Fluid and Electrolyte from PrepU
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEq/L.
Oncotic pressure refers to the
Oncotic pressure is a pulling pressure exerted by proteins such as albumin.
rehydration therapy for diarrheal disorders
Oral rehydration salts (ORS) An ORS solution may be used for rehydration therapy for diarrheal disorders. Foods that are high in simple sugars, such as undiluted apple juice or gelatin, should be avoided. Sports drinks do not replace fluid losses correctly and should not be used.
Osmotic pressure
Osmotic pressure is the amount of pressure needed to stop the flow of water by osmosis.
A client with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location rules out the use of enteral feeding. What intervention will best meet this client's nutritional needs?
Parenteral nutrition given via a peripherally inserted central catheter
adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?
Hypokalemia and hypoglycemia Blood glucose needs to be monitored in clients receiving IV insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium.
left flank pain and lower abdominal pain. The pain is severe, sharp, stabbing, and colicky in nature. The client has also experienced nausea and emesis. The nurse suspects the client is experiencing:
ureteral stones
A patient with dislocation, nurse check neuromuscular assessment for
Compartment syndrome
Gynecomastia is a common side effect of which of the following diuretics?
Spironolactone
Urine output that's less than 50 ml in 24 hours is known as:
anuria
Bleeding, high pulse rate
Extracellular fluid volume deficit.
fluid replacement is a hallmark treatment for shock. Which of the following is the crystalloid fluid that helps treat acidosis?
Lactated Ringer's is an electrolyte solution that contains the lactate ion, which is converted by the liver to bicarbonate, thus assisting with acidosis.
Acute renal failure (ARF), which nursing intervention is the most important?
Limiting fluid intake
CKD
Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin.
Osmolarity
Osmolality refers to the number of dissolved particles contained in a unit of fluid
Tube feedings administered via intermittent gravity drip should be administered
over 30 minutes or longer.
Intrinsic renal failure
results from damage to the kidney, such as from nephrotoxic injury caused by contrast media, antibiotics, corticosteroids, or bacterial toxins
Addisonian crisis
results in hyperkalemia.
Chronic Renal Failure receives hemodialysis cause
weight loss Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss.
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?
Assess for elevated blood urea nitrogen levels. Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.
A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?
Assess renal function
Acute dialysis is indicated during which situation?
Impending pulmonary edema
Hypocalcemia
Presence of Trousseau sign After radical neck resection, a client is prone to developing hypocalcemia. Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and metacarpophalangeal joints, and extended interphalangeal joints with fingers together) will occur as ischemia of the ulnar nerve develops.
Dilutional hyponatremia occurs in which disorder?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Active bleeding
The nurse monitors vital signs for changes, increased pulse rate, decreased blood pressure, and rapid, deep respirations. Cold, clammy, pale skin may indicate active bleeding.
aging on upper and lower urinary tract function?
develop hypernatremia. These clients typically have a decreased glomerular filtration rate, decreased blood flow to the kidneys, and acid-base imbalances.
60% of water is in
intracellular fluid, most of water is in the cell due to agging
Hypovolemia
low CVP (less than 2 mm Hg) indicates reduced right-ventricular preload, which is most often from hypovolemia.
adrenal deficiency and crisis i
low serum sodium (hyponatremia) and high serum potassium (hyperkalemia) levels.
During the diuresis period of acute kidney injury (AKI), the nurse should observe the client closely for what complication?
Dehydration is a complication during the diuresis phase related to elevated urine output and continued symptoms of uremia. The concern with acute kidney injury (AKI) is hyperkalemia. The diuresis phase of AKI is marked by normal or elevated urine output. Oliguria is urine output less than 400 mL in 24 hours and is seen in the oliguria phase
post-streptococcal glomerulonephritis.
Dietary management of acute post-streptococcal glomerulonephritis includes restrictions of protein, sodium, potassium, and fluids.
Which hormone causes the kidneys to reabsorb sodium?
Aldosterone is a hormone synthesized and released by the adrenal cortex. Antidiuretic hormone is secreted by the posterior pituitary gland. Growth hormone and prostaglandins do not cause the kidneys to reabsorb sodium.
Which is a gerontological consideration associated with the pancreas?
An increase in fibrous material and some fatty deposition occurs in the normal pancreas of people older than 70 years of age. There is a decreased rate of pancreatic secretion and decreased bicarbonate output in older adults. Decreased calcium absorption may also occur.
a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?
Assess vital signs and level of consciousness. Femur fractures can lead to hypovolemic shock due to blood loss in the tissue. By assessing the vital signs and level of consciousness, the nurse can assess for shock.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
central venous pressure (CVP) catheter. The nurse records the client's CVP as 9 mm Hg and recognizes that this finding indicates the client is most likely experiencing which condition?
Hypervolemia Many problems can cause an elevated CVP, but the most common is hypervolemia (excessive fluid circulating in the body) or right-sided HF.
myeloid leukemia (AML) receiving chemotherapy is treated for an acute renal injury.
Chemotherapy causes an increase in kidney stone formation. Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. This causes an increase in uric acid levels, potassium, and phosphate (also known as tumor lysis). The increase in uric acid predisposes the client to the development of kidney stones and increases the risk for renal injury.
Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that appl
Clinical manifestations of FVE (hypervolemia) include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.
the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of:
Hypocalcemia
AKI acute kidney injury
Fluid overload
Acute renal failure in oligulic phase
Fluid volume excess
Cellular injury alters the ability of the cell to maintain homeostasis. Which agent can cause fluid and electrolyte imbalance?
