UNIT 3 - FLUID AND ELECTROLYTES

Question 1

describe the nursing priority for someone with hypervolemia (fluid volume excess)

Answer 1

A - airway
B - breath sounds, BP
C - control intake and output
D - decrease risk for complications with alteration to skin integrity. Daily weight
E - electrolyte: sodium will be dilutional (<135 mEq) due to the extra fluid)
F - fluid restriction

Question 2

describe the nursing interventions for someone with hypervolemia.

Answer 2

REDUCE the flow rate.
EVALUATE breath sounds, HR, RR, BP, and ABGs, LOC.
SEMI-FOWLER’s position (easier to breath)
TREAT with oxygen, diuretics, anithypertensives; dialysis as ordered. TEACH about medications.
REDUCE fluid and sodium intake. RESTRICT fluid to 600 to 1000 mL/day. Adjust to urinary output and/or dialysis
INTAKE and OUTPUT and daily weight
CIRCULATION, color, and presence of edema - assess.
TURN and POSITION (promote skin integrity) per protocol. Teach how to distribute fluid over the day.
LOW SODIUM diet
SEIZURE PRECAUTIONS

Question 3

What are the signs and symptoms of hyponatremia (dilutional) ?

• a sodium level below 135 mEq
• this occurs early on in chronic kidney disease

Answer 3

think “EDEEMA”
E - EDEMA (pitting)
D - DECREASE in the HCT
E - ELEVATED weight. intake and output. elevated BP, HR, RR
E - EVALUATE breathing (cheyne stokes respirations)
M - MENTATION decreased (lethargic, seizures)
A - ANOREXIA flushing of the skin
there is also:
- decreased deep tendon reflexes
- severe seizures
- GI symptoms

Question 4

What are the signs and symptoms associated with hyperphosphatemia and hypocalcemia (also referred to as hyperparathyroidism) ?

• a phosphate level > 4.5 mg/dL
• a calcium level < 8.5 mg/dL
• this is caused by bc the kidneys are unable to produce activated vitamin D or to excrete phosphorus.

Answer 4

think “twitch”
T - TROSSEAU’s sign (hand and finger spasms)
W - WATCH for dysrhythmias (pulse, prolonged ST segment, prolonged QT interval on ECG)
I - INCREASe in anorexia, nausea and or vomiting
T - TETANY, twitching seizures
C - Chvostek’s sign (facial twitching)
H - hypotension, hyperactive DTR
there is also
- changes in muscle tone
- bone demineralization (renal osteodystrophy)

Question 5

what are the nursing interventions associated with hyperparathyroidism?

Answer 5

think “SAFE”
S - seizure precautions. decreased the environmental stimuli
A - administer calcium supplements. phosphate binders. Teach to take with meals to bind phosphate in food and stop phosphate absorption. Teach client about constipation.
F - foods high in calcium ( i.e. dairy, green). educate
E - emergency equipment on standby. evaluate for bone disorder. careful with bones.

Question 6

what are the signs and symptoms of metabolic acidosis as a result of chronic kidney failure?

• ph < 7.35
• HCO3 < 22 mmg

Answer 6

think “Ds”
D - deep and rapid respirations. (Kussmual). this is a compensatory actions by the lungs.
D - diarrhea, nausea, vomiting
D - decreased BP
D - dysrhythmias related to hyperkalemia
D - drowsiness, disorientation, headache, seizures

Question 7

what nursing interventions must be done in response to metabolic acidosis?

Answer 7

think “respirate”
R - review initially to determine underlying problem in order to manage.
E - evaluate RR and support to promote compensation for the metabolic acidosis
S - SaO2, pH, and HCO3 levels should be monitored. seizures precautions
P - place on ekg monitor and evaluate for dysrhythmias from hyperkalemia
I - intake and output records should be maintained
R - review weight of client
A - assess renal function and hydration status. If client has DM evaluate for ketoacidosis and administer insulin accordingly.
T - teach client rationale for nursing care and medications
E - evaluate lab values for hyperkalemia. renal function tests. ketones.

Question 8

what are the signs and symptoms of hypernatremia (late stage of chronic kidney failure) ?
- Na level > 145 mEq/L

Answer 8

• restlessness
• lethargy
• disorientation
• mental status change for both

Question 9

what are the signs and symptoms of hyperkalemia ?

- Potassium level > 5.0 mEq/L

Answer 9

• peaked T waves
• widening QRS waves
• prolonged PR interval
• dysrhythmias (both hypo and hyper)
• decreased urinary excretion

Question 10

calcium ____ can bring up the calcium level quickly. It is given through IV and push.

Answer 10

gluconate