FLUIDS AND ELECTROLYTES ch 40

specific gravity

1.005-1.030 low urine vol and high specific gravity= FVD low urine vol and low specific gravity=renal disease

avg fluid intake/loss

1500-3500mL

ECF percentage of body weight

30%

Used to treat SIADH

5% dextrose in 0.9% NaCl

water composition

50-60%- adult 70-80%-infant 70% ICF 30 % ECF 5% plasma 10-15% interstitial fluid

ICF percentage of body weight

70%

The nursing instructor is discussing fluid and electrolyte balance with a group of students. One of the students asks the instructor how fluids move to maintain homeostasis. The instructor formulates her response based on her knowledge that fluid homeostasis can be maintained by which of the following? Select all that apply. A) osmosis B) filtration C) diffusion D) acid-base balance E) active transport

A) osmosis B) filtration C) diffusion E) active transport Explanation: Osmosis, filtration, diffusion, and active transport maintain fluid homeostasis. Acid-base balance concerns chemical reactions in the body that influence metabolism. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1558.

Magnesium is essential for:

ATP -DNA replication/transcription

A client has been diagnosed with a gastrointestinal bleed and the health care provider has ordered a transfusion. At what rate should the nurse administer the client's packed red blood cells? A) As fast as the client can tolerate B) 1 unit over 2 to 3 hours, no longer than 4 hours C) 75 mL/hr for the first 15 minutes, then 200 mL/hr D) 200 mL/hr

B) 1 unit over 2 to 3 hours, no longer than 4 hours Explanation: Packed red blood cells are administered 1 unit over 2 to 3 hours for no longer than 4 hours. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1623.

potassium food sources

Citrus fruits and dried fruits, Bananas, apricots, peaches, Watermelon, Potatoes, brocolli, Lima beans

A client is admitted to the unit with a diagnosis of intractable vomiting for 3 days. What acid-base imbalance related to the loss of stomach acid does the nurse observe on the arterial blood gas (ABG)? A) Metabolic acidosis B) Respiratory acidosis C) Metabolic alkalosis D) Respiratory alkalosis

Metabolic alkalosis Explanation: Metabolic alkalosis is associated with an excess of HCO3, a decrease in H+ ions, or both, in the extracellular fluid (ECF). This may be the result of excessive acid losses or increased base ingestion or retention. Loss of stomach acid may result in this condition. Metabolic acidosis is a proportionate deficit of bicarbonate in ECF. The deficit can occur as the result of an increase in acid components or an excessive loss of bicarbonate such as in diarrhea. Respiratory acidosis is when the carbon dioxide level is high and the ph is low. Respiratory alkalosis is when the carbon dioxide level is low and the ph is high. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1574.

dark/amber urine

dehydration vomitting diarrhea

osmosis

diffusion of water from low to high conc.

what might you give to a pt with fluid volume excess

diuretic

movement of fluid through capillaries

increased vascular volume = increased capillary filtration

what age group is more susceptible to (FVD)

infants bc they have more total body fluid and ECF than adults (70-80%)

Phosphate food sources

meats, beef, lentils, nuts, grains, beans, pork, dried peas

active transport

move against concentration gradient from area of lesser to greater conc. ex: sodium potassium pump

filtration

move fluid through permeable membrane from high pressure to low pressure

A client has been admitted with fluid volume deficit. Which assessment data would the nurse anticipate? Select all that apply. blood pressure 100/48 mmHg crackles in the lungs distended neck veins poor skin turgor heart rate 128/bpm

poor skin turgor blood pressure 100/48 mmHg heart rate 128/bpm

hypertonic

pulls fluid to vascular space

An intravenous hypertonic solution containing dextrose, proteins, vitamins, and minerals is known as: A) cellular hydration. B) volume expander. C) total parenteral nutrition. D) blood transfusion therapy.

total parenteral nutrition. Explanation: Total parenteral nutrition is a hypertonic solution containing 20% to 50% dextrose, proteins, vitamins, and minerals that is administered into the venous system. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1597.

