...Lewis: Medical-Surgical Nursing, 9th Edition Chapter 17 Fluid, Electrolyte, and Acid-Base Imbalances KEY POINTS HOMEOSTASIS · Body fluids and electrolytes play an important role in maintaining a stable internal environment of the body. · A number of adaptive responses keep the composition and volume of body fluids and electrolytes within the narrow limits of normal to maintain homeostasis and promote health. · Many diseases and their treatments have the ability to affect fluid and electrolyte balance and alter homeostasis. WATER CONTENT OF BODY · Water is the primary component of the body, accounting for approximately 60% of the body weight in the adult. · The two major fluid compartments in the body are intracellular fluid (ICF), or inside the cells, and extracellular fluid (ECF), or outside the cells. ECF is composed of interstitial fluid, plasma, and transcellular fluids. ELECTROLYTES · Electrolyte composition varies between the ECF and ICF, though the overall concentration of the electrolytes is approximately the same in the two compartments. · The measurement of electrolytes is important in evaluating electrolyte balance, as well as in determining the composition of electrolyte preparations. MECHANISMS CONTROLLING FLUID AND ELECTROLYTE MOVEMENT · Many different processes are involved in the movement of electrolytes and water between the ICF and ECF. Some of these include simple diffusion, facilitated diffusion, and active transport. Two forces...
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... C.W. underwent surgery for his gastrointestinal bleed and then was admitted to the hospital for having a fluid volume deficit, due to his diarrhea and bleed. C.W. being volume deficit made his fluid, electrolyte and blood levels become very abnormal. His medication that he was on for prior health history was causing some of his levels to rise and drop. He has a past medical history of cardiovascular problems, which were described and attributed to his current admitting problems. While at the hospital he went into sinus tachycardia and was placed on a Swan-Ganz catheter. One of the main goals for treating C.W. is to control his tachycardia and control his levels. He has some serious cardiovascular conditions that can not be healed but medical professionals, using education and medication , can better his quality of the life he has left. Patient C.W., a 70-year-old male, was admitted to the hospital at 0430 with a 25-X15-mm duodenal ulcer causing a gastrointestinal bleed, which was presented by “ dark red “ bloody diarrhea. His wife states that he has had diarrhea for 3 days with “dark red” stool starting the night before. She states that when he became “very dizzy, disoriented and weak” in the morning she decided to bring him to the hospital. He went through surgery, which was successful, but then was admitted to the medical intensive care unit for his volume deficit. C.W. has a history of having an idiopathic dilated cardiomyopathy, which has now become a severe problem,...
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...whose fluid and electrolyte or acid-base imbalance is altered using tables in book, which describes parameters to be considered in physical and clinical assessments for fluid, electrolyte, and acid-base balance. Compare and contrast your findings. • Neck veins and central venous pressure- healthy adult: normally when the patient is supine the external jugular veins will fill to the anterior border of the sternocleidomastoid muscle. With the patient sitting at a 45 degree angle venous distention normally should not extend higher than 2cm above the sternal angle. Altered patient: decreased blood volume (low cvp) increased blood volume, heart failure, vasoconstriction (high cvp) • Neuromuscular irritability-healthy adult: assess for increase or decrease neuromuscular activity = negative response. Altered patient: patients with hypocalcaemia or hypomagnesaemia respond positively with unilateral twitching of the facial muscles, including the eyelids and lips. A partial response is the development of carpal spasm. • Comparison of total intake and output of fluids-healthy adult: fluid intake equals fluid output when averaged over 2-3 days. Range of 1500-3500ml fluid intake and loss 2000ml is average adult intake and loss per day. Altered patient: when the total intake is substantially less than the total output, the patient is in danger of fluid volume deficit. When the total intake is substantially more than the total output, the patient volume excess. • Urine volume and concentration-healthy...
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...Extracellular fluid volume deficit related to invasion of the stomach and intestine by a virus manifested by nausea and vomiting STG: Child will return to normal hydration status as evidenced by moist mucus membranes by discharge. LTG: Child will be free from vomiting and regain weight lost during the illness within two weeks of being free from illness by tolerating a regular diet. 1. Teach care providers to practice proper hand washing. 2. Check identification bands are correct and intact q. shift 3. Assess vital signs q.4hrs 4. Assess child’s hydration by assessing mucus membranes and skin turgor and capillary refill q.4hrs 5. Monitor and record I & O q. hr 6. Administer IV fluid D5 1/4NS @ 40ml/hr per doctor’s order. 7. Weigh child on same scale at same time each day and compare to previous weight. 8. Monitor lab tests. 1. Rigorous hand hygiene reduces bacterial counts on the hands and reduces the transmission of pathogens to clients and personnel. 2. Provides assurance of security and follows hospital protocol. Also prevents correct medication administration. 3. Vital signs: Severe dehydration resulting from extracellular fluid loss and reduced circulating blood volume cause hypovolemia. The body will try to compensate for the fluid loss by increasing the heart rate and increasing the respiratory rate and lowering the blood pressure and temperature. 4. Frequent assessment of hydration status facilitates rapid intervention and evaluation...
