Fluid & Electrolyte
Magnesium WNL
1.6-2.5 mg/dL
BUN:Creatinine WNL
10:1
NA+ WNL
135-145
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
Isotonic Lactated ringers
5% dextrose in 0.2% saline (D5W)
Moderate dehydration in pediatrics
6-9% loss of body weight
Calcium WNL
8.5-10.5 mg/dL
CI- WNL
95-105
Severe dehydration in pediatrics
>10% loss of body weight
GFR (glomerular filtration rate) lab WNL
>60
Hematocrit
% volume of red blood cells
Which of the following arterial blood gas results would be consistent with metabolic alkalosis?
Serum bicarbonate of 28 mEq/L
Conditions that potentiate fluid excess
Cardiac failure, kidney dysfunction, IV fluid, liver disease, extremes in age
Electrolyte
Charged particle when dissolved in water
CO2 WNL
24-32
K+ WNL
3.4-5.0
Serum Albumin WNL
3.5-5
Hypotonic solution
0.45% normal saline
Creatinine WNL
0.6-1.2
Isotonic Normal saline
0.9%
Urine Specific gravity WNL
1.005-1.030
Urine osmolality WNL
250-900 mOsm/Kg
Serum osmolality WNL
275-300 mOm/Kg
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of:
280 mOsm/kg.
Mild dehydration in pediatrics
3-5% loss of body weight
diphenoxylate (Lomotil)
Antidiarrheal
loperamide (Imodium)
Antidiarrheal
ondansetron (Zofran)
Antiemetics (5-HT3 receptor blocker)
prochlorperazine (Compazine)
Antiemetics (phenothiazines)
promethazine (Phenergan)
Antiemetics (phenothiazines)
acetaminophen (Tylenol)
Antipyretics
ibuprofen (Advil/motrin)
Antipyretics
Which of the following are the insensible mechanisms of fluid loss?
Breathing
Which findings indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?
Confusion and seizures
Lawrence Wilkins, a 73-year-old male, was admitted to your hospital unit after two days of vomiting and diarrhea. His wife became alarmed when he demonstrated confusion, elevated temperature and reported "dry mouth". From what condition would you suspect Lawrence may be suffering?
Dehydration
Osmosis
Diffusion of water through a selectively permeable membrane
A nurse is caring for an adult client with numerous draining wounds from gunshots. The client's pulse rate has increased from 100 to 130 beats per minute over the last hour. The nurse should further assess the client for which of the following?
Extracellular fluid volume deficit
Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis?
Extreme anxiety
Hypertonic
Having a higher concentration of solute than another solution
Hypotonic
Having a lower concentration of solute than another solution
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, partial pressure of arterial carbon dioxide (PaCO2) of 43 mm Hg, partial pressure of arterial oxygen (PaO2) of 75 mm Hg, and bicarbonate (HCO3-) of 42 mEq/L. Based on these findings, the nurse documents that the client is experiencing which type of acid-base imbalance?
Metabolic alkalosis
A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for:
Hyponatremia
Aldosterone does...
It plays a central role in the regulation of blood pressure mainly by acting on the distal tubules and collecting ducts of the nephron, increasing reabsorption of ions and water in the kidney, to cause the conservation of sodium, secretion of potassium, increase in water retention, and increase in blood pressure and blood volume.
Albumin
Major plasma protein produced by the liver
A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder?
Metabolic acidosis
Diffusion
Movement of molecules from an area of higher concentration to an area of lower concentration.
Anion
Negative ion
Cation
Positive ion
Filtration
Process that occurs in the nephron where nutrients and wastes diffuse from the glomerulus into Bowman's capsule
Brownian motion
Random movement of molecules in body fluid spaces
Excretion
Removal of metabolic wastes
A nurse is caring for a client admitted with a diagnosis of exacerbation of myasthenia gravis. Upon assessment of the client, the nurse notes the client has severely depressed respirations. The nurse would expect to identify which acid-base disturbance?
Respiratory acidosis
A client comes to the emergency department with status asthmaticus. His respiratory rate is 48 breaths/minute, and he is wheezing. An arterial blood gas analysis reveals a pH of 7.52, a partial pressure of arterial carbon dioxide (PaCO2) of 30 mm Hg, PaO2 of 70 mm Hg, and bicarbonate (HCO3??') of 26 mEq/L. What disorder is indicated by these findings?
Respiratory alkalosis
A nurse reviews the arterial blood gas (ABG) values of a client admitted with pneumonia: pH, 7.51; PaCO2, 28 mm Hg; PaO2, 70 mm Hg; and HCO3--, 24 mEq/L. What do these values indicate?
Respiratory alkalosis
Oliguria
Small amount of urine
Hydrostatic pressure
The pressure of water against the walls of its container.
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
Isotonic
When the concentration of two solutions is the same
Anuria
absence of urine
BUN
blood urea nitrogen
Why do a chest x-ray
checking for fluids, infiltrate, congestion, pulmonary edema
Crystalloids
clear fluids
Role of lungs
excrete carbonic acid (H+ + water = carbon dioxide), fluid loss thru exhalation (insensible loss)
Isotonic solution does
expand circulating extracellular fluid volume
Trans-cellular
fluid in body cavities
Osmolality
fluid measurement inside the body
Osmolarity
fluid measurement outside of the body
Intracellular (ICF)
high potassium level inside cells while keeping sodium low
Extracellular (ECF)
high sodium level outside cells while keeping potassium low
Aldosterone
hormone also helps maintain the blood's pH and electrolyte levels
Impermeable
impenetrable
Sympathetic Nervous system
initial compensatory response to changes in extracellular fluid sensed by volume (Stretch receptors)
Creatinine lab shows
level of renal function
Orthostatic hypotension
low blood pressure that occurs upon standing up
Role of serum proteins
maintain intravascular volume
Hypotonic solution does
moves fluid into cells
Hypertonic solution does
moves fluid out ofcells into extra cellular fluid
Reasons for low Serum Albumin
old age, poor nutrition
Alkalosis
pH above 7.45
Acidosis
pH below 7.35
Intravascular
plasma
Colloids
plasma volume expanders
BUN lab shows
protein metabolism
Oncotic pressure
protein molecules in plasma pull fluid into intravascular space
RAAS
renin-angiotensin-aldosterone system
Antidiuretic hormone
stimulates kidney tubules to retain water.
Role of Albumin
to maintain intravascular volume
BUN:Creatinine above NL
usually indicates hypovolemia
