Fluids, Electrolytes, Acid-Base

Question 1

What’s a complication of hypervolemia?

Answer 1

Pulmonary edema

Question 2

What are the manifestations of hypervolemia?

Answer 2

• Bounding pulse, Increased BP
• Dyspnea, crackles, pulmonary edema
• Confusion, headache, lethargy
• Edema
• Ascites
• Increased urine output
• JVD
• Muscle spasms
• S3 heart sound
• Weight gain (notify provider if over 1 kg overnight)
• Seizures, coma

Question 3

What are the complications of hypovolemia?

Answer 3

Hypovolemic shock
- Hypotension
- Tachycardia
- Cues of hypoperfusion
- > Cool, clammy skin
- > Oliguria progressing to anuria
- > Decreased LOC
- > Tachypnea (rapid breathing)

Question 4

What are the clinical manifestations of hypovolemia?

Answer 4

• Increased pulse, postural hypotension
• Increased RR
• Confusion, restlessness, drowsiness, lethargy
• Weakness, dizziness
• Thirst, dry mucous membranes
• Oliguria; concentrated urine output
• Decreased capillary refill
• Cold clammy skin
• Decreased skin turgor
• Weight loss
• Seizures, coma

Question 5

What are the clinical manifestations of hypokalemia?

Answer 5

• Irregular, weak pulse
• ECG/EKG changes
• Shallow respirations
• Fatigue
• Muscle Weakness, leg cramps
• Decreased reflexes
• Paresthesia (pins and needles)
• Constipation, nausea, paralytic ileus
• Hyperglycemia

Question 6

How to administer potassium safely?

Answer 6

• Always dilute IV KCl; do not give as a bolus or IVP
• Invert IV bags several times to ensure even distribution in the bag
• Should NOT exceed 10 mEq/hr (unless patient is in a CCU w/ continuous cardiac monitoring and central line access)
• Use infusion pump
• Monitor IV site at least hourly for phlebitis and/or infiltration

Question 7

What are the complications of hyperkalemia?

Answer 7

• Generalized fatigue & weakness
• Muscle cramps
• Palpitations
• Paresthesia
• ECG/EKG changes
• Cardiac arrest

Question 8

What are the complications of hypomagnesemia?

Answer 8

• Seizures
• Ventricular fibrillation
• Cardiac arrest

Question 9

What electrolyte imbalance is associated with Trousseau’s sign?

Answer 9

• Hypomagnesemia
• Hypocalcemia

Question 10

What are interventions for hyponatremia?

Answer 10

• Isotonic sodium-containing IVF
• Monitor fluid status
• Daily weight & I’s & O’s
• Encourage PO intake
• Hold diuretics
• Monitor neurologic changes
• Monitor sodium levels and response to therapy

Question 11

Describe uncompensated acid-base regulation.

Answer 11

• pH is abnormal, and either PaCO2 or HCO3- is also abnormal
• There is no indication that the opposite system has tried to correct the imbalance

Question 12

Describe partially compensated acid-base regulation.

Answer 12

• pH is abnormal, and both the PaCO2 or HCO3- are also abnormal
• This indicates that the opposite system has attempted to correct for the other but has not been completely successful

Question 13

Describe fully compensated acid-base regulation.

Answer 13

• If pH is normal, and both the PaCO2 or HCO3- are abnormal
• The normal pH indicates that one system has been able to compensate for the other

Question 14

Respiratory Acidosis lab values

Answer 14

pH < 7.35
PaCO2 > 45
When compensated, HCO3- > 26

Question 15

Respiratory Alkalosis lab values

Answer 15

pH > 7.45
PaCO2 < 35
When compensated, HCO3- < 22

Question 16

Metabolic Acidosis lab values

Answer 16

pH < 7.35
HCO3- < 22
If compensated, PaCO2 < 35

Question 17

Metabolic Alkalosis lab values

Answer 17

pH > 7.45
HCO3- > 26
If compensated, PaCO2 > 45