Fluid status monitoring

Yu et al. (2005) also showed that sudden changes in thoracic impedance predicted eminent hospitalization in 33 patients with severe congestive heart failiure (New York Heart Association Class III—IV). During a mean follow-up of 20.7 8.4 months, 

10 patients had a total of 25 hospitalizations for worsening heart failure. Measured impedance gradually decreased before admission by an average of 12.3 5.3% 

Some commercially available implantable devices for the treatment of congestive heart failure and/or ventricular tachyarrhythmias now continually monitor intrathoracic impedance and display fluid status trends. This information is then provided to the clinician via direct device interrogation or by remote telemetry. Recent reports based on actual clinical experience with this feature have attested to critical reliability and utility (Vollmann et al., 2007) and good correlation with other traditional tools such as brain natriuretic peptide (Luthje et al., 2007). 

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Monitoring the patient in shock requires vigilance on the part of the nurse The patient s heart rate, blood pressure, and ECG are monitored continuously. The urinary output is measured often (usually hourly), and an accurate intake and output is taken. Monitoring of central venous pressure via a central venous catheter will provide an estimation of the patient s fluid status. Sometimes additional hemodynamic monitoring is necessary with a pulmonary artery catheter. The use of a pulmonary artery catheter allows the nurse to monitor a number of parameters, such as cardiac output and peripheral vascular resistance The nurse adjusts therapy according to the primary health care provider s instructions. 

Patients should be educated to recognize the signs and symptoms of complications that would require urgent evaluation. Patients and parents of children with SCD should be educated to read a thermometer properly and to seek immediate medical care when a fever develops or signs of infection occur. With acute illnesses, prompt evaluation is important because deterioration may occur rapidly. Fluid status should be monitored to avoid dehydration or overhydration, both of which may worsen complications of SCD. Patients in acute distress should maintain oxygen saturation at 92% or at their baseline. Any supplemental oxygen requirements should be evaluated.6,27... 

The mainstay of treatment for vaso-occlusive crisis includes hydration and analgesia (see Table 65-7). Pain may involve the extremities, back, chest, and abdomen. Patients with mild pain crises may be treated as outpatients with rest, warm compresses to the affected (painful) area, increased fluid intake, and oral analgesia. Patients with moderate to severe crises should be hospitalized. Infection should be ruled out because it may trigger a pain crisis, and any patient presenting with fever or critical illness should be started on empirical broad-spectrum antibiotics. Patients who are anemic should be transfused to their baseline. Intravenous or oral fluids at 1.5 times maintenance is recommended. Close monitoring of the patient s fluid status is important to avoid overhydration, which can lead to ACS, volume overload, or heart failure.6,27... 

Acute P. falciparum malaria resistant to chloroquine should be treated with intravenous quinidine via central venous catheter and fluid status and the electrocardiogram (ECG) should be monitored closely. 

The role of diuretics in the management of SVCS is controversial. While patients may derive symptomatic relief from edema, complications such as dehydration and reduced venous blood flow may exacerbate the condition. If diuretics are used, furosemide is used most frequently with diligent monitoring of the patient s fluid status and blood pressure. 

Fluid status is assessed by monitoring urine output and specific gravity, serum electrolytes, and weight changes. An hourly urine output of at least 1 mL/kg for children and 50 mL for adults is needed to ensure tissue perfusion. 

Aerosol - Monitor respiratory function and fluid status during treatment. 

Muromonab-CD3 (Orthoclone OKT3) [Immunosuppressant/ Monoclonal Antibody] WARNING Can cause anaphylaxis monitor fluid status Uses Acute rejection following organ transplantation Action Murine Ab, blocks T-cell Fxn Dose Per protocol Adults. 5 mg/d IV for 10-14 d Peds. 0.1 mg/kg/d IV for 10-14 d Caution [C, /-] w/ Hx Szs, PRG, uncontrolled HTN Contra Murine sensitivity, fluid overload Disp Inj SE Anaphylaxis, pulm edema, fever/chills w/ 1st dose (premedicate w/ stCToid/APAP/antihistamine) Interactions t Effects W/ immunosuppressives t effects OF live virus vaccines t risk of CNS effects encephalopathy W/ indomethacin EMS Monitor for S/Sxs of Infxn monitor resp Fxn, known to... 

Yu CM, Wang L, ChauE, et al. Intrathoracic impedance monitoring in patients with heart failure correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. Aug 9 2005 112(6) 841-848. 

Fluid status, electrolytes, and urine output should be monitored in the HD-intoxicated patient. Tetanus prophylaxis should also be administered because fatal tetanus may occur even after a small partial-thickness bimi (Marshall et al, 1972). 

Follow-up checks regarding sodium, potassium, magnesium, the acid-base equilibrium and possibly zinc are required if necessary, the status has to be duly balanced. Hyponatraemia must not be treated by the intake of sodium, but by a further restriction of fluid (while monitoring sodium levels), (s. p. 308)... 

Most cases of unintentional thiazide overdoses can be managed safely at home as serious effects are not expected. Thiazides and related agents are adsorbed by activated charcoal and it may be used for substantial recent exposures. Because cathartics can also cause fluid and electrolyte losses, their use should be avoided. Fluid status, electrolytes, and EKG should be monitored. Standard supportive therapies with attention to replacement of fluid and electrolyte losses should be utilized as clinically necessary. No antidote is available. Drug levels are not readily available and are not helpful in assessing toxicity. 

The role of the clinical laboratory in the assessment and monitoring of ARF is limited to assessment of electrolyte disturbance and fluid status, as during the recovery period there is an initial polyuric phase as glomerular function recovers before tubular function recovers. This polyuric phase recedes after a few days to weeks but requires careful monitoring to enable suitable fluid and electrolyte replacement. 

The selective /32-adrenergic agonists terbutaUne and ritodrine have been reported to induce pulmonary edema when used as tocolytics. This disorder commonly occurs 48 to 72 hours after tocolytic therapy. This has never occurred with their use in asthma patients, even in inadvertent overdosage. This reaction may result from excess fluid administration used to prevent the hypotension from /32-mediated vasodilation or the particular hemodynamics of pregnancy. In a review of 330 patients who received tocolytic therapy and were monitored closely for their fluid status, no episode of pulmonary edema was reported. ... 

The serum sodium concentration and fluid status should be monitored every 2 to 3 hours over the first 24 hours of admission in patients with symptomatic hypernatremia to permit appropriate adjustment in the rate of infusion of hypotonic fluids. After symptoms resolve and the serum sodium is less than 148 mEq/L, serum sodium determinations every 6 to 12 hours and fluid status assessment every 8 to 24 hours are generally sufficient to follow the course of therapy. 

Because falciparum malaria is associated with serious complications including pulmonary edema, hypoglycemia, jaundice, renal failure, confusion, delirium, seizures, coma, and death, careful monitoring of fluid status and hemodynamic parameters is mandatory. 

During tiie ongoing assessment, tiie nurse assesses the respiratory status every 4 hours and whenever tiie drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing, hi addition, tiie nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

Monitor blood pressure, pulse, respirations, mental status, and fluid intake and output every 1-4 hours. 

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