水電解質(zhì)平衡護(hù)理雙語

1、UNIT IIINursing Sciences,,UNIT III Nursing Sciences,Fluids and Electrolytes,Chapter 9,CRITICAL THINKING,What Should You Do?The nurse notes the presence of U waves on a client’s cardiac monitor screen. What action(s) sh

2、ould the nurse take?,Pyramid terms,Fluid volume deficit/excess 體液不足/體液過多Homeostasis 內(nèi)穩(wěn)態(tài)Hyper- 過高Hypo- 過低E.g. Hypertension高血壓Hypotension 低血壓,Pyramid terms,Sodium 鈉 135-145 mEq/LHypernatremia Hyponatremia Calci

3、um 鈣 8.6-10 mg/dLHypercalcemiaHypocalcemiaPotassium 鉀 3.5-5.1 mEq/LHyperkalemiaHypokalemia,Pyramid terms,Magnesium 鎂 1.6-2.6 mg/dLHypermagnesemiaHypomagnesemia Phosphorus 磷 2.7-4.5 mg/DlHyperphosphatemiaHypopho

4、sphatemia,Properties of Electrolytes and Their Components(BOX 9-1),Atom 原子Molecule 分子Ion 離子Cation陽離子['kæta??n]Anion 陰離子,Body Fluid Compartments,Intracellular(ICF): all fluid inside the cells (70%)細(xì)胞內(nèi)液Extra

5、cellular(ECF): fluid outside the cells(30%)細(xì)胞外液Interstitial細(xì)胞間液Intravascular: fluid inside a blood vessel血管內(nèi)液,,,,,Third-spacing第三間隙液Disease or injuryFluid may be trapped in body spaces such as the pericardial, pleura

6、l, peritoneal, or joint cavities; the bowel; or the abdomen; or within soft tissues after trauma or burnsEdema[i'di?m?] 水腫,Body Fluid,Infants and older adults need to be monitored closely for fluid imbalances！,,,ICF

7、 is mostly water and is rich in K+，Mg2+，, SO4，HPO4，and protein atoms.ECF contains more Na+, Cl-, HCO3-, and Ca2+.,Blood fluid transport,Diffusion擴(kuò)散 – spread the molecules from an higher concentration to an area of Low

8、er concentration.,,Osmosis滲透 – from a Less concentrated solute into a More concentrated solute.,Filtration過濾 – from Higher hydrostatic pressure to a Lower one. Regarding to the weight.,Body fluid transport,Hydrostatic

9、pressure靜水壓Osmolality滲透壓,Body fluid intake and output,Homeostasis,,,,Fluid Volume Deficit體液不足,Dehydration 脫水TypesIsotonic dehydration等滲性脫水：水、鈉成比例丟失Hypertonic dehydration高滲性脫水：失水為主Hypotonic dehydration低滲性脫水：失鈉為主,Flu

10、id Volume Deficit體液不足,Diminished peripheral pulseDeep respirationFeverDecrease urine outputDry skin，dry mouthThirst,TABLE 9-1 Assessment Findings: Fluid Volume Deficit and Fluid Volume,Interventions,In general, iso

11、tonic dehydration is treated with isotonic fluid solutions, hypertonic dehydration with hypotonic fluid solutions, and hypotonic dehydration with hypertonic fluid solutions.,Fluid Volume Excess體液過多,Overhydration or fluid

12、 overload水中毒TypesIsotonic OverhydrationHypertonic OverhydrationHypotonic Overhydration,Fluid Volume Excess體液過多,Overhydration or fluid overloadElevated blood pressure CVC(central venous pressure中心靜脈壓） ↑Shallow res

13、piration淺呼吸Increase or decrease urine outputPale，Cool skin,TABLE 9-1 Assessment Findings: Fluid Volume Deficit and Fluid Volume,Interventions,Administer diuretics; osmotic diuretics typically are prescribed first to pr

14、event severe electrolyte imbalances.Monitor electrolyte values, and prepare to administer medication to treat an imbalance if present.,A client with acute kidney injury or chronic kidney disease is at high risk for flui

15、d volume excess.,Practical questions,,The nurse is assigned to care for a group of clients. On review of the clients’ medical records, the nurse determines that which client is most likely at risk for a fluid volume defi

16、cit?1. A client with an ileostomy2. A client with heart failure3. A client on long-term corticosteroid therapy4. A client receiving frequent wound irrigations,1,The nurse caring for a client who has been receiving in

17、travenous (IV) diuretics suspects that the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition?1. Lung congestion2. Decreased hematocrit3. Incre

18、ased blood pressure4. Decreased central venous pressure (CVP),4,The nurse is assigned to care for a group of clients. On review of the clients’ medical records, the nurse determines that which client is at risk for flui

