question

homeostasis

answer

the ability to maintain internal equilibrium

question

The goal in managing fluid, electrolyte, and acid-base imbalances is to?

answer

reestablish and maintain homeostasis

question

Total body water constitutes for about what % of body weight?

answer

60%

question

To maintain normal fluid balance body water intake and output should be?

answer

approximately equal

question

The average fluid input and output over a 24 hour period is about?

answer

2500 ml

question

What is the average urine output of adult?

answer

1200 to 1500 mL

question

What some of the functions of electrolytes? (4)

answer

1. assist with the regulation of water balance 2. regulating and maintaining acid-base balance 3. contributing to enzyme reactions 4. essential for neuromuscular activity

question

Intracellular fluid is essential for? (2)

answer

1. normal cell function 2. providing a medium for metabolic processes

question

Extracellular fluid is located outside of cells and is further calssified by?

answer

location

question

Examples of extracellular fluid?

answer

1. interstitial fluid is located in the spaces between most of the cells of the body 2. intavascular fluid, called plasma is contained within the arteries, veins, and capillaries 3. Transcellular fluid includes urine, digestive secretions, perspiration, and cerbrospical, plural, synovial, intracular, gonadal, and pericardial fluids.

question

ICF contains high concentrations of? (5)

answer

1. phosphate 2. potassium 3. magnesium 4. glucose 5. oxygen

question

ECF contains high concentrations of? (3)

answer

1. Sodium 2. Chloride 3. bicarbonate

question

Sodium; Na+ (serum component) value

answer

135-145 mEq/L

question

Chloride; Cl- value

answer

95-105 mEq/L

question

Bicarbonate; HCO3 value

answer

22-30 mEq/L

question

Calcium (Ca2++) (total) value

answer

4.5-5.5 mEq/L (9-11 mg/dL)

question

Potassium K+ value

answer

3.5-5.3 mEq/L

question

Phosphate/inorganic phosphorus (PO42-)

answer

1.7-2.6 mEq/L (2.5-4.5 mg/dL)

question

Magnesium Mg2+ value

answer

1.5-2.5 mEq/L (1.8-3.0 mg/dL)

question

serum osmolity

answer

280-300 mOsm/kg

question

Osmosis?

answer

water molecules move through a selectively permeable membrane from an area of low solute concentration to an area of high solute concentration.

question

Four chemical and physiological procsses control the movement of fluid, electorlytes, and other molecules across membranes between the intracellular and interstitial space and the interstitial space and plasma. These processes are?

answer

1. osmosis 2. diffusion 3. filtration 4. active transport

question

Osmosis continues until?

answer

the solute concentration on both sides of the membrane is equal

question

What is the primary process that controls body fluid movement between ICF and ECF?

answer

Osmosis

question

Osmolality aka?

answer

concentration of a solution.

question

What does osmolality refer too?

answer

the number of solutes per kilogram of water (by weight); it is reported in milliosmiles per killogram (mOsm/kg).

question

Serum osmolality may be estimated by?

answer

doubling the serum sodium concentration.

question

The osmolality of the ECF depends chiefly on what concentration?

answer

sodium

question

Osmotic pressure?

answer

The power of a solution to draw water across a membrane

question

Tonicity refers to the effect a?

answer

solutions osmotic pressure has on water movement across the membrane of cells within that solution

question

Isotonic solution?

answer

have the same concentration of solutes as plasma and will not shrink or swell because there is no net gain or loss of water within the cell and no change in cell volume

question

Example of a isotonic solution??

answer

Normal saline (0.9% sodium chloride solution)

question

Hypertonic solutions have?

answer

a grater concentration of solutes than plasma.

question

In the presence of hypertonic solutions what will happen to cells>?

answer

water will be drawn out causing the cell to shrink

question

example of a hypertonic solution?

answer

A 3% sodium chloride solution

question

Hypotonic solution have a concentration that is?

answer

that has a lower solute concentration than plasma

question

When red blood cells are moved into a hypotonic solution what happens?

answer

water moces into the cells, causing them to swell and rupture (hemolysis)

question

hemolysis of cells will only occur if the solution is extremely?

answer

hypotonic

question

Example of hypotonic solution?

answer

0.45% sodium chloride

question

Define diffusion?

answer

it is the process by which solute molecules move from an area of high solute concentration to an area of low solute concentration to become evenly distributed.

question

What are the two types of diffusion?

answer

simple diffusion and facilitated diffusion

question

Simple diffusion occurs by the?

answer

random movement of particles through a solution.

question

what solutes move between plasma and interstitial space by simple diffusion? (3)

answer

water carbon dioxide oxygen

question

Facilitated diffusion also called carrier-mediated diffusion large?

answer

water soluble molecules such as glucose and amino acids to diffuse across cell membranes.

question

Define Filtration

answer

it is the process by which water and dissolved substances (solutes) move from an area of high hydro static pressure to an area of low hydro static pressure

question

How is hydrostatic pressure created?

answer

by the pumping action of the heart and gravity against the capillary wall.

question

Where does filtration occur?(2)

answer

glomerulus of the kidneys and arterial end of the capillaries

question

A balance of hydrostatic (filtration) pressure and osmotic pressure regulates the movement of water between the? .

answer

intravascular and interstitial spaces in the capillary beds of the body

question

Active transport allows molecules to?

answer

move across cell membranes and epithelial membranes against a concentration gradient.

question

Homeostatis requires several regulartory mechanisms and processes to maintain the balance between fluid intake and excretion. These include? What do these mechanisms affect?

answer

1. thirst 2. the kidneys renin- angiotensin - aldosterone mechansim 3. antidiuretic hormone 4. atrial natriuretic peptide they affect the volume, distribution, and composition of body fluids.

question

What is the primary regulator of water intake?

answer

thirst

question

where is the thirst center located?

answer

hypothalamus

question

When is the thirst center aka hypothalamus stimulated?

answer

1. when blood volume drops because of water losses or 2. when serum osmolality increases

question

The thirst mechinism is highly effective in regulating extracellular?

answer

sodium levels

question

Increased sodium in the ECF increases? Fluid intake in turn? (2)

answer

increases serum osmolality, stimulating the thirst center. fluid intake in turn reduces the sodium concentration of the ECF and lowers serum osmolality

question

So a drop in serum sodium and low serum osmolality inhibits?

answer

the thirst center in the hypothalamus

question

The thirst mechinsim decreases with aging making older adults more vulnerable to? (2)

answer

dehydration and hyperosmolality

question

Besides elderly patients what are some other patients at risk for dehydration and hyperosmolality? (2)

answer

intubated patients and artificially fed patients

question

The kidneys are primarily responsible for regulating? (2)

answer

fluid volume and elctrolye balance in the body.

question

the kidneys regulate volume and osmolality of body fluids by controlling?

answer

the excretion of water and electrolytes

question

The renin-agiotensis-aldosterone system helps to maintain? (2)

answer

intravascular fluid balance and blood pressure

question

antidiuretic hormone aka?

answer

vasopressin

question

antidiuretic hormone regulates?

answer

water excretion from the kidneys

question

with increased water re absorption what happens? (3)

answer

1. urine output falls 2. blood volume is restored 3. serum osmolality drops as the water dilutes body fluids

question

ADH is also released in stress situations such as? (4)

answer

1. nausea 2. pain 3. surgery and anastesia 4. narcotics and nicotine

question

ADH release is inhibited by? (4)

answer

1. alcohol 2. medications (phenytoin) 3.increased blood volume 4. decreased serum osmolality

question

Atrial natriuretic peptide (ANP) is a hormone released by atrial muscle cells in response to?

answer

distension from fluid overload

question

ANP affects many body systems including? (5)

answer

1. cardiovascular 2. renal 3. neural 4. GI 5. endocrine

question

ANP primarily opposes what system? how?

answer

renin-angiotensin-aldosterone system by inhibiting renin secretion and blocking the secretion and sodium retaining effects of aldosterone.

question

ANP promotes? and increased?

answer

promotes sodium wasting and increased urine output

question

What is a fluid volume deficit (FVD)?

answer

it is a decrease in intravascular, interstitial, and or intracellular fluid in the body.

question

With aging sodium and water regulation becomes less?

answer

efficient

question

early manifestations of dehydration in older adults? (8)

answer

1. change in mental status 2. memory 3. attention 4. dry oral mucus membranes 5. increased tongue furrows 6. subnormal temperature 7. tachycardia 8. pinched facial expression

question

More effective places for assessing skin tugor?

answer

over sternum inner aspect of the thigh

question

Loss of extracellular fluid volume can lead to a condition called?

answer

hypovolemia

question

hypovolemia is

answer

decreased circulating blood volume

question

When both water and electrolytes are lost what happens?

answer

serum sodium remains the same however other electrolytes such as potassium be begin to fall.

question

What happens if the body is hypovolemic? (3)

answer

1. the sypathetic NS is stimulated 2. Thirst center is stimulated 3. ADH and aldosterone are released (prompts kidneys to retain sodium and water)

question

What can happen with a sever fluid loss; such as hemorrhage?

answer

can lead to shock or cardio vascular collapse

question

What is third spacing?

