fluid and electrolyte dynamic study

A nurse is unable to secure an intravenous access site due to severe dehydration. Which prescription should the nurse expect to replace this patient's fluid deficit?

"Administer fluids via hypodermoclysis." When IV access is problematic, fluids can be administered subcutaneously, using a method called hypodermoclysis. Diuretics are used to treat fluid volume excess, not dehydration. Oral fluid replacement is ordered for mild dehydration, not severe dehydration. Fluid replacement, not sodium supplements, would be anticipated. Fluids are replaced gradually, particularly in older adults, to prevent too-rapid rehydration of the cells. In general, fluid deficits are replaced at a rate of approximately 30-50% of the deficit per 24 hours.

The nurse is teaching older adult patients how to prevent fluid volume deficit. Which information should the nurse include?

"Avoid extreme temperatures."

The community health nurse is performing health screenings at a homeless shelter. When assessing for fluid and electrolyte imbalances, which statement or question is the most important for the nurse to ask?

"Describe what you eat and drink on a typical day."

The nurse is providing discharge instructions to the parent of a baby who has been treated for dehydration. Which statement by the parent should the nurse identify as indicative of a need for further instructions?

"I need to bring my baby back to the clinic if the number of wet diapers increases."

The nurse is teaching a patient about maintenance of fluid and electrolyte balance. Which patient statement indicates an understanding of the modifiable risk factor with the most direct effect on calcium balance?

"I should exercise to help me to maintain an appropriate calcium balance." Regular weight-bearing exercise helps maintain calcium balance. Stress, fluid intake, and diuretics can all affect fluid and electrolyte balance in a general way, but they do not specifically target calcium.

The nurse is teaching parents about fluid replacement in an infant who has been vomiting. Which statement made by the parents should indicate to the nurse that further teaching is required?

"I will withhold oral fluids until the vomiting stops."

A patient with severe heat exhaustion asks what type of fluid is in the intravenous infusion. Which response should the nurse provide?

"I'm giving you a solution that is a lot like the fluid outside your cells. It will replace the fluid you lost." Crystalloid solutions are given intravenously to patients like this who have lost fluids from excessive sweating, inadequate intake, or insensible water loss. Crystalloid solutions mimic the body's extracellular fluid and replace lost fluids. Colloid solutions resemble blood more closely, because they contain proteins and other large molecules, and are given in cases of excessive blood loss. Crystalloid solutions do not contain a drug that causes a person to retain water.

The nurse discusses how active transport differs from other transport processes with colleagues. Which statement should the nurse include?

"Unlike diffusion, active transport moves solutes from a solution with a lower concentration of solutes to a more concentrated solution."

The nurse is teaching a patient taking a loop diuretic about prevention of fluid volume excess. Which should the nurse include in this teaching session?

"You should perform daily weights." Daily weights are the best indicator of fluid imbalance. The patient should not increase the amount of diuretic medication because that can cause fluid volume deficit. Bananas provide a source of potassium for the patient and bear no impact on fluid balance. Decreasing fluid intake could promote a fluid volume deficit and would be incorrect advice.

A patient has a low serum sodium level. Which intervention should the nurse expect to be prescribed for this patient?

0.9% saline IV infusion

Crystalloids

5% dextrose and water Normal saline solution Lactated Ringer's solution 5% dextrose and ½ normal saline solution

A patient is prescribed daily weights. Which information should the nurse recall as the purpose of daily weights to evaluate fluid balance?

A gain or loss of 5-8% of body weight can represent fluid imbalance. A change in weight of 5-8% (gain or loss) can represent fluid imbalance. A change in body weight greater than 20% would be problematic and more serious than fluid imbalance. Blood pressure can represent alterations in fluid imbalance, but it is not always the best indicator of changes in fluid status. Daily weights are required in many patients, regardless of the medications taken.

The nurse is reviewing the medication record of a patient admitted with dehydration. Which medication type should cause the nurse concern?

