NRS 326 Exam 3 Fluid and Electrolytes

why would you give 0.9% normal saline

for patients in a hypotensive and hypovolemic states, these patients just need fluids/volume and do not need any fluid shifts

why would you give 1/2 normal saline

for patients with dehydration or hypernatremia, these patients need fluid to move into the vasculature from the tissues

why would you give 3% normal saline

for patients with elevated intracranial pressure, these patients need fluid to be pulled out of the tissues (specifically the brain) and into the vasculature

You are providing education to a client with a new diagnosis of heart failure who is newly prescribed Furosemide (Lasix). Which of the following patient statements demonstrates a need for further teaching about Furosemide?

"I should buy a scale and take my weight every other day" -patient needs to take weights DAILY because this is a potassium-wasting diuretic and a 2-3 lbs or more weight loss can indicate FVE

A nurse is teaching a client about the importance of increasing fluids when experiencing the early stages of dehydration. Which statement by the client would express understanding?

"I should drink more water when I feel thirsty or becoming irritable"

A patient is newly diagnosed with heart failure and has been educated about limiting their salt intake and having to make changes to their diet. Which of the following statements made by the patient indicates the need for further teaching?

"I will only need to cut out table salt to decrease my salt intake." -Although cutting out table salt is beneficial at decreasing how much salt intake a person has, many canned, processed, packaged foods have excessive salt added

Which of the following statements by a new nurse indicates further teaching regarding blood transfusions is required?

"Most reactions to blood transfusions will occur between 12-24 hours after the transfusion finishes." -The majority of transfusion reactions occur during or right after a transfusion - not later on.

hypertonic solutions

-3% NaCl -Dextrose 5% in 0.45% or half-strength NaCl (normal saline). -Dextrose 5% in 0.9% NaCl (normal saline). -Dextrose 5% in Lactated Ringer's.

causes of hypocalcemia

-Hypoparathyroidism -Malabsorption syndrome -Deficient serum albumin -Increased serum pH level -Renal failure

why are younger people at risk for fluid and electrolyte imbalances

-Inefficient kidneys -Body surface area = large -Increase in metabolism -Increased insensible fluid loss

types of transfusion reactions

-Simple: Hypersensitivity type 2 -Hemolytic: may lead to renal failure and organ damage (most severe)

why would we give loop diuretics

-first line for edema, including pulmonary edema -second line for hypertension

implementation/patient teaching for thiazide diuretics

-if taking insulin concurrently, may need to adjust dose as it lowers blood potassium by pulling it into cells -medication interactions: digoxin, lithium, NSAIDs, meds that lower BP

implementation/patient teaching for potassium-sparing diuretics

-if taking insulin concurrently, may need to adjust dose as it lowers blood potassium by pulling it into cells -monitor for symptoms of hyperkalemia

implementation for blood transfusions

-only 0.9% normal saline can run with blood products -TWO RNs need to check blood prior to admin and wait at least 15 mins observing for rxn -if transfusion rxn occurs, stop transfusion and notify physician, then change IV tubing, then treat symptoms

symptoms of hypermagnesmia

-relaxes muscles- poor reflexes (remember when you're hyper you can act too rashly and have poor reflexes- hypermagnesmia- poor magnification of reflexes) -vasodilation and hypotension, opposite of other hyper disorders

foods high in sodium

-sports drinks -frozen foods -processed foods -canned foods -lunch meat/cured meats

why would we give potassium-sparing diuretics

-to counteract potassium loss from other diuretics, treat edema associated w heart failure, and treat ascites associated with liver failure -Second-line for hypertension

A nurse is assigned a new patient with cerebral edema and is reviewing the patient's orders. Which of the following orders do you anticipate the nurse would question?

