Electrolyte and fluid balance - things in red

Question 1

Factors that affect total body water?

Answer 1

Age - newborn is 80% TBW
Gender - Women 50%; men 60%
Body fat - Fat tissue essentially water free

Question 2

A typical adult needs approximately how many mL per day of water?

Therefore, how many 8 oz glasses of fluid intake would a 158.5lb adult need?

Answer 2

30-40 mL/day*kg

158. 5lb / 2.2 = 72.045kg
159. 045kg * 30 mL/kg*day = 2161.36 mL/day

2161 mL/day * 1oz/30mL = 72.045 oz

72.045oz * 1glass/8oz = 9 glasses

Question 3

Sodium normal range?

Answer 3

135-145 mmol/L

Question 4

Potassium normal serum range?

Answer 4

3.5-5.0 mmol/L

Question 5

Calcium normal serum range?

Answer 5

2.2-2.58 mmol/L

Question 6

Chloride normal serum range?

Answer 6

95-105 mmol/L

Question 7

Phosphate normal range?

Answer 7

0.97-1.45 mmol/L

Question 8

When measuring fluid input, what are examples of foods that become liquid at room temp?

Answer 8

Jello, Popsicles, ice cream, yogurt

Question 9

What is the minimum urinary output?

Answer 9

30 mL/hr or 0.5 mL/hrkg ()

Question 10

What should the minimum urinary output be for a 150lb adult?

Answer 10

150lb / 2.2 lb/kg = 68.18 = 68.2kg

68.2kg * 0.5 mL/kg*hr = 34.1 mL = 34 mL/hr

Question 11

What are the normal hematocrit levels for males and females?

Answer 11

Males - 0.37-0.49

Females - 0.36-0.46

Question 12

What is the normal serum osmolality value?

Answer 12

280-300 mmol/kg

Question 13

What is the normal urine osmolality value?

Answer 13

500-800 mmol/kg

Question 14

What is the normal urine specific gravity?

Answer 14

1.01-1.025

Question 15

When taking ABGs, it is important to do this?

Answer 15

Apply pressure at the puncture site for 5 mins

Question 16

What are the six measurements of ABGs?

Answer 16

pH
PaO2 (arterial blood)
PaCO2 (arterial plasma)
Bicarb (HCO3-)
Base excess - BE
SaO2 (oxygen saturation)

Question 17

What are the normal ABG values?

Answer 17

pH = 7.35-7.45
PaCO2 = 35-45
bicarb = 22-26

Question 18

What is the normal PaO2 at RA in adults under the age of 60?

Answer 18

80-100

Question 19

When the blood pH is acidic, how does the respiratory system conpensate?

Answer 19

Respiratory rate increases

Question 20

If bicarb caused the acidosis or alkalosis, it is ________
If CO2 caused the acidosis or alkalosis, it is _______
if carbon dioxide and bicarb caused the acidosis or alkalosis, it is _________

Answer 20

metabolic
respiratory
combined

Question 21

Differentiated between uncompensated, partially compensated, fully compensated, and corrected

Answer 21

Uncompensated - abnormal pH and change in one blood parameter
Partially compensated - all 3 values are off
Fully compensated - pH normal, bicarb and CO2 off
Corrected - all three normal

Question 22

Respiratory acidosis values?

Answer 22

pH < 7.35; PaCO2 > 45

Question 23

Respiratory alkalosis values?

Answer 23

pH > 7.45; PaCO2 < 35

Question 24

Metabolic acidosis values?

Answer 24

pH < 7.35; bicarb < 22

Question 25

Metabolic alkalosis values?

Answer 25

pH > 7.45; bicarb > 26

Question 26

ABG results: pH: 7.26 PaCO2: 42 HCO3-: 17

Answer 26

acidosis metabolic uncompensated

Question 27

ABG results: pH: 7.49 PCO2: 30 HCO3-: 23

Answer 27

alkalosis respiratory uncompensated

Question 28

ABG results pH: 7.26 PCO2: 52 HCO3-: 34

Answer 28

acidosis combined partially compensated

Question 29

ABG results: pH: 7.45 PCO2: 51 HCO3-: 29

Answer 29

combined, fully compensated

Question 30

Urine pH - in metabolic acidosis, urine pH _______ in metabolic alkalosis, the pH _______

Answer 30

decreases | increases

Question 31

Hypovolemic shock | What is the difference between absolute and relative fluid loss? Gives examples of each.

Answer 31

Absolute - fluid volume loss - i.e. outside of the body - e.g. external hemorrhage; gross dehydration (vomiting), diabetes insipidus Relative - fluid volume shift - internal hemorrhage - increased vascular permeability - e.g. sepsis

Question 32

What is always a part of the treatment for hypovolemic shock?

Answer 32

Support breathing - OXYGEN ALWAYS (may require mechanical ventilation)

Question 33

What is a late sign of neurogenic shock?

Answer 33

Decreased tissue perfusion leading to decreased cap refill, pallor, cold (LATE)

Question 34

What are the important preventive treatments for anaphylactic shock?

Answer 34

Ensure that allergies are PROPERLY DOCUMENTED IN THE CHART - KNOW THEM

Question 35

What are the most important drug treatments for anaphylaxis?

Answer 35

Epinephrine | Dimenhydramine

Question 36

Bacteremia/fungemia/viremia/parasitemia - presence of viable bacteria/fungi/virus/parasites in the ______.

Answer 36

blood

Question 37

Sepsis = _____ + _____

Answer 37

SIRS + infection

Question 38

a general inflammation in organs remote from the initial insult.

Answer 38

SIRS - systemic inflammatory respones syndrome

Question 39

severe sepsis + acute circulatory failure (Severe hypotension unexplained by other causes)

Answer 39

septic shock

Question 40

Sanchia Bulgin case: What went wrong? What type of shock? How could this have been prevented?

Answer 40

Nurse didn't report the low blood pressure to the charge nurse or physician Most likely hypovolemic shock - relative type - internal hemorrhage was the culprit - decrease in BP, tachycardia and tachypnea (Sympathetic compensation are consistent) - anxiety and agitation are also consistent Prevention: - stop the blood loss - may include trip to OR - restore circulating volume - IV fluids, blood - OXYGEN - support BP

Question 41

Which of the following would you include in the nursing management of hypovolemic shock? A -Client/family teaching re: blood product safety B - Establish a large bore IV C - Monitor fluid status D - All of the above

Answer 41

A - blood transfusion often a treatment - will need to teach B - large bolus of fluids is often necessary C - mainstay of treatment D - CORRECT ANSWER as a result

Question 42

``` Which of the following are common sources of nosocomial infections? A - Bloodstream B - Lungs C - Urinary tract D - All the above ```

Answer 42

All of these contains bodily fluids and can thus cause hospital acquired infections D is correct

Question 43

``` Which of the following can increase the client’s risk of developing sepsis? Select all that apply. A - Prednisone (steroids) B - MRSA C - Myocardial infarction D - Total parenteral nutrition ```

Answer 43

A - corticosteroids reduce inflammation and immune system D - direct entry to bloodstream A, D