ppt课件-fluid electrolyte imbalance（液体电解质失衡）.pptVIP

Fluid Electrolyte Imbalance N132 Fluid Imbalance Fluid Volume Deficit(Hypovolemia, Isotonic Dehydration) Common Causes Hemorrhage Vomiting Diarrhea Burns Diuretic therapy Fever Impaired thirst Clinical Manifestations Signs/Symptoms Weight loss Thirst Orthostatic changes in pulse rate and bp Weak, rapid pulse Decreased urine output Dry mucous membranes Poor skin turgor Treatment/Interventions (FVD) Fluid Management Diet therapy – Mild to moderate dehydration. Correct with oral fluid replacement. Oral rehydration therapy – Solutions containing glucose and electrolytes. E.g., Pedialyte, Rehydralyte. IV therapy – Type of fluid ordered depends on the type of dehydration and the clients cardiovascular status. Nursing Implications Monitor postural heart rate and bp when getting patients out of bed Fluid Volume Excess Common Causes: Congestive Heart Failure Early renal failure IV therapy Excessive sodium ingestion SIADH Corticosteroid Clinical Manifestations Signs/Symptoms Increased BP Bounding pulse Venous distention Pulmonary edema Dyspnea Orthopnea (diff. breathing when supine) crackles Treatment/Interventions (FVE) Drug therapy Diuretics may be ordered if renal failure is not the cause. Restriction of sodium and saline intake I/O Weight More to consider? Age Infants Older adults Prior medical history Acute illness Chronic illness Environmental factors Diet Lifestyle Medications Physical Assessment Body systems I/O Weight Labs Electrolyte Imbalance Hypokalemia (3.5mEq/L) Pathophysiology – Decrease in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli Hypokalemia (3.5mEq/L) Contributing factors: Diuretics Shift into cells Digitalis Water intoxication Corticosteroids Diarrhea Vomiting Hypokalemia (3.5mEq/L) Interventions Assess and identify those at risk Encourage potassium-rich foods K+ replacement (IV or PO) Monitor lab values D/c potassium-wasting diuretics Treat underlying cause Hyperkalemia (