Fluid And Electrolytes/ ABG's

Question 1

Dehydration Prevention and Interventions:

Answer 1

o Offer fluids regularly to patients unable to ask for or obtain fluids on their own.
o Identify and stop sources of fluid loss
o Oral fluids for mild to moderate fluid losses
o IV fluids for significant fluid losses

Question 2

Daily weights

Answer 2

o Best indicator of fluid loss and gains

Question 3

Hyponatremia S/S

Answer 3

Confusion, restlessness, lethargy, seizures, coma. May have fluid volume excess or deficit

Question 4

Hyponatremia tx

Answer 4

Treat: Hypertonic solutions (0.9% NS, 0.3% NS); loop diuretics; fluid restriction

Question 5

Hypernatremia S/S

Answer 5

Confusion, lethargy, seizures, coma, dry mucus membranes, postural hypotension, decreased skin turgor

Question 6

Hypernatremia tx

Answer 6

Hypotonic solutions (D5W, 0.45% NS); low Na+ diet; Oral care for dry mucous membranes

Question 7

Hypokalemia S/S

Answer 7

Fatigue, poor muscle contractions, skeletal muscle weakness, possible paralysis, hyporeflexia, decreased GI motility with anorexia, N/V, ileus, paresthesia, confusion, lethargy
o Cardiac dysrhythmias with Flat T waves
o Increased sensitivity to Digitalis – Risk for digitalis toxicity

Question 8

Hypokalemia Tx

Answer 8

K+ replacement PO or IV

Question 9

Hyperkalemia S/S

Answer 9

Cardiac dysrhythmias with tall/tent T waves, abdominal cramping, hyperactive bowel sounds, diarrhea, abdominal cramping, muscle twitching and contraction with ultimately weakness and paralysis

Question 10

Hyperkalemia Tx

Answer 10

Lasix; Kayexalate (2 doses); Sorbital (promotes bowel elimination); Insulin with D50 to move K+ from ECF to ICF

Question 11

Hypocalcemia S/S

Answer 11

Paresthesias, twitching, muscle cramps, Trousseu’s and Chvostek’s signs, tetany, hyperactive bowel sounds, seizures. Rickets in children.

Question 12

Hypocalcemia Tx.

Answer 12

PO calcium replacement, vitamin D supplements, IV calcium for serious cases

Question 13

Hypercalcemia S/S

Answer 13

Muscular weakness, fatigue, hyporeflexia, lethargy, confusion, coma dysrhythmias, slowed GI motility

Question 14

Hypercalcemia Tx

Answer 14

Diuretics and IV fluids to excrete urine. IV Na+ or K+ is given for excessive calcium levels.

Question 15

Hypomagnesaemia S/S

Answer 15

Muscle twitching and spasms, hyperreflexia, tetant, cardiac dysrhythmia, anorexia, N/V/D, altered mental status, lethargy, confusion, seizures

Question 16

Hypomagnesaemia Tx

Answer 16

PO or IV magnesium; Dietary intake

Question 17

Hypermagnesaemia S/S

Answer 17

: Similar to hypercalcemia, paresthesias, muscle weakness, hyporeflexia, anorexia, naursea, constipation, cardiac dysrthmias

Question 18

Hypermagnesaemia Tx

Answer 18

Avoid meds with magnesium for pts at risk. IV calcium to counteract the effects of hypermagnesemia; Dialysis

Question 19

• Metabolic Alkalosis causes

Answer 19

Vomiting, loose acid, diuretics, too much sodium bicarbonate (Tums), NG tube suctioning

Question 20

Metabolic alkalosis lab values

Answer 20

Increased pH and HCO3

Question 21

Metabolic alkalosis S/S

Answer 21

CNS irritability, restlessness, tremors, seizures, cardiac monitoring for dysrhythmias

Question 22

Metabolic alkalosis Tx

Answer 22

Fix the underlying cause; Oral K+ supplements. Control of vomiting and avoid bicarbonate antacids are primary interventions

Question 23

• Metabolic Acidosis Causes:

Answer 23

Severe diarrhea, renal disease, Crohn’s disease, bypass surgery, aspirin overdose, untreated DM, DKA, starvation, lactic acidosis

Question 24

• Metabolic Acidosis lab values

Answer 24

Decreased pH and decreased HCO3

Question 25

Metabolic acidosis S/S

Answer 25

Lethargy, confusion, coma, dysrhythmias; deep, rapid respirations; Kussmaul respirations in people with DM

Question 26

Metabolic acidosis Tx

Answer 26

Fix underlying cause; bicarbonate IV or PO; Insulin for DM; dialysis for renal failure; O2 for lactic acidosis; antidiarrheals for diarrhea

Question 27

Respiratory Alkalosis:

Causes:

Answer 27

• Asthma, high altitude, fever, hypoxia, excessive mechanical ventilation, hyperventilation, anxiety attack

Question 28

Respiratory Alkalosis: Lab Values:

Answer 28

Increased pH and CO2

Question 29

Respiratory Alkalosis:S/S:

Answer 29

Tremors, restlessness, irritability, seizures (severe), hypocalcemia (muscle spasms, twitches, Trousseau’s and Chvostek’s sign).

Question 30

Respiratory Alkalosis:Treatment

Answer 30

: Fix underlying cause; Breath into paper bag to rebreathe CO2

Question 31

• Respiratory Acidosis: Causes:

Answer 31

Any condition that impairs gas exchange, pneumonia, COPD, chronic bronchitis, Rapid shallow breathing, brain stem injury, drug OD

Question 32

• Respiratory Acidosis:

Lab Values:

Answer 32

Decreased pH and CO2

Question 33

• Respiratory Acidosis: S/S:

Answer 33

Reduced LOC, confusion, lethargy, coma, dysrhythmias

Question 34

• Respiratory Acidosis: Treatment:

Answer 34

Respiratory support, breathing treatment, ventilator for patients with poo ventilation, IS use, bronchodilators for narrowed airways

Question 35

Total parenteral nutrition (TPN):

• Side Effects:

Answer 35

Hyperglycemia, hyperosmolar syndrome, electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia, and hypernatremia)

Question 36

Total parenteral nutrition (TPN):

• Nursing Considerations:

Answer 36

o Glucose regulation (monitor BG level)
o TPN must run in PICC or central line
o Inform patient TPN does not make them diabetic but insulin may be needed during therapy to control BG levels
o Hypoglycemia can occur if the TPN is stopped abruptly; therefore, always wean patients from TPN.
o TPN protocols for laboratory study monitoring should be in place.

Question 37

Total parenteral nutrition (TPN):
Complications:

Answer 37

Can be life-threatening and include GI atrophy, fluid overload, hyperglycemia, allergic reactions, and sepsis