7What are the factors that influence body fluids? body fluids ↑ in younger than olderAgeBody fat content Thin people > obese as fat cells contain little waterMale>FemaleSexEnvironmental factors
8The body fluid composition of tissue varies by Tissue type (lean tissues have higher fluid content than fat tissues)Gender (males have more lean tissue and therefore more body fluid)Age (lean tissue is lost with age and body fluid is lost with it)
9Water is essential for life, HOW??? Water is vital to health and normal cellular function as it is amedium for metabolic reactions within cells.transporter for nutrients and waste products.lubricant.Help in regulating and maintaining body temperature.60% of the average healthy adult’s weight is water
10Major Compartments for Fluids (Distribution of body fluids) EXTRACELLULAR FLUID ECF (37 % of fluids is Outside cell)Intravascular fluid - within blood vessels (5%)Interstitial fluid - between cells & blood vessels (15%)Trancellular fluid - cerebrospinal, pericardial , synovialINTRACELLULAR FLUID (ICF 63% of fluids)Inside cellMost of body fluid (40% weight)Decreased in elderly
14Distribution of body fluids Total body fluids =40 litersExtracellular Fluid (ECF)15 LInterstitial Fluid75%Intravascular Fluid20%Lymph +Trans-cellular fluid5%Intracellular Fluid (ICF)25 L
15Fluids Extracellular fluids include Tissue fluid found between the cells within tissues and organs of the body (interstitial)Plasma, the fluid portion of blood that carries the blood cells (intravascular)Trans-cellular fluid - cerebrospinal, pericardial , synovial
16Electrolytes Body fluid is composed of Electrolytes which are mineral salts dissolved in water, including for example:SodiumPotassiumChloridePhosphorus
17What is meant by ELECTROLYTES? *Substance when dissolved in body fluids charged ions & is able to carry an electrical current conducting electricity.* It can be:CATION - positively charged electrolyteANION - negatively charged electrolyte*No. Cations = No. Anions for homeostasis*Commonly measured in milliequivalents / liter (mEq/L)
18WHAT IS THE IMPORTANCE OF ELECTROLYTES Maintaining fluids balanceContributing to acid-base regulationFacilitating enzyme reactionTransmitting neuromuscular reactions
20MILLIEQUIVALENT (mEq) Unit of measure for an electrolyteDescribes electrolyte’s ability to combine & form other compoundsEquivalent weight is amount of one electrolyte that will react with a given amount of hydrogen1 mEq of any cation will react with 1 mEq of an anion
21DEFINITIONS SOLUTE - substance dissolved SOLVENT - solution in which the solute is dissolvedSELECTIVELY PERMEABLE MEMBRANES - found throughout body cell membranes & capillary walls; allow water & some solutes to pass through them freely
22Movement of Body Fluids and Electrolytes It can be by:Diffusion?Osmosis?Filtration?Active transport
23METHODS OF FLUID & ELECTROLYTE MOVEMENT 1- Passive TransportDiffusionOsmosisFiltration2- Active Transportusing energy (ATP)
25DIFFUSIONProcess by which a solute ( ions and molecules) in solution moves as gas or substanceMolecules move from an area of higher concentration to an area of lower concentration to evenly distribute the solute in the solutionIt can be simple or facilitated diffusion
28FACILITATED DIFFUSION Involves carrier system that moves substance across a membrane with simple diffusion , (from area of higher concentration to one of lower concentration)Example is movement of glucose with assistance of insulin across cell membrane into cell
30OSMOSISMovement of the solution =solvent = water across a membrane to equalizes the concentration of ions (solute)on each side of membraneMovement of solvent molecules across a membrane to an area where there is a higher concentration of solute that cannot pass through the membrane
33OSMOTIC PRESSUREPull that draws solvent through the membrane to the more concentrated side (or side with solute )It is determined by relative number of particles of solute on side of greater concentration
34COLLOID OSMOTIC PRESSURE OR ONCOTIC PRESSURE Special kind of osmotic pressure Created by substances with a high molecular weight (like albumin)
35ISOTONIC ISO - means alike TONICITY - refers to osmotic activity of body fluids; tells the extent that fluid will allow movement of water in & out cellMeans that solutions on both sides of selectively permeable membrane have established equilibriumAny solution put into body with the same osmolality as blood plasma.
