chapter-9-fluids-and-electrolytes-水电解质平衡-护理双语

UNITIII

NursingSciencesUNITIIINursingSciencesChapter9FluidsandElectrolytesChapter10Acid-BaseBalanceChapter11LaboratoryValuesChapter12NutritionChapter13ParenteralNutritionChapter14IntravenousTherapyChapter15AdministrationofBloodProductsFluidsandElectrolytesChapter9CRITICALTHINKINGWhatShouldYouDo?ThenursenotesthepresenceofUwavesonaclient’scardiacmonitorscreen.Whataction(s)shouldthenursetake?PyramidtermsFluidvolumedeficit/excess体液不足/体液过多Homeostasis内稳态Hyper-过高Hypo-过低E.g.Hypertension高血压Hypotension低血压PyramidtermsSodium钠135-145mEq/LHypernatremiaHyponatremiaCalcium钙8.6-10mg/dLHypercalcemiaHypocalcemiaPotassium钾3.5-5.1mEq/LHyperkalemiaHypokalemiaPyramidtermsMagnesium镁1.6-2.6mg/dLHypermagnesemiaHypomagnesemiaPhosphorus磷2.7-4.5mg/DlHyperphosphatemiaHypophosphatemiaPropertiesofElectrolytesandTheirComponents(BOX9-1)Atom原子Molecule分子Ion离子Cation阳离子['kætaɪən]Anion阴离子BodyFluidCompartmentsIntracellular(ICF):allfluidinsidethecells(70%)细胞内液Extracellular(ECF):fluidoutsidethecells(30%)细胞外液Interstitial细胞间液Intravascular:fluidinsideabloodvessel血管内液Third-spacing第三间隙液DiseaseorinjuryFluidmaybetrappedinbodyspacessuchasthepericardial,pleural,peritoneal,orjointcavities;thebowel;ortheabdomen;orwithinsofttissuesaftertraumaorburnsEdema[i'diːmə]水肿BodyFluidInfantsandolderadultsneedtobemonitoredcloselyforfluidimbalances！ICFismostlywaterandisrichinK+，Mg2+，,SO4，HPO4，andproteinatoms.ECFcontainsmoreNa+,Cl-,HCO3-,andCa2+.BloodfluidtransportDiffusion扩散

–spreadthemoleculesfromanhigherconcentrationtoanareaof

Lowerconcentration.Osmosis渗透

–fromaLessconcentratedsoluteintoaMoreconcentratedsolute.Filtration过滤

–fromHigherhydrostaticpressure

toaLowerone.Regardingtotheweight.BodyfluidtransportHydrostaticpressure静水压Osmolality渗透压BodyfluidintakeandoutputHomeostasisFluidVolumeDeficit体液不足Dehydration脱水TypesIsotonicdehydration等渗性脱水：水、钠成比例丢失Hypertonicdehydration高渗性脱水：失水为主Hypotonicdehydration低渗性脱水：失钠为主FluidVolumeDeficit体液不足DiminishedperipheralpulseDeeprespirationFeverDecreaseurineoutputDryskin，drymouthThirstTABLE9-1AssessmentFindings:FluidVolumeDeficitandFluidVolumeInterventionsIngeneral,isotonicdehydrationistreatedwithisotonicfluidsolutions,hypertonicdehydrationwithhypotonicfluidsolutions,andhypotonicdehydrationwithhypertonicfluidsolutions.FluidVolumeExcess体液过多Overhydrationorfluidoverload水中毒TypesIsotonicOverhydrationHypertonicOverhydrationHypotonicOverhydrationFluidVolumeExcess体液过多OverhydrationorfluidoverloadElevatedbloodpressureCVC(centralvenouspressure中心静脉压）↑Shallowrespiration浅呼吸IncreaseordecreaseurineoutputPale，CoolskinTABLE9-1AssessmentFindings:FluidVolumeDeficitandFluidVolumeInterventionsAdministerdiuretics;osmoticdiureticstypicallyareprescribedfirsttopreventsevereelectrolyteimbalances.Monitorelectrolytevalues,andpreparetoadministermedicationtotreatanimbalanceifpresent.Aclientwithacutekidneyinjuryorchronickidneydiseaseisathighriskforfluidvolumeexcess.PracticalquestionsThenurseisassignedtocareforagroupofclients.Onreviewoftheclients’medicalrecords,thenursedeterminesthatwhichclientismostlikelyatriskforafluidvolumedeficit?1.Aclientwithanileostomy2.Aclientwithheartfailure3.Aclientonlong-termcorticosteroidtherapy4.Aclientreceivingfrequentwoundirrigations1Thenursecaringforaclientwhohasbeenreceivingintravenous(IV)diureticssuspectsthattheclientisexperiencingafluidvolumedeficit.Whichassessmentfindingwouldthenursenoteinaclientwiththiscondition?1.Lungcongestion2.Decreasedhematocrit3.Increasedbloodpressure4.Decreasedcentralvenouspressure(CVP)4Thenurseisassignedtocareforagroupofclients.Onreviewoftheclients’medicalrecords,thenursedeterminesthatwhichclientisatriskforfluidvolumeexcess?1.Theclienttakingdiuretics2.Theclientwithkidneydisease3.Theclientwithanileostomy4.Theclientwhorequiresgastrointestinalsuctioning2Sodium钠135-145mEq/LHypernatremia低钠血症

