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Fluid-elect-acid - Practice questions, quiz 5, Fluid and Electrolyte Acid balance, good material
Fundamentals of Nursing (NRS 130 )
Long Island University
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Fundamentals Quiz # Fluids, Electrolytes, & Acid-Base Balance Body Fluid ● Water is the primary body fluid ● Water content varies with age, sex, and adipose tissue ● Water contains solutes ○ Electrolytes ○ Nonelectrolytes
Body Fluid Compartments ● Intracellular - fluid within the cells ● Extracellular - all fluid outside of the cells ○ Interstitial Compartment - surrounds tissue cells and bathes them in a solution of nutrients and other chemicals ○ Intravascular Compartment - inside the blood vessels and the lymphatic vessels (blood plasma and lymph) ○ Transcellular Compartment - small amounts of transcellular fluids such as ocular and cerebrospinal fluids are found here
Movement of Fluids and Electrolytes ● Osmosis - the movement of a solvent (such as water) through a semipermeable membrane (as of a living cell) into a solution of higher solute concentration that tends to equalize the concentrations of solute on the two sides of the membrane. ● Diffusion - the net passive movement of particles (atoms, ions or molecules) from a region in which they are in higher concentration to regions of lower concentration. It continues until the concentration of the substance is uniform throughout. ● Filtration - the passage through a filter or other material that prevents the passage of certain molecules, particles, or substances. ● Active Transport - the movement of ions or molecules across a cell membrane into a region of higher concentration, assisted by enzymes and requiring energy.
Fluid Intake ● Primarily through drinking fluids ● The Institute of Medicine (IOM) recommends: ○ Females - 2,700 mL/day or (2 - 2 liters) ○ Males - 3,500 mL/day or (3 - 3 liters) ● 20% of fluid intake comes from food/metabolism of food ● Fluid intake is regulated by thirst: ○ A change in plasma osmolality and the Hypothalamus
Fluid Output ● Urine - 1,500 mL/day ○ 30 mL/hour ● Skin - Perspiration (sweating) ● Lungs - Exhalation ● Feces - 100 to 200 mL/day
Major Electrolytes ● Sodium - ○ Extracellular Fluid (ECF): regulates fluid volume ○ Reabsorbed by the kidneys ● Potassium - ○ Intracellular Fluid (ICF): muscle contraction; cardiac conduction ○ Eliminated by the kidneys ● Phosphate (Phosphorus) - ○ Intracellular Fluid (ICF) anion ○ Bound with calcium in teeth and bones; inverse relationship ● Bicarbonate - ○ Intracellular Fluid (ICF) and Extracellular Fluid (ECF) → acid-base balance ○ Regulated by the kidneys ○ Produced by the body to act as a buffer ● Calcium - ○ Bone health; neuromuscular function; cardiac function ○ Insufficiency leads to Osteoporosis ○ In order for our bodies to absorb calcium better, it needs to be taken with Vitamin D ● Magnesium - ○ Intracellular Fluid (ICF); bone; many cellular functions ○ Alcoholism leads to low levels of magnesium ● Chloride - ○ Extracellular Fluid (ECF); bound to other ions
Acid-Base Balance ● Acid - compound that contains hydrogen (H+) ions ● Base - compound that accepts hydrogen ions ● The amounts that are in a solution are reflected by the pH ● The acceptable range for blood serum is a pH of 7 to 7. ○ Measured by arterial blood gases (ABGs) → measure pH, carbon dioxide and oxygen levels within the blood
○ Metabolic Acidosis - ■ Depression of HCO3- or an increase in noncarbonic acids ■ Metabolic acidosis starts in the kidneys. It occurs when they can’t eliminate enough acid or when they get rid of too much base. ○ Metabolic Alkalosis - ■ Elevation of HCO3- usually caused by an excessive loss of metabolic acids ■ Metabolic alkalosis develops when your body loses too much acid or gains too much base. ● Example: excessive vomiting
Interpreting ABGs ● STEP 1 - ○ Look at the pH: is the blood acidic or alkalemic? ■ Examples: pH: 7 → acidosis (under 7) pH: 7 → alkalosis (over 7) pH: 7 → normal pH (7.35-7)
● Step 2 - ○ What is the primary disorder?
