(BQ) Part 1 book Handbook of fluid, electrolyte, and acid base imbalances has contents: Extracellular fluid volume deficit, extracellular fluid volume shift, potassium imbalances, calcium imbalances, magnesium imbalances, phosphorus imbalances,... and other contents.
Handbook of Fluid, Electrolyte, and Acid-Base Imbalances Third Edition Joyce LeFever Kee, MS, RN Associate Professor Emerita College of Health Sciences University of Delaware Newark, Delaware Betty J Paulanka, EdD, RN Dean and Professor College of Health Sciences University of Delaware Newark, Delaware Carolee Polek, RN, PhD Associate Professor of Nursing College of Health Sciences University of Delaware Newark, Delaware Australia • Canada • Mexico • Singapore • Spain • United Kingdom • United States Handbook of Fluid, Electrolyte, and Acid-Base Imbalances: Third Edition Joyce LeFever Kee, Betty J Paulanka, Carolee Polek Vice President, Career and Professional Editorial: Dave Garza Director of Learning Solutions: Matthew Kane Executive Editor: Steven Helba © 2000, 2004, 2010 Delmar, Cengage Learning ALL RIGHTS RESERVED No part of this work covered by the copyright herein may be reproduced, transmitted, stored, or used in any form or by any means graphic, electronic, or mechanical, 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Manager: Andrea Majot Senior Art Director: Jack Pendleton Production House: Pre-PressPMG Library of Congress Control Number: 2008934272 ISBN-13: 978-1-4354-5368-5 ISBN-10: 1-4354-5368-9 Delmar Maxwell Drive Clifton Park, NY 12065-2919 USA Cengage Learning products are represented in Canada by Nelson Education, Ltd For your lifelong learning solutions, visit delmar.cengage.com Visit our corporate website at cengage.com Notice to the Reader Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of the product information contained herein Publisher does not assume, and expressly disclaims, any obligation to obtain and include information other than that provided to it by the manufacturer The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities described herein and to avoid all potential hazards By following the instructions contained herein, the reader willingly assumes all risks in connection with such instructions The publisher makes no representations or warranties of any kind, including but not limited to, the warranties of fitness for particular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the publisher takes no responsibility with respect to such material The publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material Printed in the United States of America XX 11 10 09 Dedication To Joyce Kee for her consistent support to faculty development in the School of Nursing in the College of Health Sciences at the University of Delaware iii Contents UNIT I FLUIDS AND THEIR INFLUENCE ON THE BODY / Chapter 1: Extracellular Fluid Volume Deficit (ECFVD) / 11 Chapter 2: Extracellular Fluid Volume Excess (ECFVE) / 22 Chapter 3: Extracellular Fluid Volume Shift (ECFVS) / 35 Chapter 4: Intracellular Fluid Volume Excess (ICFVE) / 40 UNIT II ELECTROLYTES AND THEIR INFLUENCE ON THE BODY / 49 Chapter 5: Potassium Imbalances / 54 Chapter 6: Sodium and Chloride Imbalances / 74 iv Contents ● v Chapter 7: Calcium Imbalances / 89 Chapter 8: Magnesium Imbalances / 105 Chapter 9: Phosphorus Imbalances / 116 UNIT III ACID-BASE BALANCE AND IMBALANCES / 127 Chapter 10: Determination of Acid-Base Imbalances / 132 Chapter 11: Metabolic Acidosis and Metabolic Alkalosis / 137 Chapter 12: Respiratory Acidosis and Respiratory Alkalosis / 145 UNIT IV INTRAVENOUS THERAPY / 153 Chapter 13: Intravenous Solutions and Their Administration / 160 Chapter 14: Total Parenteral Nutrition (TPN) / 178 UNIT V FLUID, ELECTROLYTE, AND ACID-BASE IMBALANCES IN CLINICAL SITUATIONS / 189 Chapter 15: Fluid Problems in Infants and Children / 190 Chapter 16: Older Adults with Fluid and Electrolyte Imbalances / 215 vi ● Contents Chapter 17: Acute Disorders: Trauma and Shock / 236 Chapter 18: Burns and Burn Shock / 263 Chapter 19: Gastrointestinal (GI) Surgical Interventions / 275 Chapter 20: Neurotrauma: Increased Intracranial Pressure / 285 Chapter 21: Clinical Oncology / 292 Chapter 22: Chronic Diseases with Fluid and Electrolyte Imbalances: Heart Failure, Diabetic Ketoacidosis, and Chronic Obstructive Pulmonary Disease / 314 Appendix A: Common Laboratory Tests and Values for Adults and Children / 354 Appendix B: Foods Rich in Potassium, Sodium, Calcium, Magnesium, Chloride, and Phosphorus / 375 Appendix C: The Joint Commission’s (TJC) List of Accepted Abbreviations / 379 References/Bibliography / 383 Glossary / 393 Index / 404 Preface The Handbook of Fluid, Electrolyte, and Acid-Base Imbalances, Third Edition is developed from a parent text, Fluids and Electrolytes with Clinical Applications: A Programmed Approach, 8th Edition by Joyce LeFever Kee, Betty J Paulanka, and Carolee Polek It is designed to be used in the clinical setting, both in conjunction with the parent text and as a stand-alone product With a clear comprehensive approach, this quick reference pocket guide of basic principles of fluid, electrolyte, and acidbase balances, imbalances, and related disorders is a must-have