Fluid and Electrolyte - Chapter 13 Med Surg 3rd Semester

The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? Phosphorus Magnesium Potassium Calcium

Magnesium

A patient comes in with a pH of 7.30 and a HCO3 of 20 what does this person have?

Metabolic Acidosis

Which electrolyte is a major cation in body fluid?

Potassium

The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction? "I will not salt my food; instead I'll use salt substitute." "I'll drink cranberry juice with my breakfast instead of coffee." "I need to check to see whether my cola beverage has potassium in it." "Bananas have a lot of potassium in them; I'll stop buying them."

"I will not salt my food; instead I'll use salt substitute."

Three main treatments for Respiratory Acidosis?

- Improve ventilation -Bronchodilators - Antibiotics

S/S of respiratory acidosis

-dyspnea -Flushing warm skin - tachycardia -weakness -hyperkalemia

S/S of Hyperkalemia

-paralysis in extremeties -Increased DTR -Diarrhea -Hyperactive Bowel Sounds -Hypotension -Bradycardia -V FIB -ST elevation and peaked T waves

Which hypotonic solution provides Na, Cl and free water used to treat hypernatremia?

0.33% Normal Saline

A client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? 0.9% NaCl Lactated Ringer solution 5% NaCl 0.45% NaCl

0.45% NaCl

Which hypotonic solution dilutes plasma saline without rapid drop?

0.45% Normal Saline

For hypovolemia, metabolic acidosis and mild hyponatremia it is common to adminiter what type of IV Solution?

0.9% Normal Saline

Which is considered an isotonic solution? 0.9% normal saline Dextran in normal saline 3% NaCl 0.45% normal saline

0.9% normal saline

The weight of a client with congestive heart failure is monitored daily and entered into the medical record. In a 24-hour period, the client's weight increased by 2 lb. How much fluid is this client retaining? 1 L 1250 ml 1500 ml 500 ml

1 L

Mg+ Normals

1.8-3.0

Na+ Normals

135-145

Sodium Normals

135-145 mmol/L

A client weighing 160.2 pounds (72.7 kg), who has been diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the client loses 1,000 mL of fluid in 24 hours. What weight would be consistent with this amount of fluid loss? 156.0 lbs (70.8 kg) 157.0 lbs (71.2 kg) 158.0 lbs (71.7 kg) 159.0 lbs (72.1 kg)

158.0 lbs (71.7 kg) A loss of 0.5 kg, or 1.1 lb, represents a fluid loss of about 500 mL. Therefore, a loss of 1,000 mL would be equivalent to the loss of 2.2 lbs (1 kg), bringing the client's weight to 158.0 lbs (71.7 kg).

Phosperous Normal

2.5-4.5

HCO3 (BICARBONATE) Normal Range

22-25 meq/L

A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? 350-544 mOsm/kg <136 mOsm/kg 275-300 mOsm/kg >408 mOsm/kg

275-300 mOsm/kg

K+ NOrmals

3.5-5.0

What is the normal range for potassium?

3.5-50

pCO2 normal range

35-45 mmHg

Normal Urine Ph

4.5-8

A patient is admitted with a diagnosis of renal failure. The patient complains of "stomach distress" and describes ingesting several antacid tablets over the past 2 days. Blood pressure is 110/70 mm Hg, face is flushed, and the patient is experiencing generalized weakness. Which is the most likely magnesium level associated with the symptoms the patient is having? 2 mEq/L 1 mEq/L 11 mEq/L 5 mEq/L

5 mEq/L MAGNESIUM EXCESS

What is the normal range of blood pH?

7.35-7.45

Ca+ Normals

8.5-10.5

pO2 Lab Normals

80-100mmHg

Normal O2 Saturation

95% or above

Chloride Normals

98-106 mEq/L

Acidosis is characterized by?

A increase in hydrogen ions which causes a decrease in blood pH

Alkalosis is characterized by ?

A decrease in hydrogen ions which cause a increase in blood pH

Fluid and electrolyte balance is maintained through the process of translocation. What specific process allows water to pass through a membrane from a dilute to a more concentrated area? A. osmosis B. filtration C. active transport D. evaporation

A. osmosis

A client with excess fluid volume and hyponatremia is in a comatose state. What are the nursing considerations concerning fluid replacement? Administer small volumes of a hypertonic solution. Correct the sodium deficit rapidly with salt. Restrict fluids and salt for 24 hours. Monitor the serum sodium for changes hourly.

Administer small volumes of a hypertonic solution.

