Fluid and Electrolytes

manifestations of respiratory alkalosis

-seizures -deep, rapid breathing -hyperventilation -tachycardia -decreased or normal BP -hypokalemia -numbness and tingling of extremities -lethargy and confusion -light headedness -nausea, vomiting

normal HC03

22-28 <22: Acidic >28: alkaline metabolic component

normal PaCO2

35-45 <35: alkaline >45: acidic (respiratory component)

normal pH levels

7.35-7.45 <7.35-->acid >7.45-->alkaline

What hormone controls water and prevents diuresis?

ADH

What hormone, when secreted would cause my osmolality to drop?

ADH

1. What hormone controls sodium and through the control of sodium causes fluid to move from the glomerular filtrate back into the vascular system?

Aldosterone

partially compensated

All values are abnormal

Respiratory alkalosis

Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2. (Increased pH, Decreased PaCO2)

Which arterial blood gas finding is most consistent with a diagnosis of metabolic acidosis?

Bicarbonate 18 mEq/L Rationale: A low bicarbonate (below 22 mEq/L) is consistent with a diagnosis of metabolic acidosis.

A common problem with both hyperkalemia and hypokalemia is which potential complication? a. seizures b. paralysis c. dysrhythmias d. AKI

C. Dysrhythmias

Uncompensated

CO2 or HCO3 normal

Which lab finding would the nurse hold the patients scheduled dose of potassium phosphate?

Calcium of 6.4 rationale: calcium and phosphate have an inverse relationship. administer phosphorus it would decrease the patients already abnormally low Calcium levels

A pt is having issues with sodium imbalance, the primary clinical manifestations are related to alterations in which body system?

Central Nervous System (CNS)

interpret this ABG: pH- 7.36 PaCO2-58 mmHg HCO3-33 mEq/L paO2-50 mmHg Explain who would have this type of ABG result

Compensated respiratory acidosis seen in a pt with hypercapnic respiratory failure

causes of metabolic acidosis

DKA, severe diarrhea, renal failure, shock (lactic acid accumulation)

Which intervention would the nurse include when administering IV potassium chloride to a patient with hypokalemia?

Diluting the dose of KCL rationale: KCl should be diluted before administration. Giving KCl in high concentrations could cause cardiac dysrhythmias.

Metabolic Acidosis

Excess carbonic acid or base bicarb deficit (Decreased pH, decreased HCO3) -Increased CO2 excretion from lungs -Kussmaul RR (deep & rapid) -kidneys secreting acid

manifestations of metabolic acidosis

Headache Lethargy Kussmaul respirations decreased BP hyperkalemia muscle twitching decreased muscle tone decreased reflexes

Which clinical manifestation would the nurse expect to see when caring for a patient with hypercalcemia?

Hypertension

Manifestations of Respiratory acidosis?

Hypoventilation-->hypoxia Hyperkalemia Rapid, shallow RR--> Decreased BP

interpret this ABG: pH- 7.39 PaCO2-38 mmHg HCO3-24 mEq/L paO2-44 mmHg Explain who would have this type of ABG result

Hypoxemic respiratory failure PaO2 is not normal, everything else is.

What will happen to my serum osmolality if I become dehydrated?

Increase because there is a greater amount of solute in my body.

A renal patient has a calcium level of 7.5mg/dL. What symptoms may the nurse expect to see?

Numbness and tingling around the mouth.

The nurse is caring for a patient diagnosed with metabolic alkalosis. Which clinical manifestation would the nurse expect to see in this patient?

Tetany

A pt has the following ABG results pH: 7.48 PaO2: 86 PaCO2: 44 HCO3: 29 When assessing the pt, what would the nurse expect to find? a. muscle cramping b. warm, flushed skin c. RR of 36 d. Bp of 94/52 mmHg

a. muscle cramping the ABG results are showing metabolic alkalosis and muscle cramping is a manifestation of that

Which indicator is most accurate when accessing the fluid balance of a patient with heart failure

daily weights

clinical manifestations would a nurse observe in a Heart failure patient with fluid volume excess?

full bounding pulse, presence of s3 heart sound, and JVD.

