N3035- Fluid and Electrolytes (REVISED for final exam)
sxs of hypotension and tissue hypoperfusion: -SBP <___ -HR>___ -RR>____ -capillary refill> ___ seconds -peripheries ___ to touch -altered ___ status
100, 90, 22, 2, cold, mental
a client is diagnosed with parathyroid dysfunction. Which serum calcium concentration supports the diagnosis? -7.8 mg/dL -8.9 mg/dL -9.7 mg/dL -10.2 mg/dL
7.8 mg/dL
calcium normal levels
9.0-10.5 (mEq/L)
HYPOCALCEMIA: -Tap the face just below and in front of the ear positive: facial twitching of one side of the mouth, nose, and cheek.
Chvostek's sign
FVD management- fluid therapy: -oral hydration -___ fluid -monitor for fluid ___ and IV site -___ daily -I&O
IV, overload, weigh
hypernatremia management- nutrition therapy: -___ restriction -adequate ___ intake (assess for hypovolemia)
Na+, fluid
bound calcium is attached to ___ and ____ calcium is the free, active form that must be kept within range
albumin, ionized
K+ is regulated by the Na-K pump and the kidneys through excretion and ____
aldosterone
sodium maintains ___ ___ by regulating water and osmotic pressure you will always see an imbalance in fluids if there is an imbalance in sodium, and vice versa
blood volume
which clinical manifestations would the nurse identify when assessing a client with hypercalcemia? SATA -muscle tremors -abdominal cramps -increased peristalsis -cardiac dysrhythmias -hypoactive bowel sounds
cardiac dysrhythmias, hypoactive bowel sounds
hypercalcemia management- drug therapy: -discontinue medication causing the imbalance -hemodialysis (last resort) -____ diuretics -_____ (pamidronate) for malignancy-associated hypercalcemia -____ to inhibit bone resorption -IV fluid therapy
loop, biphosphonates, calcitonin
FVD management- patient safety: -monitor VS -____ status -____ strength -and ____
mental, muscle, gait
FVE management- patient safety: -monitor VS -___ ___ -skin breakdown -____ status, ____ status, ____ status
peripheral edema, respiratory, cardiac, mental
hypercalcemia management- nutrition therapy: -low calcium diet -high ___ diet
phosphate
____ imbalance: neurological symptoms
sodium
____ is kept in the extracellular compartment, while ____ is kept in the intracellular compartment
sodium, potassium
___ acts as a modulator facilitating the movement of Na+ and K+ through the Na-K pump
Mg++
____ and ___ usually decreased with hypokalemia
Mg++ (more than Ca++), Ca++
hyponatremia management- nutrition therapy: -high ___ intake -restrict ___ intake (assess for hypervolemia)
Na+, fluid
Na+ is regulated by the Na-K pump and by the kidneys through ____, ____ hormone, and natriuretic peptide
aldosterone, antidiuretic
hormones like ____, ____ hormone, natriutetic peptide (NP), and renin-angiotensin II pathway regulate fluid and electrolyte balance
aldosterone, antidiuretic
which clinical manifestations would the nurse expect to find in a client with hypokalemia? SATA -thirst -anorexia -leg cramps -rapid, thready pulse -dry mucous membranes
anorexia, leg cramps
functions of Ca++: -maintains ___ strength and density -activates ____ -allows skeletal and cardiac muscle ____ -controls nerve impulses by regulating the movement of Na++ across membranes -membrane stabilizer (cardiac mostly) -allows blood ___
bone, enzymes, contraction, clotting
Patients with chronic hypocalcemia will have brittle, fragile ____ - use lift sheets when repositioning to prevent fractures
bones
hyperkalemia management- drug therapy: -discontinue medications causing the imbalance -hemodialysis (last resort) -IV ___ (if cardiac sxs present) -IV ___ and insulin, IV ____, sodium polystyrene sulfonate, loop diuretics, ______ (a new drug that decreases absorption of K+ in the GI tract), sodium ____ cyclosilicate (a new drug that works in the GI tract to lower K+)
calcium, glucose, HCO3, patiromer, zircondium
