Fluid, Electrolyte, and Acid-Base Imbalances

Question 1

Homeostasis

Answer 1

The state of equilibrium in the internal environment, naturally maintained by adaptive responses that promote health survival (stable internal environment)

Question 2

Water content of body equation

Answer 2

1L or water = 2.2 pounds = 1kg

Question 2

Body Fluid Compartments (Fluids)

Answer 2

Fluids
ICF and ECF
Interstitial and
blood

Question 3

ECF volume deficit

Answer 3

Hypovolemia
-Abnormal loss of body fluids (diarrhea, vomiting, hemorrhage, or polyuria)
-Inadequate fluid intake
-Plasma to interstitial fluid shift (burns)

Question 4

How does fluid volume deficit differ from dehydration

Answer 4

Loss of pure water without corresponding loss of sodium

Question 4

ECF volume deficit interprofessional care

Answer 4

Correct the underlying cause and replace water and electrolytes
-orally
-blood products
-balanced (isotonic) IV solutions: 0.9 normal saline or lactated ringers

Question 4

ECF volume deficit clinical manifestations

Answer 4

-Confusion, restlessness, drowsiness, lethargy
-Thirst, dry mucous membranes
-cold clammy skin
-decreased skin turgor
-decreased cap. refill
-postural hypotension (rx for falls!)
-increased HR
-low CVP
-low urine output, concentrated urine
-increased RR
-weakness and dizziness
-weight loss
-seizures and coma

Question 5

ECF volume excess

Answer 5

Hypervolemia
-excess intake of fluids
-abnormal retention of fluids: HF or renal failure
-Interstitial to plasma fluid shift

Question 6

ECF volume excess interprofessional care

Answer 6

Treat the underlying cause.
Remove fluid w/o changing electrolyte composition or osmolarity of ICF
-Diuretics, fluid restriction, restriction of Na
-Removal of fluids to treat ascites (paracentesis) or pleural effusion (thoracentesis)
-Monitor daily weights and I&O’s - Correlation is important.

Question 7

ECF volume excess clinical manifestations

Answer 7

weight gain (most consistent sign)
-HA, confusion, lethargy
-peripheral edema
-JVD
-S3 heart sounds
-Bounding pulse
-Increased BP
-Increased CVP
-Polyuria
-Dyspnea, crackles, pulmonary edema
-muscle spasms
-seizure
-coma

Question 8

Phosphorus Lab Value

Answer 8

3.0-4.5

Question 9

Sodium Lab Value

Answer 9

136-145

Question 10

Calcium Lab Value

Answer 10

9.0-10.5

Question 11

Potassium Lab Value

Answer 11

3.5-5.0

Question 12

Magnesium Lab Value

Answer 12

1.3-2.1

Question 13

Hypernatremia

Answer 13

Na+>145

Question 14

Causes of hypernatremia

Answer 14

-Inadequate water intake (unconscious, cognitively impaired)
-Excess water loss (diarrhea, high fever)
-Sodium gain (rare)

Causes hyperosmolality leading to cellular dehydration

Question 15

MODEL

Answer 15

For hypernatremia (causes)
M-medications and meals
O- Osmotic diuretics
D- Diabetes Insipidus
E- Excessive water loss
L- Low water intake

Question 16

Hypernatremia S/S

Answer 16

Depends
Decreased ECF
-Restlessness, agitation, lethargy, seizures, coma
-Intense thirst, dry swollen tongue, sticky mucous membranes
-Postural hypotension, decreased CVP, weight loss, increased pulse
-Weakness and muscle cramps

Normal/increased ECF volume
-restlessness, agitation, twitching, seizures, coma
-intense thirst and flushed skin
-weight gain, peripheral and pulmonary edema
-increased BP
-increased CVP

Question 17

Hypernatremia treatment

Answer 17

Depends
Decreased ECF volume
-Fluid replacement, either PO or IV (isotonic IV: 0.9 normal saline)

Normal/increased ECF volume
-dilute the high sodium using sodium-free IV solutions (such as D5W)
-Promote sodium excretion with diuretics
-Dietary sodium restriction
-if altered sensorium or seizures, employ seizure precautions.

Question 18

Hyponatremia

Answer 18

Na+<136
Results from loss of Na-containing fluids or from water excess (dilutional effect) or both
Usually associated with ECF hypoosmolality, fluids move into cells causing cellular edema

Question 18

Hyponatremia causes

Answer 18

diuretics, vomiting, diarrhea, inadequate salt intake, hypertonic IV solutions, GI suctioning

Question 19

Hyponatremia clinical manifestations

Answer 19

Mild- HA, irritability, difficulty concentrating
More severe- confusion, vomiting, seizures, coma

Question 20

Hyponatremia management (nursing diagnosis)

Answer 20

Electrolyte imbalance, risk for injury, acute confusion.

Question 21

Hyponatremia management

Answer 21

Loss of Na and fluids- administer isotonic IV solutions, encourage oral intake, stop diuretics.

Dilutional Hyponatremia- fluid restriction, diuretics, demeclocycline (increases renal response to ADH and produces diuresis)

correct sodium level slowly

Question 22

Hyperkalemia

Answer 22

K+>5.0

Question 22

Hyperkalemia caused by

Answer 22

massive intake of K+ (salt substitutes)
impaired renal excretion
shift from ICF to ECF (acidosis)
medications: digoxin, beta-blockers, ACE inhibitors, potassium sparing diuretics

Question 23

Hyperkalemia manifestations

Answer 23

dysrhythmias
fatigue, confusion
tetany, muscle cramps
weak or paralyzed skeletal muscle
abdominal cramping, V/D

Question 23

Hyperkalemia nursing diagnoses

Answer 23

electrolyte imbalance
activity intolerance
impaired cardiac output
potential complications: dysrhythmias

Question 24

Hyperkalemia implementations

Answer 24

stop oral or parenteral K+ intake
increase K+ excretion (diuretics, kayexalate, dialysis)
Force movement of K+ from ECF to ICF using dextrose & insulin, sodium bicarbonate or (If no IV access) beta 2 agonist- albuterol
Stabilize cardiac membranes using IV calcium

Question 24

Hypokalemia

Answer 24

K+<3.5

Question 25

Hypokalemia caused by

Answer 25

GI losses (D/V)
Renal losses (magnesium deficiency, diuretics)
Metabolic alkalosis or insulin administration (shifts K+ into ICF)
Decreased dietary K+ intake

Question 26

Hypokalemia S/S

Answer 26

Muscle weakness/ weakness of respiratory muscles/ skeletal muscle weakness (legs)
ECG changes
N/V
Decreased GI motility
Hyperglycemia

Question 27

Hypokalemia nursing diagnoses

Answer 27

electrolyte imbalance, activity intolerance, impaired cardiac output, potential complications: dysrhythmias

Question 28

Hypokalemia nursing implementations

Answer 28

Administration of potassium, increase dietary K+ intake
(oral is best, then IV)