HCC II Fluid and Electrolyte

Hyperkalemia

- excessive potassium in the blood - > 5.0 - Tall peaked T waves - Muscle twitching and cramps - Muscle weakness and paralysis - Cardiac dysrhythmias

Hypomagensemia

- (< 1.5) - Muscles are excited, neuromuscular irritability, tremors, increased DTRs, tachycardia, confusion, seizures

Hyponatremia

- < 135 - Neurologic - Headache - Confusion - Seizures - Coma - Muscle weakness - Fatigue - Restlessness/Irritability

Hypernatremia

- >145 - Thirst - Dry mucous membranes and skin - Edema - Agitation - Restlessness - Confusion - Diminished cardiac output - Seizure/Coma

Hypermagnesemia

- >2.5 - Muscles too relaxed, muscle weakness, vasodialation, hypotension, decreased DTRs, respiratory arrest, cardiac arrest

Calcium

- Bound to proteins (mostly albumin) - Ionized (free) Decreased albumin = low serum calcium, without symptoms Decreased ionized calcium = symptomatic

What electrolytes are anions? (Negative)

- Chloride - Bicarbonate - Sulfate - Phosphate

Hypocalcemia

- Deficient calcium in the blood - < 8.5 -Increase msucle contraction/spasms - Tetany (Trousseau's/Chvosteks)- Vomiting/Diarrhea - Convulsions - Heart dysrhythmias

What indicates right-sided heart failure?

- Dependent edema - Nocturnal polyuria - Jugular distention - Gastrointestinal bloating - Anorexia/nausea - Weight gain (edema/ascites) - BP increase

A nurse is preparing to administer IV therapy to a client who is compromised. Which of the following are clincial manifestations of left-sided heart failure. (Select all that apply)

- Dyspnea - Orthopnea - Paroxysmal nocturnal dyspnea

Hypercalcemia

- Excessive calcium in the blood - Decrease muscle contraction - Constipation - Decrease DTRs - Lethargy - Bone Pain - Heart dysrhythmias -Cardiac arrest

What electrolytes are cations? (Positive)

- Hydrogen - Sodium - Potassium - Magnesium - Calcium

Potassium functions

- Intracellular excitation - Crucial to heart function, and can cause arrhythmias if the levels are too high or too low. - conduction of nerve impulses and skeletal muscle activity

Digoxin (Lanoxin)

- Withhold the medication if the client's heart rate is below 60/min. - Eat foods high in potassium to prevent hypokalemia.

Hypokalemia

- deficient potassium in the blood - < 3.5 - muscle weakness/spasms/leg cramping - Numbness/tingling - Fatigue - Lightheadedness - Heart palitations - Bradycardia/Cardiac arrest - Flattened T waves - U wave

Magnesium lab value

1.5-2.5

Sodium

135-145

A nurse is admitting a client who has acute failure following myocardial infarction and is reviewing the provider's orders. Which of the following prescriptions by the provider requires clarification?

0.9% sodium chloride is isotonic and will not cause fluid shift needed in this client to reduce circulatory overload. This prescription require clarification.

A nurse is preparing to administer potassium chloride (KCl). The provider prescribes potassium chloride 20 mEq suspension PO daily. The bottle s labeled KCl elixir, 10 mEq/ml. How many milliliters should the nurse administer?

2 mL

Phosphorus

2.5-4.5

Potassium

3.5-5.0

A provider prescribes 40 mEq of potassium chloride to infuse in 500 ml of dextrose 5% in water at the rate of 10 mEq/hr. The nurse should set the IV pump to deliver how many mL/hr to the client? (Round to the nearest whole number.)

40 mEq = 10 mEq 500 mL X 5,000 = 40X X= 125mL/hr

Calcium

8.5-10.5

Chloride

95-105

A nurse is assessing a client who receives chlorothiazide sodium (Diuril). Which of the following is a sign of hypokalemia?

A client's shallow respirations are a sign of hypokalemia due to weak muscles which facilitates breathing.

A nurse is reviewing a client's laboratiry values and finds a serum potassium of 6.2 mEq/L. Which of the following treatment options should the nurse expect to implement?

Administer sodium polystyrene sulfonate (Kayexalate) Works as a laxative and excretes excess serum potassium to treat hyperkalemia.

A nurse in the emergency department is assessing a client. The client's laboratory values are obtained, and she is now requesting an alcoholic beverage. After reviewing the client's admission lab results, which of the following medication prescriptions should the nurse question? Sodium 144 mEq/L Potassium 3.5 mEq/L Chloride 106 mEq/L Carbon dioxide 32 mEq/L BUN 55 mg/dL Glucose 468 mg/dl Creatinine 5 mg/dL

Amphotericin B (Fungizone): May be an inappropriate medication for this client. It is an antifungal medication that is used for clients who have systemic fungal infections. Amphotericin B can be highly toxic to the kidneys and must be used with extreme caution in clients who have pre-existing renal dysfunction. This client's admission BUN and creatinine are elevated and highly suspicious for renal dysfunction. The nurse should question if this medication is the most appropriate medication available to treat the client's infection.

Mannitol (Osmitrol)

An osmotic diuretic that increased risk of hypnatremia and hypokalemia. (NOT hyperkalemia)

A nurse is teaching a client who takes furosemide and has a serum potassium level of 3.2 mEq/L. Which of the following instructions should the nurse include?

Bananas: The client's potassium level is low, most likely due to his diuretic therapy. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have a high potassium content, such as bananas, orange juice, spinach, and fish. The provider might also prescribe potassium supplements in addition to or instead of increasing dietary potassium.

Calcium is responsible for

Bones Blood (clotting) Beats (heart)

A client with valvular heart disease is at risk for developing left-sided heart failure. The nurse knows to monitor which of the following parameters to determine if the client has developed this disorder?