hyperkalemia management- patient safety: -___ complications -fall prevention -monitor response to therapy -monitor for hypokalemia, metabolic ____, cardiac status, and VS
cardiac, acidosis
hypercalcemia management- patient safety: -____ complications -monitor for hypocalcemia, cardiac status, neuromuscular status, ___ status, VS, and blood ____
cardiac, intestinal, clotting
hypotonic solutions hydrate the cells because they shift from ECF to ICF watch for ___ ___
cerebral edema
cerebral changes are normally seen in hyponatremia due to ___ ___ and increased ____ pressure
cerebral edema, intracranial
sodium and ___ are directly related if one is high/low, the other will be too
chloride
Chronic hypocalcemia may further increase the risk of bleeding related to delayed ____
clotting
which finding by the nurse when assessing a client who is receiving intravenous (IV) fluids indicates need for a change in the fluid infusion rate? -crackles in lungs -supple skin turgor -urine output of 480 mL over 8 hours -heart rate decrease from 126 beats/minute to 96 beats/minute
crackles in lungs
FVD management- drug therapy: -anti-____ -antibiotic -anti-____ -anti-____
diarrheal, emetic, pyretic
FVE management- patient education: -identify risks -appropriate ___ choices -weight ___
diet, gain
It is the movement of particles (solutes) across a permeable membrane from an area of higher solute to lower solute concentration Transports most electrolytes and other particles through cell membranes
diffusion
fluid volume overload with hyponatremia: -aka _____ hyponatremia -due to excessive fluids in the body -dilutes sodium -seen with conditions such as heart failure or treatment with hypotonic solutions
dilutional
fluid volume deficit with hyponatremia: -there is loss of both fluid and sodium -seen in conditions such as _____ therapy
diuretic
hyponatremia management- drug therapy: -reduce ___ doses
diuretic
FVE management- drug therapy: -_____ -_______/tolvaptan -monitor response, weigh daily, I&O
diuretics, conivaptan
K+ imbalances: -cardiac monitoring for ____ is critical: PVCs, conduction delays, ventricular fibrillation, heart blocks, tall T waves, and presence of U wave on ECG
dysrhythmias
hypercalcemia: -cardiac ____ can occur (monitoring!) -may further increase risk of ___ ___ in those who are predisposed
dysrhythmias, blood clots
It occurs with changes in hydrostatic pressure. Venous hydrostatic pressure increases, forcing fluids into the interstitial spaces
edema
balance between dietary intake of electrolytes and renal excretion or reabsorption of electrolytes
electrolyte homeostasis
solutes that express an overall electrical charge
electrolytes
extracellular compartment: -contains extracellular fluids and ____ -fluid is outside of the cell (___%)
electrolytes, 40
Allows diffusion of large, membrane insoluble compounds such as sugars and amino acids by binding to a membrane-altering system for transport
facilitated diffusion
It is the movement of water molecules (solvents) through a cell or blood vessel membrane from an area of higher hydrostatic pressure to lower hydrostatic pressure
filtration
the four regulatory processes?
filtration, diffusion, osmosis, active transport
when caring for a client who has hypokalemia, which electrocardiogram change will the nurse expect to observe? -inverted P waves -flattened T waves -absence of U waves -elevated ST segment
flattened T waves
"Water-pushing pressure" - is the force that pushes water outward from a confined space through a membrane
hydrostatic pressure
hypocalcemia management- drug therapy: -Ca++ oral/IV replacements -vitamin D supplement aluminum ____
hydroxide
Hyperphosphatemia must be treated with _____
hypocalcemia
postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. which complication would the nurse expect the patient is experiencing?
