N3035- Fluid and Electrolytes (REVISED for final exam)

hydrostatic pressure

"Water-pushing pressure" - is the force that pushes water outward from a confined space through a membrane

cerebral edema, intracranial

cerebral changes are normally seen in hyponatremia due to ___ ___ and increased ____ pressure

blood plasma

fluid in the vascular spaces (veins/arteries)

loop diuretics

hypernatremia with hypervolemia- drug therapy: -___ ___

sodium

what electrolyte is present in these foods? Worcestershire sauce, soy sauce, onion salt, garlic salt, bouillon cubes, processed meats like bacon, sausage, and ham, canned soups, canned vegetables, fast foods

Ca++

-most abundant cation in the body; stored in the bones and teeth -enters the body by dietary intake, absorbed through the intestinal tract, and stored in the bones

clotting

Chronic hypocalcemia may further increase the risk of bleeding related to delayed ____

IV, overload, weigh

FVD management- fluid therapy: -oral hydration -___ fluid -monitor for fluid ___ and IV site -___ daily -I&O

mental, muscle, gait

FVD management- patient safety: -monitor VS -____ status -____ strength -and ____

diuretics, conivaptan

FVE management- drug therapy: -_____ -_______/tolvaptan -monitor response, weigh daily, I&O

Chvostek's sign

HYPOCALCEMIA: -Tap the face just below and in front of the ear positive: facial twitching of one side of the mouth, nose, and cheek.

diffusion

It is the movement of particles (solutes) across a permeable membrane from an area of higher solute to lower solute concentration Transports most electrolytes and other particles through cell membranes

active transport

Movement of particles (solutes) across a membrane against a concentration or electrochemical gradient used to pump specific compounds in or out of the cell

nerve impulses, respiratory

Na+ imbalance: -muscle weakness, spasms, and twitching occur due to a compromised transmission of ___ ___ -assess ___ status if muscle weakness is present

aldosterone, antidiuretic

Na+ is regulated by the Na-K pump and by the kidneys through ____, ____ hormone, and natriuretic peptide

estrogen

Postmenopausal women are at risk for chronic calcium loss due to reduced weight-bearing activities and a decrease in _____ levels

sodium

____ imbalance: neurological symptoms

input

all fluids that enter the body orally or parenterally is called the ____

output

all fluids that leave the body are called the ___

potassium

an older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. in addition to sodium, which electrolyte would the nurse be most concerned about? -calcium -chlorides -potassium -phosphates

albumin, ionized

bound calcium is attached to ___ and ____ calcium is the free, active form that must be kept within range

hypertonic dehydration

fluid volume deficit with hypernatremia: -there is more fluid loss than sodium loss -also called ____ ____

diuretic

fluid volume deficit with hyponatremia: -there is loss of both fluid and sodium -seen in conditions such as _____ therapy

hypernatremia

fluid volume overload with _____: -based on principle that water follows salt -commonly seen in excessive salt ingestion

dilutional

fluid volume overload with hyponatremia: -aka _____ hyponatremia -due to excessive fluids in the body -dilutes sodium -seen with conditions such as heart failure or treatment with hypotonic solutions

calcium, glucose, HCO3, patiromer, zircondium

hyperkalemia management- drug therapy: -discontinue medications causing the imbalance -hemodialysis (last resort) -IV ___ (if cardiac sxs present) -IV ___ and insulin, IV ____, sodium polystyrene sulfonate, loop diuretics, ______ (a new drug that decreases absorption of K+ in the GI tract), sodium ____ cyclosilicate (a new drug that works in the GI tract to lower K+)

cardiac, acidosis

hyperkalemia management- patient safety: -___ complications -fall prevention -monitor response to therapy -monitor for hypokalemia, metabolic ____, cardiac status, and VS