answer

it is a shift of fluid from the vascular space into an area where it is not avaliable to support normal physiologic processes

question

What can trigger third spacing? (2)

answer

increased vascular permeability or decreased protein levels

question

Although recognizing third spacing is dificult, without prompt treatment what can occur?

answer

irreversible shock and multiorgan system failure

question

Each liter of body fluid weighs about?

answer

1 kg

question

the severity of FVD is estimated by the?

answer

percentage of rapid weight loss

question

A loss of 2% body weight? A loss of 5% body weight? A loss of 8% or greater body weight?

answer

- mild FVD - moderate FVD - severe FVD

question

A drop in how much from a lying to standing positions indicates a loss of intavascular volume?

answer

15 mmHg in systolic b/p

question

Fluid deficit: for the fallowing b/p, HR, pulse amplitude, respiration, jugular vein, edema, skin tugor, output, urine specific gravity and weight

answer

b/p: decreased systolic and postural hypotension HR: increased pulse amplitude: decreased Respiration's: Normal Jugular vein: flat Edema: Rare Skin tugor: loose, poor tugor Output: low; concentrated Urine specific gravity: high weight: loss

question

Fluid excess:for the fallowing b/p, HR, pulse amplitude, respiration, jugular vein, edema, skin tugor, output, urine specific gravity and weight

answer

b/p: increased HR: increased pulse amplitude: increased respirations: moist crackles and wheezing Jugular vein:distended Edema: dependent Skin tugor: taut Output: may be low or normal Urine specific gravity: Low Weight: gain

question

Serum electrolytes in an isotonic fluid deficit sodium levels are? when the loss is water only sodium levels are? with both of these what decreases?

answer

1. sodium levels are within normal limits 2. when the loss is water only, sodium levels are high 3. Decreases in potassium are common

question

Measurement of serum osmolality helps to differentiate?

answer

isotonic fluid loss from water loss

question

With water loss osmolality is? if isotonic fluid is lost it may be?

answer

- is high - may be within normal limits

question

FVD how is hemoglobin and hematocrit portrayed in labs?

answer

hematocrite is often elevated due to the loss of intavascular volume and hemoconcentration

question

Urine specific gravity and osmolality labs with FVD

answer

As the kidneys conserve water both specific gravity and osmolality of urine increase

question

Hemodyamic pressures such as: mean arterial pressure (MAP), Central venous pressure (CVP), right atrial pressure (RAP) and pulmonary artery wedge pressure (PAWP) are ____ with FVD.

answer

decreased (severe FVD)

question

What is the safest way to reverse FVD?

answer

Oral rehydration

question

How much water do adults require a day? what about obese adults?

answer

a minimum of 1500 mL of fluid a day or approx. 30 mL per kg of body weight. For obese adults ideal body weight is used to calculate fluid requirements.

question

Fluids should be replaced gradually especially for what group of people? why?

answer

older adults because it helps prevent rapid rehydration of cells

question

Examples of Isotonic solutions? (4)

answer

0.9% sodium chloride (normal saline) Lactated ringers solution Plasma-Lyte 148 5% dextrose in water (D5W)

question

when giving Isotonic solutions what are some nursing implications? (4)

answer

1. monitor for fluid overload if manifestation occur, d/c fluids and notify healthcare provider 2. Do no administer lactated ringers solution to patients with severe liver disease becasue the lactate may not convert to biocarbonate, leading to acidosis. 3. Do not administer ringers solution if blood P.H. is less than 7.50 4. If administering lactated ringers solution monitor: potassium levels and cardiac rhythm; if abnormal contact health care provider

question

Examples of hypotonic solutions? (2)

answer

1. 0.45% sodium chloride (1/2 NS) 2. 0.225% sodium chloride (1/4 NS)

question

Nursing implications for hyptonic solutions?(4)

answer

1. Monitor for inflammation and infiltration at IV site because hypotonic solutions may cause cell lysis, including at the insersition site. 2. Monitor plasma sodium levels 3. Do not administer to patients at risk for increased inter cranial pressure (head trauma, stroke, neurosurgery) 4. Do not adminster to patients at risk for third-space shifts (burns, tauma, liver disease, malnutrition)

question

Examples of hypertonic solutions? (6)

answer

1. D5 NS 2. D5 in lactated riingers solution 3. 10% dextrose in water (D10W) 4. 3% sodium chloride 5. 5% sodium chloride 6. Parenteral nutrition solutions

question

Nursing interventions for hypertonic solutions? (4)

answer

1. Monitor for inmlammation and infilltration at IV site because hypertonic solutions cause cells to shrink, exposing the basement membrane of the vein 2. Monitor plasma sodium levels 3. Monitor circulatory overload 4. Do not administer to patients with diabetic ketoacidosis or imparied cardiac or kidney function

question

Multisytem effects of FVD: Mucous mebranes (3)

answer

1. Dry; sticky 2. decrease in tongue size 3. increase in longitude furrows

question

Multisytem effects of FVD: Urinary (3)

answer

1. decrease urine output 2. oliguria (severe FVD) 3. increased urine specific gravity

question

Multisytem effects of FVD: musculoskeletal (1)

answer

1. Fatigue

question

Multisystem effect of FVD: Neurologic (4)

answer

1. Altered mental status 2. anxiety/restlessness 3. diminished alertness/cognition 4. possible coma (severe FVD)

question

Multisystem effects of FVD: Cardiovascular (8) and potential complication (1)

answer

1. tachycardia 2. orthostatic hypotension (moderate FVD) 3. Falling systolic/diastolic pressure (severe FVD) 4. Flat neck veins 5. decreased venous filling 6. decreased pulse volume 7. decreased cap refill 8. increased hematocrit Potential complication :hypovolemic shock

question

Multisystem effects for FVD: Metablic processes (4)

answer

1. decreased body temp (isotonic FVD) 2. increawsed body temp (dehydration) 3. Thirst 4. Weight loss 2-4% mild FVD 5-7%moderate FVD grater than or equal too 8% severe FVD

question

Hypertonic solutions should be administered though a?

answer

central venous access device to reduce the risk of vessel damage

question

Monitor the intake and output of patients at risk for abnormal fluid loss by? (6)

answer

1. vomiting 2. diarrhea 3. nasogastric suction 4. increased urine output 5. fever 6. draining wounds

question

Carefully monitor fluid intake for patients that are? (4)

answer

1. decreased LOC 2. nausea 3. anorexia 4. physical limitation

question

FVD what info should you obtain what info from health history? (3)

answer

1. medication 2. acute or chronic renal or endocrine diseases 3. precipitating factors such as weather, extensive exercise, lack of access to fluids, recent illnesses

question

FVD what info to obtain from physical assessment? (8)

answer

1. weight 2. V/s; including orthostatic b/p and pulse 3. periphreal pulses 4. Cap refill 5. jugular neck vein distention 6. skin: color, temp, tugor 7. LOC 8. urine output

question

Nursing diagnosis and interventions for the patient with fluid volume deficit focus on? (2)

answer

1.managing the effects of the deficit 2. preventing complications

question

Expected outcomes with FVD?

answer

Patients fluid volume and balance will be restored as evidence by weight within previous parameters and balanced intake and output

question

Nursing interventions for FVD? (5)

answer

1. Assess vitals, CVP, and peripheral pulses at least q 4 hrs 2. Assess intake and output accurately monitoring fluid balance. 3. Weight daily 4. Admin IV fluids as prescribed using an infusion pump. Monitor for indicators of fluid overload. 5. Monitory lab values: electrolytes, blood urea nitrogen (BUN), and hematocrit

question

Urine output should be between? (per hour and if less than what, you should contact provider)

answer

30 to 60 mL a hour (if less than 30 mL contact health care provider)

question

Signs of hypovelimia? (4)

answer

1. Hypotension 2. tachycardia 3. low CVP 4. weak, easily obliterated peripheral pulses

question

Rapid fluid replacement may lead to hypovolemia resulting in? (2)

answer

pulmonary edema or cardiac failure

question

What topics should you consider when getting a resident ready for homecare? (5)

answer

1. the importance of maintainging fluid intake (at least 1500 mL per day; more if extra fluid is being lost through perspiration, fever, diarrhea 2. Mainfestations of fluid imbalance and how to monitor fluid balance 3. How to prevent fluid deficit 4. Replacement of fluids lost through diarrhea with fruit juices or bouillon, rather than large amounts of tap water 5. Alternate sources of fluid for effective replacement of lost fluids

question

What can you teach a pt about how to prevent fluid deficit? (4)

answer

1. avoid exercising during extreme heat 2. increase fluid intake during hot weather 3. if vomiting, take small frequent amounts of ice chips, or clear liquids, such as weak tea, flat cola, or ginger ale 4. Reduce intake of coffee, tea, and alcohol, which increase urine output and can cause fluid loss.

question

Fluid volume excess results when both?

answer

water and sodium are retained in the body

question

Fluid excess may be caused by?

answer

fluid overload (excess water and sodium intake) or by impairment of the mechanisms that maintain homeostasis

question

Excess fluid can lead to excess intravascular fluid called? and excess interstitial fluid called?

