Chapter 42: Fluid, Electrolyte, and Acid-Base Balance

Question 1

Depending on the type of fluid imbalance a patient has, management may include

Answer 1

administration of fluids, restriction of fluids, monitoring of weight and intake and output volumes, and laboratory testing

Question 2

Common indicators of fluid balance status monitored by the nurse include

Answer 2

vital signs
daily weights
intake and output

Question 3

management of fluid volume deficit (FVD) involves

Answer 3

ensuring that the patient’s fluid intake is greater than the output to restore normal fluid balance

Question 4

management of fluid volume excess (FVE) involves

Answer 4

restricting fluid intake so that it is less than the output to restore normal balance

Question 5

measurement of all fluids taken in by the patient, including

Answer 5

-All oral fluids (including those in foods)
-Intravenous (IV) fluids, including medications and blood products
-Enteral feedings (also called tube feedings)
-Free water flushes for enteral tube feedings
-Nasogastric or bladder irrigations
-Large volume enemas

Question 5

measurement of fluids lost by the body, including

Answer 5

-Urine
-Liquid stool
-Wound drainage
-Suction drainage
-Emesis

Question 6

I&O and vital signs for Risk for fluid volume imbalance

Answer 6

-Intake does not equal output
-Blood pressure increasing or decreasing but still within normal range
-Heart rate increasing or decreasing but still within normal range

Question 6

I&O for Impaired Fluid Intake

Answer 6

-Output greater than input
-Blood pressure decreased
-Heart rate increased

Question 7

I&O for Fluid volume excess

Answer 7

-Intake greater than output
-Blood pressure increased
-Heart rate decreased

Question 8

Severe fluid volume excess may occur with

Answer 8

heart failure and chronic kidney disease and could require fluid restriction.

Question 9

Why has IV therapy been prescribed?

Answer 9

Fluid replacement, blood transfusion, or medication delivery

Question 10

IV solutions are categorized as

Answer 10

crystalloids and colloids

Question 11

crystalloid vs colloids

Answer 11

-crystalloids: solutions with small solute particles (usually electrolytes) that pass through the semipermeable membrane of cells, and these are the primary type of IV fluids.

-colloids: a state or division of matter in which large molecules or aggregates of molecules (1 to 100 nm in size) do not precipitate and are dispersed in another medium.

Question 12

Tonicity and conditions of hypotonic

Answer 12

-Tonicity is lower than blood plasma. When infused, it reduces serum osmolality of blood plasma, causing fluid to shift from the bloodstream into the cells
-Hypernatremia
-Severe cellular dehydration

Question 13

Tonicity and conditions of isotonic

Answer 13

-Tonicity is the same as blood plasma. When infused, serum osmolality is unchanged. Vascular volume increases without effecting intracellular fluid
-hypovolemia

Question 14

Tonicity and conditions of hypertonic

Answer 14

Tonicity is higher than blood plasma. When infused, serum osmolality increases, causing fluid to shift out of cells and into the bloodstream.
-hypovolemia
-intracellular swelling (water intoxication)

Question 15

Colloids may be considered when

Answer 15

rapid volume expansion is required like severe hypovolemia or sepsis
Common examples of colloids include:

Albumin
Dextran
Plasmanate
Hetastarch

-can cause circulatory overload, requiring close monitoring of the patient for therapeutic and nontherapeutic effects of the therapy.

Question 16

what is fluid overload

Answer 16

Excessive circulating volume causing an intravascular fluid volume excess that can lead to heart failure and pulmonary edema

Question 17

what is air embolism

Answer 17

Accidental entry of air into the bloodstream

Question 18

for blood transfusions, reactions occur within 15 minutes. Monitor the patient for signs of adverse reaction to the transfusion such as:

Answer 18

-Flushing
-Fever
-Dyspnea
-Hypotension
-Itching
-Pain

Question 19

reasons for blood transfusion

Answer 19

-significant blood loss
-destruction or malfunction of specific blood cells
-missing clotting factors