Fluid and Electrolyte Exam

Nursing care for patients with hypokalemia

-Administer potassium replacement -Monitor urine output -Monitor respirations -Monitor LOC -Monitor bowel sounds and abdominal distention -Monitor O2 -Assess for muscle weakness -Implement fall precautions

A patient with hypovolemia might show these symptoms:

-Dizziness or confusion -Thirst -Acute weight loss -Decreased urine production -Decreased capillary refill -Cool, clammy skin -Poor skin turgor/tenting

Risk factors for hypovolemia

-Excessive vomiting or diarrhea -Excessive sweating without water/electrolyte replacement -Kidney disease -Burn victims -Hemorrahage -People with anorexia, NPO patients, or patients with impaired swallowing

Nursing care for patients with hypocalcemia

-Give calcium and vitamin D supplements -Implement seizure and fall precautions -Encourage intake of food high in calcium (dairy, fish, green leafy vegetables) -If life threatening patient should be treated with calcium gluconate in dextrose 5% and water. Not pushed too quickly because it can cause cardiac arrest)

What should the nurse do for a patient with hyponatremia?

-Give food and fluids if patient isn't NPO -Give IV fluid like lactated ringers or 0.9% isotonic saline -Monitor I&O and daily weight

Risk factors for hypervolemia:

-Heart failure, kidney disease, cirrhosis -Overdose of fluids (IV, oral, enteral) -Burn victims -Prolonged corticosteroid use -Severe stress

A patient with hypovolemia may present with these vital sign changes:

-Hypothermia -Tachycardia (heart tries to maintain blood pressure by increasing heart rate) -Hypotension/orthostatic hypotension -Tachypnea -Hypoxia

Risk factors for hypocalcemia

-Inadequate intake of calcium or vitamin D -Diarrhea -Endstage kidney disease -Wound drainage -Alkalosis, acute pancreatitis, hyperproteinemia, hyperphosphatemia, immobility

Nursing care for a patient with hypervolemia

-Monitor I&O -Monitor daily weight -Assess breath sounds -Monitor peripheral edema -Restrict sodium intake -Position patient in semi-Fowler's or Fowler's position

Nursing care for patients with hypernatremia

-Monitor LOC -Auscultate lung sounds -Monitor VS and heart rhythms -Provide comfort measures to help with thirst -Monitor I&O

Risk factors for hypokalemia (low potassium)

-Overuse of diuretics or corticosteroids -Increased secretion of aldosterone -Cushing's syndrome -Excessive loss of fluid/stool -NPO status -Kidney disease -Alkalosis -Water intoxication -Hyperinsulinism

Nursing care for a patient with hypovolemia includes:

-Provide oral or IV rehydration -Monitor I&O -Monitor vitals -Monitor weight -Monitor patients mental status -Normally give isotonic or hypotonic IV solution

Risk factors for hyperkalemia (high potassium)

-RBC transfusions -Adrenal insufficiency -Kidney failure -ACE inhibitors or K-sparing diuretics -Acidosis (like diabetic ketoacidosis) -Tissue damage

Expected vital signs for someone with hypervolemia:

-Tachycardia -Bounding pulse -Hypertension -Tachypnea

Expected findings for hypocalcemia

-Tetany is the most common symptom -Parathesia of fingers and lips -Muscle twitches -Possibly seizures -Positive Chvostek's sign (tapping on facial nerve triggering facial twitching) -Diarrhea -Abdominal Cramping

A patient with hypervolemia might show these symptoms:

-Weakness -Ascites -Liver enlargement -Vision changes -Crackles in lungs -Peripheral edema -JVD -Increased urine output

Education for a client with hypervolemia

-Weight yourself daily -Consume low sodium diet and read food labels -Adhere to fluid restriction

Normal creatinine

0.6-1.4

When would an isotonic solution be used?

0.9% NaCl is used in patient's with hypovolemia to increase patient's fluids.

