Foundations Chapter 39: Fluid and Electrolyte Balance
A client who is receiving total parenteral nutrition and lipids asks the nurse why the solution looks like milk. What is the most appropriate nursing response?
"The white milky solution contains lipids or fat to provide extra calories."
bicarbonate
-body's primary buffer system -normal range: 25-29 mEq/L -lost via diarrhea, diuretics, and early renal insufficiency -regulated primarily by kidneys
sodium
-controls and regulates volume of body fluids -affects serum osmolality -normal range: 135-145 mEq/L) -lost from GI tract, kidneys, and skin
extracellular fluid
-fluid outside the cells -30% -Na, Cl, Ca, HCO3 -includes intravascular and interstitial fluids
intracellular fluid
-fluid within cells -70% -K, Ph, Mg
phosphate
-involved in important chemical reactions in the body, cell division, hereditary traits -major ICF anion -role in acid-base balance as a hydrogen buffer -absorption is diminished by concurrent ingestion of calcium, magnesium, and aluminum -eliminated by kidneys -normal range: 2.5-4.5 -regulated by PTH and activated by vitamin D -inversely related to calcium
chloride
-maintains osmotic pressure in blood, produces hydrochloric acid -normal range: 97-107 mEq/L -regulated by aldosterone alongside sodium -low potassium level leads to a low chloride level
magnesium
-metabolism of CHO and proteins -activator of most intracellular enzyme systems -normal range: 1.3-2.3 mEq/dL -lost in urine with use of loop diuretics -regulated by PTH
A physician has asked the nurse to use microdrip tubing to administer a prescribed dosage of IV solution to a client. What is the standard drop factor of microdrip tubing?
60 drops/mL Microdrip tubing, regardless of manufacturer, delivers a standard volume of 60 drops/mL. Macrodrip tubing manufacturers, however, have not been consistent in designing the size of the opening. Therefore, the nurse must read the package label to determine the drop factor (number of drops/mL).
When caring for a client who is on intravenous therapy, the nurse observes that the client has developed redness, warmth, and discomfort along the vein. Which intervention should the nurse perform for this complication?
Apply a warm compress. Prolonged use of the same vein can cause phlebitis; the nurse should apply a warm compress after restarting the IV. The nurse need not elevate the client's head, position the client on the left side, or apply antiseptic and a dressing. The client's head is elevated if the client exhibits symptoms of circulatory overload. The client is positioned on the left side if exhibiting signs of air embolism. The nurse applies antiseptic and a dressing to an IV site in the event of an infection.
A client is taking a diuretic such as furosemide. When implementing client education, what information should be included?
Decreased potassium levels Many diuretics such as furosemide are potassium wasting; hence, potassium levels are measured to detect hypokalemia.
A client is admitted to the facility after experiencing uncontrolled diarrhea for the past several days. The client is exhibiting signs of a fluid volume deficit. When reviewing the client's laboratory test results, which electrolyte imbalance would the nurse most likely find?
Hypokalemia Intestinal secretions contain bicarbonate. For this reason, diarrhea may result in metabolic acidosis due to depletion of base. Intestinal contents also are rich in sodium, chloride, water, and potassium, possibly contributing to an ECF volume deficit and hypokalemia. Sodium and chloride levels would be low, not elevated. Changes in magnesium levels typically would not be associated with diarrhea.
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?
Isotonic Isotonic fluids have an osmolarity of 250-375 mOsm/L, which is the same osmotic pressure as that found within the cell.
During a blood transfusion of a client, the nurse observes the appearance of rash and flushing in the client, although the vital signs are stable. Which intervention should the nurse perform for this client first?
Stop the transfusion immediately. The nurse needs to stop the transfusion immediately. The nurse should prepare to give an antihistamine because these signs and symptoms are indicative of an allergic reaction to the transfusion, infuse saline at a rapid rate, and administer oxygen if the client shows signs of incompatibility.
An infant is brought to the emergency room with dehydration due to vomiting. After several failed attempts to start an IV, the nurse observes a scalp vein. When accessing the scalp vein, the nurse should use a(an)
Winged infusion needle
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?
calcium and phosphorus 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.
variations in fluid content
o Healthy person: total body water is 50% to 60% of body weight o An infant has considerably more body fluid and ECF than an adult; more prone to fluid volume deficits o Gender and amount of fat cells affect body water; women and obese people have less body water
calcium
-nerve impulse, blood clotting, muscle contraction, B12 absorption -normal range: 8.6-10.2 mg/dL -regulated by PTH and calcitonin -high serum phosphate->low serum calcium; low serum phosphate->high serum calcium -lost via feces and urine -most abundant electrolyte
potassium
-regulates osmolality of intracellular fluid -role in transmission of electrical impulses -chief regulator of cellular enzyme activity -regulated by aldosterone -lost via kidneys, stool, sweat, emesis; GI secretions contain K+ in large quantities -normal range: 3.5-5.0 mEq/L
The physician writes an order for intravenous fluids to infuse at 150 mL per hour. If the drop factor of the tubing is 10, at how many drops per minute should the fluid infuse?
25 150 (mL) x 60 (minutes) / 10 (drop factor) = 25 drops per minute
A nurse is required to initiate IV therapy for a client. Which should the nurse consider before starting the IV?
Ensure that the prescribed solution is clear and transparent. Before preparing the solution, the nurse should inspect the container and determine that the solution is clear and transparent, the expiration date has not elapsed, no leaks are apparent, and a separate label is attached. The primary tubing should be approximately 110 inches (2.8 m) long and the secondary tubing should be about 37 inches (94 cm) long. To reduce the potential for infection, IV solutions are replaced every 24 hours even if the total volume has not been completely instilled.
During an assessment of an older adult client, the nurse notes an increase in pulse and respiration rates, and notes that the client has warm skin. The nurse also notes a decrease in the client's blood pressure. Which medical diagnosis may be responsible?
Hypovolemia The nurse should recognize that hypovolemia, also known as dehydration, may be responsible. Additional indicators of dehydration in older adults include mental status changes; increases in pulse and respiration rates; decrease in blood pressure; dark, concentrated urine with a high specific gravity; dry mucous membranes; warm skin; furrowed tongue; low urine output; hardened stools; and elevated hematocrit, hemoglobin, serum sodium, and blood urea nitrogen (BUN). Hypervolemia means a higher-than-normal volume of water in the intravascular fluid compartment and is another example of a fluid imbalance that would manifest itself with different signs and symptoms. Edema develops when excess fluid is distributed to the interstitial space.
An older adult has fluid volume deficit and needs to consume more fluids. Which approach by the nurse demonstrates gerontologic considerations?
Offer small amounts of preferred beverage frequently.