MDC II Exam 2 Study Guide.docx - Module 3 and 4 Fluids and...

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Module 3 and 4: Fluids and Electrolytes: Chapter 11Osmosis: Movement of water only through a selectively permeable membranePhysiological Action Hypotonic/Isotonic/Hypertonic Fluids: Clinical ApplicationsIsotonic: When osmolarity of all body fluid spaces is close to 300 mOsm/L (e.g. 0.9% NaCl, Lactated Ringer’s)- Used to ↑ extracellular fluid volumedue to blood loss, surgery, dehydration, fluid loss that has been extracellularHypertonic: > 300 mOsm/L, greater osmotic pressure (e.g. 5% Dextrose in Lactated Ringer’s, 10% Dextrose in water-D10W)- Causes cell shrinking, usually given in ICU through central line due to vesicant status (causes blisters if infiltration occurs), cerebral edema Hypotonic: < 270 mOsm/L, lower osmotic pressure (e.g. 0.45 % NS)- Causes cell swelling, used when the cell is dehydrated and fluids need to be put back in intracellularly such as in diabetic ketoacidosis (DKA)or hyperosmolar hyperglycemiaFluid ImbalancesFactors that affect fluid balance: Age (regulated thirst drive changes, older adults at increased risk), gender, amount of fat (fat cells contain almost no water), dietary intake (kidney excretion and absorption), CKD, endocrine disorders, certain drugs that alter fluid and electrolyte balanceFluid Overload/Hypervolemia: excessive intakeor inadequate excretionof fluids, can lead to HF and PE, dilution of Na+ and K+ can lead to seizures, coma, and deathAssessment Findings:oPittingedema (Anasarca) o↑ HR (bounding), BP, RRoDistendedneck (jugular vein)/hand veinsoWeight gainoSOB
oMoist crackleson auscultationoPale/cool skinoAltered LOC, H/A, visual disturbancesoDecreased lab values(hypokalemia, hypocalcemia, hyponatremia, hypomagnesemia) Interventions:oPatient safety- 1stpriority-assess patient every 2 hours to recognize pulmonary edemaoAssess for skin breakdown(skin care)oAssess Na+ and K+ values (supplemental O2 and semi-fowlers for SOB)oDrug therapy to remove excess fluids: loop diuretics (e.g. furosemide(Lasix)), fluid restrictionoNutrition therapy (monitor I & O, dailyweight, restrict Na because water will follow, check labels)Dehydration (total body water loss)/Hypovolemia (ECF fluid loss):insufficient fluid intake to meet body’s demands, decreased perfusionlow blood O2, (dehydration: too little intake, too much loss, diarrhea, vomiting, excess sweating, blood loss/hemorrhage, kidney disease, inadequate intake) diuretics, DKA, severe dehydration can cause hypovolemiaAssessment Findings:oWeight loss (1L = 2.2 lbs or 1 lb = about 500 mL)o↑ HRto help maintain BP with less blood volumeoWeak peripheral pulses (thready pulse)oOrthostatic hypotension(perfusion to the brain ↓ causing light-headedness/dizziness = ↑ risk for falling)oFlattenedneck/hand veinso↑ RRdue to ↓ blood volume which reduces perfusion and gas exchange (compensatory mechanism that attempts to maintain O2 delivery when perfusion is decreased)o↓ turgor, dry/warm skin and mucous membranes oChanges in cognition (common in older adults, may be 1stsign of fluid imbalance)oLow-grade fever

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