NSG 170 Fluid and Electrolytes

Symptoms of hypocalcemia

"Charley horses" in the calf during rest or sleep, and tingling in the lips. Neuromuscular changes. Abdominal cramping and diarrhea may also occur.

How many pounds does 1 liter of water weight?

2.2 pounds

What is the maximum recommended infusion rate of potassium?

5-10 mEq/hr. This rate should never exceed 20 mEq/hr under any circumstances. Potassium should never be administered via IV push.

Approximately how many mLs of retained fluid are there for each pound gained in weight?

500 mL

A patient has a serum magnesium level of 1.2 mEq/L. Which instruction by the nurse is appropriate? A. "Notify me if you have diarrhea." B. "I will be giving you an intramuscular injections of magnesium sulfate." C. "Your urine may become darker and more concentrated in appearance." D. "I will be administering a phosphorous supplement in addition to the magnesium supplement."

A. A serum magnesium level of 1.2 mEq/L represents mild hypomagnesemia (normal is 1.3-2.1 mEq/L) for which oral magnesium supplements are administered. Oral magnesium may lead to diarrhea; diarrhea contributes to magnesium loss. With severe hypomagnesemia, the IV route (instead of IM) is used because the IM route causes tissue damage and pain. Any medications containing phosphorus are contraindicated because they would contribute to associated hypocalcemia. Magnesium therapy does not affect the urine.

Which nursing action is recommended when providing care to a patient with hypokalemia? A. Question the continued administration of bumentanide B. Administer prescribed oral potassium chloride before a meal or snak C. Establish a peripheral IV, preferably in the hand, for administering IV potassium chloride D. Obtain the prescribed vial of IV potassium chloride from the pharmacy and dilute before administration

A. Bumetanide is a loop diuretic, which contributes to potassium loss and should be questioned. The Joint Commission has mandated that all concentrated electrolytes be mixed by a pharmacist and that vials of KCl should not be available in patient care areas. A large vein with high blood flow should be accessed to avoid phlebitis; it is recommended that the hand be avoided. Oral potassium supplements should be given with or following a snack or meal to avoid nausea.

When administering 20 mEq potassium chloride intravenously (IV), which is the priority intervention? A. Administer at a rate of 10mEq/hr. B. Monitor respiratory rate and depth C. Monitor for pain or burning at the IV infusion site D. Place the patient on a heart monitor during administration.

A. The maximum recommended infusion rate is 5 to 10 mEq/hr to avoid potentially lethal cardiac dysrhythmias. Monitoring for pain at the IV infusion site, assessing respiratory rate and depth, and placing the patient on a heart monitor are all appropriate options, but because a rapid rate of administration could have lethal effects, it has the greatest priority.

The primary health care provider prescribes intravenous administration of 100 mL of 20% glucose along with 20 units of insulin in a patient who is receiving furosemide therapy. What is the probable diagnosis of the patient? A. Hyperkalemia B. Hyperglycemia C. Hypernatremia D. Hypercalcemia

A. Hyperkalemia Hyperkalemia is a condition where serum potassium levels are high. Potassium movement into the cells is enhanced by insulin. Intravenous administration of 100 mL 10% to 20% glucose with 10 to 20 units of regular insulin helps decrease serum potassium levels. Insulin increases the activity of sodium-potassium pumps, which decreases serum potassium levels temporarily by moving potassium from the extracellular fluid to the cells. This therapy is prescribed as an add-on therapy along with diuretics in a hyperkalemic patient. Conditions such as hyperglycemia, hypernatremia, and hypercalcemia cannot be managed with this insulin and glucose therapy.

