Homeostasis, Stress, Fluid & Electrolyte Balance, Shock

1. Homeostasis, Stress, Fluid & Electrolyte Balance,Shock NURS 2016 Chapters 6, 14, 15

2. Homeostasis • Homeostasis: processes that occur quickly in response to stress – adjustments made rapidly to maintain internal environment. • Adaptation: processes resulting in structural or functional changes over time. This is a desired goal. • Coping: a compensatory mechanism so that a person can reach equilibrium.

3. Stress • A state produced by change in the environment that is threatening or damaging

4. Responses to Stress • Psychological: appraisal – coping • Physiological: • Alarm, resistance, exhaustion • Maladaptive: • Faulty appraisal • Ineffective coping

5. The S&S of Stress Write down at least 10

6. Nursing Care • Intervene when individual’s own compensatory processes are still functioning. • Relate S&S of distress to physiological happenings. • Identify person’s position on a continuum of function from wellness/compensation to pathophysiology/disease.

7. Stress at the Cellular Level • Individual cells may cease to function without posing threat to the organism; however as the number of dead cells increases, the specialized function of the tissue is altered – health is threatened.

8. Nursing Care • Assess S&S for indicators of physiologic processes. • Relate symptoms/complaints to physical signs. • Assist individual to respond to stress with stress management.

9. Weight loss Restlessness Dry mucous membranes Increased respirations Decreased urine output Thirst Flushed skin Poor skin turgor Systolic drop 10-15mmHg Sunken eyes Fluid Volume Deficit (FVD)Hypovolemia

10. Nursing Care • Monitor I&O • Daily weight (1kg = 1000ml fld) • Vital signs • Skin turgor- consider age • Moisture level • Lung sounds • Urine concentration

11. Preventing and Correcting FVD • Who’s at risk? Replacement • Oral • Enteral • Parenteral

12. Weight gain Edema Abnormal lung sounds Increased urine output Puffy eyelids Distended neck veins Tachycardia Increased BP and pulse pressure. Fluid Volume Excess (FVE)Hypervolemia

13. Nursing Care • Monitor I & O • Daily weight • Assess lung sounds • Check edema: degree of pitting measure extremities.

14. Preventing and Correcting FVE • Promote rest: favours diuresis and increases circulation (lower) • Na+ and fluid intake restrictions • Monitor parenteral fluids • Positioning

15. Edema • Localized or generalized • Occurs when there is a change in capillary member ANASARCA: severe generalized edema ASCITES: edema in peritoneal cavity Dependent area: ankles, feet, sacrum, scrotum, periorbital regions Pulmonary edema: increased fluid in pulmonary interstitium and alveoli

16. Electrolytes Sodium • Normal 135-145mmol/L Potassium • Normal 3.5-5mmol/L Calcium • Normal2.25-2.74mmol/L

17. Sodium: Hyponatremia • At Risk • Loss of Na • Dilution of Na Nursing Care: Monitor I&O Daily weight Encouraging foods high in Na (normal requirement 500mg) Fluid restriction:800ml/day Clinical Manifestations: Anorexia, muscle cramps, exhaustion. Poor skin turgor, dry mucosa/skin Confusion, headache

18. Sodium: Hypernatremia At Risk Loss of water Gain of sodium Nursing Care I&O No added salt diet Monitor meds high in Na If IV hypotonic solution used -- want gradual decrease in serum Na 9prevent cerebral edema Clinical Manifestations Thirst, dry mouth Restlessness, disorientation Edema Increased BP

19. Potassium: Hypokalemia Nursing Care ECG for flattened T-wave ID cause Diet – high K Teaching – use of diuretics, laxatives IV K replacement At Risk Vomiting/gastric suctioning Alcoholics/cirrhosis Anorexia nervosa Non-K sparing diuretics Clinical Manifestations Muscle weakness, fatigue, anorexia, N&V, leg cramps, dysrrythmia

20. Potassium: Hyperkalemia At Risk Kidney disease Addison’s disease Extreme tissue trauma K replacement Nursing Care Verify high serum levels Restrict K foods Teaching re K supplements Clinical Manifestation Ventricular dysrrhythmia, muscle weakness, peaked t-wavwes, respiratory paralysis

21. Calcium:Hypocalcemia Nursing Care Seizure precautions Airway status Nutritional intake and supplements Limit alcohol and caffeine At Risk Renal failure Postmenopausal Low Vit D consumption Antacids, caffeine Hypoparathyroidism Clinical manifestations Tetany, seizures, depression,impaired memory, confusion

