1. Assess a healthy individual and a patient whose fluid and electrolyte or acid-base imbalance is altered using tables in book, which describes parameters to be considered in physical and clinical assessments for fluid, electrolyte, and acid-base balance. Compare and contrast your findings.
• Neck veins and central venous pressure- healthy adult: normally when the patient is supine the external jugular veins will fill to the anterior border of the sternocleidomastoid muscle. With the patient sitting at a 45 degree angle venous distention normally should not extend higher than 2cm above the sternal angle. Altered patient: decreased blood volume (low cvp) increased blood volume, heart failure, vasoconstriction (high cvp)
• Neuromuscular irritability-healthy adult: assess for increase or decrease neuromuscular activity = negative response. Altered patient: patients with hypocalcaemia or hypomagnesaemia respond positively with unilateral twitching of the facial muscles, including the eyelids and lips. A partial response is the development of carpal spasm.
• Comparison of total intake and output of fluids-healthy adult: fluid intake equals fluid output when averaged over 2-3 days. Range of 1500-3500ml fluid intake and loss 2000ml is average adult intake and loss per day. Altered patient: when the total intake is substantially less than the total output, the patient is in danger of fluid volume deficit. When the total intake is substantially more than the total output, the patient volume excess.
• Urine volume and concentration-healthy adult: normal urine output is 1ml/kg of body weight per hr. stress may diminish the 24 hr. urine volume in the adult to 750-1000ml because of increase in aldosterone and ADH secretion. Altered patient: a low urine volume with a specific gravity indicates fluid volume deficit. A low urine volume with low specific gravity indicates renal disease.
• Body weight- healthy adult: a patient’s dry weight should remain relatively stable. Altered patient: rapid variations in weight closely reflect changes in body fluid volume. A rapid loss in body weight occurs when total fluid intake is less than total fluid output.
2. Review the record of a patient who has been receiving IV fluid for a period over 3 days or more. Note the daily input and output records, pertinent lab values, and clinical behaviors. Make a judgment about patient’s fluid, electrolyte, acid-base imbalance. What factors complicate a hospitalized patient’s ability to remain in balance?
Factors include medicine, stress, depression, dysphagia, disease, and dietary intake.