Fluid And Electrolyte Concept Prompts

Fluid & Electrolyte Concept Map Prompts Please type your response in the right column Include any references in the box Include any additional resources labeled as such in the box Prompt Answer Cellular Fluids Provide examples of hypertonic IV solutions 3% Saline 5% Saline 10% Dextrose in Water (D10W) 5% Dextrose in 0.9% Saline 5% Dextrose in 0.45% saline 5% Dextrose in Lactated Ringer’s Describe what a hypertonic IV solution is Provide examples of isotonic IV solutions The cell has an excessive amount of solute extracellularly and osmosis is causing water to rush out of the cell intracellularly to the extracellular area which will cause the CELL TO SHRINK. 0.9% Saline 5% dextrose in water (D5W) 5% Dextrose in 0.225% saline (D5W1/4NS) Lactated Ringer Describe what an isotonic IV solution is The cell has the same concentration on the inside and outside which in normal conditions the cell’s intracellular and extracellular are both isotonic. Find examples of hypotonic IV solutions 0.45% Saline (1/2 NS) 0.225% Saline (1/4 NS) 0.33% saline (1/3 NS) Describe what a hypotonic IV solution is The cell has a low amount of solute extracellularly and it wants to shift inside the cell to get everything back to normal via osmosis. This will cause CELL SWELLING which can cause the cell to burst or lyses. What does a potassium N sparing diuretic mean? Medicines that increase diuresis (urination) without the loss of potassium. They are generally weak diuretics and work by interfering with the sodium-potassium exchange in the distal convoluted tubule of the kidneys or as an antagonist at the aldosterone receptor. Discuss how to recognize acid base imbalances Identify what the RN can do to prevent complications of IV therapy A blood pH out of normal range 7.35-7.45 Increased/decreased breathing, seizures, irritability, weakness, muscle cramping, Select an appropriate I.V. site, avoiding areas of flexion. Use proper venipuncture technique. Follow your facility policy for securing the I.V. catheter. Observe the I.V. site frequently. Advise the patient to report any swelling or tenderness at the I.V. site. Extracellular fluid is? What electrolytes are present? Intracellular fluid is? What electrolytes are present? Fluid outside the cell -Sodium and Chloride Sodium Calcium Chloride Potassium Magnesium Fluid within the cell -Potassium and Phosphate Major Electrolytes (Role of each and Abbreviation/Symbol) Na 136-145 mEq/L Maintains BP and fluid balance Ca 9=10.5 mg/dL Maintains Cell permeability, muscular system, heart and bones Cl 98-106 mEq/L Maintaining BP, fluid balance and stomach acid K 3.5-5 mEq/L Maintains Fluid Balance, muscle contraction and nerve signals Mg 1.8-2.6 mEq/L Phosphate Important in ATP, cardiovascular system, regulates muscle contractions P 3-4.5 mEq/L Build and repair bones and teeth, part of ATP production and carb metabolism Bicarbonate CO2 23-30 mEq/L Helps maintain body’s pH Common Fluid & Electrolyte Imbalances (What are the effects & Potential causes of each) Fluid Volume Isotonic loss of water and electrolytes Deficit Fluid Volume Isotonic gain of water and electrolytes Excess Affects the heart and can lead to ineffective pumping Edema Hypo- natremia Sodium deficit as a result of the decreased concentration in the extracellular fluid, water moves into the cell, causing cellular swelling. Hyper- natremia Sodium excess results from water deficit or over-ingestion of Na+ Hypo- Kalemia Potassium deficit: GI losses, diarrhea, insufficient intake, non-K+ sparing diuretics Hyper- Kalemia Potassium excess: excessive intake of potassium (salt substitutes), transfusions and medications, impaired renal function, and cellular movement. Hypo- Calcemia Calcium deficit -inadequate intake of calcium, lack of absorption, or excessive losses HyperCalcemia HypoMagnesium Calcium excess- High intake of calcium and increased release of calcium from the bone Magnesium deficit Decreased serum levels result from decreased intake, decreased absorption, or increased loss through the kidneys or GI. HyperMagnesium Magnesium excess not common, excessive intake of magnesiumcontaining antacids or cathartics, renal failure HypoPhosatemia Phosphate deficit an abnormal shift of phosphate into the cell, decreased absorption of phosphorus from the gastrointestinal tract, or increased excretion of phosphorus by the kidneys. HyperPhosphatemia Phosphate excess- impaired renal function Define Diffusion Define Osmosis Define Filtration Define Active Transport Movement of Electrolytes is the continuing intermingling of molecules in liquids, gases and solids; movement of molecules is random With diffusion, molecules move from a solution of higher concentration to a solution of lower concentration the movement of water across cell membranes. process whereby fluids and solutes move together across a membrane from one compartment to another, higher to lower when substances move across the cell membranes from a less concentrated solution to a more concentrated solution Nursing Goals and Interventions to correct/maintain Fluid Balances 1 Client will demonstrate stable fluid volume as evidenced by stable vital signs, balanced intake and output, stable weight, and absence of signs of edema by: Monitoring vital signs Monitoring intake and output Assess for presence and location of edema formation 2 Client will demonstrate behaviors to monitor fluid status and prevent or limit recurrence by: Evaluate client’s ability to manage own hydration. Assess client’s beverage preferences, and set up a 24-hour schedule for fluid intake 3 Client will verbalize understanding of individual dietary and fluid restrictions by: Evaluate client’s ability to manage own hydration. Education of proper restrictions Deficit Fluid Volume Excess fluid volume Nursing Diagnoses Assoc w/Electrolyte imbalances (Provide an example of what it can be "Related to") Bleeding Abnormal losses Diarrhea Decreased cardio output Excessive fluid intake Excessive sodium intake Risk for imbalanced fluid volume Decreased cardiac output Vomiting Abnormal drainage Increased metabolic rate ( fever, infection) Weight gain Edema Hypotension What patients are at highest risk for F&E imbalance? What are s/s of fluid overload? Older adults and young children What are s/s of fluid deficit? Altered mental state Weakness Thirst Tachycardia Weak pulse Weight loss 2 nurse check Check vitals What needs to be done prior to a blood transfusion? What are s/s of transfusion reaction? What steps should the nurse take? What do you assess to monitor F&E status? What does weight gain mean in regards to fluid status? How would you Swelling Hypertension SOB Chest pain Headache Abdominal cramps Chills Nausea/Vomiting Skin rash (sometimes Benadryl administered) Dyspnea Headache Tachycardia Chest pain Temperature change Severe reaction = anaphylactic shock and death!!!!!! Vitals Skin Mucous membranes Fluid overload Explain rationale implement a fluid restriction? What are best practices for compliance? Make sure you know lab values Establish 24 hr plan (majority when awake and eat meals) Set short term goals, identify fluids pt likes Be sensitive to cultural preferences/restrictions Help pt select foods that become liquid at room temp Supply cups, straws Serve at appropriate temps Have pt record Avoid caffeine