Chapter 17: Fluid, Electrolyte, and Acid-Base Imbalances Flashcards by Cheetah Girl

Substances whose molecules dissociate into ions when placed in water.

electrolytes

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Cations are __________ charged.

positively

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Anions are _________ charged.

negatively

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ICF prevalent cation is:

A. K+
B. PO43-
C. Na+
D. CL-

A. K+

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ECF prevalent cation is:

A. K+
B. PO43-
C. Na+
D. CL-

C. Na+

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ICF prevalent anion is:

A. K+
B. PO43-
C. Na+
D. CL-

B. PO43-

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ECF prevalent anion is:

A. K+
B. PO43-
C. Na+
D. CL-

D. CL-

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What is the body primarily composed of?

A. blood
B. water
C. tissue
D. bone

B. water

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T/F

Lean body mass has a lower percentage of water weight.

false; a higher percentage

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T/F

Fat tissue has a lesser percentage of water weight.

true

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inside the cells

intracellular space

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spaces between cells

extracellular space

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bicarbonate range

22-26 mEq/L

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chloride range

98-106 mEq/L

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phosphate range

3.0-4.5 mg/dL

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calcium range

9.0-10.5 mg/dL

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magnesium range

1.3-2.1 mEq/L

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potassium range

3.5-5.0 mEq/L

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sodium range

136-145 mEq/L

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Capillary hydrostatic pressure and interstitial oncotic pressure move water __________ of the capillaries.

out

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Plasma oncotic pressure and interstitial hydrostatic pressure move fluid __________ the capillaries.

into

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T/F

If capillary or interstitial pressure changes, fluid may abnormally shift from one compartment to another.

true

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Edema occurs if venous hydrostatic pressure __________, plasma oncotic pressure __________, or interstitial oncotic pressure __________.

A. increases, decreases, increases
B. decreased, decreases, increased
C. increases, increases, decreases
D. decreases, increases, increases

A. increases, decreases, increases

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Edema is swelling of the __________ space.

interstitial

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term used to describe the distribution of body water

fluid spacing

describes the normal distribution of fluid in ICF and ECF compartments A. first spacing B. second spacing C. third spacing

A. first spacing

refers to an abnormal accumulation of interstitial fluid (i.e., edema) A. first spacing B. second spacing C. third spacing

B. second spacing

occurs when excess fluid collects in the nonfunctional area between the cells A. first spacing B. second spacing C. third spacing

C. third spacing

__________ can occur with abdominal body fluid loss, inadequate fluid intake, or a shift from plasma to interstitial fluid. A. hypernatremia B. hyponatremia C. fluid volume deficit D. fluid volume excess

C. fluid volume deficit

T/F Fluid volume deficit and dehydration are the same thing.

false

For rapid fluid replacement, __________ is preferred. A. 45% isotonic B. lactated ringers C. 33% sodium chloride D. 0.9% sodium chloride

D. 0.9% sodium chloride

__________ fluid volume excess may result from excess fluid intake, abnormal fluid retention, or a shift from interstitial fluid into plasma fluid. A. hypernatremia B. hyponatremia C. fluid volume deficit D. fluid volume excess

D. fluid volume excess

What is the most consistent manifestation of fluid volume excess? A. mood swings B. weight gain C. abdominal cramping D. lightheadedness

B. weight gain

T/F Many prescription drugs can cause fluid imbalance.

true

The patient with a fluid volume deficit often has __________ BUN, sodium, and hematocrit levels with _________ plasma and urine osmolarity.

increased ; increased

The patient with fluid volume excess will have __________ BUN, sodium, and hematocrit levels, with __________ plasma and urine osmolarity.

decreased ; decreased

What does the serum sodium level reflect? A. the amount of sodium in the body B. the amount of sodium being excreted in the body C. the ratio of sodium to water D. the ratio of sodium and water to platelets and RBC

C. the ratio of sodium to water

Sodium imbalances are typically associated with imbalances in __________ volume. A. ECF B. ICF C. ETC D. ITF

A. ECF

How does sodium leave the body?

through urine, sweat, and feces

The __________ mainly regulates sodium balance. A. liver B. kidneys C. heart D. large intestine