hypocalcemia
the manifestations of hyperphosphatemia are consistent with the manifestations of ____
hypocalcemia
glucose binds with ___ to enter most cell membranes by facilitated diffusion
insulin
fluid in between the cells of the body
interstitial fluid
na+/k+ pump (active transport): -pumps k+ ___ the cell, and na+ ___ of the cell requires ATP energy
into, out
___ fluid constitutes most of the body's fluid (approximately 2/3)
intracellular
-contains intracellular fluid and electrolytes -fluid is inside the cell (60%)
intracellular compartment
isotonic solutions do not shift between compartments, which effectively expands ___ (ECF) volume and improves ____ ____
intravascular, blood pressure
which finding for a client who has a potassium level of 2.8 mEq/L (2.8 mmol/L) would be of most concern to the nurse? -abdominal cramps -irregular heart rate -decreased reflexes -muscle weakness
irregular heart rate
if a patient is hyponatremic, give ____ solutions
isotonic
if there are signs of hypotension or tissue hypoperfusion, give ____ solutions
isotonic
hypernatremia with hypovolemia: -____ solution to resuscitate -once BP is stable, ___ or ____
isotonic, hypotonic, D5W
the fluids and electrolytes we eat/drink are excreted or reabsorbed through the ____
kidneys
hypocalcemia may cause ___- watch respiratory status
laryngospasms
hypernatremia with hypervolemia- drug therapy: -___ ___
loop diuretics
initially considered hypertonic, dextrose-containing solutions become isotonic or hypotonic once the dextrose is _____ ex. D5NS becomes isotonic, D51/2NS becomes hypotonic
metabolized
which nursing action is the priority for a client who has a serum potassium level of 6.7 mEq/L (6.7 mmol/L)? -monitor for cardiac dysrhythmias -inquire about changes in bowel patterns -assess for leg muscle twitching or weakness -assess for signs and symptoms of dehydration
monitor for cardiac dysrhytmias
which clinical manifestations would the nurse identify when assessing a client with hypocalcemia? SATA -muscle tremors -abdominal cramps -increased peristalsis -cardiac dysrhythmias -hypoactive bowel sounds
muscle tremors, abdominal cramps, increased peristalsis
the nurse is caring for a postoperative client who has a NGT attached to low continuous suction. Which assessment finding indicates that the client may be experiencing hypokalemia? -tingling of the fingertips and toes -dry and sticky mucous membranes -abdominal cramping and irritability -muscle weakness and cardiac dysrhythmias
muscle weakness and cardiac dysrhythmias
which clinical manifestations will the nurse assess for in a client with a serum potassium level of 6.4 mEq/L (6.4 mmol/L)? SATA -anorexia -consipation -muscle weakness -irregular heart rhythm -hyperactive bowel tones
muscle weakness, irregular heart rhythm, hyperactive bowel tones
sodium maintains proper ____ transmissions for skeletal muscle and brain functioning if there is a sodium imbalance, symptoms will always affect the brain
nerve
Na+ imbalance: -muscle weakness, spasms, and twitching occur due to a compromised transmission of ___ ___ -assess ___ status if muscle weakness is present
nerve impulses, respiratory
How fast can K+ IV be administered safely?
no more than 20 mEq/hr
hyponatremia with hypovolemia- drug therapy: -_____ ____ -with neuro symptoms: ___ solution (3-5% normal saline)
normal saline, hypertonic
___ adults, ____, and ___ are prone to fluid imbalances because they have less body water
older, obese, women
lowered urinary output
oliguria
when a client is admitted with dehydration, which clinical manifestations would the nurse expect to find? SATA -oliguria -dyspnea -hypotension -pulmonary crackles -tenting skin turgor
oliguria, hypotension, tenting skin turgor
hypokalemia management- drug therapy: -K+ ___ supplements -K+ ___ infusion -discontinue medications causing imbalance
oral, IV
IV fluid therapy is based on the plasma's ____
osmolality
the concentration of osmotic solutions per liter of solution
osmolality
the concentration of osmotic solutions per kg of solution
osmolarity
all fluids that leave the body are called the ___
output
hypokalemia management- patient safety: -adequate ___ -fall prevention -injury prevention from K+ administration -monitor response to therapy -monitor for hyperkalemia, metabolic ___, cardiac/respiratory status, muscle weakness, constipation, VS
oxygenation, alkalosis
neuromuscular changes such as ___, tingling, numbness, and ____ occur particularly in hypocalcemia
paresthesia, tetany
the ____ concentration of a body fluid dictates the osmosis and diffusion
particle (solute)
diffusion is ___ and does not require energy
passive
which result would the nurse expect to see on the ECG tracing monitor when a client has diabetic ketoacidosis and potassium level of 5.4 mEq/L (5.4 mmol/L)? -abnormal P waves and depressed T waves -peaked T waves and widened QRS complexes -abnormal Q waves and prolonged ST segments -peaked P waves and an increased number of T waves
peaked T waves and widened QRS complexes
hypocalcemia management- nutrition therapy: -high calcium diet -low ___ diet
phosphate
calcium and ___ have an inverse relationship
phosphorus
an older client is admitted to the hospital for rehydration therapy after 3 days of diarrhea. in addition to sodium, which electrolyte would the nurse be most concerned about? -calcium -chlorides -potassium -phosphates
potassium
what electrolyte is present in these foods? All meats (red meat and chicken) and fish, such as salmon, cod, flounder, sardines, soy products, veggie burgers., broccoli, peas, lima beans, tomatoes, potatoes (particularly their skins), sweet potatoes, winter squash, citrus fruits, cantaloupe, bananas, kiwi, prunes, and apricots, milk, yogurt, and nuts
