Chapter 6 - Fluid and Electrolytes

11/29/2024 Chapter 6 Fluid, Electrolyte, and AcidBase Balance Quiz 2 1 Lesson 6.1 (Slide 1 of 2) 1. Describe the extracellular and intracellular fluid compartments. 2. Describe the composition of the extracellular and intracellular body fluid compartments. 3. Discuss the mechanisms of fluid transport and fluid balance. 4. Identify the causes, signs and symptoms, and treatment of fluid imbalances. 5. Describe the major functions of the major electrolytes: sodium, potassium, calcium, magnesium, and chloride. 6. Identify the causes, signs and symptoms, and treatment of electrolyte imbalances. 2 2 1 11/29/2024 Lesson 6.1 (Slide 2 of 2) 7. List data to be collected for the focused assessment of fluid and electrolyte status. 8. Discuss the medical treatment and nursing management of persons with fluid and electrolyte imbalances. 9. Explain why older persons are at increased risk for fluid and electrolyte imbalances. 10. List the four types of acid-base imbalances. 11. Identify the major causes of each acid-base imbalance. 12. Explain the medical treatment and nursing management of acid-base imbalances. 3 3 Homeostasis • Maintaining relatively constant conditions as in fluid compartments • To maintain internal balance, body must be able to regulate fluids • All organs and structures of the body involved in homeostasis 4 4 2 11/29/2024 Body Fluid Compartments • Intracellular fluid • Fluid within a cell • Most of the body’s fluids found within the cell • Extracellular fluid • Fluid outside the cell • Primarily responsible for carrying fluids with nutrients & wastes on a random basis throughout the body 5 5 Body Fluid Compartments Extracellular fluids > Intravascular fluid In blood vessels in the form of plasma or serum > Interstitial fluid In fluid surrounding cells, including lymph, digestive secretions, sweat and CSF 6 6 3 11/29/2024 Composition of Body Fluids WATER • Largest portion of body weight • Percentage affected by age, sex, body fat • Percentage of body water decreases with age • Females have a lower percentage of body water than males throughout adult years because women have more fat than men and fat cells contain less water than other cells • Obese people have a lower percentage of body water because of the increased number of fat cells 7 7 Composition of Body Fluids • SOLUTES • Electrolytes • Sodium (Na) • Potassium (K) • Chloride (Cl) • Calcium (Ca) • Magnesium (Mg2+) • Nonelectrolytes 8 8 4 11/29/2024 Electrolytes • Subst ances t hat develop an elect r ical char ge when it dissolves in wat er . • These electrically charged particles are called IONS • Ions with a positive charge are CATIONS • Sodium (Na) • Potassium (K) • Calcium (Ca) • Magnesium (Mg) • Ions with a negative charge are ANIONS • Chloride (Cl) • Bicarbonate (HCO3) • Sulfate (SO4) • Hydrogen phosphate (HPO4) • For every positively charged cation there is a negatively charged anion Cations and anions combine to balance one another 9 9 SODIUM Na+ (136-145 meq/L) ATI (130-145 meq/L) Elsevier ➢ most abundant electrolyte (cation) in the body ➢ the primary electrolyte in the extracellular fluid. ➢ FUNCTIONS : Plays major role in the regulation of: • body fluid volumes • Muscular activities • Nerve impulse conduction • Acid base balance “Water goes where sodium is” 10 5 11/29/2024 POTASSIUM K+ (3.5-5.0 meq/L) ATI (3.5-5.0 meq/L) Elsevier Potassium (K) • Found mainly in the intracellular fluid; the major intracellular cation Functions • Important in maintaining fluid osmolarity and volume within the cell • Essential for normal membrane excitability—a critical factor in transmitting nerve impulses • Needed for protein synthesis, for the synthesis and breakdown of glycogen, and to maintain plasma acid-base balance 11 CHLORIDE Cl (98-106 meq/L) ATI (98-107 meq/L) Elsevier • Is an extracellular anion that is usually bound with other ions, especially sodium and potassium. • FUNCTIONS • Regulates osmotic pressure between fluid compartments • Assist in regulating acid-base balance 12 6 11/29/2024 CALCIUM Ca2+ (9.0 -10.5 mg/dL) ATI (5 