Fluid and Electrolyte, Acid/Base Inbalances

Question 1

90 - Fluid Volume Deficit:

+ Causes, Symptoms, Labs, Nursing care, Complications

Answer 1

CAUSES: Gi losses, diuretics, hemorrhage, diaphoresis, diabetes insipidus, kidney disease, hyperventilation

SYMPTOMS: Tachycardia, tachypnea, hypotension, weak pulse, fatigue, weakness, thirst, dry mucus membranes, GI upset, oliguria, decreased skin turgor, decreased capillary refill, diaphoresis, flattened neck veins.

LABS: INCREASE HCT, SERUM OSMOLARITY, URINE SPECIFIC GRAVITY, BUN, SERUM SODIUM.

NURSING CARE: Fluid replacement, monitor weight and I&Os, NOTIFY PROVIDER FOR URINE OUTPUT < 30ML/HR., implement fall precautions.

COMPLICATIONS: Hypovolemic shock. Administer O2, colloids, crystalloids, vasoconstrictors.

Question 2

91 - Fluid Volume Excess:

+ Causes, Symptoms, Lobs, Nursing care, Complications

Answer 2

CAUSES: Heart failure, steroid use, kidney dysfunction, cirrhosis, burns, excess sodium intake.

SYMPTOMS: Tachycardia, tachypnea, hypertension, bounding pulses, weight gain, edema, ascites, dyspnea, crackles, distended neck veins.

LABS: DECREASED HCT AND HGB, SERUM OSMOLARITY, URINE SPECIFIC GRAVITY, BUN.

NURSING CARE: Place patient in seni or high Fowler’s position, monitor weight daily, monitor I&Os, limit fluid and sodium intake, administer diuretics and oxygen as ordered.

COMPLICATIONS: Pulmonary edema.

Question 3

92 - Sodium:
+ Normal levels
+ Function in the body
+ Hyponatremia: causes, symptoms, nursing care
+ Hypernatremia: causes, symptoms, nursing care

Answer 3

SODIUM: 136-145 mEa/L

FUNCTION: Maintains fluid balance in body, nerve and muscle function

HYPONATREMIA:
+ CAUSES: GI losses, diuretics, kidney disease, skin losses, SIADH, hyperglycemia, heart failure.
+ SYMPTOMS: Tachycardia, hypotension, CONFUSION (common in the elderly!), fatigue, n/v, headache.
+ CARE: Administer isotonic (0.9% NaCl), increase sodium intake. For acute hyponatremiam, administer hypertonic (3% NaCl) IV fluids SLOWLY.

HYPERNATREMIA:
+ CAUSES: Water deprivation, excess sodium intake, kidney failure, Cushing’s syndrome, Diabetes insipidus, burns, excess sweating.
SYMPTOMS: Tachycardia, muscle twitching/weakness, GI upset.
+ CARE: Administer isotonic (0.9% NaCl) or hypotonic IV (0.45% NaCl) IV fluids, decrease sodium intake, increase water intake.

Question 4

93 - Potassium:
+ Normal Levels
+ Function in body
+ Hypokalemia: causes, symptoms, nursing care
+ Hyperkalemia: causes, symptoms, nursing care

Answer 4

POTASSIUM: 3.5-5.5 mEq/L

FUNCTION: Maintains ICF (intracellular fluid balance), nerve function, regulates muscle and heart contractions.

HYPOKALEMIA:
+ CAUSES: GI losses, diuretics, skin losses, metabolic alkalosis.
+ SYMPTOMS: DYSRHYTHMIAS, muscle weakness and cramps, constipation/ileus, hypotension, weak pulse.
+ CARE: Increase foods high in potassium, administer supplements (PO, IV), cardiac monitoring.

HYPERKALEMIA:
+ CAUSES: Uncontrolled diabetes (DKA), metabolic acidosis, salt substitutes, kidney failure, potassium-sparing diuretics (spironolactone).
+ SYMPTOMS: DYSRHYTHMIAS, muscle weakness, numbness/tingling, diarrhea.
+ CARE: Limit foods high in potassium. Administer loop diuretics, sodium polystyrene sulfonate (Kayexalate), insulin (with dextrose).

Question 5

94 - Calcium:
\+ Normal Levels
\+ Function in body
\+ Hypocalcemia:  causes, symptoms, nursing car
\+ Hypercalcemia:  causes, symptoms

Answer 5

CALCIUM: 9.0-10.5 mg/dL

FUNCTION: bone/teeth formation, nerve and muscle function, clotting.