19、d volume excess?1. The client taking diuretics2. The client with kidney disease3. The client with an ileostomy4. The client who requires gastrointestinal suctioning,2,Sodium,鈉 135-145 mEq/LHypernatremia低鈉血癥 Hyponat

20、remia 高鈉血癥,Na+,Hyponatremia and hypernatremia,Normal serum sodium level Na+ : 135-145 mEq/LCommon food sources: Box 9-2,p88Causes Assessment: Table9-2.p89Intervention,Na+,Common food sources: Box 9-2,p88,Bacon熏肉But

21、ter黃油Canned food罐頭食品Cheese奶酪Frankfurters灌腸Ketchup番茄醬Lunch meat午餐肉,Milk牛奶Mustard芥菜Processed food加工食品Snack food休閑食品Soy sauce醬油Table salt食鹽White and whole-wheat bread白面包和全麥面包,Na+,Hyponatremia＜135 mEq/L低鈉血癥,Cause

22、s: Diuretics利尿劑Wound drainage, especially gastrointestinalRenal disease/failureAldosterone(醛固酮）↑Low-salt dietExcessive ingestion of hypotonic fluids or irrigation with hypotonic fluids過度攝入低滲的液體或沖洗低滲的液體Freshwater d

23、rowning淡水淹溺Syndrome of inappropriate antidiuretic hormone(抗利尿激素)secretionHyperglycemia高血糖癥Congestive heart failure充血性心力衰竭,Na+,Hypernatremia >145mEq/L,Causes: Corticosteroids皮質(zhì)類固醇Cushing’s syndromeRenal failureH

24、yperaldosteronism高醛甾酮癥Oral sodium ingestion/sodium-containing IV fluidsDecreased Water intake: Nothing by mouthIncreased water loss: metabolism↑， fever, hyperventilation換氣過度, infection, excessive diaphoresis, watery d

25、iarrhea, diabetes insipidus（尿崩癥）,Na+,Assessment,Hyponatremia,hypernatremia,Shallow, ineffective respiratory movement淺的，無效的呼吸運動Generalized skeletal muscle weakness全身骨骼肌肉無力Headache, seizures頭痛，癲癇發(fā)作Hyperactive bowel soun

26、ds腸鳴音亢進(jìn)Dry mucous membranes粘膜干燥,Hypervolemia → pulmonary edema肺水腫Extreme thirst極度口渴Decreased urinary output尿量減少,Na+,Intervention,Monitor cardio, renal……statusIf the client is taking lithium, hyponatremia can cause di

27、minished lithium(鋰） excretion, resulting in toxicity!! → → →monitor the lithium level!!!,The nurse is reviewing laboratory results and notes that a client’s serum sodium level is 150 mEq/L. The nurse reports the serum so

28、dium level to the health care provider (HCP) and the HCP prescribes dietary instructions based on the sodium level. Which food item does the nurse instruct the client to avoid?1. Peas2. Nuts3. Cauliflower4. Processed

29、 oat cereals,4,The nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium level of 130 mEq/L on one client’s laboratory report. The nurse understands that which client is at hig

30、hest risk for the development of a sodium value at this level?1. The client who is taking diuretics2. The client with hyperaldosteronism3. The client with Cushing’s syndrome4. The client who is taking corticosteroids

31、,1,The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendo

32、n reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in a client with hyponatremia?1. Muscle twitches2. Decreased urinary output3. Hyperactive bowel sounds4. Increased spe

33、cific gravity of the urine,3,Potassium K+ 3.5-5.0 mEq/L,Common food sources Avocado鱷梨BananasCantaloupe哈密瓜Carrots胡蘿卜FishMushroomsOrangesPotatoesPork, beef, vealRaisins葡萄干Spinach菠菜StrawberriesTomatoes,Hypokal

34、emia - 5.1mEq/L 高鉀血癥 Major cause : Renal failure；Addison’s disease,K+,,Potassium is never administered by IV push, intramuscular, or subcutaneous routes.嚴(yán)禁通過靜脈推注、肌肉注射或皮下補鉀。IV potassium is always diluted and admini

35、stered using and infusion device.通過靜脈補鉀時必須稀釋?。?！,K+,ECT Changes in Electrolyte Imbalances,,The nurse provides instructions to a client with a low potassium level about the foods that are high in potassium and tells the c

36、lient to consume which foods? Select all that apply.1. Peas2. Raisins3. Potatoes4. Cantaloupe5. Cauliflower6. Strawberries,2/3/4/6,,The nurse is preparing to care for a client with a potassium deficit. The nurse re