What disorder is present? pH PaCO2 or HCO Respiratory Acidosis pH low 0 PaCO2 high /
Metabolic Acidosis pH low 0 HCO3 low 0 Respiratory Alkalosis pH high / PaCO2 low 0
Metabolic Alkalosis pH high / HCO3 high /
ROME (Acid-Base Mnemonic)
Hyperkalemia ● Serum Potassium (K+) Level: > 6 mEq/L ○ Causes of Hyperkalemia: ■ Increased potassium (K+) intake ■ Shifts of K+ from intracellular fluid (ICF) → extracellular fluid (ECF) ■ Decreased renal excretion ■ Insulin deficiency ■ Cell trauma ■ Addison’s Disease ● Decreased production and secretion of aldosterone ● Impaired K+ excretion by the kidneys ○ Clinical Manifestations of Hyperkalemia: ■ Muscle cramping followed by weakness ● Skeletal muscle ● Respiratory muscles ● GI upset (cramping, diarrhea) ■ Cardiac dysrhythmia ● Decreased depolarization → flattened P wave, widened QRS ● Increased repolarization time → shortened QT interval ● Risk of V-Fib ○ How to Correct Hyperkalemia: ■ Decrease potassium intake ■ Dialysis if patient is in renal failure ■ Increase fluid intake ■ Medications ● Insulin forces potassium (K+) out of extracellular space and into intracellular space ● Kayexalate: helps excrete potassium through feces ■ Treat underlying diseases like Addison’s Disease and hypoaldosteronism with corticosteroids ○ Hyperkalemia: Nursing Implications and Patient Teaching - ■ Monitor/Educate about low potassium diet ● AVOID: high K+ foods - potatoes, bananas, carrots, orange juice, and V ● ENJOY: low K+ foods - most bread, most cheese, and cranberry juice ■ Monitor ECG and Vital Signs
■ Check for signs of muscle weakness ■ Administer adequate amount of insulin ■ If lab value doesn’t seem right (lysed RBCs) → redraw ■ Talk to your PCP about stopping potassium supplements and K+ sparing diuretics like spironolactone
Hypokalemia ● Serum Potassium (K+) Level: < 2 mEq/L ○ Causes of Hypokalemia: ■ Deficient intake of potassium (K+) ■ Increased entry of potassium into cells so less is available in the bloodstream ■ Black licorice ingestion/toxicity ■ Increased excretion of potassium from the kidneys ● Burns ● Metabolic Alkalosis ● Hyperaldosteronism ● Cushing’s Syndrome ○ Clinical Manifestations of Hypokalemia: ■ Alkalosis ■ Shallow respirations ■ Irritability ■ Confusion and drowsiness ■ Weakness and fatigue ■ Arrhythmias ■ EKG CHANGES ● Shallow T-wave ● Prominent U-wave ● ST depression ■ Lethargy ■ Thready pulse ○ How to Correct Hypokalemia: ■ Estimation of total body potassium loss ■ Correction of acid-base imbalances ■ Monitor Kidney Function (secretes K+) ■ Encouragement of K+ rich foods ● Bananas, potatoes, V8, orange juice ■ Max PO ● 40 - 80 mEq/day
■ Emergency → hypertonic saline (3% NS) plus diuretic ■ CORRECT SLOWLY: risk of myelinolysis resulting in death or permanent neurologic injury can occur ○ Hyponatremia: Nursing Implications - ■ Monitor lab results for serum sodium labs ■ Perform neurological checks ■ Take precautionary safety measures for fall and seizure risk ■ Monitor intake and output (I&O’s) ■ Daily morning weigh-ins for weight gain
Hypernatremia ● Serum Sodium (Na) Level: > 145 mEq/L ○ Causes of Hypernatremia: ■ Excess oral or IV intake of Na+ fluid ■ Inadequate fluid intake ■ Increased loss of body fluids ■ GI - vomiting, diarrhea, food poisoning ■ Other - drainages, hemorrhage, urine ■ Osmotic diuretics ■ Diabetes insipidus ○ Clinical Manifestations of Hypernatremia: ■ Intracellular dehydration (water movement from ICF to the ECF) ■ ECF becomes hypertonic, water leaves the cell and the cell shrinks ■ Convulsions ■ Pulmonary edema ■ Hypotension ■ Tachycardia ■ Fever (low grade) and flushed skin ■ Restless (irritable) ■ Dry mouth ○ How to Correct Hypernatremia: ■ Stop fluid loss and give H2O ■ Administer fluids SLOWLY to prevent rapid movement of H2O into brain cells (cerebral edema) ■ Seizures ■ Brain injury ■ Death ■ Type of fluid to give → HYPOTONIC ● It has a lower osmolarity than normal blood plasma
● It causes a fluid shift out of the blood vessels and goes into the cells ● It hydrates cells while reducing fluid in the circulatory system ○ Hypernatremia: Nursing Implications - ■ Prevent water loss by encouraging fluid intake ■ Monitor intake and output (I&O’s)
Hypocalcemia ● Serum Calcium (Ca) Level: < 8 mg/dL ○ Causes of Hypocalcemia: ■ Inadequate intestinal absorption ■ Deposition of ionized calcium into bone or soft tissue ■ Blood administration ■ Decreases in PTH and Vitamin D ■ Hypoparathyroidism ■ Renal failure ■ Pancreatitis ○ Risk Factors for Hypocalcemia: ■ Parathyroid disorder (too little parathyroid hormone) ■ End-stage renal disease ■ Thyroidectomy ■ Steroids ○ Clinical Manifestations of Hypocalcemia: ■ Neuromuscular irritability (tetany) ■ Cardiac arrhythmias (QT prolongation) ■ Muscle spasm ■ Paresthesias ■ Intestinal cramping ■ Hyperactive bowel sounds ○ Signs of Hypocalcemia: ■ Trousseau’s sign (hand/finger spasms) ■ Watch for arrhythmias (prolonged QT interval, cardiac arrest...) ■ Increase in bowel sounds (diarrhea) ■ Tetany ■ Chvostek’s sign (facial twitching) ■ Hypotension hyperactive DTR ○ How to Correct Hypocalcemia: ■ Seizure precautions ■ Administer calcium supplements