Breath sounds. Classic manifestations of left- sided heart failure are crackles or wheezes, which the nurse can identify by monitoring the client's breath sounds.

A nurse is preparing to administer potassium chloride. The nurse reviews the client's serum potassium level results and discovers the client's potassium is 5.2 mEq/L. Which of the following actions should the nurse take?

Call the prescribing physician and inform her of the client's serum potassium level. The nurse should notify the provider and inform her of the client's serum potassium level.

A client visits his provider's office, stating that he does not feel like himself. Laboratory testing indicates a low potassium level Which of the following physiological responses should the nurse expect related to the client's hypokalemia?

Cardiac dyshythmias Low potassium levels affect cardiovascular function, causing ventricular dysrhythmias, ECG changes, and a weak and irregular pulse.

A nurse is caring for a client who was admitted to the hospital with congestive heart failure and is taking digoxin (Lanoxin) 0.25 mg daily. The client refused breakfast and is complaining of nausea and generalized weakness. Which of the following actions should the nurse perform first?

Check the client's vital signs. It is possible that the client's nausea is secondary to the digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the drug and call the provider if the client has bradycardia

A nurse is reinforcing discharge teaching with a client recently diagnosed with heart failure. Which of the following statements should the nurse include in the teaching?

Exercise at least three times per week.

1/3 of the fluid in the body is

Extracellular Fluid`

A nurse in a cardiac care unit is caring for a client with acute heart failure. Which of the following findings should the nurse expect?

Elevated central venous pressure (CVP) Side Note: ( BNP is elevated, Pulmonary pressure is increased, Urinary output is decreased)

A nurse is preparing to administer digoxin (Lanoxin) to a client who has heart failure. Which of the following actions is appropriate?

Evaluating the client for nausea, vomiting and anorexia. Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs and digoxin toxicity.

A nurse is making a home visit to a client who receives diuretics daily for heart failure. Which of the following signs would the client manifest with hypokalemia?

Fatigue: the nurse should expect to find the client with fatigue due to muscle weakness with hypokalemia.

A nurse is caring for an older adult client who has left-sided heart failure. Which of the following assessment findings should the nurse expect?

Frothy sputum. Left-sided heart failure reduces cardiac output and raises pulmonary venous pressure. Manifestations include hacking cough, frothy sputum, wheezing, fatigue, and weakness.

A nurse is caring for a client who has heart failure and has a potassium level of 2.4 mg/dL. An adverse effect of which of the following medications is a possible cause of this potassium level?

Furosemide (Lasix): is a loop diuretic that inhibits the re-absorption of sodium and chloride and results in dieresis. Potassium is lost through excretion in the distal nephrons when the patient receives the drug. The lab result is interpreted as hypokalemia, which is an adverse effect associated with the administration of furosemide.

A nurse is caring for a client whose serum level is 5.3 mEq/L. Which of the following schduled medication should the nurse plan to administer?

Furosemide: Results in loss of potassium from the nephron as part of it diuretic effect.

Furosemide

High ceiling loop diuretic that increased risk of hypnatremia and hypokalemia. (NOT hyperkalemia)

A nurse is caring for a client who has congestive heart failure and was started on digoxin. Which of the following client statements should alert the nurse that the client may be experiencing a side effect of digoxin?

I feel nauseated and have no appetite. Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digitalis toxicity.

A nurse is providing discharge instructions to a client who has congestive heart failure. Which of the following statements by the client indicates to the nurse that the teaching was effective?

I plan to slow down if I am tired the day after exercising. Clients who experience chest pain or dyspnea while exercising or experience fatigue the next day are probably advancing the activity too quickly and should slow down

2/3 of the fluid in the body is

Intracellular Fluid

A nurse is caring for a infant who has congestive heart failure secondary to a ventricular septal defect and was brought to the clinic by the parent with a report of poor feeding. After instructing the parent about nasogastic tube feedings, the nurse evaluates that teaching has been effective when the parent states, "I will."

Nurse my baby for 20 minutes then give the rest by NG tube. Nursing the infant for 20 minutes allows the baby gratification from sucking, and the limited time frame does not place great exertion on the heart nore does it cause excessive fatigue. Using the NG tube to administer the additional feeding ensures adequate calorie and fluid intake.

A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect?

Orthopnea, or shortness of breath when the client lies down, is a characteristic manifestations of left-sided heart failure. Increased lung pressures from interstitial and alveolar edema cause it.

A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse be sure to monitor specifically for this client?

Potassium

A nurse is caring for a client who has heart failure and is prescribed furosemide. For which of the following findings should the nurse withhold the medication?

Potassium 2.8 is correct. because it is low.

What electrolytes are associated with intracellular fluid?

Potassium and Magnesium

What electrolytes are associated with extracellular fluid?

Sodium and Chloride

A nurse is giving a presentation about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts the clients at risk for both hyperkalemia and hyponatremia?

Spironolactone (Aldactone) is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and retention of potassium. Thus possible adverse reactions include hyperkalemia and hyponatremia.

A nurse is caring for four clients who have drainage tubes. Which of the following clients should the nurse recognize is at risk for hypokalemia?

The client who has an NG tube to suction. Hypokalemia is a low serum potassium. An NG tube is used to decompress the stomach. When hooked to suction drainage, an NG tube will empty the stomach of gastric contents, which are high in electrolytes, and this loss will put the client at risk for hypokalemia.

A nurse is monitoring cardiac output on a client who has left-sided heart failure. The nurse should expect which of the following finding to compromise the readings?

The client who has premature atrial contractions. Premature atrial contractions will compromise the readings.

Hydrocholorothiazide

Thiazide diuretic. Increases risk of hypokalemia (NOT hyperkalemia)