FLUID AND ELECTROLYTES UNIT 4 semester 2
What do hypotonics do?
pull fluid out of vessels into cells
What do hypertonics do?
pulls fluid INTO the vessels
The nurse is educating a client who is required to restrict potassium intake. What foods would the nurse suggest the client eliminate that are rich in potassium?
citrus fruits
Blood administration is ordered for a client receiving chemotherapy. The nurse is obtaining all supplies needed for infusion. Which intravenous solution is obtained?
0.9% sodium chloride injection USP
Which solution can you use for renal excretion and hypernatremia?
D5W
Treatment for Hypervolemia (FVE)
FUROSEMIDE ASAP - OR HCTZ (monitor hypokalemia for both and restrict fluids) - spronolactone ( potassium sparing diuretic - monitor hyperkalemia ) monitor o2 and administer PRN assess breath sounds check CBC CHECK DAILY WEIGHT (1kg = 1L fluid) reduce IV rate to 30mL/hr evaluate and measure edema for peripherals turn q2h monitor i/o decrease sodium (diet and OTC) - ibuprofen, alka-seltzer, acetaminophen, noproxin
What do hypertonics treat?
FVE ( hyperolemia ) - from administering too much fluid fluid too rapidly - kidney injury - excessive table salt
Which solution can you use for hypovalemia, diarrhea, and burns?
LR and it can also replace acute blood loss temporarily
Which solution can you use for mild hyponatremia and hypercalcemia?
NS 0.9%
Nursing interventions for a patient with normal fluid volume and hyponatremia include: a. restricting fluid intake b. encouraging water intake c. restricting sodium intake d. administering hypotonic IV fluids
a
On morning assessment of your client who has severe burns, you notice that fluid is starting to accumulate in his abdominal tissue. You note that his weight has not changed and his intake and output is equal. What do you suspect? a. third spacing b. this is normal and expected after a burn and it is benign c. document this finding as non-pitting abdominal edema d. intravascular compartment syndrome
a
Which patient is at most risk for hypomagnesemia? a. a 55 year old chronic alcoholic b. a 57 year old with hyperthyroidism c. a patient reporting overuse of antacids and laxatives d. a 25-year old suffering from hypoglycemia
a
Which patient is more at risk for an electrolyte imbalance? a. an 8 month with a fever of 102.3 and diarrhea b. a 55 year old diabetic with nausea and vomiting c. a 5 year old with RSV d. a healthy 87 year old with intermittent episodes of goat
a
A nurse is caring for a client with dehydration. Which of the following signs are observed in a client with dehydration? Select all that apply. Skin turgor over sternum Decreased blood pressure Low urine output Increased pulse rate Increased respiratory rate
a, b, c
The nurse is planning care for a group of clients. Which clients should the nurse prioritize as "at risk" for hypercalcemia and advocate for monitoring calcium levels? Select all that apply. A client with prolonged immobility A client with hypophosphatemia A client with hypoparathyroidism A client who has breast cancer with bone metastasis A client with heart failure who is taking a loop diuretic
a, b, c
A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply. Decreased kidney mass Increased conservation of sodium Increased total body water Decreased renal blood flow Decreased excretion of potassium
a, d, e
A client has been encouraged to increase fluid intake. Which measure would be most effective for the nurse to implement? a. explaining the mechanisms involved in transporting fluids to and from intracellular compartments b. keeping fluids readily available for patient c. emphasizing the long-term outcome of increasing fluids when the patient returns home d. planning to offer most daily fluids in the evening
b
Causes of Hypovalemia (FVD)
blood loss shock too much diuretic too much hypotonic sweating, vomiting, diarrhea burns (third spacing) advanced liver disease diabetes indipidus too much GI suction decrease access to fluid
A nurse is performing physical assessments for clients with fluid imbalance. Which finding indicates a fluid volume excess? a. a pinched and drawn facial expression b. deep, rapid respirations c. crackles heard upon auscultation d. tachycardia
c
A patient is admitted with exacerbation of CHF. What would you expect to find during your admission assessment? a. flat neck and hand veins b. furrowed dry tongue c. increased BP and crackles throughout the lungs d. bradycardia and pitting edema in lower extremities
c
In report from a transferring family you receive information that your patient's magnesium level is 1.2. When the patient arrives you are ordered by the doctor to administer Magnesium Sulfate via IV. Which of the following interventions takes priority? a. set up bedside suction b. set up IV antropine at bedside due to bradycardia effects of Magnesium Sulfate c. monitor the patient for reduced deep tendon reflexes and initiate seizure precautions d. none of the above
c
Insensible fluid losses include: a. gastric drainage b. urine c. perspiration d. bleeding
c
The nurse prepares for the possibility of magnesium sulfate toxicity by having at the bedside: a. suction equipment b. nalline c. calcium gluconate d. oxygen
c
Causes of Hypervolemia (FVE)
chf too much fluid renal failure third-spacing sodium retention inflammation severe stress excess corticosteroid
A nurse is assessing infants in the NICU for fluid balance status. Which nursing action would the nurse depend on as the most reliable indicator of a patient's fluid balance status? a. recording I/O b. testing skin turgor c. reviewing the complete blood count d. measuring weight daily
d
The physician has ordered IV replacement of potassium for a patient with severe hypokalemia. The nurse would administer this : a. diluted in 10cc over 10 min b. IV push c. rapid bolus d. diluted in 100cc over 1 hour with an infusion pump
d
You are taking a patient's BP manually. As you pump up the cuff above the systolic pressure, you notice that the patient develops a carpal spasm. Which of the following is true? a. the patient is having a normal nervous response to an inflating blood pressure cuff that is inflated above the systolic pressure b. this is known as trousseau's sign and is present in patients with hypercalcemia c. this is known as chvostek's sign d. this is known as trousseau's sign and is present in patients with hypocalcemia
d
S/S of Hypovalemia (FVD)
decreased : - urine output - vascular volume - weight - assessments increased: - labs - thirst - dizziness, weakness, light headedness, confusion - slow skin turgor - dry mucous membranes - concentration
0.45% NS can be used to treat what?
dehydration and FVD ( hypovalemia )
Which particular area(s) should be examined to assess peripheral edema?
feet, ankles
A physician orders regular insulin 10 units 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?
hyperkalemia
What is D5 1/2 NS an example of?
hypertonic solution and can be used for third spacing
The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance would a positive Chvostek's sign indicate?
hypocalcemia
treatments for hypovalemia (FVD)
monitor vs and i/o and weight assess LOC and skin turgor give isotonic fluids and force fluids administer blood products replace electrolytes administer ALBUMIN (pulls fluid from third spacing) place in trendelenburg if shock occurs
When can you NOT use NS 0.9%?
in patients with increased sodium
S/S of Hypervolemia (FVE)
increased : - assessment values - urine output - weight gain - edema - confusion - wet lung sounds - distended neck veins decreased : - labs (BUN, sodium, HGB, HMTC, urine specific gravity)
Which of the following would the nurse expect to find when reviewing the laboratory test results of a client with renal failure?
increased serum creatinine level
You are the nurse evaluating a newly admitted patient's laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone (ADH)?
increased serum sodium
NS 0.9%, LR, and D5W are examples of which solutions?
isotonics
What do isotonics do?
they are administered to STAY IN THE BLOOD STREAM
S/S of FVD ?
thirst and shock (decreased BP, increased HR)
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:
trousseau's sign
A nurse cares for an acutely ill client. The nurse understands that the most accurate indicator of fluid loss or gain in an acutely ill client is:
weight