Fluids, Electrolytes, Acid-Base Imbalances and IV Therapy

Hinweis der Redaktion

1. Discuss the physical and chemical properties of water that make it an efficient medium for transport, heat regulation, maintenance of hydrogen ion balance, and for enzymatic action. Consider the water component of cells, tissues, organs, and systems. Describe the various fluid compartments.
2. Discuss the hormonal regulation of water. What is the function of the following: Anti-diuretic hormone Aldosterone Atrial natriuretic peptide What are the roles of osmoreceptors and baroreceptors?
3. Compare and contrast diffusion, osmosis, and filtration. What are the effects of hypotonic, isotonic, and hypertonic solutions on the red blood cells? What is the significance of osmotic and hydrostatic pressure in maintaining fluid balance?
4. List specific types of patients who demonstrate the risk factors. Identify specific age groups who are at risk for deficient fluid volume. What are the physiologic changes associated with aging that put the older adult at risk for deficient fluid volume? Explain the role of various hormones that regulate fluid balance.
5. Demonstrate how to elicit these signs of deficient fluid volume. List appropriate nursing interventions associated with these clinical findings. Describe abnormal BP and pulse associated with deficient fluid volume.
6. List appropriate nursing interventions for a patient with acute episodes of nausea and vomiting. What the likely causes of nausea and vomiting? Correlate nausea and vomiting with fluid loss.
7. Discuss the mechanism of action of the various medications used to alleviate nausea and vomiting. What are some common herbal remedies for nausea and vomiting? What is the role of carbonated drinks in alleviating nausea and vomiting?
8. What are the common causes of diarrhea? Compare and contrast diarrhea associated with various health conditions such as ulcerative colitis, irritable bowel syndrome, lactose intolerance, etc. Discuss the use of antidiarrheal medications.
9. List appropriate nursing diagnosis for a patient with diarrhea. Discuss appropriate nursing assessments for patients with abdominal pain associated with diarrhea. What other clinical data must the nurse consider when formulating a plan of care for a patient with diarrhea?
10. What is the rationale for the nursing interventions? What are the cultural considerations regarding these nursing interventions? Identify key points in patient teaching.
11. What is the mechanism of action of these various antidiarrheal medications? What are the key patient teaching instructions regarding antidiarrheal medications?
12. Describe specific nursing actions that: Provide physical and mental rest Prevent unnecessary loss of water and nutrients Protect the rectal mucosa Replace fluids What are some of the considerations when dealing with the older adult?
13. What are the common causes of excess fluid volume? Explain the pathophysiology of the changes in urine concentration associated with excess fluid volume. Correlate changes in urine concentration (urine specific gravity) with antidiuretic hormone, aldosterone, and circulating fluid volume.
14. Explain the pathophysiology of edema. Define “dependent edema.” What is "third spacing“? What are the common causes? What is the pathophysiology? It may occur with extensive trauma, burns, peritonitis, intestinal obstruction, nephrosis, sepsis, and cirrhosis of the liver where there is an increase in capillary hydrostatic pressure or increased capillary membrane permeability.
15. Describe the mechanism of action of various treatment options. What are key patient teaching instructions for a low-sodium diet? What are the rationales for these nursing interventions?
16. How can the nurse motivate the patient to take small amounts of liquids? What are nursing considerations for taking fluids? Describe specific patient teaching instructions regarding access to immediate care and fluid volume deficit.
17. Identify specific nursing considerations regarding daily weights. What are the critical teaching points regarding fluid excess? Describe how the nurse assesses edema.
18. Give examples of negatively charged ions and positively charged ions. Review the various fluid compartments of the body. What are the specific electrolytes responsible for nerve transmission, muscle contraction, and excretion of hormones.
19. Review the different fluid compartments of the body: extracellular fluid compartment and intracellular fluid compartment. Include other fluid compartments like intravascular volume, intercellular fluid compartment, and “third” spacing. What is the importance of serum osmolarity and urine osmolarity?
20. Review the functions of sodium and regulation of sodium balance. Correlate serum sodium with osmolarity and effect on the fluid balance. Discuss the pathophysiology of the signs and symptoms of hyponatremia.
21. Discuss the pathophysiology of the signs and symptoms of hypernatremia. Explain the physiologic responses to hypernatremia. Include hormonal feedback mechanisms. How does the nurse assess the specific signs and symptoms associated with hypernatremia?
