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PNN152 Test-2 Hydrat

Medical

QuestionAnswer
S/S of Fluid volume deficit/dehydration Urine, Sweating, Respirations, Bowels
Sensible fluid volume Urine
Insensible fluid volume Sweating, Respirations, Bowels
Osmosis Liquids move from high to low concentration
Diffusion Solutes move from high to low concentration
ATP Active transport moves from area low to high concentration
Isotonic Same as blood plasma, Expand vascular volume, May result in fluid overload
Hypotonic Provide free water, treat cellular dehydration by causing fluid to move into the cells
Hypertonic Draws fluid out of the intracellular and interstitial compartments, Expand vascular volume
Isotonic IV Fluids Examples 0.9% Sodium Chloride (NS),Ringer's lactate (LR), Dextrose 5% in Water (D5W)
Hypotonic IV Fluid Examples 0.45% Socium Chloride (1/2 NS)
Hypertonic IV Fluid Examples Dextrose 5% in 0.45% Sodium Chloride (D5 1/2NS) Dextrose 5% in 0.9% Sodium Chloride (D5NS) Dextrose 5% in Ringer's lactate (D5LR)
Special Considerations related to dehydration in Infants/Children Immature kidneys, Rapid respiratory rate (insensible), Proportionally larger body surface area, Greater insensate loss, Fluid loss can lead quickly to electrolyte imbalances
Special Considerations related to dehydration in Elderly Decreased thirst sensation,renal function, intercellular fluid and total body water, ability to regulate fluid and electrolytes, Increased use of diuretics/antihypertensive medications, incidence of diseases that affect hydration
S/S of Fluid Volume Excess Weight Gain, Intake greater than Output, Full, bounding pulse/tachycardia(overloaded water weight),Increased Blood Pressure, Peripheral Edema, Moist Crackles in lungs;dyspnea, Mental confusion (fluid pressed out)
Fluid Volume Overload Excess intake of Sodium-containing IV fluids, Excess intake of Sodium, Impaired fluid balance regulation related to disease
Hydration Nursing Considerations Monitor I & O and lab values, Place in Fowler's position, Diuretics, Fluid restriction, low sodium diet, measures to prevent skin breakdown
Sodium (Na) Lab Value Normal 135-145 mEq/L, Controls and regulates water balance
Hyponatremia Causes (Na) Loss of sodium, Gain of water(drank too much in short time)
Hypernatremia Causes (Na) Loss of water, Gain of sodium ( diarrhea, not drinking)
Hyponatremia (Na) KEY Clinical Manifestations Muscle twitching, Abdominal cramps, Confusion (water in cells)
Hypernatremia (Na) KEY Clinical Manifestations Weakness, Decreased level of consciousness, Confusion
Hyponatremia (Na) Nursing Considerations Encourage food and fluids high in sodium, Limit water intake
Hypernatremia (Na) Nursing Considerations Monitor behavior changes, Encourage fluids, Restrict intake of sodium
Potassium (K) Lab Value Normal 3.5-5.0 mEq/L Vital for skeletal, cardiac, and smooth muscle activity moves back and forth across cell membranes
Hypokalemia (K) Causes Loss of Potassium, Vomiting, Diarrhea, use of potassium-wasting diuretics, inadequate intake food (just IV in hosp)
Hyperkalemia (K) Causes Decreases potassium excretion, High potassium intake, Need to watch salt substitute(all potassium)KCL
Hypokalemia (K) KEY Clinical Manifestations Muscle weakness; leg cramps, cardiac dysrhythmias, gastrointestinal hypoactivity, take note of 3 different diuretics (potassium)
Hyperkalemia (K) KEY Clinical Manifestations Irregular pulse, Gastrointestional hyperactivity
Hypokalemia (K) Nursing Considerations Monitor heart rate and rhythm, Administer oral potassium replacesments (with food), Encourage potassium rich foods, Monitor cliends on potassium-wasting diuretics
Hyperkalemia (K) Nursing Considerations Closely monitor cardiac status, Monitor potassium levels, Hold potassium supplements, restrict potassium rich foods, Listen to Bowels and Heart Rhythm
Calcium (Ca) Lab Value Normal 8.5-10.5 mEq/L Vital in regulating muscle contrations and relaxation, neuromuscular function, and cardiac function
Hypocalcemia (Ca) Causes Surgical removal of parathyroid gland, Inadequate Vitamin D intake (out in sun, milk)
Hypercalcemia (Ca) Causes Prolonged immobilization, Hyperparathyroidism, Bone abnormalities, (Ca) moves out of bones and into vascular system
Hypocalcemia (Ca) Key Clinical Manifestations Cardiac dysrhythmias;decreased cardiac output, (+) Trousseau's Sign-carpal spasm occurs when a BP cuff is inflated to 20mm Hg greater thatn SBP and left in place for 2-5 mins. (+) Chvostek's Sign-facial twitch incl. eyelids and lips when face nerve tapped
Hypercalcemia (Ca) Key Clinical Manifestations Flank pain secondary to renal calculi, Constipation, Dysrhythmias, possible heart block, kidney stones