Glucose
A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion?
Hydrocortisone Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution.
Massive burn obstruction from burning injury
Hyperkalemia Hypokalemia (potassium depletion) may occur later with fluid shifts and inadequate potassium replacement.
Addisonian crisis
Hyperkalemia increased BUN Hyponatremia Hypoglycemia
A client is being treated in the ICU 24 hours after having a radical neck dissection completed. The client's serum calcium concentration is 7.6 mg/dL (1.9 mmol/L). Which physical examination finding is consistent with this electrolyte imbalance?
Presence of Trousseau sign After radical neck resection, a client is prone to developing hypocalcemia. Hypocalcemia is defined as a serum value <8.6 mg/dL (<2.15 mmol/L). Signs and symptoms of hypocalcemia include Chvostek sign, which consists of muscle twitching enervated by the facial nerve when the region that is about 2 cm anterior to the earlobe, just below the zygomatic arch, is tapped; and a positive Trousseau sign can be elicited by inflating a blood pressure cuff on the upper arm to about 20 mm Hg above systolic pressure; within 2 to 5 minutes, carpal spasm (an adducted thumb, flexed wrist and metacarpophalangeal joints, and extended interphalangeal joints with fingers together) will occur as ischemia of the ulnar nerve develops. Slurred speech and muscle weakness are signs of hypercalcemia.
the compensation stage of shock. The nurse knows that one of the body's mechanisms of compensation in this stage of shock is the renin-angiotensin-aldosterone system. What does this system do?
Restores blood pressure The renin-angiotensin-aldosterone system is a mechanism that restores blood pressure (BP) when circulating volume is diminished
Hypercalcemia
Slurred speech and muscle weakness
essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure?
The kidney excretes sodium and water. Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together.
acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine.
The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]).
The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?
The oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
which skin layer would the instructor include as having the capacity to absorb water?
The stratum corneum, the outermost layer of the epidermis, has the capacity to absorb water,
CKD
Uremia Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure.
Which clinical finding should a nurse look for in a client with chronic renal failure?
Uremia is the buildup of nitrogenous wastes in the blood, evidenced by an elevated blood urea nitrogen and creatine levels. Uremia, anemia, and acidosis are consistent clinical manifestations of chronic renal failure. Metabolic acidosis results from the inability to excrete hydrogen ions. Anemia results from a lack of erythropoietin.
The client presents with nausea and vomiting, absent bowel sounds, and colicky flank pain. The nurse interprets these findings as consistent with:
Ureteral colic
A client with a traumatic brain injury has developed increased intracranial pressure resulting in diabetes insipidus. The expected treatment would consist of which of the following?
Vasopressin therapy
A client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, the nurse knows that the client is most likely to experience:
Weight loss Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesn't increase urine output because it doesn't correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure.
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate?
When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
multiple myeloma and include: CRAB
calcium levels elevated (hypercalcemia), renal insufficiency, anemia, bone lesions.
Hypokalemia
causes fatigue, weakness, anorexia, nausea, vomiting, cardiac dysrhythmias, leg cramps, muscle weakness, and paresthesias.
Cushing's syndrome
causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase the intake of potassium-rich foods, such as fresh fruit.
The greatest volume of fluid loss
ccurs in the first 24 to 36 hours after the burn, peaking by 6 to 8 hours.
Kidney functions
control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins. T hey also produce the enzyme renin.
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see?
A serum potassium level of 6.8 mEq/L indicates hyperkalemia, which can occur in adrenal insufficiency as a result of reduced aldosterone secretion. A BUN level of 2.3 mg/dl is lower than normal. A client in addisonian crisis is likely to have an increased BUN level because the glomerular filtration rate is reduced. A serum sodium level of 156 mEq/L indicates hypernatremia. Hyponatremia is more likely in this client because of reduced aldosterone secretion. A serum glucose level of 236 mg/dl indicates hyperglycemia. This client is likely to have hypoglycemia caused by reduced cortisol secretion, which impairs glyconeogenesis.
diverticulosis
Drink at least 8 to 10 large glasses of fluid every day The client should include unprocessed bran in the diet because it adds bulk, and should avoid the use of laxatives or enemas except when recommended by the physician.
Osmotic diuresis
Osmotic diuresis occurs when urine output increases as a result of excretion of substances such as glucose.
Hyperglycemic hyperosmolar syndrome
a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs (e.g., alteration of consciousness, seizures, hemiparesis).
Polyuria
results from osmotic diuresis, which is compensatory to hyperglycemia. Large amounts of glucose can cause osmotic shifts, affecting the fluid and electrolyte balance and leading to polyuria, or increased urination.
Patient with hemorrhage in compensate stage of shock
tachycardia and tachypnea
After a Roux-en-Y gastric bypass
the client should not drink fluids with meals, withhold fluids for 15 minutes before eating to 90 minutes after eating. Chewing foods slowly and thoroughly; keeping total serving sizes to less than 1 cup; and choosing foods such as breads, cereals, and grains that provide less than 2 g of fiber per serving.
The nurse cares for a client with acute kidney injury (AKI). The client is experiencing an increase in the serum concentration of urea and creatinine. The nurse determines the client is experiencing which phase of AKI?
the oliguria period is accompanied by an increase in the serum concentration of substances usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular cations [potassium and magnesium]). The initiation periods begins with the initial insult and ends when oliguria develops. The diuresis period is marked by a gradual increase in urine output. The recovery period signals the improvement of renal function and may take 6 to 12 months.