37HYPOTONIC HYPERTONIC Solution of lower osmotic pressure Less salt or more water than isotonicIf infused into blood, RBCs draw water into cells ( can swell & burst )Solutions move into cells causing them to enlargeSolution of higher osmotic pressure3% sodium chloride is exampleIf infused into blood, water moves out of cells & into solution (cells wrinkle or shrivel)Solutions pull fluid from cells
38HYPOTONIC SOLUTIONS 5% DEXTROSE & WATER 0.45% SODIUM CHLORIDE
42OSMOLALITYMeasure of solution’s ability to create osmotic pressure & thus affect movement of water (tonicity)Number of osmotically active particles per kilogram of waterPlasma osmolality is * mOsm/ kgECF osmolality is determined by sodiumMEASURE used in clinical practice to evaluate serum & urine
44Osmolality In Clinical Practice * Serum mOsm/kgUrine mOsm/kgSerum osmolality can be estimated by doubling serum sodiumUrine specific gravity measures the kidneys’ ability to excrete or conserve water
45Osmolality In Clinical Practice * BUN - blood urea nitrogen; made up of urea an end-product of protein metabolism.inc. with protein intake, fever, & sepsis; dec. with starvation, end-stage liverdx., low protein diet, expanded fluid vol. (as with pregnancy)
46Osmolality In Clinical Practice * Creatinine - end product of muscle metabolism; better indicator of renal function; normal level mg/d LHematocrit - vol. % of RBCs in whole blood; normal level in male %In female %
47FILTRATIONMovement of fluid and solutes together through a selectively permeable membrane from an area of higher hydrostatic pressure to an area of lower hydrostatic pressureArterial end of capillary has hydrostatic pressure > than osmotic pressure so fluid & diffusible solutes move out of capillary
48HYDROSTATIC PRESSUREForce of the fluid pressing outward against vessel wallWith blood not only refers to weight of fluid against capillary wall but to force with which blood is propelled with heartbeat“Fluid- pushing pressure inside a capillary”*
50ACTIVE TRANSPORT SYSTEM Moves molecules or ions uphill against concentration & osmotic pressureRequires specific “carrier” molecule as well as specific enzyme (ATP)Hydrolysis of adenosine triphosphate (ATP) provides energy neededSodium-potassium pump is an active transport system. It moves substances from area of low solutes concentration to a higher one
52REMEMBER MOVEMENT OF SOLUTE ONLY (SUBSTANCE) DEFUSION MOVEMENT OF SOLVENT ((SOLUTION OR WATERONLYOSMOSISMOVEMENT OF BOTHSOLUT AND SOLVENT from area of higher hydrostatic pressure to lower oneFELTERATIONMOVEMENT OF ION OR MOLECULES AGAINST CONCENTRATION OR OSMOTIC PREASSUREACTIVE TRANSPORT
54Regulating Body Fluids I- Fluid intake:In health by:DrinkingEating In illness by:Parenteral route (IV – SC)Enteral feeding (in the stomach or intestine)
55II- Fluid output:Organs of fluids loss:KidneySkinLungsG I T
56Homeostatic Mechanisms Kidneys:The kidneys are functioning under the mastering of aldosterone and antidiuretic hormone (ADH).Regulate electrolytes levels in the ECF by selective retention of needed substances and excretion of unneeded substances.Regulate pH of ECF by excretion or retention of hydrogen ions.Heart and Blood Vessels:If pumping action of the heart fails, it will interfere with the renal perfusion and thus water and electrolytes regulation.
57Homeostatic Mechanisms cont. Lungs:Remove 300 ml of water daily.Cough will ↑ the loss of water.Mechanical ventilation + excessive moisture ↓ loss.Parathyroid Gland:Parathyroid gland secretes parathyroid hormone:It regulates calcium and phosphate balance.It influences Ca++ reabsorption from interstitial and renal tubules
58Homeostatic Mechanisms cont. Pituitary Gland:Hypothalamus manufactures antidiuretic hormone (ADH) which is stored in the pituitary gland as needed for the maintenance of osmotic pressure of the cells by controlling renal water retention or excretion and control blood volume.Adrenal Gland:Adrenal gland secretes aldosterone↑ Secretion of aldosterone → sodium retention → water retention → potassium loss.↓ Secretion of aldosterone → sodium loss→ water loss→ potassium retention.
