Exam 01: Perioperative Care, Pain, Fluid & Electrolyte

Question 1

Normal Serum Sodium (Na⁺) Range

Answer 1

136 to 145 mEq/L

Question 2

Normal Serum Potassium (K⁺) Range

Answer 2

3.5 to 5.0 mEq/L

Question 3

Normal Serum Calcium (Ca²⁺) Range

Answer 3

• 9.0 to 10.5 mg/dL
• A change in Calcium levels will cause an equal and opposite change in phosphate levels and vice versa

Question 4

Normal Serum Chloride (Cl^-) Range

Answer 4

98-106 mEq/L

Question 5

Normal Serum Magnesium (Mg²⁺) Range

Answer 5

1.3 to 2.1 mEq/L

Question 6

Normal Serum Phosphorous (PO4) Range

Answer 6

• 3.0 to 4.5 mg/dL
• A change in phosphate levels will cause an equal and opposite change in calcium levels and vice versa

Question 7

Normal Serum Osmolarity

Answer 7

• 280-300 mOsm/kg
  
  • High is water deficit (concentrated)
  • Low is water excess (dilute)
  • Measures the concentration of dissolved particles, mostly determined by Na+, glucose, and BUN.

Question 8

Normal Blood Gas pH

Answer 8

7.35 to 7.45

Question 9

Normal PCO2

Answer 9

35 to 45 mm Hg

Question 10

Normal PO2

Answer 10

80 to 100 mm Hg

Question 11

Normal HCO3-

Answer 11

21- to 28 mEq/L

Question 12

Normal Hemoglobin (Hgb)

Answer 12

• Male: 14 to 18 g/dL
• Female: 12 to 16 g/dL

Question 13

Normal Hematocrit (Hct)

Answer 13

Male: 42 to 52% Female: 37 to 47%

Question 14

Normal RBC count

Answer 14

• M: 4.7 to 6.1 million cells/mm3
• F: 4.2 to 5.5 million cells/mm3

Question 15

Normal WBC count

Answer 15

4,500 to 10,000

Question 16

Normal Platelet count

Answer 16

150,000 to 400,000

Question 17

Normal Urine Output

Answer 17

• Tina: 1,000 to 1,500 mL/24 hours; 40 to 60 mL/hour
• HESI: 1,500 to 2,000 mL/24 hours
• Critical: Notify physician if UO <30 mL/hr

Question 18

What is Chvostek’s Sign? What does a positive result indicate?

Answer 18

• To perform: tap side of face gently and observe for facial twitching. If mouth twitches, indicates tetany
• Test for HYPOcalcemia and tetany (lock jaw)

Question 19

What is Trousseau’s sign? What does a positive indicate?

Answer 19

Trousseau sign is a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes.

Question 20

Where is the fluid:

• First spacing
• Second spacing
• Third spacing

Answer 20

• When capillary or interstitial pressures change, fluid can shift from one compartment to another.
  
  • First spacing: normal distribution of ICF and ECF
  • Second spacing: abnormal accumulation of interstitial fluid (edema)
  • Third spacing: fluid accomulation in part of body where it isn’t easily exchanged with ECF (ascites, edema w/burns)

Question 21

Critical Thinking: What mechanisms lead to edema?

Answer 21

• Decreased oncotic pressure (decreased protein levels)
  
  • Liver dysfunction, burn patients, Poor nutrition, etc
• Increased hydrostatic pressure
  
  • HF, HTN, fluid overload, renal failure
• Damage to lymphatic system
  
  • Radical masectomy
• Inflammation
  
  • Leaky capillaries

Question 22

• 1 Liter of H₂O weighs ___________
• 500 mLs of H₂O weighs ___________

Answer 22

• 1 Liter of H₂O weighs 1kg
• 500 mLs of H₂O weighs 1lb

Question 23

• What is insensible water loss?
• How much water is lost via insensible water loss each day?
• What increases the rate of insensible water loss?

Answer 23

• Water loss from the skin, lungs, and stool.
• In a healthy adult 500 to 1000mL/day.
• Thyroid crisis, trauma, states of extreme stress, fever, hot/dry environments, pts on mechanical ventilation, tachypnea, diarrhea.

Question 24

• What three hormones regulate fluid balance?

Answer 24

• Aldosterone, ADH (aka vasopressin), and natriuretic peptide (NP).

Question 25

• How does aldosterone impact fluid balance?

Answer 25

• Secreted when sodium levels are low → reabsorption of sodium → prevents water AND sodium loss → increased blood osmolarity and blood volume.
• Prevents potassium levels from becoming too high.

Question 26

• What are some factors make older patients more vulnerable to dehydration?

Answer 26

• Less total body water than younger adults.
• Decreased thirst sensation.
• Physical difficulties that make it harder to obtain water.
• Drugs that increase fluid excretion
  
  • Diuretics
  • Antihypertensives
  • Laxatives

Question 27

• What are some common causes of fluid overload?

Answer 27

• Excessive fluid replacement
• Kidney failure
• Heart failure
• Long-term coricosteroid therapy
• SIADH
• Psychiatric disorders w/polydipsia
• Water intoxication

Question 28

• What are some common causes of dehydration?

Answer 28

• hemorrhage, vomiting, diarrhea, profuse salivation, fistulas, ileostomy, profuse diaphoresis, burns, long-term NPO, severe wounds, diuretics, GI suction, hyperventilation, renal failure (early phases), diabetes insipidus, difficulty swallowing, impaired thirst, unconsciousness, fever, impaired motor function

Question 29

• What are common S&S of dehydration?
  
  • Cardiovascular
  • Respiratory
  • Skin
  • Neurological
  • Kidney

Answer 29

• Cardiovascular: increased HR, decreased BP
• Respiratory: Increased RR
• Skin: decreased skin turgor, dry mucous membranes, dry/scaly skin, fissures on tongue and side of mouth
• Neurologic: alterations in mental status and body temperature, anxiety, restlessness
• Kidney: concentrated urine, decreased UO, dark amber

Question 30

• What lab values might you see with dehydration?

Answer 30

• Elevated: H/H, serum osmolarity, glucose, BUN, protein & various other electrolutes
• Note this hemoconcentration does not occur with isotonic volume loss (e.g., hemorrhage)

Question 31

• List three nursing priorities for the patient with dehydration.

Answer 31

1. Patient safety
2. Fluid replacement
3. Drug therapy

Question 32

• What nursing intervnetions are help achieve patient safety in the patient with fluid loss?

Answer 32

• Assess: HR, BP, dysrrythmias, muscle weakness, gait stability, level of alertness
• Fall precautions
• Instruct pt. to change positions & stand slowly