Function of water

transports substances facilitates metabolism, digestion & elimination maintains temp

plasma

watery plasma/serum portion of blood

used in treating hypernatremia

0.33% NaCl (1/3 strength normal saline) 0.45%NaCl (1/2 strength normal saline) Hypotonic saline or 5% D5W

What commonly used intravenous solution is hypotonic? A) 0.45% NaCl B) 0.9% NaCl C) lactated Ringer's D) 5% dextrose in 0.45% NaCl

0.45% NaCl 0.45% NaCl is hypotonic. Normal saline and lactated Ringer's are isotonic. 5% dextrose in 0.45% NaCl is hypertonic. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1579.

factors influencing homeostasis

1) kidneys selectively retain electrolytes/water and excrete wastes 2) cardiovascular sys pumps nutrients/H2O throughout body 3)lungs regulate O2/CO2 levels of blood (maintain acid-base balance) 4) parathyroid gland secrete parathyroid hormone which regulates ca+ and phosphate

A nurse is assessing the central venous pressure of a client who has a fluid imbalance. Which reading would the nurse interpret as suggesting an ECF volume deficit? A) 3.5 cm H2O B) 5 cm H2O C) 9.5 cm H2O D) 12 cm H2O

3.5 cm H2O Explanation: The normal pressure is approximately 4 to 11 cm H2O. An increase in the pressure, such as a reading of 12 cm H2O may indicate an ECF volume excess or heart failure. A decrease in pressure, such as 3.5 cm H2O, may indicate an ECF volume deficit. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1559.

A client's intake and output is being measured and recorded each shift. The client has had the following intake: 3 oz apple juice 4 oz tea 5 oz pureed chicken 2 oz mashed potatoes 4 oz orange gelatin 2 oz vanilla ice cream What amount would the nurse document as fluid on the intake sheet?

390mL

Which client is at a greater risk for fluid volume deficit related to the loss of total body fluid and extracellular fluid? A) an infant age 4 months B) an adolescent age 17 years C) a woman age 45 years D) a man age 50 years

An infant has considerably more total body fluid and extracellular fluid (ECF) than does an adult. Because ECF is more easily lost from the body than intracellular fluid, infants are more prone to fluid volume deficits. An adolescent at 17 years is considered to have an adultlike body system similar to the 45-and 50-year-old. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1556.

A nurse is caring for an older adult client who is scheduled for a cystoscopy the next day to determine the cause of an overdistended bladder. The client expresses being nervous and informs the nurse that this the first time that the client has been admitted to a health care facility for an illness. Which diagnostic label would the nurse use to formulate the nursing diagnosis? A) Anxiety B) Compromised C) Physical immobility D) Overdistention

Anxiety Explanation: Anxiety is an accurate diagnostic label, the name of the nursing diagnosis as listed in the taxonomy. It is also the only option related to the client's experience to the new experience of being hospitalized. Compromised is a descriptor; physical immobility is a risk factor; overdistension is a related factor. Reference: Chapter 15: Diagnosing, p. 371.

The nurse is caring for a client with severe edema. Which intervention will the nurse choose to restore fluid balance? Select all that apply. Increase oral intake to flush excess fluids. Ask provider to order a low-salt diet. Administer furosemide as ordered. Reduce infusing fluid volume as ordered. Treat the underlying condition that contributes to increased fluid volume.

Ask provider to order a low-salt diet. Administer furosemide as ordered. Reduce infusing fluid volume as ordered. Treat the underlying condition that contributes to increased fluid volume. Explanation: Control of edema, and thus restoration of fluid balance, can be accomplished by treating the disorder contributing to the increased fluid volume, restricting or limiting oral fluids, reducing salt consumption, discontinuing IV fluid infusions or reducing the infusing volume, and/or administering drugs that promote urine elimination. Increasing oral intake to flush excess fluids is not an appropriate intervention. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1556.

Which symptom will have a great impact on the extracellular fluid for water conservation? A) Burns B) Fracture C) Small laceration D) Pain

Burns Explanation: The water saving, to regulate the concentration of solutes in the ECF, results in decreased urine output. Increased loss of body fluids can occur with vomiting, diarrhea, excessive diaphoresis secondary to fever or exercise, excessive wound drainage, extensive burns, or blood loss from trauma or surgery. Reference: Chapter 37: Urinary Elimination, p. 1348.

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: A) allergic reaction. B) pulmonary embolism. C) fluid overload. D) anaphylaxis.

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. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1590.

A nurse is reviewing the client's serum electrolyte levels which are as follows: Sodium: 138 mEq/L (138 mmol/L) Potassium: 3.2 mEq/L (3.2 mmol/L) Calcium: 10.0 mg/dL (2.5 mmol/L) Magnesium: 2.0 mEq/L (1.0 mmol/L) Chloride: 100 mEq/L (100 mmol/L) Phosphate: 5.75 mg/dL (1.8 mEq/L) Based on these levels, the nurse would identify which imbalance?

