Fluid & Electrolyte

Magnesium WNL

1.6-2.5 mg/dL

BUN:Creatinine WNL

10:1

NA+ WNL

135-145

A patient who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue and a body temperature of 99.3°F. The urine specific gravity is 1.020. What is the most likely serum sodium value for this patient?

155 mEq/L

Isotonic Lactated ringers

5% dextrose in 0.2% saline (D5W)

Moderate dehydration in pediatrics

6-9% loss of body weight

Calcium WNL

8.5-10.5 mg/dL

CI- WNL

95-105

Severe dehydration in pediatrics

>10% loss of body weight

GFR (glomerular filtration rate) lab WNL

>60

Hematocrit

% volume of red blood cells

Which of the following arterial blood gas results would be consistent with metabolic alkalosis?

Serum bicarbonate of 28 mEq/L

Conditions that potentiate fluid excess

Cardiac failure, kidney dysfunction, IV fluid, liver disease, extremes in age

Electrolyte

Charged particle when dissolved in water

CO2 WNL

24-32

K+ WNL

3.4-5.0

Serum Albumin WNL

3.5-5

Hypotonic solution

0.45% normal saline

Creatinine WNL

0.6-1.2

Isotonic Normal saline

0.9%

Urine Specific gravity WNL

1.005-1.030

Urine osmolality WNL

250-900 mOsm/Kg

Serum osmolality WNL

275-300 mOm/Kg

A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:

280 mOsm/kg.

Mild dehydration in pediatrics

3-5% loss of body weight

diphenoxylate (Lomotil)

Antidiarrheal

loperamide (Imodium)

Antidiarrheal

ondansetron (Zofran)

Antiemetics (5-HT3 receptor blocker)

prochlorperazine (Compazine)

Antiemetics (phenothiazines)

promethazine (Phenergan)

Antiemetics (phenothiazines)

acetaminophen (Tylenol)

Antipyretics

ibuprofen (Advil/motrin)

Antipyretics

Which of the following are the insensible mechanisms of fluid loss?

Breathing

Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?

Confusion and seizures

Lawrence Wilkins, a 73-year-old male, was admitted to your hospital unit after two days of vomiting and diarrhea. His wife became alarmed when he demonstrated confusion, elevated temperature and reported "dry mouth". From what condition would you suspect Lawrence may be suffering?

Dehydration

Osmosis

Diffusion of water through a selectively permeable membrane

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?

Extracellular fluid volume deficit

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis?

Extreme anxiety

Hypertonic

Having a higher concentration of solute than another solution

Hypotonic

Having a lower concentration of solute than another solution

A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?

Metabolic alkalosis

A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for:

Hyponatremia

Aldosterone does...

It plays a central role in the regulation of blood pressure mainly by acting on the distal tubules and collecting ducts of the nephron, increasing reabsorption of ions and water in the kidney, to cause the conservation of sodium, secretion of potassium, increase in water retention, and increase in blood pressure and blood volume.

Albumin

Major plasma protein produced by the liver

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?

Metabolic acidosis

Diffusion

Movement of molecules from an area of higher concentration to an area of lower concentration.

Anion

Negative ion

Cation

Positive ion

Filtration

Process that occurs in the nephron where nutrients and wastes diffuse from the glomerulus into Bowman's capsule

Brownian motion

Random movement of molecules in body fluid spaces

Excretion

Removal of metabolic wastes

A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?

Respiratory acidosis

A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?

Respiratory alkalosis

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?

Respiratory alkalosis

Oliguria

Small amount of urine

Hydrostatic pressure

The pressure of water against the walls of its container.

Treatment of FVE involves dietary restriction of sodium. Which of the following food choices would be part of a low-sodium diet, mild restriction (2 to 3 g/day)?

Three ounces of light or dark meat chicken, 1 cup of spaghetti and a garden salad

Isotonic

When the concentration of two solutions is the same

Anuria

absence of urine

BUN

blood urea nitrogen

Why do a chest x-ray

checking for fluids, infiltrate, congestion, pulmonary edema

Crystalloids

clear fluids

Role of lungs

excrete carbonic acid (H+ + water = carbon dioxide), fluid loss thru exhalation (insensible loss)

Isotonic solution does

expand circulating extracellular fluid volume

Trans-cellular

fluid in body cavities

Osmolality

fluid measurement inside the body

Osmolarity

fluid measurement outside of the body

Intracellular (ICF)

high potassium level inside cells while keeping sodium low

Extracellular (ECF)

high sodium level outside cells while keeping potassium low

Aldosterone

hormone also helps maintain the blood's pH and electrolyte levels

Impermeable

impenetrable

Sympathetic Nervous system

initial compensatory response to changes in extracellular fluid sensed by volume (Stretch receptors)

Creatinine lab shows

level of renal function

Orthostatic hypotension

low blood pressure that occurs upon standing up

Role of serum proteins

maintain intravascular volume

Hypotonic solution does

moves fluid into cells

Hypertonic solution does

moves fluid out ofcells into extra cellular fluid

Reasons for low Serum Albumin

old age, poor nutrition

Alkalosis

pH above 7.45

Acidosis

pH below 7.35

Intravascular

plasma

Colloids

plasma volume expanders

BUN lab shows

protein metabolism

Oncotic pressure

protein molecules in plasma pull fluid into intravascular space

RAAS

renin-angiotensin-aldosterone system

Antidiuretic hormone

stimulates kidney tubules to retain water.

Role of Albumin

to maintain intravascular volume

BUN:Creatinine above NL

usually indicates hypovolemia