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Fluid & Electrolytes

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  • Fluid & Electrolytes/Acid Base BalanceGoal: Reestablish & maintain normal balance -assess clients likely to develop imbalances -monitor clients for early manifestations -implement collaborative interventions
  • Necessary for cells to be able to carry out their work. Body fluids are in constant motionBody fluids maintain healthy living conditions for body cells
  • nutrients in foodnormal digestive processesnormal volume, composition, distribution, & pH of body fluids
  • Homeostasis involvesDelivery of essential elements such as oxygen and glucose to the cellsRemoval of wastes such as carbon dioxide from the cells
  • Intracellular fluid 40% total body weightEssential for normal cell functionProvides medium for metabolic processes
  • Extracellular fluid 20% total body weightInterstitial fluid: spaces between cellsIntravascular fluid (plasma-arteries, veins, capillaries)Transcellular fluidUrine, digestive secretions, perspirationCerebrospinal, pleural, synovial fluidsIntraocular, gonadal, pericardial fluids
  • 82 year old women
  • Isotonic dehydration, the most common type of fluid deficit, is caused by loss of plasma volume. In this case, the client lost volume by excessive vomiting and diarrhea
  • Urine specific gravity >1.010 Urine volume decreased Serum sodium normal Serum hct & hgb increasedBUN normal or increased Serum osmolality normal
  • Orthostatic hypotension and flat neck veins
  • Increased sympathetic discharge
  • Rapid hydration of IVF
  • D5W
  • Urinary output
  • crackles
  • weight
  • Distended hand and neck veins
  • All except diminished peripheral pulses, thirst, orthostatic hypotension
  • Restrict free water
  • Stop IV
  • Urine output
  • ElectrolytesMaintain fluid balanceRegulate & maintain acid-base balanceContribute to enzyme reactionsEssential for neuromuscular activityMeasured in mEq/L of watermEq-measure of chemical binding power of the ion
  • Heart rhythm
  • Cardiac monitoring
  • Bacon, fresh fruit salad if it contains bananas, cantalope, kiwi, orange) potato, spinach, & dried fruit; salt subsitute
  • Deficit knowledge related to dietary intake of potassium as evidenced by dietary intake of potassium rich foods such as potatoes, bacon, and salt subsitute. Deficit knowledge related to lack of familiarity with information resources as evidenced by inaccurate follow through on instructions for medication and dietary intake of potassium rich foods
  • Loose diarrhea stools. Symptoms are a result of the excess potassium moving from ICF to ECF creating an stimulation of the bowel and resulting in diarrhea.
  • There is no need to clarify the order. GI s/s of hyperkalemia are increased motility, hyperactive bowel sounds and diarrhea. The kayxalate will reduce the potassium levels consequently the intestinal motility decreases if the enema is successful
  • Spironolactone is a potassium sparing diuretic and should be d/c.Teach diet, medications, and recognition of s/s of hyperkalemia. Importance of follow up care
  • Seizure precautions
  • Because of her symptoms and history knowing that dehydration can be characteristic of hypernatremia the sodium level is expected to be elevated. Assessment: CNS, neurovascular, and CV manifestations Treatment fluid replacement with isotonic solution (NaCl) Teaching sodium content in foods and beverages, safety measures (physiologic changes in the elderly, s/s of dehydration to report, prevention of dehydration and hypernatremia by drinking adequate water
  • High Ca can cause constipation, polyuria which causes increased thirst; cardiac arrestLow Ca Lethargy, coma
  • Heart rhythm-dysrhythmias, ECG changes possible HTN, cardiac arrest
  • Severe Low phos affects every major organ
  • Magnesium
  • Transcript

    • 1. Fluid & Electrolytes
      C. Washington RN, MSNEd
    • 2.
    • 3. Homeostasis Depends On
    • 4. Homeostasis Depends on
    • 5.
    • 6.
    • 7.
    • 8. Fluid Balance
    • 9.
    • 10.
    • 11.