A patient is admitted to the hospital with a heart rate of 166 beats/min, increased thirst, restlessness, and agitation. Which electrolyte imbalance does the nurse suspect? A. Hypernatremia B. Hypercalcemia C. Hypomagnesemia D. Hyperphosphatemia

A. Hypernatre;mia These symptoms are indicative of hypernatremia. Clinical manifestations of hypomagnesemia are seen in the neuromuscular, central nervous, and intestinal systems. Hypercalcemia manifests with an altered level of consciousness that can range from confusion and lethargy to coma, and severe hypercalcemia depresses electrical conduction, slowing heart rate. Hyperphosphatemia causes few direct problems with body function (although hypocalcemia is usually also present).

Which conditions may contribute to a patient's insensible water loss? Select all that apply. A. Sever diarrhea B. Respiratory rate of 36/min C. Hot, dry home environment D. Body temperature of 96.4 F/36 C E. Large volume of urinary output

A.B.C. Insensible water loss occurs through the skin, lungs, and stool. Factors that contribute are a hot, dry environment, fever, tachypnea (a respiratory rate higher than 20 breaths per minute), and severe diarrhea. Urinary output is not considered an insensible water loss.

The patient with fluid overload has been taking a diuretic for the past 2 days and now experiences these changes. Which changes indicate to the nurse that the diuretic resulted in overdiuresis? Select all that apply. A. Reports fatigue B. Weight loss of 9 pounds C. Heart rate increase from 70-96 beats/min D. Heart rate decrease from 80-72 beats/min E. Respiratory rate decrease from 20 to 16 breaths/min F. Reports of light-headedness when first standing from a lying position

A.B.C.F. Diuretic drugs cause water loss and are often prescribed for edema. One liter of water weighs 2.2 pounds. Weight loss is expected when the patient gets rid of excess water. If the prescribed diuretic is overly effective, too much water may be excreted by the kidneys and signs of dehydration from overdiuresis may occur. A weight loss of 9 pounds is approximately 4 liters of fluid. Light-headedness when changing positions may suggest orthostatic hypotension. Other signs of too much fluid loss include an increase in heart rate and fatigue. The decrease in heart rate and respiratory rate would suggest the diuretic was effective.

A 77-year-old woman is brought to the emergency department by her family after she has had diarrhea for 3 days. The family tells the nurse that she has not been eating or drinking well, but that she has been taking her diuretics for congestive heart failure. She is receiving lactated Ringer's solution intravenously for rehydration. What clinical manifestations does the nurse monitor during rehydration of the patient? Select all that apply. A. Urinary output B. Blood pressure C. Blood serum glucose D. Pulse rate and quality E. Urine specific gravity levels

A.B.D.E. The two most important areas to monitor during rehydration are pulse rate and quality and urine output; however, decreasing specific gravity of urine is also an indication of rehydration. Blood pressure is also important to monitor during rehydration. Blood glucose changes do not have a direct relation to a patient's rehydration status.

Antidiuretic hormone

Acts on the collecting ducts of the kidney to normalize the blood osmolarity

What is the function of aldosterone in the body? A. It causes constriction of renal arterioles B. It promotes resorption of water and sodium C. It stimulates secretion of renin for the kidneys D. It causes constriction of peripheral blood vessels

B. Aldosterone promotes reabsorption of sodium and water into the body, which helps in maintaining blood pressure. Angiotensin II causes constriction of renal arterioles, resulting in low urine output. Factors such as low blood pressure, low blood volume, low oxygen, and low sodium trigger secretion of renin. Angiotensin II causes constriction of peripheral blood vessels and helps in maintaining perfusion to vital organs.

A patient is brought in an unconscious state to the emergency department. The primary health care provider suspects dehydration and advises laboratory investigation to ascertain the cause. Which parameter in the laboratory investigations would indicate internal hemorrhage as a reason for dehydration? A. Increased osmolarity B. Absence of hemoconcentration C. Elevated levels of blood components D. Decreased levels of blood hemoglobin

B. Hemoconcentration is not present when dehydration is caused by hemorrhage, because loss of all blood and plasma products occurs together. Increased osmolarity and elevated levels of blood components are also characteristic findings of dehydration, but do not indicate hemorrhage. Decreased blood hemoglobin indicates anemia but not dehydration.