Clinical manifestation would the nurse see with a patients admitting diagnosis of deficient fluid volume related to nausea and vomiting.

general restless rationale: restlessness is an early sign of a fluid volume shift

metabolic alkalosis

high pH, high HCO3

Causes of respiratory alkalosis

hyperventilation (anxiety, PE, fear), mechanical ventilation

Upon physical examination, the nurse identifies Trousseau's and Chvostek's signs. Based on these findings the nurse would suspect which electrolyte disorder

hypocalcemia

Which common electrolyte imbalance would the nurse access for in a patient with sickle cell anemia?

increased phosphate rationale: increased phosphates in the body because of renal damage due to the sickled cells

Which Solution is like the composition of a cell and will not promote change in cell size?

isotonic

What body system is the main source for water loss?

kidneys-renal

clinical manifestations would a nurse observe in a Heart failure patient with fluid volume deficit

orthostatic hypertension and increased HR

compensated

pH is normal

interpret this ABG: pH- 7.20 PaCO2-28 mmHg HCO3-18 mEq/L paO2-81 mmHg Explain who would have this type of ABG result

partially compensated metabolic acidosis rationale: decreased pH and CO2; uncontrolled diabetes

interpret this ABG: pH- 7.57 PaCO2-46 mmHg HCO3-38 mEq/L paO2-87 mmHg

partially compensated metabolic alkalosis rationale: increased pH and CO2

clinical manifestations of a patient with fluid volume excess

pulmonary congestion, SOB, and moist crackles on inspiration

Causes of of Respiratory acidosis?

respiratory depression anesthesia overdose increased ICP airway obstruction decreased alveolar capillary diffusion pneumonia: COPD, ARDS, PE

manifestations of metabolic alkalosis

restlessness/lethargy symptoms of hypokalemia (dysrhythmias/ tachycardia) compensatory hypoventilation decreased LOC/confusion

What is the main contributor to serum osmolality?

serum sodium

Causes of metabolic alkalosis

severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3

Interpret this ABG: pH- 7.20 PaCO2-58 mmHg HCO3-24 mEq/L paO2-59 mmHg Explain who would have this type of ABG result

uncompensated respiratory acidosis rationale: decreased pH and increased CO2, bicarb is normal. occur in patients w/ hypoxemia, respiratory infection or exacerbation of COPD

interpret this ABG: pH- 7.50 PaCO2-28 mmHg HCO3-24 mEq/L paO2-85 mmHg Explain who would have this type of ABG result

uncompensated respiratory alkalosis rationale: increased pH, decreased CO2, normal bicarb seen in a pt w/ hypoxemia or acute pulmonary disorders

Which patient condition can result in hypermagnesemia?

use of laxatives

Which type of fluid is most used due to its isotonic tonicity?

0.9% normal saline (NS)

Respiratory acidosis

A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2. Also, could be do to respiratory failure. (low pH, high CO2)

A pt with an acid-base imbalance has altered K+ level. The nurse recognizes the K+ is altered because?

Acidosis causes H+ ions in the blood to be exchanged for K+ from the cells.

Which intervention would the nurse anticipate for a patient with hyperphosphatemia?

Administering calcium carbonate rationale: Calcium carbonate acts as a phosphate-binding agent which can help lower levels of phosphate in the blood.

A patient is admitted from a nursing home with altered level of consciousness and hypertension due to severe dehydration. What is the initial priority nursing intervention:

Adminster IV fluids

A client may have developed fluid volume excess because the client's intake is greater than her output and both ankles and feet are swollen. What assessment is important for the nurse to perform?

Auscultate breath sounds. rationale: Fluid volume excess often causes abnormal breath sounds. Fluid collection in the lungs can impair oxygen exchange.

