i bc27f85be50b71b1 (237 page)

• Tachycardia and hypertension

• Nausea and vomiting

• Low-grade fever

• Hand tremor

• Anxiety, insomnia, agitation, or hallucinations

• Grand mal seizure or delirium (if severe)

Interventions to prevent or minimize alcohol withdrawal syndrome

include hydration, adequate nutrition, reality orientation, thiamine,

and the prophylactic lise of bcnzodiazepines.

References

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Basic to Advanced Skills (5th ed). Upper Saddle River, NJ: Prentice Hall

Health, 2000;139-146.

3. Downey RJ, Weissman C. Physiological Changes Associated with Bed

Rest and Major Body Injury. In EG Gonzalez, SJ Myers, JE Edelstein, er

al. (cds), Downey and Darling's Physiological Basis of Rehabiliration

Medicine (3rd ed). Boston: Bunerworth-Heinemann, 2001;449.

4. Buschbacher RM, Porter CD. Decondirioning, Conditioning, and the

Benefits of Exercise. In RL Braddol11 (cd). Physical Medicine and Rehabilitation (2nd ed). Philadelphia: Saunders, 2000;716.

5. American Association of Critical-Care Nurses. Position Statement on

Withholding and/or Withdrawing Life-Sustaining Treatment. In MR

Kinney, SB Dunbar, J Brooks-Brunn, et al. (eds), AACN's Clinical Reference for Critical Care Nursing (4th ed). St. Louis: Mosby, I 998;1253-1254.

6. DeVita MA, Grenvik A. Forgoing Life-Sustaining Therapy in Intensive

Care. In A Grenvick (ed), Textbook of Critical Care (4th ed). Philadelphia: Saunders, 2000;21 10-2 I 13.

7. Schnell S5. Nursing Care of Comatose or Confused Clients. In JM

Black, E Matassarin-Jacobs (cds), Medical-Surgical Nursing: Clinical

762 AClJTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Management for Continuity of Care (5th ed). Philadelphia: Saunders,

1997;743.

8. Thelan LA, Urden LD, Lough ME, Stacy KM (eds). Neurologic Disorders. In Critical Care Nursing: Diagnosis and Management (3rd ed). St.

Louis: Mosby, 1998;795-798.

9. Sullivan J, Seem DL, Chabalewski F. Determining brain death. Critical

Care Nurse 1999;19:37-46.

10. Urban N. Patient and Family Responses to the Critical Care Environment. In MR Kinney, 5B Dunbar, J Brooks-Brunn, et al. (cds), AACN's Clinical Reference for Critical Care Nursing (4th ed). Sr. Louis: Mosby,

1998;145-162.

11. Hennemann AE. Preventing Complications in the Intensive Care Unit.

In A Grenvick (ed), Textbook of Critical Care (4th ed). Philadelphia:

Saunders, 2000;2035-2037.

"12. Roberts BL. Managing delirium in adult intensive care patients. Critical

Care Nurse 2001 ;21 :48-55.

13. Wise MG, Cassem NH. Behavioral Disturbances. In JM Civetta, RW

Taylor, RR Kirby (eds), Critical Care_ Philadelphia: Lippincott-Raven,

1997;2022-2024.

14. Victor M, Ropper AH (cds). Diseases of [he Peripheral Nerves. In

Adams and Victor's Principles of Neurology (7th ed). New York:

McGraw-Hili, 2001; 1388.

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Adams and Victor's Principles of Neurology (7th ed). New York:

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II

Fluid and Electrolyte Imbalances

Susan Polich and Jaime C. Paz

Many causes and factors can alter a patient's fluid and electrolyte

balance. These imbalance can result in a multitude of clinical

manifestations, which in turn can affect a patient's functional

mobility and activity tolerance. Recognizing the signs and symproms of electrolyte imbalance is, therefore, an important aspect of physical therapy. Additionally, the physical therapist must be

aware of which patients are at risk for these imbalances, as well as

the concurrent pathogenesis, diagnosis, and medical management

of these imbalances.

Maintaining homeostasis between intracellular fluid, extracellular

fluid, and electrolytes is necessary to allow proper cell function.

Proper homeostasis depends on the following factors:

• Concentration of intracellular and extracellular fluids

• Type and concentration of electrolytes

• Permeability of cell membranes

• Kidney function

763

764 AClTfE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Fluid Imbalance

Fluid imbalance occurs when fluids are lost, either by loss of body water

or failure to intake, or gained, either by fluid shift from the vasculature to

the cell space or excessive intake without proper e1imination.I-3

Loss of bodily fluid (hypovolemia) can occur from loss of blood

(hemorrhage), loss of plasma (burns), or loss of body water (vomiting, diarrhea). Any of these situations can result in dehydration, hypovolemia, or shock in extreme cases. Clinical manifestations

include decreased blood pressure, increased heart rate, changes in

mental status, thirst, dizziness, hypernatremia, increased core

body temperature, weakness, poor skin turgor, altered respirations, and orthostatic hypotension.l-4 Clinical manifestations in children also include poor capillary refill, absent tears, and dry

mucous membranes,s

Excessive bodily fluid (hypervolemia) can occur when there is a

shift of water from the vascular system to the intracellular space. This

can result from excessive pressure in the vasculature (venrricular failure), loss of serum albumin (liver failure), or fluid overload (excessive rehydration during surgery). Clinical manifestations of fluid overload include weight gain, pulmonary edema, peripheral edema, and bounding pulse. Clinical manifestations of this fluid shift may also

resemble those of dehydration, as there is a resultant decrease in the

intravascular fluid volume.I-3 Table II-I provides an overview of

hypovolemia and hypervolemia.

Clinical Tip

During casual conversation among physicians and nurses,

patients who are hypovolemic are often referred to as

being dry, whereas patients who are hypervolemic are

referred to as being wet.

Electrolyte 1mbalance

Fluid imbalances are often accompanied by changes in electrolytes.

Loss or gain of body water is usually accompanied by a loss or gain

of electrolytes. Similarly, a change in electrolyte balance often