mEq/L) Elsevier • Usually combined with phosphorus to form the mineral salts of the bones and teeth • Of total body calcium, 99% concentrated in the bones and teeth; 1% is in the extracellular fluid • Ingested through the diet and absorbed through the intestine Functions: • Promotes transmission of nerve impulses • helps regulate muscle contraction and relaxation 13 MAGNESIUM Mg 2+ (1.3-2.1 mEq/L) ATI (1.5 – 2.5 mEq/L) Elsevier) • Cation; Usually found in bones (50-60%), intracellular fluid (39-49%) and extracellular fluid (1%) • Excreted through the kidneys and rate of excretion is regulated by sodium and calcium excretion, extracellular fluid volume & parathyroid hormones FUNCTIONS • Vital to cellular functions • Metabolism of CHO and CHON • Storage and use of intracellular energy and neural transmission • Important in functioning of the heart, nerves and muscles 14 7 11/29/2024 Nonelectrolytes • Other substances dissolved in the body fluids • Urea, protein, glucose, creatinine, and bilirubin • These solutes do not carry an electrical charge and are measured in milligrams per deciliter (mg/dL) 15 Transport of Water and Electrolytes Membranes • Selectively permeable membranes • Separate fluid compartments and control movement of water and certain solutes • Maintain unique composition of each compartment of the body while allowing transport of nutrients and wastes to and from cells • To carry out their functions, they must cross the semipermeable membrane surrounding each body cell to enter the cell through active or passive transport 16 8 11/29/2024 TRANSPORT PROCESSES 1. Diffusion (passive transport) • The random movement of particles in all directions is necessary for a substance to move from an area of higher natural tendency concentration to an area of lower concentration • No energy needed Example: movement of O2 from arteries to capillaries so patient with dyspnea is encouraged to sit in high Fowlers to move O2 from pulmonary capillaries to blood. It regulates balance between positive and negative ions 17 ACTIVE TRANSPORT 2. Active transport • Carrier proteins transport substances from an area of lower concentration to an area of equal or greater concentration • Requires expenditure of energy • Many solutes, such as sodium, potassium, glucose, and hydrogen, are actively transported across cell membranes • Example of active transport is sodium pump 18 9 11/29/2024 PASSIVE TRANSPORT 3. Filtration • Transfer of water and solutes through a membrane from an area of high pressure to an area of low pressure • A force behind filtration is called hydrostatic pressure, or the force pressing outward on a vessel wall • The pumping action of the heart is responsible for the amount of force of the hydrostatic pressure that causes water and electrolytes to move from capillaries to the interstitial fluid • Filtration is a necessary process to move fluid out of capillaries into tissues and filter plasma through the kidneys 19 PASSIVE TRANSPORT 4. Osmosis Movement across a membrane from a less concentrated to a more concentrated solution Involves movement of water only; sometimes force of movement across membrane carries solutes along If a fluid compartment has less water and more sodium, water from another compartment moves to the more concentrated compartment by osmosis to create a better fluid balance 20 10 11/29/2024 OSMOLALITY • Concentration of solution determined by number of dissolved particles per kg water • Controls water movement and distribution by regulating the concentration of fluid in each body fluid compartment • The osmolality of intracellular fluid and extracellular fluid tends to equalize because of the constant shifting of water • Osmolarity refers to the concentration of particles per liter of solution, rather than kilograms 21 21 1. KIDNEYS Main regulators of fluid balance Regulatory Mechanisms Control extracellular fluid by adjusting the concentration of specific electrolytes, osmolality of body fluids, the volume of extracellular fluid, blood volume, and pH The nephron is the functioning unit of the kidney Glomerulus is the