Ch 39: Fluid & Fluid Imbalances

Hormones controlling fluid balance

- Renin-angiotensin - Atrial natriuretic peptide, brain natruretic peptide, c-type natriuretic peptide - Thyroid hormone - ADH - Aldosterone

Diffusion

- similar to osmosis - passive process - Higher concentration to lower concentration - Equilibrium

Upon assessment, the nurse identified a positive Trousseau's sign. What electrolyte is of concern?

Calcium

Hypokalemia

Cardiac arrhythmias Prolonged PR intervals

Clients at risk for hypervolemia

Decreased cardiac output Excessive IV fluid administration Poor kidney functioning Liver failure Excess salt intake

Symptoms of dehydration

Dry skin Thirst Orthostatic hypotension Increased heart rate Decrease urine output Increase B/P

The nurse is caring for a client whose intravenous infusion ran in quickly over a short amount of time, placing the client in fluid overload. What symptoms should the nurse anticipate? Select all that apply.

Elevated blood pressure Increased pulse strength Increased pulse rate

Isotonic Solution

Equal in concentration to blood, NO fluid loss or gain

The nurse is caring for a client with a hypotonic fluid ordered for infusion. What would be the reason for this type of fluid being used? Select all that apply.

Extracellular spaces are swollen. Intracellular space is dry

Locations of fluid loss

Feces Lungs Skin Urine

Hypernatremia

Fluid excess-Edema & HTN Thirst & Oliguria- Fluid deficit

Hyponatremia

Fluid excess/fluid deficit Cell swelling- hypervolemic hypnatremia Hypovolemic hyponatreamia- diarrhea, kidney failure

Clients at risk for hypovolemia

Hiker w/out water supply Vomiting from a viral infection Motor vehicle accident with trauma Uterine rupture during childbirth Significant burns to the body

Vic is in the final stages of cancer with metastatic bone disease. He is weak and constipated with anorexia, nausea, and vomiting. He is very thirsty and urinating often. Which electrolyte imbalance is causing the problem?

Hypercalcemia Causes include hyperparathyroidism, malignant bone disease, prolonged immobilization, excess calcium supplementation, and thiazide diuretics.

Mark has chronic renal failure. He missed dialysis yesterday and today he feels weak with intestinal colic. His ECG shows dysrhythmias with tall T waves. Which electrolyte imbalance is causing the problem?

Hyperkalemia With hyperkalemia, the heart muscle becomes irritable and the client is at risk for ECG abnormalities and dysrhythmias that can lead to cardiac arrest. Causes include renal failure, potassium-sparing diuretics, hypoaldosteronism, acidosis, and major trauma.

The nurse is caring for a client with severe diabetic ketoacidosis. Which electrolyte imbalance will occur as a result of the acidotic state?

Hypermagnesemia

Iliana has been dealing with adrenal insufficiency for 5 years. She has hypotension, feels warm to touch, and is lethargic. Her reflexes are hypoactive.

Hypermagnesemia Causes include renal failure, adrenal insufficiency, and excessive magnesium replacement. The body systems slow down with hypermagnesium, and the patient can experience hypotension, drowsiness, hypoactive reflexes, and depressed respirations.

Kimberly went on a hike with friends on a hot summer day. She did not take adequate amounts of water and is brought to the emergency department with a high fever, dry mouth, sticky mucous membranes, and hallucinations. Which electrolyte imbalance is causing the problem?

Hypernatremia

Christina is on chemotherapy for breast cancer. She is experiencing tetany symptoms with tingling of the extremities. She has been started on aluminum hydroxide with meals. Which electrolyte imbalance is causing the problem?

Hyperphosphatemia High phosphate is the result of renal failure, hyperthyroidism, chemotherapy, and excessive use of phosphate-based laxatives. Many of its symptoms are similar to those of hypocalcemia because they are inverse electrolytes. Aluminum hydroxide is a phosphate binder and removes excess phosphate from the blood.

Anna is recovering from a thyroidectomy in which her parathyroid gland was also removed. She tells the nurse she has muscle cramping as well as numbness and tingling in her fingers and toes. The nurse assesses a positive Chvostek's sign.

Hypocalcemia Calcium is responsible for bone health and neuromuscular and cardiac functions. It is also involved in clotting. When the serum calcium is low, the calcium can leach from the bones to compensate, which weakens them. Reasons for hypocalcemia include hypoparathyroidism, malabsorption, pancreatitis, alkalosis, and vitamin D deficiency as seen in renal failure.

Maddie, an older adult, takes a loop diuretic twice a day for congestive heart failure. She tells her daughter that she's very tired and weak, feels nauseated, and notices heart palpitations. Which electrolyte imbalance is causing the problem?