Hypokalemia

The nurse is caring for a client, who was admitted after falling from a ladder. The client has a brain injury which is causing the pressure inside the skull to increase that may result in a lack of circulation and possible death to brain cells. Considering this information, which intravenous solution would be most appropriate?

You Selected: hypertonic Correct response: hypertonic Explanation: Because a hypertonic solution has a greater osmolarity, water moves out of the cells and is drawn into the intravascular compartment, causing the cells to shrink. Because of a lower osmolarity, a hypotonic solution in the intravascular space moves out of the intravascular space and into intracellular fluid, causing cells to swell and possibly burst. An isotonic fluid remains in the intravascular compartment. Plasma is an isotonic solution.

Which two electrolytes have an inverse relationship?

calcium and phosphate

Extracellular electrolytes

chloride and sodium "Na+ I dont need any EXTRA CLothes"

interstitial edema

colloidal osmotic pressure

Hypovolemia (FVD)

dry mucous membranes poor skin turgor increase pulse warm skin decrease BP sunken eyes - loss of ECF volume exceeds the intake of fluid; water and electrolytes are lost in the same proportion as they exist in normal body fluids (isotonic fluid loss) infants more susceptible bc they have more total body fluid and ECF than adults

Magnesium food sources

fish, nuts, veggies, whole grain, peas, beans

phlebitis

inflammation of a vein

Which solution is a crystalloid solution that has the same osmotic pressure as that found within the cells of the body and is used to expand the intravascular volume? A) hypertonic B) colloid C) isotonic D) hypotonic

isotonic Isotonic fluids have an osmolarity of 250-375 mOsm/L, which is the same osmotic pressure as that found within the cell. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1564.

What might decreased hematocrit signify?

late stage kidney disease

purpose of intracellular fluid

maintains cell size

diffusion

move from area of greater to lesser concentration O2 and CO2 exchange in lungs

sodium food sources

pork, condiments, processed cheese, bread, cereal, snack foods, canned/frozen items

Intracellular electrolytes

potassium, magnesium, phosphate "K+ Meg def Puts Out"

what patient would need a total parenteral route

pt w/ severe pancreatitis bloody diarrhea major trauma/burn client with IBS renal failure

thrombus

red/warm tender, edema

infiltration

swelling/pallor along IV site may be cold, puffy & painful fluid escapes to tissue

chloride food sources

table salt

what might you give to a pt with hypovolemia, metabolic alkalosis, mild Hyponatremia, or hypocalcemia

0.9% NaCL (normal saline)

Hyponatremia

<135 NEUROLOGIC diseases caused by SIADH!! s/s SEIZURES!!! tachycardia, weak/thready pulses respiratory arrest + Edema Anorexia N/V Cramps

Mr. Jones is admitted to the nurse's unit from the emergency department with a diagnosis of hypocalcemia. His laboratory results show a serum calcium level of 8.2 mg/dL (2.05 mmol/L). For what assessment findings will the nurse be looking? A) muscle cramping and tetany B) nausea, vomiting, and constipation C) diminished cognitive ability and hypertension D) muscle weakness, fatigue, and constipation

A) muscle cramping and tetany

A client has been receiving intravenous normal saline at a rate of 125 mL/hour since her surgery 2 days earlier. As a result, she has developed an increase in vascular volume and edema. Which of the following phenomena accounts for this client's edema? Obstruction of lymph flow Increased capillary permeability Decreased capillary colloidal osmotic pressure Increased capillary filtration pressure

Increased capillary filtration pressure Feedback: An increase in vascular volume results in an increase in capillary filtration pressure. Consequently, movement of vascular fluid into the interstitial spaces increases and edema ensues. An increase in vascular volume does not directly result in obstruction of lymph flow, increased capillary permeability, or decreased capillary colloidal osmotic pressure.

what is used to treat hypovolemia, BURNS, and fluid lost from GI sources

Lactated ringers solution

How is control over the extracellular concentration of potassium within the human body is exerted? A) aldosterone. B) albumin. C) progesterone. D) testosterone.

aldosterone. Explanation: Aldosterone exerts major control over the extracellular concentration of potassium. It also enhances renal secretion of potassium. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1560.