B. kidneys

high serum sodium

hypernatremia

T/F Hyponatremia causes hyperosmolarity.

false; hypernatremia

The primary protection against our developing hyperosmolarity is __________. A. vision B. cerebrum C. thirst D. tactile receptors

C. thirst

__________ of brain cells results in changes in mental status, ranging from drowsiness, restlessness, confusion, and lethargy to seizures and coma.

dehydration

Serum sodium levels should not decrease by more than 8-15 mEq/L in an __________ hour period. A. 5 B. 6 C. 7 D. 8

D. 8

Do not decrease serum sodium levels by more than __________ mEq/L in an 8-hour period. A. 8-15 B. 22-26 C. 3-9 D. 1-4

A. 8-15

low serum sodium

hyponatremia

T/F Inappropriate use of sodium-free or hypotonic IV fluids causes hyponatremia from water excess.

true

Where do the manifestations of hyponatremia FIRST appear?

in the CNS

Mild or severe hyponatremia? headache, irritability, and difficulty concentrating

mild hyponatremia

Mild or severe hyponatremia? confusion, vomiting, seizures, and even coma

severe hyponatremia

In mild hyponatremia caused by water excess, __________ may be the only treatment.

fluid restriction

__________ is given IV to hospitalized patients with severe hyponatremia from water excess.

conivaptan (Vapriol)

__________ is given orally to treat hyponatremia from heart failure or SIADH.

tolvaptan (Samsca)

98% of the body __________ is inside the cells

potassium

What helps stimulate the sodium-potassium pump?

insulin

_________ is involved with regulating intracellular osmolarity and promoting cellular growth; it is required for glycogen to be deposited in muscle and liver cells.

potassium

__________ is the main source for potassium.

diet

What is the primary route for potassium loss?

the kidneys

high serum potassium

hyperkalemia

__________ may result from impaired renal excretion, a shift of potassium from ICF to ECF, a massive intake of potassium, or a combination of these factors

hyperkalemia

Adrenal insufficiency with subsequent aldosterone deficiency leads to __________.

potassium retention

In __________, potassium ions shift from ICF to ECF in exchange for hydrogen ions moving into the cell. A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis

A. metabolic acidosis

initial finding of hyperkalemia on a cardiac rhythm

tall, peaked T-waves

As potassium __________, cardiac depolarization __________.

increases ; decreases

T/F Low and high potassium is very dangerous for CV patients.

true

hyperkalemia or hypokalemia ECG changes → tall, peaked T waves, as K+ increases, cardiac depolarization decreases, leading to loss of P waves, a prolonged PR interval, ST segment depression, and widening QRS complex

hyperkalemia

T/F The hyperkalemia patient does not need continuous ECG monitoring.

false

Patients experiencing dangerous cardiac dysrhythmias should receive __________ immediately.

IV calcium

low serum potassium

hypokalemia

__________ can result from an increased loss of potassium, an increased shift of potassium from ECF to ICF, or, rarely, from decreased dietary intake.

hypokalemia

__________ can cause a shift of potassium into cells in exchange for hydrogen, which lowers potassium in ECF.

alkalosis

hyperkalemia or hypokalemia clinical manifestations → constipation/nausea/paralytic ileus, fatigue, hyperglycemia, irregular/weak pulse, muscles soft/flabby, muscle weakness/leg cramps, paresthesias/decreased reflexes, shallow respirations

hypokalemia

hyperkalemia or hypokalemia ECG changes → impaired repolarization, resulting in a flattened T wave, depressed ST segment, and the presence of a U wave

hypokalemia

T/F Hypokalemia impairs insulin secretion

true

Potassium IV infusion Infusion rates should not exceed __________ mEq/hr unless monitored closely.