answer

hypervolemia and edema

question

Excess fluid volume usually results from conditions that cause retention of both sodium and water. These conditions include? (6)

answer

1. heart failure 2. cirrhosis of the liver 3. renal failure 4. adrenal gland disorders 5. corticosteroid adminstration 6. stress conditions causing the release of ADH and aldosterone

question

Management of fluid overload consists of? (3)

answer

1. limiting sodium 2. limiting water 3. administering diuretics

question

Lab ordered for suspected fluid overload? (4)

answer

serum electrolytes serum osmolatily serem hematocrit hemoglobin

question

Serem electrolytes and serem osmolality will appear as? for fluid overload

answer

they usually remain within normal limits

question

serem hematocrit and hemoglobin often appear as what in a fluid overload situation?

answer

they are often decreased due to plasma dilution from excess extracellular fluid

question

What are some addition tests that may be ordered to determine the cause of fluid overload? (3)

answer

serum creatinine BUN liver enzymes

question

Most common diuretics given for fluid overload? (3)

answer

Loop diuretics Thiazide type diuretics Potassium sparing diuretics

question

Fluid Volume excess clinical manifestations? (15)

answer

1. Periphreal edema, or if severe anasarca (severe, generalized edema) 2. Full bounding pulse 3. distended neck and periphreal veins 4. increased central venous and right atrial pressures 5. cough 6. dyspnea 7. orthopnea (difficulty breathing while laying supine) 8. Dyspnea at rest 9. Tachycardia 10. HTN 11. Reduced O2 Sat 12. Moist crackles/ pulmonary edema 13. Polyuria 14. decreased hematocrite and BUN 15. altered mental status or anxiety

question

Common side effects of diuretics? (4)

answer

1. orthostatic hypotension 2. dehydration 3. electrolyte imbalance 4. possible hyperglycemia

question

Describe the action of loop diuretics

answer

they inhibt sodium and chloride reabsorption in the ascending loop of Henle. As a result loop diuretics premote the excretion of sodium, shloride, potassium, and water.

question

Thiazide and thiazide like diuretics promote the excretion of?

answer

sodium, chloride, potassium and water by decreaseing aborption in the distal tubule

question

Potassium sparing diuretics promote excretion?

answer

sodium and water by inhibiting sodium-potassium exchange in the distal tubule

question

Health Education for the Patient and Family about diuretics? (7)

answer

1. The drug will increase the amount and frequency of urination 2. The drugs must be taken even when you feel well 3. Take the drugs in the morning and afternoon to avoid having to get up at night to urinate 4. Chage position slowly to avoid dizziness 5. Avoid using the salt shaker when you are eating 6. If the drug increases potassium loss, consume foods high in potassium such as orange juice and bananas 7. Do not use salt substitute if you are taking a potassium sparing diuretic

question

Tell the patient taking a diuretic to report what symptoms to their health care provider? (3)

answer

dizziness trouble breathing swelling of the face, hands, or feet

question

If giving oral cares to a patient with excess fluid volume avoid using?

answer

hydrogen peroxide thymol and alcohol containg products and lemon and glycerine swabs becasue they can further dry and damage oral tissues

question

examples of foods high in sodium?

answer

lunch meat bacon cheese dry meal canned soup popcorn ketchup pickles seafood

question

Instruct patients who are at risk of fluid volume excess (kidney and heart failure) to weight themselves?

answer

on a regular basis, using the same scale, and to notify their primary care provider if they gain more that 5 lb in a week or less

question

Physical assessment of someone that has possible excess fluid volume? (11)

answer

weight VS periphreal pulses cap refill jugular vein distention edema lung sounds dyspnea cough sputum urine output mental status

question

What are the priority nursing responsibilities for someone with excess fluid? (2)

answer

supporting the cardiovascular and respiratory function esp. if accompined by dyspnea and HF

question

What are some nursing diagnosis for excess fluid volume?

answer

1. excess fluid volume 2 . risk for impaired skin integrity 3. impaired gas function

question

Initially edema effects dependent postions in a patient with fluid overload. where would it affect an amblatory patient? a bedridden patient? and what would be more of a general edema?

answer

ambulatory: the lower extremities Bedridden: sacrum General: periorbital edema

question

A weight gain of 2.2 lbs is approximatly how many L?

answer

1 L

question

People with excess fluid will be on a water restriction. Due to this the nurse should preform oral hygeine per?

answer

2 hours

question

Pt. teaching low sodium diet?

answer

1. reducing sodium intake will help the body excrete excess sodium and water 2. the body needs less than 1 tenth of a teasepoon of salt per day 3. Read labels 4. Many nonperscription drugs as well as toothpastes and mouthwashes contain high amounts of sodium 5. In place of salt or salt substitutes use herbs, spices, lemon juice, winegar, wine as flavoring when cooking

question

Ways to decreased dependent edema? (5)

answer

1. change postion frequently 2. Avoid restrictive clothing 3. Avoid crossing the legs when sitting 4. wear a support stockings or hose 5. Elevate feet and legs when sitting

question

How to protect edematous skin from injury? (3)

answer

1. do not walk barefoot 2. buy properly fitted shoes 3. shop in the afternoon when feet are more likely to be swollen

question

Sodium is the most plentiful electrolyte in the?

answer

ECF

question

Sodium is the primary regulator of what in the ECF?

answer

volume osmolality and distribution

question

When sodium levels are low water vs cells

answer

water is drawn into the cells making them swell

question

When sodium levels are high water vs. cells

answer

water is drawn out of the body cells causing them to shrink

question

Although 500 mg of sodium per day is usualy sufficant to meet the bodys needs the American Heart Association recommends that all American limit their sodium intake to?

answer

1500 mg a day (about 3/4 teaspoon)

question

Manifestations of Hyponatremia? (12)

answer

plasma sodium level less than 135 mEq/L decreased serum osmolatiy muscle cramps weakness headache anxiety lethary stupor anorexia nausea vomiting hypotension shock

question

Hypernatremia manifestations? (13)

answer

1. Plasmma sodium levels greater than 145 mEq/L 2. Increased serum osmolality 3. Increased thirst 4. increased urine specific gravity 5. Dry skin and mucus membranes 6. dry mouth 7. headache 8. restlessness 9. seizures 10 coma 11. tachycardia 12. hypotensive 13. vascular shock

question

Hyponatremia usually results from?

answer

a loss of sodium from the body but also can be caused by water gains that dilute ECF

question

Excess sodium loss can occur through? (3)

answer

the kidneys, GI tract, or skin

question

What can lead to excess sodium loss in urine? (3)

answer

Diuretics kidney diseases adrenal insufficency with impared cortisol production

question

Neurologic conditions that can lead to a decreases in sodium? (4)

answer

stroke cerebral hemorrhage trauma surgery

question

Other ways you can lose sodium? (3)

answer

exsesive sweating burns third spacing

question

Common ways that you lose exsess sodium? (3)

answer

Vomiting diarrhea GI secretion

question

Water gains that lead to hyponatremia can be do to systemic diseases such as? (4)

answer

HF RF cirrhosis of the liver syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

question

Hyponatremia can also occur from other things such as? (2)

answer

1. administration of hypotonic IV fluids 2. Self administered water intoxication

question

Symptoms of hyponatremia usually are not apparent until sodium levels reach around?

answer

125 mEq/L

question

What labs would you expect to see for a someone that was hyponatremia?

answer

Serum sodium osmolality 24- hour urine specimen

question

Serum sodium and osmolality is a person that has hyponatremia would be?

answer

decreased

question

A 24 hour urine specimen for someone that is hyponatremic you would expect to see?

answer

urinary sodium increased for reasons such as (SIADH) in conditions resulting in losses of isotonic flids (sweating, vomiting, diarrhea. third space) urine concentration would be very low

question

To replace both water and sodium what IV fluid would you give? (2)

answer

Isotonic RIngers solution or isotonic saline solution

question

Pts with very low sodium levels (110-115) what would you give?

answer

IV 3% NaCL solution

question

Patients recieving hypertonic or sodium containing IV fluids should be monitored for signs of?

answer

hypervolemia

question

hypervolemia s/s?

answer

1. increased b/p 2. bounding pulse 3. tachypena 4. tachycardia 5. gallop rythm 6. SOB 7. Crackles

question

What are given to patients that have normal to excess ECF (hyponatremia)?

answer

Loop diuretics salt tablets

question

Sodium loss via sweating you would give?

answer

Salt tablets

question

People at risk for mild hyponatremia include those who participate in activities that increase fluid loss through diaphresis. They should be encouraged to replace these fluids by?

answer

drinking large amounts of water or drinks with high sugar content

question

Manifestations of mild hyponatremia include? (4)

answer

1. headache 2. nausea 3. abdominal cramps 4. muscle weakness

question

What present great dangers for patients that are hyponatremic? (2)

answer

cerebral edema and impaired neurological function

question

Nursing diagnosis for hyponatremic patient?(2)

answer

1. Risk for imbalanced fluid volume 2. Risk for ineffective cerebral tissue perfusion

question

Hypertonic solutions should be monitored carefully when given to a patient with hyponatremia because? (2)

answer

there is an increase risk of pulmonary and cerebral edema due to water retention

question

Fluid restriction guidelines? (7)

answer

1. Subtract required fluids (ordered IV fluids, fluids used to dilute IV medications) from total daily allowance 2. Divide remaining fluid allowance- Daytim: 50% of total; evening: 25%-33% of total; nighttime: remainder 3. Identify preferred fluids and intake pattern of patient 4. Place allowed fluids in small glasses 5. offer ice chips 6. Provide frequent oral cares 7. provide sugarless chewing gum

question

Hypernatremia may occur if?