A patient's morning laboratory results show a serum ionized calcium of 2.85 mmol/L. For what sign must the nurse assess? A. Tachypnea B. Blood clotting C. Muscle spasms D. Increased peristalsis

B. Hypercalcemia allows blood clots to form more easily, especially in the lower legs and pelvic region. The nurse should assess for signs of blood clotting associated with the elevated serum calcium. Increased peristalsis and muscle spasms are associated with hypocalcemia. Tachycardia can occur initially with mild hypercalcemia, but bradycardia is associated with severe hypercalcemia.

A hypertensive patient was brought to the emergency department with a heart rate of 115 beats per minute and an abnormal electrocardiogram showing a shortened QT interval. The laboratory findings of the patient show a serum calcium level of 11 mg/dL. What nursing interventions would help stabilize the patient? Select all that apply. A. Administering thiazide diuretics B. Administering high ceiling or loop diuretics. C. Administering 0.9? normal saline intravenously D. Administering nonsteroidal, anti-inflammatory agents. E. Administering lactated Ringer's solution intravenously

B.C. Hypercalcemia clinically manifests as serum calcium levels above 10.5 mg/dL. This condition can be managed by using loop diuretics such as furosemide, which promote the excretion of calcium. One cause of hypercalcemia is dehydration, which can be well managed by administering 0.9% normal saline intravenously. Thiazide diuretics do not promote the excretion of calcium and thus are not suitable treatments for hypercalcemia. Lactated Ringer's solution contains calcium; administering this solution does not help decrease the serum calcium levels. Administering nonsteroidal, anti-inflammatory agents prevents hypercalcemia by calcium resorption from the bone; however, it does not treat hypercalcemia.

Which assessment findings will indicate the need for continuation of prescribed fluid replacement therapy in a patient diagnosed with dehydration? Select all that apply. A. Hemoglobin of 13.5 g/dL B. Pulse pressure of 28 mm Hg C. Urine output of 400 mL per day D. Respiratory rate of 20 breaths per minute E. Neck veins distention when the patient is in a supine position

B.C. Pulse pressure below 40 mm Hg and urine output below 500 mL are abnormal and require continuation of the fluid replacement therapy. Hemoglobin of 13.5 g/dL is within the normal range. Respiratory rate of 20 breaths per minute is also a normal finding. Neck veins distention is evidence of fluid overload.

A patient reports swelling of the right foot and ankle. Upon assessing the patient, the health care provider confirms it as pitting edema and prescribes diuretic therapy. Which nursing interventions are necessary for this patient? Select all that apply. A. Monitoring the respiratory rate B. Monitoring the urine output of the patient. C. Assessing the sodium and potassium values D. Checking the urine for correct specific gravity E. Monitoring the electrocardiogram (ECG)

B.C.D. Patients with fluid overload often have pitting edema, and diuretic therapy focuses on removing the excess fluid. The nursing interventions would be monitoring the patient's response to drug therapy, especially increased urine output and weight loss. Diuretic therapy is associated with electrolyte imbalance; therefore sodium and potassium levels need to be monitored. Severe electrolyte disturbances may result in arrhythmias. Therefore changes in the electrocardiogram (ECG) should be monitored. Diuretic therapy does not cause respiratory depression or changes in respiratory rate, so the respiratory rate does not need to be monitored. Checking the urine specific gravity is beneficial in patients to detect the fluid overload. However, it is not useful in patients on diuretic therapy.

What is the defense mechanism to combat the effects of isotonic dehydration and maintain blood flow to the vital organs? A. Decreased heart rate B. Decreased peripheral resistance C. Increased blood vessel constriction D. Increased pulmonary ventilation rate

C. Dehydration may cause hypovolemia along with decreasing blood pressure. Vasoconstriction is a mechanism that helps to increase the blood pressure and maintain blood flow to the vital organs. The heart rate increases in a hypovolemic condition to maintain the blood flow and blood pressure to the vital organs. Peripheral resistance is increased in order to maintain blood pressure and circulation during dehydration. Increased pulmonary ventilation rate or hyperventilation causes dehydration that further leads to hypovolemia and decreased blood pressure.