59INTAKE FLUIDS OUT Ingested liquids 1500 Water in foods 800* Water from oxidation *TOTAL *INSENSIBLESkin *Lungs through expired air *FecesKidneys *TOTAL *
60INTAKE & OUTPUT INTAKE Oral fluids - including ice, gelatin, etc. Parenteral fluidsTube feedings with flushesCatheter irrigants that are not withdrawnOUTPUTUrine outputLiquid fecesVomitusNG drainageExcessive sweatingWound drainageDraining fistulaRapid or labored RR
61Quiz ????1. Who has the highest body % of water? Infant? Adolescent? 50 year old? Elderly?2. The chief cation of the ICF is Sodium? Chloride? Potassium? Phosphorus
62More Questions ????4. If you don’t drink any water or have lost a lot of water, what do you think will happen to: renal blood flow, renal BP, Glomerular filtration rate (GFR), ADH, Urine output5. Your patient’s blood volume is low due to hemorrhage. What do you expect to see with: BP ? HR ? Skin hot or cool ? Urine output ?
63You just ate 4 bags of potato chips so what would you expect? THIRST ?ADH ?OSMOLALITY ?ALDOSTERONE ?URINE OUTPUT ?
64You decide to drink 5 gallons of water so what do you expect ? THIRST ?ADH ?OSMOLALITY ?BLOOD VOLUME ?RENAL BLOOD VOLUME ?URINE OUTPUT ?
65Fluids DisturbancesECF deficit → both Na+ and water loss (hypovolemia or dehydration).In the strict sense dehydration is not an ECF deficit but water deficit only.ECF excess → both Na+ and water retention (hypervolemia or edema).Over hydration is an ↑ only in the amount of water only not electrolytes.
66Assessment of Fluid Balance Health HistoryDaily WeightThirstIntake and OutputVital SignsSkin TurgorMucous MembranesHand Vein Filling/EmptyingLabs – Urine SG; H&H; Sodium; Total Protein; Albumin; Serum Osmolality; BUN; Creatinine
67THIRST Conscious desire for water Major factor that determines fluid intakeInitiated by the osmoreceptors in hypothalamus that are stimulated by increase in osmotic pressure of body fluids to initiate thirstAlso stimulated by a decrease in the ECF volume
68FLUID VOLUME DEFICIT (FVD Hypovolemia or FVD is result of water & electrolyte lossCompensatory mechanisms include: Increased sympathetic nervous system stimulation with an increase in heart rate & cardiac contraction; thirst; plus release of ADH & aldosteroneSevere case may result in hypovolemic shock or prolonged case may cause renal failure
69CAUSES OF FVDAbnormal GI fluid loss such as N&V or drainage of GI tractAbnormal fluid loss from skin such as high temperature or burnsIncreased water vapor from the lungs such as hyperpneaConditions that increase renal excretion of fluids such as diuretics & hypersomolar tube feedingsDecrease in fluid intakeThird-space shift such as ascites or trauma
70LAB VALUES IN FVDINCREASE IN: HEMATOCRIT nl 44*-52*% M nl 39*-47% F BUN nl 10*-20 mg/dl URINE SPECIFIC GRAVITY nl *-1.025*
71SIGNS & SYMPTOMS OF FVD Dry mucous membranes Weight loss Orthostatic hypotension & tachycardiaSubnormal Body temperatureFlat neck veins & decrease in CVPDecreased urinary output & altered sensorium
72NURSING MANAGEMEMT OF FVD Monitoring I&O on a regular schedule depending on the patientIf urine output is below 30 mL / hr. notify the physicianMay check urine specific gravity q 8hrs.Weigh patient daily at the same time & recognize that a change of 2.2 lbs. represents a loss of 1000 mLMonitor skin turgor, oral membranes, lab
73Dehydration !!!! Water isn’t replaced in body Fluid shifts from cells to EC spaceCells lose waterHappens in confused, comatose, bedridden persons along with infants & elderlyMay be treated with hypotonic sol (like dextrose 5% in water)
75Dehydration cont. Risk Factors (Causes) Insufficient intake due to anorexia, nausea, impaired swallowing, confusion, depression.Loss of water and electrolytes from: vomiting, diarrhea, nasogastric suction, excessive sweating, fever, polyuria, abdominal drainage, or wound losses.