0.45% NaCl solution, contraindication for people with cerebral edema since it causes edema

how much calcium is found in blood serum

1%

interventions for fluid volume overload and pulmonary edema

1. stop infusion and notify provider 2. reposition patient with legs elevated 3. have patient turn, cough, and deep breathe 4. assess vitals

what should the nurse do if a transfusion reaction occurs

1. stop transfusion and notify physician 2. change IV tubing 3. treat symptoms

normal magnesium levels

1.8-2.6 mq/L

normal hemoglobin

12-17.4 g/dL

normal sodium levels

135-145 mEq/L

which part of kidney do thiazide diuretics affect

1st part

what part of the kidney do loop diuretics affect

2nd part

normal albumin levels

3.4-5.4 g/dL

normal potassium levels

3.5-5.2 mEq/L

normal RBC count

3.6-5.4 x 10^6 / µL

normal hematocrit

36-48%

which part of the kidney do potassium sparing diuretics affect

3rd part

normal calcium levels

8.2-10.2 mg/dL

Which patient is most at risk for a fluid and electrolyte imbalance based on the assessment data/background history that the nurse collected?

A 45-year-old patient that is on prednisone following a liver transplant- prednisone is a corticosteroid, which can hypernatremia and hypokalemia bc it causes aldosterone levels to increase

Which blood type is the universal recipient?

AB+

which fluid/electrolyte imbalance does alcoholism cause

Beer potomania, severe hyponatremia (remember that alcohol makes you slow, think slow for hippo- hyponatremia), happens slowly

A nurse is administering a packed RBC transfusion to a 60-year-old female patient with type B+ blood. Which of the following blood types would the nurse question transfusing into this patient?

B+ can receive blood from B+, B-, O+, and O-, so therefore the nurse would question giving AB+

which foods have high potassium

Banana Leafy greens- broccoli White potatoes, sweet potatoes Citrus Avocados

Which of the following statements regarding dietary teaching is accurate (Select all that apply)

Banana's are a source of potassium Grains are source of magnesium

symptoms of hypocalcemia

Ca2+ levels below 8.2, increased muscle reflexes, tetany, numbness and tingling, bradycardia and hypotension, brittle bone, and positive chvostek and trousseau's sign (remember HYPO for slow heart and low BP)

which meds effect potassium

Digoxin- if k too low, can cause dig toxicity ACEs/ARBs- hyperkalemia Corticosteroids- hypokalemia Sulfonamides Amphotericin B Amiodarone Insulin- hypokalemia

what do we need to monitor for when administering sodium polystyrene sulfonate

GI output and potassium level, continuous cardiac monitoring

adverse effects of diuretics

Gets rid of fluid and sometimes electrolytes Can lead to hypokalemia- loop diuretics Can cause hyperkalemia- spironolactone

what are the names of thiazide diuretics

HCTZ- hydrochlorothiazide, ends with THIAZIDE

The nurse is reviewing a patients complete blood count (CBC) following the administration of 2 units packed red blood cells. The nurse anticipates which values will have changed as a a result of that administration:

Hgb, Hct, RBC count

what do you need to assess when giving IV fluids

I & O daily weights ambulation LOC skin turgor edema BP, HR, lung and cardiac assessment

why are older people at risk for fluid and electrolyte imbalances

Inefficient kidney - lower urine concentration Lower thirst drive Higher risk for chronic conditions- heart failure -Increased chance of taking meds

You are preparing to administer Spironolactone for a client with acute exacerbations of HF. Which of the following assessment findings would cause you to HOLD the dose?

K+ level of 5.5 because spironolactone retains K+, they are already in hyperkalemia

what are loop diuretics usually given with

K+ supplement bc they are potassium-wasting

what should you assess when administering any type of diuretic

Labs- potassium, BP, HR, daily weight

Which of the following nursing actions are appropriate for a patient experiencing a post-partum hemorrhage (Select all that apply)

Lay the patient down Massage the fundus Administer Packed Red Blood Cells

Which blood type is the universal donor?

O-

how is sodium polystyrene sulfonate administered

PO or RR

Which breakfast diet would you recommend to a patient that has magnesium levels of 1.3?