22. Review the functions of the potassium ion. Discuss regulation of serum potassium levels. Correlate physiologic functions with the signs and symptoms associated with hypokalemia. Discuss how the nurse assesses these signs and symptoms.
23. Review the role of potassium in the cardiac conduction system. Discuss the role of potassium in muscle contraction and nerve transmission. Correlate the importance of checking potassium levels when giving intravenous solutions containing potassium.
24. Review the function of calcium. Discuss the regulation of calcium. Include vitamin D and parathyroid hormone. Demonstrate Trousseau and Chvostek signs.
25. Discuss the pathophysiology of the signs and symptoms of hypercalcemia. Discuss common causes of hypercalcemia. Correlate cardiac dysrhythmias with calcium levels.
26. Review the function of magnesium. Include its effect on other electrolytes. Discuss the pathophysiology of hypomagnesemia in relation to the various disease processes. Correlate diuretic use with hypomagnesemia.
27. Correlate hypermagnesemia with renal failure. Give examples magnesium-containing antacids and cathartics. Describe how these medications can cause hypermagnesemia.
28. Define “anions” and “cations.” Review the functions of these anions: chloride, phosphate, and bicarbonate. Discuss the physiologic control of chloride.
29. Correlate the anion imbalances with the cation imbalances. Discuss how vitamin D deficiency and hyperparathyroidism affect bicarbonate levels. Correlate hyperphosphatemia with renal failure.
30. What is the importance of buffer systems? What are some of the diagnostic tests that measure buffer systems? Explain the importance of compensatory mechanisms.
31. Give examples of clinical conditions that could potentially cause these acid base imbalances. Discuss physical assessments to determine acid-base imbalances. Review the regulation of acid-base balance.
32. Emphasize the importance of distinguishing between oxygenation and acid-base balance when interpreting arterial blood gases. Review the functions of hydrogen ions and bicarbonate-carbonic acid buffer systems. Compare and contrast oxygen saturation and partial pressure oxygen
33. Give examples of the common disorders that cause respiratory acidosis. Explain how an increase in carbon dioxide could cause increased difficulty in breathing and other signs and symptoms. How does the nurse assess the changes in mental alertness?
34. What is the rationale for these interventions? Demonstrate postural drainage and deep breathing exercises. Explain how respiratory depressants treat respiratory acidosis.
35. Explain how diabetic ketoacidosis causes metabolic acidosis. Correlate renal failure with metabolic acidosis.
36. Explain the pathophysiology of symptoms of metabolic acidosis. Distinguish between confusion and stupor. Explain the pathophysiology of fruity odor and ketone bodies.
37. What is the mechanism of action of insulin? What is the role of dialysis in treating metabolic acidosis? What is the role of the LVN/LPN in the administration of IV bicarbonate or lactate?
38. Explain how anxiety, high fever, and aspirin overdose can cause respiratory alkalosis? What is the underlying cause of respiratory alkalosis? Explain the role of carbon dioxide in respiratory alkalosis.
39. What is the rationale for these interventions? What is the role of the LVN/LPN in implementing these nursing measures? Give specific patient instructions regarding breathing into a paper sack.
40. Explain how vomiting, extensive GI suction, and excessive consumption of antacids with bicarbonate cause metabolic alkalosis. How does steroid therapy cause metabolic alkalosis? Review the mechanism of action of diuretics and how these could potentially cause metabolic alkalosis.
41. How does the nurse assess disorientation and irritability? Explain how metabolic alkalosis causes tetany, seizures, and coma? What are the symptoms of calcium and potassium depletion?
42. What is the role of the LVN/LPN in fluid and electrolytes replacement? What is the mechanism of action of ammonium chloride in the treatment of metabolic acidosis?
43. List critical patient teaching instructions. How does the nurse assess the learning needs of the patient/family? Discuss nursing interventions that promote sodium restriction.
44. What is the role of the LVN/LPN in intravenous therapy? List the responsibilities of the nurse in administering intravenous fluids. What specific intravenous fluids can be administered by the LVN/LPN?
45. What are the emerging roles and responsibilities of the LVN/LPN in intravenous therapy? What is the National Patient Safety Goals and how do these affect nursing practice? What are the roles and responsibilities of the LVN/LPN in caring for vascular access devices and intraosseous infusion?