What is the reason for relative dehydration? A. Too much fluid loss B. Too little fluid intake C. Fluid shift from plasma to interstitial space D. Fluid shift from interstitial space to plasma

C. Dehydration without actual loss of total body water, such as when the fluid shifts from plasma to the interstitial space, is called relative dehydration. Too much fluid loss is the decrease in the total body water, leading to dehydration. Too little fluid intake also causes an actual decrease in the total water content of the body, which results in dehydration. A fluid shift from the interstitial space to the plasma causes an increase in plasma volume, which is a condition known as hypervolemia.

The nurse is instructing a patient who is being discharged with a diagnosis of congestive heart failure (CHF). Which patient statement indicates a correct understanding of CHF? A. "I can gain 2 pounds of water a day without risk." B. "I should call my provider if I gain more than 1 pound a week." C. "Weighing myself daily can reveal increased fluid retention." D. "Weighing myself daily can determine if my caloric intake is adequate."

C. Fluid retention may not be visible. Rapid weight gain is the best indicator of fluid retention and overload. Each pound of weight gained (after the first half-pound) equates to 500 mL of retained water. The patient should be weighed at the same time every day (before breakfast) on the same scale. Daily weights are not an indication of effective dieting for purposes of weight loss or gain. They will show fluid retention after an especially high sodium intake (in a patient with fluid retention problems), but caloric intake is related to food intake rather than fluid retention problems. The patient should call the health care provider if more than 1 or 2 pounds are gained in a 24-hour period of if more than 3 pounds are gained in 1 week.

The nurse is caring for a patient who is receiving intravenous (IV) magnesium sulfate. Which assessment parameter is critical? A. 24-hour urine output B. Monitoring of serum calcium levels C. Hourly deep tendon reflexes (DTRs) D. Asking the patient about feeling depressed

C. The patient who is receiving IV magnesium sulfate should be assessed for signs of toxicity every hour by assessment of DTRs. Most patients who have fluid and electrolyte problems will be monitored for intake and output (I&O); this will not immediately generate data about problems with magnesium overdose. Low magnesium levels can cause psychological depression, but assessing this parameter as the levels are restored would not be a method by which to safely assess a safe dose or an overdose. Although administration of magnesium sulfate can cause a drop in calcium levels, this occurs over a period of time and would not be the best way to assess magnesium toxicity.

An electrocardiogram (ECG) is ordered for a patient who was placed on intravenous (IV) fluids containing potassium. Which ECG finding is consistent with hyperkalemia? A. Absent T waves B. Elevated P waves C. Prolonged PR intervals D. Shortened QRS complexes

C. Prolonged PR intervals When hyperkalemia is present, an individual may show absent P waves, tall T waves, prolonged PR intervals, and widened QRS complexes.

The nurse is admitting a 78-year-old patient with severe diarrhea in the emergency department. Which assessment findings indicate that the patient may be dehydrated? Select all that apply. A. Distended neck veins B. Bounding radial pulses C. Temperature of 99.4 F D. Dizziness when standing E. Newly reported confusion

C.D.E. Postural hypotension causing dizziness may occur with dehydration. Because of decreased perfusion to the brain, confusion is common in older adults. Low-grade fever is a common result of dehydration. With dehydration, neck veins are flat, not distended; peripheral pulses are weak, not bounding.

Hyponatremia most affects the cells of which body systems?