37、views the client’s record and determines that the client was at risk for developing the potassium deficit because of which situation?1. Sustained tissue damage2. Requires nasogastric suction3. Has a history of Addison

38、’s disease4. Is taking a potassium-retaining diuretic,2,,The nurse reviews a client’s electrolyte laboratory report and notes that the potassium level is 2.5 mEq/L. Which pattern would the nurse note on the electrocardi

39、ogram as a result of the laboratory value?1. U waves2. Absent P waves3. Elevated T waves4. Elevated ST segment,1,,The nursing student needs to administer potassium chloride intravenously as prescribed to a client wit

40、h hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which action is part of the plan for preparation and administration of the potassium?1. Obtai

41、ning an intravenous (IV) infusion pump2. Monitoring urine output during administration3. Preparing the medication for bolus administration4. Ensuring that the medication is diluted in the appropriate amount of normal

42、saline,3,Hypocalcium - 10mg/dLAssessment findings: Absent deep tendon reflex,Ca2+,Hypocalcemia and hypercalcemia,Serum calcium level: 8.6-10 mg/dLCommon food sources: box 9-5,p92Causes

43、Assessment: Table 9-5,p93Intervention,Ca2+,Causes of hypocalcemia,Lactose intolerance乳糖不耐癥Malabsorption吸收不良syndromes: celiac sprue乳糜瀉or Crohn’s disease克羅恩病End-stage renal diseaseRenal failure, polyuric phaseDiarrhe

44、aSteatorrhea脂肪痢Wound drainage, especially gastrointestinal,Ca2+,Causes of hypocalcemia Cont.,Hyperproteinemia高蛋白血癥Alkalosis堿中毒Medications such as calcium chelators螯合劑or binders粘結(jié)劑Acute pancreatitis急性胰腺炎Hyperphospha

45、temia高磷酸鹽血癥ImmobilityRemoval or destruction of the parathyroid glands甲狀旁腺,Ca2+,Causes of hypercalcemia,Oral intake of calcium/vitamin D↑Renal failureUse of thiazide diuretics噻嗪利尿劑 Hyperparathyroidism甲狀旁腺機(jī)能亢進(jìn)Hyperth

46、yroidism甲狀腺機(jī)能亢進(jìn)Malignancy惡性（腫瘤等）Glucocorticoids糖皮質(zhì)激素Adrenal insufficiency腎上腺機(jī)能不全,Ca2+,Interventions,Vitamin DHypo: initiate seizure precautionsMonitor for hypercalcemiaPathological fractureMove the client carefull

47、y and slowly Assist the client with ambulation,Ca2+,,The nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client?1. Twitching2.

48、 Hypoactive bowel sounds3. Negative Trousseau’s sign4. Hypoactive deep tendon reflexes,,.The nurse caring for a client with hypocalcemia would expect to note which change on the electrocardiogram (ECG)?1. Widened T wa

49、ve2. Prominent U wave3. Prolonged QT interval4. Shortened ST segment,Hypomagnesemia - 2.6mg/dL,Mg2+,Hypophosphatemia - 4.5 mg/dL,Hypophosphatemia and hyperphosphatemia,Serum phosphorus level: 2.7-4.5 mg/dLCommon foo

50、d sources: box 9-7,p95Causes AssessmentIntervention,Causes of hypophosphatemia,Intake ↓:malnutrition and starvationExcretion ↑:hyperparathyroidism（甲狀旁腺功能亢進(jìn)）, malignancy（惡性腫瘤）, magnesium-based antacids（抗酸劑）Hyperglyce

51、mia（高血糖）Respiratory alkalosis（呼吸性堿中毒）,Causes of hyperphosphatemia,Renal failureTumor lysis syndrome腫瘤溶解綜合征Intake ↑:dietary, phosphorus-containing laxatives（瀉劑） or enemas（灌腸）Hypoparathyroidism 甲狀旁腺功能減退,,The nurse revi

52、ews a client’s laboratory report and notes that the client’s serum phosphorus level is 2 mg/dL. Which condition most likely caused this serum phosphorus level?1. Alcoholism2. Renal insufficiency3. Hypoparathyroidism4

53、. Tumor lysis syndrome,CRITICAL THINKING,What Should You Do?The nurse notes the presence of U waves on a client’s cardiac monitor screen. What action(s) should the nurse take?,AnswerCardiac changes in hypokalemia inclu

54、de impaired repolarization, resulting in a flattening of the T wave and eventually the emergence of a U wave. Therefore, the nurse should suspect hypokalemia. The incidence of potentially lethal ventricular dysrhythmias

55、is increased in hypokalemia. The nurse should immediately assess the client’s vital signs and cardiac status and for signs of hypokalemia. The nurse should also check the client’s most recent serum potassium level and th