__________ is the main cation in bones and teeth.

calcium

__________ plays a role in blood clotting, transmission of nerve impulses, myocardial contractions, and muscle contractions.

calcium

What is the main source for calcium?

dietary intake

calcium absorption requires the active form of __________

vitamin D

T/F Serum pH influences how much calcium is ionized or bound to albumin.

true

high serum calcium

hypercalcemia

T/F Total calcium values increase or decrease indirectly with serum albumin levels.

false; directly

Parathyroid hormone (PTH) and calcitonin regulate __________ levels.

calcium

__________ is caused by hyperparathyroidism in about 2/3 of persons.

hypercalcemia

hypocalcemia or hypercalcemia rare causes → thiazide diuretic use, prolonged immobilization, and increased calcium intake (use of calcium-containing antacids)

hypercalcemia

hypocalcemia or hypercalcemia neurological manifestations → fatigue, lethargy, weakness, and confusion and progress to hallucinations, seizures, and coma

hypercalcemia

hypocalcemia or hypercalcemia manifestations → increased BP, bone pain/fractures, confusion/psychosis, fatigue/lethargy/weakness/ depressed reflexes, decreased memory, kidney stones, nausea/vomiting/anorexia, polyuria/dehydration, seizures

hypercalcemia

hypocalcemia or hypercalcemia ECG changes → short ST segment, short QT interval, ventricular dysthymias, increased digitalis effect

hypercalcemia

mild or severe hypercalcemia interventions → stop any medications r/t hypercalcemia, start diet low in calcium, increase weight-bearing activity, maintain adequate hydration

mild hypercalcemia

mild or severe hypercalcemia interventions - Administer saline, a bisphosphonate, and calcitonin - Hydrate patient with IV isotonic saline to maintain urine output of 100-150 mL/hour

severe hypercalcemia

hypocalcemia or hypercalcemia manifestations → decreased BP, Chvostek sign, confusion/depression/irritability. fatigue/weakness, hyperreflexia/muscle cramps, laryngeal and bronchial spasms, numbness and tingling in extremities and around mouth, tetany/seizures, Trousseau sign

hypocalcemia

hypocalcemia or hypercalcemia ECG changes → elongated ST segment, prolonged QT interval, ventricular tachycardia

hypocalcemia

low serum sodium

hypocalcemia

results from any condition associated with PTH deficiency

hypocalcemia

__________ are the major route for phosphate excretion.

kidneys

T/F Phosphate imbalances are common in chemotherapy patients.

false; dialysis patients

high serum phosphate

hyperphosphatemia

common in patients with acute kidney injury or chronic kidney disease

hyperphosphatemia

Excess phosphate intake from Shift from ICF to ECF Hypoparathyroidism Vitamin D intoxication

hyperphosphatemia

hyperphosphatemia or hypophosphatemia causes → excess ingestion, hyperthermia, hypoparathyroidism, renal failure, rhabdomyolysis, sickle cell, thyrotoxicosis

hyperphosphatemia

hyperphosphatemia or hypophosphatemia manifestations → hyperreflexia/muscle cramps, hypocalcemia, numbness and tingling in extremities and around mouth, tetany/seizure

hyperphosphatemia

hyperphosphatemia or hypophosphatemia causes → chronic alcohol use, chronic diarrhea, DKA, malabsorption syndrome, hyperparathyroidism, parenteral nutrition, respiratory alkalosis

hypophosphatemia

hyperphosphatemia or hypophosphatemia manifestations → CNS depression, heart problems, muscle weakness, seizures, rhabdomyolysis, osteomalacia

hypophosphatemia

mild or severe hyperphosphatemia interventions → restrict dietary intake of foods and fluids high in phosphorus (dairy products)

mild

mild or severe hyperphosphatemia interventions - Hemodialysis used to rapidly decrease levels - Volume expansion and forced diuresis with a loop diuretic may increase phosphate excretion

severe

__________ is used to fix hyperphosphatemia

calcium carbonate

low serum potassium

hypophosphatemia

Decreased intestinal absorption Increased urinary excretion ECF to ICF shifts

hypophosphatemia

mild or severe hypophosphatemia often asymptomatic

mild

mild or severe hypophosphatemia fatal because of decreased cellular function

severe

alters bone metabolism, resulting in rickets and osteomalacia

chronic hypophosphatemia

T/F Always give magnesium using an infusion pump.