potassium
___, ___, and ___ are the electrolytes most often lost with diarrhea
potassium, sodium, bicarbonate
the amount of water in any body fluid space determines ____
pressure
patients at highest risk for hyperkalemia include those with ___ dysfunction, chronically ill, ____ patients, and older adults
renal, debilitated
hypokalemia: -assess ___ status if muscle weakness is present -monitor for common clinical complaints of ___ cramps and ___ -watch for ___ toxicity
respiratory, leg, constipation, digoxin
FVE management- nutrition therapy: -fluid and diet _____
restrictions
which clinical manifestation is associated with hypernatremia in burns? -fatigue -seizures -paresthesias -cardiac dysrhythmias
seizures
when monitoring a patient for hyponatremia, which assessment findings would the nurse consider significant? SATA -thirst -seizures -erythema -confusion -constipation
seizures, confusion
which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client? -serum sodium of 139 mEq/L -serum chloride of 100 mEq/L -serum calcium of 10.2 mg/dL -serum potassium of 7.2 mEq/L
serum potassium of 7.2 mEq/L
what electrolyte is present in these foods? Worcestershire sauce, soy sauce, onion salt, garlic salt, bouillon cubes, processed meats like bacon, sausage, and ham, canned soups, canned vegetables, fast foods
sodium
particles dissolved or suspended in water
solutes
the body is composed of fluids and particles dissolved or suspended in water; the fluid portion is called a ____
solvent
a client is admitted to the emergency department with reports of frequent loose, watery stools and anorexia during the past week. Blood pressure is 90/68 mmHg and pulse is 124. which prescribed action should the nurse take FIRST? -obtain blood and urine cultures -start infusion of normal saline -insert retention catheter -transfer the client to intensive care unit
start infusion of normal saline
when a client in the emergency department has a blood pressure of 90/60 mmHg, weak quality radial pulse of 108 beats/min, and reports working outside for several hours on a hot day, which prescribed action would the nurse take first? -complete head-to-toe assessment -start infusion of normal saline 500 ml -ask the client about current medications -obtain blood samples for laboratory testing
start infusion of normal saline 500 ml
hypocalcemia management- patient safety: -reduce environmental ___ -prevent fractures from chronic hypocalcemia -____ precaution -Monitor for hypercalcemia, K+, Mg++, Vit D, PTH levels, cardiac status, respiratory status, neuromuscular status, VS, skeletal - for chronic hypocalcemia, and ___ ___
stimuli, seizure, delayed clotting
HYPOCALCEMIA: -place BF cuff around arm, inflate greater than the patient's systolic BP for 1-4 minutes positive: occurs when hand and fingers go into spasm in palmar flexion
trousseau sign
vitamin ___ is needed for the absorption of calcium
D
normal sodium levels
135-145 (mEq/L)
It is the movement of water molecules (solvent) across a selectively permeable (semi-permeable) membrane from a less concentrated solution to a more concentrated solution
osmosis
"water pulling pressure" force that stops osmosis
osmotic pressure
____ imbalance: cardiac, GI, musculoskeletal system manifestations
potassium
regulatory processes are in place to keep internal environment ___. they determine how, when, and where fluids and particles move across ____ ____
stable, cell membranes
Postmenopausal women are at risk for chronic calcium loss due to reduced weight-bearing activities and a decrease in _____ levels
estrogen
treating hypokalemia: -do not give intravenous potassium at a rate higher than ___ mEq per hour -never give potassium supplements by the ___, ____, or IV push routes -use a pump or controller when giving IV potassium-containing solutions -assess IV site hourly- stop if phlebitis/infiltration is suspected -give oral potassium during/after meal to avoid nausea and vomiting
20, IM, SUBQ
the osmolality of blood plasma (ECF) is ___-____ mOsm/L
270, 300
normal range of potassium
3.5-5.0 (mEq/L)
obligatory urine output to effectively excrete toxic waste products is ___-___ ml/day
400, 600
insensible water loss from the skin, lungs, and GI system is ___ to ____ mL/day must be replaced to avoid severe dehydration and electrolyte imbalances
500, 1000
patients at highest risk for hypokalemia include those with ___ and on ____
CHF, diuretics
-most abundant cation in the body; stored in the bones and teeth -enters the body by dietary intake, absorbed through the intestinal tract, and stored in the bones
Ca++
-major intracellular cation -essential for the depolarization and generation of action potentials to maintain cardiac, skeletal, and smooth muscle function -transmits nerve and cardiac impulses -regulates protein synthesis, glucose use and storage, and acid-base balance
K+
-major extracellular cation -maintains blood volume by regulating water -generates electrical impulses for proper brain functioning and muscle concentration -maintains osmotic pressure
Na+
Movement of particles (solutes) across a membrane against a concentration or electrochemical gradient used to pump specific compounds in or out of the cell
active transport
fluid in the vascular spaces (veins/arteries)
blood plasma
extracellular fluid (ECF) is divided into ___ ___ and ____ fluid
blood plasma, interstitial
Moves blood from the heart to the capillaries where the exchange of water, nutrients, wastes between blood and tissues occur
blood pressure
two main examples of filtration?