    • 12. Body Fluid Distribution
      • ICF
      • 13. Potassium, magnesium, & phosphate
      • 14. Glucose, oxygen
      • 15. ECF
      • 16. Sodium, chloride, bicarbonate, calcium
      • 17. High Na+ concentration regulates body fluid volume
    • Body Fluid Movement
    • 18. Body Fluid Movement
      • Osmolality 275-295 mOsm/kg
      • 19. Used to describe concentration of body fluids
      • 20. # solutes /kg H20 (by weight)
      • 21. Estimated by doubling serum Na concentration
      • 22. Osmolarity of ECF depends on Na+ concentration
    • Body Fluid Movement
      Diffusion
      Molecules -> from an area of ↑ concentration to an area of ↓ concentration
      Osmotic Pressure
      • Power of fluid to draw H20
      across a membrane
    • 23. Body Fluid Movement
      Filtration
      H2O & dissolved substances -> from an area of > hydrostatic pressure to an area of < hydrostatic pressure
    • 24.
    • 25. Body Fluid Movement
    • 26.
    • 27.
    • 28.
    • 29.
    • 30.
    • 31. Fluid Replacement
    • 32. Fluid Replacement
    • 33. Why should you care?
      ↑ sodium concentration in ECF
      Causes H2O to shift from ICF -> ECF compartment
      Treatment: 0.45% NS (hypotonic) facilitates H2O back into intracellular space
    • 34.
    • 35. Body Fluid Regulation
    • 36. Renin-Angiotensin-Aldosterone System
    • 37.
    • 38. Hydration: Important for Good Health
    • 39. Assessment of Fluid Balance
      Diagnostic and Laboratory Data
      Osborn page 420
    • 40. Assessing Fluid Balance
    • 41. Assessing Fluid Balance
    • 42. Assessing Fluid Balance
    • 43. Assessing Fluid Balance
    • 44. Nursing Diagnosis: Fluid Imbalances
      Fluid volume excess
      Fluid volume deficit
      Fluid volume deficit, risk for
      Gas exchange, impaired
      Cardiac output, decreased
      Knowledge deficit
      Breathing pattern, ineffective
      Anxiety
      Thought processes, altered
      Injury, risk for
      Oral mucous membrane, altered
    • 45. Fluid Balance: Common Interventions
      Monitoring daily weight
      Measuring vital signs
      Measuring intake and output
      Providing oral hygiene
      Initiating oral fluid therapy
      Maintaining tube feeding
      Monitoring intravenous therapy
    • 46. Fluid & Electrolyte disorders
      Excess fluids result from excessive intake or decreased output, from any cause
      Fluid deficits result from poor intake or excessive output, from any cause
      Both occur from shifts that occur with various health disorders
    • 47. FVD: Cause
    • 48. FVD: Cause
    • 49. FVD: Cause
    • 50. FVD: Cause
    • 51. Fluid Volume Deficit
      Hypovolemia
      Loss of extracellular fluid volume
      Isotonic fluid volume deficit
      Electrolytes loss along with fluid
    • 52. FVD
      Third spacing
      Shift of fluid into vascular space
      abdomen, pleural/ peritoneal space
    • 53. Signs & Symptoms: FVD
      • Weight loss
      • 54. 1 liter of body fluid weighs 1 kg (2.2lb)
      • 55. ↓interstitial fluid→ diminished skin turgor
      • 56. ↓skin turgor less accurate in elderly
      • 57. More accurate indicator of FVD
      • 58. Assess tongue for size, dryness, longitudinal furrows
    • Test Yourself
      • You are caring for a patient taking the diuretic furosemide.
      • 59. Yesterday, the patient’s weight was 62 kg.
      • 60. After the dose of furosemide yesterday, the patient’s urine output was 2,500 ml.
      • 61. What do you expect the patient’s weight to be today?