filtering portion of the nephron, and the tubule is responsible for secretion and reabsorption Nephrons conduct work of the kidney through filtration, reabsorption, and secretion 22 22 11 11/29/2024 23 23 Kidneys (cont.) • Filtration • Blood plasma entering the kidney via the renal artery is delivered to the glomerulus • About 20% of plasma filtered into glomerular capsule • Most remaining plasma leaves kidney through the renal vein • Filtrate then moves through the tubules, where it is transformed into urine by tubular reabsorption and secretion 24 24 12 11/29/2024 Kidneys (cont.) • Tubular reabsorption • A process by which most of the glomerular filtrate is returned to the circulation • Water and selected solutes move from the tubules into the capillaries but when water absorption in renal tubules becomes greater that normal, urine will be more concentrated • Waste products remain in tubules for excretion, whereas most water and sodium is reabsorbed into the bloodstream • Adjusts volume and composition of the filtrate; prevents excessive fluid loss through kidneys 25 25 Kidneys (cont.) • Tubular secretion • The last phase in the work of the kidneys • The filtrate is transformed into urine • Various substances—drugs, hydrogen ions, potassium ions, creatinine, and histamine—pass from the blood into the tubules • Process eliminates some excess substances to maintain fluid and electrolyte balance, as well as metabolic waste products 26 26 13 11/29/2024 Regulatory Mechanisms (cont.) 2. HORMONES • Renin • Hormone secreted when blood volume or blood pressure falls • Causes the release of aldosterone with subsequent sodium and water retention • Aldosterone • Acts on kidney tubules to increase reabsorption of sodium and decrease reabsorption of potassium • Because the retention of sodium causes water retention, aldosterone acts as a volume regulator 27 27 Hormones (cont.) 28 • Antidiuretic hormone (ADH) • Causes capillaries to reabsorb more water, so urine is more concentrated and less volume is excreted • Atrial natriuretic factor (ANF) • Hormone released by the atria in response to stretching of the atria by increased blood volume • Stimulates excretion of sodium and water by the kidneys, decreased synthesis of renin, decreased release of aldosterone, and vasodilation • Reduces blood volume and lowers blood pressure 28 14 11/29/2024 29 29 Regulatory Mechanism (cont.) 3. Thirst • Regulates fluid intake • Increased plasma osmolality stimulates osmoreceptors in the hypothalamus to trigger the sensation of thirst • More sodium and less water in the body make a person thirsty • Additional fluids consumed; kidneys conserve water until osmolality returns to normal 30 30 15 11/29/2024 Regulatory Mechanism (cont.) 4. Fluid Gains and Losses In healthy adult, 24-hour fluid intake and output approximately equal Fluids gained by drinking and eating and lost through the kidneys, skin, lungs, and GIT The usual adult urine volume is between 1 and 2 L/day, or 1 mL/kg of body weight per hour , 1Liter = 1kg • In kidneys, water loss varies largely with the amount of solute excreted and with the level of ADH • Average Daily Intake: 2200-2700 mL/day • 1100-1400 mL/day PO fluids • 800-1000 mL/day solid foods • 300 mL/day fluid produced from cellular metabolism • Table 6.3 31 31 Age-Related Changes Affecting Fluid Balance • Aging kidney slower to adjust to changes in acidbase, fluid, and electrolyte balances • Older adult often has a reduced sense of thirst and therefore may be in a state of chronic dehydration • Total body water declines with age; greatest loss from the intracellular fluid compartment • Older person has limited reserves to maintain fluid balance when abnormal losses occur • Antihypertensives, diuretics, and antacids can also contribute to imbalances 32 32 16 11/29/2024 Assessment of Fluid and Electrolyte Balance 33 1. Health history • Determines if patient has conditions that contribute to fluid or electrolyte imbalances • Vomiting, diarrhea, kidney diseases, diabetes, salicylate poisoning, burns, congestive heart failure, cerebral