Fluid & Electrolytes - Exam 3 C&P

Potassium

-3.5-5.0 mEq/L- Heart Functioning- ICF Cation- Regulated by Kidneys- Skeletal and Cardiac Muscles

Hypervolemic Management

-Daily Weights I & O Sodium and Fluid Restrictions- Protect Edematous Skin (Stretching)- Avoid Prolonged Standing (Fluid Flows to Bottom)-Mobilized Fluid to Excrete (Walking Recommended)

Hypervolemia

-Fluid Volume Excess-Intravascular (IN BLOOD STREAM) Volume Overload-CAUSES: Heart Failure, Too much IV Fluid, Renal Failure, Fluid Shift MANIFEST: Weight Gain, Edema, Ascites, Shortness of Breath, Elevated BP, Bounding Pulse, Increase RR, Decreased Serum and Urine Osmolality

Which statement most accurately describes the process of osmosis? 1) Water moves from an area of lower solute concentration to an area of higher solute concentration. 2) Solutes pass through semipermeable membranes to areas of lower concentration. 3) Water shifts from high-solute areas to areas of lower solute concentration. 4) Plasma proteins facilitate the reabsorption of fluids into the capillaries.

1) Water moves from an area of lower solute concentration to an area of higher solute concentration. Explanation: Osmosis is the primary method of transporting body fluids, in which water moves from an area of lesser solute concentration and more water to an area of greater solute concentration and less water. Solutes do not move during osmosis. Plasma proteins do not facilitate the reabsorption of fluid into the capillaries, but assist with colloid osmotic pressure, which is related to, but not synonymous with, the process of osmosis.

Magnesium

1.5-2.1 mEq/L-50-60% Contained in Bone- Regulated by Kidneys and GI Absorption

The nurse is caring for a male client who has a diagnosis of heart failure. Today's laboratory results show a serum potassium of 3.2 mEq/L (3,2 mmol/L). For what complications should the nurse be aware, related to the potassium level? 1) Fluid volume excess 2) Pulmonary embolus 3) Cardiac dysrhythmias 4) Tetany

3) Cardiac dysrhythmias Explanation: Typical signs of hypokalemia include muscle weakness and leg cramps, fatigue, paresthesias, and dysrhythmias. Pulmonary emboli and fluid volume excess are not related to a low potassium level. Tetany can be a result of low calcium or high phosphorus but is not related to potassium levels.

Calcium

8.5-10 mg/dL- 40% is bound to plasma protein (ALBUMIN)- 50% is free (ionized), responsible for cellular functioning

Hypocalcemia (Causes & Manifestations)

Causes: Increased Serum Phosphorus Effects: Numbness, Seizures, Chvostek's and Trousseau's Sign, Carpopedal Spasm, Decreased BP

Fluid Volume Excess Test Results

Hemodilution-Decreased HGB-Decreases Potassium-Decreased HCT-Decreased Urine Specific Gravity

Treatment of Hyperkalemia

Monitor Cardiac Status Limit Potassium Intake (Supplements/Medications)-Increase Elimination of Potassium (Kayexalate)-Administer Calcium Gluconate-IV Insulin (Moves in Glucose which has a Piggyback of Potassium)

Calcium Key Role

Musculoskeletal and Cardiovascular Status

Calcium Regulation

Parathyroid Glands (hypocalcemia)- Increases Calcium- Increases Renal Re-absorption- Increases Ca Re-absorption Thyroid Glands (hypocalcemia)- Calcitonin: Lowers the Ca level in the blood

Tetany

The most characteristic manifestation of HYPOcalcemia HYPOmagnesemia

Physiology of Potassium

Transmission & Conduction of Nerve & Muscle Impulses Cellular Growth-Maintenance of Cardiac Rhythms- Acid-Base Balance

Decreased Protein Intake-> Increased Protein Loss->

Weight loss, Delayed healing, Repeated infections, Fatigue, Muscle Loss

Gerontologic Considerations

-Structure Changes in Kidneys- Hormonal Changes (Estrogen)- Loss of Subcutaneous Tissue- Reduced Thirst Mechanism (Impaired)- Functional- Access (Health)