blood pressure, edema
in symptomatic hyperkalemia, giving ____ stabilizes the cardiac membrane to prevent lethal dysrhythmias
calcium
sodium is needed for the excretion of ___ through the kidneys
calcium
what electrolyte is present in these foods? Yogurt, most cheeses, buttermilk, milk, green leafy vegetables such as broccoli, collards, kale, mustard greens, turnip greens, Chinese cabbage, salmon and sardines canned with their soft bones, almonds, Brazil nuts, sunflower seeds, tahini, dried beans, blackstrap molasses, orange juice, soy milk, tofu, ready-to-eat cereals, and bread
calcium
when caring for a client admitted with massive vomiting of blood, which finding would be the most concern to the nurse? -hematocrit of 35% -cool hands and feet -heart rate 124 beats/min -stools positive for occult blood
heart rate 124 beats/minute
when you give a large amount of normal saline solution (has good amount of sodium and chloride), you are at risk for giving patients ___ ___ ___, which can lead to kidney injuries if not resolved
hyperchloremic metabolic acidosis
____ slows the flow of ca++ into the cardiac cells
hypernatremia
fluid volume overload with _____: -based on principle that water follows salt -commonly seen in excessive salt ingestion
hypernatremia
Patients with chronic renal failure will most likely have hypocalcemia due to ______
hyperphosphatemia
if patient has symptomatic hyponatremia, give ____ solutions (3-5% NS)
hypertonic
fluid volume deficit with hypernatremia: -there is more fluid loss than sodium loss -also called ____ ____
hypertonic dehydration
a client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. the nurse identifies a U wave on the cardiac monitor. which electrolyte imbalance is causing these clinical findings?
hypokalemia
if hypernatremic, give ____ solutions or ___ containing crystalloids
hypotonic, dextrose
all fluids that enter the body orally or parenterally is called the ____
input
hypercalcemia standard treatment is to give ___ ___ IV therapy
normal saline
What routes can K+ be administered safely?
parenteral IV, oral
hypernatremia management- patient safety: -monitor response to therapy -___ protection -monitor for hyponatremia, ____, neuro status, VS, and I&O
skin, dehydration
hyponatremia management- patient safety: -monitor response to therapy -___ protection -monitor for hypernatremia, fluid ____, ___ status, VS, and I&O
skin, overload, neuro
FVD management- patient education: -adequate hydration ____ the day -avoid ____ and injuries -identify risks
throughout, falls
calcium is regulated by ___ hormones (increases) and ____ (decreases)
thyroid, thyrocalcitonin
hyponatremia with hypervolemia (dilutional hyponatremia)- drug therapy: -___ or ____ (removes water but keeps Na+)
tolvaptan, conivaptan
a client is prone to hyponatremia. which factors would the nurse identify that can precipitate hyponatremia? SATA -wound drainage -diuretic therapy -GI suction -parenteral infusion of 0.9% sodium chloride -inappropriate antidiuretic hormone (ADH) secretion
wound drainage, diuretic therapy, GI suction, inappropriate antidiuretic hormone secretion