Hypocalcemia (Ca) Nursing Considerations Closely monitor respiratory and cardiac status, Administer calcium supplements
Hypercalcemia (Ca) Nursing Considerations Increase client movement, Encourage fluids and fiber, Encourage intake of acid-wash fluids (cranberry juice, prune)
Magnesium (Mg) Lab Value Normal 1.5-2.5 mEq/L. Important for intracellular metabolism, especially important in the production and use of ATP. Involved in regulating neuromuscular and cariac function
Hypomagnesaemia (Mg) Causes Excessive loss from gastrointestinal tract, Chronic alcoholism
Hypermagnesaemia (Mg) Causes Abnormal retention of magnesium due to disease
Hypomagnesaemia (Mg) KEY Clinical Manifestations (+)Chvostek's Trousseau's signs, Tachycardia, dysrhythmias, Increased reflexes, tremors, convulsions
Hypermagnesaemia (Mg) KEY Clinical Manifestations Hypotension, bradycardia, Muscle weakness/paralysis respiratory and cardiac arrest if severe
Hypomagnesaemia (Mg) Nursing Considerations Carefully monitor clients with alcohol intoxication, monitor for increased risk of seizures, Encourage magnesium rich foods(nuts & spinach)
Hypermagnesaemia (Mg) Nursing Considerations Monitor vital signs and level of consciousness, reflexes, respiratory rate
Chloride (Cl) Lab Value Normal 95-108 mEq/L Involved in regulating acid-base balance
Hypochloremia (Cl) Causes Loss of chloride through the GI tract, Loss of chloride through the kidneys
Hyperchloremia (Cl) Causes Sodium retention, Excessive replacement of NaCl or KCL
Hypochloremia (Cl) KEY Clinical Manifestations Muscle twitching, tremors
Hyperchloremia (Cl) KEY Clinical Manifestations Muscle Weakness, Lethargy (tired)
Hematocrit Normal Values Women 37-47% Men 40-54%
Hematocrit relationship to Hydration Affected by changes in plasma volume INCREASED with dehydration , DECREASED with fluid overload
Urine Specific Gravity Normal Value: 1.005-1.030
Urine Specific Gravity (relationship to Hydration) INCREASED indicates concentrated urine - Dehydration DECREASED indicates diluted urine
Purpose of IV therapy Replace fluid and /or electrolytes, Administer medications, Provide nutrients (TPN)
IV Access Peripheral Vascular Access, Central Venous Access
Peripheral Vascular Access Needles and short catheters that prodice access to the peripheral vascular system Intracaths-plastic tube inserted into a vein.
Central Venous Access Various Catheters inserted into Central venour system- Superior Vena Cava, Provide long term IV access
Central Venous Catheters Subclavian, Jugular
Nursing Considerations and IV site assessment Assess patency of infusion, Assess dressing-Dry and intact, Assess insertion site-No redness or swelling, NO bleeing, No Discomfort
Monitoring the Infusion Type of fluid being infused, Rate of flow, Client response
IV Site Complications Infiltration, Extravasation, Phlebitis
Infiltration Leaking of fluids or medication into the surrounding tissue due to dislodged IV catheter
Infiltration Causes Trauma during insertion-Abrasion of vessel wall, large catheter in small vessel, Compromised vascular walls
Infiltration Clinical Manifestations Discomfort at the IV site, Swelling at or above the insertion site, Cool to touch, Pale Skin
Infiltration Nursing Considerations Stop infustion, Discontinue IV catheter, Apply warm moist heat, Verify the need for reinsertion
Extravasation The leakage of fluid out of its container
Extravasation Causes An infiltration of a vesicant drug, Can lead to tissue death
Extravasation Nursing Considerations Stop infustion immediately, Attempt to aspirate any of the drug still in the catheter hub, Treat with antidote as needed or discontinue IV catheter, Notify Dr., Apply ice or heat depending on drug
Phlebitis Imflammation of the vein
Phlebitis Causes Injury to the vein, Mechanical-IV was hurt into the vein, Chemical- the drug going into vein
Phlebitis Clinical Manifestations Tenderness at IV site, Redness or pink or red stripe along vein, Warm to touch, Swelling
Phlebitis Nursing Considerations Stop infusion, Discontinue IV catheter, Apply warm moist heat, Verify the need for reinsertion
IV Tubing and Bag Change Aseptic Prodecure-Must keep ends sterile, Guidelines-Bag good for 24 hrs.after accessed, tubing good for 96-120 hrs, sticker the tubing and bag
Discontinuing an IV Catheter Aseptic Procedure, Check the intactness of the IV catheter (tip broke off), Cover the site with a sterile dressing
Using an IV Pump Purpose-Used to regulate the rate of infusion, Should always be used for elderly and pediatric clients.
IV Pump Nursing Considerations Double check all programming, Verify flow pressure with hourly checks, Respond to alarms, Engage Lockout if necessary
Created by: sacotton
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