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? A. Tetany and increased blood urea nitrogen (BUN) levels B. Confusion and seizures C. Sunken eyeballs and spasticity D. Flaccidity and thirst

B. Confusion and seizures BC CEREBRAL EDEMA

The emergency department (ED) nurse is caring for a client with a possible acid-base imbalance. The physician has ordered an arterial blood gas (ABG). What is one of the most important indications of an acid-base imbalance that is shown in an ABG? PO2 Carbonic acid PaO2 Bicarbonate

Bicarbonate

What condition do you see respiratory acidosis ?

COPD

A client reports tingling in the fingers as well as feeling depressed. The nurse assesses positive Trousseau's and Chvostek's signs. Which decreased laboratory results does the nurse observe when the client's laboratory work has returned? Calcium Phosphorus Iron Potassium

Calcium

The physician has prescribed 0.9% sodium chloride IV for a hospitalized client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply. Compare ABG findings with previous results. Document presenting signs and symptoms. Administer IV bicarbonate. Maintain intake and output records. Suction the client's airway.

Compare ABG findings with previous results. Document presenting signs and symptoms. Maintain intake and output records.

The nurse is caring for a client with a serum sodium concentration of 113 mEq/L (113 mmol/L). The nurse should monitor the client for the development of which condition? Confusion Nausea Hallucinations Headache

Confusion s/s of hyponatremia-lethargy, confusion, muscle twitching, focal weakness, hemiparesis, papilledema, seizures, and death, may occur.

A priority nursing intervention for a client with hypervolemia involves which of the following? A. Drawing a blood sample for typing and crossmatching. B. Establishing I.V. access with a large-bore catheter. C. Encouraging the client to consume sodium-free fluids. D. Monitoring respiratory status for signs and symptoms of pulmonary complications.

D. Monitoring respiratory status for signs and symptoms of pulmonary complications.

The rapid loss of body weight due to the loss of water or sodium is termed ____________.

Dehydration

The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? Rapid respiration Elevated blood pressure Low heart rate Subnormal temperature

Elevated blood pressure s/s FVE bounding pulse elevated BP

Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration? Low white blood count Low urine specific gravity Abnormal potassium level Elevated hematocrit level

Elevated hematocrit level

Hyperoxia meaning and Range

Excess O2 Over 100mmHg

What most commonly causes Liver Cirrhosis?

Excessive Alcohol Consumption

Polyuria

Excessive Urination

A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following? Metabolic alkalosis Extracellular fluid volume deficit Altered blood urea nitrogen (BUN) value Respiratory acidosis

Extracellular fluid volume deficit

Sunken eyeballs, thirst and increased BUN levels indicate what fluid volume disturbances?

FLUID VOLUME DEFECIT

Which ions are exchanges when O2 and CO2 are exchanged?

HCO3 and Cl

In which of the following medical conditions would administering IV normal saline solution be inappropriate? Select all that apply. Burns Heart failure Renal impairment Severe hemorrhage Pulmonary edema

Heart failure Renal impairment Pulmonary edema

__________ ____________ is the pressure created by the weight of fluid against the wall that contains it.

Hydrostatic Pressure

A solution with an osmolality highter than that of serum is called a ___________ solution.

Hypertonic

What type of solution has a greater osmolality(concentration) then plasma and water moves out of cells and is drawn into Intravascular compartments causing cells to shrink?

Hypertonic Solution

Oral intake is controlled by the thirst center, located in which of the following cerebral areas?

Hypothalamus

A solution with an osmolality lower than that of serum is called a ______________ solution.

Hypotonic

For hypovolemia, burns and fluid loss from a GI source it is common to administer what type of isotonic solution?

Lactated Ringer's Solution

The nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? Pancreas and stomach Lungs and kidney Heart and lungs Kidney and liver

Lungs and kidney

A solution with the same osmolality as serum and other body fluids is called a ___________ solution.

Isotonic

What organ helps keep your bicarbonate levels in balance?

Kidneys

Hypomagnesemia Levels

Less than 1.8

Hypophosphatemia Levels

Less than 2.5

Hypocalcemia Levels

Less than 8.5

What most commonly caused ascites?

Liver Cirrhosis

Hypoxia

Low oxygen saturation of the body, not enough oxygen in the blood Under 80 mmHg

The nurse is caring for a client with severe diarrhea. The nurse recognizes that the client is at risk for developing which acid-base imbalance? Metabolic alkalosis Metabolic acidosis Respiratory acidosis Respiratory alkalosis

Metabolic acidosis Metabolic acidosis is caused by diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes (e.g., lactate).

A patient comes in with a pH of 7.35 and a HCO3 of 22 what do they have?

Nothing, these are normal values

The nurse on a surgical unit is caring for a client recovering from recent surgery with the placement of a nasogastric tube to low continuous suction Which acid-base imbalance is most likely to occur? Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Metabolic alkalosis

Hypercalcemia Levels

More than 10.5

Hypermagnesemia Levels

Over 3.0

Hyperphosphatemia Levels

Over 4.5

Hyperkalemia Ranges

Over 5.0

What two main things are going to increase physiologically in respiratory acidosis?

