Chapter 13 Fluid-Electrolytes: Balance and Disturbance Workbook

The most characteristic manifestations of hypocalcemia and hypomagnesemia is

tetany

Factors that contribute to hypercalcemia

*Hyperparathyroidism *malignant tumors *immobilization because of multiple fractures *thiazide diuretics

Factors that contribute to hyperphosphatemia

*Kidney failure *neoplastic disease chemotherapy

Factors that contribute to hypomagnesemia

*alcohol abuse *diarrhea *gentamicin administration *untreated ketoacidosis

Factors that contribute to Hypokalemia

*alkalosis *vomiting *gastric suction *anorexia nervosa *hyperaldosteronism *furosemide (Lasix) administration *steroid administration *penicillin administration

Factors that contribute to hypophosphatemia

*hyperparathyroidism *major thermal burns *alcohol withdrawal

Things respiratory alkalosis causes

*hypoxemia *gram-negative bacterial infection

Factors that contribute to hypermagnesemia

*kidney failure

Things Metabolic acidosis causes

*lactic acidosis *ketoacidosis *diarrhea

Factors that contribute to hypocalcemia

*massive administration of citrated blood *pancreatitis *kidney failure * aminoglycoside administration

Things respiratory acidosis causes

*sedative overdose *severe pneuomonia *acute pulmonary edema

Factors that contribute to Hyperkalemia

*tourniquet too tight when collecting a blood sample *leukocytosis *kidney failure *adrenal steroid deficiency

What is blood urea nitrogen?

It is made up of urea. It is an end product of protein(muscle and dietary) metabolism by the liver.

What is urine specific gravity?

It measures the kidney's ability to excrete or conserve water.

Factors that contribute to Hyponatremia

*vomiting *diarrhea *diuretics *adrenal insufficiency *syndrome of inappropriate antidiuretic hormone *excessive parenteral administration of dextrose and water solution

Things metabolic alkalosis causes

*vomiting *hypokalemia

Factors that contribute to Hypernatremia

*watery diarrhea *Inability to quench thirst *burns over a large surface area *heat stroke *status post-therapeutic abortion *diabetes insipidus with water restriction

The average daily urinary output in an adult is

1.5 L

A patient with abnormal sodium losses is receiving a regular diet. How can the nurse supplement the patient's diet to provide 1600 mg of sodium daily?

12a

About ____ % of the 6 liters of total blood volume is plasma

50 %

The upper and lower blood pH levels that are incompatible with life are _____ and ______ ?

6.8 on lower range; 7.8 on upper range

About ______ of total body fluid is in the intracellular space

66%

The normal blood pH is ______

7.35-7.45

Cardiac effects of hyperkalemia are usually present when the serum potassium level reaches

8 mEq/L

A normal oxygen saturation value for arterial blood is

95%

The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer?

A. .45% sodium chloride

The nurse notes that a patient's urine osmolality is 980 mOsm/kg. What should the nurse assess as a possible cause of this finding?

A. acidosis

The nurse is caring for a patient with a diagnosis of hyponatremia. What nursing intervention is appropriate to include in the plan of care for this patient?

A. assessing for symptoms of nausea and malaise C. monitoring neurologic status D. restricting tap water intake

What foods can the nurse recommend for the patient with hypokalemia?

A. fruits such as bananas and apricots

A patient is admitted with a diagnosis of renal failure, That patient complains of stomach distress and describes ingesting several antacid tablets over the past 2 days. Blood pressure is 110/70 mm Hg, face is flushed, and the patient is experiencing generalized weakness. Which is the most likely magnesium level associated with the symptoms the patient is having?

B. 5 mEq/L

Which medication does the nurse anticipate administering to antagonize the effects potassium on the hear for a patient in severe metabolic acidosis?

B. magnesium sulfate

What clinical indication of hypophosphatemia does the nurse assess in a patient?

B. paresthesia

The most common buffer system in the body is the

Bicarbonate-carbonic acid-buffer system

A patient is admitted with severe vomiting for 24 hours as well as weakness and feeling exhausted. The nurse observes flat T waves and ST segment depression on the electrocardiogram. Which potassium level does the nurse observe when the laboratory studies are complete?