22. Calcium: Hypercalcemia Nursing care Increase activity Encourage fluids Encourage fluids Na – favour Ca excretion Safety/comfort At Risk Hyperparathyriodism Bone/mineral loss during inactivity Thiazide diuretics Clinical Manifestations Reduced neuromuscular activity, weakness, incoordination, anorexia, constipation

23. Respiratory Acidosis • Individuals at risk • Inadequate excretion of carbon dioxide • Chronic emphysema, bronchitis • Obstructive sleep apnea • Obesity • Clinical Manifestations • Increased cerebrovascular flow (vasodilation)Increased pulse, respirations and BP • Mental cloudiness, feelings of fullness in head

24. Respiratory Acidosis Nursing care • Improve ventilation • Clear respiratory tract • Ensure adequate hydration

25. Respiratory Alkalosis • Individuals at risk • Hyperventilation • Increased anxiety • Hypoxemia • Clinical Manifestations • Lightheadedness, low concentration, numbness/tingling, tinnitus

26. Respiratory Alkalosis Nursing Care • Recycle carbon dioxide • Treat underlying cause

27. Shock • Physiological state in which there is inadequate blood flow to tissues and cells of body • Cells try to produce energy anaerobically • Leads to low energy yield and acidotic intracellular environment

28. Categories of Shock • Hypovolemic • Cardiogenic • Circulatory/Distributory

29. Stages of Shock • Compensatory • Progressive • Irreversible

30. BP normal Vasoconstriction Fight or flight Increased HR Increased contractility Blood shunted to heart and brain. Compensatory Stage

31. Nursing Care in Compensatory Stage • Close assessment and catch subtle changes before decrease in BP occurs • Monitor tissue perfusion. • Report deviations in hemodynamic status • Reduce anxiety • Promote safety

32. Progressive Stage: Mechanism for regulating BP no longer compensates • Respiratory: shallow, rapid • Cardiac: dysrrhythmia, ischemia, tachycardia • Neurologic: decrease status • Renal:failure • Hepatic:decrease met. of meds and waste • Hematologic:DIC • Gastrointestinal: Ischemia, increase risk infection

33. Nursing Care in Progressive Stage • Usually care for in ICU (increased monitoring) • Preventing complications • Promote comfort and rest • Support family members

34. Irreversible Stage • Individual in not responding to treatment. • Renal and hepatic failure lead to release of necrotic tissue toxins

35. Nursing Care inIrreversible Stage • Similar to progressive stage • Brief explanations to patient • Supportive presence for patient and significant others. • In collaboration with significant stakeholders, discuss end of life wishes/decisions.

36. Overall Management of Shock • Fluid replacement • Crystalloids: electrolyte solution • Colloids: plasma proteins • Blood components

37. Risks of Fluid Replacement • Cardiovascular overload • Pulmonary edema

38. Fluid Replacement: Nursing Care • Monitor I& O • Mental status • Skin perfusion • Vital signs • Lung sound

39. Vasoactive medication to improve hemodynamic stability. Myocardial contract Myocradial resistence vasoconstriction Nutritional support Meet needs of increased met. Often parenteral feeding Overall Management of Shock

41. Hypovolemic Shock • Decreased intravascular volume due to fluid loss

42. Prevention Fluid and blood administration Monitor for cardiac overload and pulmonary edema Monitor vital signs I&O Temperature Lung sounds Cardiac rhythm and rate. Nursing Care in Hypovolemic Shock

43. Cardiogenic Shock • Heart’s ability to contract and pump is impaired • General management • Correct cause • Administer oxygen • Control chest pain • Monitor hemodynamic status

44. Nursing Care in Cardiogenic Shock • Prevention • Monitor hemodynamic status • Administer IV fluids and medications • Promote safety and comfort

45. Distributive Shock • Blood is abnormally placed in the vasculature • Septic - wide spread infection. Number one cause of death in ICU • Neurogenic • Anaphylactic

46. Hyperdynamic phase Hypodynamic phase ID site and source of infection Antipyretic if T >40 Monitor response to medications Comfort measures Oxygen needs Nursing Care in Septic Shock

47. Results from loss of sympathetic tone Spinal cord injury Spinal anesthesia Nervous system damage Preventative: elevate head 30 degrees Support CV and neuro functions Elastic stockings Elevate head of bed Check Homan’s sign Passive ROM Nursing Care inNeurogenic Shock

48. Systemic antigen-antibody reaction Prevention: assess for allergies and observe response to new medications/ blood administration Remove causative agent Support cardiac and pulmonary systems Nursing Care inAnaphylactic Shock