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... Delayed Surgical Suffocation, risk for Suicide, risk for Therapeutic Regimen: effective management Therapeutic Regimen: ineffective management Therapeutic Regimen management: readiness for enhanced Therapeutic Regimen: Family, ineffective management Therapeutic Regimen: Community, ineffective management Trauma, risk for Wandering (specify sporadic or continual) NUTRITIONAL— METABOLIC PATTERN Aspiration, risk for Body Temperature, imbalanced, risk for Breastfeeding, effective Breastfeeding, ineffective Breastfeeding, interrupted Dentition, impaired Failure to thrive, adult Fluid Balance, readiness for enhanced Fluid Volume, risk for deficient Fluid Volume Deficient [active loss] Fluid Volume Deficit [regulatory failure] Fluid Volume Deficit, risk for Fluid Volume Excess Fluid Volume Imbalance, risk for Hyperthermia Hypothermia Infant Feeding Pattern, ineffective Latex Allergy Response Latex Allergy Response, risk for Nausea Nutrition: imbalanced, less than body requirements Nutrition: imbalanced, more than body requirements Nutrition: imbalanced, risk for more than body requirements Nutrition: readiness for enhanced Oral Mucous Membrane, impaired Skin Integrity, impaired Skin Integrity, impaired, risk for Swallowing, impaired...
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...A Complete Patient Assessment Susan Eisen RN Ramapo College of New Jersey A 63 y/o African American female presents to the emergency room complaining of shortness of breath worsening over the past week. Patient states she becomes severely short of breath while preforming everyday activities and has noticed that her legs have been “getting bigger”. Patient had been sleeping with 3-4 pillows a night for comfort and occasionally sleeping in a recliner. Patient states this evening she got up to use the restroom and had a sudden onset of severe shortness of breath. Felt as though she wasn’t moving any air. Patient called 911. The paramedics on scene established IV access and medicated patient with 40 of furosemide and Nitroglycerin sublingual 0.4 mg times 3 doses. Patient was placed on CPAP and brought to the ER. Upon arrival CPAP was continued, a nitroglycerin infusion was started at 20mcg/min. Additional IV access was established and labs were obtained. Stat EKG and Chest Xray were completed. Additional dose of furosemide 80mg was administered IV push and patient was provided with an indwelling foley catheter which is draining clear yellow urine. Past Medical History is significant for Hypertension, Diabetes, Congestive Heart failure, and Atrial Fibrillation with two unsuccessful cardioversions. Medications: Patient currently taking Furosemide, Lisinopril, Digoxin, ...
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...term dehydration may be used loosely to refer to any condition where fluid volume is reduced; most commonly, it refers to hypernatremia (loss of free water and the attendant excess concentration of salt), but is also used to refer to hypovolemia (loss of blood volume, particularly plasma). What electrolyte imbalances would you expect to find with dehydration?may show hypernatremia, isonatremia, or hyponatremia; enteral losses: associated with hypokalemia and low bicarbonate level; crush injuries and burns: may be associated with hyperkalemia. Urine Osmolality usually>450 mOsm/kg. The urine specific gravity of normally functioning kidneys: >1.025; abnormally functioningkidneys: normal or inappropriately lowWhat assessment findings are consistent with dehydration?Mental status, activity level assessment: this provides critical diagnostic information. Infants and smallchildren who are inconsolable or listless, or do not seem to resist invasive or uncomfortable proceduresshould be assumed to have serious illness.Mucous membranes: dry or tacky mucous membranes are seen with hypovolemia; pallid mucous membranessuggest chronic blood loss.Capillary refill: classically, volume depletion is associated with a prolonged capillary refill time (>3 seconds).This is most likely to be true in the setting of gradual volume depletion, as is seen in gastroenteritis. A meta-analysis concluded that the 3 most useful clinical findings in a child with volume depletion and dehydrationwere prolonged capillary...
