Handouts for Fluid & Electrolytes 1-19-2011

Handouts for Fluid & Electrolytes 1-19-2011 -...

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1 Nursing 412 Spring 2011 Lydia R. Zager, MSN, RN Clinical Professor Copyright ICAN Publishing Inc 2009
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Osmolality – number of molecules of solute per kg  of water   a.  Normal level = 275–295mOsm/kg of body        weight   b.  Fluids with  275-295mOsm/kg = isotonic    c.  Fluids with  > 295mOsm/kg = hypertonic   d.  Fluids with  < 275mOsm/kg = hypotonic    2 Copyright ICAN Publishing Inc 2009
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Oncotic Pressure (colloid osmotic pressure) A pulling force solution has for water due to its protein content. Protein (Albumin) needed to maintain Oncotic  pressure S AFE - System Specific Physiology Fluid Volume 3 Copyright ICAN Publishing Inc 2009
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Oncotic pressure is the influence of: a. Calcium b. Potassium c. Albumin d. Sodium 4 Copyright ICAN Publishing Inc 2009
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What would be some clinical causes that result in fluid volume deficit? 5 Copyright ICAN Publishing Inc 2009
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Assessment of FVD Labs ↑ Hct (more that 3x Hgb) BUN > 20 Specific Gravity > 1.030 Osmolality > 295mOsm/kg water Serum Na > 145 mEq/ L Expected Outcome Evaluation of client’s Labs (↓ to normal range) Hct (3x Hgb) BUN 10 -20 Specific Gravity 1.005 – 1.030 Osmolality 285 - 295mOsm/kg water Serum Na 135 – 145mEq/L 6 Copyright ICAN Publishing Inc 2009
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SAFE TY –Fluid Volume Deficit S –System Assess. A nalys is F irst do Priority Interventions E valuation Outcomes D ecrease in weight D ecreased urine output D ry mucous membranes = ↑ thirst D ecrease in B/P D ecrease fluid to pump so pulse is ↑ D ecreased skin turgur Labs ↑ specific gravity, BUN, Fluid Volum e Deficit F Fluid replacement L Level of consciousness, (safety) report to HCP U Urine < 30 ml / hr, report trends I I & O D Document daily weight, vital signs S Safety - position changes slowly, if in shock -↓B/P (back with legs ↑) M oist mm O riented, Output WNL I mproved skin turgor S pecific gravity WNL T he weight within 2 lbs of client normal N ormal lab values and normal VS 7 Copyright ICAN Publishing Inc 2009
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Client Teaching for Discharge: Maintain adequate hydration Recognize signs and symptoms Daily self-monitoring Weight Fluid intake Urine output Signs and symptoms to report 8 Copyright ICAN Publishing Inc 2009
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    Which system specific assessment findings would the client present with who has been vomiting for 24 hours? a. B/P increase from 110/70 to 130/80 b. Urine output decrease from 95cc/hr to 75cc/hr c. BUN -15 d. Pulse increased from 68/min to 100/min 9 Copyright ICAN Publishing Inc 2009
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What would be the priority nursing intervention for a client with a B/P change from 140/88 to 86/62? a. Put client in supine position with legs elevated.
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Handouts for Fluid &amp;amp; Electrolytes 1-19-2011 -...

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