answer

If water is lost in excess sodium or if excess sodum is ingested or administrated

question

Who is is at risk for hypernatremia?

answer

Older adults with diminished thirst or who have limited access to water are at particular risk for hypernatremia

question

What is the first manifestation of hypernatremia?

answer

thirst

question

If thirst is not relived the primary manifestations of hypernatremia relate to?

answer

alterned neurologic function

question

Treatment of Hypernatremia is based on the cause. Hypernatremia is corrected over what time period and why?

answer

slowly over a 48 hour period to avoid development of cerebral edema secondary to a shift of water into the brain cells

question

Serum sodium levels and Serum osmolality in a patient that is hypernatremic will be?

answer

Sereum sodium: greater than 145 mEq/L Serum osmolality: greater than 295 mOsm/kg

question

What medication may be administered for hypernatremia?

answer

1. Hypotonic IV solutions such as o.45% NaCl or 5% dextrose in water 2. Diuretics may also begiven to increase sodium excretion

question

The primary focus for nursing care related to hypernatremia is?

answer

prevention

question

Priorities of care for a patient with hypernatremia? (3)

answer

Mental Status Brain Function rapid correction of the condition can lead to cerebral edema

question

What safety precautions should you put in place for a hypernatremic patient and why? (3/2)

answer

keep bed in low position side rails up and padded airway at bedside pts with sodium disorders are at increased risk for injury due to seizure activity and changes in mental status

question

Potassium plays a vital role in? (3)

answer

cell metabolism cardiac function neuromuscular function

question

Most potassium is found in?

answer

ICF

question

Population that may be at risk for inadequate potassium intake?

answer

hospitalized pts

question

An intake of how much K+ is needed to compensate for urinary loses

answer

40-50 mEq/L

question

What is the most common cause of hypokalemia worldwide?

answer

infectious diarrhea

question

Excess potassium loss through the kidneys is often secondary to drugs such as? (4)

answer

1. potassium wasting diuretics 2. corticosteriods 3. amphotericin B 4. Large doses of some antibiotics

question

What condition(s), in which the adrenal glands secrete excess aldosterone, which causes excess elimination of potassium? (2)

answer

Hyperaldosteronism or Cushings syndrome

question

Renal losses of potassium can also occur from? (4)

answer

1. stress 2. trauma 3. metabolic acidosis 4. magnesium deficiency

question

What are some patients that may develop hyponatremia? (2)

answer

anorexia nervosa and alcholics

question

Serum electolytes that are often elevated do to hypokalmia? (4)

answer

Na Ca HCO3 Mg

question

ABGs of someone that is hypokalemic will show?

answer

an increased PH (alkalosis)

question

What labs may be ordered to find a potential cause of hypokalmia?

answer

Renal function studies and blood urea nitrogen (BUN)

question

The dose required to treat hypokalmia is? (3)

answer

daily maintenance requirement + replacement of ongoing losses + addition potassium to correct the existing deficit

question

Examples of food high in potassium? (10)

answer

bananas oranges avocados spinach potatoes tomatoes meat seafood milk yogurt

question

Nursing Responsibilities when giving oral forms of potassium? (3)

answer

1. Dilute or dissolve effervescent, solute, or liquid potassium in fruit or vegtable juice or cold water 2. chill to increase palatabillity 3. Give with food to minimize GI effects

question

When giving parenteral forms of potassium (KCl)?

answer

1. Infuse at a rate not to exceed 10 mEq/h 2. Do NOT admin IV push, and not add fluids already hanging 3. do NOT administer undiluted 4. Assess injection site frequently for manifestation pf pain and inflammation. D/c and restart to another vein at first sign of infiltration 5. Use an infusion pump 6. Use a cardiac monitor when administering high doses

question

The Nurse should assess for what manifestations when pt is receiving K+? and if these manifestations are present the nurse should? (3/2)

answer

abdominal pain distention GI bleeding if present do not administer medication. Notify healthcare provider

question

Health and family education for hypokalemia treatment? (4)

answer

1. Do not take potassium supplements if you are also taking a potassium sparing diuretic 2. When parenteal potassium is discontinued, eat potassium rich foods 3. Take potassium supplements with meals. 4. DO not use salt substitutes when taking potassium

question

Multisystem effect of hypokalemia: Respritory (1)

answer

Respiratory arrest (severe hypokalemia)

question

Multisystem effect of hypokalemia: Urinary (3)

answer

1. Dilute urine 2. Polyuria 3. Polydipsia

question

Multisystem effect of hypokalemia: GI (5)

answer

1. Nausea and vomiting 2. Anorexia 3. Diarrhea 4. Decreased bowel sounds 5. Ileus

question

Multisystem effect of hypokalemia: Musculoskeletal (6)

answer

1. Fatigue 2. Leg cramps 3. Muscle weakness 4. Poor muscle tone 5. Paresthesias 6. Paralysis

question

Multisystem effects of hypokalemia: Neurologic (3)

answer

1. Confusion 2. Depression 3. Lethargy

question

Multisystem effects of hypokalemia: Cardiovascular (6)

answer

1. Dysrhythmias 2. Irregular pulse 3. Postural hypotension 4. ECG conduction abnormalities 5. Increased risk of digitalis toxicity 6. Cardiac arrest

question

Monitor patients taking what medication if hypokalemic?(1) Why?(1) What are some clinical manifestations? (6)

answer

digoxin because dig toxicity may occur; fatigue, weakness, confusion, dizziness, hypotension, nausea

question

Early manifestations of hypokalemia include?

answer

muscle cramping and weakness usually affecting the lower extremities first

question

Hyperkalemia can result from? (3)

answer

1. inadequate excretion of potassium 2. exsessive intake of ptassium 3. A shift of potassium from the ICF to ECF

question

Hyperkalemis affect the function of? (2)

answer

1. neuromuscular 2. cardiac function

question

What is the primary cause of hyperkalemia?

answer

Impaired renal excretion of potassium

question

What are some disorders that can lead to hyperkalemia? (2)

answer

1. Untreated renal failure 2. adrenal insufficency (Addisons or inadequate aldosterone production)

question

What types of medications can impair potassium excretion?

answer

1. potassium sparing diuretics 2. ACE inhibitors 3. angiotensin receptor blockers (ARBs)

question

what can lead to high potassium levels (transfusion of)

answer

aged blood

question

ECG changes for hypokalemia? (3)

answer

1. peaked T waves 2. prolonged PR interval 3. Widening of QRS complex

question

When may cardiac arrest occur if pt has hyperkalemia (serum levels)?

answer

greater than 8 mEq/L

question

Early manifestions of hyperkalemia?(7)

answer

diarrhea colic (abdominal cramping) anxiety paresthesis irritability muscle tremors twitching

question

What electrolytes are usually/ might cause hyperkalemia and therefore are checked? (2)

answer

Low calcium low sodium

question

ABGs are done for a hyperkalemic patient to see if what is present?

answer

to see if acidosis is present

question

The nurse sees and another nurse d/c a ECG monitor for a hyperkalmeic patient the nurse should tell the other nurse?

answer

That the ECG must be continuously running and monitoring due to the patients high potassium levels

question

If renal function is normal what is given for a patient that is hyperkalmic?

answer

diuretics such as furosemide

question

Foe moderate hyperkalemia what is given to treat?

answer

calcium gluconate IV

question

Calcium gluconate only lasts?

answer

1 hour

question

To rapidly lower potassium levels what is done/given? Why?

answer

regular insulin and 50 g of glucose are administered. Insulin and glucose promote potassium uptake by the cells, shifting potassium out of ECF.

question

In addition to insulin and glucose what also may be given to speed up potassium movement into cells?

answer

a B2- antagonist such as albuterol

question

To premote potassium from the body what is given and how?

answer

sodium polystyrene sulfonate ( a resin that binds potassium in the GI tract) may be administered orally or rectally

question

When renal function is severly imparied what is done to remove the excess potassium?

answer

Dialysis (either peritoneal or hemodialysis)

question

Pts at greatest risk for developing hyperkalmia? (6)

answer

those taking potassium supplements using potassium sparing diuretics salt substitutes experiencing renal failure body builders or those taking anabolic steroids

question

electrical conduction and contractility of the heart are the highest priority of nursing care for hyperkalemia. Especially when levels are?

answer

6.5 mEq/L or higher

question

What would you monitor for Risk for Activity Intolerance for a patient that is hyperkalemia?

answer

Monitor muscle strength and tone. Increasing weakness, muscle paralysis, or progression of affected muscles to affect the upper extremities or trunk can indicate serum potassium levels Monitor respritory rate and depth. Regularly assess lung sounds. Muscle weakness due to hyperkalemia can impair ventilation.

question

What is used to treat moderate to severe hyperkalemia? (3)

answer

Insulin, hypertonic dextrose (10-50%) and possibly sodium bicarbonate.