Hypokalemia Potassium is important for ICF osmolality, cardiac conduction, acid-base balance, and electrical impulse transmission. Causes of hypokalemia include diuretics, GI fluid loss from vomiting, gastric suction or diarrhea, steroid administration, hyperaldosteronism, anorexia, and bulimia. The greatest concern with low potassium is dysthymias that can cause cardiac arrest.

A client with a history of chronic alcoholism is brought to the emergency department after falling. He is disoriented, with periods of calm and disruptiveness. He is having dysrhythmias on the cardiac monitor. What electrolyte imbalance could be causing the problem?

Hypomagnesemia

Eric has been an alcoholic for 10 years. He drinks daily and consumes the majority of his caloric intake this way. He is disoriented, irritable, and showing dysrhythmias on the cardiac monitor. Which electrolyte imbalance is causing the problem?

Hypomagnesemia Low magnesium levels are often a result of chronic alcoholism, malabsorption, diabetic ketoacidosis, and prolonged gastric suctions. The loss of magnesium can cause irritability to the neuromuscular and cardiac systems.

As the nurse is assessing the hypotonic intravenous fluids, he realizes that the rate was not properly regulated and the client received 1,000 mL over 2 hours. What electrolyte imbalance is of greatest concern?

Hyponatremia

James is experiencing water intoxication as a result of psychogenic polydipsia, a condition compelling him to drink excessive amounts of water. He is weak, lethargic, and confused. The nurse is concerned about seizures. Which electrolyte imbalance is causing the problem?

Hyponatremia

Santos has been without food for almost 2 weeks as a result of digestive problems. He has been started on a meal and is eager to clean his plate. After eating, he experiences joint stiffness and paresthesia of the extremities. Which electrolyte imbalance is causing the problem?

Hypophosphatemia Phosphate exists in an inverse relationship with calcium, so in hypophosphatemia, the client will likely have hypercalcemia. Causes of low phosphate include refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, and respiratory acidosis.

Hypertonic Solution

ICF->ECF fluid

Hypervolemia

Increased urine output Elevated fluid pressure Edema

Symptoms of fluid overload

JVD HTN Tachycardia Bounding pulses Tachypnea

Active Transportation

Low concentration to higher concentration. Needs energy (ATP)

Hypotonic Solution

Lower concentration in the blood stream, ECF-> Intracellular (swell)

A client is admitted to the emergency department (ED) in respiratory distress. The arterial blood gases are pH = 7.30; Pco2 = 40; HCO3 = 19 mEq/L. How should the nurse interpret the results?

Metabolic acidosis

A client underwent abdominal surgery and has a nasogastric tube to suction. There has been a large amount of drainage from the nasogastric tube. The client is disoriented to person, place, and time. ABGs show pH 7.57, Paco2 37 mmHg, and HCO3 30 mEq/L. What is the acid-base imbalance?

Metabolic alkalosis, uncompensated

A client is admitted to the emergency department (ED). After treatment, the arterial blood gases are: pH = 7.38; Pco2 = 32; HCO3 = 19 mEq/L. What conclusions can the nurse make from this information?

Metabolic alkalosis; the treatment plan is effective.

Filtration

Movement from higher pressure areas to lower pressure areas

hypercalcemia & hypophosphatemia

Occur with a PTH secreting tumor bone pain & muscle weakness

Which electrolytes are inversely related to each other?

Phosphorous and calcium

The nurse notes an increase in the fluids removed with gastric suctioning. What electrolyte should be monitored more closely as a result?

Potassium

A client is admitted with shortness of breath, pyrexia, and a productive cough with yellow-green sputum. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, Paco2 68, HCO3 28, and Pao2. How would the nurse interpret this?

Respiratory acidosis, partially compensated

A client comes to the hospital after falling. She has tachycardia and is tachypneic. Painkillers were administered to lessen her pain, and 30 minutes later she states that she is still in pain and is now experiencing muscle cramps, tingling, and paresthesia. Arterial blood gas reveals pH 7.6, Paco2 31 mm Hg, and HCO3 25 mmol/L. What is the acid-base imbalance?

Respiratory alkalosis, uncompensated

The nurse receives hand-off report on each of these clients. Who is at the greatest risk for fluid volume excess?

The client with heart failure

Fluid deficit

Thirst poor skin turgor dark urine dry mucous membranes

The nurse is assessing a client after surgery who is dehydrated and experiencing hypotension, tachycardia, and decreased urine output. What additional assessment should the nurse perform?

Tongue & skin turgor

The nurse is concerned about fluid loss for the at-risk client. What should be included in the output measurement? Select all that apply.

Urine Emesis Wound drainage

Hyovolemia

Urine output decreases Release of ADH & Renin - hypotension - tachycardia

Hyperkalemia

Wide QRS complexes, Peaked T waves

Osmoreceptors

activate thirst

Hypomagnesemia

alcoholics

Albumin

attracts water

Fluid Overload

crackles in lungs weight gain edema

ADH

decreases urine output

Hypocalcemia

muscle spasms

Renin

retain water & sodium