Fluid and Electrolyte Imbalances and Acid-Base Balance

Causes of hyponatremia

-Inadequate sodium intake -Vomiting -Gastrointestinal suctioning -Wound drainage -Renal disease -Congestive heart failure

Symptoms of hypercalcemia

-Increased heart rate -Bounding pulses -Increased blood pressure -Anorexia -Muscle weakness -Disorientation -Increased urine output

Signs and Symptoms of fluid-volume deficit

-Increased temp -Thready, rapid pulse -Dryness of skin -Thirst -Decreased urine output -Altered level of consciousness

Causes of hypophosphatemia

-Insufficient phosphorus intake -Hyperparathyroidism -Renal failure -Hyperglycemia -Malignancy

Causes of respiratory alkalosis

-Conditions that increase metabolism -Hyperventilation -Hypoxia -Hysteria -Overventilation -Pain

Food containing phosphorus

-Dairy products -Fish -Legumes -Nuts -Pork/beef/chicken -Whole grain

Steps to assessing blood gas results

-Look at the pH. Is it up or down? If it is up, alkalosis may be present. A decreased pH reflects acidosis. -Look at the PCO2. Is it up or down? If its response is opposite that of the pH, you know that the condition is a respiratory imbalance. If its response is not opposite that of the pH, move on to step 3. -Look at the bicarbonate (HCO3-). Does the change in HCO3- correspond with that of the pH? If it does, the condition is a metabolic imbalance. -Compensation has occurred if the pH is in the normal range of 7.35 to 7.45. If the pH is not within the normal range, look at the respiratory or metabolic function indicators to determine the degree of compensation.

Causes of hypomagnesemia

-Malnutrition -Starvation -Vomiting -Diarrhea -Chronic alcoholism

Foods high in calcium

-Milk -Soy milk -Sardines -Spinach -Tofu

Hyperkalemia tips

-Monitor the client closely for signs of a potassium imbalance -A potassium imbalance can cause cardiac dysrhythmias that can be life threatening -Monitor serum potassium level closely when a client is receiving a potassium retaining diuretic

Hypokalemia tips

-Potassium is never administered by IV push, intramuscular, or subcutaneous routes -IV potassium is always diluted and administered using an infusion device

Symptoms of hypernatremia

-Pulmonary edema -Muscle twitching -Diminished deep tendon reflexes -Extreme thirst -Decreased urine output

Causes of hypermagnesemia

-Renal failure -Excessive administration of magnesium

Causes of hyperphosphatemia

-Renal failure -Hypoparathyroidism -Increased intake of phosporus

Symptoms of hyperkalemia

-Slow, weak, irregular heart rate -Decreased blood pressure -Muscle twitching -Cramps -Abdominal cramping -Diarrhea

Symptoms of hypomganesemia

-Tachycardia -Hypertension -Shallow respirations -Tall T waves/depressed ST segments -Seizures -Irritability

Symptoms of hyponatremia

-Tachycardia -Shallow respirations -Headache -Nausea -Increased urine output

Symptoms of hypokalemia

-Thready, weak, irregular heart rate -Shallow respirations -Muscle weakness -Leg cramps -Nausea -Constipation

Causes of hypokalemia

-Vomiting -Wound drainage -Renal disease -Inadequate potassium intake -Water intoxication

A loss of ____ of body fluid in the adult is serious

10%

A loss of _____ of body fluid in the adult is fatal

20%

Normal bicarbonate levels

22 to 27 mEq/L

Normal PCO2 levels

35 to 45 mm Hg

How much does total body fluid account for in body weight?

60%

Normal blood pH values

7.35 to 7.45

Normal PO2 levels

80 to 100 mm Hg

A nurse monitoring the 24-hour fluid balance of a client with diarrhea calculates the client's intake as 2500 mL and notes that urine output is 1500 mL and fecal output 150 mL. What is the additional expected maximal amount of insensible fluid loss the nurse should include in the calculation? A. Skin, 800 mL; lungs, 600 mL B. Skin, 400 mL; lungs, 500 mL C. Skin, 200 mL; lungs, 300 mL D. Skin, 100 mL; lungs, 100 mL

A

The nurse hears a health care provider discussing a client's condition with a medical resident in the nursing unit conference room. The health care provider tells the resident that the client needs an IV infusion of an isotonic solution. Which solution should the nurse expect the medical resident to prescribe? A. 0.9% NS B. 0.45% NS C. 10% dextrose in water D. 5% dextrose in 0.9% normal saline