Antipsychotic Patients with dehydration are likely to develop electrolyte imbalances as the body attempts to compensate for the lost fluid. Individuals taking antipsychotic agents are often at risk for alterations in fluid intake due to the effect on thirst mechanisms. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics are not associated with fluid or electrolyte imbalances and do not affect fluid balance.

Ways to prevent fluid and electrolyte imbalances in pregnant women include:

Avoiding caffeinated beverages. Drinking an adequate amount of water. Avoiding extremes of temperature that may cause insensible fluid loss.

The nurse is assessing a patient with a fluid volume deficit. Which finding should the nurse expect in this patient?

BP 92/56 mmHg, P 134 beats/min, R 22 breaths/min When a patient experiences a deficiency in fluid volume, the body's vital signs will try to compensate for the decreased volume to maintain perfusion. Typical changes that are seen with fluid volume deficit include decreased blood pressure, increased heart rate, and increased respiration, along with decreased urine output. Vital signs of BP 92/56 mmHg, P 134 beats/min, and R 22 breaths/min would be consistent with these typical changes.

Low electrolyte level

Cardiac arrhythmias Weakness Muscle twitching Blood pressure changes Confusion Seizures Numbness Sleep disturbances Constipation

The nurse is teaching a patient about oral fluid volume replacement. Which fluid should the patient be advised to avoid?

Coffee Coffee contains caffeine, which exerts a diuretic effect. Water, milk, and juice are acceptable forms of oral fluid replacement and will not exert a diuretic effect.

A patient is experiencing a fluid imbalance caused by excessive blood loss. Which fluid should the nurse expect to be prescribed for this patient?

Colloid

Chronic kidney disease (CKD)

Confusion Fluid retention

Assessment of fluid balance should include:

Daily weight. Vital signs. Intake and output of fluids and food. Diagnostic tests such as serum electrolytes, CBC, serum osmolality, and urine specific gravity.

Fluid imbalances can occur in older adult patients due to:

Decreased thirst mechanism. Decreased kidney function.' Reduced fluid reserves. Increased levels of atrial natriuretic factor (ANF).

A patient with fluid volume excess has hypokalemia. Which collaborative therapy should the nurse expect to implement for this patient?

Diuretic Diuretics are used to remove excess fluid. A specific diuretic that does not remove potassium will be prescribed. Oral fluids, isotonic electrolyte solutions, and heparin are not appropriate for this patient's health problem.

The nurse is performing an assessment on a patient who has had nothing by mouth since the previous evening. Which manifestation related to the patient's fluid restriction should be of concern to the nurse?

Dry mucous membranes Oral fluid restriction can cause dehydration. The nurse should monitor for manifestations of dehydration such as dry mucous membranes, increased hematocrit, and tenting skin. Edema, increased blood pressure, and bounding pulse are manifestations of fluid volume excess, not deficit.

Fluid volume excess MANIFESTATIONS

Edema Pitting edema Weight gain Ascites Adventitious lung sounds Increased central venous pressure (CVP)

Phosphate (PO4-)

Forming bones and teeth Metabolizing carbohydrate, protein, and fat Cellular metabolism; producing adenosine triphosphate (ATP) and DNA Muscle, nerve, and RBC function Regulating acid-base balance Regulating calcium levels

Calcium (Ca2+)

Forming bones and teeth Transmitting nerve impulses Regulating muscle contractions Maintaining cardiac pacemaker (automaticity) Blood clotting Activating enzymes such as pancreatic lipase and phospholipase

Diuretics

Furosemide Hydrochlorothiazide Spironolactone (Aldactone)

Chloride (Cl-)

HCl production Regulating ECF balance and vascular volume Regulating acid-base balance Buffering oxygen-carbon dioxide exchange in RBCs

The nurse prepares to assess patients arriving at the clinic for routine prenatal care. Which factor should the nurse identify that contributes to fluid and electrolyte imbalances in pregnant patients?