injuries, ulcerative colitis, and hormonal imbalances; the intake of drugs, such as diuretics and cathartics; and medical interventions, such as gastric suctioning • Complaints of fatigue, palpitations, dizziness, edema, muscle weakness or cramps, dyspnea, and confusion may be associated with fluid imbalances • Fluid balance is mainly monitored by two systems: circulatory and renal - Box 6.4 33 Assessment of Fluid and Electrolyte Balance (cont.) 34 2. PHYSICAL ASSESSMENT • Vital signs • Pulse, respiration, temperature, and blood pressure can indicate changes in fluid and electrolyte balance. • Temperature variations can be associated with fluid volume excess or deficit. • Pulse rate and quality may change in response to blood volume alterations; electrolyte changes can affect heart rate and rhythm. Blood pressure is directly related to blood volume. Respirations are minimally affected by electrolyte changes. • Box 6.1 34 17 11/29/2024 Assessment of Fluid and Electrolyte Balance 35 • Intake and output • Accurate records are essential to determine whether the patient’s intake is equal to output, normal adult urine output –40-80 ml/hr - Box 6.2 • All fluids entering or leaving the body should be noted • A changing urine output may reflect attempts by the kidneys to maintain or restore balance, or it may reflect a problem that causes fluid disturbances • Urine characteristics also give clues to fluid balance • Body Weight • Measurement of body weight is a good indicator of fluid loss and retention (Box 6.3) • 1 Liter of fluid weighs 2.2 lb. • Weigh patient daily on same scale, same time/day, wearing same type of clothing 35 Assessment of Fluid and Electrolyte Balance 36 • Skin • Characteristics • Moisture, turgor, and temperature reflect fluid balance. Dry, flushed skin—dehydration. Pale, cool, clammy skin—severe fluid volume deficit that occurs with shock. Moist, edematous tissue seen with excess fluid volume • Facial characteristics • Severely dehydrated patient has a pinched, drawn facial expression. Soft eyeballs and sunken eyes indicate severely deficient fluid volume. Puffy eyelids and fuller cheeks suggest excess fluid volume 36 18 11/29/2024 Assessment of Fluid and Electrolyte Balance (cont.) Skin turgor Edema Measured by pinching the skin over the sternum, the inner aspects of the thighs, or the forehead In patients who are dehydrated, skin flattens more slowly after the pinch is released, “TENTING” Reflects water and sodium retention, which can result from excessive reabsorption or inadequate secretion of sodium, as may occur with kidney failure Pitting depression remains in the tissue after pressure is applied with a fingertip 37 37 Assessment of Fluid and Electrolyte Balance (cont.) Mucous membranes Tongue turgor : In a well person, tongue has one longitudinal furrow. Fluid volume deficit causes additional longitudinal furrows, and the tongue is smaller. Sodium excess causes the tongue to appear red and swollen. Moisture of the oral cavity : A dry mouth may be the result of deficient fluid volume or mouth breathing. ➢ Veins : Appearance of the jugular veins in the neck and the veins in the hands can suggest either a fluid volume deficit or excess. 38 38 19 11/29/2024 Diagnostic Tests and Procedures 39 • Urine studies (Table 6.4) • Urine pH : metabolic acidosis imbalance • Urine specific gravity-measure of urine concentration • A good indicator of fluid balance • Osmolality-more precise measurement of kidneys’ ability to concentrate urine • Creatinine clearance: detect glomerular damage in kidney • A 24 hour specimen is required • Sodium: intake & fluid volume status • Potassium: measure renal tubular function 39 Diagnostic Tests and Procedures (cont.) 40 • Blood studies • Serum hematocrit • Percentage of blood volume composed of RBC • Serum creatinine • A metabolic waste product • Indicator of renal function • Blood urea nitrogen (BUN) • A measure of renal function • Serum albumin • A plasma protein that helps maintain blood volume by creating colloid osmotic pressure • Serum electrolytes • Sodium, potassium, chloride, and calcium 40 20 11/29/2024 FLUID IMBALANCES Table 6.5 - Fluid Volume Deficit • Less water than normal in the body • Isotonic extracellular fluid deficit • Hypovolemia • Hypertonic extracellular fluid deficit • Dehydration – increased hematocrit laboratory value • Decreased intake, abnormal fluid losses, or both • Examples: loss of water from excessive bleeding, excessive sweating, severe vomiting, diarrhea, severe burns. 