76Nursing intervention in dehydration Oral fluid is given at frequent intervals in a small amount.Replace the lost electrolyte.Frequent mouth care.Replace fluids by enteral or parenteral route if oral replacement can not tolerate.Prevent skin breakdown.
77FLUID VOLUME EXCESS FVE FVE is a result of expansion of fluid compartment due to increase in total sodium content .Fluid excess in the intravascular space is called hypervolemia.Fluid excess in interstitial space is called edemaExcess of extra cellular fluid in other body compartment Third space is called. Fluids may be trapped in abdomen, peritoneum (ascites) or plural space (plural effusion).
78SIGNS & SYMPTOMS OF FVE SOB & orthopnea Edema & weight gain Distended neck veins & tachycardiaIncreased blood pressureCrackles & wheezesMay be ascites & pleural effusionIncrease in CVP
79NURSING MANAGEMENT OF FVE Monitor I & O plus monitor for physical signs of hypervolemiaCheck for edema & weigh patient dailyRestrict sodium intake as prescribedLimit intake of fluidsWatch for signs of potassium imbalanceMonitor for signs of pulmonary edemaPlace patient in semi-Fowler’s position
80Nursing management in edema Assessment:Measure intake and output at regular intervals.Assess breath sound.Monitor degree of edema at the most dependent parts of the body.Assess the degree of pitting edema.
81EDAEMAIt is excessive accumulation of fluid isn the interstitial space it may belocalized edema if it due to trauma or inflammation.Generalized edema involves the whole body. It is severe.
82Pitting edema on the foot Pitting edema on the leg
84Water Intoxication !!!! Excess fluid moves from EC space to IC space Happens with SIADH, rapid infusion of hypotonic IV sol or tap water as NG irrigant or enemas; can happen with psychogenic polydipsia ( may drink L/day )Findings Serum NA < 125 mEq/L Serum Osmolality < 280 mOsm/kg
86SODIUM (NA+) DOMINANT EXTRACELLULAR ELECTROLYTE CHIEF BASE OF BLOOD NL SERUM LEVEL mEq/L
87SODIUM (NA)* Main extracellular fluid (ECF) cation Helps govern normal ECF osmolalityHelps maintain acid-base balanceActivates nerve & muscle cellsInfluences water distribution (with chloride)
88SODIUM (NA+) SODIUM AFFECTS FLUID VOLUME & CONCENTRATION IN ECF IS REGULATED BY: Aldosterone Renal blood flow Renin secretion Antidiuretic hormone (ADH) due to its effect on water Estrogen Carbonic anhydrase enzyme
90HYPERNATREMIASerum Na + level > 148 mEq/L serum osmolality > 295 mOsm/kg & urine sp gr > with nl kidneysCollaborative management tries to gradually lower serum sodium by *infusion of 0.45% NaCl *monitoring U/O & serum sodium level *administering fluids carefully* restricting sodium intakeThe thirsty person will not get this !!!!