Hyponatremia高钠血症Na+HyponatremiaandhypernatremiaNormalserumsodiumlevelNa+:135-145mEq/LCommonfoodsources:Box9-2,p88CausesAssessment:Table9-2.p89InterventionNa+Commonfoodsources:Box9-2,p88Bacon熏肉Butter黄油Cannedfood罐头食品Cheese奶酪Frankfurters灌肠Ketchup番茄酱Lunchmeat午餐肉Milk牛奶Mustard芥菜Processedfood加工食品Snackfood休闲食品Soysauce酱油Tablesalt食盐Whiteandwhole-wheatbread白面包和全麦面包Na+Hyponatremia＜135mEq/L

低钠血症Causes:Diuretics利尿剂Wounddrainage,especiallygastrointestinalRenaldisease/failureAldosterone(醛固酮）↑Low-saltdietExcessiveingestionofhypotonicfluidsorirrigationwithhypotonicfluids过度摄入低渗的液体或冲洗低渗的液体Freshwaterdrowning淡水淹溺Syndromeofinappropriateantidiuretichormone(抗利尿激素)secretionHyperglycemia高血糖症Congestiveheartfailure充血性心力衰竭Na+Hypernatremia>145mEq/LCauses:Corticosteroids皮质类固醇Cushing’ssyndromeRenalfailureHyperaldosteronism高醛甾酮症Oralsodiumingestion/sodium-containingIVfluidsDecreasedWaterintake:NothingbymouthIncreasedwaterloss:metabolism↑，fever,

hyperventilation换气过度,infection,excessivediaphoresis,waterydiarrhea,diabetesinsipidus（尿崩症）Na+AssessmentHyponatremiahypernatremiaShallow,ineffectiverespiratorymovement浅的，无效的呼吸运动Generalizedskeletalmuscleweakness全身骨骼肌肉无力Headache,seizures头痛，癫痫发作Hyperactivebowelsounds肠鸣音亢进Drymucousmembranes粘膜干燥Hypervolemia→pulmonaryedema肺水肿Extremethirst极度口渴Decreasedurinaryoutput尿量减少Na+InterventionMonitorcardio,renal……statusIftheclientistakinglithium,hyponatremiacancausediminishedlithium(锂）excretion,resultingintoxicity!!→→→monitorthelithiumlevel!!!Thenurseisreviewinglaboratoryresultsandnotesthataclient’sserumsodiumlevelis150mEq/L.Thenursereportstheserumsodiumleveltothehealthcareprovider(HCP)andtheHCPprescribesdietaryinstructionsbasedonthesodiumlevel.Whichfooditemdoesthenurseinstructtheclienttoavoid?1.Peas2.Nuts3.Cauliflower4.Processedoatcereals4Thenursecaringforagroupofclientsreviewstheelectrolytelaboratoryresultsandnotesasodiumlevelof130mEq/Lononeclient’slaboratoryreport.Thenurseunderstandsthatwhichclientisathighestriskforthedevelopmentofasodiumvalueatthislevel?1.Theclientwhoistakingdiuretics2.Theclientwithhyperaldosteronism3.TheclientwithCushing’ssyndrome4.Theclientwhoistakingcorticosteroids1Thenurseiscaringforaclientwithheartfailurewhoisreceivinghighdosesofadiuretic.Onassessment,thenursenotesthattheclienthasflatneckveins,generalizedmuscleweakness,anddiminisheddeeptendonreflexes.Thenursesuspectshyponatremia.Whatadditionalsignswouldthenurseexpecttonoteinaclientwithhyponatremia?1.Muscletwitches2.Decreasedurinaryoutput3.Hyperactivebowelsounds4.Increasedspecificgravityoftheurine3PotassiumK+3.5-5.0mEq/LCommonfoodsourcesAvocado鳄梨BananasCantaloupe哈密瓜Carrots胡萝卜FishMushroomsOrangesPotatoesPork,beef,vealRaisins葡萄干Spinach菠菜StrawberriesTomatoes

Hypokalemia-<3.5mEq/L低钾血症

Majorcause:Diuretics

(Potassium)

Hyperkalemia

->5.1mEq/L高钾血症Majorcause:Renalfailure；Addison’sdiseaseK+PotassiumisneveradministeredbyIVpush,intramuscular,orsubcutaneousroutes.严禁通过静脉推注、肌肉注射或皮下补钾。IVpotassiumisalwaysdilutedandadministeredusingandinfusiondevice.通过静脉补钾时必须稀释！！！K+ECTChangesinElectrolyteImbalancesElectrolyte

