Unit 1 Module 2: F&E, Acid-Base Balance Flashcards
A renal patient has high phosphorus levels. What lab finding is EXPECTED in this patient?
low calcium levels
Which lab value is more concerning?
K 3.0 mEq/L
Na 130 mEq/L
K 3.0 mEq/L (small changes in K are more important!)
Normal ranges:
K 3.5-5
Na 135-145
Which is more concerning?
Na 120
Na 150
Na 120
Normal range 135-145
A patient is admitted to the hospital and is given a hypotonic solution (1/2 normal saline). Where will the fluid move?
from the bloodstream to the cell
ABG:
pH 7.27
pCO2 49
HCO3- 25
respiratory acidosis with no compensation
pH 7.35-7.45
pCO2 35-45
Bicarb 22-26
Which two lab values have an inverse relationship?
calcium and phosphorus
t/f: A hypotonic solution will provide cellular rehydration when given.
true
What does “partial compensation” mean when discussing ABG interpretation?
The pH does not return to normal.
If a patient has a low albumin level noted on his laboratory work, the nurse suspects that the patient will have what physical assessment finding?
edema
Patients with low albumin don’t have the oncotic pulling power to hold fluid in the intravascular space. Remember albumin is a bully—if it is not there, then the water won’t still around. These patients often have edema as the fluid is in the interstitial space.
ABG:
pH 7.26
pCO2 37
HCO3- 18
Metabolic acidosis without compensation
pH 7.35-7.45
pCO2 35-45
Bicarb 22-26
A patient with end stage COPD is breathing very shallow at a rate of 8 breaths per minute. An ABG is drawn. What does the nurse expect to find as the result?
This patient would have very shallow respirations and would retain CO2, which would lead to respiratory acidosis (too much carbonic acid in the bloodstream.)
A patient with type 1 diabetes mellitus presents to the emergency department in diabetic ketoacidosis. Which ABG result does the nurse expect to find?
metabolic acidosis
What is the most common cause of hyponatremia?
overhydration
A hospitalized patient has gained 4.4 lbs in a 24 hour period. Making the assumption that the weight gain is all fluid, how many liters does that equate to?
The patient gained 2 liters worth of fluid.
1 liter=1 kg=2.2 lbs
Which symptom is an expected finding for a patient admitted in fluid volume overload because of missing two sessions of dialysis for renal failure?
This patient will have greater intravascular fluid volume and this will be seen through the distension of the jugular vein. Other symptoms may include hypertension, bounding pulses, weight gain, peripheral edema
Which is the most likely to cause edema:
- hypertension
- low albumin
- hypoglycemia
- heart failure
low albumin (but heart failure will also cause edema)
ABG:
pH 7.29
pCO2 32
HCO3- 19
metabolic acidosis with partial compensation
pH 7.35-7.45
pCO2 35-45
Bicarb 22-26
If an isotonic solution is given into a patient’s IV. What should happen to the fluid?
It will remain in the intravascular space.
Isotonic solutions are equal in tonicity to the human body and will remain in the intravascular space where it was infused. Isotonic solutions like normal saline are used to raise blood pressure because it will stay in the intravascular space.
A patient with diabetes has splurged on a bag of candy and the blood sugar has elevated. What symptom does the nurse expect?
Thirst
Glucose is a bully and it has a pulling power to it. It pulls fluid. When blood sugar is high, fluid is pulled from inside the cell. The increase in fluid in the bloodstream promotes urination. The individual is then dehydrated and becomes thirsty.
If the Renin-Angiontensin-Aldosterone system is activated in the body, the end result will be:
increased blood pressure
RAAS and ADH both result in the retention of Na and water; which would in turn increase intravascular volume and blood pressure.
Aldosterone results in the retention of K and fluid retention
A patient is having an anxiety attack and is breathing super fast (50 breaths per minute). If an ABG was drawn, the nurse would expect what abnormality?
respiratory alkalosis: The fast breathing is “blowing off carbon dioxide” also known as blowing off carbonic acid. That means that the person will have low levels of carbonic acid in the blood and therefore will have a respiratory alkalosis.
Which solution has the highest number of solutes?
hypotonic, hypertonic, isotonic
hypertonic
Hypertonic solutions are more concentrated and have more solutes in them in comparison to normal human fluids. Examples include D5.45 NS, D5NS, D5LR.
Which is most likely to cause edema:
- congestive heart failure
- diuretics
- sickle cell anemia
- IV fluids for dehydration
congestive heart failure
fluid volume overload
An alteration in which electrolyte has the most profound effects on the body?
Potassium
What system is the quickest to respond to acid-base imbalances?
The respiratory system can respond with minutes to hours.
A patient is admitted with severe dehydration after becoming lost out in the woods for a week. The provider orders an isotonic solution (normal saline). The nurse understands what movement will happen to this fluid administered into the bloodstream.
The fluid will maintain in the bloodstream and will raise the blood pressure
A patient presents to the ED with hyponatremia. What symptoms does the nurse expect to find?
Hyponatremia symptoms include: muscle cramps, weakness, fatigue, GI symptoms, headache, confusion, seizures and coma. Neuro symptoms like headache, confusion, seizures and coma are the most concerning.
ABG:
pH 7.32
pCO2 27
HCO3- 18
metabolic acidosis with partial compensation
pH 7.35-7.45
pCO2 35-45
Bicarb 22-26
ABG:
pH 7.52
pCO2 22
HCO3- 24
respiratory alkalosis with no compensation
pH 7.35-7.45
pCO2 35-45
Bicarb 22-26