Normal urine specific gravity

1.010-1.025

Normal magnesium

1.3-2.1

Normal BUN

10-20

Normal Sodium

136-145

Normal phosphorus

3-4.5

Normal potassium

3.5-5

Normal calcium

9.0-10.5

Normal chloride

98-106

A nurse is admitting an older adult client who reports a weight gain of 5 lbs in 48 hours. Which of the following manifestations of fluid volume excess should the nurse expect? (SATA) A. Dyspnea B. Edema C. Bradycardia D. Hypertension E. Weakness

A, B, D, E

A nurse is admitting a client who reports nausea, vomiting, and weakness. The client has dry mucus membranes and blood pressure of 102/64. Which of the following findings should the nurse identify as manifestations of fluid volume deficit? (SATA) A. Decreased skin turgor B. Concentrated urine C. Bradycardia D. Low-grade fever E. Tachypnea

A, B, D, E (Fever bc it is one of the body's ways to maintain homeostasis to compensate for lack of fluid)

What are some risk factors for hypernatremia? (high sodium)

Actual sodium excess: kidney failure, some meds (like glucocorticoids), cushings syndrome, aldosteronism, Sodium excess because of decreased fluid volume: watery stools, NPO status, burns, hypertonic enteral feedings, excessive sweating

What is hypervolemia? (Also called fluid volume excess)

An excess of water and electrolytes. Example: excessive sodium intake causes the body to retain water, so there is excess of both. (The two will stay in the right proportions, there will just be too much).

A nurse is caring for a client in a long-term care facility who has become weak, confused, and experiences dizziness when standing. The client's temperature is 100.9 F, pulse 92/min, respirations 20/min, and blood pressure 108/60. Which of the following actions should the nurse take? A. Initiate fluid restrictions to limit intake B. Check for peripheral edema C. Encourage the client to ambulate to promote oxygenation D. Monitor for orthostatic hypotension

D

A nurse is assessing a client who is dehydrated. Which of the following findings should the nurse expect? A. Moist skin B. Distended neck veins C. Increased urinary output D. Tachycardia

D.

What is some client education when a patient has hypovolemia?

Drink plenty of fluids, educate on what can cause hypovolemia

What are some risk factors for hyponatremia? (low sodium)

Excessive sweating, diuretics, NG tube suction, kidney disease, heart failure, hypotonic fluid excess

What is hypovolemia? (Also called fluid volume deficit)

Lack of water and electrolytes that causes a decrease in circulating blood volume.

Normal hematocrit

Males: 42-52% Females: 36-48%

Interprofessional care for patients with hyponatremia and hypernatremia

Nephrology and nutrition. Possibly repiratory services.

When would a hypotonic solution be given to a patient?

Patients with increased cranial pressure, burns, trauma, or hypovolemic.

Nursing care for patients with hyperkalemia

Priority is to prevent falls, assessing for cardiac complications, and health teaching -Monitor cardiac rhythm -Monitor I&O -Assess muscle weakness -Monitor blood potassium levels -Give medications to get rid of potassium (loop diuretics like furosemide, albuterol)

Interprofessional care for a patient with hypervolemia may include:

Pulmonology, respiratory therapist

When should a hypertonic solution be used?

They can be infused for patients with hyponatremia or cerebral edema. It pulls sodium back into intravascular system

What is a hypotonic solution?

They have a lower concentration of dissolved solutes than blood. An example of a hypotonic IV solution is 0.45% Normal Saline (0.45% NaCl). When given these, it puts blood into cells to decrease solutes in the blood.

Expected findings for hypokalemia

VS: Decreased BP, weak and thready pulse, orthostatic hypotension, shallow breathing Neuro: Altered mental status, anxiety, lethargy GI: abdominal distention, hypoactive bowels Muscular: Weakness *Can cause dysrhythmias that can lead to cardiac arrest and can cause respiratory failure*

Expected findings for hyperkalemia

VS: Slow and irregular pulse, hypotension Musculoskeletal: Restlessness, irritability, weakness, parasthesia GI: Increased motility, diarrhea, hyperactive bowels, oliguria

What are some expected findings for hyponatremia? (if the patient also has hypovolemia)

Vitals: Tachycardia, rapid and thready pulse, hypotension Musculoskeletal: muscle weakness to the point of possible respiratory compromise, decreased DTRs, GI: nausea, abdominal cramping

Expected findings for hypernatremia

Vitals: hyperthermia, tachycardia, orthostatic hypotension Neuromusculoskeletal: Irritiability, restlessness, muscle twitching, decreased or absent DTRs GI: thirst, dry mucus membranes, vomitting

What is an isotonic solution

a solution that has the same salt concentration as the normal cells of the body and the blood

What is a hypertonic solution?

have a higher concentration of dissolved particles than blood. An example of hypertonic IV solution is 3% Normal Saline (3% NaCl). This solution causes cells to shrink because the fluid moves from the solution to the cell

What is osmosis?

movement of a solvent (like water) through a semipermeable membrane from an area of low concentration to an area of higher concentration

What is diffusion?

movement of particles from an area of high concentration to an area of low concentration.

What is tonicity?

the ability of a surrounding solution to cause a cell to gain or lose water