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Fluids and Electrolytes Demystified - part 4

Alea Suarez, 24 tuổi, đã thừa nhận cách đây 2 ngày sau khi một tai nạn xe hơi trong đó cô bị một chấn thương đầu với một khối máu tụ dưới màng cứng (chảy máu bên trong hộp sọ) và gãy xương ở cơ sở của hộp sọ. Bà Suarez là buồn ngủ nhưng định hướng cho người, địa điểm, và thời gian | Alea Suarez age 24 was admitted 2 days ago after a car accident in which she suffered a head injury with a subdural hematoma bleeding inside the skull and a fracture at the base of the skull. Ms. Suarez is drowsy but oriented to person place and time. Vital signs reveal blood pressure BP 100 30 mm Hg pulse P 110 beats minute faint respiration R 10 breaths minute shallow and temperature T 36.8 C. Ms. Suarez is receiving 2 L of oxygen via nasal cannula. The nurse notes that her urine output has increased and today is averaging 250 mL h. Diagnostic blood tests are done and reveal Na 149 mEq L or mmol L K 3.0 mEq L or mmol L Cl- 119 mEq L or mmol L CO2 32 mEq L or mmol L Arterial blood-gas analysis reveals pH 7.30 Pco2 50 mm Hg Po2 80 mm Hg HCO3 31 mEq L Base excess 3 mEq L Urinalysis showed a specific gravity of 1.010 The nurse explores the pathophysiology of head injury to determine what fluid electrolyte and acid-base imbalances Ms. Suarez is at risk for and discovers Head trauma can result in pituitary damage and can decrease or eliminate ADH release i.e. diabetes insipidus or can cause an increase in ADH release i.e. SIADH . Respiratory controls are located in the brain and can be damaged from head trauma or from pressure buildup in the skull owing to hematoma formation. Disorders in sodium potassium and glucose may be noted owing to damage to the hypothalamus and pituitary that will affect the release of hormones that control metabolism e.g. thyrotropin-releasing hormone TRH and thyroid-stimulating hormone TSH and fluids and electrolytes e.g. corticotrophin-releasing hormone CRH and adrenocorticotropin hormone ACTH . C 56 Fluids and Electrolytes Demystified Aldosterone secretion may be affected resulting in sodium potassium and fluid changes. Blood glucose levels may be affected with possible hypoglycemia or hyperglycemia with osmotic diuresis and possible ketoacidosis. With these thoughts in mind the nurse would examine the test results and note The sodium level