    • Signs & Symptoms: FVD
      • Hypovolemia
      • 62. Orthostatic hypotension
      • 63. >15 mmHg drop in SBP from lying to standing
      • 64. Loss of intravascular volume
      • 65. ↑HCT
      • 66. Venous pressure falls
      • 67. Flat neck veins
    • Signs & Symptoms: FVD
      • To conserve water & sodium pt may experience
      • 68. Tachycardia
      • 69. Pale, cool skin (vasoconstriction)
      • 70. Decreased urine output
      • 71. Specific gravity increases as water is reabsorbed in the tubules
    • Diagnostic Tests: FVD
      Serum electrolytes
      Isotonic deficit Na+ wnl
      Water loss only Na+ ↑
      ↓ K+ common
      Serum osmolality ↑ with water loss
      Serum Hgb & Hct ↑
      Urine specific gravity & osmolality ↑
    • 72.
    • 73. Assessment: FVD
      • Health History
      • 74. Medication
      • 75. Renal or endocrine disease
      • 76. Hot weather
      • 77. Excessive exercise
      • 78. Lack of access to fluids
      • 79. Recent illness accompanied by fever, vomiting/diarrhea
    • Assessment: FVD
      Physical Assessment
      Weight
      Vital signs
      Peripheral pulses/capillary refill
      Jugular neck vein
      Skin color
      Temperature
      Turgor
      LOC/mentation
      Urine output
    • 80. Fluid Management: FVD
      Isotonic Electrolyte solutions
      0.9% NaCL/Ringer’s solution
      Expand plasma volume (↓ BP pt’s)
      Replace abnormal losses
      Total body water deficits
      D5W
      Dextrose is metabolized to carbon dioxide & water ->availability of free water for tissue needs
    • 81. Fluid Imbalance
      Nursing Process: Patient Care Plan for
      Dehydration
      Osborn page 421
    • 82. Dehydration
      • When more water is lost from the body than is replaced.
      • 83. Dehydration refers to loss of water alone
      • 84. Caused by water deprivation, excessive urine production, profuse sweating, diarrhea, and extended periods of vomiting.
    • 85. Nursing Diagnosis: FVD
      Deficient Fluid Volume
      Ineffective Tissue Perfusion
      Risk for Injury
    • 86. Test Yourself
      • In prioritizing patient care, you recognize that the pt most at risk for FVD is
      • 87. A 30 year old man with a fractured tibia
      • 88. An 82 year old women with a fractured hip
      • 89. A 62 year old man with a heart attack
      • 90. A 35 year old woman who just delivered a baby
    • Ms. Hicks
      39 year old female
      history of vomiting & diarrhea from the flu
      rapid pulse
      orthostatic hypotension
      urine output of 20 mL/hr
      skin turgor poor with tenting
      increased respiratory rate
    • 91. Ms. Hicks
      Which type of
      dehydration do you
      suspect that this
      Ms. Hicks has? Explain
      your answer.
    • 92. Ms. Hicks
      In evaluating the
      client’s laboratory
      values, would you
      expect the following
      values to be normal,
      elevated, or
      decreased?
      Urine specific gravity
      Urine volume
      Serum sodium
      Serum hct & hgb
      BUN
      Serum osmolality
    • 93. Ms Hicks
      When assessing a patient with FVD, the nurse would expect to find:
      Increased pulse rate and BP
      Dyspnea and respiratory crackles
      Headache and muscle cramps
      Orthostatic hypotension and flat neck veins
    • 94. Ms Hicks
      What compensatory mechanism responsible for the client’s rapid pulse?
    • 95. Ms Hicks
      What immediate interventions are necessary to correct this client’s fluid volume imbalance?
    • 96. Ms Hicks
      Admitted with hypovolemia. Which IV solution would the nurse anticipate administering?
      Ringer’s solution
      10% dextrose in water
      3% sodium chloride
      0.24% sodium chloride
    • 97. Ms Hicks
      What would be most important to monitor to determine the client’s response to corrective interventions?
    • 98. Mr Hicks
      What assessment data would indicate that the client is having a negative response to fluid resuscitation?