41 41 Fluid Volume Deficit (cont.) 42 • Body’s compensatory mechanism for fluid volume deficit by: ➢ Decreasing urine output ➢ Heart rate increases to maintain blood flow to body tissues ➢ Blood pressure may fall due to reduced blood volume Treatments: ➢ correct underlying cause ➢ water & electrolyte replacement, ➢ antiemetics, antidiarrheals, ➢ oral fluids& IVF 42 21 11/29/2024 Fluid Imbalances (cont.) 43 • Table 6.6 - Fluid Volume Excess • An increase in body water • Extracellular fluid excess • Isotonic fluid excess • Intracellular water excess • Hypotonic fluid excess • From renal or cardiac failure with retention of fluid, increased production of antidiuretic hormone or aldosterone, overload with isotonic IV fluids, or administration of dextrose 5% in water (D5W) after surgery or trauma • Treatment: restrict sodium intake, give diuretics, restrict fluid intake. 43 ELECTROLYTE IMBALANCES 44 HYPONATREMIA (sodium deficit) • Lower than normal sodium in the blood serum • Can be actual deficiency of sodium or increase in body water that dilutes the sodium excessively Causes: • excessive intake of water without sodium • Excessive loss of sodium as with vomiting, diarrhea, or diaphoresis with only water replacement • Use of distilled water to irrigate body cavities • Excessive secretion of ADH – SIADH (syndrome of inappropriate antidiuretic hormone) 44 22 11/29/2024 HYPONATREMIA 45 HYPONATREMIA NURSING INTERVENTIONS • Monitor I&O • Vital Signs, assist with ambulation if low BP • Monitor neurologic status frequently, prevent injury if confuse • Monitor level of consciousness • Weigh daily • Monitor skin turgor Q shift • Fluid restriction per MD orders • Sodium replacement per MD orders • IV fluids containing sodium • Monitor Chloride levels (drop when Na drops) 46 23 11/29/2024 Hypernatremia 47 • Higher than normal concentration of sodium in the blood • Very serious imbalance; decreased level of consciousness and can lead to death if not corrected • Occurs when excessive loss of water or excessive retention of sodium Causes : • Vomiting • Diarrhea • Diaphoresis (profuse sweating) • Insufficient antidiuretic hormone • Avoid abnormally large intake of sodium like bouillon, canned foods, potato chips, vegetables prepared in sauce, table salts, smoke. 47 48 48 24 11/29/2024 Hypernatremia (cont.) 49 • Medical treatment • Oral or IV replacement of water to restore balance • A low-sodium diet often prescribed • Nursing care • Encourage patients with hypernatremia to drink water • Closely monitor the infusion of IV fluids • Teach patient to track daily intake and output and to recognize the signs and symptoms of fluid retention or depletion • Box 6.5 Sodium Restrictions 49 Hypokalemia 50 • Low serum potassium • May result in gastrointestinal, renal, cardiovascular, and neurologic disturbances • Can cause abnormal, potentially fatal, heart rhythm • Signs and symptoms • Anorexia, abdominal distention, vomiting, diarrhea, muscle cramps, weakness, dysrhythmias (abnormal cardiac rhythms & weak irregular pulse), postural hypotension, dyspnea, shallow respirations, confusion, depression, polyuria (excessive urination), and nocturia 50 25 11/29/2024 HYPOKALEMIA 51 Hypokalemia (cont.) 52 • Medical treatment • Potassium replacement by the IV or oral route • Nursing care • Monitoring at-risk patients for decreased bowel sounds, a weak and irregular pulse, decreased reflexes, and decreased muscle tone • Cardiac monitors may be used to detect dysrhythmias • Administer oral or IV potassium • Urine output should be no less than 30 mL/hr. • Encourage dietary sources of Potassium (Box 6.6) • Monitor client receiving nasogastric suction 52 26 11/29/2024 