question

What is the onset action of insulin and hypertonic dextrose? how long is it effective for a hyperkalmic pt?

answer

onset: within 30 min Duration: 4 to 6 hours

question

Sodium bicarbonate is given to the patient that is hyperkalemic and who has metabolic acidosis. Onset? Duration?

answer

Onset: 15-30 min Duration: approx 2 hours

question

Nursing responsibilities for insulin and dextrose for the hyperkalemic patient?

answer

admin over prescribed interval of time using an infusion pump

question

Sodium bicarb nursing responsibilities for the hyperkalmic patient? (3)

answer

Admin as prescribed It can be administered via IV bolus or added to a dextrose in water solution and given by infusion Monitor for sodium overload. Particularly in patients with heart failure and renal failure

question

When giving sodium polystyrene sulfonate it should also be given with?

answer

a laxative such as lactulose to promote bowel elimination.

question

SPS can be given via? (3)

answer

PO NG tube Rectally

question

Nursing responsibilities for SPS for the hyperkalmic patient? (3)

answer

1. Becasue SPS contains sodium monitor pts with heart failure and edema closely for water retention 2. Restrict sodium intake in pts who are unable to tolerate increased sodium load 3. SPS should not be given to patients who are at risk for intestinal necrosis, post op, have hx of bowel obstruction, ischemic bowel disease, or renal transplant

question

Ionized calcium is important for? (4)

answer

1. stabilizing cell membranes 2. regulating muscle contraction and relaxation 3. maintaining cardiac function 4. blood clotting

question

Sereum calcium levels are regulated by what three hormones?

answer

1. parathyroid hormone 2. calcitonin 3. calcitriol

question

Common causes of hypocalcemia? (4)

answer

parathyroidectomy thiroidectomy radical neck dissection acute pacreatitis

question

For the patient who has undergone surgery when is it likely to see symptoms of hypocalcemia?

answer

24-48 hours

question

What are some other causes of hypocalcemia? (4)

answer

electorlyte imbalances (hypomagnesium or hyperphosphatemia) alkalosis malabsorbtion in the bowel renal failure

question

Drugs that can cause hypocalcemia? (4)

answer

loop diuretic anticonvulsants phosphates drugs that lower Mg levels

question

What is tetany?

answer

tonic muscular spasms

question

Hypocalcemia memory cue?

answer

increased neuromuscular excitability, twitching, spasms, and possible tetany

question

Hypercalcemia memory cue?

answer

Decreased neuromuscular excitability, muscle weakness, and fatigue

question

What two signs do you look for in hypocalcemia?

answer

Chovsteks sign- contaction of the facial muscles produced by tapping the facial nerve in front of the ear Trousseau's sign- carpal spasm induced by inflating a blood pressure cuff on the upper arm to above systolic blood pressure for 2- 5 min

question

Hypocaclemia manifestations? (10)

answer

1. calcium level lower that 9mg/dL 2. numbness and tingling 3. muscle cramping 4. hyperactive reflexes 5. tetany 6. carpopedal and laryngeal spasms 7. Positive chovosten and trousseau signs 8. decreased b/p 9. ventricular dysrhythmias 10. Bone pain

question

If sereum mg is low and it causing hypocalcemia what must happen in order to correct both of these?

answer

give Mg

question

ECG changes would show what abnormality in someone with hypocalcemia? (1)

answer

prolonged ST segment

question

Serious complications of hypocalcemia? (5)

answer

1. airway obstruction due respiratory arrest from laryngeal spasm 2. ventricular dysrhythmias 3.. prolonged QT intervals 4. cardiac arrest 5. ventricular dysrhythmias

question

Saftey alert for IV calcium preparations? (2)

answer

Calcium preps IV can causes necrosis and sloughing of tissue if they infiltrate into subq tissue rapid admin can cause bradycardia

question

Nursing responsibilities for calcium salts (tums)? (2)

answer

1. admin 1 to 1.5 hours after meals and at bedtime 2. give calcium tabs with a full glass of water

question

Nursing responsibilities for IV calcium salts? (5)

answer

1. Assess IV site for patency 2. May be given by slow IV push or added to compatible parenteral fluids such as NS, lactated Ringers solution, or D5W 3. Admin into the largest avaliable vein 4. Continously monitor ECG 5. Do not admin with bicarbonate or phosphate because insoluble salt with form

question

Health education for the patient and family for hypocalcemia drugs? (5)

answer

1. Take calcium tabs with full glass of water 1- 2 hours after meals 2. Do not take with food or milk 3. If possible do not take 1-2 hours of other medications 4. Maintain vitamin d levels (diet or sun) 5. Calcium carbonate can cause constipation. Eat a diet high in fiber

question

Laryngeal spasm is considered?

answer

respritory emergency requiring immediate intervention to maintain ventilation and gas exchange

question

Monitor what for hypocalcemia patients? (4)

answer

1. Airway and respritory status 2. Heart rate and rhythm 3. ECG esp with patients on digitalis 4. provide seizure precautions with airway at bedside

question

The two most common causes of bone re absorption are?

answer

hyperparathyroidism malignancies

question

Drugs that can cause hypercalcemia? (2)

answer

thiazide diuretics lithiam carbonate

question

Hypercalcemia manifestations? (10)

answer

1. Increased thirst 2. increased urine output 3. anorexia 4. Nausea 5. Vomiting 6. constipation 7. increased B/p 8. AV block 9. lethargy 10. Coma

question

What are some complications of hypercalcemia? (3)

answer

1. peptic ulcer disease 2. pancreatitis 3. kidney stones

question

Hypercacemia is particularlly important to patients that have one or more of? (4)

answer

1. levels greater than 12 mg/dL 2. overt manifestations of hypercalcemia 3. compromised renal function 4. inability to maintain adequate fluid intake

question

ECG changes for a patient with hypercalcemia? (5)

answer

1. shortened QT interval 2. shourtened and depressed ST segment 3. widened T wave 4. Bradycardia 5. AV heart block

question

IV fluids are given with what medication to promote the excreation of calcium?

answer

loop diuretics

question

Drugs commonly used to treat hypercalcemia when associated with malignancy? (3)

answer

1. bisphosphonates 2. pamidronate 3. etidronate

question

Rapid reversal of hypercalcemia in emergency situations includes IV administration of? (2)

answer

sodium phosphate potassium phosphate

question

IV fluids that are usually given to patient with hypercacemia? why?

answer

isotonic saline to restore vascular volume and promote renal excretion of calcium

question

Patients with hypercacemia should be encouraged to drink how much per day?

answer

3 to 4 quarts of water

question

Patients that have prolonged immobility and have hypercacemia should drink?

answer

liquids that increased the acicidy of their urine such as prune or cranberry juice

question

foods that can help acidify urine? (7)

answer

1. meats 2. fish 3. poultry 4. eggs 5. cranberries 6. plums 7. prunes

question

Magnesium is essential for? (2)

answer

neuromuscular function cardiovascular

question

Mg levels are affected by what other electrolyte? (2)

answer

potassium and calcium

question

Risks for hypomagnesemia? (10)

answer

GI fluids loss from diarrhea disruption of nutrient absorption in small intestine increased renal excretion starvation DKA kidney disease loop or thiazide diuretics aminoglycoside antibiotics cyclosporine rapid administration of citrated blood

question

Magnesium deficiency usually occurs with?

answer

with low serum potassium and calcium levels

question

Hypomagnesium manifestations? (10)

answer

1. increased neuromuscular excitability 2. muscle weakness 3. tremors 4. changes in personality 5. Nystygmus (lateral twitching of the eyeballs) 6. possitive babinski, Chvostek, and Trousseau sign 7. HTN 8. Tachycardia 9. Cardiac dysrhythmias

question

ECG for hypomagnessium would show? (4)

answer

prolonged PR interval widened QRS complex depression of the ST segment with T-wave inversion

question

Mild Mg deficiency may be treated by oral intake. What are some foods high in Mg? (6)

answer

green leafy vegetables seafood milk bananas citrus fruit chocolate

question

Patients that are being treated for hypomg are treated via? (3)

answer

parentral Mg sulfate several days IV or IM injection

question

Monitor what for a Mg deficiency? (6)

answer

serum electrolytes serum albumin ECG GI function bowel sounds abdominal distention

question

Depressed tendon reflexes indicate?

answer

a high mg level

question

If alcohol abuse precipitated a mg deficit, discuss alcohol treatment options including? (3)

answer

Alcoholics Anonymous Al-Anon Alateen

question

Which is more common hypo or hyper Mg?

answer

hypo

question

hypermagnesemia can develop in what patients?

answer

Renal failure patients

question

Nursing responsibilities for magnesium sulfater for the hypomg pt?

answer

Admin IM doses deep into the ventral or dorsal gluteal sites IV mg sulfate may be given by direct IV push or by continuous infusion Solutions with a concentration of 20% or lower may be administered undiluted by direct IV injection at a rate of no faster than 150mg/min When administering by infusion give required dose over 4 hours but no faster than 150mg/min

question

Hypermagnesemia manifestations? (12)

answer

1. confusion and lethargy 2. Hypotenstion 3. cardiac dysrhythmias 4. coma 5. cardiac arrest 6. N/v 7. brady cardia 8. dysrhthmias 9. flushing 10. diaporesis 11. Respiratory depression 12. Complete heart block

question

Interperfessional care for hypermagnesemia? (3)

answer

Calcium gluconate to be administered IV to reverse neuromuscular and cardiac effects may require mechanical ventilation pacemaker to maintain cardiac function

question

Nursing diagnosis for hypermg?

