Nursing: Fluids, Electrolytes and ABGs

electrolytes play an important role in maintaining homeostasis within our body. Our body is constantly transporting nutrients, electrolytes, and oxygen to cells and carrying waste products away from cells. In order for our body to do this, body fluids and electrolytes have to be maintained within the narrow limits of normal in order to maintain homeostasis and promote health

Risk factors
•Hemorrhage
•Emesis/Diarrhea
•Burns
•Large draining wounds
•Diuretic therapy
•Diabetes Insipidus
•Prolonged/high fever
S/S
Decreased
•Mental Status
•Bowel Sounds
•Strength
•Mucous production
•Skin turgor
•Weight
•Temperature
•Tear production
•Urine output
•Intake
BP
Increased
-hemoconcentration, urine specific gravity, tachycardia, tachypnea, thirst, HCT, BUN, sodium levels.
I@O checks
Low level urine production can indicate dehydration
INTERVENTIONS
Hydration therapy/IV fluids
Admiister drugs that can correct cause
Ex: antiemetics, antidiarrheal, antibiotics, and antipyretics

Risk factors
•Excess fluid replacement
•Kidney failure
•Heart failure
•Long-term steroid therapy
•SIADH
•Conditions involving polydipsia
•Water intoxication
•Excess salt intake
S/S
Increases in
•Pulse
•Confusion
•Weakness
•Crackles
•Dyspnea / Respiratory effort
•Ascites
•Mucous production
•Weight
•Intake
•Edema
•BUN/creatinine
•Electrolytes
•BP
Decrease in
HGB, HCT, sodium....related to hemodilution
INTERVENTIONS
•Drug therapy focusing on removing the excess fluid - diuretics if kidney failure is not the cause
•Nutrition therapy involving restrictions of both fluid and sodium intake to control fluid volume
•Stop parenteral fluids and/or change IVF to a hypertonic solution
•Additional monitoring for indicators of increased fluid volume
üVS
üIntake and output
üLab values
üDaily weights

Normal ranges
HGB- women 12.0- 15.5
HGB- men 13.5- 17.5
HCT- women 34.9- 44.5
HCT- men 38.8-50

Think neuro
Causes
•SIADH and heart failure
•Diuretics
•NPO
•Low-salt diet
•Excessive ingestion of hypotonic fluids
•Conditions causing polydipsia
•Excessive diaphoresis
S/S
•Change in LOC, confusion
•Muscle weakness
•Increased intestinal motility, N/D
•Cardiac changes depending if hypovolemia or hypervolemia in bloodstream
Nursing Interventions
-Drug therapy: osmotic diuretics, with FVE states, reduce diuretics that increase sodium loss (ex: loop diuretics).
-Diet therapy to increase sodium intake and restrict fluids to build sodium count
-Safety measures?
-Monitor I & O, daily weights, VS, LOC, encourage changing positions slowly

Think neuro
Causes
•Excessive oral ingestion or IVF
•Fever and diaphoresis
•Infection
•Dehydration
•KIDNEY FALIURE and Cushing's syndrome
Too much salt or IV fluids
S/S
•Lethargic
•Confused
• Agitated
•Muscle twitching and weakness
Decreased cardiac output symptoms
INTERVENTIONS
-replace fluid volume with 0.225% or 0.45% NS
-diet therapy: sodium restriction
-Adequate water intake
-Monitor LOC
-Maintain safety
-Provide oral hygiene
-Monitor I & O

Causes
•Diuretics, steroids
•Diarrhea
•Vomiting
•Excess wound drainage
•TPN
•Water intoxication
•IV therapy without K+
S/S
ALKALOSIS
shallow resp
Irritability
Confucion drowsiness
Weakness fatigue
ARRYTHMIAS (TACHY)
Thready pulse
decreased intestinal motility
INTERVENTIONS
-Potassium replacement
-Monitoring cardiac rhythm
-Monitor respiratory and lung sounds
-02 as needed
-Maintain safety
-Monitor bowel sounds, bowel movements, and abdominal distention

