Fluids and electrolytes

Which medication would the nurse anticipate being prescribed for the client with renal failure who has hyperphosphatemia? Vitamin D (Calcitriol) Calcium carbonate Levothyroxine Cinacalcet

Calcium carbonate-Phosphate-binding antacids -Other phosphate binding antacids:(aluminum salts, calcium carbonate, or calcium acetate)

what are the causes of hypochloremia?

- Excessive vomiting - GI suctioning - Metabolic Alkalosis - Excessive intake of alkaline materials - Excessive loss of urine

What are the clinical manifestations of hyperkalemia?

-Abdominal pain -tingling fingers

What are the clinical manifestations of Hypokalemia?

-Apnea -Hypotonic bowel sounds -muscle fatigue -Cardiac arrhythmias

What is chloride and what lab range

-Chloride is the major anion of extracellular fluids -Normal serum range =95 to 105meq/l

Clinical indications for hypervolemia?

-Crackles -ventricular gallop -clammy skin -SOB -Dyspnea

What are the causes of hyponatremia?(4)

-Excessive Diuresis -Excessive sweating -GI fluid loss (vomiting, diarrhea and fistula) -Adrenocorticoid insufficiency

What are three steps to treat hypervolemia?

-Identify and treat underlying causes -Restrict sodium and water -If severe, then oxygen therapy, morphine,intravenous diuretic and mechanical ventilation

What are the causes of hypokalemia?(4)

-Renal failure -Heart failure -Cirrhosis -Nephrotic Syndrome

What are the treatment for hyperchloremia

-Treat metabolic acidosis -sodium bicarbonate IV -lacted ringers Iv

The prolonged gastric suctioning can cause Hypokalemia?

-True

True/False- Severe hypo/hypernatremia can lead to seizures,coma and death

-True

Name one cause of hypovolemia

-fistulas

What are the clinical manifestations of hypovolemia

-hypotension -tachycardia -flattened neck veins

What are causes of hyperatremia?

-intake of excessive sodium -loss of water +diarrhea +DI,

What is lab range for severe hyponatremia? What is the complication?

-less than 115Meq/l -Permanent neurological defifcts

Clinical indications for hypervolemia (3)

-ventricular galllop -Crackles -clammy ski

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? Restrict fluids and salt for 24 hours. Correct the sodium deficit rapidly with salt. Administer small volumes of a hypertonic solution. Monitor the serum sodium for changes hourly.

Administer small volumes of a hypertonic solution. if neurologic symptoms are severe (e.g., seizures, delirium, coma), or if the client has traumatic brain injury, it may be necessary to administer small volumes of a hypertonic sodium solution with the goal of alleviating cerebral edema.

What are the clinical manifestations of hyponatremia?

Edema, orthostatic hypotension, muscle cramps, obtundation,seizures

A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for: Dehydration. Hyperglycemia. Hyponatremia. Acidosis.

Hyponatremia

What is hypokalemia?

Increased loss of potassium from body or movement of potassium into the cell Lab value less than 3.5med/L

The nurse is caring for a client who has excessive diarrhea. Which acid-base disturbance does the nurse anticipate will result from having excessive diarrhea? No change in values from normal An increase in bicarbonate Metabolic acidosis Increased pH value

Metabolic acidosis The client who has diarrhea has increased loss of bicarbonate from the intestinal tract, which results in metabolic acidosis. The pH value would be decreased, and the bicarbonate would be decreased.

Chloride deficit results in ____

Metabolic alkalosis

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis

Metabolic alkalosis Metabolic alkalosis results in increased plasma pH because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include excessive oral or parenteral use of bicarbonate-containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning. Acidotic states are from excess carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit that occurs when rapid breathing releases more CO2 than necessary.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH? Restricting fluids to 800 ml/day Administering vasopressin as ordered Elevating the head of the client's bed to 90 degrees Restricting sodium intake to 1 gm/day

Restricting fluids to 800 ml/day Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day.

What is the major cation of extracellular fluid?

Sodium

Which diuretic acts by preventing the reabsorption of sodium chloride in the distal convoluted tubule? Thiazide diuretics Loop diuretics Potassium-sparing diuretics Osmotic diuretics

Thiazide diuretics Rationale: Thiazide diuretics act by preventing the reabsorption of sodium chloride in the early distal convoluted tubule. K+-sparing diuretics reduce sodium reabsorption and decrease K+ secretion in the late distal tubule. Loop diuretics act on the ascending loop of Henle. Osmotic diuretics cause water to be retained in the proximal tube.

What medications are ordered for hypovolemia

Vasopressors such as epiphirine,norepinephrine Inotrope like Dobutamine

The concern with acute kidney injury (AKI) is ___

hyperkalemia.

A nurse is monitoring a client being evaluated who has a potassium level of 7 mEq/L (mmol/L). Which electrocardiogram changes will the client display? prolonged T waves elevated ST segment peaked T waves shortened PR interval

peaked T waves The earliest changes occur when the serum potassium level is 7 mEq/L (mmol/L). Cardiac tracings include peaked and narrow T waves, ST segment depression, and a shortened QT interval.

What is the other name for ADH?

vasopressin

A 4-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. The nurse should suspect that the child's I.V. fluid intake is excessive if assessment reveals worsening dyspnea. gastric distention. nausea and vomiting. a temperature of 102° F (38.9° C).

worsening dyspnea. Dyspnea and other signs of respiratory distress signify fluid volume overload, which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. Gastric distention suggests excessive oral (not I.V.) fluid intake or infection. Nausea and vomiting or an elevated temperature may indicate a fluid volume deficit, not an excess.