Na+, fluid

hypernatremia management- nutrition therapy: -___ restriction -adequate ___ intake (assess for hypovolemia)

skin, dehydration

hypernatremia management- patient safety: -monitor response to therapy -___ protection -monitor for hyponatremia, ____, neuro status, VS, and I&O

hydroxide

hypocalcemia management- drug therapy: -Ca++ oral/IV replacements -vitamin D supplement aluminum ____

phosphate

hypocalcemia management- nutrition therapy: -high calcium diet -low ___ diet

stimuli, seizure, delayed clotting

hypocalcemia management- patient safety: -reduce environmental ___ -prevent fractures from chronic hypocalcemia -____ precaution -Monitor for hypercalcemia, K+, Mg++, Vit D, PTH levels, cardiac status, respiratory status, neuromuscular status, VS, skeletal - for chronic hypocalcemia, and ___ ___

oral, IV

hypokalemia management- drug therapy: -K+ ___ supplements -K+ ___ infusion -discontinue medications causing imbalance

hypotonic, dextrose

if hypernatremic, give ____ solutions or ___ containing crystalloids

hypertonic

if patient has symptomatic hyponatremia, give ____ solutions (3-5% NS)

isotonic

if there are signs of hypotension or tissue hypoperfusion, give ____ solutions

calcium

in symptomatic hyperkalemia, giving ____ stabilizes the cardiac membrane to prevent lethal dysrhythmias

intravascular, blood pressure

isotonic solutions do not shift between compartments, which effectively expands ___ (ECF) volume and improves ____ ____

oliguria

lowered urinary output

into, out

na+/k+ pump (active transport): -pumps k+ ___ the cell, and na+ ___ of the cell requires ATP energy

paresthesia, tetany

neuromuscular changes such as ___, tingling, numbness, and ____ occur particularly in hypocalcemia

3.5-5.0 (mEq/L)

normal range of potassium

135-145 (mEq/L)

normal sodium levels

400, 600

obligatory urine output to effectively excrete toxic waste products is ___-___ ml/day

solutes

particles dissolved or suspended in water

renal, debilitated

patients at highest risk for hyperkalemia include those with ___ dysfunction, chronically ill, ____ patients, and older adults

CHF, diuretics

patients at highest risk for hypokalemia include those with ___ and on ____

chloride

sodium and ___ are directly related if one is high/low, the other will be too

calcium

sodium is needed for the excretion of ___ through the kidneys

blood volume

sodium maintains ___ ___ by regulating water and osmotic pressure you will always see an imbalance in fluids if there is an imbalance in sodium, and vice versa

nerve

sodium maintains proper ____ transmissions for skeletal muscle and brain functioning if there is a sodium imbalance, symptoms will always affect the brain

electrolytes

solutes that express an overall electrical charge

osmolality

the concentration of osmotic solutions per liter of solution

kidneys

the fluids and electrolytes we eat/drink are excreted or reabsorbed through the ____

filtration, diffusion, osmosis, active transport

the four regulatory processes?

hypocalcemia

the manifestations of hyperphosphatemia are consistent with the manifestations of ____

muscle weakness and cardiac dysrhythmias

the nurse is caring for a postoperative client who has a NGT attached to low continuous suction. Which assessment finding indicates that the client may be experiencing hypokalemia? -tingling of the fingertips and toes -dry and sticky mucous membranes -abdominal cramping and irritability -muscle weakness and cardiac dysrhythmias

270, 300

the osmolality of blood plasma (ECF) is ___-____ mOsm/L

20, IM, SUBQ

treating hypokalemia: -do not give intravenous potassium at a rate higher than ___ mEq per hour -never give potassium supplements by the ___, ____, or IV push routes -use a pump or controller when giving IV potassium-containing solutions -assess IV site hourly- stop if phlebitis/infiltration is suspected -give oral potassium during/after meal to avoid nausea and vomiting

blood pressure, edema

two main examples of filtration?

potassium

what electrolyte is present in these foods? All meats (red meat and chicken) and fish, such as salmon, cod, flounder, sardines, soy products, veggie burgers., broccoli, peas, lima beans, tomatoes, potatoes (particularly their skins), sweet potatoes, winter squash, citrus fruits, cantaloupe, bananas, kiwi, prunes, and apricots, milk, yogurt, and nuts

calcium

what electrolyte is present in these foods? Yogurt, most cheeses, buttermilk, milk, green leafy vegetables such as broccoli, collards, kale, mustard greens, turnip greens, Chinese cabbage, salmon and sardines canned with their soft bones, almonds, Brazil nuts, sunflower seeds, tahini, dried beans, blackstrap molasses, orange juice, soy milk, tofu, ready-to-eat cereals, and bread

oliguria, hypotension, tenting skin turgor

when a client is admitted with dehydration, which clinical manifestations would the nurse expect to find? SATA -oliguria -dyspnea -hypotension -pulmonary crackles -tenting skin turgor

