Chapter 6-fluids & Imbalance

Question 1

Diffusion

Answer 1

Substance moves from high to low

Question 2

Filtration

Answer 2

Movement of both water and sm molecules move through a semipermeable membrane.

Question 3

Hydrostatic

Answer 3

Force of water

Question 4

Isotonic

Answer 4

Same osmolarity as the blood

Question 5

Importance of water

Answer 5

Cellular metabolism, blood volume, body temp, solute transport.

Question 6

Average adult water loss

Answer 6

2500 mL daily

Question 7

Hypovolemia

Answer 7

Decrease in blood volume
Most common form of dehydration
Hemorrhage

Question 8

Hypovolemia can occur 2 ways

Answer 8

Hemorrhage

Fluid from the intravasvular space moves into the interstitial space

Question 9

Dehydration symptoms

Answer 9

Thirst 
Tenting turgor 
Rapid weak pulse
Low bp
Elevated temp
Decreased urine (less 30 mL)
Dark urine
Constipation 
Weight loss

Question 10

Complications of dehydration

Answer 10

Organ function failure

Question 11

Diagnostic test for dehydration

Answer 11

BUN
Blood urea nitrogen
Specific gravity increases
Elevated hematocrit

Question 12

Nursing diagnosis for dehydration

Answer 12

Risk for deficient fluid volume

Question 13

Nursing diagnosis expected outcome for dehydration

Answer 13

Pt will be adequately hydrated as evidence of stable weight, moist mucous membranes, and elastic skin turgor.

Question 14

As a person ages, water decreases from 60% to 50% of total body weight

Secondary to increase in body fat

Answer 14

Secondary to increase in body fat

Question 15

Fluid excess

Answer 15

Too much fluid in the body

Question 16

Hypervolemia

Answer 16

Excess fluid in the intravasvular shape

Question 17

Conditions that cause hypervolemia

Answer 17

Poorly controlled IV therapy
Excessive arrogant ion of wounds
Excessive ingestion of water

Question 18

Conditions that can result in hypervolemia

Answer 18

Renal failure
Heart failure
Inappropriate antidiuretic hormone

Question 19

Prevention of hypervolemia

Answer 19

Monitor IV therapy
Use of an electronic fusion pump
Monitor the amt of fluid used for arrigation

Question 20

Symptoms of hypervolemia

Answer 20

Elevated bp
Bounding pulse
Increased and shallow respiration

Question 21

Diagnostic test for hypervolemia

Answer 21

BUN and hematocrit decrease
Plasma increased
Decrease in specific gravity

Question 22

Therapies for hypervolemia

Answer 22

Diuretic and diet

Question 23

Positioning

Answer 23

Keep head elevated to avoid aspiration
Fowler’s position–allows for greater lung expansion
Oxygen if ordered–provides oxygen to organs

Question 24

Drugs used for hypervolemia

Answer 24

Lasix
Furosemide
Excretes sodium and water and potassium

Question 25

Diet therapy for hypervolemia

Answer 25

Mild fluid intake

Sodium restricted diet

Question 26

Data collection for hypervolemia

Answer 26

Edema in back and lower limbs
I&O
Pitting edema over a honey area
Assess lung sounds
     Crackles if there is an accumulation of fluid
Weight gain or loss

Question 27

Nursing diagnosis foe hypervolemia

Answer 27

Excess fluid volume related to excessive fluid intake

Question 28

Expected outcome for hypervolemia

Answer 28

Patient return to normal status as evidenced by return to weight that is normal for pt, absence of edema, and clear lung sounds

Question 29

Hypo atresia

Answer 29

Sodium deficit

Question 30

Normal level of serum sodium

Answer 30

135-145

Question 31

Hypokalemia

Answer 31

Calcium deficit

Question 32

Signs and symptoms of hypokalemia

Answer 32

Muscle cramps
Shallow respiration
Weak, irregular pulse
Orthostatic hypotension (postural)
Dysrythmia
Changes in mental status
Lethargy
GI motility decreases

Question 33

Alkalosis

Answer 33

Acid-base imbalance

Question 34

Therapeutic measures foe hypokalemia

Answer 34

IV potassium supplements after pt has voided (kidneys eliminate excess potassium).
Potentially dangerous
Too high causes cardiac arrest
Administered slowly and NEVER by push
RN administers only