Peanut butter whole grain toast and oatmeal with almonds

adverse effects corticosteroids

Sodium retention, water retention Hypokalemia

possible treatments for someone with fluid overload from isotonic IV fluids

albumin hypertonic solution diuretic non-invasive treatments: ambulate, elevate legs, low sodium diet, compression stockings

signs of dehydration

Thirst Irritable Dry mucous membranes Skin tenting Oliguria- low urine output (normal is at LEAST 30 mL/hour) Specific gravity of urine increases- increased concentration- YELLOW Orthostasic hypotension/orthostasis- lightheadedness upon standing

interventions for fluid/electrolyte imbalance

Treat symptoms -Vomiting/diarrhea- Immodium, antinausea -Replace lost fluid Water replacement therapy Electrolyte supplements and replacement Blood/blood product transfusion Dietary education- disease and treatment specific -Meds that change potassium- teaching -renal disease, huge limits

A nurse is preparing to administer 3% NS to one of their patients, and is wondering if this IV fluid will be safe to administer to their patient. Which of the following patients would the nurse expect this IV fluid to be given to?

a patient that was just admitted for a traumatic head injury -3% NS is HYPERtonic, which is used to treat cerebral edema

2nd space

abnormal accumulation of water/fluid in the interstitial space; example= = edema

effects of calcium

affects neuronal excitability

what is osmolality of blood

amount of solutes/how concentrated their blood is, shows dehydration and over hydration

signs of right-sided heart failure

ascites: fluid goes into 3rd space, extreme stomach bloating lower extremity dependent edema: leg pain, limited mobility -can get venous stasis ulcers nausea and anorexia JVD- jugular vein distention

FR is being assessed while recovering from giving birth just 2 hours prior. The nurse reports that FR's vitals are currently: BP: 90/60, HR 120, SpO2 96%RA, RR 22, and Temp 37.1 C. What is the nurse's best next action?

assess the patient's perineal pads and uterus for bleeding

normal urine output

at least 30 mL/hr

effects of albumin

attracts fluid bc it increases osmolality (remember a for attracts), affects fluid balance, and binds drugs (remember alBumin B for binds)

foods with high magnesium

avocados, spinach, dark chocolate, nuts/legumes, cashews, and almonds

How do potassium sparing diuretics work?

block effects of aldosterone in the distal tubule in the kidneys, thus promoting excretion of sodium and water and retention of potassium

which meds cause hyperkalemia

blood pressure meds -ACE inhibitors and ARBs -beta blockers NSAIDs Heparin diuretics

symptoms of fluid volume excess

bounding pulse and crackles in the lungs

hypotonic solutions

brings fluid into cells, moves fluid from vessels to tissues -½ normal saline 0.45% NaCl -Dextrose 5% in water

hypertonic solutions

cause cells to shrink, takes fluid out of cells, moves fluid from tissues to vessels -3% NaCl -Dextrose in NS or lactated ringers

Chvostek's sign

cheek/facial spasm when cheek is tapped associated with hypocalcemia

symptoms of hyponatremia

confusion, weakness, restlessness

A client with lower extremity edema and excess fluid in the lungs has been discharged home with the medication furosemide. For this client, which finding is the best indicator that the medication is working effectively:

consistent daily weight

colloid IV fluids

contains large molecules that stay in intravascular space, milky, albumin

interventions for heart failure in general

daily weights- if 3-5 lbs gained in one day, take diuretics limit Na intake- limit processed, canned, and frozen foods fluid restriction down the line

what can too much hypotonic solution cause and how do we fix it

crackles in lungs and cerebral edema, which is then treated with hypertonic solution

A patient is being seen in the hospital for a heart failure exacerbation. Which of the following symptoms would the nurse expect to see? SATA

crackles in the lower lobes of their lungs due to fluid buildup in left ventricle, lower extremity edema due to blood pooling, decreased urine output due to decreased kidney function, dyspnea at rest and w/exertion, weight gain due to water retention

crystalloid IV fluids

crystal clear, electrolytes dissolved in water, MOST COMMON, what people are most often referring to when saying IV fluids, ⅓ stays in vessels, ⅔ in tissues -normal saline: salt & water -lactated ringers: sodium chloride, sodium lactate, potassium chloride, calcium chloride