92Nursing Diagnosis in Hypernatremia Fluid volume deficit r/t abnormal water loss, inadequate water intakeFluid volume excess r/t excessive intake of salt, abnormal Na retentionRisk for injury r/t restlessness and agitationImpaired oral mucous membrane r/t decreased salivationRisk for aspiration r/t stupor
93HYPONATREMIASerum Na+ < 135 mEq/L (patient may be asymptomatic until level drops below 125)Collaborative management seeks to correct cause & give sodium with caution due to possible rebound fluid excess by : *infusing isotonic saline in IV fluids *restricting oral & IV water intake *increasing dietary sodium *monitoring for signs of hypervolemia
94Nursing diagnosis of Hyponatremia Fluid volume excess r/t water intoxication, SIADHKnowledge deficit r/t specific need to replace NaRisk for injury r/t confusion, weakness, seizures
98HYPERKALEMIA K+ > 5.5 mEq/L Dangerous due to potential for fatal dysrhythmias, cardiac arrestMajor cause is renal diseaseEKG shows tall, peaked T waves & dysrthythmiasBeware of pseudohyperkalemia due to prolonged tourniquet, hemolysis of blood, sampling above KCl infusion
99Nursing diagnosis in Hyperkalemia Risk for injury r/t lower extremity weakness, possible seizuresActivity intolerance r/t neuromuscular weaknessRisk for decreased cardiac output r/t dysrhythmia and cardiac conduction changes
100HYPERKALEMIA TX Watch EKG for fatal dysrthymias or cardiac arrest Collaborative management may include: Calcium to counteract effect on heart Sodium bicarbonate to alkalinize fluids Hemodialysis or peritoneal dialysis Cation exchange resins (Kayexalate) by mouth or enema Small dose of insulin & dextrose Restrict dietary K+
102HYPOKALEMIA K+ < 3.5mEq/L Most common type of electrolyte imbalance Major cause is increase renal loss most often associated with diureticsEKG shows dysrhythmias, flattened T waveCan increase the action of digitalisNEVER GIVE K+ IV PUSH & ALWAYS DILUTE IN IV FLUIDS
103Memory Jogger Hypokalemia S - skeletal muscle weaknessU - U wave (ECG changes)C - constipation, ileusT - toxicity of digitalis glycosidesI - irregular, weak pulseO - orthostatic hypotensionN - numbness
104Nursing diagnosis in hypokalemia Altered nutrition, less than body requirementsRisk for injury, vessels, tissues, GI trackAltered urinary elimination of K+Risk for decreased C.O. r/t dysrhythmia from electrolyte imbalance, cardiac arrest
105HYPOKALEMIA TX Correct the cause Oral or IV administration of potassiumSalt substitutes containing K+Foods high in potassium : bananas, pears, dried apricots; fruit juices; tea, cola beverages; milk; meat, fish; baked potato; dried beans (cooked); ANYTHING THAT TASTES GOOD LIKE CHOCOLATE !!
108Fluids represent 60 % of weight Distributed as EXTRACELLULAR FLUID ECF (37 % of fluids is Outside cell)Intravascular fluid - within blood vessels (5%)Interstitial fluid - between cells & blood vessels (15%)Transcellular fluid - cerebrospinal, pericardial , synovialINTRACELLULAR FLUID (ICF 63% of fluids)Inside cellMost of body fluid here - 40% weightDecreased in elderly
109Electrolytes Body fluid is composed of Water Electrolytes: mineral salts dissolved in water, includingSodiumPotassiumChloridePhosphorus
110Movement of Body Fluids and Electrolytes It can be by:Diffusion?Osmosis?Filtration?Active transport
112Fluids DisturbancesECF deficit → both Na+ and water loss (hypovolemia or dehydration).In the strict sense dehydration is not an ECF deficit but water deficit only.ECF excess → both Na+ and water retention (hypervolemia or edema).Over hydration is an ↑ only in the amount of water only not electrolytes.
118Fundamentals of Nursing II 2nd year UNIT III: BASIC NURSING CONCEPTSLecture II:Acid-Base Balance and ImbalanceDr Naiema Gaber
119Acid-Base Balance Objectives Describing the regulation of acid-base balance in the bodyIdentifying nursing interventions for clients with altered acid-base balance.
120Which way will the scale tip???* Acidosis vs. Alkalosis
121DefinitionsAcid: is a substance that can donate hydrogen ions in solution.Strong acid such as hydrochloric acid (HCl)release all the H+.Weak acids like carbonic acid (H2CO3) release some H+.Base or Alkali: is a substance that can accept hydrogen ions in solution.Acidity or alkalinity is measured by pH.