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...Water is essential to maintain blood volume, regulate body temperature and allow muscle contractions to take place. During exercise, the main way the body maintains optimal body temperature is by sweating. Heat is removed from the body when beads of sweat on the skin evaporate, resulting in a loss of body fluid. Sweat production, and therefore fluid loss, increases with a rise in ambient temperature and humidity, as well as with an increase in exercise intensity. Drinking fluid during exercise is necessary to replace fluids lost in sweat. This will reduce the risk of heat stress, maintain normal muscle function, and prevent performance decreases due to dehydration. In most cases during exercise, the rates of sweat loss are higher than the rate you can drink, so most athletes get into fluid deficit. Therefore, fluid guidelines promote drinking more fluid to reduce the deficit and potential performance detriments associated with dehydration. However, it is also important to acknowledge that it is possible to over-drink during exercise. Drinking more fluid than is comfortable, in any conditions, has the potential to interfere with your performance. In cool weather or when the exercise pace is gentle, the rate of sweat loss may be quite low. It is unnecessary and potentially dangerous to drink at rates that are far greater than sweat losses. Knowing your sweat rate can give you an indication of how much you should be drinking during exercise. Dehydration and Performance...
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...Glimepride 4 mg everyday by mouth. Subjective: my client told me that she had been diabetic for almost 25-30 years. She also told me that she feels dizzy most of the time. She said that she spends most of time in bed by taking plenty of rest. Objective: I seen my client became tired really soon. For example, after taking shower she feels tired and goes to bed. Evidence Based Research Related to Medical Diagnosis: 1. Diabetes Mellitus type-2 2. Prevention of complications of diabetes Oral therapies for T2D. Nursing Diagnoses (prioritized): (1) Fluid volume deficit r/t osmotic diuresis AEB polydipsia and sweet taste of urine. (2) Imbalanced nutrition less than Body requirements r/t insufficiency of insulin, decreased oral input AEB consuming very less vegetables and fiber in the diet. (3) Risk for infection related to hyperglycemia AEB polydipsia, polyuria, and polyphagia. #1 nursing diagnosis: fluid volume deficit r/t osmotic diuresis AEB polydipsia and sweet...
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...Another type is the hyponatremia with decreased extracellular volume, which consists of sodium and water deficits, seen more in chronic renal disease, osmotic diabetic diuresis, and mineralocorticoid to mention but a few. Subsequently, in non-renal conditions such as dehydration, diarrhea, vomiting, burns, endurance exercise and diaphoresis may be the cause. Excessive production of ADH increases the glomerular filtrate and sodium reabsorption decreases, resulting in higher urine osmolality than high serum level. Although, the renal, cardiac, hepatic, adrenal, and the thyroid function within normal range (Buttaro, et al, 2013) Signs and Symptoms Signs and symptoms of hypernatremia include: headache, thirst, dry skin, and mucus membrane, elevated temperature, weight loss, reduced or concentrated urine due to water deficit. Fortunately, symptoms of hypovolemia associated with this condition include: tachycardia, weak pulse, and postural hypertension (Heuther, & McCance, 2013). Signs and symptoms of hyponatremia include; cerebral edema with confusion and convulsion. Weakness nausea, muscle twitching, headache, weight gain due to water retention (Huether, & McCance, 2013). Causes...
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...reimbursement for nursing care (Thede & Schwirian, 2015). NANDA-I states that it’s diagnoses are intended to communicate the professional judgements that nurses make every day to patients, other healthcare professional and the public (NANDA International, 2015). NANDA-I diagnoses relevant to the patient scenario given are 1) fluid volume deficit related to increased fluid loss and insufficient fluid intake 2) electrolyte imbalance related to increased fluid loss and insufficient fluid intake 3) knowledge deficit. The Center for Nursing Classification and Clinical Effectiveness, CNC (2015) defines the Nursing Intervention Classification (NIC) as a comprehensive, research-based, standardized classification of nursing interventions. “The Classification includes the interventions that nurses do on behalf of patients, both independent and collaborative interventions, both direct and indirect care” (CNC, 2015). NIC interventions relevant to the discussed scenario are fluid and electrolyte management. Activities or interventions include: 1) monitor for abnormal serum electrolytes, 2) monitor for manifestations of electrolyte imbalance, 3) maintain patent IV access and administer fluids, as...
