PrepU questions: Fluid & Electrolyte

Intracellular Fluid

(fluid inside cells) represents the greatest proportion of water in the body

A client is experiencing withdrawal from alcohol and admitted to the behavioral health unit. The client begins to have muscle weakness, tremors, hyperactive deep tendon reflexes, and a change in mental status. What should the nurse prepare to replace in this client?

Magnesium

A nurse is assessing for the presence of edema in a client who is confined to bed and who often lies supine. The nurse would pay particular attention to which area?

Sacral area *Edema is most noticeable in dependent areas of the body. The edema cannot be assessed in the face, hands and abdomen, as these are not dependent areas.

Isotonic solutions

those with the same solute and concentration, balanced

extracellular fluid

fluid outside the cells and is subdivided into interstitial fluid and intravascular fluid

Isotonic solutions are used when...

generally administered to maintain fluid balance in clients who may not be able to eat or drink for a short period

Hypovolemia

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 S/S

Lactated Ringers are used to treat...

hypovolemia, burns, and fluid lost as bile or diarrhea and in treating mild metabolic acidosis

A client needs an intravenous fluid that will pull fluids into the vascular space. What type of fluid does the nurse prepare to administer as prescribed?

Hypertonic *A hypertonic solution has a greater osmolarity than plasma, which causes water to move out of the cells and be drawn into the intravascular compartment. A hypotonic solution has a lower osmolarity than plasma; therefore, fluid would move out of the intravascular space rather than pulling fluids from the tissues into the vascular space. An isotonic fluid remains in the intravascular compartment without any net flow across the semipermeable membrane. The concentration of particles in a solution is referred to as the osmolarity of a solution.

Hypomagnesium manifestations..

muscle weakness, tremors, tetany, seizures, heart block, change in mental status, hyperactive deep tendon reflexes (DTRs), and respiratory paralysis. This may occur with the client that is withdrawing from alcohol

Manifestations of hypercalcemia

nausea, vomiting, constipation, bone pain, excessive urination, thirst, confusion, lethargy, and slurred speech

Manifestations of hypocalcemia

numbness and tingling of fingers, mouth, or feet; tetany; muscle cramps; and seizures

The student nurse asks, "What is interstitial fluid?" What is the appropriate nursing response?

Fluid in the tissue space between and around cells.

examples of isotonic solutions

normal saline, lactated ringers

Colloid solutions are used when...

replace circulating blood volume because the suspended molecules pull fluid from other compartments

A client has been admitted with fluid volume deficit. Which assessment data would the nurse anticipate? Select all that apply.

1. blood pressure 100/48 mmHg 2. poor skin turgor 3. heart rate 128/bpm *Fluid volume deficit causes a low BP (100/48 mmHg), poor skin turgor, and an elevated heart rate (128/bpm). Fluid excess can cause crackles and distended neck veins.

examples of hypertonic solutions

5% dextrose in 0.45% NaCl and 5% dextrose in lactated Ringer's solution are hypertonic

Calcium Level

8.9-10.1 mg/dL

Which nursing diagnosis would the nurse make based on the effects of fluid and electrolyte imbalance on human functioning?

Acute Confusion related to cerebral edema *Edema in and around the brain increases intracranial pressure, leading to the likelihood of confusion

A client who is admitted to the health care facility has been diagnosed with cerebral edema. Which intravenous solution needs to be administered to this client?

Hypertonic solution *Hypertonic solutions are used in extreme cases when it is necessary to reduce cerebral edema or to expand the circulatory volume rapidly because it is more concentrated than body fluid and draws cellular and interstitial water into the intravascular compartment

Electrolyte Imbalance Manifestations

Muscle twitching, and nausea and vomiting

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?

Muscle weakness, fatigue, and dysrhythmias Typical signs of hypokalemia include muscle weakness and leg cramps, fatigue, paresthesias, and dysrhythmias. *With Potassium, always think heart!

A nurse monitoring a client's IV infusion auscultates the client's lung sounds and detects crackles in the bases in lungs that were previously clear. What would be the most appropriate intervention in this situation?

Notify the primary care provider immediately for possible fluid overload.