■ Administration of bisphosphonate drugs → prevents bone breakdown caused by malignancy ■ Treat underlying disease ■ Dialysis ○ Hypercalcemia: Nursing Implications - ■ Perform an ECG ● Check for changes associated with hypercalcemia (short QT interval and short ST segment) ■ Encourage fluid intake ● Facilitates calcium excretion by the kidneys ■ Monitor intake and output ■ Restrict dietary calcium intake ■ Increase patient mobility ■ Identify and closely monitor patients with risk: hyperparathyroidism, cancer, prolonged immobility, thiazide diuretics, kidney transplant
Hypophosphatemia ● Serum Phosphate Level: < 2 mg/dL ○ Causes of Hypophosphatemia: ■ Vitamin D deficiency ■ Antacid use ■ Long-term alcohol abuse ■ Malabsorption syndromes ■ Respiratory alkalosis ■ Hyperparathyroidism (increased renal excretion of phosphate) ○ Symptoms of Hypophosphatemia: ■ Respiratory failure ■ Numbness ■ Confusion ■ Reduced oxygen transport ■ Bone resorption ■ Cardiomyopathies ■ Convulsions ■ Irritability ■ leukocyte/platelet dysfunction ■ muscle/nerve dysfunction ■ Coma ○ How to Correct Hypophosphatemia: ■ Eat more phosphorus and Vitamin D
■ Vitamin D supplements ■ Treat hyperparathyroidism ■ If levels are critically low; IV phosphate ○ Hypophosphatemia: Nursing Implications - ■ Monitor WBC, RBC, and platelets ■ Monitor nutritional status for signs of malabsorption ■ Monitor oxygen saturation ■ Assess mental status
Hyperphosphatemia ● Serum Phosphate Level: > 5 mg/dL ○ Causes of Hyperphosphatemia: ■ Acute or chronic renal failure ■ Long-term use of enemas and laxatives containing phosphates ■ Chemotherapy that releases phosphate into the blood ■ Hypoparathyroidism ○ Symptoms of Hyperphosphatemia: ■ Tetany ■ Calcification (of soft tissues in lungs, kidneys, and joints) ■ Convulsions ■ Cardiac arrest ■ Hyperneuromuscular activity ■ Prolonged QT interval ○ How to Correct Hyperphosphatemia: ■ Limit foods high in phosphate (dairy products, meats, nuts, etc.) ■ Eat less processed foods ■ Treat hypoparathyroidism ■ Enhance renal excretion through saline diuresis ○ Hyperphosphatemia: Nursing Implications - ■ Diet is especially important for renal failure patients ■ Be alert for signs of hypocalcemia (both lab values and symptoms) ■ Place patient on continuous cardiac monitoring
■ Respiratory distress ■ Nausea/Vomiting ■ Excess nerve function ■ Loss of deep tendon reflexes ○ How to Correct Hypermagnesemia: ■ IV calcium is a magnesium antagonist ■ IV fluids to treat hypotension ■ Enhance renal excretion through saline diuresis ○ Hypermagnesemia: Nursing Implications - ■ Strict Intake and Output (I&O’s) ■ Place patient on continuous cardiac monitoring ■ Watch for hypotension, bradycardia, and respiratory depression ■ Assess neuromuscular function and level of consciousness (LOC)
Intravenous Therapy ● IV Therapy: crystalloids ● Types of Solutions: ○ Isotonic ○ Hypotonic ○ Hypertonic CAUTION: too rapid or excessive infusion of any IV fluid has the potential to cause serious problems
Nursing Diagnosis ● Decreased cardiac output ● Excess fluid volume ● Risk for injury ● Acute confusion ● Risk for electrolyte imbalance ● Deficient fluid volume ● Impaired gas exchange ● Deficient knowledge regarding disease management
Fluid Imbalances Deficit of Fluid Volume ● Hypovolemia - ○ Occurs when there is a proportional loss of fluid and electrolytes from the ECF ○ Loss of blood volume ● Dehydration - ○ Describes a state of negative fluid balance in which there is a loss of water from the intracellular, extracellular, or intravascular spaces ○ Dry skin, dry mucous membranes, non-elastic skin turgor ● Decreased urine output and blood pressure (hypotension); increased heart rate (tachycardia); rise in temperature ● Weight loss
Fluid Volume Excess ● Hypervolemia - ○ This involves excessive retention of sodium and water in the ECF ○ Fluid volume excess can result from excessive salt intake, disease affecting kidney or liver function, or poor pumping action of the heart. The retained sodium increases osmotic pressure in the ECF. This pressure pulls fluid from the cells into the ECF ● Overhydration - ○ Elevated blood pressure, bounding pulse ○ Pale, cool skin ○ Edema/Ascites ○ Crackles
Fluid-elect-acid - Practice questions, quiz 5, Fluid and Electrolyte Acid balance, good material
Course: Fundamentals of Nursing (NRS 130 )
University: Long Island University
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