true

- second most abundant intracellular cation - is important for cellular processes - cofactor in many enzyme systems

magnesium

high serum magnesium level

hypermagnesemia

occurs only with increased magnesium intake accompanied by renal insufficiency or failure

hypermagnesemia

hypomagnesmia tratment

magnesium sulfate

low serum magnesium level

hypomagnesemia

hypermagnesemia or hypomagnesemia causes → adrenal insufficiency, antacids/laxatives, hypothyroidism, IV administration of magnesium, metastatic bone disease, renal failure

hypermagnesemia

hypermagnesemia or hypomagnesemia causes → acute pancreatitis, chronic alcohol use, GI tract fluid losses, hyperglycemia, malabsorption syndrome, prolonged malnutrition, PP inhibitor therapy, increased urine output

hypomagnesemia

hypermagnesemia or hypomagnesemia manifestations → decreased deep tendon reflexes, flushed/warm skin, lethargy/drowsiness, nausea/vomiting, muscle weakness, decreased HR and BP, urinary retention

hypermagnesemia

hypermagnesemia or hypomagnesemia manifestations → Chvostek and Trousseau signs, confusion, hyperactive deep tendon reflexes, muscle cramps, increased BP and HR, tremors/seizures, vertigo

hypomagnesemia

An increase in H+ concentration leads to __________.

acidity

A decrease in H+ concentration leads to __________.

alkalinity

Name this acid-base imbalance based on the causes. atelectasis chest wall abnormality chronic respiratory disease mechanical hypoventilation

respiratory acidosis

Name this acid-base imbalance based on the causes. severe pneumonia pulmonary edema respiratory muscle weakness sedative overdose

respiratory acidosis

Name this acid-base imbalance based on the laboratory findings. ↓ plasma pH ↑ PaCO2 normal

respiratory acidosis

Name this acid-base imbalance based on the causes. hyperventilation liver failure mechanical hyperventilation stimulated respiratory center

respiratory alkalosis

Name this acid-base imbalance based on the causes. DKA diarrhea GI fistulas lactic acidosis

metabolic acidosis

Name this acid-base imbalance based on the causes. renal failure renal tubular acidosis shock starvation

metabolic acidosis

Name this acid-base imbalance based on the causes. diuretic therapy excess NaHCO3 intake hypokalemia

metabolic alkalosis

Name this acid-base imbalance based on the causes. mineralocorticoid use NG suctioning vomiting

metabolic alkalosis

pH range

7.35-7.45

PaCO2 range

35-45 mm Hg

PaO2 range

80-100 mm Hg

Name this acid-base imbalance. pH is ↑ and the PaCO2 is ↓

respiratory alkalosis

Name this acid-base imbalance. pH is ↓ and the PaCO2 is ↑

respiratory acidosis

Name this acid-base imbalance. pH and HCO3 are ↑ and the PaCO2 is ↑ or normal

metabolic alkalosis

Name this acid-base imbalance. pH and HCO3 and ↓ and the PaCO2 is ↓ or normal

metabolic acidosis

During the postoperative care of a 76-ear-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because A. older adults have an impaired thirst mechanism and need reminding to drink fluids B. older adults are more likely than younger adults to lose extracellular fluid during surgeries C. water accounts for a greater percentage of body weight in the older adult than in younger adults D. small losses or fluid are significant because body fluids account for 45% to 50% of body weight in older adults

D. small losses or fluid are significant because body fluids account for 45% to 50% of body weight in older adults

During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is (recognize) A. osmosis B. diffusion C. active transport D. facilitated diffusion

A. osmosis

An older adult is admitted to the medical unit with GI bleeding. Assessment findings that occur with fluid volume deficit include: (SATA) A. weight loss B. dry oral mucosa C. full bounding pulse D. engorged neck veins E. orthostatic

A. weight loss B. dry oral mucosa E. orthostatic

The nursing care for a patient with hyponatremia and fluid volume excess includes: A. administration of hypotonic IV fluids B. administration of a cation-exchange resin C. placement of an indwelling urinary catheter D. fluid restriction

D. fluid restriction

The nurse should be alert for which manifestation in a patient receiving a loop diuretic? A.restlessness and agitation B. paresthesias and irritability C. weak, irregular pulse and poor muscle tone D. increased blood pressure and muscle spasms

