Fluid and electrolytes

Question 1

Magnesium

a) lab rate
b) Where is most abundant?
c) Modifies what?

Answer 1

a) 1.3-2.1 mEq/L
b) Second most abundant ICF

c) Modifies nerve impulse transmission
Skeletal muscle response

Question 2

Osmosis

Answer 2

Water move from low solute to high solute

Question 3

Isotonic solution IV?

Answer 3

• *Increase fluid volume**
• due to blood loss, surgery, or dehydration

0.9% Sodium shloride
(normal saline)
Lactated ringers
Dextrose 5%(D5W)

Question 4

Hypertonic solution IV?

Answer 4

Severe hyponatremia and cerebral edema (for cell under hypotonic condition)

Anything higher than 0.9% NACL

3% NACL
10% Dextrose
50% Dextrose

Question 5

Hypotonic solution IV?

Answer 5

• *Cell is dehydrated and fluids need to be put back intracellularly**
• *Cell is shrink=hydration**

Anything less than 0.9% NACL

0. 45% NACL(1/2 noramal saline)
1. 25% NACL

Question 6

Flush IV site every ???? hours when not in use

Answer 6

8-12 hr

Question 7

Chang IV site usually every ??? hours

Answer 7

72 hr

Question 8

IV solution overload

Clinical sing?

(Fluid overload)

Answer 8

Distended neck veins
Increased BP
Tachycardia
Shortness of breath
Crackles in the lungs
Edema

Question 9

IV solution overload

Treatment

(Fluid overload)

Answer 9

Raise the head of the bed
Check vital sing(O2 as well)

Ajust the rate after correcting fluid overload
Administer diuretics (water pills)

Question 10

Diuretics?

Answer 10

Water pills
Help rid your body of salt (sodium) and water

Question 11

Cellulitis?

Answer 11

Serious bacterial skin infection

Pain
Warmth
Edema
Fever

Question 12

Cellulitis treatment

Answer 12

Discontinue and remove IV
Elevate the extremity
Apply warm compresses 3 to 4 time/day

Administer antibiotics, analgesics

Question 13

Catheter embolus?

Answer 13

Missing catheter tip on removal

Question 14

Catheter embolus

Treatment

Answer 14

Place a tourniquet(band) high on the extremity to limit venous flow
Prepare for removal under X ray or surgery

Save the catheter after removal to determine the cause

Question 15

DO NOT use vein in the antecubital fossa.

Why?

Answer 15

Because it will limit the mobility of the pt’s arm

Question 16

Fluid volume deficit?

Answer 16

Hypovolemia
Isotonic dehydration

A lack of both water and electrolytes
Causing a decrease in circulating blood volume

Question 17

Cause of dehydration?

Answer 17

Prolonged fever
Diabetic ketoacidosis
Hyperventilation(low CO2)

Excessive hypertonic IV fluid

Question 18

Hypovolemia

Answer 18

When the amount of fluid in the intravascular system is too low

Question 19

Causes of hypovolemia?

Answer 19

Vomiting, diarrhea
Renal disfunction
Burns
Hemorrhage
Altered intake
-nausea
-anorexia
-NPO

Question 20

Hypovolemia

Assessment

Answer 20

Hypotension
Tachycardia

Every lab values increase!!
Oliguria
Rapid weight loss
syncope

Question 21

Oliguria

Answer 21

Urine output below normal 30-50mL

less than 30mL emergency condition!!

Question 22

Hypovolemia

Interventions

Answer 22

Oral rehydration
Isotonic water 0.9% NS

Oral hygiene Q2
Frequent skin assessment (turgor)

Question 23

Hypervolemia

Causes?

Answer 23

Chronic kidney failure
High sodium foods
Enteral tube feeding
Excess isotonic IV fluid

SIADH

Question 24

Hypervolemia

Assessment

Answer 24

Hypertension
Tachycardia

Decreased all lab values!!

Chest X-ray fluid in lung

Question 25

Hypervolemia interventions

Answer 25

Observe breath sounds Auscultate breath sounds(edema) Dyspnea Elevate HOB devises to reduce pressure

Question 26

Syncope

Answer 26

A temporary loss of consciousness usually related to insufficient blood flow to the brain

Question 27

Polydipsia?

Answer 27

Excess thirst

Question 28

Hyponatremia Expecting finds (Heat to toe)

Answer 28

Confusion Orthostatic hypotension Nausea, vomiting abdominal cramps Weight gain, Edema Muscle spasms けいれん

Question 29

Hyponatremia Expecting finds (Heat to toe)

Answer 29

Confusion Seizures Coma Orthostatic hypotension Nausea, vomiting abdominal cramps Weight gain, Edema Muscle spasms けいれん Decease serum osmolality

Question 30

Hyponatremia Causse

Answer 30

Heart and renal failure Vomiting Burns Hyperglycemia Medication s such as antidiabetics, diuretics

Question 31

Hyponatremia Interventions

Answer 31

Restrict fluid intake Seizure precautions Administer isotonic I.V. fluids Monitor pt's conciseness

Question 32

Arterial Blood Gases (ABGs) Normal rang a) pH b) pCO2 c) HCO3 d) PO2 e) SaO2

Answer 32

a) 7.35-7.45 b) 35-45 mmHg c) 22-26 mEq/L d) 80-100 mmHg e) (95-100%)

Question 33

Mean Arterial Pressure (MAP) Definition What is the normal range

Answer 33

Pressure necessary to adequately perfuse organs normal range is 70-100

Question 34

How to calculate MAP

Question 35

Map caculation a) 120/60? b) 140/80?