for all who work in the field! The convenient handbook size enables readers to keep it handy for quick access to over 200 diagrams and tables containing valuable information A developmental approach is used to provide examples across the life span that illustrate common health problems associated with imbalances The chapter on increased intracranial pressure has been completely rewritten with a stronger focus on neurotrauma and common conditions that cause increased intracranial pressure A glossary has been added for quick reference The reference/ bibliography list has been completely updated and expanded Also, the appendix on common lab vii viii ● Preface studies has been reduced to focus on lab studies with particular reference to fluid imbalances and electrolyte disorders associated with the clinical manifestations of these disorders A new appendix with the Joint Commission’s (TJC) list of accepted abbreviations has been added for the reader’s convenience Nursing assessments, nursing diagnoses, interventions, and rationales are in a tabular format for quick retrieval and ease of comprehension All the important information readers need is right at their fingertips! ORGANIZATION Handbook of Fluid, Electrolyte, and Acid-Base Imbalances comprises 22 chapters organized into five units: Unit I lays the foundation for influence of fluids on the body It covers fluid imbalances related to extracellular fluid volume deficit, excess, and fluid shift, and intracellular fluid volume excess Unit II builds upon this material and discusses six electrolyte imbalances—potassium, sodium, chloride, calcium, magnesium, and phosphorus Unit III provides a quick guide to determine the types of acid-base imbalances Unit IV covers intravenous therapy The chapters on intravenous fluid therapy and total parenteral nutrition (TPN) inclpiratory Acidosis and Respiratory Alkalosis ● 149 CLINICAL MANAGEMENT The three treatment modalities for respiratory acidosis are: remove the cause; have the patient perform deep breathing exercises; use a ventilator In respiratory acidosis, the kidneys conserve alkali and excrete hydrogen or acid in the urine Excess CO2 accumulation stimulates the lungs to blow off carbon dioxide or acid to compensate for the respiratory acidotic state With respiratory alkalosis, the three treatment modalities include: remove the cause; have the patient rebreathe expired air to obtain CO2; use antianxiety drugs The kidneys excrete alkaline ions (HCO3) and retain acid or hydrogen ions Figure 12-2 demonstrates the body’s defense action and treatment for respiratory acidosis and alkalosis CLINICAL CONSIDERATIONS: RESPIRATORY ACIDOSIS AND ALKALOSIS Respiratory acidosis is characterized by an increase in CO2 and H2CO3 concentration in body fluids The pH is Ͻ7.35 and PaCO2 Ͼ45 mm Hg ABGs should be closely monitored when respiratory acidosis is suspected; e.g., with chest injuries, respiratory distress syndrome, COPD (asthma, emphysema, chronic bronchitis), pneumonia Warm, flushed skin (vasodilation from increased CO2), dyspnea, increased pulse rate are signs and symptoms of respiratory acidosis due to hypercapnia Respiratory alkalosis is characterized by a decrease in CO2 and H2CO3 concentration in body fluids The pH is Ͼ7.45 and PaCO2Ͻ35 mm Hg Severe apprehension and anxiety lead to hyperventilation and respiratory alkalosis Dizziness and tetany-like symptoms occur Treatment modalities include rebreathing expired air via paper bag (not plastic bag) and use of antianxiety drugs 150 ● Unit III Acid-Base Balance and Imbalance Respiratory Acidosis (Excess of carbonic acid in the extracellular fluid) Kidneys compensate Lungs Lungs are affected: insufficient gas exchange and/or ventilation High PaCO2 will cause a reflexive attempt to increase ventilation Urine is acid Kidneys conserve base (bicarbonate ions) and excrete acid Treatment: Remove the cause Administer an IV alkali solution Deep breathing exercises or use of a ventilator Respiratory Alkalosis (Deficit of carbonic acid in the extracellular fluid) Lungs Ventilation is affected Treatment would be recommended Kidney Urine is alkaline Kidneys excrete base (bicarbonate ions) and retain acid Treatment: Remove the cause Rebreathe expired air, e.g., CO , from a paper bag Antianxiety drugs, e.g., Ativan (lorazepam) FIGURE 12-2 Body’s defense action and treatment for respiratory acidosis and alkalosis PATIENT MANAGEMENT Assessment ● Obtain a patient history of clinical problems Identify health problems associated with respiratory acidosis and alkalosis (refer to Tables 12-1 and 12-2) ... Magnesium Imbalances / 10 5 Chapter 9: Phosphorus Imbalances / 11 6 UNIT III ACID- BASE BALANCE AND IMBALANCES / 12 7 Chapter 10 : Determination of Acid- Base Imbalances / 13 2 Chapter 11 : Metabolic Acidosis... respiratory acidosis and alkalosis (refer to Tables 12 -1 and 12 -2) Chapter 12 Respiratory Acidosis and Respiratory Alkalosis ● 15 1 ● Check for signs and symptoms of respiratory acidosis and alkalosis... Chapter 14 : Total Parenteral Nutrition (TPN) / 17 8 UNIT V FLUID, ELECTROLYTE, AND ACID- BASE IMBALANCES IN CLINICAL SITUATIONS / 18 9 Chapter 15 : Fluid Problems in Infants and Children / 19 0 Chapter 16 :