C. weak, irregular pulse and poor muscle tone

Which patient is at greatest risk for developing hypermagnesmia? A. 83-year-old man with lung cancer and hypertension B. 65-year-old woman with hypertension taking B-adrenergic blockers C. 42-year-old woman with systemic lupus erythematosus and renal failure D. 50-year-old man with benign prostatic hyperplasia and a UTI

C. 42-year-old woman with systemic lupus erythematosus and renal failure

It is important for the nurse to assess for which manifestation(s) in a patient who has just undergone a total thyroidectomy? (SATA) A. confusion B. weight gain C. depressed reflexes D. circumoral numbness E. positive Chvestek sign

A. confusion D. circumoral numbness E. positive Chvestek sign

The nurse expects the long-term treatment of a patient with hyperphosphatemia from renal failure will include: A. fluid restriction B. calcium supplements C. magnesium supplements D. increased intake of dairy products

B. calcium supplements

The lungs act as an acid-base buffer by: A. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load B. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load C. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load D. decreasing respiratory rate and depth when CO2 levels in the blood are low, reducing acid load

A. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load

A patient has the following arterial blood gas results: pH 7.52, PaCO2, 30 mm Hg, HCO3 24 mEq/L. The nurse demonstrates that these results indicate A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis

D. respiratory alkalosis

The typical fluid replacement for the patient with a fluid volume deficit is A. dextran B. 0.45% saline C. lactated Ringer's solution D. 5% dextrose in 0.45% saline

C. lactated Ringer's solution

sodium serum level > 145 mEq/L

hypernatremia

serum sodium level < 136 mEq/L

hyponatremia

serum potassium level > 5.0 mEq/L

hyperkalemia

serum potassium level < 3.5 mEq/L

hypokalemia

serum calcium level > 10.5 mg/dL

hypercalcemia

serum calcium level < 9.0 mg/dL

hypocalcemia

serum phosphate level > 4.5 mg/dL

hyperphosphatemia

serum phosphate level < 3.0 mg/dL

hypophosphatemia

serum magnesium level > 2.1 mEq/L

hypermagnesemia

serum magnesium level < 1.3 mEq/L

hypomagnesemia

Examples of insensible fluid loss: A. blood B. perspiration C. nasogastric drainage D. third spacing E. wound drainage

B. perspiration D. third spacing

The nurse is caring for a client with an electrolyte imbalance. Which should the nurse consider as contributing to this client’s health problem? (SATA) A. vomiting B. constipation C. medications D. imaging studies E. cosmetic procedures

A. vomiting C. medications

Upon assessment of a client in renal failure, the nurse observes a mental status change with hyperactive deep tendon reflexes. She inflates the blood pressure cuff to a level above his systolic pressure for 3 minutes and Trousseau’s sign is positive. The nurse recognizes this as which electrolyte imbalance? A. hypermagnesemia B. hypomagnesemia C. hypercalcemia D. hypocalcemia

D. hypocalcemia

The nurse is caring for a client with acute digoxin toxicity. Serial electrocardiograms have been performed and the client is placed on continuous cardiac monitoring for which electrolyte disturbance? A. hypomagnesemia B. hypercalcemia C. hyperkalemia D. hypokalemia

C. hyperkalemia

A person who has gastroesophageal reflux disease (GERD) and overuses calcium carbonate tablets would be at risk for which acid-base disorder? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

D. metabolic alkalosis

The nurse is caring for a bulimic client who abuses laxatives. The nurse will monitor the client for which acid-base illness? A. metabolic alkalosis B. metabolic acidosis C. repsitaory alkalosis D. respiratory acidosis

B. metabolic acidosis

A nurse is caring for a nulligravida preoperative C-section client who reports tingling of the fingers. Lab studies reveal pH 7.46, PCO2 31. Which action by the nurse is most appropriate? A. administer oxygen and reposition the client in the semi-Fowler's position B. instruct the client to deep breath and cough, and utilize incentive spirometry C. plan rest periods to maximize client's energy along with appropriate activities D. provide a paper bag to rebreathe into for the client, as well as reassurance

D. provide a paper bag to rebreathe into for the client, as well as reassurance

A client is admitted to the ER with confusion, restlessness, and diaphoresis. Lab studies reveal pH 7.1, PCO2 48, and a potassium of 5.6. Which acid-base balance disorder does the data collected indicate? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

