NUR 112 Exam 1 Electrolytes: FVD, FVE & Na+

Question 1

What is hypovolemia?

Answer 1

ECF volume deficit

Question 2

What is hypervolemia?

Answer 2

ECF volume excess

Question 3

Is FVD the same as dehydration?

Answer 3

No!

Dehydration = loss of pure water w/out Na+

Question 4

List the 3 MAIN causes of FVD

Answer 4

1. abnormal loss of body fluid
2. inadequate fluid intake
3. Shift of fluid from plasma to IF (edema)

Question 5

List 5/10 causes/examples of abnormal loss of body fluids leading to FVD

Answer 5

vomiting
diarrhea
fistula
hemorrhage
polyuria
NG suction
x.s. diuretics
insensible loss/perspiration
diabetes insipidus (x.s. ADH)
third spacing - burns, intestinal obstruction

Question 6

list 3 possible Tx for FVD

Answer 6

LR
0.9% NS
Blood

Question 7

s/s FVD 1. CNS related (5)

Answer 7

1. restlessness, drowsiness, lethargy, confusion, coma

Question 8

Do the following indicate FVD or FVE?
inc resp rate
inc pulse rate
dec CVP
dec urine output
urine specific gravity 1.035

Answer 8

FVD
less vol blood to carry O2 so resp rate inc.
less vol blood to carry O2 so HR rate inc
less blood vol so CVP dec
kidneys compensate by reabsorbing H2O
urine becomes more concentrated

Question 9

What do the following s/s indicate?
thirst
dec skin turgor
postural hypotension
weakness
dizziness
weight loss

Answer 9

FVD

Question 10

List the 3 MAIN causes of FVE

Answer 10

1. Excess in take of fluids
2. Abnormal retention of fluids
3. Shift of fluid from IF to plasma

Question 11

List 3/5 causes/examples of abnormal retention of body fluids leading to FVE

Answer 11

heart failure (correct exchange does not occur with IF/cells)
renal failure (kidneys do not excrete appropriate fluid)
SIADH too much ADH = too much H2O kept
Cushing's (x.s. cortisol acts like aldosterone and retains Na+ which in turn retains H2O)
Long term corticosteroid use (see above)

Question 12

list 3 possible Tx for FVE

Answer 12

1. restrict fluids
2. diuretics
3. restrict Na+

Question 13

s/s FVE related to lungs (3)

Answer 13

1. dyspnea
2. crackles
3. pulmonary edema

Question 14

What do the following s/s indicate?
headache
confusion
lethargy 
peripheral edema
weight gain

Answer 14

FVE
cells swell and x.s.fluid in blood puts pressure on nerves causing pain
CNS - cells swell
CNS - cell swell
pressure caused by x.s.fluid in intravascular forces fluid to interstitium = edema
1L weighs 2.2 lbs

Question 15

Pt. presents with bounding pulse, JVD, normal renal function and polyuria what do you suspect is the primary cause?

Answer 15

FVE

Question 16

FVE or FVD?

seizures, muscle spasms progressing to coma

Answer 16

FVE
pressure on nerves causes seizures
electrolytes overdiluted causes muscle spasms

Question 17

What do nurses assess for FVE/FVD?

6 main categories/systems

Answer 17

1. I & O
urine specific gravity
2. daily weights
3. Cardiac system
HR, Pulse pressure, JVD, BP
4. Respiratory system
resp rate inc = FVD 
SOB, crackles, cough = FVE
5. Neurological
LOC A&O x3, pupillary response, voluntary movement of extremities & strength
6. Integumentary
skin turgor
dry mucous membranes,

Question 18

Edematous skin may be cool to touch - why?

Answer 18

dec in blood flow, secondary to increased pressure of interstitial fluid build up.

Question 19

Pt. on NG suction are not typically given water to drink - why?

Answer 19

H2O pulls electrolytes from GI cells - which are then suctioned and removed from body.

Question 20

What fluid is used to irrigate a NG suction tube?

