolic state
– Normal range: 0.7-1.5mg/dL in 24 hr urine
collection
– Serum: adult female: 0.5 to 1.1mg/dL
adult male: 0.6 to 1.2mg/dL
Lab Data (cont’d)
• Urine Specific Gravity
– Measures ability of kidney to excrete or
conserve water
• Normal range = 1.010 - 1.025
– Increased S.G.= concentrated urine
– Decreased S.G.= dilute urine
Lab Data (cont’d)
• Serum Osmolarity
– Most accurate for kidney function
• Remember norm?
– 280-295 mOsm/L
– Measured directly through blood
– Indirectly using Serum Osmolarity Formula
serum glucose
BUN
Serum Osmolarity = 2  Na  
+
18
3
+
Maintaining Fluid Balance
Fluid Imbalances
• Isotonic
– Deficit – water, electrolytes and solutes lost in
equal proportions to body solutions
– Excess – water, electrolytes and solutes gained in
equal proportions to body solution
– FVD - fluid volume deficit-HYPOVOLEMIA
– FVE - fluid volume excess-HYPERVOLEMIA
Fluid Disturbances
Osmolar Imbalances
– Hyperosmolar – Dehydration
– Hypoosmolar – Water excess
– Loss or excesses of water only
– Leads to alteration in concentration of serum
ISOTONIC FLUID DISTURBANCES
Fluid Volume Deficit (FVD)
• Water AND solutes lost in equal proportion.
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Diarrhea, vomiting, fistulas, drains
Bleeding, burns
Fever, excessive perspiration
Inadequate fluid intake
Diuretics
GI suctioning
FVD: Signs & Symptoms
•Mild
–Dry mouth, furrowed
tongue
–Orthostatic or postural
hypotension
–Restlessness & anxiety
–Tachycardia
–Less than 5% weight loss
• Moderate
– Confusion, irritability,
thirst, cool & clammy
– Urine output 30cc/hr or
less
– Rapid weight loss
– Slowed vein filling
FVD: Signs & Symptoms (cont’d)
• Severe
–Pale
–Flattened neck veins, delayed capillary refill
–Urine output less than 10cc/hr
–Marked hypotension, tachycardia, weak or
absent pulses (shock)
–Can lead to unconsciousness
FVD: Labs
• Lab findings vary depending on the cause
–Decreased H/H with hemorrhage
–Increased Hct
–Elevated BUN
–Urine specific gravity greater
than 1.030
FVD: Nursing Diagnosis Statement
• Example:
–Fluid volume deficit r/t active fluid volume loss as
evidenced by decreased blood pressure (90/50
mmHg), thirst, fever (102°), rapid heart rate (110
bpm), urine output less than or equal to 25 mL/hr, &
urine specific gravity of 1.040.
FVD: Goal Statement
• Client will achieve fluid balance AEB
– urine output equal to or greater than 30 mL/hr
– Elastic skin turgor and moist mucous membranes
FVD: Medical Interventions
• Treat cause
• Replacing fluids intravenously
•
isotonic if hypotensive (expand plasma volume)
•
hypotonic if normotensive (provides electrolytes
and water)
• Encourage fluids
• Ensure adequate O2 and perfusion
• Increase blood counts, BP, & albumin levels
• Teaching
FVD: Nursing Interventions
• Ensure patent airway, adjust O2 levels as
ordered
• Lower HOB if tolerated or not
contraindicated
• Direct pressure to bleeding, if present
• Administer meds, blood, albumin, & IV
fluids
FVD: Nursing Interventions (cont’d)
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Weigh patients daily
Provide skin care
Maintain strict I&O
Monitor vital signs
Monitor lab work
FVD: Teaching
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Nature of condition & causes
Warning S/S
Treatments & importance of compliance
Change positions slowly
Monitor BP & pulse rate
Give prescribed medications
Fluid Volume Excess (FVE)
• Water AND solutes gained in excess of
normal body levels
• Causes:
– Isotonic fluid overload
– Excess sodium intake
– CHF, renal failure, cirrhosis
– Increase in steroids or serum aldosterone
FVE: Signs & Symptoms
• Generalized
– Acute weight gain
• Mild-mod 5-10%
• Severe > 10%
– Edema
• dependent, sacral,
pulmonary
• Cardiovascular
– Tachycardia, bounding
pulse, distended neck
veins, increased BP
• Respiratory
– Dyspnea, tachypnea,
crackles, frothy cough
FVE: Lab Values
• Decreased hematocrit
• Decreased BUN
• Low O2 levels
FVE: Nursing Diagnosis Statement
• Fluid volume excess r/t excess fluid intake aeb
Hct of 23, 10# weight gain in two days,
dyspnea (Pt states, “I can’t get enough air.”),
and crackles on inspiration and expiration in
all lobes.