Potassium and CO2

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? Muscle weakness Presence of Trousseau sign Negative Chvostek sign Slurred speech

Presence of Trousseau sign

In what medical situation would you be administering 5% dextrose?

Replaces electrolytes, supplies fluid calories to the body and vascular volume

A patient comes in with a PH of 7.25 and a PCO2 of 50, what would their diagnosis be?

Respiratory Acidosis

ROME

Respiratory Opposites Metabolic Equal

What are the two ways the the renal system regulates pH?

Secretes Ammonia OR Reabsorbs bicarbonate

A client with nausea, vomiting, and abdominal cramps and distention is admitted to the health care facility. Which test result is most significant? Serum sodium level of 132 mEq/L Serum potassium level of 3 mEq/L Blood urea nitrogen (BUN) level of 29 mg/dl Urine specific gravity of 1.025

Serum potassium level of 3 mEq/L

Oliguria

Small amounts of urine

Hypokalemia Ranges

Under 3.5

A nurse is reviewing a report of a client's routine urinalysis. Which value requires further investigation? Urine pH of 3.0 Absence of protein Specific gravity of 1.02 Absence of glucose

Urine pH of 3.0

An adult client is brought in to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargy. The nurse reconciles the client's medication list and notes that salt tablets had been prescribed. What would the nurse do next? a. Consider sodium restriction with discontinuation of salt tablets. b. Continue to monitor client with another appointment. c. Be prepared to administer a lactated Ringer's IV. d. Be prepared to administer a sodium chloride IV.

a. Consider sodium restriction with discontinuation of salt tablets.

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? a. Instruct the client to breathe into a paper bag. b. Administer ordered supplemental oxygen. c. Offer the client fluids frequently. d. Administer an ordered decongestant.

a. Instruct the client to breathe into a paper bag.

A nurse caring for a patient with metabolic alkalosis knows to assess for the primary, compensatory mechanism of: a. Increased serum HCO3. d. Decreased PaCO2. b. Increased PaCO2. c. Decreased serum HCO3.

b. increased PaCO2 The respiratory system compensates by decreasing ventilation to conserve CO2 and increase the PaCO2.

A nurse is providing client teaching about the body's plasma pH and the client asks the nurse what is the major chemical regulator of plasma pH. What is the best response by the nurse? renin-angiotensin-aldosterone system bicarbonate-carbonic acid buffer system sodium-potassium pump ADH-ANP buffer system

bicarbonate-carbonic acid buffer system

What are the two ways that the respiratory system regulates pH?

blows off more CO2 with increased Respirations OR Slow respirations to retain CO2

A priority nursing intervention for a client with hypervolemia involves which of the following? a. Encouraging the client to consume sodium-free fluids. b. Drawing a blood sample for typing and crossmatching. c. Monitoring respiratory status for signs and symptoms of pulmonary complications. d. Establishing I.V. access with a large-bore catheter.

c. Monitoring respiratory status for signs and symptoms of pulmonary complications.

A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate? a. Metabolic alkalosis b. Respiratory acidosis c. Respiratory alkalosis d. Metabolic acidosis

c. Respiratory alkalosis

What does an increase in hydrogen ions cause to decrease?

decrease in blood pH and thus acidosis

s/s of Hypercalcemia (too much calcium)

deep bone pain constipation anorexia n+v polyuria thirst fractures mental status changes

S/S of Hyperkalemia

diarrhea nausea muscle weakness paresthesias cardiac dysrhythmias

Ascites

edema w/i the peritoneal cavity

S/S OF HYPOKALEMIA

fatigue weakness anorexia nausea + vomitting cardiac dysrhythmias, leg cramps, muscle weakness, paresthesias

A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypertension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance? hypocalcemia hyperkalemia hypokalemia hypercalcemia

hypokalemia

What does a decrease in hydrogen ions cause to increase?

increase in blood pH and thus alkalosis

The __________ assist in acid-base balance by retaining or excreting bicarbonate ions.

kidneys

The _______ regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate.

lungs

The concentration of particles in a solution "pulling power" is referred to as ______________________.

osmolarity

When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis? HCO 21 mEq/L O saturation 95% PaCO 36 pH 7.48

pH 7.48

PCO2 stands for ?

partial pressure of carbon dioxide

s/s of hypocalcemia

tingling in extremities ^ mouth, muscles abdominal cramps

A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching? tingling sensation in the fingers polyuria flank pain hypertension

tingling sensation in the fingers

A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status? vital signs intake and output weight edema

weight