Answer 35

MAP = (SBP + 2DBP) ÷ 3 a) (120 +120) /3= 80 MAP b) (140+160)/3= 100 MAP

Question 36

A high MAP means?

Answer 36

A lot of pressure in the arteries Eventually lead to blood clots or damage to the heart muscle

Question 37

What is a low MAP?

Answer 37

Blood may not be reach to the major organs Without blood and nutrients, the tissue of these organs begins to die

Question 38

**Use of Incentive Spirometry** a) Use a\_\_\_\_\_\_\_ method b) Put mouth on mouthpiece and make? c) Inhale or exhale? slowly and deeply d) When the pt cannot c any more remove the mouthpiece. Hold breathe for how long? then slowly inheal or exheale? Repeat and when finish make cough Set up position Prevent pnemonia

Answer 38

a) teach-back method b) seal c) Inhale d) 3 sec Slowly exhale

Question 39

Hypoventilation?

Answer 39

Too shallow or too slow to meet the needs of the body Low O2, more CO2 COPD

Question 40

Hyperventilation?

Answer 40

Rapid or deep breathing Usually caused by anxiety or panic Diabetic ketoacidosis Respiratory alkalosis

Question 41

Hyperventilation Intervention?

Answer 41

Monitor RR, depth, breath sounds Monitor Level of Consciousness Monitor SpO2, ABG Assessment – possible anxiety and cause Assess need for & provide supplemental O2 as ordered

Question 42

Hypoventilation Intervention?

Answer 42

Monitor RR, depth, breath sounds Monitor LOC Monitor SpO2, ABG Assess need for and provide supplemental O2 as ordered

Question 43

Hypo and hyper/ventilation Nursing DX

Answer 43

Problem-focused vs. risk focused nursing dx: Ineffective airway clearance Ineffective breathing pattern Impaired gas exchange Activity intolerance Fatigue Acute confusion Risk for aspiration Risk for infection Risk for falls

Question 44

Non-productive cough meaning?

Answer 44

**Dry cough** Exposure to smoke or dust Viral illnesses Irritation of the airway Allergies Medication Asthma

Question 45

Mobilizing secretions

Answer 45

Answer 46

Frequent repositioning Deep breathing and coughing

Question 47

Hypernatremia Causes

Answer 47

``` Water loss Inadequate water intake Excessive sodium intake Diabetes Insipidus (DI) ``` Cell shrink

Question 48

Hy**PER**natremia S/S

Answer 48

Thirst Dry sticky mucous membranes Restlessness disorientation Muscle weakness and irritability

Question 49

Hy**PER**natremia Nursing Intervention

Answer 49

Maintain urine output of 0.5 to 1.5 mL/kg/hr Maintain normal blood pressure Provide low sodium, no salt added diet Seizure precautions Administer hypotonic and non-sodium containing isotonic fluids D5W at first

Question 50

arouse

Answer 50

awaken (someone) from sleep

Question 51

Potassium a) range b) Ragulate what? c) Can affect what rate

Answer 51

a) 3.5 - 5.0 mEq/L b) Cell excitability Nerve impulse conduction c) Cardiac rate rythem

Question 52

HyPOkalemia Excessive K+ output Why?

Answer 52

(\<3.5 mEq/L) GI losses from diarrhea Prolonged gastric suctioning Prolonged vomiting

Question 53

HyPOkalemia S/S

Answer 53

Confuse Depression Cardiac arrest Fatigue Muscle weakness

Question 54

Hy**PO**kalemia Intervention

Answer 54

Assess the patient’s diet for a lack of potassium Encourage intake of high-potassium foods IV must given very slowly

Question 55

Hy**PER**kalemia Causes

Answer 55

Why excessive K+ intake? Oral supplements Salt substitutes (\>5.0 mEq/L)

Question 56

HyPERkalemia S/S

Answer 56

Arrhythmias HR mess up Decreased strength of contraction Cardiac arrest Nausea, vomiting diarrhea Decreased bowel sounds Abdominal distention

Question 57

Hy**PER**kalemia Intervention

Answer 57

Apply and monitor ECG Restrict K+ intake Administer oral meds for K+ excertion

Question 58

Calcium Function

Answer 58

Muscles must have Ca+ to contract Calcination shifts into bone 8.5- 10.2 mg/dL | (including heart)

Question 59

Hy**PO**calcemia Excessive losses why?

Answer 59

Chronic diarrhea Shit into bone Acute pancreatitis Vitamin D deficiency

Question 60

Question 61

Answer 61

Hypocalcemia

Question 62

Question 63

Question 64