    • 99. Fluid Volume Excess (FVE)
      • Results from water & sodium retention
      • 100. Hypervolemia
      • 101. Excess intravascular fluid
      • 102. Edema
      • 103. Excess interstitial fluid
    • FVE: Causes
    • 104. FVE: Cause
    • 105. FVE: Cause
    • 106. FVE: Cause
    • 107. Signs & Symptoms: FVE
    • 108. Signs & Symptoms: FVE
    • 109. Signs & Symptoms: FVE
      Weight gain >5% of body weight
    • 110. Diagnostic Tests: FVE
      To determine cause
      Serum creatinine
      BUN
      liver enzymes
    • 111. Medications: FVE
      Diuretics
      Inhibit Na+ & water reabsorption
      Increase urine output
    • 112. Diuretics: Pt & Family Teaching
      Take in morning and afternoon
      Change position slowly
      Weigh daily
      Avoid salt shaker & processed foods
      Read food labels
      ↑ potassium foods (banana/orange juice)
      Potassium sparing diuretics do not use salt substitute
    • 113. Assessment Data: FVE
      • Health history:
      • 114. Meds or change of meds
      • 115. Heart failure; recent illness
      • 116. Acute/chronic renal or endocrine disease
      • 117. Change in diet/recent weight gain
      • 118. Persistent cough, SOB
      • 119. Swelling of feet and ankles
      • 120. Difficulty sleeping when lying down
    • Assessment Data: FVE
      • Physical Assessment
      • 121. Weight, vital signs
      • 122. Peripheral pulses & capillary refill
      • 123. Jugular neck vein distention, edema
      • 124. Lung sounds (crackles or wheezes)
      • 125. dyspnea, cough, & sputum
      • 126. Urine output
      • 127. Mental status
    • Edema
      Amount of interstitial fluid (fluid in tissue spaces around each cell) returning to the circulatory system lessens
      Fluid accumulate in the tissue spaces, the tissues become swollen.
    • 128.
    • 129. Pitting Edema
      Extravasation & accumulation of interstitial fluid in tissues
      Dependent areas of the body
      Leaves indentation when skin surface is pressed by a finger
      Reflects high right atrial pressure, for example, in heart failure
      More severe than non-pitting edema
    • 130. Nursing Diagnosis: FVE
      Excess fluid volume
      Risk for Impaired Skin Integrity
      Risk for Impaired Gas exchange
    • 131. Mrs. Hsu
      • Admitted to the hospital with a decreased serum osmolality and a serum sodium of 126 mEq/L.
      • 132. You recognize that dehydration or overhydration may accompany hypotonic conditions.
    • Mrs. Hsu
      A priority assessment for this client with FVE is:
      Mental status
      Weight
      Postural vital signs
      Urine output
    • 133. Mrs Hsu
      In further assessing the client, what assessment data would indicate that the client has fluid volume excess?
      Distended hand & neck veins
      Decreased urine output
      Decreased capillary refill
      Increased rate and depth of respirations
    • 134. Mrs. Hsu
      Increased, bounding pulse
      JVD
      Diminished peripheral pulses
      Presence of crackles
      Thirst
      Elevated blood pressure
      Orthostatic hypotension
      Skin pale & cool to touch
      Which of the following
      assessments would
      indicate that Mrs. Jones
      has fluid volume excess?
    • 135. Mrs Hsu
      After determining the client is not dehydrated, which of the following interventions would be appropriate to correct this hypotonic overhydration?
      Administration of 0.9% NS
      Restriction of free water
      Administration of antihypertensives
      Restriction of potassium
    • 136. Mrs. Hsu
      A patient is exhibiting sudden onset of crackles in the lungs, moist respirations, & rapid respiratory rate. Which intervention should be performed first?
      Weigh the patient
      Assess capillary refill
      Measure edema
      Reduce IV rate
    • 137. Mrs Hsu
      What would you assess for evidence of a worsening hypotonic condition?
      Mental status
      Urine output
      Skin changes
      Bowel sounds
    • 138.
    • 139.