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...disease, is referred to as inflammatory bowel disease (IBD). IBD is characterized by diarrhea (up to 20 stools during acute exacerbation), crampy abdominal pain, and exacerbations (“flare-ups”)/remissions. B. Pathophysiology Ulcerative colitis usually starts in the rectum and moves in a continual fashion toward the cecum. Although there is sometimes mild inflammation in the terminal ileum, ulcerative colitis is a disease of the colon and the rectum. The inflammation and ulcerations occur in the mucosal layer, the inner-most layer of the bowel wall. Since it does not extend through all bowel wall layers, fistulas and abscesses are rare. Water and electrolytes cannot be absorbed through inflamed mucosa. Diarrhea with large fluid and electrolyte losses is a characteristic feature of damage to the colonic mucosa epithelium. Breakdown of cells results in protein loss through stool. Areas of inflamed mucosa form pseudo-polyps, tongue-like projections into the bowel lumen. C. Common signs & symptoms or clinical manifestations The common signs of ulcerative colitis include diarrhea, bloody stools, weight loss, abdominal pain, fever and fatigue. It is considered a chronic disorder a chronic disorder with mild to severe acute exacerbations that occur at unpredictable intervals over many years. The primary manifestations of ulcerative colitis are bloody diarrhea and abdominal pain. Pain may vary from the mild lower abdominal cramping associated...
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...Family Health Evaluation Introduction Health Assessment is the plan of care that identifies or recognizes particular needs of an individual and how the needs will be addressed and conducted by the health practitioners or health care systems. Health Assessment is the gathering of information by physical assessment or extensive medical questionnaire. The health evaluation is done diagnose diseases early in characters that seem to be in good health condition. The purpose of the health assessment is to establish a plan of care for the patient and family. The health assessment takes into consideration eleven health patters. The interview was conducted using these eleven health care patterns with three open ended family focused questions per health pattern. A family health assessment is a critical approximation tool used in the healthcare system for the formulation of the family health plan. The research by the health practitioners as in the paper gives detailed information on the role of nurses in the family assessment and how the task can be done. Based on Gordon's principle of functional health pattern, the paper provides a summary of the findings of the health patterns of the involvement of the family with the inclusion of nursing diagnosis of each assessment offered to them. The use of this technique creates a standard systematic approach to collect information and data analysis considering the nurses determine to consider the aspects of health management, sexuality, sleep/rest...
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...Japanese Encephalitis is identified as a leading form of viral encephalitis that is known to be spreading globally. Belonging to the genus Flavivirus and the family of Flaviviridae, Japanese encephalitis exists in a zoonotic cycle that occurs in mosquito and vertebrate hosts, such as water birds and pigs. Epidemiological patterns of Japenese encephalitis have been discovered in both epidemic and endemic regions. Shlim and Solomon's (2002) research found: In northern temperate areas (Japan, Taiwan, China, Korea, northern Vietnam, northern Thailand, Nepal, and northern India), large epidemics occur during the summer months (roughly, May to October). In Southern tropical areas (southern Vietnam, southern Thailand, Indonesia, Malaysia, Philippines, Sri Lanka, and southern India), JE tends to be endemic; here, cases occur sporadically throughout the year, with a peak after the start of the rainy season. (p. 184) Japanese encephalitis has been more commonly seen in children or in visitors to areas of the endemic region than in resident adults. In endemic countries, adults acquire immunity through natural infection. Solomon's (2004) research found: In rural Asia, where exposure to infected mosquitos is unavoidable, serologic surverys show that almost everyone is exposed to Japanese encephalitis virus during childhood. However, fever develops in only a small proportion (about 1 in 300) of those exposed, and neurologic disease develops in even fewer persons. Thus, Japanese...
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...Introduction An athlete needs to ensure that they consume enough fuel to complete activities undertaken. The amount of energy required depends on many factors including size and weight of the athlete, level and intensity of the training, and due to this the amount of energy required varies from person to person. However if more energy is consumed than required, the excess is stored as fat and weight will increase, on the other hand if insufficient energy is consumed the body calls upon its stores to meet the demand and weight will be lost. To consume a balanced diet we need to consume items from the macro and micro nutrient groups. Macronutrients comprise of carbohydrates, lipids and protein. Carbohydrates are quickly accessible and thus the body utilises them first, lipids are the body’s secondary source, and protein is the body’s last energy source to be used. While the micronutrients comprise of vitamins and minerals. Water is also an essential part of the human diet. Female 400m Runner Firstly the athlete’s calorie requirements need to be worked out to find out what is needed each day before any training is undertaken. To do this the following calculation is made – BMR = (8.7 x 56(kg)) + 829 x 2.2, so BMR = 2895.64 calories a day. Now the activity requirement needs to be taken into account, at 1075 calories p/h. As exact training figures are not available it has been estimated that 6 hours are completed each week, which works out as an extra 6450 calories a...
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