Hyperemesis gravidarum Hyperemesis gravidarum can cause fluid and electrolyte imbalances. It is a disorder that involves an extreme amount of vomiting during pregnancy. Increased intravascular volume is expected during pregnancy. Decreased kidney function and decreased thirst mechanism are not causes of fluid imbalance in pregnant women.

Elevated electrolyte level

Hyperkalemia: fatigue, nausea, muscle weakness, cardiac irregularities Hypernatremia: swelling, irritability, muscle spasms, thirst, confusion, coma Hypercalcemia: nausea and vomiting, excessive thirst, frequent urination, constipation, muscle pain

Crystalloids are used in:

Hypovolemic shock. Dehydration.

Magnesium

Intracellular metabolism Operating sodium-potassium pump Relaxing muscle contractions Transmitting nerve impulses Regulating cardiac function

Mechanisms for Homeostasis

Kidneys regulate and filter waste. Cardiovascular and respiratory systems ensure adequate oxygen is available for use and use fluid and electrolytes as appropriate. The immune system destroys pathogens. Hormones such as ADH, the renin-angiotensin-aldosterone pathway, and ANF (atrial natriuretic factor) maintain and control vascular volume.

Potassium (K+)

Maintaining ICF osmolality Transmitting nerve and other electrical impulses Regulating cardiac impulse transmission and muscle contraction Skeletal and smooth muscle function Regulating acid-base balance

Bicarbonate (HCO3-)

Major body buffer involved in acid-base regulation

Mucous membranes: Assess for dryness and cracking.

Membranes are moist in appearance. Membranes are dry or cracking.

Edema: Assess for pitting by depressing the skin over the tibia or on top of the foot.

No swelling is noted. Depressed skin rebounds immediately. Depression remains when tissue is depressed ("pitting").

A patient has the following laboratory values: Na 130 mEq/L, K 4.3 mEq/L, Cl 96 mEq/L, and Mg 2.3 mg/dL. Based upon these values, which medication should the nurse anticipate to be prescribed?

Normal saline IV infusion

Acute kidney injury

Oliguria Fluid and electrolyte imbalances Fluid retention Drowsiness Dyspnea Fatigue Confusion Nausea

Turgor: Gently pinch up a fold of skin over the sternum or inner aspect of the thigh for adults.

Pinched tissue immediately returns to normal. Skin remains tented for several seconds instead of immediately returning to normal position.

Sodium (Na+)

Regulating ECF volume and distribution Maintaining blood volume Transmitting nerve impulses and contracting muscles

A nurse is assessing a patient with fluid volume overload. Which mechanism should the nurse understand assists in the regulation of body fluids?

Renin-angiotensin-aldosterone pathway The renin-angiotensin-aldosterone pathway is one of the mechanisms used to maintain fluid balance in the body. Cortisol and epinephrine are stress hormones that are not related to the maintenance of body fluids. Erythropoiesis is the process to stimulate red blood cell production. This process would be stimulated to increase oxygenation but not to maintain the balance of body fluids.

Colloids

Serum albumin Dextran 40

View the general appearance of the skin.

Skin is the appropriate color for ethnicity. Skin is firm, warm, and moist. Skin is flushed, warm, or very dry. Skin is very moist or diaphoretic or cool and pale.

Following are normal electrolyte values for adults* based on a venous blood sample.

Sodium 135-145 mEq/L Potassium 3.5-5.3 mEq/L Chloride 95-105 mEq/L Calcium (total) 4.5-5.5 mEq/L or 9-11 mg/dL Calcium (ionized) 50% of the total calcium (2.2-2.5 mEq/L or 4.25-5.25 mg/dL) Magnesium 1.5-2.5 mEq/L or 1.8-3.0 mg/dL Phosphate (phosphorus) 1.7-2.6 mEq/L or 2.5-4.5 mg/dL Serum osmolality 280-300 mOsm/kg

The nurse prepares an educational program for colleagues about intracellular and extracellular fluid compartments. Which solutes or electrolytes that are predominantly found within the intracellular and extracellular fluids, should the nurse explain help with transmitting nerve impulses and contracting muscles?