    • 140. Potassium (K+) 3.5 to 5.5 mEq/L
      Major cation in the ICF
      Affects cardiac muscle concentration, electrical conductivity, & cell excitability
      Aids neuromuscular transmission of nerve impulses.
      Alteration in K+ balance will result in acid-base imbalance
      Regulation of protein synthesis
      Regulation of glucose use & storage
    • 141. Hypokalemia K+ <3.5 mEq/L
    • 142. Hypokalemia K+ <3.5 mEq/L
    • 143. Hypokalemia K+ <3.5 mEq/L
    • 144. Hypokalemia K+ <3.5 mEq/L
      Hyperaldosteronism
    • 145.
    • 146. Diagnostic Tests: ↓ K+
    • 147. Assessment: Hypokalemia
      Health history
      Anorexia, nausea, vomiting, abdominal discomfort
      Muscle weakness or cramping
      Diuretic use
      Prolonged vomiting or diarrhea
      Diabetes, Addison or Cushing disease
      Current medications
    • 148. Assessment: Hypokalemia
      • Mental status
      Physical assessment
      • Vital signs, including orthostatic
      • 149. Apical and peripheral pulses
      • 150. Bowel sounds, abdominal distention
      • 151. Muscle strength & tone
    • Treatment: ↓ K+
      Oral potassium supplements
      Oral: dilute liquid K+ in fruit or vegetable juice or cold water
      Never give K+ if pt is not voiding
      Chill to increase palatability
      Give with food to minimize GI effects
      Parental potassium supplements
    • 152. Pt Teaching: K+ Supplement
      • No K+ supplement if taking K+ sparing diuretic
      • 153. Do not chew enteric-coated tablets
      • 154. Take with meals
      • 155. Do not use salt substitutes (potassium based)
    • Foods High in K+
    • 156. Nursing Diagnosis: ↓K+
      Activity intolerance
      Decreased cardiac output
      Risk for Imbalanced Fluid Volume
    • 157. The assessment of a patient with hypokalemia should focus on
      BP
      Edema
      Chvostek’s sign
      Heart rhythm
    • 158.
      • Laboratory results for a patient show a potassium level of 2.2 mEq/L. Which of the following nursing actions is highest priorty for this patient?
      Keep the patient on bedrest
      Initiate cardiac monitoring
      Start oxygen at 2L/min
      Initiate seizure precautions
    • 159. Hyperkalemia: K+>5.0 mEq/L
      Causes
    • 160. Hyperkalemia: K+>5.0 mEq/L
    • 161. ↑ K+
    • 162. Hyperkalemia: K+>5.0 mEq/L
    • 163.
    • 164. Diagnostic Tests: ↑ K+
    • 165. Assessment: ↑ K+
      • Health history
      • 166. Numbness, tingling, muscle weakness
      • 167. Nausea, vomiting, abdominal cramping
      • 168. Palpitations
      • 169. Use of salt substitutes & potassium supplements
      • 170. Reduced urine output
      • 171. Renal failure/endocrine disorders
      • 172. Current medications
    • Assessment: ↑ K+
      Physical assessment
      Apical & peripheral pulses
      Bowel sounds
      Muscle strength
      ECG pattern
    • 173. Management: ↑ K+
      Medications
      Calcium gluconate (emergency)
      Regular insulin & 50g of glucose (emergency)
      Sodium bicarbonate (acidosis) (emergency)
      Kayexalate & Sorbital
      Diuretics
      Dialysis
    • 174. Nursing Diagnosis: ↑ K+
      Risk for Activity Intolerance
      Risk for Decreased Cardiac Output
      Risk for Imbalanced Fluid Volume
    • 175.
      • You are caring for a patient with hyperkalemia. You prepare for administration of which medication?
      • 176. Kayexalate
      • 177. K-Lor
      • 178. Kaopectate
      • 179. Keflex
    • Mr. Williams
      Adm for palpitations
      K+ 5.4 mEq/L
      Takes Spironolactone 50 mg daily for HTN
      Missed 1 month follow-up appointment
    • 180. Mr. Williams
      • Day prior to admission he ate:
      • 181. Which foods in his diet contribute to his hyperkalemia?
