1245 fluid and electrolytes

A client reports occasional numbness in the fingers and lips. Which dietary choices should the nurse encourage the client eat? Bananas Chicken broth Wheat breads Milk products

Milk products

For the past 24 hours, a client with dry skin and dry mucous membranes has had a urine output of 600 ml and a fluid intake of 800 ml. The client's urine is dark amber. These assessments indicate which nursing diagnosis? Excess fluid volume Deficient fluid volume Impaired urinary elimination Imbalanced nutrition: Less than body requirements

Deficient fluid volume

Fluid Volume Excess (FVE)

(hypervolemia) retention of both water and sodium in ECF CAUSES: kidney malfunctions (inability to excrete) Heart failure (fluid accumulation) liver issues (ascites) increased Na intake pulmonary edema excess ECF, depleted cells

what is the desired amount of fluid intake/loss in adults?

1500-3500ml per 24 hours

what is the minimum amount of urine needed to excrete toxic waste products?

400-600ml a day (30ml/hour)

third space fluid shift

A distributional shift of body fluids out of ICF and into the transcellular compartments, SUCH AS: the pleural, peritoneal (ascites), or pericardial areas; joint cavities; the bowel; or an excess accumulation of fluid in the interstitial space. ECF deficit occurs RELATED TO: colloid osmotic pressure (low albumin) and capillary hydrostatic pressure (HF) increased fluid volume hyponatremia and increased permeability of capillary membranes CAUSES: severe burns bowel obstructions surgical procedures ascites sepsis

A client with a serum glucose level of 618 mg/dl (34.33 mmol/L) is admitted to the facility. The client is awake and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F (38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on these assessment findings, which nursing diagnosis takes highest priority? Decreased cardiac output related to elevated heart rate Deficient fluid volume related to osmotic diuresis Ineffective thermoregulation related to dehydration Imbalanced nutrition: Less than body requirements related to insulin deficiency

Deficient fluid volume related to osmotic diuresis

diffusion

Movement of molecules (solutes) from an area of higher concentration to an area of lower concentration.

A client is receiving intravenous fluids and upon assessment presents with increased pulse, increased respirations, and jugular vein distension. What is the priority action by the nurse? Slow the intravenous rate and notify the physician. Repeat the vital signs in 1 hour. Lower the head of the bed. Administer oxygen and encourage the client to breathe deeply.

Slow the intravenous rate and notify the physician.

A client is admitted for acute kidney injury and has a potassium level of 5.6 mEq/L (mmol/L), a blood glucose level of 80 mg/dL (4.4 mmol/L), and an electrocardiogram demonstrating peaked T waves. What prescription would the nurse question? Sodium polystyrene sulfonate PO. Furosemide I.V. Regular insulin and dextrose I.V. Spironolactone PO.

Spironolactone PO.

A client has been taking furosemide for 2 days. The nurse should review the laboratory record for changes in which blood level? a decreased potassium an elevated sodium an elevated potassium an elevated blood urea nitrogen (BUN)

a decreased potassium

what factors cause variations in body fluid content?

age gender body fat%

A client with an I.V. of normal saline at 150 mL/hour reports dyspnea and restlessness. What is the priority nursing action? assess lung sounds obtain electrolyte laboratory results decrease IV rate obtain client weight

assess lung sounds

what separates the intracellular fluid from extracellular fluid?

capillary walls and cell membranes

Fluid Volume Deficit (FVD)

caused by : loss of water and solutes from ECF (hypovolemia) Hemorrhage trauma D/V sweat thoracentesis decreased intake polyuria 5% weight loss=pronounced fluid deficit 8% weight loss=severe fluid deficit 15% weight loss=life threatening fluid deficit

What does K do in the body?

chief regulator of cell enzyme activity and water content

what does Na do to the body?

controls and regulates water balance.

When assessing a client diagnosed with third spacing, a nurse should expect to assess manifestation? oliguria decreased blood pressure diuresis bradycardia

decreased blood pressure

Hypovolemia

decreased blood volume

what are 0.9NS and lactated ringers for?

dehydration you would give to a diabetic

The nurse is caring for a client with a serum sodium level of 128 mEq/L. Which order for intravenous fluids should the nurse should question? lactated Ringer's solution normal saline solution 0.9 dextrose 5% in water (D5W) dextrose 5% in half-normal saline solution D5.45

dextrose 5% in water (D5W)

FVE symptoms

edema crackles in lungs shiny taught skin rapid bounding pulse HTN (increased blood vol) jugular vein distention (BEST ASSESSED LAYING) weight gain 5% polyuria dyspnea

isotonic solution

equal solute and solvent ratio same osmolarity as plasma no fluid shift 275-295 0.9NS lactated ringers can cause hyperkalemia

why do women and obese people carry less water?

fat doesn't hold as much water as muscle

hypertonic solution

higher solute (salt) and lower solvent (water) than ICF higher osmolarity (thicker) than plasma water moves out of cells and is drawn into ECF causing the cells to shrink >295 D5 0.9NS D5 0.45NS D5 lactated ringers D10W

capillary filtration has hydrostatic pressure and colloid osmotic pressure, what are they?