Which assessment finding would the nurse expect for a patient with hypocalcemia?

Chovestek sign muscle cramps numbness around mouth

1. What will happen to my serum osmolality if I drink too much and don't get rid of the fluids?

Decrease because you are diluting salt to H20 ratio.

The nurse is caring for a patient prescribed a hypertonic solution. Which solution would the nurse anticipate administering?

Dextrose 5% in 0.9% saline rationale: Dextrose 5% in 0.9% normal saline is a hypertonic solution.

In the hospital, you frequently draw blood for the measurement of electrolytes. What are you measuring the intracellular or extracellular level of the electrolyte?

Extracellular, venipuncture is measuring the amount of electrolyte in that space.

A patient comes to the ED with a chief complaint of SOB. Nursing assessment reveals full bounding pulse, peripheral edema, distended neck veins, and audible cackles in both lungs. This is a sign of?

Fluid volume excess (hypervolemia)

Which electrolyte imbalance would the nurse suspect for a patient that is bedbound and exhibits confusion, muscle weakness, and depressed reflexes?

Hypercalcemia rationale: Hypercalcemia results from prolonged immobility, such as being bedbound because of calcium release from bones. Hypercalcemia presents with confusion, muscle weakness, and depressed reflexes.

Thirst, poor skin turgor, hypotension, dark concentrated urine, and weak rapid pulse are all clinical signs of which fluid volume disorder?

Hypovolemia (dehydration)

A patient is admitted to the hospital with a c-diff infection. The patient is at greatest risk for which complications?

Hypovolemia (fluid volume deficit due to diarrhea) and Hypokalemia

If a heart failure patient takes too many diuretics, what respiratory manifestation would the nurse expect to find?

Increased respiratory rate rationale: pt has fluid volume deficient, decreased tissue perfusion and hypoxia.

Which medication can cause hypokalemia?

Insulin rationale: Insulin promotes movement of potassium into cells which decreases the volume of potassium in the vessels.

Which acid-base imbalance would the nurse monitor for in a patient with diabetic ketoacidosis?

Metabolic acidosis rationale: Metabolic acidosis can result from DKA due to acid accumulation in the body.

The nurse is caring for a patient in the emergency department who reports severe vomiting for three days. Which acid-base imbalance would the nurse suspect in this patient?

Metabolic alkalosis rationale: Metabolic alkalosis can be caused by severe vomiting, nasogastric (NG) suction, and use of diuretics

The nurse starts an intravenous line to administer fluids. The prescription states, "3% sodium chloride Injection to infuse at 100 mL/hour." The client's most recent serum sodium level is 135 mEq/L (135 mmol/L). What action should the nurse take?

Notify the HCP and obtain an order for appropriate IV fluids. Rationale: Three percent sodium chloride Injection is a hypertonic solution, which will pull fluid from the interstitial and intracellular spaces into the bloodstream. It is usually prescribed for severe hyponatremia (sodium <115 mEq/L). Since the client is already experiencing a fluid volume deficit, this IV solution could worsen her condition. The nurse should obtain a prescription for an appropriate IV fluid from the healthcare provider.

Which acid-base imbalance would the nurse suspect in a patient with a low pH, high PaCO2, and normal HCO3?

Respiratory acidosis rationale: Respiratory acidosis is indicated with a low pH, high PaCo2, and normal HCO3.

A patient who is involved in a MVC has had a trach placed for mechanical ventilation. How should the nurse interpret the following ABG: pH: 7.48 PaCO2: 32 mmHg HCO3: 25 mEq/L

Respiratory alkalosis Rationale: pH is increased-->alkaline, PaCO2 is decreased (alkaline) respiratory alkalosis

What are the most serious complications of hyponatremia?

Seizures

When obtaining a pts BP, the nurse notices a carpal spasm. Which serum lab test would the nurse review after this finding?