Causes
•Over ingestion of potassium-containing foods or meds
•Potassium-sparing diuretics
•Transfusions
•Addison's disease and Kidney failure
S/S
Muscle twitchs
Anxiety Irrtability
LOW BP
EKG Changes
DYSRYTHMIAS
Abdominal Cramping
Diarrhea
INTERVENTIONS
-Monitor cardiac rhythm (telemetry)
-Maintain safety
-Decrease potassium intake, increase potassium excretion
-Dietary teaching
-Promote movement of potassium (kayexelate) and if it is sever, insulin IV with be give. We want potassium to go to the ICF.
TELLY

Causes
•Inadequate intake of Ca++/Vitamin D
•Malabsorption syndromes
•Lactose intolerance
•ESRD (end stage kidney disease)
•Diarrhea
ABSORPTION OF CALCIUM REQUIRES VID D
S/S
•Painful muscle spasms/cramping in the calf/foot
•Paresthesias
•Muscle twitching - Chvostek's sign and Trousseau's sign
•Bradycardia or Tachycardia
•Weak thready pulse
•Hypotension
•Increased peristalsis activity
INTERVENTIONS
assess/manage pain
oral/IV supplementation
Monitor cardiac status
Teach dietary modifications
Maintain safety
Encourage foods high in calcium
Dietician consult if needed

Causes
•Excessive oral intake of calcium or Vitamin D
•Kidney failure
•Thiazide diuretics
•Malignancy of bone
•Hyperthyroidism
•Dehydration
S/S
•Increased BP & pulse
•Dysrhythmias
•Blood clots
•Severe muscle weakness
•Decrease in peristalsis activity
INTERVENTIONS
-reduce calcium and vitamin D through altered nutrition
-drug therapy
-dialysis
-rehydration
-cardiac monitoring/Resp monitoring FOR CLOTS ETC

Causes
•Malnutrition
•Starvation
•Diarrhea
•Malabsorption syndromes
S/S
•Hyperactive reflexes and paresthesias
•Positive Trousseau's and Chvostek's signs
•Skeletal muscle weakness
•Confusion and psychosis
•Decreased GI motility
Interventions
-Magnesium replacement oral/IV
-Teaching
-Encouraging dietary modifications- green leafy vegetables/spinach. Some beans/nuts are also high in magnesium
-Dietician consult as needed

Causes
•Increased intake - foods and drugs
•Decreased kidney excretion of magnesium from kidney disease
ANTACID CONSUMTIONS
S/S
•Bradycardia, hypotension
•Drowsy/lethargic
•Skeletal muscle weakness
Interventions
Keep hydrated
Lower Mg intake

7.35-7.45 pH
45-35 paCO2 RESP
22-26 HCO3 Metabolic
Acidic-Basic
ROME

•Buffers
Act as sponges by soaking up hydrogen ions when too many are present, and squeezing out hydrogen ions when too few are present

•Respiratory system
•Breathing controls amount of free hydrogen ions by controlling amount of CO2 in arterial blood.
•Hyperventilation and hypoventilation will change amounts of arterial CO2
•More sensitive to acidase changes and can begin compensation within seconds to minutes after a change in pH

•Renal system
•More powerful but are not triggered unless imbalance continues for 24-48 hours
•Kidney movement of bicarbonate, formation of acids, formation of ammonium à all can increase excretion and reabsorption rates of acids or bases, depending on direction of pH changes

If respiratory pH & PaCO2
If metabolic pH & HC03
Respiratory acidosis: occurs whenever there is hypoventilation
Respiratory alkalosis: occurs with hyperventilation
Metabolic alkalosis: occurs when a loss of acid (prolonged vomiting or gastric suction) or a gain in bicarbonate (ingestion of baking soda) occurs
Metabolic acidosis: occurs when an acid other than carbonic acid accumulates in the body or when bicarbonate is lost from body fluids