Hyperkalemia • High serum potassium • Patients at risk: decreased renal function in metabolic acidosis, taking potassium supplements, diabetes • A serious imbalance because of potential for life-threatening dysrhythmias • Severe traumatic injuries d/t loss of K from damaged cells to extracellular fluid 53 53 HYPERKALEMIA 54 27 11/29/2024 Hyperkalemia (cont.) 55 • Medical treatment • Correct the underlying cause • Restrict potassium intake (renal damage with diabetes) • Polystyrene sulfonate (Kayexalate) • Intravenous calcium gluconate • IV insulin & glucose • Inhaled beta-adrenergic agonists • Nursing care • Patients with low urine output or those taking potassium-sparing diuretics must be monitored carefully for signs and symptoms • Carefully monitor flow rate of IV fluids, which should not exceed 10 mEq/hr through peripheral veins • Screen the results of laboratory studies & always inform the provider of the client’s K+ level. 55 Chloride Imbalance • Usually bound to other electrolytes; therefore, chloride imbalances accompany other electrolyte imbalances • Hyperchloremia • Usually associated with metabolic acidosis • Hypochloremia • Usually occurs when sodium is lost because chloride most frequently bound with sodium 56 56 28 11/29/2024 Calcium Imbalance 57 Regulated by the parathyroid glands Hypocalcemia - results from diarrhea, inadequate dietary intake of calcium or vitamin D, and multiple blood transfusions (banked blood contains citrates that bind to calcium), in addition to some diseases, including hypoparathyroidism with positive Trousseau’s sign Hypercalcemia - results from a high calcium or vitamin D intake, hyperparathyroidism, and immobility that causes stores of calcium in the bones to enter the bloodstream 57 • Hypocalcemia: Tingling of the lips, extremities, face, positive Trousseau’s sign ( monitor Chvostek’s sign) Tx: direct sun light, calcium replacement, dietary planning • Hypercalcemia: skeletal muscle weakness, decrease deep tendon weakness, hypoactive bowel sounds 58 58 29 11/29/2024 Magnesium Imbalance • Hypomagnesemia: decreased gastrointestinal absorption or excessive gastrointestinal loss, usually from vomiting and diarrhea, or increased urinary loss • Hypermagnesemia: occurs most often with excessive use of magnesiumcontaining medications or intravenous solutions in patients with renal failure or preeclampsia of pregnancy 59 59 60 60 30 11/29/2024 ACID-BASE DISTURBANCES • Acid base balance – homeostasis of the hydrogen ion concentration in the body fluids. • ACID – solution containing high number of hydrogen ions • BASE – or alkaline - solution containing lower number of hydrogen ions • pH – symbol used to indicate hydrogen ion concentration 61 61 ACID-BASE DISTURBANCES (cont.) • Normal acid-base balance is maintained by: (body’s line of defense to control blood pH) 1. Buffers – blood buffers excreting hydrogen ion if the fluid is too acidic, adding hydrogen ion if the fluid is too alkaline – Normal pH of blood - 7.35-7.45 2. Respiratory control of carbon dioxide – lungs PaCO2 – 35-45mmHg 3. Renal regulation of Bicarbonate – kidneys – metabolic regulators of pH HCO3 - 21-28 mEq/L 62 62 31 11/29/2024 63 63 ACID-BASE DISTURBANCES (cont.) 64 Respiratory Acidosis Respiratory system fails to eliminate the appropriate amount of carbon dioxide to maintain the normal acid-base balance ➢ High PaCO2 with a resultant low in pH • Caused by pneumonia, drug overdose, head injury, chest wall injury, obesity, asphyxiation, drowning, or acute respiratory failure • Medical treatment Improve ventilation, which restores partial pressure of carbon dioxide in arterial blood (PaCO2) to normal, by providing oxygen as well as bronchodilators 64 32 11/29/2024 65 Expected s/s: decreased level of consciousness, warm, flushed skin, muscle twitching, dizziness (possible seizure) 65 Respiratory Acidosis (cont.) 66 Nursing care Assess PaCO2 levels in the arterial blood Observe for signs of respiratory distress: slow, shallow respirations, headache, restlessness, anxiety, confusion, tachycardia Interventions Encourage fluid intake Position