Medical-surgical Nursing Demystified

(Sean Pound) #1

CHAPTER 11 Fluids and Electrolytes^425



  • Decreased level of consciousness due to decrease in neural activity with
    hypervolemia

  • Muscle twitching due to irregular muscle contractions

  • Muscle weakness bilaterally

  • Blood pressure increased—compare with normal for patient

  • Decreased myocardial contractility, resulting in less effective pumping action
    of heart muscle

  • Distended neck veins in hypervolemic patients

  • Less cardiac output, especially with hypovolemic patients

  • Increased thirst in an attempt to increase fluid intake


INTERPRETING TEST RESULTS



  • A blood serum sodium level > 145 mEq/L. Normal sodium is 135 to 145
    mEq/L.

  • Spot urine for sodium level.


TREATMENT


Hypotonic IV fluids are typically given to correct hypernatremic patients who are
volume-depleted. Diuretics are also used to help correct the sodium balance.



  • Administer 0.225 percent sodium chloride, 0.33 percent sodium chloride, or
    0.45 percent sodium chloride to correct fluid and sodium status.

  • Administer diuretics to remove excess fluids and promote sodium loss:

    • furosemide, bumetanide




NURSING DIAGNOSES



  • Disturbed thought process

  • Excess fluid volume

  • Deficient fluid volume


NURSING INTERVENTION



  • Monitor vital signs, check pulse rate and rhythm, check blood pressure, and
    compare with prior.

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