ECTchangesHypocalcemiaProlongedSTintervalProlongedQTintervalHypercalcemiaShortenedSTsegmentWidenedTwaveHypokalemia

STdepressionShallow,flat,orinvertedTwaveProminentUwaveHyperkalemiaTall,peakedTwavesFlatPwavesWidenedQRScomplexProlongedPRintervalHypomagnesemiaTallTwaves‘depressedSTsegmenthypermagnesemiaProlongedPRintervalWidenedQRScomplexesThenurseprovidesinstructionstoaclientwithalowpotassiumlevelaboutthefoodsthatarehighinpotassiumandtellstheclienttoconsumewhichfoods?Selectallthatapply.1.Peas2.Raisins3.Potatoes4.Cantaloupe5.Cauliflower6.Strawberries2/3/4/6Thenurseispreparingtocareforaclientwithapotassiumdeficit.Thenursereviewstheclient’srecordanddeterminesthattheclientwasatriskfordevelopingthepotassiumdeficitbecauseofwhichsituation?1.Sustainedtissuedamage2.Requiresnasogastricsuction3.HasahistoryofAddison’sdisease4.Istakingapotassium-retainingdiuretic2Thenursereviewsaclient’selectrolytelaboratoryreportandnotesthatthepotassiumlevelis2.5mEq/L.Whichpatternwouldthenursenoteontheelectrocardiogramasaresultofthelaboratoryvalue?1.Uwaves2.AbsentPwaves3.ElevatedTwaves4.ElevatedSTsegment1Thenursingstudentneedstoadministerpotassiumchlorideintravenouslyasprescribedtoaclientwithhypokalemia.Thenursinginstructordeterminesthatthestudentisunpreparedforthisprocedureifthestudentstatesthatwhichactionispartoftheplanforpreparationandadministrationofthepotassium?1.Obtaininganintravenous(IV)infusionpump2.Monitoringurineoutputduringadministration3.Preparingthemedicationforbolusadministration4.Ensuringthatthemedicationisdilutedintheappropriateamountofnormalsaline3Hypocalcium-<8.6mg/dLAssessmentfindings:Chvostek’ssign

Trousseau’ssign

(Calcium)Hypercalcium->10mg/dLAssessmentfindings:AbsentdeeptendonreflexCa2+HypocalcemiaandhypercalcemiaSerumcalciumlevel:8.6-10mg/dLCommonfoodsources:box9-5,p92CausesAssessment:Table9-5,p93InterventionCa2+CausesofhypocalcemiaLactoseintolerance乳糖不耐症Malabsorption吸收不良syndromes:celiacsprue乳糜泻orCrohn’sdisease克罗恩病End-stagerenaldiseaseRenalfailure,polyuricphaseDiarrheaSteatorrhea脂肪痢Wounddrainage,especiallygastrointestinalCa2+CausesofhypocalcemiaCont.Hyperproteinemia高蛋白血症Alkalosis碱中毒Medicationssuchascalciumchelators螯合剂orbinders粘结剂Acutepancreatitis急性胰腺炎Hyperphosphatemia高磷酸盐血症ImmobilityRemovalordestructionoftheparathyroidglands甲状旁腺Ca2+CausesofhypercalcemiaOralintakeofcalcium/vitaminD↑RenalfailureUseofthiazidediuretics噻嗪利尿剂Hyperparathyroidism甲状旁腺机能亢进Hyperthyroidism甲状腺机能亢进Malignancy恶性（肿瘤等）Glucocorticoids糖皮质激素Adrenalinsufficiency肾上腺机能不全Ca2+InterventionsVitaminDHypo:initiateseizureprecautionsMonitorforhypercalcemiaPathologicalfractureMovetheclientcarefullyandslowlyAssisttheclientwithambulationCa2+Thenurseisassessingaclientwithasuspecteddiagnosisofhypocalcemia.Whichclinicalmanifestationwouldthenurseexpecttonoteintheclient?1.Twitching2.Hypoactivebowelsounds3.NegativeTrousseau’ssign4.Hypoactivedeeptendonreflexes.Thenursecaringforaclientwithhypocalcemiawouldexpecttonotewhichchangeontheelectrocardiogram(ECG)?1.WidenedTwave2.ProminentUwave3.ProlongedQTinterval4.ShortenedSTsegmentHypomagnesemia-<1.6mg/dLMg2+（magnesium）Hypermagnesemia->2.6mg/dLMg2+Hypophosphatemia-<2.7mg/dL

（calcium）

（phosphorus）Hyperphosphatemia->4.5mg/dLHypophosphatemiaandhyperphosphatemiaSerumphosphoruslevel:2.7-4.5mg/dLCommonfoodsources:box9-7,p95CausesAssessmentInterventionCausesofhypophosphatemiaIntake↓:maln