    • Mr. Williams
      What would be a relevant nursing diagnosis for this client based on the client’s assessed data?
    • 182. Mr. Williams
      C/O abdominal cramping and several very loose diarrhea stools since yesterday.
      What is the etiology of the client’s symptoms?
    • 183. Mr. Williams
      Physician orders Kayexalate retention enema to be given stat.
      Should you clarify the physician’s orders before administering the enema?
    • 184. Mr. Williams
      Will the physician continue the order for Spironolactone? Explain.
      What would be some teaching and learning priorities for d/c.
    • 185. Sodium (Na+) 135-145 mEq/liter
      Normal physiologic function
      Maintains ECF volume
      Maintenance of ECF osmolality.
      Initiation of skeletal muscle contraction
      Initiation of cardiac contractility
      Transmission of neuronal impulses
      Maintenance of renal urine-concentration system
    • 186. Sodium Imbalance
      Affect osmolality of ECF
      Affect water distribution between fluid compartments
      Low Na+ H2O is drawn into cells (swell)
      High Na+ H20 drawn out of cells
    • 187. Signs & Symptoms
      Hyponatremia
      Muscle cramps, Weakness, fatigue
      Dulled sensorium, irritability, personality changes
      Hypernatremia
      Most serious effects are seen in the brain
      Lethargy, weakness, irritability can progress to seizures, coma, death
    • 188. Point to Remember
      Pt’s with low Na+ will present with acute onset of confusion
      Risk for falls in the elderly
    • 189. Foods High in Sodium
    • 190.
    • 191. A patient presents with a serum sodium level of 115 mEq/L. A priority nursing intervention is
      Seizure precautions
      Vital signs every two hours
      Frequent mouth care
      Cardiac rhythm monitoring
    • 192.
      • The nurse caring for a client with hypernatremia includes which of the following in the plan of care? (Select all that apply)
      • 193. Conduct frequent neurologic checks
      • 194. Restrict fluids to 1500 ml per day
      • 195. Orient to time, place, & person frequently
      • 196. Maintain intravenous access
      • 197. Limit length of visits
    • A patient receiving D5W at 100 mL/hr is most at risk for developing
      Hypernatremia
      Hyponatremia
      FVE
      FVD
    • 198. Mrs. Hudson
      77-year-old female
      Found confused, unable to get up to the bathroom
      Weak, anxious, confused to time & place
      P 110; B 108/58
      Skin dry
      Urine Specific gravity 1.028
      Deep tendon reflexes slightly reduced
    • 199. Mrs. Hudson
      Would the client’s serum sodium be elevated, decreased, or normal?
      What would be your priority assessment plan?
      • What treatment would you expect this client to receive at this time?
      • 200. What would be a teaching plan for this client?
    • Chloride (Cl-) 95 to 108 mEq/liter
      Formation of hydrochloric acid in stomach
      Cl- and Na+ levels usually change in direct proportion to one another.
      Works with Na+ to maintain ECF osmotic pressure & water balance
    • 201. Calcium (Ca++)8.5 – 10.5 mEq/dl (4-5.5 mEq/L)
      Functions
      Enhances activity of enzymes or reactions
      Skeletal muscle contraction
      Cardiac contractility
      Helps activate steps in blood coagulation.