Serum calcium rationale: a carpal spasm during a BP reading is indicative of Trousseau's sign which is a clinical manifestation of hypocalcemia

The nurse is reviewing a pts lab results. Which is the greatest concern? a. Serum Na+ of 150 mEq/l b. Serum Mg of 1.1 mEq/L c. Serum PO4 of 4.5 mEq/L d. Serum Ca total of 8.6 mg/dl

b. Serum Mg of 1.1 mEq/L that is low (normal serum Mg levels are 1.3-2.6) A decrease in Mg causes an increased chance of a decreased in K+ and Ca+ which could cause Seizures and dysrhythmias

Patient is admitted with excessive diarrhea and vomiting. BP is 70/40 mmHg. Urinary output is very concentrated and less than 30mL/hr. What is the following priority?

begin IV infusion of NS

Which conditions are likely to cause hyponatremia?

burns diarrhea diuretic use

The nurse is caring for a patient who has a massive burn injury and possible hypovolemia. Which assessment data is most concerning for the nurse? a. urine output is 30 ml/hr b. skin tenting over sternum is prolonged c. blood pressure is 90/40 mmHg d. oral fluid intake is 100ml for 8 hrs

c. BP of 90/40 mmHg

Lab values for a newly admitted patient are reported to the nurse. Which serum value represents a patient care priority? a. Magnesium 2.5 mg/dL b. Sodium 135 mEq/dl c. potassium 6.7 mEq/dL d. calcium 8.6 mg/dL

c. Potassium is 3.5-5 hypokalemia or hyperkalemia can both lead to life-threatening dysthymias

A patient with draining wounds is admitted for hypovolemia. What is the most accurate way for the nurse to evaluate fluid balance? a. urine output b. edema c. daily weight d. skin turgor

c. daily weight

A patient with chronic kidney disease is experiencing issues with hyperphosphatemia. What is an associated electrolyte imbalance? Why? a. Hypokalemia b. hyponatremia c. hypocalcemia d. hypomagnesium

c. hypocalcemia rationale: Phosphorus and Ca+ have an inverse relationship.

A patient is admitted with Diabetic Ketoacidosis (DKA) and has rapid, deep respirations. Which action should the nurse take? a. Give prescribed PRN ativan b. encourage pt to take slow deep breaths c. Start prescribed O2 at 2-4 L/min d. Administer the prescribed fluid bolus and insulin

d. administer the prescribed fluid bolus and insulin?

Which lab result would require immediate intervention by the nurse for the client scheduled for surgery? a. Calcium 9.2 b. Bleeding time 2 minutes c. Hemoglobin 15 d. Potassium 2.4

d. normal potassium is 3.5-5 mEq/L this is a LOW K+

A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data will require the most rapid response by the nurse? a. The patient's radial pulse is 105 beats/minute. b. There is sediment and blood in the patient's urine. c. The blood pressure increases from 120/80 to 142/94. d. There are crackles audible throughout both lung fields.

d. there are crackles throughout both lung fields

For ongoing evaluation of a client's fluid volume status, which assessment data is most important to obtain?

daily weight rationale: weight provides important indicators about fluid volume status, whether a client is retaining fluid or losing fluid.

Which problem often occurs in older clients and may have contributed to the fluid volume deficit a patient is experiencing?

decreased hepatic blood flow rationale: decreased hepatic blood flow decreased srug metabolism which causes the drug to remain in the body longer & produce a greater drug effect

A nursing student is volunteering at a medical tent at a road race when one of the runners' collapses. The runner is alert but dizzy, face is flushed with profuse diaphoresis. Eyes are sunken, temp is 100 degrees. What is the nursing diagnoses?

fluid volume deficit

Interpret this ABG: pH- 7.50 PaCO2-30 mmHg HCO3-24 mEq/L paO2-79 mmHg

uncompensated respiratory alkalosis rationale: Increased pH, decreased PaCO2 bicarb is normal so it is uncompensated