hydrostatic pressure is the push force from blood out of the capillaries colloid osmotic pressure is the pulling of fluid back into the capillaries

A primary health care provider prescribes regular insulin 10 units intravenously (I.V.) along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? hypercalcemia hyperkalemia hypernatremia hypermagnesemia

hyperkalemia

Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream? isotonic hypotonic hypertonic sodium chloride

hypertonic

A physician orders a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance? hypervolemia hyperkalemia hypokalemia hypernatremia

hypokalemia

labs relating to FVD

if they're dry, they're high increased BUN increased serum osmolarity increased specific gravity of urine decreased urine output (dry)

Hypervolemia

increased blood volume

right side heart failure causes:

increased capillary pressure due to inadequate pulling force which leads to peripheral edema

what are the two types of body fluid compartments?

intracellular: fluid within the cells (70% of body water) extracellular: all fluid outside of the cell (30% of TBW)

what are the three categories of extracellular fluid?

intravascular: plasma, the liquid component of blood interstitial: fluid surrounding the tissue cells and lymph transcellular: cerebrospinal, pericardial, synovial, pleural, sweat, and digestive fluids

how does lack of protein cause ascites

it is unable to pull fluid into the capillaries

what does aldosterone do for fluid/electrolyte homeostasis?

it regulates sodium homeostasis and it is a vasoconstrictor

A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? lactated Ringer's solution 5% dextrose and normal saline solution 10% dextrose in water half-normal saline solution

lactated Ringer's solution

symptoms of fluid deficit

low BP (from low blood vol) tachycardia (with weak pulse) weakness confusion poor perfusion (evident is capillary refill) dry mucous membranes poor skin turgor

FVE labs

low BUN low Hct low Na low serum osmolarity

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply. aphasia tingling polyuria numbness polydipsia muscle twitching and spasms

numbness tingling muscle twitching and spasms

A client has a nursing diagnosis of fluid volume deficit. Which nursing assessment finding would support this diagnosis? orthostatic blood pressure changes leathery, pliable skin pedal pulses of 4+ pretibial pitting edema

orthostatic blood pressure changes

A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatesteffect on fluid loss? warm, dry skin hypotension decreased serum potassium level rapid, deep respirations

rapid, deep respirations

Sensible vs insensible water loss

sensible: urine, defacation, wounds insensible: respirations, skin evaporation

what are the major electrolytes in the extracellular fluid?

sodium chloride calcium bicarbonate

fluid imbalance occurs when

the compensatory mechanisms can't maintain a homeostatic state

definition of solvent

the liquid in which a solute is dissolved (water is the primary solvent)

why are infants more prone to fluid volume deficits?

they contain more body fluid and extra cellular fluid

what is the term for the total amount of water in the body?

total body water (50-60% of body weight is water)

osmolarity

total concentration of all solute particles in a solution

what is the primary body fluid?

water

when would you give D5W, 0.45NaCl (1/3NS) or 0.33NaCl (1/3NS)

when we need to put fluids into the cells cellular dehydration Diabetic Ketoacidosis and HHNS hypernatremia

osmosis

Diffusion of water through a selectively permeable membrane. a solvent passes from an area of less solutes to an area with more solutes until there is equilibrium this is the major method of transporting body fluids

edema

Abnormal accumulation of fluid in interstitial spaces of tissues. increase in hydrostatic pressure OR increased osmotic pressure (HTN) leads to capillary damage

1 liter of water = _______ lbs or _____kg

2.2lbs or one kg

what is the percentage of total body fluid in someone 60+ years old

45% (increased risk of fluid imbalances)

how many ml is one lb of fluid

500ml

A client is receiving spironolactone for treatment of bilateral lower extremity edema. The nurse should instruct the client to make which nutritional modification to prevent an electrolyte imbalance? Decrease foods high in potassium. Restrict fluid intake to 1,000 mL/day. Increase intake of milk and milk products. Increase foods high in sodium.

Decrease foods high in potassium.

active transport

Energy-requiring process that moves material across a cell membrane against a concentration difference from areas off less solute to areas of more solute combats diffusion energy used is ATP this process is used by amino acids, Na,K,H, and Ca EX: sodium potassium pump

what are the primary organs for homeostasis in the body?

KIDNEYS AND GI PLAY LARGEST ROLE GI tract: absorbs water and nutrients parathyroid gland: regulates Ca levels in ECF kidneys: creates 1-1.5 liters of urine a day. selectively retains/eliminates electrolytes Cardiovascular system: circulates nutrients and water throughout the body Lungs: regulate O2 and CO2 adrenal glands: conserve Na, excrete K, and save H20 and Cl pituitary gland: secrete ADH, which causes kidneys to retain water thyroid gland: increase blood flow Nervous system: controls mechanisms of fluid balance

hypotonic solution

lower osmolarity (less salt) than plasma less salt and more water than your body fluid moves out of intravascular space and into cell (ICF) causing cells to swell <275 D5W (not for diabetics, can cause hyperglycemia) 0.45NaCl (1/3NS) 0.33NaCl(1/3NS)

A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess Hegar's sign. Goodell's sign. Homans' sign. Trousseau's sign.