heart rate 124 beats/minute

when caring for a client admitted with massive vomiting of blood, which finding would be the most concern to the nurse? -hematocrit of 35% -cool hands and feet -heart rate 124 beats/min -stools positive for occult blood

flattened T waves

when caring for a client who has hypokalemia, which electrocardiogram change will the nurse expect to observe? -inverted P waves -flattened T waves -absence of U waves -elevated ST segment

seizures

which clinical manifestation is associated with hypernatremia in burns? -fatigue -seizures -paresthesias -cardiac dysrhythmias

crackles in lungs

which finding by the nurse when assessing a client who is receiving intravenous (IV) fluids indicates need for a change in the fluid infusion rate? -crackles in lungs -supple skin turgor -urine output of 480 mL over 8 hours -heart rate decrease from 126 beats/minute to 96 beats/minute

irregular heart rate

which finding for a client who has a potassium level of 2.8 mEq/L (2.8 mmol/L) would be of most concern to the nurse? -abdominal cramps -irregular heart rate -decreased reflexes -muscle weakness

monitor for cardiac dysrhytmias

which nursing action is the priority for a client who has a serum potassium level of 6.7 mEq/L (6.7 mmol/L)? -monitor for cardiac dysrhythmias -inquire about changes in bowel patterns -assess for leg muscle twitching or weakness -assess for signs and symptoms of dehydration

hypocalcemia

Hyperphosphatemia must be treated with _____

electrolytes, 40

extracellular compartment: -contains extracellular fluids and ____ -fluid is outside of the cell (___%)

blood plasma, interstitial

extracellular fluid (ECF) is divided into ___ ___ and ____ fluid

hypocalcemia

postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. which complication would the nurse expect the patient is experiencing?

stable, cell membranes

regulatory processes are in place to keep internal environment ___. they determine how, when, and where fluids and particles move across ____ ____

osmotic pressure

"water pulling pressure" force that stops osmosis

intracellular compartment

-contains intracellular fluid and electrolytes -fluid is inside the cell (60%)

Na+

-major extracellular cation -maintains blood volume by regulating water -generates electrical impulses for proper brain functioning and muscle concentration -maintains osmotic pressure

K+

-major intracellular cation -essential for the depolarization and generation of action potentials to maintain cardiac, skeletal, and smooth muscle function -transmits nerve and cardiac impulses -regulates protein synthesis, glucose use and storage, and acid-base balance

facilitated diffusion

Allows diffusion of large, membrane insoluble compounds such as sugars and amino acids by binding to a membrane-altering system for transport

throughout, falls

FVD management- patient education: -adequate hydration ____ the day -avoid ____ and injuries -identify risks

restrictions

FVE management- nutrition therapy: -fluid and diet _____

diet, gain

FVE management- patient education: -identify risks -appropriate ___ choices -weight ___

peripheral edema, respiratory, cardiac, mental

FVE management- patient safety: -monitor VS -___ ___ -skin breakdown -____ status, ____ status, ____ status

osmosis

It is the movement of water molecules (solvent) across a selectively permeable (semi-permeable) membrane from a less concentrated solution to a more concentrated solution

filtration

It is the movement of water molecules (solvents) through a cell or blood vessel membrane from an area of higher hydrostatic pressure to lower hydrostatic pressure

edema

It occurs with changes in hydrostatic pressure. Venous hydrostatic pressure increases, forcing fluids into the interstitial spaces

dysrhythmias

K+ imbalances: -cardiac monitoring for ____ is critical: PVCs, conduction delays, ventricular fibrillation, heart blocks, tall T waves, and presence of U wave on ECG

parenteral IV, oral

What routes can K+ be administered safely?