Cerebral, Cardiovascular, Neuromuscular

A patient presents with dehydration. Which parameter should be considered when deciding isotonic fluid replacement therapy for the patient? A. Urine output of 550 mL per day B. Heart rate of 100 beats per minute C. Respiratory rate of 18 breaths per minute D. Body temperature of 40 C for more than 8 hours

D. A body temperature of 40°C is abnormally high, which causes dehydration in patients. To replace the fluid loss caused by dehydration, the nurse administers isotonic fluid replacement therapy. A urine output of 550 mL per day is the optimal urine output required to eliminate toxic substances. A heart rate of 100 beats per minute is the normal heart rate of an adult and does not indicate fluid replacement therapy. A respiratory rate of 18 breaths per minute is the normal respiratory rate in adults and does not indicate the need for replacement fluid.

Which consequence of fluid overload may result in seizures, coma, and death? A. Decreased hematocrit B. Decreased hemoglobin C. Decreased serum proteins D. Decreased serum sodium and potassium levels

D. Fluid overload may cause a decrease in serum electrolytes such as sodium and potassium, which can lead to seizures, coma, and death. A decrease in hematocrit due to fluid overload decreases the serum osmolarity, which may cause pulmonary edema or heart failure. A decrease in hemoglobin increases the respiratory rate to meet the oxygen needs of the body. A decrease in serum proteins decreases the serum osmolarity and may cause pulmonary edema or heart failure.

What is the major cause of death in patients diagnosed with hypokalemia? A. Stroke B. Renal failure C. Cardiac arrest D. Respiratory insufficiency

D. Respiratory insufficiency Respiratory changes may occur in patients with hypokalemia because of respiratory muscle weakness resulting in shallow respirations. The respiratory status of a patient with hypokalemia should be assessed at least every 2 hours because respiratory insufficiency is the major cause of death for these patients. A stroke is not a risk factor for hypokalemia. Hypokalemia does not cause renal failure; rather, hyperkalemia is caused by renal failure. Dysrhythmias may occur due to hypokalemia but are not the major cause of death in patients with hypokalemia.

A patient with severe vomiting and diarrhea was brought to the emergency department in a semiconscious condition. What interventions does the nurse implement to stabilize the patient? Select all that apply. A. Monitor the urine output B. Monitor the respiratory rate C. Administer the oral rehydration salts D. Monitor blood pressure and heart rate E. Administer replacement fluids intravenously F. Administer drugs to correct the cause of dehydration

E.F. Nursing priorities in stabilizing a patient with dehydration include patient safety, fluid replacement, and drug therapy. To increase the fluid volume to normal, intravenous replacement fluids are administered. Drug therapy can correct some causes of dehydration such as diarrhea and vomiting. Therefore antidiarrheals and antiemetic drugs are administered to manage dehydration in the patient. Monitoring the urine output, respiratory rate, blood pressure, and heart rate is necessary to prevent further complications. However, monitoring these parameters will not stabilize the patient with dehydration. The patient cannot tolerate oral fluids when the dehydration is severe. Therefore oral rehydration salts are not preferred initially to stabilize the patient.

Interventions for Hyperkalemia

Hyperkalemia can lead to life-threatening bradycardia, the initial action should be to place the patient on a cardiac monitor. Administering a potassium-reducing medication, recommending a potassium-restricted diet, and teaching the patient about diet.

A history of anterior neck injury may be associated with what electrolyte imbalance?

Hypocalcemia

Positive Trousseau's and Chvostek's signs are consistent with which electrolyte imbalance?

Hypocalcemia Trousseau's sign (palmar flexion) and Chvostek's sign (facial twitching) are consistent with acute hypocalcemia. These manifestions are caused by overstimulatoin of the nerves and muscles.

Hyponatremia

It may present with neuromuscular changes including muscle weakness of the legs, arms, and respiratory muscles. The nurse should assess the respiratory effectiveness of a patient with hyponatremia as a priority.

Natriuretic peptide (NP)

NP hormone levels are altered in response to increased blood volume and blood pressure.

Food sources of potassium

Oranges, broccoli, and dairy products.

Common Diabetes insipidus clinical manifestation

Polyuria