Diagnostic
pH < 7.35
Pac02 > 45
HC03 22-26 (WNL)
Causes
Lower resp stimulazation
Anesthesia
DRUG OD
COPD
Pnemonia
Atelectasis
S/S
Hyperventaliation=HYPOXIA
Rapid shallow breaths
Dysthrymias (INCREASE IN VIT K)
INTERVENTIONS
Maintain patent airway and enhance gas exchange including drug therapy, 02 therapy, positioning and breathing techniques, ventilation support.
Memorize these with the ABGS

Diagnostic
Ø7.45
ØPac02 <35
ØHC03 22-26 (WNL)
Causes
Hyperventilation
Anxiety fear PE
Mechanical ventilation
S/S
Deep rapid breathing
HYPERVENTILATION
HYPOKALEMIA
Numbness tingling of exremidies
INTERVENTION
-Prevent further loss of C02 from lungs, reduce anxiety and fear, bag for hyperventilation to rebreathe C02.
-
-BROWN PAPER BAG RESETTING LUNGS REBREATING CO2
-PULMANARY EMBOLISM (BLOOD CLOT IN LUNG)

Diagnostic
Ph <7.35
PaC02 35-45 (WNL)
HC03 <22
CAUSES
Dia KETO ACID
Severe diarrhea
Renal failure
Shock
S/S
HYPERKALEMIA
Kussmaul breathing
Warmed flushed skin
Muscle twitches
INTERVENTION
hydration, drugs, treatment to control problem.
-DKA- overproduction of hydrogen ions, insulin is given to correct hyperglycemia
-over elimination of bicarb. In diarrhea: rehydration and antidiarrheal drugs given if prolonged diarrhea
-Under elimination of hydrogen ions in renal failure: leads to decreased excretion.

Diagnostic:
pH > 7.45
PaC02 35-45 (WNL)
HC03 >26
CAUSES
SEVERE VOMITTING
EXCESSIVE GI SUCTIONING
Diuretics
S/S
Restlesness into lethargy
HYPOKALEMIA
Dysthrimias (TACHY)
Tremers tinging in fingers and toes
INTERVENTIONS
-Prevent further losses of hydrogen, potassium calcium, chloride ions.
-Restore fluid balance, monitor changes
-Drugs to restore normal fluid, electrolyte and acid-base balance (fluid and electrolytes given orally or parenterally
-Antiemetic drugs to help with nausea and vomiting
-Monitor lab values

a test performed on arterial blood to determine levels of oxygen, carbon dioxide, and other gases present

oParenteral Fluids
•IV solutions
•Parenteral nutrition (TPN)
•Blood and blood components
•Drugs in solution form
oVascular Access Devices
•Short peripheral catheters (IV insertion)
•PICC
•Central catheters
Implanted ports

oLimited Complications
•Infiltration
•Phlebitis
•Thrombosis
•Ecchymosis/Hematoma
Localized Site Infection
LIFE THREATENING COMP
-Blood infection
-Extravasation: accidental administration of IV infused medications into the extravascular space/tissue around the infusion site
-Circulatory overload
-Allergic reaction
-Pneumothorax/hemothorax: air or blood within the pleural cavity
-Air embolism
-RN is responsible for checking the IV site every hour noting any changes or delays in IV care etc.

NO CHANGE IN CELLS (Hydrate us)0.9% ns 5% Dextrose in water (DSW)5% dextrose in 0.22%LACTATED RINGERS (most popular)Dehydration (LR)open iv solutions Post pre surgury after blood loss dehydration situations

CELL SWELLING0.45% saline0.22% saline 0.33% saline Used for Extreme HIGH BLOOD SUGAR DO NOT GIVE TO INTER-CRANIAL PRESSURE PATIENCE

CELLS SHRINK3% saline 5% saline 10% dextrose in water2% dextrose in 0.9% saline5% dextrose in 0.45% saline 5% dextrose in LR Should be given in central line Pateince who have hypernatrimia (low sodium reconcerntrate it) Cerebral edema