older, obese, women

___ adults, ____, and ___ are prone to fluid imbalances because they have less body water

intracellular

___ fluid constitutes most of the body's fluid (approximately 2/3)

potassium, sodium, bicarbonate

___, ___, and ___ are the electrolytes most often lost with diarrhea

Mg++ (more than Ca++), Ca++

____ and ___ usually decreased with hypokalemia

potassium

____ imbalance: cardiac, GI, musculoskeletal system manifestations

sodium, potassium

____ is kept in the extracellular compartment, while ____ is kept in the intracellular compartment

hypernatremia

____ slows the flow of ca++ into the cardiac cells

electrolyte homeostasis

balance between dietary intake of electrolytes and renal excretion or reabsorption of electrolytes

bone, enzymes, contraction, clotting

functions of Ca++: -maintains ___ strength and density -activates ____ -allows skeletal and cardiac muscle ____ -controls nerve impulses by regulating the movement of Na++ across membranes -membrane stabilizer (cardiac mostly) -allows blood ___

insulin

glucose binds with ___ to enter most cell membranes by facilitated diffusion

aldosterone, antidiuretic

hormones like ____, ____ hormone, natriutetic peptide (NP), and renin-angiotensin II pathway regulate fluid and electrolyte balance

loop, biphosphonates, calcitonin

hypercalcemia management- drug therapy: -discontinue medication causing the imbalance -hemodialysis (last resort) -____ diuretics -_____ (pamidronate) for malignancy-associated hypercalcemia -____ to inhibit bone resorption -IV fluid therapy

phosphate

hypercalcemia management- nutrition therapy: -low calcium diet -high ___ diet

cardiac, intestinal, clotting

hypercalcemia management- patient safety: -____ complications -monitor for hypocalcemia, cardiac status, neuromuscular status, ___ status, VS, and blood ____

normal saline

hypercalcemia standard treatment is to give ___ ___ IV therapy

dysrhythmias, blood clots

hypercalcemia: -cardiac ____ can occur (monitoring!) -may further increase risk of ___ ___ in those who are predisposed

isotonic, hypotonic, D5W

hypernatremia with hypovolemia: -____ solution to resuscitate -once BP is stable, ___ or ____

oxygenation, alkalosis

hypokalemia management- patient safety: -adequate ___ -fall prevention -injury prevention from K+ administration -monitor response to therapy -monitor for hyperkalemia, metabolic ___, cardiac/respiratory status, muscle weakness, constipation, VS

respiratory, leg, constipation, digoxin

hypokalemia: -assess ___ status if muscle weakness is present -monitor for common clinical complaints of ___ cramps and ___ -watch for ___ toxicity

diuretic

hyponatremia management- drug therapy: -reduce ___ doses

Na+, fluid

hyponatremia management- nutrition therapy: -high ___ intake -restrict ___ intake (assess for hypervolemia)

skin, overload, neuro

hyponatremia management- patient safety: -monitor response to therapy -___ protection -monitor for hypernatremia, fluid ____, ___ status, VS, and I&O

tolvaptan, conivaptan

hyponatremia with hypervolemia (dilutional hyponatremia)- drug therapy: -___ or ____ (removes water but keeps Na+)

normal saline, hypertonic

hyponatremia with hypovolemia- drug therapy: -_____ ____ -with neuro symptoms: ___ solution (3-5% normal saline)

cerebral edema

hypotonic solutions hydrate the cells because they shift from ECF to ICF watch for ___ ___

metabolized

initially considered hypertonic, dextrose-containing solutions become isotonic or hypotonic once the dextrose is _____ ex. D5NS becomes isotonic, D51/2NS becomes hypotonic

500, 1000

insensible water loss from the skin, lungs, and GI system is ___ to ____ mL/day must be replaced to avoid severe dehydration and electrolyte imbalances

100, 90, 22, 2, cold, mental

sxs of hypotension and tissue hypoperfusion: -SBP <___ -HR>___ -RR>____ -capillary refill> ___ seconds -peripheries ___ to touch -altered ___ status

particle (solute)

the ____ concentration of a body fluid dictates the osmosis and diffusion

pressure

the amount of water in any body fluid space determines ____

solvent

the body is composed of fluids and particles dissolved or suspended in water; the fluid portion is called a ____