Trousseau's sign.

The student nurse asks why a client is receiving an I.V. of lactated Ringer's with potassium following an episode of diabetic ketoacidosis. What is the best response by the nurse? In acidosis, the sodium moves into the cells to buffer the acid and displaces the potassium. The lactated Ringer's helps restore the alkaline pH. With acidosis, the intracellular potassium switches places with the plasma hydrogen ions to buffer the acidosis; the lactated Ringer's helps restore the bicarbonate reserves. Lactated Ringer's will help lower the blood pH when hypokalemia is related to ketoacidosis. Hypokalemia is associated with uncontrolled diabetes, and the lactated Ringer's is isotonic fluid replacement.

With acidosis, the intracellular potassium switches places with the plasma hydrogen ions to buffer the acidosis; the lactated Ringer's helps restore the bicarbonate reserves.

how is fluid homeostasis achieved in the body?

through autonomic shifts and cellular/vascular shifts. almost every organ plays a role in homeostasis of the body

functions of water in the body

transport nutrients to cells transport waste away from cells transport hormones, enzymes, platelets, WBC, and rbc facilitate cellular metabolism act as a solvent for electrolytes temperature regulation aids in digestion and elimination acts as a tissue lubricant (dehydration compromises these)

what does bicarbonate do in the body?

body's primary buffer system (comes from the kidneys)

symptoms of fluid overload

bounding pulse HTN jugular vein distention edema crackles in lungs

FVE interventions

fluid restrictions diuretics hemodialysis sodium restrictions monitor VS, respiratory status, edema, weight, I&O

An older adult client is admitted to the hospital with a diagnosis of pneumonia. The nurse learns that the client lives alone and has not been eating or drinking properly. Upon physical assessment, the nurse notes tachycardia, hypotension, and hyperthermia. Which admission order would the nurse implement first? acetaminophen orally as needed small-volume nebulizer breathing treatments intravenous fluid hydration regular diet

intravenous fluid hydration

what does Mg do in the body?

metabolism of carbohydrates and proteins aids in vital actions involving enzymes

FVD interventions

monitor daily weights monitor pt vitals, labs, I&O fluid replacement (hypertonic or isotonic solutions)

A client who has been taking furosemide has a serum potassium level of 3.2 mEq/L. Which assessment findings by the nurse would confirm an electrolyte imbalance? muscle weakness and a weak, irregular pulse tetany and tremors mental status changes and poor tissue turgor diarrhea and cramps

muscle weakness and a weak, irregular pulse

The sudden onset of which sign indicates a potentially serious complication for the client receiving an IV infusion? pupillary constriction moist skin noisy respirations halitosis

noisy respirations

what are the four mechanisms of homeostasis in the body

osmosis diffusion active transport capillary filtration

what does Ca do in the body?

plays a role in nerve impulse, clotting, muscle contraction, and vitamin b12 absorption

A client is at risk for excess fluid volume. Which nursing intervention ensures the mostaccurate monitoring of the client's fluid status? measuring and recording fluid intake and output checking the client's lungs for crackles during every shift weighing the client daily at the same time each day assessing the client's vital signs every 4 hours

weighing the client daily at the same time each day

what are D5 0.9NS, D5 0.45NS, D5RL, D10W for?

when we need to pull water out of the tissues and into the vein (intravascular spaces) to attempt to create a better ratio of water and solute people with pitting edema hypovolemia heat exhaustion peritonitis

solute

A substance that is dissolved in a solution (electrolytes)

A nurse is caring for a client with a nursing diagnosis of fluid volume deficit related to impaired thirst mechanism. Which outcome would the nurse determine as most appropriate for this client? The client's intake and output are balanced. The client's skin remains dry and intact throughout the hospital stay. The client verbalized the importance of increasing fluid intake. The client performs oral hygiene every 4 hours.

The client's intake and output are balanced.

what does Cl do in the body?

maintains osmotic pressure in the blood

the greater the difference in concentration of two solutions on each side of a semi-permeable membrane, the greater the _________

osmotic pressure (drawing power of water)

capillary filtration

passage of fluid across the wall of the capillary results from the force of blood "pushing" against the walls of the capillaries high pressure->low pressure dependent on arterial blood pressure on arterial end and venous blood pressure on venous end

An older adult client with heart failure and 2+ pitting edema is prescribed furosemide. Due to the effects of furosemide, which additional medication should the nurse recommend to the client to supplement when taking furosemide? phosphates potassium calcium magnesium

potassium

what is the number one electrolyte to manage during dialysis?

potassium

what are the major electrolytes in the intracellular fluid?

potassium phosphorus magnesium

left side heart failure causes

pulmonary edema

why are elderly at risk for fluid volume issues?

they have decreased muscle and higher fat

what is fluid intake regulated by?

thirst mechanism in the hypothalamus; stimulated by intracellular dehydration and decreased blood volume.