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Administer IV fluids as prescribed by the physician.
Provide straws and offer fluids between meals.
Develop plan for added fluid intake over 24 hours
Teach family members to assist client with fluid intake
Flattened neck veins when client is in supine position
Full and bounding pedal and post-tibial pulses
Pitting edema located in feet, ankles, and calves
Shallow respirations with crackles on auscultation
Remind client to avoid commercial mouthwashes.
Encourage mouth rinsing with warm saline.
Assess lips, tongue, and mucous membranes
Provide mouth care every 2 hours while client is awake
Seek dietary consult to increase fluids on meal trays.
Weight client every morning.
Maintain accurate intake and output.
Restrict fluid to 1500 mL per day
Administer furosemide (Lasix) 40 mg IV push
Sodium
Potassium
Magnesium
Calcium
Administer Kayexalate 15 g orally
Administer spironolactone 25 mg orally
Assess WCG strip for tall T waves
Administer potassium 10 mEq orally
Hypokalemia
Hyperkalemia
Hyponatremia
Hypernatremia
Provide oral care every 3-4 hours
Monitor for indications of dehydration
Administer 0.45% saline by IV line
Assess daily weights for trends
Reassess the client’s blood pressure and heart rate
Review the client’s morning calcium level
Request a neurologic consult today
Check the client’s papillary reaction to light
“I will call my doctor if I experience muscle twitching or seizures.”
“I will make sure to take my vitamin D with my calcium each day.”
“I will take my calcium pill every morning before breakfast.”
“I will avoid dairy products, broccoli, and spinach when I eat.”
“The client’s low phosphorus is probably due to malnutrition.”
“The client is just worn out form not getting enough rest.”
“The client’s skeletal muscles are weak because of the low phosphorus.”
“The client will do more for herself when her phosphorus is normal”
Serum potassium 5.2 mEq/L
Serum sodium 134 mEq/L
Serum calcium 10.6 mg/dL
Serum magnesium 0.8 mEq/L
A 68-year-old client on ventilator with acute respiratory failure and respiratory acidosis
A 72-year-old client with COPD and normal arterial blood gases (ABGs) who is ventilator-dependent
A 56-year-old new admission client with diabetic ketoacidosis (DKA) on a n insulin drip
A 38-year-old client on a ventilator with narcotic overdose and respiratory alkalosis
Increase the ventilator rate from 6 to 10 per minute
Decrease the ventilator rate from 10 to 6 per minute
Increase the oxygen concentration fro 30% to 40%
Decrease the oxygen concentration fro 40% to 30%
Check fingerstick glucose every hour.
Record intake and output every hour.
Check vital signs every 15 minutes.
Assess for indicators of fluid imbalance.
Myocardial infarction 1 year ago
Occasional use of antacids
Shortness of breath with extreme exertion
Chronic renal insufficiency
Respiratory rate of 8 to 10 per minute
Pain level decreased from 6/10 to 2/10
Client requests room door be closed.
Heart rate 90-100 per minute
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Repeated episodes of nausea and vomiting
Complaints of pain associated with exertion
Failure to eat all food on breakfast tray
Client hair loss during morning bath
“It’s common for clients with uncomfortable procedures such as nasogastric tubes to have a higher rate to breathing.”
“The client may have a metabolic alkalosis due to the NG suctioning and the increased respiratory rate is a compensatory mechanism.”
“Whenever a client develops a respiratory acid-base problem, increasing the respiratory rate helps correct the problem.”
“The client is hyperventilating because of anxiety and we will have to stay alert for development of a respiratory acidosis.”
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