Hypervolemia (FVE)

caused by: CHF/renal failure crackles in lungs edema increased bp distended neck veins

amt of fluid lost from GI

~300mL

transcellular

3rd spacing, traps ECF -cerebrospinal fluid -GI tract -Pleural space -synovial space -peritoneal fluid space ex: alc. abuse, distended abdomen due to fluid accumulation in PERITONEAL cavity (ascites)

hypomagnesemia

<1.5 caused by diarrhea, burns, NG suctioning s/s increased HR, RR, BP TORSADES DE POINTES Nystagmus Hyperactive DTR (+4) mental status changes ex: pt w/ mg level 0.8 highest priority= remain A/Ox3 & no confusion/ seizure activity.

hyphosphatemia

<2.5 INVERSE OF HYPERCALCEMIA can be caused by alcohol withdrawal s/s constopation kidney stones bone pain decreased DTR muscle weakness confusion cardiac arrhytmia

Hypokalemia

<3.5 CARDIAC cardiac dysrhythmia muscle weakness fatigue increased BP, HR, DTR constipation s/s Muscle weakness/ cramps skeletal problems

Hypocalcemia

<8.6 can be caused by surgical hypoparathyroidism s/s CHVOSTEK/ TROUSSEAU diarrhea CIRCUM ORAL TINGLING - increased bone fracture, bleeding, dysrhythmia tetany/seizures*** maintain airway latency ex: chronic renal failure w. ca+ serum @ 7.9 - watch out for numb-mouth and spasms

hypochloremia

<97 cause by burns, K+ deficiency, GI loss: vomitting/diarrhea same as hyponatremia s/s SEIZURE resp. arrest irritability hyper excitability dysrhythmia

Hypercalcemia

>10.2 can be caused by hyperparathyroidism s/s muscle weakness tired/lethargic kidney stones (renal calculi) constipation SOFT BONES (chronic) bone pain decreased DTR ex: ca+ serum= 14.2 and pt has hyperparathyroid disease what is the primary nursing intervention: SAFETY & FALL PRECAUTIONS

hyperchloremia

>107 caused by hypernatremia, head injury s/s edema RED SWOLLEN TONGUE lethargy, weakness, tachypnea, hypertension, dysrhythmia

Hypernatremia

>145 s/s RED/DRY SWOLLEN TONGUE N/V increased muscle tone Dry, sticky mucous membrane CNS: restless/confused

Hypermagnesemia

>2.5 caused by renal failure s/s decreased DTR, RR, HR, BP constipation

Hyperphosphatemia

>4.5 INVERSE OF HYPOCALCEMIA caused by Hyperthyroidism s/s CHVOSTEK/ TROUSSEU diarrhea CIRCUM ORAL TINGLING increased bone fracture, risk for bleeding and dysrhythmias tetany tachycardia

Hyperkalemia

>5 CARDIAC can be caused by renal failure s/s muscle weakness/ paralysis arrhythmias DECREASED BP, HR, DTR diarrhea (prolonged PR/ vent. fib)

Mr. Jones is admitted to the nursing unit from the emergency department with a diagnosis of hypokalemia. His laboratory results show a serum potassium of 3.2 mEq/L (3.2 mmol/L). For what manifestations should the nurse be alert? A) Muscle weakness, fatigue, and dysrhythmias B) Nausea, vomiting, and constipation C) Diminished cognitive ability and hypertension D) Muscle weakness, fatigue, and constipation

A) Muscle weakness, fatigue, and dysrhythmias *HEART IS MOST IMPORTANT!!!! Explanation: Typical signs of hypokalemia include muscle weakness and leg cramps, fatigue, paresthesias, and dysrhythmias. Manifestations of hypercalcemia include nausea, vomiting, constipation, bone pain, excessive urination, thirst, confusion, lethargy, and slurred speech. Diminished cognitive ability and hypertension may result from hyperchloremia. Constipation is a sign of hypercalcemia. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1566.

A client who is NPO prior to surgery reports feeling thirsty. What is the physiologic process that drives the thirst factor? A) decreased blood volume and intracellular dehydration B) increased blood volume and intracellular dehydration C) increased blood volume and extracellular overhydration D) decreased blood volume and extracellular overhydration

A) decreased blood volume and intracellular dehydration Explanation: Located within the hypothalamus, the thirst control center is stimulated by intracellular dehydration and decreased blood volume. When a client does not drink, the body begins intracellular dehydration and the client becomes thirsty. There is no extracellular dehydration. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1556.

A home care nurse is visiting a client with renal failure who is on fluid restriction. The client tells the nurse, "I get thirsty very often. What might help?" What would the nurse include as a suggestion for this client? A) Avoid salty or excessively sweet fluids. B) Use regular gum and hard candy. C) Eat crackers and bread. D) Use an alcohol-based mouthwash to moisten your mouth.