A

A nurse is reviewing the medical records of the clients she has been assigned to care for. Which of them are at risk of metabolic alkalosis? Select all that apply. A. A client with COPD B. A client with heart failure who is receiving large doses of a diuretic C. A client with malnutrition who will be started on parenteral nutrition D. A client with rheumatoid arthritis who is receiving high doses of acetylsalicylic acid (aspirin) E. A client who has just undergone surgery and has a nasogastric tube that is attached to intermittent suction

B, E

Hypermagnesemia tip

Calcium gluconate is the antidote for magnesium overdose

A nurse performs an assessment of a client with a serum calcium level of 8.0 mg/dL (2.0 mmol/L). Which clinical manifestations of this electrolyte imbalance would the nurse expect to note? Select all that apply. A. Tachycardia B. Hypertension C. Bounding peripheral pulses D. Presence of the Trousseau sign E. Hyperactive deep tendon reflexes

D, E

What is the metabolic function indicator?

HCO3-

Homeostasis

Indicates the relative stability of the internal environment

What is the respiratory function indicator?

PCO2

Hypercalcemia

Serum calcium level above 10 mg/dL

Hypercalcemia tips

-A client with a calcium imbalance is at risk for a pathological fracture -Move the client carefully and slowly -Assist client with ambulation

Metabolic alkalosis

-A deficit of carbonic acid accompanied with decrease in hydrogen ions -pH is up -HCO3- is up

Respiratory alkalosis

-A deficit of carbonic acid and a decrease in hydrogen ion concentration -pH is up -PCO2 is down

Causes of respiratory acidosis

-Asthma -Brain trauma -Bronchitis -Emphysema -Hypoventilation -Pulmonary edema -Pneumonia

Foods containing magnesium

-Avocado -Canned white tuna -Cauliflower -Low fat yogurt -Peanut butter -Peas -Pork/beef/chicken -Potatoes

Foods to increase oral sodium intake

-Bacon -Butter -Cheese -Ham -Ketchup -Lunch meat -Processed food -Soy sauce -Table salt -White and whole wheat bread

Common dietary sources of potassium

-Bananas -Beef -Dried fruit -Milk -Oranges -Potatoes -Spinach -Strawberries -Tomatoes -Whole grains

Signs and Symptoms of fluid-volume excess

-Bounding, rapid pulse -Increased blood pressure -Increased respiratory rate -Moist crackles in lungs -Pitting edema -Altered level of consciousness

Symptoms of hypermagnesemia

-Bradycardia -Hypotension -Muscle weakness -Prolonged PR interval/widened QRS complexes -Drowsiness

Hypophosphatemia tips

-Decrease in phosphorus means an increase in calcium -Increase in phosphorus means a decrease in calcium

Symptoms of hypocalcemia

-Decreased heart rate -Hypotension -Abdominal cramping -Muscle twitching -Facial muscle spasms -Carpal spams from compression of upper arm

Causes of hypernatremia

-Decreased sodium excretion -Renal failure -Cushing syndrome -Decreased water intake -Increased water loss -Fever -Hyperventilation

Metabolic acidosis

-Describes a lower than normal total concentration of buffer base -pH is down -HCO3- is down

Causes of metabolic acidosis

-Diabetes -High fat diet -Malnutrition -Renal failure -Severe diarrhea

Causes of metabolic alkalosis

-Diuretics -Excessive vomiting -Massive transfusion of whole blood

Symptoms of hypophosphatemia

-Dysrhythmias -Shallow respirations -Muscle weakness -Diminished deep tendon reflexes -Irritability -Seizures

Causes of hypercalcemia

-Excessive oral intake of calcium or vitamin D -Renal failure -Dehydration -Medications like glucocorticoids or lithium carbonate

Causes of hyperkalemia

-Excessive potassium intake, orally or IV -Decreased potassium excretion -Tissue damage

Symptoms of respiratory alkalosis

-Headache -Nausea -Vomiting -Lethargic -Paresthesias (tingling of fingers and toes) -Tachycardia

Symptoms of respiratory acidosis

-Headache -Restlessness -Blood pressure drops -Skin is warm and flushed

Symptoms of metabolic acidosis

-Headaches -Fruity smelling breath -Skin is warm and flushed

Respiratory acidosis tips

-If the client has a condition that causes an obstruction of the airway or depresses the respiratory system, monitor the client for respiratory acidosis -Clients with a history or emphysema or COPD usually are not given oxygen greater than 2 liters by cannula since high levels of oxygen in the blood may decrease the stimulus to breathe leading to CO2 retention and respiratory acidosis

Causes of hypocalcemia

-Inadequate intake of calcium or vitamin D -Lactose intolerance -Renal failure -Diarrhea -Acute pancreatitis -Immobility -Medications like calcium chelators or binders