A. respiratory acidosis

A nurse is caring for a postoperative hemicolectomy client undergoing continuous suction for postoperative ileus. Which information from the client’s medical history should the nurse question? A. the client is taking lisinopril/hydrochlorothiazide for hypertension B. the client has a past medical history of exacerbation of COPD C. the client is a diabetic on sliding-scale insulin D. the client is a diabetic on hemodialysis therapy

A. the client is taking lisinopril/hydrochlorothiazide for hypertension

A nurse is assessing a client who reports nausea, vomiting, and weakness. Which of the following findings are manifestations of fluid volume deficit? (SATA) A. potassium level B. urine specific gravity C. heart rate D. temperature E. oxygen saturation

B. urine specific gravity C. heart rate D. temperature

A nurse is planning care for a client who has fluid volume excess. Which of the following interventions should the nurse include in the plan of care? (SATA) A. check the client's weight 2 times per weeks B. place the client in a semi-Fowler's position C. monitor the client's breath sounds D. change the client's position every 4 hours E. assess the client for peripheral edema

B. place the client in a semi-Fowler's position C. monitor the client's breath sounds E. assess the client for peripheral edema

A nurse is teaching a class about electrolyte imbalances. The nurse should include that which of the following conditions places a client at risk for hyperkalemia? A. DKA B. HF C. Cushing's syndrome D. thyroidectomy

A. DKA

hypoactive bowel sounds

hyponatremia with

tall, peaked t-waves

hypocalcemia

positive Trousseau's sign

hyperkalemia

bounding pulse

hypokalemia

The nurse is assessing the client for Chvostek's sign. Which of the following actions should the nurse take? A. apply a BP cuff to the client's arm B. place a stethoscope bell over the client's carotid artery C. ask the client to lower their chin to their chest D. tap lightly on the client's cheek

D. tap lightly on the client's cheek

The nurse is assessing the client who reports nausea, vomiting, and weakness. Which of the following findings are manifestations of hypocalcemia? A. tingling in fingers B. poor skin turgor C. abdominal pain D. elevated temperature E. muscle twitching

A. tingling in fingers C. abdominal pain E. muscle twitching

A nurse is caring for a client who was in a motor vehicle accident and reports chest pain and difficulty breathing. A chest x-ray reveals the client has a pneumothorax. Which of the following ABG results should the nurse expect? A. pH 7.25, PaCO2 52 mm Hg, HCO3- 24 mEq/L B. pH 7.42, PaCO2 38 mm Hg, HCO3- 23 mEq/L C. pH 7.30, PaCO2 36 mm Hg, MCO3- 18 mEq/L D. pH 7.50, PaCO2 29 mmHg, MCO3- 26 mEq/L

B. pH 7.42, PaCO2 38 mm Hg, HCO3- 23 mEq/L

pH 7.30, PaCO2 48 mm Hg, HCO3- 26 mEq/L A. respiratory alkalosis B. metabolic alkalosis C. respiratory acidosis D. metabolic acidosis

C. respiratory acidosis

pH 7.50, PaCO2 28 mm Hg, HCO3- 24 mEq/L A. respiratory alkalosis B. metabolic alkalosis C. respiratory acidosis D. metabolic acidosis

A. respiratory alkalosis

pH 7.32, PaCO2 35 mm Hg, HCO3- 18 mEq/L A. respiratory alkalosis B. metabolic alkalosis C. respiratory acidosis D. metabolic acidosis

D. metabolic acidosis

pH 7.50, PaCO2 38 mm Hg, HCO3- 30 mEq/L A. respiratory alkalosis B. metabolic alkalosis C. respiratory acidosis D. metabolic acidosis

B. metabolic alkalosis

A nurse is teaching a group of nurses about conditions what can cause metabolic acidosis. Which of the following conditions should the nurse include? A. DKA B. myasthenia gravis C. asthma D. laxative overuse

A. DKA

fluid volume deficit or fluid volume excess sunken eyeballs poor skin turgor fever

fluid volume deficit

fluid volume deficit or fluid volume excess bounding pulse crackles heard in lung fields distended neck veins

fluid volume excess