Physiological Adaptation

A healthy stoma is moist and beefy red or pink. A pale, dusky, purple, or black stoma means impaired blood supply (ischemia or necrosis) and is reported to the surgeon at once. Routine care: empty the pouch when it is about one-third full so its weight does not break the seal.

IV calcium (calcium gluconate, or calcium chloride via central line) is given first because it stabilizes the cardiac cell membrane within minutes. It does not lower serum potassium. Next, regular insulin with dextrose (and inhaled albuterol) shifts potassium into cells, and potassium binders (sodium polystyrene sulfonate, patiromer, sodium zirconium cyclosilicate), loop diuretics, or dialysis remove it from the body.

Acid gain or bicarbonate loss: DKA, lactic acidosis (shock, sepsis), kidney failure, severe diarrhea, and some poisonings. ABG: low pH with low HCO3. The lungs compensate by blowing off CO2 with deep, rapid Kussmaul respirations, so PaCO2 falls.

Loss of acid or gain of base: prolonged vomiting, nasogastric suction, excess antacid or bicarbonate intake, and diuretic-induced hypokalemia. ABG: high pH with high HCO3; the lungs compensate with slower, shallower breathing that raises PaCO2.

Bounding pulse, hypertension, jugular vein distension, crackles, dyspnea, dependent edema, and rapid weight gain. Labs may show a low hematocrit and BUN from hemodilution. Management: restrict sodium and fluid, give diuretics as ordered, raise the head of the bed, and weigh the client daily.

Tachycardia, weak thready pulse, hypotension (often orthostatic), dry mucous membranes, poor skin turgor, flat neck veins, low urine output with high specific gravity, and rapid weight loss. Hematocrit and BUN rise from hemoconcentration.