C. 2.0 mEqL

A patient complains of tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the patients laboratory work was returned?

C. calcium

With which condition should the nurse expect that a decrease in serum osmolality will occur?

C. kidney failure

How are calcium levels regulated?

Combined actions of parathyroid hormone and vitamin D.

Explain why the administration of a 3% to 5% sodium chloride solution requires intense monitoring.

Intense supervision is required because only small volumes are needed to elevate the serum sodium from dangerously low levels

Third space fluid shift

Intravascular fluid volume deficit

Name the primary complication of hyperphosphatemia which occurs when the calcium-magnesium product exceeds 70mg/dL?

Metastatic calcification of soft tissue, joints, and arteries

What is the mathematical formula that a nurse would use to approximate the value of serum osmolality?

Na * 2 = glucose divided by 18 + BUN divided by 3

What is osmotic pressure?

The amount of hydrostatic pressure needed to stop the flow of water by osmosis. It is primarily determined by the concentration of solutes.

Sodium, the most abundant electrolyte in extracellular fluid, is primarily responsible for maintaining fluid _____, which ______________________________.

Osmolality; affects the movement of water between fluid compartments.

The major positively charged ion in intracellular fluid is

Potassium

Osmoreceptors

Sense changes in sodium concentration

List four of six symptoms associated with air embolism, a complication of intravenous therapy.

Symptoms include dyspnea, cyanosis, a weak pulse, hypotension, unresponsiveness, and pain (chest, shoulder, low back ).

What is creatinine?

The end product of muscle metabolism, is a better indicator of renal function than blood urea nitrogen

What are baroreceptors?

They are responsible for monitoring the circulating volume. They are small nerve receptors that detect changes in pressure within blood vessels.

The nurse should assess the patient for signs of lethargy, increasing intracranial pressure, and seizures when the serum sodium reaches what level ?

a. 115 mEq/L

What laboratory findings does the nurse determine are consistent with hypovolemia in a female patient?

a. hematocrit level of >47% c. urine specific gravity of 1.027 d. urine osmolality of >450 mOsm/kg

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be ?

b. 275-300 mOsm/kg

What does the nurse recognize as one of the indicators of the patient's renal function?

b. serum creatinine

A patient has been involved in a traumatic accident and is hemorrhaging from multiple sites. The nurse expects that the compensatory mechanisms associated with hypovolemia would cause what clinical manifestations?

b.oliguria, c. tachycardia, e. tachypnea

The primary concentration of phosporus (85%) is located in the ______ with about 15% located in _______

bones; soft tissue

A patient who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue and a body temperature of 99.3F. The urine specific gravity is 1.020. What is the most likely serum sodium value for this patient?

c. 155 mEq/L

In a patient with excess fluid volume, hyponatremia is treated by restricting fluids to how many milliliters in 24 hours ?

c. 800 mL

The nurse is caring for a patient with hypernatremia. What complication of hypernatremia should the nurse continuously monitor for?

c. cerebral edema

A patient with mild volume excess is prescribed a diuretic that blocks sodium reabsorption in the distal tubule. Which diuretic does the nurse anticipate administering to this patient?

c. hydroDiuril

THe nurse is caring for a patient with diabetes type I who is having severe vomiting and diarrhea. What condition that exhibits blood values with a low pH and low plasma bicarbonate concentration should the nurse assess for

c. metabolic acidosis

Space where plasma is contained

intravascular space

comprises the intravascular, interstitial, and transcellular fluid

extracellular fluid compartment

comprises fluid surrounding cell

interstitial space

comprises about 60% of body fluid

intracellular space

Sodium establishes the electrochemical state necessary for ________ and the ____________.

muscle contraction; transmission of nerve impulses

The major positively charged ion in extracellular fluid is

sodium ions

Sodium is regulated by

thirst, antidiuretic hormone, and the renin-angiotensin aldosterone system

The smallest compartment of the extracellular fluid space

transcellular space

The extracellular space is divided into three compartments

vascular, interstitial, and transcellular