122DefinitionspH: means the concentration of hydrogen ions [H+] of the solution.In the body, weak acids and weak bases regulate acid-base balance to prevent sudden changes in the pH of the body fluids.Normal pH= 7.35 – 7.45.<7.35 = acidosis, >7.45 = alkalosis
123ACID-BASE BALANCEGoverned by the regulation of hydrgen ion (H+) concentration in the bodypH = negative logarithm of the H+ concentrationAcids - proton donors & give up H+Bases - H+ acceptorsAcidic - inc. in concentration of H+Basic - dec. in concentration of H+
127ACID-BASE REGULATORY MECHANISMS CHEMICAL BUFFER SYSTEMS - bicarbonate, phosphate, protein, hemoglobinLUNGS - carbonic acid broken down into CO2 & H2OKIDNEYS - increasing or decreasing bicarbonate ions
128Regulation of Acid-Base Balance Review of definitions Base – accepts or removes hydrogen ionBuffer- controls the hydrogen ion concentration:Absorbing hydrogen ions when an acid is added ORReleasing hydrogen ions when base is added.Three Buffer Systems:Bicarbonate – operates in lungs & kidneysPhosphate – renal tubulesProtein – Hgb, plasma proteins, & intracellular protein
129I. Buffer mechanisms The bicarbonate buffer system (HCO3-). important in controlling the pH of extracellular fluids.2. The phosphate buffer system (HPO4 2- and H2PO4 -)important in controlling pH of intracellular fluids3. The protein buffer system.The largest buffer system inside the cells
130II. Respiratory regulation It controls the rate of CO2 which reacts with water to give carbonic acid which ↑ or ↓ pH of the blood.
131III. Renal regulationThe kidney excretes hydrogen ions (H+) and forms bicarbonate ions (HCO3 -) in specific amounts as indicated by the pH of the blood.
137Respiratory Acidosis* pH < 7.35PaCO2 > 45mm HgDue to inadequate alveolar ventilationTx aimed at improving ventilationRespiratory Opposite
138Respiratory Alkalosis* pH > 7.45PaCO2 < 35mm HgDue to alveolar hyperventilation & hypocapniaTx depends on underlying cause
139Regulation of Acid-Base Balance Respiratory Function pHPC02ConditionDecreasedIncreasedRespiratory acidosisRespiratory alkalosis
140Pair Share – Critical Thinking What acid-base imbalance would you suspect for the patient having respiratory problems with respiratory rate: 28/min and expiratory wheezing?
141Pair Share – Critical Thinking What acid-base imbalance would you suspect for the post-operative patient with respiratory rate 10/min, difficulty to arouse, but arouses with verbal stimuli
142Metabolic Acidosis* pH < 7.35 HCO3 < 22mEq/L Due to gain of acids or loss of base (like excessive GI loss from diarrhea)May have associated hyperkalemiaTx aimed at correcting metabolic defectMetabolic Even
143Metabolic Alkalosis* pH > 7.45 HCO3 > 26 mEq/L Due to loss of acid or gain of base (most common is vomiting or gastric suction)Hypokalemia may produce alkalosisTx aimed at underlying disorder
144Regulation of Acid-Base Balance Metabolic Function pHHC03ConditionDecreasedMetabolic acidosisIncreasedMetabolic alkalosis
145Regulation of Acid-Base Balance > = increased; < = decreased ABGConditionMetabolic process>PCO2Metabolicacidosis< HCO3- elimination by the kidneys – increased acid<PC02Alkalosis>HCO3- elimination by the kidneys –increased base
146Regulation of Acid-Base Balance Arterial Blood Gas Interpretation > = increased; < = decreasedStep 1: Evaluate the pHpH <7.35 = acidosispH >7.45 = alkalosisStep 2: Evaluate Respiratory FunctionPaco2 >45 mm HG = ventilatory failure & respiratory acidosisPaco2 <35 mm HG = hyperventilation & respiratory alkalosis
147Regulation of Acid-Base Balance Arterial Blood Gas Interpretation Step 3: Evaluate Metabolic ProcessesSerum bicarbonate HCO3 <22 mEq/L = metabolic acidosisSerum bicarbonate HCO3 >26 mEq/L = metabolic alkalosisStep 4: Determine the Primary DisorderWhen Paco2 & HCO3 are both abnormal:Determine which follows the deviation from the pHandDeviates the most from normal