answer

Decreased cardiac output ineffective breathing pattern risk for injury

question

Phosporus levels vary with? (3)

answer

age gender and diet

question

Phospahate is important for? (9)

answer

ATP production muscle contraction nerve cell transmission electrolyte transport red blood cell function o2 dilivery to tissues nervous system function muscle function helps maintain acid base balance

question

Phosphate and calcium have an inverse relationship meaning?

answer

When one increases the other decreases

question

Causes of hypophosphatemia? (8)

answer

refeeding syndrome can develop when malnourished patients are started on enteral or parenteal nutrition Alcoholism affects both the intake and absorption Hyperventilation respiratory alkalosis DKA excess loss in urine stress responses extensive burns

question

how is the CNS affect by low phosphate levels? what are some manifestations (8)

answer

Reduced O2 ad ATP synthesis in the brain causes neurologic manifestations such as: irritability apprehension weakness paresthesias lack of coordination confusion seizures coma

question

How is the hematologic system affected by low phosphate? (2)

answer

Oxygen delivery to the cells is reduced Hemolytic anemia may develop due to lack of ATP in RBCs

question

How is the Musculoskeletal system affected by low phosphate levels? (3)

answer

Decreased ATP causes 1. muscle weakness 2. rhabdomyolysis (muscle breakdown) 3. muscle cell destruction which can lead to acute kidney injury

question

Cardiovascular affects from low phosphate? (3)

answer

decreases myocardial contactility decreases oxygenation can cause chest pain and dysrhthmias

question

Manifestations of the GI tract due to low phosphate? (5)

answer

Anorexia dysphagia N/v decreased bowel sounds possible ileus due to reduced GI motility

question

Hypophosphateemia manifestations? (7)

answer

Intention tremor paresthesias confusion stupor bone pain bleeding disorders impaired white blood cell function seizures

question

IV phosphate is given when levels are?

answer

less than 1 mg/dL

question

Causes of hyperphosphatemia?

answer

acute or chronic renal failure is the primary cause of imparied phosphate excretion rapid admin of phosphate containg solutions excess Vit D A shift of phosphate from the intracellular to extracellular space can occu during chemotheraphy, sepsis, or hypothermia, or heat stroke

question

Monitor labs of high phosphate patient for? (2)

answer

high potassium deficit of calcium

question

Although more manifestations for hyperphosphatemia are usually due to the low level of calcium. The clinical manifestations that may be present include? (7)

answer

1. paresthsia 2. muscle weakness 3. N/v 4. Dysphagia 5. Tetany 6. decreased b/p 7. cardiac dysrhythmias

question

the normal pH for most body fluids?

answer

7.35-7.45

question

Sodium bicarbonate level?

answer

24 mEq/L

question

Carbonic acid level?

answer

1.2 mEq/L

question

define acidosis?

answer

when the pH drops below 7.35

question

Define alkalosis?

answer

when the pH rises above 7.45

question

ABGs include? (5)

answer

pH PaCO2 PaO2 HCO3- BE

question

ABGS: normal range pH? What does the pH level represent? When is pH considered acidosis/alkalosis?

answer

Normal range: 7.35-7.45 Reflects hydrogen ion concentration less than 7.35= acidosis greater than 7.45 = alkalosis

question

ABGs: normal range for PaCO2? What does this level measure? when is it considered hypocapnia/ acidosis? and when are levels considere hypercapnia/ alkalosis?

answer

Normal range: 35-45 mmHg Partial pressure of carbon dioxide (CO2) in arterial blood less than 35 mmHG = hypocapnia greater than 45 mmHG= hypercapnia

question

ABGs: Normal range for PO2 and significance?

answer

Partial pressure of oxygen in atrial blood normal range: less than 80 mmHg = hypoxemia

question

ABGs: HCO3- normal range? What does this level reflect?

answer

Bicarbonate concentration in plasma normal range: 22-26 mEq/l

question

ABGs: BE normal and significance?

answer

normal range: -3 to 3+ Base excess; a measure of buffering capacity

question

The respritory system regulates carbonic acid in the body by?

answer

eliminating or retaining carbon dioxide

question

What occurs in the respritory sytem when it is considered acidic?

answer

depth and rate of respirations increase to eliminate carbon dioxide from the body and carbonic acid levels fall bringing the pH to a more normal range

question

How does alkalosis affect the respritory system?

answer

it depresses the respiratory center and both depth and rate of respiration decrease and carbon dioxide is retained. The retained carbon dioxide then combines with water to restore carbonic acid levels and bring the pH back within the normal range

question

What are the kidneys responsible for in acid base balancing?

answer

elimination excess volitle acids produced during metabolism regulate bicarbonate levels in the extracellular fluid

question

which system works faster in the acid base?

answer

respritory

question

what do the kidneys do in acidosis is present?

answer

when excess hydrogen ion is present and the pH falls, the kidneys excrete hydrogen ions and retain bicarbonate

question

What do the kindeys do in alkalosis?

answer

the kidneys retain hydrogen ions and excrete bicarbonate to restore acid-base balance

question

What is the primary way to test acid-base balance?

answer

ABGs

question

Why is atrial blood used to assess acid base balance? (2)

answer

because it reflects acid base balance throughout the entire body provides info on how effective the lungs are in oxygenating blood

question

The PaCO2 measures?

answer

the pressure exerted by disolved carbon dioxide in the blood

question

PaCO2 assess what buffer system?

answer

the lungs

question

The PaO2 measures?

answer

the pressure exerted by oxygen that is dissolved in the plasma

question

Sodium bicarbonate of HCO3- measures the function?

answer

of the kidneys on maintains the acid-base balance

question

The base excess (BE) measures? (4)

answer

substances that can accept or combine with hydrogen ion. It reflects the degree acid-base imbalance by indicating the status of the bodys total buffering compacity It represents the amount of acid or base that must be added to a blood sample to achieve a pH of 7.4 It essentially is a measure of increased or decreased bicarbonate

question

Acidosis occurs when?

answer

the hydrogen ion concentration increases above normal

question

Alkalosis occurs when?

answer

when the hydrogen ion concentration falls below normal

question

In metabolic acidosis what occurs?

answer

the amount of bicarbonate is decreased in relation to the amount of acid in the body

question

Metabolic alkalosis what occurs?

answer

it occurs when there is excess bicarbonate in relation to the hydrogen ion

question

Diabetic ketoacidosis patient would probably be in?

answer

metabolic acidosis

question

COPD pt would probably be in?

answer

respritory acidosis

question

Anxiety related/hyperventalation the patient would be in?

answer

resiratory alkalosis

question

Metablic acidosis is characterized by? (3)

answer

low pH low bicarbonate normal paCO2

question

Metabolic acidosis may be caused by? (2)

answer

excess acid in the body loss of bicarbonate from the body

question

When metabolic acidosis occurs the respiratory system attempts to return the pH to normal by?

answer

increasing the rate and depth of respirations

question

Metabolic acidosis is rarely a primary disorder it ussually develops during the course of?

answer

another disease

question

some risk factors for having metabolic acidosis? (4)

answer

Increased acid production - Lactic acidosis - Ketoacidosis related to diabetes, starvation, or alcholoism Decreased acid production -Renal failure Increased Bicarbonate loss - Diarrhea, ileostomy drainage, instestinal fistula -biliary or pancreatic fistulas Increased chloride -sodium chloride IV solutions -Renal tubular acidosis

question

Critical valuse for metabolic acidosis? (2)

answer

pH less than 7.20 HCO3 less than 10 mEq/L

question

What are the three basic mechanisms that can cause metabolic acidosis?

answer

Accumulation of metabolic acids Excess loss of bicarbonate An increase in chloride levels

question

Manifestations of metabolic acidosis? (11)

answer

Anorexia n/v abdominal pain weakness fatigue general malaise decreasing levels of consciousness dysrhythmias bradycardia warm, flushed skin Hyperventilation (Kissmaul's respirations)

question

ABGs for metabolic acidosis usually show?

answer

pH less than 7.35 bicarb level less that 22 mEq/L decreased PaCO2 to less than 35 mmHg

question

Serem electorlytes in metabolic acidosis? (2)

answer

elevated potassium levels and possibly low Mg levels

question

What is used to calculate anion gap? (3)

answer

sodium, chloride, and bicarbonate

question

What studies may be ordered to find the underlying cause of metabolic acidosis? (2)

answer

blood glucose and renal function

question

Metabolic acidosis is considered severe if pH is less than 7.1 what may be given to treat this(2)

answer

alkalinizing solution such as bicarbonate

question

Alkaline solutions are given IV if? and the oral rout is used if the metabolic acidosis is?

answer

1. Acute or severe 2. Chronic

question

If the pt is being treated with bicarbonate you must monitor for?