You are caring for a patient receiving an infusion of 0.45% NS. Which assessment finding is more concerning?

decreasing level of consciousness

interventions for right-sided heart failure symptoms

dependent edema and ulcers- elevate legs (remember R in right for Raise legs), compression stockings

A patient with congestive heart failure is taking furosemide and a potassium supplement, though they said that they haven't taken their supplement in a few days. Which of the following signs and symptoms does the nurse expect to see? SATA

depressed T waves and muscle cramping -since this patient has not taken their potassium supplement in a few days and is taking a K+-wasting diuretic, it is expected that this patient is hypokalemic- depressed T-waves which can result in life-threatening dysrhythmias, muscle cramping, constipation

side effects of sodium polystyrene sulfonate

diarrhea

what are adverse effects of laxatives

diarrhea and hypokalemia

which meds interact with thiazide diuretics and loop diuretics

digoxin, lithium, NSAIDs, meds that lower BP

which meds cause hyponatremia

diuretics, antidepressants, and pain medications

when is magnesium often given?

during preterm labor bc it lessens contractions and if patient has preeclampsia bc it lowers BP (remember mag for magnitude of contractions, lowers it as well as BP)

adverse effects of IV fluids

fluid volume excess

effects of potassium

excites muscles and nervous system, especially heart

where is sodium found

extracellular fluid outside of cell

side effects of IV fluids

fluid volume overload/electrolyte imbalance

why would we give a thiazide diuretic

first line of treatment for hypertension, second line for edema

symptoms of hypokalemia

flat T waves, muscle weakness, dysrhythmias- bradycardia, muscle cramping (remember HYPO for depressed and slow)

A patient has been on spironolactone for five years and is getting an EKG at their primary care provider after feeling lightheaded recently. Which finding would you not expect to see in this patient?

flat T waves- with this medication you would expect signs of hyperkalemia and therefore peaked T waves, diarrhea, muscle/GI cramps, and dysrhythmias

3rd space

fluid goes where body can't get access to it; example = pleural space in lungs

which meds are loop diuretics

furosemide

effects of magnesium

helps with firing of muscles (remember M in magnesium for Muscles)

The nurse is reviewing laboratory values for a patient suspected of having a fluid imbalance. Which laboratory value should indicate a diagnosis of dehydration to the nurse?

hematocrit>48%, sodium above 145

what does a CBC tell us about fluid and electrolyte imbalances

hemoconcentration

effects of sodium

huge impact on fluid balance and excites muscles and nervous system

contraindications for potassium-sparing diuretics

hyperkalemia

what is sodium polystyrene sulfonate used to treat

hyperkalemia

what should we monitor for when administering potassium-sparing diuretics

hyperkalemia, anti-androgen effects- impotence, menstrual irregularities

what are adverse effects of anti-acids/sodium bicarbonate

hypernatremia and hypercapnia

what effects do hypotonic solutions have on fluids

hypo sounds like hippo and hippos go into water, hypotonic solutions bring fluid into cells like hippos go into water

The nurse is caring for a patient with a positive Chvostek's sign. Which electrolyte imbalance is the patient likely experiencing?

hypocalcemia

contraindication for loop diuretics

hypokalemia

contraindications for thiazide diuretics

hypokalemia

side effects of loop diuretics

hypokalemia, hyponatremia, hypotension, dehydration, ototoxicity, and rarely hyperglycemia

what do we need to monitor for when administering thiazide diuretics

hyponatremia, hypokalemia, hypotension, dehydration, and rarely hyperglycemia

when is albumin given

hypovolemia, hypovolemic shock, hypoalbuminemia -helps pull fluid into cells and helps BP increase because it's an expander