FVE: Related Nursing Diagnoses
• Ineffective breathing pattern r/t increased
fluids
• Impaired skin integrity r/t excess fluids
• Confusion
FVE: Client Goals & Outcomes
Aimed at cause
• Decrease circulating fluid volume
• Lower BP and pulse
• Improve breathing status
• Maintain skin integrity
• Teaching
FVE: Goal Statement
• Client will achieve fluid balance manifest in
following outcomes
– Clear breath sounds
– Denies dyspnea and affirms the ability to breathe
adequately
FVE: Nursing Interventions
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Restrict Na+ & fluid intake
Watch for edema - dependent & respiratory
Provide measures to facilitate breathing
Provide skin care for weeping & edema
FVE: Nursing Interventions (cont’d)
• Monitor response to medications
• Accurate I/O, Consistent daily weight, VS,
monitor labs
• Advise HCP if poor response to therapy
– Hemodialysis may be needed
FVE: Teaching
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Nature of condition and causes
Signs and symptoms
Treatments and importance of compliance
Need to monitor BP, P, O2 Sat, & weight
Rationale for Na+ and fluid restrictions
Medications
Osmolar Imbalances
Hyperosmolar: Dehydration
• Loss of water = increased serum osmolality
increased serum Na+
Compensatory Mechanism: water shifts out of
cells (ICF) into the ECF…..if not corrected, water
continues to move out of cells (ICF) and into
ECF causing the cells to shrink….shrunken cells
don’t function properly!!
Causes of Dehydration
• Causes:
– Diabetes insipidus, prolonged fever, watery
diarrhea, hyperglycemia, failed thirst drive
– Iatrogenic: hypertonic solutions (IV & tube
feeding)
– Diuresis of water alone
Dehydration: Signs & Symptoms
• Irritability, confusion, weakness, dizziness
• Decreased urine output, darkened urine
• Dry, sticky mucous membranes, sunken eyeballs,
poor turgor, extreme thirst !!!
• Fever (insensible – continuous)
• Coma
• Tachycardia, weak, thready pulse, hypotension
Dehydration: Labs
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Elevated hematocrit
Elevated serum osmolarity > 295 mOsm/kg
Elevated serum sodium > 145 mEq/L
Urine specific gravity > 1.030
Dehydration: Nursing Diagnoses
• Fluid volume deficit r/t fluid loss
• Deficient fluid volume r/t excessive fluid
loss from GI tract
• Risk for impaired skin integrity r/t altered
metabolic state
If you’ve lost 20% of you initial weight from
dehydration, you’re probably dead
Dehydration: Potential Nursing Diagnoses
• Deficient knowledge: unfamiliarity of disease
process
• Disturbed thought processes r/t neurologic
changes / decreased cardiac output
• Decreased cardiac output r/t excessive fluid
loss
Dehydration: Client Goals & Outcomes
• Aimed at correcting cause
• Replace fluids – hypotonic, slowly re-hydrate
over 48 hrs (if you go too quickly, you die)
• Maintain skin integrity
• Teaching
Dehydration: Nursing Interventions
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Replace fluids by PO route first
SLOW admin. of salt-free IV solutions
Monitor S/S cerebral & pulmonary edema
Monitor accurate I/O, VS, daily weights
Monitor labs
Provide skin and mouth care
Dehydration: Teaching
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Disease process of dehydration
Treatments
Warning signs and symptoms
Medications / IV (Vasopressin – D5W)
Importance of compliance with therapy
– Fluid intake not based on thirst alone
Hypoosmolar
• Water excess
• Causes
– SIADH or excess water intake
• Signs & Sxms
– Decreased LOC, convulsions, coma
• Labs
– Serum Na+ below 135 mEq/L and Serum osmolality below
280 mOsm/kg
Nsg Dx – Goals - Interventions
• Similar to FVE
• Make relevant to underlying cause
• Is very acute illness
Physical Assessment
History
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Medical – Acute Illness, surgery, burns
Environment – exercise, hot/cold/dry areas
Diet – proteins, lytes, fluids
Lifestyle – smoking/alcohol
Medication history
Areas of Concern in PA
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Mental status
BP and pulse
Skin
I & O’s & WEIGHT
Lungs
Geriatric Focus
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Body-water content (mass related)
Kidney function
Cardiac & respiratory function
Hormonal regulatory function
Thirst sensation
Medication Use
Skin & subcutaneous fat
Assessment of Geriatric Clients
• Skin turgor
– Assessment is performed where?
