N3035- Fluid and Electrolytes (REVISED for final exam)

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

100, 90, 22, 2, cold, mental

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

7.8 mg/dL

calcium normal levels

9.0-10.5 (mEq/L)

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

Chvostek's sign

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

IV, overload, weigh

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

Na+, fluid

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

albumin, ionized

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

aldosterone

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

blood volume

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

cardiac dysrhythmias, hypoactive bowel sounds

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

loop, biphosphonates, calcitonin

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

mental, muscle, gait

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

peripheral edema, respiratory, cardiac, mental

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

phosphate

____ imbalance: neurological symptoms

sodium

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

sodium, potassium

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

Mg++

____ and ___ usually decreased with hypokalemia

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

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

Na+, fluid

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

aldosterone, antidiuretic

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

aldosterone, antidiuretic

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

anorexia, leg cramps

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 ___

bone, enzymes, contraction, clotting

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

bones

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+)

calcium, glucose, HCO3, patiromer, zircondium

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

cardiac, acidosis

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

cardiac, intestinal, clotting

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

cerebral edema

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

cerebral edema, intracranial

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

chloride

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

clotting

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

crackles in lungs

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

diarrheal, emetic, pyretic

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

diet, gain

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

diffusion

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

dilutional

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

diuretic

hyponatremia management- drug therapy: -reduce ___ doses

diuretic

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

diuretics, conivaptan

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

dysrhythmias

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

dysrhythmias, blood clots

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

edema

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

electrolyte homeostasis

solutes that express an overall electrical charge

electrolytes

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

electrolytes, 40

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

facilitated diffusion

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

filtration

the four regulatory processes?

filtration, diffusion, osmosis, active transport

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

flattened T waves

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

hydrostatic pressure

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

hydroxide

Hyperphosphatemia must be treated with _____

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?

hypocalcemia

the manifestations of hyperphosphatemia are consistent with the manifestations of ____

hypocalcemia

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

insulin

fluid in between the cells of the body

interstitial fluid

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

into, out

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

intracellular

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

intracellular compartment

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

intravascular, blood pressure

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

irregular heart rate

if a patient is hyponatremic, give ____ solutions

isotonic

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

isotonic

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

isotonic, hypotonic, D5W

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

kidneys

hypocalcemia may cause ___- watch respiratory status

laryngospasms

hypernatremia with hypervolemia- drug therapy: -___ ___

loop diuretics

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

metabolized

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

monitor for cardiac dysrhytmias

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

muscle tremors, abdominal cramps, increased peristalsis

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

muscle weakness and cardiac dysrhythmias

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

muscle weakness, irregular heart rhythm, hyperactive bowel tones

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

nerve

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

nerve impulses, respiratory

How fast can K+ IV be administered safely?

no more than 20 mEq/hr

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

normal saline, hypertonic

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

older, obese, women

lowered urinary output

oliguria

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

oliguria, hypotension, tenting skin turgor

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

oral, IV

IV fluid therapy is based on the plasma's ____

osmolality

the concentration of osmotic solutions per liter of solution

osmolality

the concentration of osmotic solutions per kg of solution

osmolarity

all fluids that leave the body are called the ___

output

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

oxygenation, alkalosis

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

paresthesia, tetany

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

particle (solute)

diffusion is ___ and does not require energy

passive

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

peaked T waves and widened QRS complexes

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

phosphate

calcium and ___ have an inverse relationship

phosphorus

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

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

potassium

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

potassium, sodium, bicarbonate

the amount of water in any body fluid space determines ____

pressure

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

renal, debilitated

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

respiratory, leg, constipation, digoxin

FVE management- nutrition therapy: -fluid and diet _____

restrictions

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

seizures

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

seizures, confusion

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

serum potassium of 7.2 mEq/L

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

sodium

particles dissolved or suspended in water

solutes

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

solvent

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

start infusion of normal saline

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

start infusion of normal saline 500 ml

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 ___ ___

stimuli, seizure, delayed clotting

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

trousseau sign

vitamin ___ is needed for the absorption of calcium

D

normal sodium levels

135-145 (mEq/L)

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

osmosis

"water pulling pressure" force that stops osmosis

osmotic pressure

____ imbalance: cardiac, GI, musculoskeletal system manifestations

potassium

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

stable, cell membranes

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

estrogen

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

20, IM, SUBQ

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

270, 300

normal range of potassium

3.5-5.0 (mEq/L)

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

400, 600

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

500, 1000

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

CHF, diuretics

-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

Ca++

-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

K+

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

Na+

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

active transport

fluid in the vascular spaces (veins/arteries)

blood plasma

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

blood plasma, interstitial

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

blood pressure

two main examples of filtration?

blood pressure, edema

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

calcium

sodium is needed for the excretion of ___ through the kidneys

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

calcium

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

heart rate 124 beats/minute

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

hyperchloremic metabolic acidosis

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

hypernatremia

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

hypernatremia

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

hyperphosphatemia

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

hypertonic

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

hypertonic dehydration

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?

hypokalemia

if hypernatremic, give ____ solutions or ___ containing crystalloids

hypotonic, dextrose

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

input

hypercalcemia standard treatment is to give ___ ___ IV therapy

normal saline

What routes can K+ be administered safely?

parenteral IV, oral

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

skin, dehydration

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

skin, overload, neuro

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

throughout, falls

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

thyroid, thyrocalcitonin

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

tolvaptan, conivaptan

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

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