Alterations in Fluid and Electrolytes & Case Study 4 Notes PDF

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Taught by Paul Stubbings/ Shellie Steidle...

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N201- Alteration in Fluid and Electrolytes & Case Study #4 1. Explain the various types of dehydration and the causes of each.

Isotonic Dehydration - When proportionally the same amount of water and sodium is lost from the body, the sodium concentration of the extracellular fluid and hence its tonicity will not change in most cases about 80% of dehydration is isotonic - Causes  Excessive sweating  Not drinking enough  Repeated vomiting  Diarrhea  Severe bleeding Hypertonic (Hypernatremic) Dehydration - When proportionally more water than sodium is lost from the body, the extracellular fluid has increased concentration of sodium and becomes hypertonic regarding the intracellular fluid and therefore attracts water from the cells. This results in cell shrinkage, which may cause brain shrinkage. - Causes  Diarrhea in children  Water deprivation  Excessive sweating (hot weather, exercise, marathon)  Hyperventilation (prolonged fever, anxiety)  Poorly treated DM  Heat stroke  End-stage renal failure  Drinking sea water in attempt to treat hydration  Accidental infusion of hypertonic solutions  Certain diuretics Hypotonic (Hyponatremic) Dehydration - When proportionally more sodium than water is lost, the sodium

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2. Describe the manifestations of dehydration.

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concentration of the extracellular fluids falls, which therefore becomes hypotonic in comparison to intracellular fluid, so water moves from the extracellular fluid into the cells. This causes cell swelling, possibly resulting in the brain swelling (cerebral edema) Causes  Treating dehydration in small children or marathon runners with fluids that contain little or no sodium  Vomiting or diarrhea (in some cases)  GI obstruction, fistula, ileus  Heat stroke  Heart exhaustion  Pancreatitis  Burns  Trauma (muscle damage)  Ketonuria (large amounts of ketone bodies in the urine) d/t starvation, DM  Chronic malnutrition  Cystic fibrosis with excessive salt loss in sweat  Diuretics  Prolonged treatment of HTN and low-sodium diet and thiazide diuretics  Furosemide  Accidental infusion of hypotonic fluids Increased thirst (polydipsia) Dry mouth/ dry skin Tired or sleepy Decreased urine output Urine is low volume and more concentrated Headache Dizziness Decreased salivation and lacrimation Low BP/ orthostatic hypotension

3. List predisposing factors to fluid and electrolyte problems in young children and elderly patients.

- Tachypnea - Fever - Poor skin elasticity (increased turgor) - Lethargy, confusion, coma - Seizure Children - Greater amount of extracellular fluid - Greater tendency to become febrile - Higher metabolic rate - Increased body surface area - Immature kidneys Elderly - Diminished thirst sensation (hypodipsia) - Decreased renal function - Some medications

4. Describe various causes and manifestations of gastroenteritis including E. coli & 0157:H7.

How/why do the above points predispose children and elderly to dehydration? What is gastroenteritis? - Inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhea Some causes of gastroenteritis - Viruses - Bacteria - Parasites - Gastroenteritis is most commonly spread via fecal to oral route or contact with infected individual HUS Hemolytic-Uremic Syndrome is a type of gastroenteritis caused by the E. coli or 0157:H7 bacteria - Comes from undercooked ground beef (most cases) - Can be transmitted in animal and human feces - Found in unpasteurized dairy and fruit Manifestations

- Watery diarrhea with cramping - Vomiting may be present - Fever, nausea, headache - Bloody diarrhea after several days - Pallor, tired - Edema - Oliguria or anuria - Petechiae (bruising) - Hemolytic anemia - Thrombocytopenia- low platelets Some complications - Chronic renal failure because RBCs are being broken down, the fragmented RBCs get caught in the kidney filters and blocking them - Seizures - Coma - Congestive heart failure What would cause the above listed signs, symptoms and complications? – Link to pathophysiology

5. Interpret diagnostic tests related to gastroenteritis and dehydration.

6. Describe the nursing assessment and management of a child with gastroenteritis.

7. Identify the potential learning needs of parents whose children have

Diagnostic tests for gastroenteritis Diagnostic tests for dehydration - Kidney function - Electrolyte abnormalities Nursing interventions for individual with gastroenteritis - Symptomatic treatments - Education - Isolation precautions - Management of dehydration  Restore appropriate fluid balance  Correction of electrolyte imbalances  Prevent complications what are some complications of dehydration? - Check #9 on case study

gastroenteritis.

What is the normal water % of body weight for…?  An infant:  75% - 80% of body weight  An adult:  Male - 60% of body weight  Female – 50% of body weight  An older adult:  Male- 52% of body weight  Female- 46% of body weight The major fluid compartments in the body are:  Intracellular (within the cells) potassium, magnesium, and phosphate  Extracellular (between the cells) sodium, calcium, chloride, and bicarbonate What percentage is intracellular? - 2/3 of body’s water What percentage is extracellular? - 1/3 of body’s water How do we normally get water into the body? - Oral intake as water - Metabolic processes water is found in foods - Water of oxidation water from breathing in air What are the normal ways in which we lose water? – List 5 1. Through the kidneys urine 2. Through the skin (insensible loss= occurs without person’s awareness)  sweat 3. Through the lungs insensible loss 4. Gastrointestinal tract feces What are the abnormal ways that we lose water? – List 5 1. Diarrhea 2. Vomiting 3. Excessive blood loss 4. High fever

5. Lack of ADH (anti-diuretic hormone) ADH reabsorbs water so when there is too little

ADH, we are losing water through constant urination which can actually cause hypernatremia (because the kidneys aren’t getting a chance to filter the sodium)...