Respiratory acidosis

-Total concentration of buffer base is lower than normal -pH is down -PCO2 is up

A nurse is monitoring a client with emphysema in whom respiratory acidosis has developed. Which clinical manifestation of this acid-base imbalance would the nurse expect to note? A. pH of 7.50 B. Potassium level of 5.5 mEq/L C. Complaints of paresthesias by the client D. Decreased rate and depth of respirations

B

Which clinical manifestations of hypokalemia will the nurse expect to note while assessing the patient? Select all that apply. A. Weak peripheral pulses B. Orthostatic hypotension C. Decreased urine output D. An absence of deep tendon reflexes E. Decreased bowel sounds and constipation

A, B, D, E

The patient's condition has improved. The patient has not had any episodes of vomiting or diarrhea for 24 hours and is still receiving an IV infusion, but she is tolerating the intake of oral fluids. The health care provider writes an order discontinuing the IV fluid infusion and prescribes a saline lock until discharge tomorrow. Which actions by the nurse are essential in completing this prescription? Select all that apply. A. Washing the hands B. Informing the client C. Labeling the tubing D. Inserting the IV catheter E. Checking the client's vital signs F. Flushing the lock with NS per agency policy

A, B, F

The venipuncture site has been cared for, and the patient is resting comfortably. Twenty-four hours after the patient's admission to the medical unit, the health care provider increases the flow rate of the IV solution to 100 mL/hr because the patient continues to experience episodes of diarrhea and is still exhibiting signs of dehydration. Which actions should the nurse take to monitor the patient for complications after increasing the flow rate? Select all that apply. A. Monitoring the patient's weight B. Watching for slow, shallow breathing C. Auscultating for crackles in the lungs D. Assessing the patient for flat jugular veins E. Monitoring blood pressure to detect hypertension F. Monitoring intake and output for increasing urine output

A, C, E

The nurse is providing information to a client who must restrict sodium intake about the foods that are high in sodium. Which foods should the nurse tell the client to avoid? Select all that apply. A. Ketchup B. Broccli C. Baked ham D. Cantaloupe E. Watermelon F. American cheese

A, C, F

A nurse is reviewing the medical records of the clients hospitalized on the medical-surgical unit. Which of the clients would the nurse identify as being at risk for respiratory alkalosis? Select all that apply. A. A client with a fever B. A client with bronchitis C. A client with postoperative atelectasis D. A client with COPD E. A client with an endotracheal tube that is attached to a ventilator

A, E

Edema

An excess accumulation of fluid in the interstitial space

A nurse is providing self-care instructions to a client whose serum phosphorus level is 2.3 mg/dL (0.74 mmol/L). Which information should the nurse provide to the client? A. Eat foods high in calcium B. Eat foods high in phosphorus, such as dairy products, nuts, and legumes C. take phosphate-binding medications daily with meals or immediately after meals D. Read the labels on over-the-counter medications and avoid phosphate-containing medications such as laxatives and enemas.

B

The nurse is monitoring a client with renal failure who is at risk for fluid volume excess. Which assessment finding is indicative of this fluid imbalance? A. Flat neck veins B. Increased blood pressure C. Poor skin turgor with tenting D. Diminished peripheral pulses

B

A nurse in the cardiac telemetry unit is reviewing a client's laboratory results and notes that the potassium level is 5.8 mEq/L (5.8 mmol/L). In light of this laboratory value, which finding would the nurse expect to note while looking at the client's cardiac monitor? A. Inverted T waves B. Prominent U wave C. ST-segment depression D. Widened QRS complexes

D

A nurse reviewing the results of an arterial blood gas determination notes a pH of 7.50, PCO2 of 30 mm Hg, and bicarbonate (HCO3-) of 20 mEq/L (20 mmol/L). The nurse determines that the client is exhibiting: A. Metaolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

D

A client with hyponatremia accompanied by a fluid-volume deficit is being treated with IV normal saline solution. Which serum sodium laboratory finding indicates to the nurse that the treatment has been effective? A. 120 mEq/L (120 mmol/L) B. 130 mEq/L (130 mmol/L) C. 140 mEq/L (140 mmol/L) D. 150 mEq/L (150 mmol/L)

C

A nurse is reviewing the medical records of the clients she has been assigned to care for. Which client is at the greatest risk for hypercalcemia? A. A client with Crohn disease B. A client with lactose intolerance C. A client with severe dehydration D. A client who has undergone thyroidectomy

C

A nurse reviewing a client's laboratory results sees a magnesium level of 1.0 mg/dL (0.41 mmol/L). Which clinical manifestation would the nurse expect to note in this client in light of this laboratory finding? A. Bradycardia B. Hypotension C. Chvostek sign D. Diminished deep tendon reflexes