what can ECG tell us about fluid/electrolyte imbalances

if there is a flat T wave, hypokalemia if there is peaked T wave, hyperkalemia

when are packed red blood cells given

in hypovolemic shock or specifically to increase the oxygen carrying capacity of the blood, when H/H are low- anemia, hemorrhaging, given with normal saline

what fluid/electrolyte imbalance does diabetes cause

insulin drives potassium into cells- can cause hypokalemia

where is potassium found

intracellular fluid, inside cell

how does sodium polystyrene sulfonate work

it traps K+ in the GI tract for excretion

when is fresh frozen plasma given

just plasma, no platelets, given to replace clotting factors when profusely bleeding

another name for sodium polystyrene sulfonates

kayexalate

which diuretic is the most powerful

loop diuretics

A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day?

maintaining serum potassium levels

who do we caution use with potassium-sparing diuretics

meds that raise potassium- potassium supplements, ACE inhibitors, ARBs

foods high in calcium

milk, cheese, dark green vegetables, dried figs, soy, legumes

implementation for IV fluids

monitor rate of infusion monitor IV site assess for edema and cough/crackles

symptoms of hypomagnesmia

muscles more excitable- increased reflexes (remember hypo magnesmia sounds like hippo magnify and hippos are strong and have fast reflexes- hypomagnesmia MAGNIFIES reflexes) tachycardia and hypertension (remember opposite of other hypo disorders, causes FAST HR and high BP)

secondary prevention

no screening monitoring occurs if patient is on cardiac meds or diuretics bc they cause electrolyte imbalances- CMP

does spironolactone cause potassium loss

no, it is potassium-sparing

1st space

normal fluid distribution, intravascular

The nurse is caring for a 2-month old infant and is providing education to the parent about risks associated with fluid imbalances in the newborn. All of the following are risks for excessive fluid loss in the newborn identified by the nurse except for?

not being swaddled to keep infant warm -risks include increased risk for fever and infection, inability to breastfeed or ingest formula, vomiting and diarrhea, larger surface area, thinner skin, insensible fluid loss, increase in metabolism, inefficient kidneys

A patient with hypocalcemia is being admitted on the MedSurg floors. Which findings would you likely observe while conducting an admission assessment? SATA

numbness and tingling, a positive chvostek sign, increased muscle reflexes

primary prevention

patient teaching- signs of dehydration fluid management- water, drink electrolyte water only if sweating, vomiting, diarrhea safety

who do we caution use with loop diuretics

people with renal disease, diabetes, and pregnant women

who do we caution use with thiazide diuretics

people with renal disease, diabetes, and pregnant women

A patient is presenting with a thready and weak pulse of 58, and decreased bowel tones. In addition, the patient has been having frequent episodes of vomiting and nausea and is taking hydrochlorothiazide. Which of the following findings would explain the patient's condition?

potassium level of 2.4 bc thiazide diuretics are potassium-wasting, symptoms of hypokalemia include bradycardia and decreased bowel tones

Which of the following is the best indicator that Kayexalate has achieved the desired effect?

potassium within 3.5-5.2

On assessment, the nurse notices a patient receiving an IV bolus is short of breath, has crackles in their lungs and a bounding HR, and is confused. Which of the following is the priority nursing intervention for this patient?

priority is to stop the infusion, patient is showing signs of fluid volume overload and pulmonary edema

A patient receiving a long-term infusion of Lactated Ringers is at risk of developing which of the following conditions? SATA

pulmonary edema, fluid overload, hyperkalemia

signs of left-sided heart failure

pulmonary edema- crackles upon auscultation, fluid orthopnea- breathlessness while laying down, need to sit or stand or elevate w 3 pillows (remember L in left for Levitate) PND- paroxysmal nocturnal dyspnea- if they wake up short of breath

which solutions are hypotonic

remember hippo has 4 legs and 0.45% NaCl is a hypotonic solution, along with dextrose 5% in water, hippos live in water

precautions for IV fluids

renal/cardiac disease and head injury

patient teaching for loop diuretics

same as thiazide diuretics: -if taking insulin concurrently, may need to adjust dose as it lowers blood potassium by pulling it into cells -medication interactions: digoxin, lithium, NSAIDs, meds that lower BP

which meds interact with loop diuretics

same as thiazide diuretics: digoxin, lithium, NSAIDs, meds that lower BP

isotonic solutions

same tonicity/concentration as blood, stay in blood vessels

An 87-year-old client presented to the ED with complaints of a headache and said she has not drank water in a couple of days because she is not thirsty. She appears confused, restless, and lethargic. Which lab finding would you expect to see when you draw her labs?