148Clinical Manifestation Respiratory acidosisRisk FactorsClinical ManifestationNursing InterventionAcute lung disease: pneumonia, acute pulmonary edema, aspiration of foreign body…Chronic lung disease: asthma, cystic fibrosis, emphysemaOverdose of narcoticsBrain injuryAirway obstructionChest injuryIncreased pulseIncreased respiratory rateHeadacheConfusionConvulsionsWarm flushed skinAssess respiratory status and lung soundMonitor air way and ventilationInhalation therapyPercussion and postural drainageMonitor fluid intake and outputMeasure vital signsMeasure arterial blood gases
149Respiratory alkalosis Risk FactorsClinical ManifestationNursing InterventionHyperventilation due to:-Extreme anxiety-Elevated body temp.-Overventilation-Hypoxia-Salicylate overdoseBrain energyFeverIncreased basal metabolic rateShortness of breathChest tightnessNumbness and tingling of extrimitiesDifficulty concentratingBlurred visionMonitor vital signs and ABGsAssist client to breath more slowlyHelp client breath in a paper bag
150Clinical Manifestation Metabolic acidosisRisk FactorsClinical ManifestationNursing InterventionIncrease of non volatile acids in blood:-renal impairment-DMDecrease in bicarbonates:-Prolonged diarrheaExcessive NaCl infusionSalicylates overdoseCardiac arrestDeep rapid respirationLethargy, confusionHeadacheWeaknessNausea and vomitingMonitor ABG valuesMonitor intake and outputMonitor of LOCAdminister IV sodium bicarbonate
151Clinical Manifestation Metabolic alkalosisRisk FactorsClinical ManifestationNursing InterventionExcessive acid base due to:-Vomiting-Gastric suctionExcessive use of K-losing diuireticsExcessive adrenal corticoid hormones due to:-Cushing’s syndrome-HyperaldosteronismExcessive bicarbonate intake from:-Antacids-Parenteral NaHCO3Increase respiratory rate and depthDizzinessNumbness and tingling of the extremitiesHypertonic muscles, tetanyMonitor intake and outputMonitor vital signs especially respiration and LOCAdminister IV fluid carefully
152EVALUATING ABGs* 1. List pH, PaCO2, & HCO3- 2. Compare to normals & rate as ACID, BASE OR NORMAL. Write A (acid), B (base), or N (normal) or think ROME3. Circle any two letters that are the SAME to tell IMBALANCE.pH PaCO2 80mmHg HCO mEq/l ???? IMBALANCE ????Look at PaO2 & SaO2 for oxygenation
153ABG ASSESSMENT*36 yo pt. complains of acute SOB, R sided pleuritic painpH 7.50PaCO2 29 mmHgPaO2 60 mmHgHCO mEq/lSaO2 78%? Meaning ?32 yo pt. with drug OD & breathing 5 times / minutepH 7.25PaCO2 61 mmHgPaO2 74 mmHgHCO mEq/lSaO2 89%? Meaning ?
154ABGs* 70 year old diabetic with hx of not taking insulin pH 7.26 PaCO2 42HCO3 17????58 year old pt. With CHF for 6 mos. & placed on digoxin & LasixpH 7.48PaCO2 45HCO3 26????
155Resp Failure – Medical Tx Goals Maintain adequate oxygenation & ventilationOxygen therapyMobilization of secretionsEffective coughing and positioningHydration & humidificationChest physical therapyAirway suctioningPositive pressure ventilationRelief of bronchospasmReduction of airway inflammationReduction of pulmonary congestionTreatment of pulmonary infectionsReduction of severe anxiety, pain, and agitationTreat underlying causeMaintain adequate cardiac outputMaintain adequate hemoglobin concentration
156Nursing Diagnosis Top Three Nsg Dx? 66-year old man with shortness of breath, dyspnea, orthopnea, profuse perspiration, feeling like he can’t catch his breath. You observe him to have prolonged expiration.Breath sounds: expiratory wheezing – upper lung fields bilaterally; rhonchi hear in right lung fieldABGs: Pulse Oximetry: 89pH -7.28Paco2 – B/P: 160/90 HR: Resp: 14HCOPao2 – 66Priority Nsg Actions?Top Three Nsg Dx?
157Nursing Diagnosis Ineffective airway clearance Ineffective breathing patternRisk for imbalanced fluid volumeAnxietyImpaired gas exchangeImbalanced nutrition: less than bodyrequirements