Sodium and potassium Sodium and potassium are found in both intracellular and extracellular fluid and are involved in transmitting nerve impulses and contracting muscles. Albumin is a protein found in cellular fluid but plays no role in transmitting nerve impulses or contracting muscles. Calcium and phosphate are involved in teeth and bone formation. Phosphate is involved with nerve function but does not transmit nerve impulses. Chloride and bicarbonate are involved with acid-base balance.

Electrolyte supplements

Sodium chloride (sodium supplement) Potassium chloride (potassium supplement)

A patient is experiencing signs of a decrease in extravascular volume. Which should the nurse expect the patient to experience in response to this drop in volume?

Stimulation of the thirst center

A patient is experiencing signs of a decrease in extravascular volume. Which should the nurse expect the patient to experience in response to this drop in volume?

Stimulation of the thirst center In order to temporarily respond to decreased extracellular volume, the hypothalamus will be stimulated to initiate thirst. Increasing kidney function would cause more fluid volume loss. Decreased secretion of insulin and stimulation of thyroid function would not decrease extracellular fluid volume.

The nurse is caring for a patient who exhibits manifestations of fluid volume overload. Which body mechanism should the nurse anticipate will be activated to assist in the regulation of body fluids?

Suppression of antidiuretic hormone from the posterior pituitary gland Antidiuretic hormone (ADH) regulates water excretion from the kidneys. With fluid volume overload, decreased blood osmolality leads to suppression of ADH, causing distal tubules to become less permeable to water. This leads to decreased reabsorption of water into blood and an increase in urine output as serum osmolality returns to normal.

A patient reports experiencing vomiting and diarrhea for the past 2 days, resulting in a 5% weight loss. In addition to diminished skin turgor, which manifestation should the nurse expect to find during assessment?

Tachycardia When a patient experiences a deficiency in fluid volume, the heart rate will increase (tachycardia) in an attempt to improve circulation. Ascites and dyspnea are frequently noted with fluid volume excess. Warm, flushed skin is typically seen with a fever.

The nurse recalls that sodium and potassium are major electrolyte components in the intracellular and extracellular fluid. Which function should the nurse identify that these electrolytes share?

Transmitting electrical impulses and muscle contraction Sodium and potassium are involved in the transmission of electrical impulses and muscle contraction. Calcium and phosphate are involved in the formation of bones and teeth. Potassium, along with chloride and bicarbonate, is involved in regulating acid-base balances, but sodium is not. Sodium, along with chloride, maintains blood volume, but potassium does not.

The nurse is reviewing laboratory values for a patient with hyperthyroidism. Which component of the urinalysis should the nurse use to help determine the patient's fluid status?

Urine specific gravity Specific gravity is an indicator of urine concentration that can be performed quickly and easily by nursing personnel. Normal specific gravity ranges from 1.005 to 1.030 (usually 1.015-1.024). When the concentration of solutes in the urine is high, the specific gravity rises. In very dilute urine with few solutes, it is abnormally low. Ketones are found in the urine when the body is breaking down fats to have an alternate form of energy. Nitrites found in the urine are usually related to an infection. Glucose found in the urine can indicate elevated blood sugar.

Extracellular fluids include:

principal electrolytes: sodium, chloride, bicarbonate interstitial fluid (surrounds cells), 75% intravascular fluid (plasma), 20% transcellular and lymph fluid

Fluid volume deficit MANIFESTATIONS

rapid weight loss, decreased skin turgor, oliguria, concentrated urine, postural hypotension, rapid weak pulse, increased temperature, cool clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness, cramps Dry to tenting skin Dry mucous membranes Increased hemoglobin and hematocrit Thirst Decreased urine output Weight loss

Intracellular fluids include:

solutes: oxygen, electrolytes, glucose cations: potassium, magnesium anions: phosphate, sulfate.