answer

metabolic alkalosis and hypokalemia (if corrected to quickly) Hypernatremia and hyperosmolality which can lead to water retention and fluid overload

question

As metabolic acidosis is corrected potassium shifts back into the intracellular space. This can lead to ________ and ________

answer

hypokalemia and cardiac dysrhythmias (monitor potassium levels during treatment)

question

Metabolic acidosis disorders: DKA tx includes?

answer

IV insulin and fluid

question

Metabolic acidosis disorders: Alcoholic ketoacidosis is treated with?

answer

saline solutions and glucose

question

Metabolic acidosis disorders: lactic acidosis treatment? (shock/ cardiac arrest)

answer

focuses on correcting the underlying problem and improving tissue profusion

question

Metabolic acidosis disorder: chronic renal failure or mild to moderate metabolic acidosis may or may not require treatment. It all depends on?

answer

pH and bicarbonate levels

question

Metabolic acidosis disorders: Diarrhea treatment includes?

answer

correcting underlying cause and providing fluid and electrolyte replacement

question

The main focus of care for treating is metabolic acidosis is determining the?

answer

cause and treating the cause to reverse the metabolic acidosis

question

Suspected metabolic acidosis the nurse would assess for what in the health history?

answer

ask patient if they are experiencing: -anarexia - n/v - abdominal discomfort - fatigue - lethargy - diarrhea ingestion of a toxin such as: -aspirin - methonol - ethylene Chronic diseases such as: - diabetes - renal failure - cirrhosis off the liver - endocrine disorders Current medications

question

How does metabolic acidosis affect cardiac output?

answer

it decreased myocardial contractility, slowing the heart rate, and increasing it for risk of dyrhythmias. It is also accompanied by hyperkalemia

question

Nursing Dx for metabolic acidosis?

answer

Decreased cardiac output Risk for fluid volume excess Risk for injury

question

When pH falls what happens to mentality?

answer

mental function declines, leading to confusion, stupor, and decreasing levels of consciousness

question

Metabolic alkkalosis (bicarbonate excess) is characterized by?

answer

high pH greater than 7.45 high bicarbonate greater than 26 PaCO2 in greater than 45

question

Metabolic alkalosis is normally caused by?

answer

loss of acid or excess bicarbonate

question

When metabolic alkalosis develops the respiratory system attempts to return pH to normal by?

answer

slowing respiration rate which leads to retention of CO2 which accounts for the high PaCO2 reading.

question

Risk factors of metabolic alkalosis include? (3)

answer

hospitalization hypkalemia tx with alkalinizing solutions (bicarbonate)

question

Metabolic lakalosis due to the loss of hydrogen ions usually occurs because of? (2)

answer

vomiting or gastric suctioning

question

Increased renal excretion of hyrogen ions can be prompted by hypokalemia as the kidneystry to conserve potassium excreting what instead?

answer

hydrogen ions

question

Hypokalemia contributes to metabolic alkalosis in another way as well? When potassium shifts out of cells to maintain extracelluolar potassium levels?

answer

hydrogen ions shift into the cells to maintain the balance between cations and anions within the cell

question

Excess bicarbonate in which leads to metabolic alkolosis is usually caused by?

answer

ingesting antiacids that contain bicarbonate or overzealous administration of bicarbonate to treat metabolic acidosis.

question

Metabolic alkalosis can be caused by? (4)

answer

increased acid loss or excretion - vomiting and gastric suctioning - Hypokalemia Increased bicarbonate - Alkali ingestion (bicarbonate of soda) - Excess bucarbonate administration

question

Critical values of metabolic alkalosis? (2)

answer

pH greater than 7.60 HCO3- greater than 40 mEq/L

question

the clinical manifestations of metabolic alkalosis occur as a result of?

answer

decreased calcium ionization and are similar to those of hypocalcemia

question

Manifestations of metabolic alkalosis? (9)

answer

1. Confusion 2. Decreased LOC 3. Hyperreflexia 4. Tetany (Trousseau's sign) 5. Dysrhythimias 6. Hypotension 7. Seizures 8. Respiratory failure 9. Respritory acidosis may occur due to respritory failure and hypoxemia

question

Serum electrolytes for metabolic alkalosis? (4)

answer

hypokalemia decreased chloride (less than 95 mEq/L) Bicarbonate will be high total serum calcium may be normal but the ionized fraction of calcium will be low

question

If metabolic alkalosis is caused by hypokalemia the urine pH will be? and the urinary chloride will be?

answer

Urine pH- may be low Urinary chloride- greater than 250 mEq/24 hrs

question

Treatment of metabolic alkalosis includes? (3)

answer

restoring normal fluid volume and administering potassium chloride and sodium chloride solution

question

Health promotion focuses on what for metabolic alkalosis?

answer

the risks of taking a sodium bicarbonate as a antiacid educate about other types of treatments and prescriptions

question

Priority of care for metabolic alkalosis?

answer

the risk for impaired gas exchange as a compensatory response to metabolic alkalosis

question

Nursing diagnosis for metabolic alkalosis? (2)

answer

risk for impaired gas exchange deficient fluid volume

question

What you teach a patient with metabolic alkalosis on discharge? (3)

answer

1. use appropriate antiacides for the relief of heart burn and gastric distress 2. using potassium supplements as ordered or eating a high potassium foods to avoid hypokalemia if taking potassium wasting diuretic or if aldosterone production is impaired 3.Contact the primary care provider if uncontrolled or extended vomiting occurs

question

Respritory acidosis is caused by an excess of?

answer

dissolved carbon dioxide or carbonic acid

question

Respritory acidosis is characterized by? (3)

answer

a pH of less than 7.35 and a (low ph) PaCO2 greater than 45 mmHg (high CO2) Normal HCO3

question

Respiratory acidosis can be either acute or chronic. In chronic respiratory acidosis the bicarbonate will be?

answer

higher than 26 mEq/L as the kindeys compensate by retaining bicarbonate

question

Risk factors for acute respritory acidosis? (3)

answer

acute repiratory conditions (pulmonary edema, pneumonia, asthma) Opiate overdose Chest trauma

question

Risk factors for chronic respiratory acidosis? (2)

answer

chronic respiratory conditions (COPD and cystic fibrosis) MS and other neuromuscular diseases

question

Both acute and chronic respiratory acidosis result from?

answer

carbon dioxide retention caused by alveolar hypoventilation

question

What frequently accompanies respritory acidosis?

answer

hypoxemia

question

define hypoxemia?

answer

low o2 in the atrial blood

question

Define hypercapnia?

answer

increased levels of carbon dioxide

question

Manifestations for acute respiratory acidosis? (7)

answer

1. Headache 2. Warm flushed skin 3. Blurred vision 4. Irritability 5. Altered mental status 6. Decreasing LOC 7. Cardiac arrest

question

Manifestations of chronic respiratory acidosis? (5)

answer

1. Weakness 2. DUll headache 3. Sleep disturbances with daytime sleepiness 4. impaired memory 5. personality changes

question

Carefully monitor neurological and respiratory status in patients with chronic respiratory acidosis who are receiving oxygen therapy. Immediately report? (2)

answer

1. decreasing LOC 2. depressed respiration's

question

Serum electrolytes may show what in chronic respiratory acidosis?

answer

hypochloremia less than 98 mEq/L

question

Medications that may be used to help treat the underlying cause of respiratory acidosis? (3)

answer

Bronchodilator- open airway antibiotics- treat underlying infection if narcotics are the cause then drugs such as naloxone may be used to reverse the acidosis

question

since there is a risk for many respiratory complications in patients with respiratory acidosis what may be used for respiratory support? (3)

answer

breathing treatments percussion and drainage adequate hydration

question

Why do you want to be cautious with the use of oxygen for tx of chronic respiratory acidosis?

answer

because o2 administration can cause carbon dioxide narcosis

question

What is the priority if care for repository acidosis? (2)

answer

Restoring effective alveolar ventilation and gas exchange

question

Nursing diagnosis for respiratory acidosis? (2)

answer

1. Impaired gas exchange 2. Ineffective airway clearance

question

Encourage what for respiratory acidosis patients? (2)

answer

1. Pursed lip breathing (helps maintain open airway and elimination of carbon dioxide) 2. Encourage fluid intake of up to 3000 mL per day as tolerated or allowed (fluids help liquefy secretions and hydrate respiratory mucous membranes, promoting airway clearance)

question

Respiratory alkalosis is characterized by? (3)

answer

a pH greater than 7.45 (Increased pH) and PaCO2 less than 35 mmHg (Low CO2) normal HCO3

question

Respiratory alkalosis is always caused by? leading too?

answer

hyperventilation leading to carbon dioxide deficit

question

Risk factors to respiratory alkalosis? (4)

answer

Anxiety induced hyperventilation fever Early salicylate intoxication Hyperventilation with mechanical ventilator

question

Compensation for respiratory alkalosis?

answer

Kidneys excrete bicarbonate and converse H+ to restore carbonic acid:bicarbonate ratio

question

Compensation for respiratory acidosis?

answer

Kindeys conserve bicarbonate to restore carbonic acid: bicarbonate ratio of 1:20

question

Metabolic alkalosis compensation?

answer

Rate and depth of respiration's decrease retaining CO2

question

Metabolic acidosis compensation?