      Bone strength & density
      Regulation of neural impulse transmission
    • 202. Calcium Imbalance
      Calcium levels regulated by
      parathyroid hormone
      Calcitonin
      Calcitriol
    • 203. Ca+ Imbalance: Signs & Symptoms
      Hypocalcemia
      Tetany, paresthesias, muscle spasms
      Hypotension
      Anxiety, confusion, psychosis
      Hypercalcemia
      Muscle weakness, fatigue
      Personality changes
      Anorexia, nausea, vomiting
    • 204. Foods High in Calcium
    • 205. The most important assessment in a patient with hypercalcemia is
      Heart rhythm
      Urine output
      Trousseau’s sign
      Weight
    • 206. The nurse evaluates teaching about calcium supplement therapy as effective when the patient states that she will take her calcium tablets
      All at one time in the morning
      With meals
      As needed for tremulousness
      With a full glass of water
    • 207. Phosphorus 2.5 – 4.5 mEq/dl
      Vital for intracellular activities
      Activation of B complex vitamins
      Plays major role in acid-base balance through its action as a urinary buffer
      Cell division
      Plays essential role in muscle, RBC, neurological function
      Aids in carbohydrate, protein and fat metabolism
    • 208. Hypophosphatemia
      Muscle pain & tenderness
      Muscle weakness
      Paresthesia
      Confusion
      Manifestations of hypophosphatemia
      Muscle spasms, tetany
      Soft tissue calcifications
    • 209.
    • 210. Magnesium (Mg++) 1.5-2.5 mEq/l
      Muscle contractility
      Carbohydrate and protein metabolism.
      Affects neuromuscular irritability & contractility of cardiac and skeletal muscle.
      Facilitates transport of Na+ and K+ across cell membranes.
      DNA & Protein synthesis
    • 211. Magnesium Imbalance
      Hypomagnesemia
      Muscle weakness & tremors
      Dysphasia
      Tachycardia, HTN
      Mood & personality changes
      Hypermagnesemia
      Depressed DTRs
      Hypotension
      Respiration
    • 212.
      • A patient who is known to be an alcoholic presents with confusion, hallucinations, and positive Chvostek’s sign. Which medication should the nurse anticipate administering?
      • 213. Magnesium sulfate
      • 214. Calcium chloride
      • 215. Insulin and glucose
      • 216. Sodium bicarbinate
    • A patient is experiencing nausea with severe vomiting.
      The nurse realizes that this patient is at risk for which of the following?
    • 217. Interstitial fluid volume overload
      Intracellular fluid volume deficit
      Extracellular fluid volume deficit
      Interstitial fluid volume deficit
    • 218. A male patient’s hematocrit is 56%
      Serum sodium 150 mEq/L and
      Potassium of 5.8 mEq/L
      Which of the following would be indicated for this patient?
    • 219. Prepare to administer a hypertonic IV soultion
      Prepare to administer a hypotonic IV solution
      Prepare to administer an isotonic IV solution
      Implement a fluid and sodium restriction for the patient
    • 220. The nurse is caring for a patient and has just received the laboratory data report.
      Which of the following results would cause the most concern to the nurse?
    • 221. Na+: 115 mEq/L
      K+: 4.0 mEq/L
      Ca+: 9mg/dL
      Mg+: 2.0mg/dL
    • 222. The nurse is caring for a patient with severe vomiting and diarrhea
      Nasogastric tube to low wall suction.
      The nurse realizes that this patient is at risk for which of the following electrolyte imbalances?
    • 223. Hypokalemia
      Hypercalcemia
      Hypermagnesemia
      Hypophosphatemia
    • 224. A patient is admitted to the hospital with a fluid volume excess.
      Which of the following will the nurse most likely assess for this patient?
    • 225. Dependent edema
      Blood pressure: 92/55 mm Hg
      Respiratory rate 14 breaths/minute and unlabored
      Heart rate 86 beats per minute without ectopy
    • 226. The nurse is caring for a patient in renal failure with a serum potassium level of 7.1mEq/L.
      Which of the following should the nurse do first to assist this patient?
    • 227. Assess level of consciousness.
      Measure urine output hourly.
      Have arterial blood gases drawn.
      Obtain an electrocardiogram.
    • 228. The nurse is providing discharge instructions to a patient with hypokalemia.
      Which of the following should the nurse include in these instructions?
    • 229. Take oral Kaexylate as prescribed.
      Limit the intake of spinach and carrots.
      Eat a balanced diet, including tomato juice and potatoes.
      Expect muscle cramps and weakness for at least six weeks.