A client with a diagnosis of colon cancer has opted for a treatment plan that will include several rounds of chemotherapy. What vascular access device is most likely to meet this client's needs? 1) An implanted central venous access device (CVAD) 2) A peripheral venous catheter inserted to the antecubital fossa 3) A peripheral venous catheter inserted to the cephalic vein 4) A midline peripheral catheter

1) An implanted central venous access device (CVAD) Explanation: Implanted CVADs are ideal for long-term uses such as chemotherapy. The short-term nature of peripheral IVs, and the fact that they are sited in small-diameter vessels, makes them inappropriate for the administration of chemotherapy. Because of the caustic nature of most chemotherapy agents, peripheral IV's are not appropriate.

The nurse is caring for a client who had a parathyroidectomy. Upon evaluation of the client's laboratory studies, the nurse would expect to see imbalances in which electrolytes related to the removal of the parathyroid gland? 1) calcium and phosphorus 2) potassium and sodium 3) chloride and magnesium 4) potassium and chloride

1) calcium and phosphorus Explanation: The parathyroid gland secretes parathyroid hormone, which regulates the level of calcium and phosphorus. Removal of the parathyroid gland will cause calcium and phosphorus imbalances. Sodium, chloride, and potassium are regulated by the kidneys and affected by fluid balance.

Calcium Function

1. Nerve Impulse Regulation 2. Myocardial Contractions (Strengthen) 3. Blood Clotting 4. Formation of Teeth and Bone 5. Muscle Contractions 6. Acts Directly on Myoneural Junction

Which client would be a candidate for total parenteral nutrition? 1) a client with diabetic ketoacidosis 2) a postoperative appendectomy client 3) a client with colitis and bloody diarrhea 4) a client receiving intravenous antibiotics

3) a client with colitis and bloody diarrhea Explanation: Total parenteral nutrition is indicated when there is interference with nutrient absorption from the gastrointestinal tract or when complete bowel rest is necessary for healing. A client with bloody diarrhea and colitis requires complete bowel rest.

When an older adult client receiving a blood transfusion presents with an elevated blood pressure, distended neck veins, and shortness of breath, the client is most likely experiencing: 1) allergic reaction. 2) pulmonary embolism. 3) fluid overload. 4) anaphylaxis.

3) fluid overload. Explanation: Fluid overload can occur when blood components are infused too quickly or too voluminously. Symptoms include increased venous pressure, distended neck veins, dyspnea, coughing, and abnormal breath sounds.

A client loses consciousness after strenuous exercise and needs to be admitted to a health care facility. The client is diagnosed with dehydration. The nurse knows that the client needs restoration of: 1) interstitial fluid. 2) nonelectrolytes.electrolytes. 3) colloid solution. 4) electrolytes.

4) electrolytes. Explanation: The nurse knows that the client's electrolytes need to be restored. Rehydration after exercise can only be achieved if the electrolytes lost in sweat, as well as the lost water, are replaced. The client does not need to have nonelectrolytes, colloid solution, or interstitial fluid restored. Nonelectrolytes are chemical compounds that remain bound together when dissolved in a solution. Interstitial fluid is the fluid in the tissue space between and around cells. Colloids are substances that do not dissolve into a true solution and do not pass through a semipermeable membrane.

Potassium Key Role

Cardiac Status

Hyperkalemia (Causes & Manifestations)

Causes: Oliguric Renal Failure, Potassium Diuretic, Salt Substitutes (Potassium Chloride) Effects: EKG Changes (abnormal heart rhythms or arrhythmia)

Best Indicator of Fluid Balance

Daily Weight (BEST indicator)- I&O Trends- BP and Pulse - Orthostatic hypotension

Physiology of Sodium

ECF Volume and Concentration- Generation and Transmission OF Nerve Impulses- Acid-Base Balance

Hypercalcemia (Manifestations)

Effect: Pathologic Fractures, Calcium Stones, Hypertension

Calcium Dislikes...

Phosphorus* If one is increased, the other decreases.

Homeostatic Mechanisms

Renal Regulations- Hypothalamic/ Pituitary Regulation- Adrenal Cortical (RAAS) Regulation