• Cognition
• Physical being
• Continence
Laboratory Data
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BMP / CMP
Serum osmolarity
Urine specific gravity
Urine sodium
Hematocrit
Blood urea nitrogen (BUN)
Creatinine
Clients at Risk for F&E Imbalances
• Age
– Very young
– Very old
• Chronic Diseases
– Cancer
– Cardiovascular disease, such
as congestive heart failure
– Endocrine disease, such as
Cushing's disease and
diabetes
– Malnutrition
– Chronic obstructive
pulmonary disease
– Renal disease, such as
progressive renal failure
– Changes in level of
consciousness
Clients at Risk for F&E Imbalances
• Trauma
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Crush injuries
Head injuries
Burns
Major surgery
• Therapies
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Diuretics
Steroids
Intravenous (IV) therapy
Total parenteral nutrition
(TPN)
• Gastrointestinal losses
– Gastroenteritis
– Nasogastric suctioning
– Fistulas
Fluid & Electrolytes Nursing DXs
• Risk for imbalanced Body
temperature
• Ineffective Breathing pattern
• Decreased Cardiac output
• Deficient Fluid volume
• Risk for deficient Fluid volume
• Excess Fluid volume
• Impaired Gas exchange
• Knowledge deficient regarding
disease management
• Impaired Mobility
• Impaired Oral mucous membrane
• Impaired Skin integrity
• Risk for impaired Skin integrity
• Ineffective Therapeutic regimen
management
• Impaired Tissue integrity
• Ineffective Tissue perfusion
Intravenous Fluid Therapy in Fluid
Balance Disorders
ISOtonic solutions
• Same osmolarity as body fluids
– 280 - 300 mOsm/kg
• Expands the IVC without pulling
fluids from other compartments
• Examples
– Normal saline (NS)
– Lactated Ringers (LR)
IVs: Normal Saline (NS)
•
•
•
•
Isotonic
0.9% Sodium Chloride
Different amounts
Sample order
– NS @ 75cc/hr
IVs: Lactated Ringer’s (LR)
• Isotonic Solution
• Contents
– Na+, Cl-, K+, Ca++, Lactate in sterile water
• One strength, two common amounts
• Sample orders
– LR @ 100cc/hr
– RL @ 75cc/hr
HypOtonic solutions
• Osmolarity less than serum
• Pulls fluid from the IVC into the ICC
causing cells to expand
– Over hydration
– Rehydration
RISK
• Example
– ½ NS
– D5W - after absorbed into body
IVs: Dextrose Solutions
• Concentrations
– 5% in water (hypotonic after enters body)
– 10% in water (hypertonic)
– 50% in water (rescue solution – small volume)
– As additive to NS or LR
• D5NS or D5LR
HypERtonic solutions
• Osmolarity of solution is higher than
serum osmolarity
– >300 mOsm/kg
• Pulls fluid from ICC into IVC causing
cells to shrink
– dehydrate
• Examples
– D51/2 NS - D5NS - D5LR
– 3% NS (CRITICAL Strength)
IVs: Common Additives
• Potassium (never add to a bag!)
• Multivitamins
• Additives makes the solution hypertonic to
some extent – depends on amount
IV Additives: Potassium
• Available as KCl (potassium chloride)
• NEVER add K+ to a bag of fluid
– Added by pharmacy or premixed
• Different strengths
• Sample orders
– NS c 20 mEq KCl @ 75 cc/hr
– LR c 40 mEq KCl @ 75 cc/hr
Medications Used in Fluid &
Electrolyte Imbalance Disorders
Meds: Antidiarrheals
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Assess I /O & electrolytes
Provide oral care
Monitor for constipation
Teaching
– Take as directed
– Avoid overdose
• Examples: Lomotil & Immodium
Meds: Antiemetics
• Assess VS & emesis status before and after
• Monitor for extrapyriamidal side effects
– involuntary movement of eyes, face or limbs, flat
affect, shuffled gait, drooling
• Provide fluid replacements
– Oral electrolyte solutions
– Water
• Sample Meds: Zofran, Phenergan & Vistaril
Meds: Diuretics
• Assess
– Weight, edema, skin
turgor, & mucus
membranes, lung sounds
• Monitor
– weight, I /O, electrolytes
• Teaching
– diet, weigh daily, & dosing
times
• Examples:
– Thiazides (HCTZ) – HTN
– Potassium sparing
(spironolactone)
– Osmotic (mannitol) –
decrease ICP
– Loop (lasix) – pull fluids
Meds: Potassium
• Forms: tablets (SR), effervescent, EC, IV
• Administration considerations
– PO: Give on a full stomach at mealtime am/pm
– IV: NEVER give as bolus, follow protocol, dilute for IV
administration, can burn & lead to infiltration
• Monitor: K+ levels – monitor EKG if elevated
Meds: Kayexelate
• Removes K+ from system
• Available as enema or by PO route
– Retain enema for ½ to 1 hr
– Follow resin w 100 mL water
– After expulsion, rinse colon w 1 liter of water and
drain out immediately
Other Meds r/t F/E status
• Glucocorticosteroids
• Digoxin
• Electrolyte supplements
Stuff To Add for the Test
•
A L of fluid weighs 2.2 lbs
– 1 lb of fluid is 454 mL
– If a L of fluid weighs 2.2 lbs you need to be able to figure out how many mL a ½ lb is
•
•
10% fluid loss is serious, but 20% loss is mostly death
If you have someone who begins to have a transfusion reaction (hemolytic) watch
for
– Fever, low back pain, itching, hypotension, N/V, drop in urine output, chest pain,
dyspnea
– If you are doing VS for these people and they have these symptoms, GO FIND THE
NURSE IMMEDIATELY! They don’t need any more blood whatsoever!