C

The IV catheter is inserted and infusion of the prescribed solution is started. The ED nurse transports the patient to the medical unit for admission and provides a detailed report on her status to the nurse on the medical unit. On admission to the medical unit, the patient complains of pain at the venipuncture site. Checking the venipuncture site, the nurse notes that it is swollen and cool to touch and also sees that the solution is not infusing. How does the nurse interpret these findings? A. The IV line needs to be flushed B. Infiltration of the IV site has occurred C. Phlebitis caused by the IV catheter is beginning to set in D. Heat should be applied to the venipuncture site to dilate the vein so that the solution will infuse as prescribed

C

The emergency department nurse, preparing to insert an IV catheter, assesses a patient (who had a fall affecting the right side of her body) for an appropriate venipuncture site. Which site should the nurse select as the best place to insert the catheter? A. Left foot B. Right hand C. Left inner arm D. Right inner arm

C

The nurse is monitoring the patient's serum potassium level while administering the IV potassium. Which serum potassium reading tells the nurse that the treatment has been effective? A. 3.0 mEq/L B. 3.3 mEq/L C. 4.0 mEq/L D. 5.6 mEq/L

C

An emergency department nurse is caring for a client with diabetic ketoacidosis who is being treated with a continuous IV infusion of regular insulin and IV fluids. For which expected outcome of treatment for the disorder should the nurse monitor the client? A. Fruity smelling breath B. Deep, rapid respirations C. Arterial blood pH of 7.30 D. Potassium level of 3.5 mEq/L

D

A nurse is reviewing the medical records of the clients for whom she will be caring. Which of these clients does the nurse identify as being at risk for a fluid-volume deficit? Select all that apply. A. A client with congestive heart failure B. A client with syndrome of inappropriate ADH C. A client with a nasogastric tube attached to suction D. A client undergoing long-term corticosteroid therapy E. A client with a fever who is experiencing severe diaphoresis

C, E

An electrocardiogram (ECG) is performed on a hypokalemic patient. Which ECG findings would the nurse expect to note? Select all that apply. A. Flat P waves B. Peaked T waves C. Prominent U wave D. Prolonged PR interval E. Depressed ST segment F. Widened QRS complexes

C, E

The ED health care provider writes a prescription for an IV catheter and tells the nurse that a hypertonic IV solution will be prescribed. The nurse reviews the health care provider's prescription. Which hypertonic solution does the nurse expect to see prescribed by the health care provider? A. 0.9% normal saline solution B. 5% dextrose in water C. 0.45% NS D. 5% dextrose in 0.45% NS

D

The health care provider prescribes a continuous intravenous (IV) infusion of 250 mL of normal saline solution with 40 mEq (40 mmol) of potassium chloride to be infused at a rate of 50 mL/hour by way of an infusion device. Which laboratory result is most important for the nurse to check before administering the infusion? A. Sodium B. Hematocrit C. Hemoglobin D. Blood urea nitrogen (BUN)

D

The patient's serum potassium level has returned to normal. She will be discharged with a prescription for oral potassium supplementation in addition to the previously prescribed lanoxin and furosemide. Which comment indicates that the patient understands the discharge instructions? A. "I may get black stools" B. "I'll start using a salt substitute" C. "I can take an extra pill if I forget to take one" D. "I will call my doctor if I suddenly get weak"

D

The nurse is teaching a client at risk for hypokalemia about foods that are high in potassium. Which foods should the nurse tell the client to be sure to consume? Select all that apply. A. Egg B. Cocoa C. Cheese D. Spinach E. Tomatoes F. Strawberries

D, E, F

Hyponatremia tip

Hyponatremia precipitates lithium toxicity in a client taking lithium

Body Fluid tip

Infants and older adults need to be monitored closely for fluid imbalances

Hypocalcemia

Serum calcium level below 8.6 mg/dL

Hypermagnesemia

Serum magnesium level above 2.6 mg/dL

Hypomagnesemia

Serum magnesium level lower than 1.6 mg/dL

Hyperphosphatemia

Serum phosphorus level above 4.5 mg/dL

Hypophosphatemia

Serum phosphorus level below 2.7 mg/dL

Hyperkalemia

Serum potassium level above 5.1 mEq/L

Hypokalemia

Serum potassium level below 3.5 mEq/L

Hypernatremia

Serum sodium level above 145 mEq/L

Hyponatremia

Serum sodium level below 135 mEq/L

Symptoms of hyperphosphatemia

Similar to symptoms of hypocalcemia

Third-spacing

The accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury