adults 1 fluid & electrolytes
The nurse is caring for a client diagnosed with bulimia. The client is being treated for a serum potassium concentration of 2.9 mEq/L (2.9 mmol/L). Which statement made by the client indicates the need for further teaching?
"I can use laxatives and enemas but only once a week." Explanation: The client is experiencing hypokalemia, most likely due to the diagnosis of bulimia. Hypokalemia is defined as a serum potassium concentration <3.5 mEq/L (3.5 mmol/L), and usually indicates a deficit in total potassium stores. Clients diagnosed with bulimia frequently suffer increased potassium loss through self-induced vomiting and misuse of laxatives, diuretics, and enemas; thus, the client should avoid laxatives and enemas. Prevention measures may involve encouraging the client at risk to eat foods rich in potassium (when the diet allows), including fruit juices and bananas, melon, citrus fruits, fresh and frozen vegetables, lean meats, milk, and whole grains. If the hypokalemia is caused by abuse of laxatives or diuretics, client education may help alleviate the problem.
The nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricted diet. Which statement by the client indicates the need for additional instruction?
"I will not salt my food; instead I'll use salt substitute."
The community health nurse is performing a home visit to an older client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response?
"Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids." Explanation: In elderly clients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or atypical. For example, fluid deficit may cause confusion or cognitive impairment in the elderly person. There is no mention of medications in the stem of the question or any specific evidence given for the need for readmission to the hospital. Confusion is never normal, common, or expected in the elderly. Urinary retention does normally cause confusion.
beta blockers end in
"olol" Metoprolol Atenolol
how does kidney dialysis work
- Selectively permeable barrier separates patient's blood from dialysis fluid - Materials are exchanged across the barrier e.g. urea, excess ions and water move out of the blood and into the dialysis fluid - Large cells and proteins remain in the blood
symptoms of high BUN
- dehydration - impaired renal/kidney function - excessive protein intake - GI bleeding - Fever, sepsis
diuretics end in
-ide or -one
ace inhibitors end in
-pril -catapril -enalapril -lisinopril -quinapril
amount of sweat loss (varies) between what range
0-1000mL/hour
Which solution is hypotonic?
0.45% NaCl Explanation: Half-strength saline is hypotonic. Lactated Ringer solution and normal saline (0.9% NaCl) are isotonic. A 5% NaCl solution is hypertonic.
The physician has prescribed a hypotonic IV solution for a patient. Which IV solution should the nurse administer? 0.9% sodium chloride 5% glucose in water 0.45% sodium chloride 5% glucose in normal saline solution
0.45% sodium chloride Explanation: Half-strength saline (0.45% sodium chloride) solution is frequently used as an IV hypotonic solution.
Normal creatinine levels
0.7-1.4 mg/dL
Which is considered an isotonic solution?
0.9% normal saline Explanation: An isotonic solution is 0.9% normal saline (NaCl). Dextran in normal saline is a colloid solution, 0.45% normal saline is a hypotonic solution, and 3% NaCl is a hypertonic solution.
A 2-lb weight gain in 24 hours indicates that the client is retaining
1 L of fluid
how much urine will the kidneys of a healthy person produce per day and per hour
1-2 L/day and approximately 1mL/kg/hour
RAAS System: Renin-Angiotensin-Aldosterone System
1. Drop in BP. Decreased Blood flow to kidneys. Juxtaglomerular cells respond by releasing renin. 2. Renin coverts angiotensinogen into angiotensin 1. 3. Angiotensin 1 circulates to the lungs, Where angiotensin-converting enzyme (ACE), converts it into angiotensin 2. 4. Angiotensin 2 stimulates adrenal glands to secrete aldosterone. 5. Aldosterone causes the distal convoluted tubule to retain sodium, which leads to water retention, increasing blood pressure along with blood volume.
Fluid Volume deficit labs
1. INCREASED serum osmolality 2. INCREASED hematocrit 3. INCREASED blood urea nitrogen (BUN) 4. INCREASED serum sodium 5. INCREASED urine specific gravity
Normal specific gravity of urine
1.005-1.030
Normal BUN range
10-20 mg/dL
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
A client weighing 160 pounds (72.6 kg), who has been diagnosed with hypovolemia, is weighed every day. The health care provider asked to be notified if the client loses 1,000 mL of fluid in 24 hours. What weight would be consistent with this amount of fluid loss?
158 lbs (71.7 kg) Explanation: A loss of 0.5 kg, or 1 lb, represents a fluid loss of about 500 mL. Therefore, a loss of 1,000 mL would be equivalent to the loss of 2 lbs (0.9 kg), bringing the client's weight to 158 lbs (71.7 kg).
plasma osmolarity is
275-290 m0sm/kg
Normal Human Plasma Osmolality
285-295 mOsm/kg
The nurse knows which is the normal serum value for potassium
3.5-5.0 mEq/L (3.5-5.0 mmol/L). Explanation: Serum potassium must be within normal limits to prevent cardiac dysrrhythmia. Normal serum sodium is 135-145 mEq/L (3.5-5.0 mmol/L). Normal serum chloride is 96-106 mEq/L (96-106 mmol/L). Normal total serum calcium is 8.5-10.5 mg/dL (2.13-2.63 mmol/L).
water loss via evaporation is approximately how much
500mL/day
anion gap
= Na - (Cl + HCO3) Normal is 14 and below
The nurse is caring for four clients on a medical unit. The nurse is most correct to review which client's laboratory reports first for an electrolyte imbalance?
A 52-year-old with diarrhea Explanation: Electrolytes are in both intracellular and extracellular water. Electrolyte deficiency occurs from an inadequate intake of food, conditions that deplete water such as nausea and vomiting, or disease processes that cause an excess of electrolyte amounts. The 52-year-old with diarrhea would be the client most likely to have an electrolyte imbalance. The orthopedic client will not likely have an electrolyte imbalance. Myocardial infarction clients will occasionally have electrolyte imbalance, but this is the exception rather than the rule.
what urine output indicates a client is maintaining adequate fluid intake and balance?
A client with minimal urine output of 30 mL/hour provides the nurse with the information that the patient is maintaining proper fluid balance. Less then 30 mL/hour of urine output indicates dehydration and possible poor kidney function.
Anti-diuretic hormone (ADH)
A hormone produced by the pituitary gland when the body is dehydrated. It causes the kidneys to reabsorb more water into the blood making the urine more concentrated.
A client is experiencing edema in the tissue. What type of intravenous fluid would the nurse expect to be prescribed?
A hypertonic solution is used to pull water back into circulation, as it has more particles than the body's water. If hypertonic is given too rapidly or in large quantities, they may cause an extracellular volume excess and precipitate circulatory overload and dehydration. As a result, these solutions must be given cautiously and usually only when the serum osmolality has decreased to dangerously low levels. Hypertonic solutions exert an osmotic pressure greater than that of the extracellular fluid.
During RAAS activation, what gland releases aldosterone?
Adrenal Cortex
The nurse is reviewing lab work on a newly admitted client. Which of the following diagnostic studies confirm the nursing diagnosis of Deficient Fluid Volume? Select all that apply.
An elevated hematocrit level and Electrolyte imbalance
What is one of the most important indications of an acid-base imbalance that is shown in an ABG?
Arterial blood gas (ABG) results are the main tool for measuring blood pH, CO2 content (PaCO2), and bicarbonate.
A client presents with severe diarrhea and a history of chronic renal failure to the emergency department. Arterial blood gas results are as follows: pH 7.30 PaO2 97 PaCO2 37 HCO3 18
Clammy skin, blood pressure 86/46, headache
fluid volume excess labs
DECREASED serum osmolality DECREASED hematocrit DECREASED BUN DECREASED serum sodium DECREASED urine specific gravity
sepsis
Dangerous infection of the blood
The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with dehydration
Dark, concentrated urine Explanation: Dehydration indicates a fluid volume deficit. Dark, concentrated urine indicates a lack of fluid volume. Adding more fluid would dilute the urine. The other options indicate fluid excess.
You are caring for a 72-year-old client who has been admitted to your unit for a fluid volume imbalance. You know which of the following is the most common fluid imbalance in older adults?
Dehydration Explanation: The most common fluid imbalance in older adults is dehydration. Because of reduced thirst sensation that often accompanies aging, older adults tend to drink less water. Use of diuretic medications, laxatives, or enemas may also deplete fluid volume in older adults. Chronic fluid volume deficit can lead to other problems such as electrolyte imbalances. Therefore, options A, C, and D are incorrect.
Colloid Solutions
Dextran in NS or D5W Available in low-molecular-weight (Dextran 40) and high-molecular-weight (Dextran 70) forms
concentration gradient
Difference in osmolarity across a semipermeable membrane
The nurse is caring for a client with a serum potassium concentration of 6.0 mEq/L (6.0 mmol/L). The client is ordered to receive oral sodium polystyrene sulfonate and furosemide. What other order should the nurse anticipate giving?
Discontinue the intravenous lactated Ringer solution.
Which of the following is a clinical manifestation of fluid volume excess (FVE)? Select all that apply.
Distended neck veins Crackles in the lung fields Shortness of breath Explanation: Clinical manifestations of FVE include distended neck veins, crackles in the lung fields, shortness of breath, increased blood pressure, and tachycardia.
A client was admitted to the unit with a diagnosis of hypovolemia. When it is time to complete discharge teaching, which of the following will the nurse teach the client and family? Select all that apply.
Drink at least eight glasses of fluid each day. Drink water as an inexpensive way to meet fluid needs. Respond to thirst Explanation: In addition, the nurse teaches clients who have a potential for hypovolemia and their families to respond to thirst because it is an early indication of reduced fluid volume; consume at least 8 to 10 (8 ounce) glasses of fluid each day and more during hot, humid weather; drink water as an inexpensive means to meet fluid requirements; and avoid beverages with alcohol and caffeine because they increase urination and contribute to fluid deficits.
The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process?
Elevated blood pressure Explanation: Indicative of hypervolemia is a bounding pulse and elevated blood pressure due to the excess volume in the system. Respirations are not typically affected unless there is fluid accumulation in the lungs. Temperature is not generally affected.
Which laboratory result does the nurse identify as a direct result of the client's hypovolemic status with hemoconcentration?
Elevated hematocrit level Explanation: When hemoconcentration occurs due to a hypovolemic state, a high ratio of blood components in relation to watery plasma occurs, thus causing an elevated hematocrit level. A high white blood cell count and urine specific gravity is also noted. Other causes of an abnormal potassium level may be present.
Hypokalemia can cause which symptom to occur?
Excessive thirst
Hypokalemia S/S
Fatigue, Anorexia, N/V, Muscle weakness, Decreased GI motility, Dysrhythmias, Paresthesia, Flat T waves on ECG
The nurse is caring for a client diagnosed with a syndrome of inappropriate antidiuretic hormone secretion (SIADH). The plan of care includes an assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the client's health.
Fluid volume status Explanation: A specific gravity will detect if the client has a fluid volume deficit or fluid volume excess. Nutrition, potassium, and calcium levels are not directly indicated.
how sodium and potassium work together in the body
Foods with potassium can help control blood pressure by blunting the effects of sodium. The more potassium you eat, the more sodium you process out of the body. It also helps relax blood vessel walls, which helps lower blood pressure
blood urea nitrogen (BUN) increases with
GI bleeding, fever, sepsis
Loop Diuretics Adverse Effects
HYPOkalemia, HYPOnatremia, HYPOvolemia, and HYPOtension (dizziness, lightheadedness)
A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
Hyperkalemia is a common complication of acute renal failure. It's life-threatening if immediate action isn't taken to reverse it. Administering glucose and regular insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels.
treatment of fluid volume deficit
IV isotonic fluid replacement
what effect does hypernatremia have on serum osmolality
In hypernatremia, the serum sodium level exceeds 145 mEq/L (145 mmol/L) and the serum osmolality exceeds 300 mOsm/ kg (300 mmol/L).
The nurse is evaluating a newly admitted client's laboratory results, which include several values that are outside of reference ranges. Which of the following alterations would cause the release of antidiuretic hormone (ADH)?
Increased serum sodium Explanation: Increased serum sodium causes increased osmotic pressure, increased thirst, and the release of ADH by the posterior pituitary gland. When serum osmolality decreases and thirst and ADH secretions are suppressed, the kidney excretes more water to restore normal osmolality. Levels of potassium, hemoglobin, and platelets do not directly affect ADH release.
Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?
Jugular vein distention
A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone. Which finding requires further action?
Jugular vein distention requires further action because this finding signals vascular fluid overload along with weight gain and fluid retention from oliguria. Polyuria is associated with diabetes insipidus, which occurs with inadequate production of ADH.
Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?
Limit sodium and water intake. Explanation: Implement prescribed interventions such as limiting sodium and water intake and administering ordered medications that promote fluid elimination. Assessing for dehydration and teaching to decrease urination would not be appropriate interventions.
The nurse is caring for a client undergoing alcohol withdrawal. Which serum laboratory value should the nurse monitor most closely? Potassium Calcium Magnesium Phosphorus
Magnesium Explanation: Chronic alcohol abuse is a major cause of symptomatic hypomagnesemia in the United States. The serum magnesium concentration should be measured at least every 2 or 3 days in clients undergoing alcohol withdrawal. The serum magnesium concentration may be normal at admission but may decrease as a result of metabolic changes, such as the intracellular shift of magnesium associated with intravenous glucose administration.
normal hematocrit levels
Male: 45%-52% Female: 37-48%
nursing considerations for ace inhibitors
Monitor blood pressure and pulse. Hypotension is a common adverse effect. Monitor urinary output Monitor for evidence of heart failure, such as edema. ACE inhibitors can cause heart and kidney (BUN and Creatinine levels) complications.
A priority nursing intervention for a client with hypervolemia involves which of the following?
Monitoring respiratory status for signs and symptoms of pulmonary complications. Explanation: Hypervolemia, or fluid volume excess (FVE), refers to an isotonic expansion of the extracellular fluid. Nursing interventions for FVE include measuring intake and output, monitoring weight, assessing breath sounds, monitoring edema, and promoting rest. The most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds are assessed at regular intervals.
Lactated ringers contain
Na+, K+, Cl-, Ca+, and lactate
The nurse is assigned a client with calcium level of 4.0 mg/dL. Which system assessment would the nurse ask detailed questions?
Neurological system
A client has questioned the nurse's administration of IV normal saline, asking, "Wouldn't sterile water would be a more appropriate choice than saltwater?" Under what circumstances would the nurse administer electrolyte-free water intravenously?
Never, because it rapidly enters red blood cells, causing them to rupture. Explanation: IV solutions contain dextrose or electrolytes mixed in various proportions with water. Pure, electrolyte-free water can never be given by IV because it rapidly enters red blood cells and causes them to rupture.
A 64-year-old client is brought to the clinic feeling thirsty with dry, sticky mucous membranes; decreased urine output; fever; a rough tongue; and lethargic. Serum sodium level is above 145 mEq/l (145 mmol/L). Should the nurse start salt tablets when caring for this client?
No, sodium intake should be restricted. Explanation: The symptoms and the high level of serum sodium suggest hypernatremia, (excess of sodium). It is necessary to restrict sodium intake. Salt tablets and sodium chloride IV can only worsen this condition but may be required in hyponatremia (sodium deficit). Hypotonic solution IV may be a part of the treatment but not along with the salt tablets.
•What is the effect of hypernatremia on ADH?
Normal defenses against hypernatremia are thirst and the secretion of ADH. ADH causes the urine to become concentrated, that is, the kidney retains water.
Which of the following would be appropriate nursing interventions for a client with hypokalemia? Select all that apply.
Offer a diet with fruit juices and citrus fruits and Monitor intake and output every shift.
The calcium concentration in the blood is regulated by which mechanism?
Parathyroid hormone (PTH) Explanation: The serum calcium concentration is controlled by PTH and calcitonin. The thyroid hormone, adrenal gland, or androgens do not regulate the calcium concentration in the blood.
passive transport
Requires NO energy, Movement of molecules from high to low concentration, Moves with the concentration gradient
A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention helps prevent complications associated with SIADH?
Restricting fluids to 800 ml/day Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion, thus worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted.
increased urine osmolality
SIADH, fluid volume deficit, acidosis, congestive heart failure, prerenal kidney injury
A patient with diabetes insipidus presents to the emergency room for treatment of dehydration. The nurse knows to review serum laboratory results for which of the diagnostic indicators?
Sodium level of 150 mEq/L Explanation: Hypernatremia (normal serum sodium is 135 to 145 mEq/L) is consistent with increased fluid loss and dehydration in diabetes insipidus.
To compensate for decreased fluid volume (hypovolemia), the nurse can anticipate which response by the body?
Tachycardia Explanation: Fluid volume deficit, or hypovolemia, occurs when the loss of extracellular fluid exceeds the intake of fluid. Clinical signs include oliguia, rapid heart rate, vasoconstriction, cool and clammy skin, and muscle weakness. The nurse monitors for rapid, weak pulse and orthostatic hypotension.
the nurse is caring for a client with multiple organ failure and in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation
The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.
An older client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature and reported "dry mouth." The nurse suspects the client is experiencing which condition?
The most common fluid imbalance in older adults is dehydration.
RAAs system results in
The net effects of the activation of the RAAS include vasoconstriction, sodium, and water retention, increased arterial blood pressure, and increased myocardial contractility, which in combination increase the effective circulating volume.
these are increased as the kidneys attempt to conserve water
The urine specific gravity and urine osmolality are increased as the kidneys attempt to conserve water (provided the water loss is from a route other than the kidneys). Body temperature may increase mildly, but it returns to normal after the hypernatremia is corrected.
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 Explanation: Ham (1,400 mg Na for 3 oz) and bacon (155 mg Na/slice) are high in sodium as is tomato juice (660 mg Na/¾ cup) and low fat cottage cheese (918 mg Na/cup). Packaged meals are high in sodium.
roles of angiotensin II when it is activated in the renin-angiotensin-aldosterone system
Triggers the release of aldosterone, Increases blood volume, Increases systemic vascular resistance, and Causes the release of ADH (antidiuretic hormone)
A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess what ?
Trousseau's sign. Explanation: This client's serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.
Oncotic pressure (colloid osmotic pressure)
a form of osmotic pressure exerted by proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that usually tends to pull water into the circulatory system.
An elevated serum potassium level may lead to
a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrhythmia can occur suddenly.
active transport moves
against the concentration gradient (low to high)
main colloid
albumin
water moves from
an area of lesser solute concentration and more water to an area of greater solute concentration and less water until equilibrium is achieved
treatment of influenza sepsis
antibiotics/antivirals, ISOTONIC fluids, oxygen support, vasopressors, increase preload/volume
the lungs eliminate approximately how much water vapor (insensible water loss) per day
approximately 300mL/day
The health care provider ordered an IV solution for a dehydrated patient with a head injury. Select the IV solution that the nurse knows would be contraindicated.
b. 5% DW
Lactate Metabolism leads to
bicarbonate production
Conversely, foods with minimal potassium content include
butter, margarine, cranberry juice or sauce, ginger ale, gumdrops or jellybeans, hard candy, root beer, sugar, and honey. Labels of cola beverages must be checked carefully because some are high in potassium and some are not.
A client presents with anorexia, nausea and vomiting, deep bone pain, and constipation. The following are the client's laboratory values. sodium 130 mEq/L (130 mmol/L)potassium 4.6 mEq/L (4.6 mmol/L)chloride mEq/L (94 mmol/L)calcium 12.9 mg/dL (3.2 mmol/L) What laboratory value is consistent with the client's symptoms?
calcium 12.9 mg/dL (3.2 mmol/L) Explanation: More than 99% of the body's calcium is found in the skeletal system. Hypercalcemia, or calcium levels exceeding 10.2 mg/dL (2.5 mmol/L), can be a dangerous imbalance. The client presents with anorexia, nausea and vomiting, constipation, abdominal pain, bone pain, and confusion.
A client with emphysema is at a greater risk for developing which acid-base imbalance?
chronic respiratory acidosis
plasma proteins too big to pass through the capillary wall
create oncotic pressure
Function of ACE inhibitors
decrease BP by decreasing aldosterone, Na+ and water volume.
function of beta blockers
decrease HR and BP
Sepsis is often associated with a deficit in effective blood volume causing
decreased intake, increased external losses, leakage to the interstitial space, and vasodilation (low blood pressure). so large amounts of intravenous fluid are often needed to increase cardiac output and improve peripheral blood flow
Metabolic acidosis, a common clinical disturbance, is characterized by
decreased pH and plasma bicarbonate concentration.
Hypercalcemia causes
deep bone pain, constipation, anorexia, nausea, vomiting, polyuria, thirst, pathologic fractures, and mental changes.
Hematocrit increases with
dehydration and polycythemia (high concentration of RBCs in the blood)
Vasopressin is administered to clients with
diabetes insipidus (a condition causing deficient ADH circulation)
decreased urine osmolality
diabetes insipidus, fluid volume excess, hyponatremia (low sodium)
Common causes of metabolic acidosis include
diarrhea, chronic renal failure, use of diuretics, intestinal fistulas, and ureterostomies. The client will experience the following signs and symptoms: headache, confusion, increased respiratory rate, nausea, vomiting, cold and clammy skin, and decreased blood pressure.
symptoms of hyperkalemia include
diarrhea, nausea, muscle weakness, paresthesias, and cardiac dysrhythmias.
solutes move by
diffusion
If prolonged, hypokalemia can lead to an inability of the kidneys to concentrate urine which causes
dilute urine and excessive thirst
Solvents
dissolve other substances
treatment for heartfailure and hypervolemia
diuretics, ace inhibitors, Angiotensin reuptake inhibitors, nitrates, beta-blockers
Treatment of fluid volume excess
diuretics, paracentesis
hypertonic solutions are used for
edema (helps draw out fluids), dehydration(hypovolemia), hyponatremia, hypoglycemia, and providing calories
hronic respiratory acidosis is associated with disorders such as
emphysema, bronchiectasis, bronchial asthma, and cystic fibrosis
Blood urea nitrogen (BUN) decreases with
end-stage liver disease, low protein diet, starvation, any condition that expands fluid volume and dilutes urea in the blood
Decreased BUN (not retained)
end-stage liver disease, low-protein diet, starvation, and conditions that cause increased fluid volume, such as pregnancy
Hypervolemia and Heart Failure
excess fluid creates a hypotonic state, increased sodium consumption triggers hypothalamus to increase ADH, increased volume/preload, tightening up increased resistance(afterload) which in turn decreases cardia output and increases fluid retention, adrenal glands increase aldosterone and hold onto water
Metabolic alkalosis results in increased plasma pH because of an accumulated base bicarbonate or decreased hydrogen ion concentration. Factors that increase base bicarbonate include
excessive oral or parenteral use of bicarbonate-containing drugs, a rapid decrease in extracellular fluid volume and loss of hydrogen and chloride ions as with gastric suctioning.
Hypervolemia causes
excessive sodium or fluid intake, fluid or sodium retention, shift in fluid from interstitial to intravascular space, administering sodium infusions too rapidly, low intake of dietary protein
Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. excessive ADH causes an inability to
excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 mL/day
Hypokalemia causes
fatigue, weakness, anorexia, nausea, vomiting, cardiac dysrhythmias, leg cramps, muscle weakness, and paresthesias.
what variables effect how much fluid loss happens through the skin
fever, environment, exercise, burns
regulation in hypovolemia
fluid loss creates a hypertonic state, volume/preload is decreased, hypothalamus increases ADH to hold onto water, thirst reponse is triggered, adrenal glands increase aldosterone, stretch receptors tighten up
SIADH secretion causes antidiuretic hormone overproduction, which leads to
fluid retention and severe SIADH can cause complications such as vascular fluid overload, signaled by jugular vein distention. It may cause weight gain and fluid retention (secondary to oliguria).
intracellular fluid
fluid within cells
If hydrostatic pressure is greater than osmotic pressure, then the movement of fluid is
from ECF toward the ICF
Potassium-rich foods include
fruits and vegetables, legumes, whole-grain breads, lean meat, milk, eggs, coffee, tea, and cocoa.
A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed?
furosemide Explanation: Furosemide is the only loop diuretic choice. Hydrochlorothiazide and metolazone are thiazide diuretics that block sodium reabsorption. Spironolactone is a potassium-sparing diuretic that prevents sodium absoprtion.
Potassium depletion depresses the release of insulin and results in
glucose intolerance
lactated ringers is not to be given with what pH
greater than 7.5 because bicarb is formed as lactate breaks down which causes alkalosis
hematocrit is about three times as much as
hemoglobin
colloid solution contraindications
hemorrhage, thrombocytopenia, renal disease, and severe dehydration •Not a substitute for blood or blood products
The urine specific gravity, due to concentrated particle level is
high
what would you expect aldosterone levels to be in a dehydrated patient
high, you want to hold on to Sodium and fluid
if urine specific gravity is greater than 1.025
higher specific gravity and patient might be DEhydrated
the energy to drive the pump is released by
hydrolysis of ATP
hematocrit is high meaning the patient is
hyper osmolar
Respiratory alkalosis is always caused by
hyperventilation, which causes excessive "blowing off" of CO2 and, hence, a decrease in the plasma carbonic acid concentration. Causes include extreme anxiety, hypoxemia, early phase of salicylate intoxication, gram-negative bacteremia, and inappropriate ventilator settings.
reason to discontinue IV lactated ringer solution
hypervolemia, hypernatremia, hyperkalemia
hematocrit is low meaning the patient is
hypo osmolar
A client reports muscle cramps in the calves and feeling "tired a lot." The client is taking ethacrynic acid (Edecrin) for hypotension. Based on these symptoms, the client will be evaluated for which electrolyte imbalance?
hypokalemia
Symptoms of fluid volume deficit
hypotension, tachycardia, weak/thready pulse, tachypnea, weakness, thirst, diminished capillary refill, oliguria (not peeing enough), flattened jugular veins
A client has a respiratory rate of 38 breaths/min. What effect does breathing faster have on arterial pH level?
increase
hypotonic state has what effect on preload
increase in preload
Early signs of hypervolemia include
increased breathing effort and weight gain. Explanation: Early signs of hypervolemia are weight gain, elevated blood pressure, and increased breathing effort. Eventually, fluid congestion in the lungs leads to moist breath sounds. One of the earliest symptoms of hypovolemia is thirst.
high temperature and subsequently metabolic processes increase which will have what effect on the respiratory rate
increased respiratory rate
Decreased osmolality and increased blood volume can
inhibit the release of ADH and cause less water to be reabsorbed causing urine to be more diluted
Potassium concentrations are higher
inside the cell
osmotic pressure pulls fluid
into the capillary from the ICF
Types of extracellular fluid
intravascular, interstitial, transcellular
fluid treatment for sepsis
isotonic fluids
what happens to angiotensin in a dehydrated patient
it goes up because you want to increase blood pressure and keep fluid flowing
creatinine is a good indicator of
kidney function because it does not vary with protein intake or hydration status
Hypervolemia and renal failure
kidneys aren't working to remove excess fluid as healthy kidneys would.
Routes of Fluid Gains and Losses
kidneys, skin, lungs, GI tract
a patient with a kidney injury should not be given what solution?
lactated ringers because it contains potassium and can cause hyperkalemia
lactated ringers should not be used in the treatment of
lactic acidosis because this condition impairs the ability to convert lactate into bicarb
An elevated hematocrit level reflects
low fluid level and a hemo concentration. Electrolytes are in an imbalance as sodium and potassium levels are excreted together in clients with dehydration.
if urine specific gravity is less than 1.010
lower specific gravity and patient may be OVERhydrated
sepsis can cause capillaries to leak which can let fluid go into the
lungs
Low Blood Urea Nitrogen (BUN)
may indicate malnutrition (low protein diet), fluid volume excess, or severe hepatic (liver) damage.
Creatinine is a breakdown product of
muscle metabolism that is almost totally cleared from the bloodstream and excreted by the kidney.
Normal potassium level is 3.5 to 5.5 mEq/L. Elevated potassium levels can lead to
muscle weakness, paresthesias, and cardiac dysrhythmias.
A client with a calcium level of 4.0 mg/dL has hypocalcemia. The nurse closely monitors the client with hypocalcemia for
neurological manifestations such as tetany, seizures, and spasms. If the calcium level continues to decrease, seizure precautions are necessary. Cardiac dysrhythmias and airway obstruction may also occur.
nursing considerations for monitoring Potassium levels
offering a diet containing sufficient potassium, which includes fruits and vegetables, and monitoring the intake and output. Approximately 40 mEq of potassium is lost for every liter of urine output.
more concentrated solutes equals a greater
osmolarity and a greater pull for water in that direction
fluid movement stops when
osmolarity on both sides of the membrane is equal (there is no concentration gradient)
Sodium concentrations are higher
outside the cell
Hematocrit decreases with
over hydration and anemia
extracellular fluid is
peed out
when capillaries dilate they become more
permeable (leaky)
lactated ringers has a tonicity similar to
plasma
hypertonic fluids are considered
plasma expanders
Osmolarity of IV fluid is based on
plasma osmolarity
Example of extracellular fluid
plasma/blood
conditions that may result in hypovolemia
polyuria, vomiting, diarrhea, hemorrhage, fistulas, fever, excessive NG tube suctioning
Increased BUN (retained)
poor kidney function, GI bleeding, dehydration, increased protein intake, fever, sepsis
Many diuretics, such as ethacrynic acid (Edecrin), also waste
potassium
A client presents with fatigue, nausea, vomiting, muscle weakness, and leg cramps. The laboratory values are as follows:sodium 147 mEq/L (147 mmol/L)potassium 3.0 mEq/L (3.0 mmol/L)chloride 112 mEq/L (112 mmol/L)Magnesium 2.3 mg/dL (0.95 mmol/L)What laboratory value is consistent with the client's symptoms?
potassium 3.0 mEq/L (3.0 mmol/L) Explanation: Potassium is the major intracellular electrolyte. Hypokalemia (potassium levels lower than 3.5 mEq/L) usually indicates a deficit in total potassium stores. Potassium deficiency can result in derangements in physiology. Clinical signs include fatigue, anorexia, nausea, vomiting, muscles weakness, leg cramps, decreased bowel motility, and paresthesias. The sodium, chloride, and magnesium levels listed are within normal limits.
ace inhibitors decrease
preload and afterload
Glomerulus function
produces ultra filtrate which then passes through tubules. Capsules block the passage of red blood cells and large molecules like protein
Acidotic states are from excess carbonic acid and hydrogen ions in the system. Respiratory alkalosis results from a carbonic acid deficit that occurs when
rapid breathing releases more CO2 than necessary.
Crushing's disease
rare disorder that develops when too much cortisol is released by the adrenal cortex as a result of stimulation of the pituitary
Serum creatinine increases when
renal function decreases
serum creatinine increases when
renal function decreases
lactated ringers are used most commonly for
replacing intravascular volume
increase in water loss through lungs when there is an increase in
respiratory rate, dry climate, high temperature, and exercise
common solutes
sodium, potassium, magnesium, calcium, chlorine,
hypertonic solutions
solutions that cause cells to shrink or shrivel due to loss of water and Increase ECF volume 3% NaCl (hypertonic saline), 5% NaCL (hypertonic solution) IV Mannitol 5-25% (hypertonic
Water is a universal
solvent. -water dissolves more substances than any other liquid
solutes
substance dissolved in a solution by a solvent
where is blood pressure determined in the human body
the amount of blood the heart pumps and how hard it is for the blood to move through the arteries.
hydrostatic pressure
the pressure within a blood vessel that tends to push water out of the vessel
increased osmolality and decreased blood volume can stimulate
the release of ADH which increases the kidney's reabsorption of water which produces more concentrated urine
A client has been admitted to the hospital unit with signs and symptoms of hypovolemia; however, the client has not lost weight. The client exhibits a localized enlargement of her abdomen. What condition could the client be presenting?
third-spacing Explanation: Third-spacing describes the translocation of fluid from the intravascular or intercellular space to tissue compartments, where it becomes trapped and useless. The client manifests signs and symptoms of hypovolemia with the exception of weight loss. There may be signs of localized enlargement of organ cavities (such as the abdomen) if they fill with fluid, a condition referred to as ascites. Pitting edema occurs when indentations remain in the skin after compression. Anascara is another term for generalized edema, or brawny edema, in which the interstitial spaces fill with fluid. Hypovolemia (fluid volume deficit) refers to a low volume of extracellular fluid.
Signs of hypocalcemia include
tingling in the extremities and the area around the mouth and muscle and abdominal cramps.
A client is diagnosed with hypocalcemia and the nurse is teaching the client about symptoms. What symptom would the nurse include in the teaching?
tingling sensation in the fingers Explanation: Tingling or numbess in the fingers is a symptom of hypocalcemia. Flank pain, polyuria, and hypertension are symptoms of hypercalcemia.
diffusion and filtration are
two types of passive transport
colloid solution functions
used as volume/plasma expander for intravascular part of ECF •Affects clotting by coating platelets and decreasing ability to clot •Remains in circulatory system for up to 24 h •Used to treat hypovolemia in early shock to increase pulse pressure, cardiac output, and arterial blood pressure •Improves microcirculation by decreasing red blood cell aggregation
A nurse is providing an afternoon shift report and relates morning assessment findings to the oncoming nurse. Which daily assessment data is necessary to determine changes in the client's hypervolemia status?
weight Explanation: Daily weight provides the ability to monitor fluid status. A 2-lb (0.9 kg) weight gain in 24 hours indicates that the client is retaining 1 L of fluid. Also, the loss of weight can indicate a decrease in edema. Vital signs do not always reflect fluid status. Edema could represent a shift of fluid within body spaces and not a change in weight. Intake and output do not account for unexplainable fluid loss.
symptoms of fluid volume excess
weight gain, edema, tachycardia, tachypnea, hypertension, bounding pulses, dyspnea, crackles (fluid in the lungs), jugular vein distension
Crystalloids
•Balanced salt / electrolyte solution •Known as IV fluids •Capable of passing through semipermeable membranes
dextrose 5% in water
•Osmolarity ~ 252 mOsmol/L •Used to treat water losses/dehydration & hypernatremia •Dextrose quickly metabolized à free water moves from vessels into cells (For every liter; 2/3 ICF, 1/3 ECF)
osmotic pressure
•The amount of pressure required to stop the osmotic flow of water •osmotic pressure is the pressure exerted by the solutes within the plasma. •Determined by the concentration of solutes in a solution •Measured in milliosmoles per kilogram, m0sm/kg
Direction fluid moves between ECS & ICS affected by
•The osmolarity of fluid in the adjacent area •Higher the Osmolarity = greater amount of "pull" it has •Water will then move in that direction •To the cells, or to the capillaries?