D

vitamin ___ is needed for the absorption of calcium

start infusion of normal saline 500 ml

when a client in the emergency department has a blood pressure of 90/60 mmHg, weak quality radial pulse of 108 beats/min, and reports working outside for several hours on a hot day, which prescribed action would the nurse take first? -complete head-to-toe assessment -start infusion of normal saline 500 ml -ask the client about current medications -obtain blood samples for laboratory testing

seizures, confusion

when monitoring a patient for hyponatremia, which assessment findings would the nurse consider significant? SATA -thirst -seizures -erythema -confusion -constipation

hyperchloremic metabolic acidosis

when you give a large amount of normal saline solution (has good amount of sodium and chloride), you are at risk for giving patients ___ ___ ___, which can lead to kidney injuries if not resolved

muscle weakness, irregular heart rhythm, hyperactive bowel tones

which clinical manifestations will the nurse assess for in a client with a serum potassium level of 6.4 mEq/L (6.4 mmol/L)? SATA -anorexia -consipation -muscle weakness -irregular heart rhythm -hyperactive bowel tones

anorexia, leg cramps

which clinical manifestations would the nurse expect to find in a client with hypokalemia? SATA -thirst -anorexia -leg cramps -rapid, thready pulse -dry mucous membranes

cardiac dysrhythmias, hypoactive bowel sounds

which clinical manifestations would the nurse identify when assessing a client with hypercalcemia? SATA -muscle tremors -abdominal cramps -increased peristalsis -cardiac dysrhythmias -hypoactive bowel sounds

peaked T waves and widened QRS complexes

which result would the nurse expect to see on the ECG tracing monitor when a client has diabetic ketoacidosis and potassium level of 5.4 mEq/L (5.4 mmol/L)? -abnormal P waves and depressed T waves -peaked T waves and widened QRS complexes -abnormal Q waves and prolonged ST segments -peaked P waves and an increased number of T waves

9.0-10.5 (mEq/L)

calcium normal levels

laryngospasms

hypocalcemia may cause ___- watch respiratory status

no more than 20 mEq/hr

How fast can K+ IV be administered safely?

blood pressure

Moves blood from the heart to the capillaries where the exchange of water, nutrients, wastes between blood and tissues occur

hyperphosphatemia

Patients with chronic renal failure will most likely have hypocalcemia due to ______

Mg++

___ acts as a modulator facilitating the movement of Na+ and K+ through the Na-K pump

start infusion of normal saline

a client is admitted to the emergency department with reports of frequent loose, watery stools and anorexia during the past week. Blood pressure is 90/68 mmHg and pulse is 124. which prescribed action should the nurse take FIRST? -obtain blood and urine cultures -start infusion of normal saline -insert retention catheter -transfer the client to intensive care unit

7.8 mg/dL

a client is diagnosed with parathyroid dysfunction. Which serum calcium concentration supports the diagnosis? -7.8 mg/dL -8.9 mg/dL -9.7 mg/dL -10.2 mg/dL

phosphorus

calcium and ___ have an inverse relationship

thyroid, thyrocalcitonin

calcium is regulated by ___ hormones (increases) and ____ (decreases)

passive

diffusion is ___ and does not require energy

interstitial fluid

fluid in between the cells of the body

osmolarity

the concentration of osmotic solutions per kg of solution

diarrheal, emetic, pyretic

FVD management- drug therapy: -anti-____ -antibiotic -anti-____ -anti-____

trousseau sign

HYPOCALCEMIA: -place BF cuff around arm, inflate greater than the patient's systolic BP for 1-4 minutes positive: occurs when hand and fingers go into spasm in palmar flexion

osmolality

IV fluid therapy is based on the plasma's ____

aldosterone

K+ is regulated by the Na-K pump and the kidneys through excretion and ____

bones

Patients with chronic hypocalcemia will have brittle, fragile ____ - use lift sheets when repositioning to prevent fractures

wound drainage, diuretic therapy, GI suction, inappropriate antidiuretic hormone secretion

a client is prone to hyponatremia. which factors would the nurse identify that can precipitate hyponatremia? SATA -wound drainage -diuretic therapy -GI suction -parenteral infusion of 0.9% sodium chloride -inappropriate antidiuretic hormone (ADH) secretion

hypokalemia

a client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. the nurse identifies a U wave on the cardiac monitor. which electrolyte imbalance is causing these clinical findings?

isotonic

if a patient is hyponatremic, give ____ solutions

muscle tremors, abdominal cramps, increased peristalsis

which clinical manifestations would the nurse identify when assessing a client with hypocalcemia? SATA -muscle tremors -abdominal cramps -increased peristalsis -cardiac dysrhythmias -hypoactive bowel sounds

serum potassium of 7.2 mEq/L

which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client? -serum sodium of 139 mEq/L -serum chloride of 100 mEq/L -serum calcium of 10.2 mg/dL -serum potassium of 7.2 mEq/L