patients with head elevated 30 degrees 66 33 11/29/2024 Respiratory Alkalosis 67 ➢ Low PaCO2 with a resultant rise in pH Most common cause of respiratory alkalosis is hyperventilation Medical treatment Major goal of therapy: treat underlying cause of condition; sedation may be ordered for the anxious patient Nursing care Intervention In addition to giving sedatives as ordered, reassure the patient to relieve anxiety Encourage patient to breathe slowly, which will retain carbon dioxide in the body 67 68 68 34 11/29/2024 Respiratory Alkalosis (cont.) • Nursing care • Intervention • In addition to giving sedatives as ordered, reassure the patient to relieve anxiety • Encourage patient to breathe slowly, which will retain carbon dioxide in the body 69 69 Metabolic Acidosis 70 • Body retains too many hydrogen ions or loses too many bicarbonate ions; with too much acid and too little base, blood pH falls • Causes are starvation, dehydration, diarrhea, shock, renal failure, and diabetic ketoacidosis • Signs and symptoms: changing levels of consciousness, headache, vomiting and diarrhea, anorexia, muscle weakness, cardiac dysrhythmias • Medical treatment: treat the underlying disorder • Hyperventilating metabolic acidosis patient can cause respiratory alkalosis 70 35 11/29/2024 71 71 Metabolic Acidosis (cont.) 72 • Nursing care • Assessment of the patient in metabolic acidosis should focus on vital signs, mental status, and neurologic status. Ex. Nurse should assess compensatory condition such as respiratory alkalosis when a patient has metabolic acidosis with hyperventilation. • Emergency measures to restore acid-base balance. Administer drugs and intravenous fluids as prescribed. Reassure and orient confused patients. 72 36 11/29/2024 Metabolic Alkalosis 73 • Increase in bicarbonate levels or a loss of hydrogen ions • Loss of hydrogen ions may be from prolonged nasogastric suctioning, excessive vomiting, diuretics, and electrolyte disturbances • Signs and symptoms: headache; irritability; lethargy; changes in level of consciousness; confusion; changes in heart rate; slow, shallow respirations with periods of apnea; nausea and vomiting; hyperactive reflexes; and numbness of the extremities 73 74 74 37 11/29/2024 Metabolic Alkalosis (cont.) 75 • Medical treatment • Depends on the underlying cause and severity of the condition • Nursing care • Assessment • Take vital signs and daily weight; monitor heart rate, respirations, and fluid gains and losses • Keep accurate intake and output records, including the amount of fluid removed by suction • Assess motor function and sensation in the extremities; monitor laboratory values, especially pH and serum bicarbonate levels • Check medications since Antacids are made of bicarbonate & can be a risk for metabolic alkalosis 75 Metabolic Alkalosis (cont.) 76 • Intervention • To prevent metabolic alkalosis, use isotonic saline solutions rather than water for irrigating nasogastric tubes because the use of water for irrigation can result in a loss of electrolytes • Provide reassurance and comfort measures to promote safety and well-being Arterial Blood Gases (ABG’s) LET’s DO TIC TAC TOE ! Https://youtu.be/URCS4t9aM5o https://youtu.be/JjN5ITbLsZc 76 38 11/29/2024 77 77 ABG Practice 78 1. pH = 7.50; PaCO2 = 26; HCO3 = 23 2. pH = 7.33; PaCO2 = 66; HCO3 = 25 3. pH = 7.52; PaCO2 = 43; HCO3 = 36 4. pH = 7.25; PaCO2 = 55; HCO3 = 25 5. pH = 7.57; PaCO2 = 25; HCO3 = 22 6. pH = 7.21; PaCO2 = 39; HCO3 = 19 78 39 11/29/2024 Question 1 Which of the following is a true statement? A. B. C. D. Approximately 60% to 70% of the human body is composed of water. When the body does not maintain homeostasis, the cells can still function properly. Most of the body’s fluids are found outside the cell. Extracellular fluid is mainly responsible for the transport of nutrients and wastes throughout the body. 79 79 Question 2 ______________ is the transfer of water and solutes through a membrane from an area of high pressure to an area of low pressure. A. B. C. D. Active transport Filtration Facilitated diffusion Osmosis 80 80 40