fluid and electrolyte

Question 1

hypotonic solution

Answer 1

lower solute concentration
NEVER GIVEN IV
excessive IV infusion of this will cause severe fluid and electrolyte imbalance
0.45% NS, 5% dextrose in water

Question 2

Hypertonic solution

Answer 2

higher solute concentration
water is pulled from cells, causing crenation (shrinking)
10% dextrose in water

Question 3

isotonic solution

Answer 3

plasma solute concentration (same osmolarity as plasma)
0.9% sodium chloride, NS, lactated ringers

Question 4

hypovolemia (fluid volume deficit)

Answer 4

loss of H2O and electrolytes from ECF
confusion, combative, coma
veins become flat in supine position
prolonged capillary refill (above 5 seconds)
concentrated urine, oliguria, dry skin, furrowed tongue, decreased moisture in oral cavity
tachycardia, tachypnea, hypotensive
loss of sensation

Question 5

hypovolemia defining characteristics

Answer 5

extreme thirst, irritable, dizzy, weak, fever, dry skin, dry mucous, increased urine specific gravity and HR, decreased BP, orthostatic hypotension, weak and rapid pulse, increased hematocrit and BUN and serum sodium, decreased hemoglobin

Question 6

hypovolemia interventions and assessments

Answer 6

monitor sodium level, urine specific gravity, osmolarity, virals, I&O, abdominal girth, daily weights
encourage salt free foods
administer IV fluids
replace lost fluids (over 48 hours)
provide skin care
administer oxygen

Question 7

hypervolemia (fluid volume excess)

Answer 7

sodium and water retention
excessive sodium intake

Question 8

defining characteristics of hypervolemia

Answer 8

confusion, disorientated, convulsion, coma
increased BP
decreased BUN, hematocrit, sodium, specific gravity
SOB, tachypnea, dyspnea, weak, crackles/wheezes, pleural effusion, pulmonary edema, bounding pulse, neck,hand vein distention, quick weight gain, peripheral edema, ascites, polyuria

Question 9

hypervolemia interventions and assessments

Answer 9

monitor ABG, resp status, response to diuretics, rate of IV therapy, measure abdominal girth for ascites patient, STRICT I&O and weights
restrict sodium and fluid intake, administer diuretics as prescribes, O2 therapy, elevate HOB

Question 10

acid base balance

Answer 10

blood chemical buffers
respiratory system
kidneys

Question 11

blood chemical buffers

Answer 11

constantly regulates hydrogen
body’s first line of defense

Question 12

respiratory system (acid base)

Answer 12

controls carbon dioxide levels within minutes of a change in pH
second line of defense

Question 13

kidneys (acid base)

Answer 13

excrete or retain bicarbonate
third line of defense

Question 14

compensations (complete vs partial)

Answer 14

involves opposites
complete: pH is in normal range
partial: pH remains outside the normal range

Question 15

ABG normal values

Answer 15

pH: 7.35-7.45
pCO2: 33-45 mmHg
HCo3-: 22.26 (or 28) mEq/L

Question 16

respiratory acidosis risk factors

Answer 16

hypoventilation (COPD, pneumonia, atelectasis)
respiratory depression (barbiturate or sedative overdose, guillian barre)
respiratory arrest

Question 17

resp acidosis clinical manifestations

Answer 17

neurological (coma, drowsy, disoriented)
cardiovascular (hypotension, tachycardia)
respitatory (shallow, dyspenea, tachypnea, bradypnea)
muscular (weak, tremors)
GI (n/v/d)
pH below 7.35, paCO2 above 45, HCO3 normal

Question 18

respiratory alkalosis risk factors

Answer 18

hyperventilation, anxiety, salicylates, disease states, mechanical over ventilation, hypermetabolic states, acute hypoxia, pulmonary disease, anemia, hypotension

Question 19

respiratory alkalosis clinical manifestations

Answer 19

neurologic: hyporeflexia, disoriented, weak, coma
muscular: tetany hyperreflexia
respiratory: hyperventilation, dyspnea, tachypnea
cardiac: syncope, chest pain, EKG changes
diaphoresis
pH above 7.45, paCO2 below 35, HCO3 normal

Question 20

metabolic acidosis risk factors

Answer 20

cardiac arrest, aspirin, overdose,
excess production of acids (DKA, lactic acidosis)
inadequate loss of acids (uremia)
excess loss of base (diarrhea)

Question 21

metabolic acidosis clinical manifestations

Answer 21

neurologic: hyporeflexia, disoriented, weak, coma
GI: NVD, abdominal pain, dehydration
cardiacL peripheral edema, weak pulse, hypotension
respiratory: hyperventilation
pH is less than 7.35, paCo2 normal, HCO3 less than 22

Question 22

metabolic acidosis nursing interventions

Answer 22

treat underlying cause (diarrhea, DKA)
monitor K+ levels neurologic status
provide mechanical ventilation
dialysis as ordered

Question 23

metabolic alkalosis risk factors

Answer 23

loss of acids (vomit, excess gastric suctioning)
base or buffer inbalance (K+ deficit, excess NaHCO3 intake)
disease states (cushing, kidney)
multiple transfusions
overcorrection of acidosis

Question 24

metabolic alkalosis clinical manifestations

Answer 24

neurologic: confusion, stupor, coma
GI: anorexia, nausea, vomiting
muscular: weakness, tetany, paresthesia, hyperreflexia, tremors, cramps
respiratory, hypoventilation cyanosis
pH above 7.45, PaCO2 above 45, HCO3 above 26

Question 25

potassium important info

Answer 25

never give IM or IV push or bolus, it is too rapid an infusion
never given on an empty stomach

Question 26

diuretics

Answer 26

furosemide/ lasix
main cause of potassium/ sodium loss

Question 27

dehydration

Answer 27

skin sticks together due to decrease in interstitial fluids
elderly turgor= skin has decreased elasticity