Fluids and Electrolytes Traditional.pptx - Fluids and Electrolyte s NSG 170 THERESE WILLOUGHBY MSN RN Interrelated Concepts Lots of happy little cells

Fluids and Electrolytes Traditional.pptx - Fluids and...

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Fluids and Electrolyte s NSG 170 THERESE WILLOUGHBY, MSN, RN
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Interrelated Concepts
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Total Body Water (TBW) Lots of happy little cells!
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Extracellula r Fluid
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Fluid & Electrolytes on the Move Osmosis Movement of water Semi-permeable membrane between two fluid spaces where particles cannot move through Diffusion Movement of particles permeable membrane from higher concentration to lower Filtration Fluid movement cell or blood vessel membrane hydrostatic (water) pressure differences Active Transport Movement of ions or molecules Cell membrane From lower to higher concentration Requires energy 5 Fluctuations in water and/or e lectrolytes in the body can be harmful or even fatal
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Dehydration Fluid intake or fluid retention is less than what is needed to meet body’s fluid needs Deficit in fluid volume Common causes: Contributing factors: Body compensatory measures: Types of Dehydration: hypernatremic, hyponatremic, isonatremic Where salt goes – water follows!
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Replacement Fluids See “IV Fluids” Sheet Nursing thoughts: Sudden change in cognition Encouraging fluids Fluid restriction order 7 WARNING: random nursing thoughts
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Replacement Fluids Crystalloids ISOTONIC Normal Saline NS, 0.9% NaCl, Sodium Chloride Dextrose 5% in water D5W, D5 Ringer’s Lactate LR, RL, Lactated ringers HYPOTONIC Half Normal Saline 1/2NS, 0.45% NaCl HYPERTONIC 3% NaCl 5% NaCl Dextrose 10% in water D10W Dextrose 5% in 0.45% NaCl D5 and 1/2 Dextrose 5% in Lactated Ringer’s D5LR
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Replacement Fluids Crystalloids Potential problems when using crystalloids Edema peripheral pulmonary Dilution of plasma proteins (colloids) – reducing osmotic pressure Prolonged use may worsen alkalosis or acidosis
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Replacement Fluids Colloids Albumin 5%, 25% a blood protein – helps keep fluid in vasculature considered a blood transfusion product Fresh Frozen Plasma (FFP) Starches, dextrans, gelatins 10
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Replacement Fluids Blood and Blood Components Whole Blood Packed Red Blood Cells PRBCs Washed Red Blood Cells Platelets Fresh Frozen Plasma FFP White Blood Cells WBC; granulocytes 11 ONLY USE NORMAL SALINE WITH BLOOD PRODUCTS!!
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NURSING PROCESS: ASSESSMENT History – medications, ... Intake and Output Vital Signs – frequency, HR – rhythm & quality Level of activity (LOA) Sensorium Skin turgor, color, temperature Mucous membranes Muscle strength Bowel sounds Sunken – eyes, fontanel Fall risk – gait belt Lab work 12
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ASSESSMENT: Labs 13 BMP (basic metabolic panel, basic, chem 7, chemistry) Glucose Calcium Sodium Potassium Chloride CO2 - bicarbonate BUN Creatinine CMP (comprehensive metabolic panel, chem 12) All of BMP plus... Albumin Total Protein ALP ALT AST Bilirubin URINE 24-hour urine
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Impact of Aging-Related Changes on Fluid Balance Skin: Loss of elasticity, decreased turgor, decreased oil production So... skin becomes unreliable indicator of fluid status, especially back of hand; skin dry and easily damaged Kidneys : Decreased glomerular filtration, decreased
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