Avoid salty or excessively sweet fluids. Explanation: To minimize thirst in a client on fluid restriction, the nurse should suggest the avoidance of salty or excessively sweet fluids. Gum and hard candy may temporarily relieve thirst by drawing fluid into the oral cavity because the sugar content increases oral tonicity. Fifteen to 30 minutes later, however, oral membranes may be even drier than before. Dry foods, such as crackers and bread, may increase the client's feeling of thirst. Allowing the client to rinse the mouth frequently may decrease thirst, but this should be done with water, not alcohol-based, mouthwashes, which would have a drying effect. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1578.

The nurse is caring for a client with "hyperkalemia related to decreased renal excretion secondary to potassium-conserving diuretic therapy." What is an appropriate expected outcome? A) Bowel motility will be restored within 24 hours after beginning supplemental K+. B) ECG will show no cardiac dysrhythmias within 48 hours after removing salt substitutes, coffee, tea, and other K+-rich foods from diet. C) ECG will show no cardiac dysrhythmias within 24 hours after beginning supplemental K+. D) Bowel motility will be restored within 24 hours after eliminating salt substitutes, coffee, tea, and other K+-rich foods from the diet.

B) ECG will show no cardiac dysrhythmias within 48 hours after removing salt substitutes, coffee, tea, and other K+-rich foods from diet. Explanation: If the client is taking a potassium-conserving diuretic, he must be mindful of the amount of potassium he is ingesting because the potassium level is more likely to elevate above normal. Cardiac dysrhythmias may result if hyperkalemia occurs. Supplemental potassium should not be added to the client's intake. Potassium does not have a direct impact on bowel motility. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, pp. 1565-1566.

A nurse who has diagnosed a client as having "fluid volume excess" related to compromised regulatory mechanism (kidneys) may have been alerted by what symptom? A) muscle twitching B) distended neck veins C) fingerprinting over sternum D) nausea and vomiting

B) distended neck veins Fluid volume excess causes the heart and lungs to work harder, leading to the veins in the neck becoming distended. Muscle twitching, and nausea and vomiting may signify electrolyte imbalances. The sternum is not an area assessed during fluid volume excess. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1564.

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? A) calcium and phosphorus B) potassium and sodium C) chloride and magnesium D) potassium and chloride

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. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1560.

A nurse is caring for a client admitted to the hospital for dehydration. The physical findings consistent with this diagnosis that the client's general appearance can nonverbally communicate to the nurse include: A) easy wrinkling of the skin and sunken eyes. B) slow heart rate and prolonged capillary refill. C) pallor and diaphoresis. D) cold intolerance and brittle nails.

easy wrinkling of the skin and sunken eyes. Explanation: Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone. On the other hand, a person in good health tends to radiate this healthy status through general appearance. Although prolonged capillary refill is consistent with dehydration, slow heart rate is not. Pallor may be associated with dehydration but diaphoresis is not associated with this condition. Cold intolerance and brittle nails are consistent physiologic changes seen in clients with hypothyroidism. Reference: Chapter 8: Communication, p. 153.

When the nurse reviews the client's laboratory reports revealing sodium, 140 mEq/L (140 mmol/L); potassium, 4.1 mEq/L (4.1 mmol/L); calcium 7.9 mg/dL (1.975 mmol/L), and magnesium 1.9 mg/dL (0.781 mmol/L); the nurse should notify the physician of the client's: A) low potassium. B) low calcium. C) high sodium. D) high magnesium.

low calcium. Explanation: Normal total serum calcium levels range between 8.9 and 10.1 mg/dL (2.225 to 2.525 mmol/L). Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1559.

Calcium food sources

milk, dairy, dark/leafy greens & veggies, canned salmon, dried beans

The nurse writes a nursing diagnosis of "Fluid Volume: Excess." for a client. What risk factor would the nurse assess in this client? A) excessive use of laxatives B) diaphoresis C) renal failure D) increased cardiac output

renal failure Explanation: Excess fluid volume may result from increased fluid intake or from decreased excretion, such as occurs with progressive renal disease. Excessive use of laxatives, diaphoresis, and increased cardiac output may lead to a fluid volume deficit. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1564.

A decrease in arterial blood pressure will result in the release of: A) protein. B) thrombus. C) renin. D) insulin.

renin. Explanation: Decreased arterial blood pressure, decreased renal blood flow, increased sympathetic nerve activity, and/or low-salt diet can stimulate renin release. Reference: Chapter 40: Fluid, Electrolyte, and Acid-Base Balance, p. 1559.