The oncoming nurse is assigned to the following clients. Which client should the nurse assess first?

a newly admitted 88-year-old with a 2-day history of vomiting and loose stools *Hypovolemia

Hypotonic solutions are used when..

administered to clients with fluid losses in excess of fluid intake, such as those who have diarrhea or vomiting

Fluid volume excess

crackles and distended neck veins

Hyperchloremia

diminished cognitive ability and HTN

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?

distended neck veins *Fluid volume excess causes the heart and lungs to work harder, leading to the veins in the neck becoming distended.

Edema develops when...

excess fluid is distributed to the interstitial space

insterstitial fluid

fluid in the tissue space between and around cells

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 (dehyrdation) *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).

fluid volume deficit

low BP, poor skin turgor, and an elevated heart rate

Hypotonic solutions

those with lower solute concentrations and higher water concentrations

intravascular fluid

watery plasma, or serum, portion of blood

The nurse is monitoring intake and output (I&O) for a client who has diarrhea. What will the nurse document as input on the I&O record? Select all that apply.

1. 100 mL from melted ice chips 2. serving of jello 3. infusion of intravenous solution 4. cup of ice cream *The nurse will document all fluid intake and fluid loss. This includes drinking liquids and intravenous fluids. The liquid equivalent of melted ice chips is fluid intake. Foods that are liquid by the time they are swallowed, such as gelatin, ice cream, and thin cooked cereal, are documented as fluid intake. A bowl of chili is a solid food as is a barbecue sandwich. While the amount eaten may be documented in the chart, it is not part of the fluid intake.

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:

low calcium

Hypertonic solutions

those with higher solute concentrations and lower water concentrations

Phosphorus deficit

irritability, fatigue, weakness, paresthesias, confusion, seizures, and coma

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?

muscle cramping and tetany

examples of hypotonic solution

0.45% NaCl (½ strength saline) 0.33% NaCl (1/3 strength normal saline)

A nurse must administer an isotonic intravenous solution to a client who has lost fluid. Which fluids are isotonic? Select all that apply.

1. Lactated Ringer's Solution 2. 0.9% NaCl (Normal Saline)

A client is hypotensive secondary to hypovolemia resulting from dehydration. Based on the nurse's knowledge about intravenous solutions, the nurse would expect the physician to prescribe which type of solution?

Isotonic Solution *Isotonic fluids have an osmolarity of 250 to 375 mOsm per liter, which is the same osmotic pressure as that found within the cell. Isotonic fluids are used to expand the intravascular compartment and thus increase circulating volume. Because these solutions do not alter serum osmolarity, interstitial and intracellular compartments remain unchanged (Smeltzer, Bare, Hinkle, & Cheever, 2010). An isotonic solution is helpful for hypotension caused by hypovolemia in dehydration. When a hypotonic solution is infused, it lowers serum osmolarity, causing body fluids to shift out of the blood vessels and into the cells and interstitial space. For this reason, hypotonic fluids are administered when a client needs cellular hydration. Hypertonic fluids have an osmolarity of 375 mOsm per liter or higher and a greater osmotic pressure than the cell. When a hypertonic solution is infused, serum osmolarity is increased, pulling fluid from the cells and the interstitial tissues into the vascular space. The primary use for these solutions are management of intracranial hypertension and shock. Volume expanders, such as albumin, a plasma protein contained within the plasma, is used to restore intravascular volume and to maintain cardiac output in clients with hypoproteinemia.

A nurse is caring for a client who has recently suffered burns on 30% of his body. Based on his condition, what type of IV solution might be ordered for this client?

Lactated Ringer's (Isotonic solution) *Lactated Ringer's solution is a roughly isotonic solution that contains multiple electrolytes in about the same concentrations as found in plasma (note that this solution is lacking in Mg2+ and PO43- ). It is used in the treatment of hypovolemia, burns, and fluid lost as bile or diarrhea and in treating mild metabolic acidosis.

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

Hypochloremia

tachypnea, weakness, lethargy, diminished cognitive ability, hypertension, decreased cardiac output, dysrhythmias, and coma