sodium above 145: Confusion, restlessness, and lethargy are all signs of hypernatremia. The thirst response often becomes weaker with age, causing them to not drink as much water as they should. A sodium reading of 149 would indicate elevated levels.

what is the name of potassium-sparing diuretic

spironolactone

A patient with a potassium level of 2.1 has been taking Furosemide daily. Which medication will the nurse anticipate the patient being switched to?

spironolactone, patient is experiencing hypokalemia and this is a potassium-sparing diuretic that will help lose fluids w out too much K+

You are reassessing a client receiving an IV bolus infusion and are preparing to administer their morning medication. After careful reassessment, you notice they are short of breath, their skin is clammy, and there are crackles in their lungs. What is your priority nursing intervention for this client?

stop the infusion, patient is experiencing FVE and showing signs of pulmonary edema THEN we can place in Fowler's position and assess vitals

Which of the following nursing actions is the priority for a patient experiencing a potential transfusion reaction?

stop the transfusion

A patient comes into the ED after excessive fluid loss from vomiting and diarrhea. Which manifestations may the patient present with? (SATA)

tachycardia (HR above 100), hypotension, poor skin turgor, dry skin, weight loss, headache/dizziness, hematocrit above 48%, hemoglobin above 17.4, oliguria (small amounts of urine)

symptoms of hyperkalemia

tall T waves, dysrhythmias, muscle twitching, diarrhea (remember being HYPER- causes tachycardia and dysrhythmias, when you're hyper you might be nervous and have diarrhea)

tonicity

the ability of a solution to cause a cell to gain or lose water

How do loop diuretics work?

they block reabsorption of sodium in the ascending loop of henle

How do thiazide diuretics work?

they block resorption of sodium from early distal renal tubules

symptoms of hypernatremia

thirst, edema, confusion

cautions/side effects for blood transfusions

transfusion reactions: low back pain, hypotension, tachycardia, fever and chills, hives/rashes, cyanosis, shaking, nausea and vomiting leading to renal failure

true or false patients positive for rH factor can safely receive either + or - blood

true

when are platelets given

used for thrombocytopenia, platelet replacement

whole blood transfusions

used only when blood loss is rapid and substantial

illnesses that can affect fluid/electrolyte balance

vomiting, diarrhea, fever inadequate intake excessive intake burns crush, head injuries acute kidney injury (AKI) chronic kidney disease heart failure liver disease chronic alcoholism eating disorders diabetes cancer

Does furosemide spare or waste potassium?

waste, it is a loop diuretic

which fluid/electrolyte imbalance does liver disease cause and what are the signs

water balance problem- caused by blood hydrostatic pressure, means there is so much fluid inside vessel, fluid must leave vessel -portal vein hypotension- so much pressure happening in vessel that fluid goes into second space -esophageal varisces- enlarged veins -hemorrhoids -big belly- ascites (3rd space- fluid goes to stomach)

when do we give isotonic solutions

when patient is dehydrated or losing blood at a high rate to increase BP -Normal saline - 0.9% sodium chloride in H2O -Lactated ringers - sodium chloride, sodium lactate, potassium chloride, calcium chloride

when do we give hypotonic solutions

when serum sodium is elevated, intracellular dehydration, when fluids need to be shifted into cells examples: diabetic ketoacidosis and hyperosmolar hyperglycemic state

when do we give hypertonic solutions

when serum sodium is low, to treat cerebral edema

do loop diuretics cause potassium loss

yes