answer

Rate and depth of respiration's increase eliminating additional CO2

question

Manifestations of Respiratory alkalosis? (12)

answer

1. Dizziness 2. numbness and tingling around mouth, hands, and feet 3. Palpations 4. Dyspnea 5. Chest tightness 6. anxiety/panic 7. Tremors 8. Tetany 9. Tremors 10. seizures, loss of consciousness 11. Positive Chvostek's and Trousseau's sign 12. Tinnitus

question

In chronic respritory alkalosis bicarbonate and pH may appear to be

answer

pH- may be near normal bicarbonate may be less than 22 mEq/L

question

A patient is admitted to the ED with hypovolemia. Which IV solution should the nurse anticipate administering? A. 3% sodium chloride B. 10% dextrose C. 0.45% Sodium chloride D. lactated Ringer's solution

answer

A. 3 % sodium chloride

question

Which manifestations would should a nurse expect to assess in a patient with fluid volume deficit? A. headache and muscle cramps B. Dyspnea and respiratory crackles C. Increased pulse rate and blood pressure D. Orthostatic hypotension and flat neck veins

answer

D. Orthostatic hypotension and flat neck veins

question

The nurse is planning care for a patient with acute hypernatremia. What should the nurse include in this patient's plan of care? (SADA) A. Maintain IV access B. Limit length of visits C. Restrict fluids to 1500 mL per day D. Conduct frequent neurologic checks E. Orient to time, place, and person every 2 hours

answer

A. Maintain IV access D. Conduct frequent neuro checks E. Orient to time, place, and person every 2 hours

question

A patients serum potassium level is 2.2 mEq/L. Which nursing intervention action id the highest priority for this patient? A. Start oxygen at 2L/min B. Initiate cardiac monitoring C. Initiate seizure precautions D. Keep the patient on bed rest

answer

B. Initiate cardiac monitoring

question

The nurse instructs a patient on calcium supplement therapy. Which statement indicates that the patient understand how to take the calcium supplement? A. I will take the calcium with meals B. I will that the calcium with a full glass of water C. I will take these supplements as needed for tremulousness D. I will take these supplements all at one time in the morning

answer

B. I will take the calcium with a full glass of water

question

A patient is demonstrating confusion, hallucinations, and a postive Chvostek's sign. Which medications should the nurse prepare to provide to the patient? A. calcium chloride B. Magnesium sulfate C. Insulin and glucose D. Sodium bicarbonate

answer

A. Calcium chloride

question

A patient arterial blood gas results are pH 7.21, PaO2 98 mmHG, PaCO2 32 mmHG, and HCO3- 17 mEq/L. Which acid base imbalance do these results indicate to the nurse? A. Metabolic acidosis B. Metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis

answer

B. Metabolic alkalosis

question

A patient diagnosed with suspected heroin overdose has respiratory rate of 5 to 6 per min. Which additional data should the nurse expect to collect on this patient? (SADA) A. pH 7.29 B. PaCO2 54mmHG C. HCO3- 32 mEq/L D. Alert and orientated E. Skin warm and flushed

answer

A. pH of 7.29 B. PaCO2 54 mmHg E. skin warm and flushed

question

The nurse is caring for a patient undergoing gastric decompression. For which potential acid-base balance should the nurse plan interventions? A. metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

answer

B. Metabolic alkalosis

question

A patient being mechanically ventilated after a sever chest wall injury and flail chest complains of chest tightness, anxiety, and air hunger. The patient fears a heart attack is pending. What should the nurse do first? A. Notify the physician B. Obtain ABGs C. Administer prescribed analgesic D. Contact respiratory therapy to evaluate ventilator setting

answer

B. Obtain ABGs

question

A nurse is assessing a patient who has dehydration. Which of the following is the top priority? Skin tugor Urine output Weight Mental Status

answer

Mental Status

question

Respiratory Acidosis will have increase, decreased, normal values?

answer

pH- decreased PaCO2- Increased HCO3- normal

question

Respiratory Alkalosis will have increased, decreased, normal values?

answer

pH- increased PaCO2- decreased HCO3- normal

question

Metabolic Acidosis will have increased, decreased, normal?

answer

pH- decreased PaCO2- normal HCO3- decreased

question

Metabolic Alkalosis will have increased, decreased, normal?

answer

pH- increased PaCO2- normal HCO3- increased

question

pH range? when is it a acid and when is it a base?

answer

pH: 7.35-7.45 Acid less than 7.35 Base greater than 7.45

question

pCO2 range? when is it an acid and when is it a base?

answer

pCO2: 35-45 Acid greater than 45 (acidosis) Base less than 35 (alkalosis)

question

HCO3 range? when is it an acid and when is it a base?

answer

HCO3: 22-26 acid less than 22 base greater than 26

question

human blood is naturually?

answer

alkalotic

question

why is atrial blood better from measuring blood gasses vs. venous blood?

answer

pH range can vary picks up waste less reliable

question

Buffer systems are critical in maintaing?

answer

normal body fluid pH

question

Acid relasee?

answer

hydrogen ions when disolved in water

question

Bases bind?

answer

with hydrogen ions in solutions

question

Salt is what kind of substance

answer

nutral

question

Buffers act with in

answer

seconds to minutes to a change in pH

question

What are the functions of water for fluid/electrolyte/acid-base balance? (3)

answer

1. Transportation of nutrients 2. Medium for metabolic reaction 3. Regulation of body temperature

question

Isotonic solutions has an osmolarity of?

answer

greater than 300 mOsm/L

question

Hyper tonic solutions have a osmolarity of?

answer

fluids less than 270 mOsm/L

question

Is osmolarity is >600 (greater than) mOsm/L it is best infused in a centreal circulation where greater flow provides?

answer

adequate hemodilution

question

TPN has a osmolarity of?

answer

(greater than) > 1400 mOsm/L

question

TPN should never be infused into what type of circulation and why?

answer

It should never be infused into peripheral circulation because it can damage blood cells and endothelial lining of vein.

question

Increased thirst, olguria, increased urine specific gravity in hypernatremia is caused because?

answer

H20 is not going into cells

question

Sodium levels of 130-135 may be asymptomatic and can usually be replaced by?

answer

oral intake

question

When sodium levels are critically low (120-125) the patient is at risk for?

answer

brain stem herniation due to cerebral edema

question

someone that has hyponatremia the urine color will be?

answer

clear

question

Cardiac monitoring for hypokalemia? (5)

answer

1. slightly prolonged PR interval 2. Slighlty peaked P wave 3. Shallow T wave 4. ST depression 5. PROMINENT U wave

question

Chloride levels mimic the s/s of what other electrolyte imbalance?

answer

sodium

question

Why do kidney disease patients have an increased risk for hypomagnesmia?

answer

because they have to have a diet low in protein

question

Magnesium is high in what food?

answer

meat

question

In patients with hypomagnesemia you should watch for s/e related to?

answer

digoxin; digoxin toxicity

question

Low magnesium symptoms in a patient could be mistaken for what other electrolyte imbalances? (2)

answer

imbalances in calcium or potassium

question

Generally, hypermagnesmia only occurs in patients with?

answer

Renal insufficiency

question

Symptoms of hypophosphatemia that set this electrolyte imbalance apart from other imbalances? (2)

answer

Anemia and bruising Bone pain Joint stifness Bleeding disorders Impaired WBC function

question

What disorders may cause hypocalcemia? (5)

answer

Hypoparathyroidism Acute Pancreatitis Hyperphosphatemia Thyroid carcinoma Vitamin D deficiency

question

What disorders may cause an increase in calcium levels? (3)

answer

Prolonged immobilization Hyperparathyroidism Malignancy of bone

question

Disorders or conditions that may lead to hyponatremia? (4)

answer

1. Exsessive loss through vomiting, urination, perspiration, or diarrhea 2. drug use 3. Excessive water intake 4. Head injury

question

Disorders or conditions that can cause hypernatremia include? (5)

answer

1. Loss of fluids through diarrhea 2. Water deprevation 3. Excessive salt intake 4. Diabetes insipidus 5. Heat stroke

question

Disorders than may cause hypochloremia? (5)

answer

1. Assisons disease 2. Diarrhea 3. Meabolic alkalosis 4. Respiratory acidosis 5. Vomiting

question

Hyperchloremia can be caused by what disorders? (5)

answer

Cardiac decompensation Metabolic acidosis Respiratory alkalosis corticosteroid therapy uremia

question

Disorders that can cause hypomagnesemia? (5)

answer

1. excessive loss from GI tract 2. Use of drugs 3. Chronic alcoholism 4. DKA 5. Hyperparathyroidism

question

Disorders than may cause hypermagnesemia?

answer

1. Renal disease and renal failure 2. Tx with magnesium and magnesium containing medications (antiacids)

question

Disorders or conditions that may cause hypophosphatemia? (5)

answer

1. Alkalosis 2. Diabetes 3. Chronic alcholoism 4. Recovery from malnutrition 5. Severe diarrhea

question

Disorders or conditions that may cause hyperpophosphatemia? (5)

answer

1. Renal failure 2. Hypoparathyroidism 3. Excessive ingestion of phosphorus 4. Trauma 5. Heat Stroke

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