Answer 20

0.9% NS

Question 21

3 ways Na+ excreted from body?

Answer 21

urine
sweat
feces

Question 22

1. ADH regulates water or sodium?

2. Aldosterone directly regulates water or sodium?

Answer 22

1. H2O - retention

2. Na+ - reabsorption

Question 23

changes in serum Na+ may reflect a primary _________________ imbalance.
A primary _______________ imbalance or __________

Answer 23

1. water (too much or too little)
2. sodium (too much or too little)
3. both!

Question 24

hypernatremia caused by 1. _______ of H2O, or ___________ of Na+

Answer 24

1. loss H2O

2. gain Na+

Question 25

list 4 disease states that cause hypernatremia

Answer 25

1. diabetes insipidus (too much ADH - too much H2O lost in urine) 2. hyperglycemia - due to uncontrolled diabetes mellitus - causes osmotic diuresis so dilute urine is lost & Na+ is left behind. 3. cushing's X.S. cortisol acts like aldosterone and keeps Na+ 4. primary aldosteronism - x.s. aldosterone made by body.

Question 26

s/s hypernatremia with normal ECF volume | do not list all that occur with FVD and normal FV - just those specific to normal FV

Answer 26

Intense thirst with normal mucous membranes | weight gain

Question 27

s/s hypernatremia with FVD

Answer 27

``` restlessness agitation twitching (neurons more easily activated) seizures coma weakness lethargy intense thirst - dry swollen tongue - sticky mucous membranes postural hypotension weight loss ```

Question 28

Tx for H2O deficit hypernatremia 1. aim of Tx 2. fluids used 3. Tx fast or slow & why?

Answer 28

1. Replace H2O, prevent further loss 2. IV D5W Hypotonic NS (0.45% NS) 3. slow - prevent cerebral edema

Question 29

Tx for X.S Na+ hypernatremia (2)

Answer 29

1. diuretics | 2. restrict Na+ intake

Question 30

loss of Na+ from body | inc. in H2O in body can both lead to .......

Answer 30

hyponatremia

Question 31

2 types of Iv fluids can cause hyponatremia

Answer 31

1. hypotonic | 2. sodium free

Question 32

does SIADH cause hypernatremia or hyponatremia? | Explain:

Answer 32

Hypo. | x.s. ADH causes body to retain x.s. H2O - dilutes Na+ alters ratio. effectively dec. Na+ in body

Question 33

List 6 ways Na+ rich fluids are abnormally lost from body

Answer 33

``` diarrhea vomiting NG suction fistulas burns wound drainage ```

Question 34

What effect do hypoaldosteronism and adrenal insufficiency have on the body?

Answer 34

too little Na+ reabsorbed

Question 35

``` What do the following indicate? irritability apprehension confusion dizziness personality changes tremors seizures coma tachycardia thready pulse orthostatic hypotension cold clammy skin dry mucous membranes ```

Answer 35

Dec ECF Vol hyponatremia | cells swell - CNS effects

Question 36

Normal ECF Vol with hyponatremia s/s include:

Answer 36

``` NVD abdominal cramps headache apathy confusion muscle spasms seizures coma ```

Question 37

Tx hyponatremia caused by x.s. H2O (2)

Answer 37

1. fluid restrictions | 2. if seizures develop 3% NS

Question 38

Tx hyponatremia caused by fluid loss

Answer 38

replace fluid with IV solutions containing Na+

Question 39

Drugs that block ADH can be used to Tx hyponatremia (2)

Answer 39

Conivaptan - inc urine output while conserving Na+ & K+ | Tolvaptan - used for HF, Liver cirrhosis, SIADH

Question 40

Implementation of nursing care for a patient with hypernatremia includes: a. fluid restriction b. administration of 3% NS IV fluids c. administration of D5W IV fluids d. administration of drugs that block ADH such as Conivaptan

Answer 40

c. administration of D5W IV fluids | hypotonic - adding free water to dilute NA+