HYPOCALCEMIA:
+ CAUSES: Vitamin D deficiency, hypoparathyroidism, hyperphosphatemia, pancreatitis.
SYMPTOMS: POSITIVE CHVOSTEK’S AND TROUSSEAU’S SIGNS, MUSCLE SPASMS, NUMBNESS/TINGLING IN LIPS/FINGERS, GI upset, hypotension, decreased heart rate.

HYPERCALCEMIA:
+ CAUSES: Hyperparathyroidism, long-term steroid use, bone cancer.
+ SYMPTOMS: Constipation, decreased deep tendon reflexes, kidney stones, lethargy.

Question 6

95 - Magnesium
+ Normal Levels
+ Function in body
+ Hypomagnesemia: causes, symptoms, nursing care
+ Hypermagnesemia: causes, symptoms, nursing carease

Answer 6

MAGNESIUM: 1.3-2.1 mEq/L

FUNCTION: Nerve and muscle function, bone formation. Critical for many biochemical reactions in the body.

HYPOMAGNESEMIA:
+ CAUSES: Gi losses, diuretics, malnutrition, alcohol abuse.
+ SYMPTOMS: Hyperactive deep tendon reflexes, tetany, seizures, constipation/ileus.
+ CARE: Increase foods high in magnesium, provide supplements (oral Mg can cause diarrhea!).

HYPERMAGNESEMIA:
CAUSES: Kidney disease, laxatives containing magnesium.
SYMPTOMS: Hypotension, muscle weakness, lethargy, respiratory and cardiac arrest.

Question 7

96 - Acid Base Balance:

+ Chemical/protein buffers, Respiratory buffers, Renal buffers.

Answer 7

ACID BASE BALANCE

CHEMICAL/PROTEIN BUFFERS: First line of defense. Bind or release hydrogen ions to quickly change pH.

RESPIRATORY BUFFERS: Second line of defense. Chemoreceptors sense change in CO2, send signal to brain to adjust respirations.
+ Increased CO2 results in increased rate and depth of respirations (reduces the number of hydrogen ions).
+ Decreased CO2 results in decreased rate and depth of respirations (increases the number of hydrogen ions).

RENAL BUFFERS: Third line of defense. Slower to respond, but has longest duration.
+ Kidneys reabsorb and produce more bicarbonate in response to high levels of hydrogen ions.
+ Kidneys excrete more bicarbonate in response to low levels of hydrogen ions.

Question 8

97 -n Acid Base Imbalances:
+ Respiratory Acidosis: causes, labs, symptoms, nursing care
+ Respiratory Alkalosis: causes, labs, symptoms, nursing care

Answer 8

ACID BASE IMBALANCES

RESPIRATORY ACIDOSIS:
+ CAUSES: RESPIRATORY DEPRESSION, inadequate chest expansion, airway obstruction, PE, pulmonary edema.
+ LABS: pH < 7.35 and PaCO2 > 45.
+ SYMPTOMS: Tachycardia, tachypnea, shallow breathing, pale/cyanotic skin, confusion.
+ CARE: Administer O2, bronchodilators

RESPIRATORY ALKALOSIS:
+ CAUSES: HYPERVENTILATION (r/t fear, anxiety, salicylate toxicity).
+ LABS: pH > 7.45 and PaCO < 35
+ SYMPTOMS: Tachypnea, deep and rapid breathing, anxiety, chest pain, dysrhythmias.
+ CARE: Reduce anxiety.

Question 9

98 - Base Imbalances:
+ Metabolic Acidosis: causes, labs, symptoms, nursing care
+ Metabolic Alkalosis: causes, labs, symptoms, nursing care

Answer 9

ACID BASE IMBALANCES

METABOLIC ACIDOSIS:
+ CAUSES: DKA, KIDNEY FAILURE, diarrhea, pancreas/liver failure.
+ LABS: pH < 7.35, HCO3 < 22
+ SYMPTOMS: Bradycardia, hypotension weak pulses, dysrhythmias, Kussmaul respirations (deep, rapid breathing), warm/flushed skin.
+ CARE: Administer insulin for DKA, sodium bicarbonate.

METABOLIC ACIDOSIS:
+ CAUSES: ANTACID OVERDOSE, Gi losses, (vomiting, NG suctioning)
+ LABS: pH > 7.45, HCO3 > 26
+ SYMPTOMS: Tachycardia, dysrhythmias, muscle weakness
+ CARE: Administer antiemetics for vomiting.