NUR 521: Exam 1 Study Guide Fluid, Electrolyte, and Acid-Base Balance with complete solution.

NUR521: Exam1 StudyGuide Fluid, Electrolyte,
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and Acid-Base Balance with complete solution.
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Exam1Study GuideNUR 521 c4 c4 c4 c4 c4




(Chapters10,34,35,36,37) c4 c4 c4 c4 c4




Chapter10 (20 questions)
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1. Understand the special needs of the olderadult pertaining to fluid and electrolytes
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a. Impact of waterloss including “insensible fluid loss” c4 c4 c4 c4 c4 c4 c4




i. Water makes up most of our bodies. An older adult’s water percentage (45% c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




forwomenand55% formen)isabout 10%lessthanayoung adult.
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ii. theyhavelessbodyreserve(meaningthatinterruptionswithbodyfluids are c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




more severe for the geriatric population & imbalances with fluids always
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affect electrolytes [less water means more electrolytes; less electrolytes
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means more water] → thus interrupting homeostasis all together)
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b. Organ function c4




i. Sodium and water regulation become less efficient w/ aging c4 c4 c4 c4 c4 c4 c4 c4




ii. Kidneys(lessabletoconcentrateurineandconserveH2OandNa),Renal blood c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




flow and glomerular filtration decline c4 c4 c4 c4 c4




iii. ThirstMechanism(hypothalamusisthethirstcenterinbrain)Perception of c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




thirst decrease c4 c4




c. Muscle mass c4




i. skeletal muscleretainsthemostwater(menhave moreskeletalmuscleso they c 4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




have a higher percentage than women [they hold more fat and adipose tissue
c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




does not retain much water]) c4 c4 c4 c4 c4




ii. Inthispopulation:Leanmusclemassisdecreased,andbodyfatis c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




increased. c4




d. Increasedrisks (e.g. dehydration) c4 c4 c4




i. (Risk factors for FVD) Those with a: self-care deficit, confused, c4 c4 c4 c4 c4 c4 c4 c4 c4




depressed, tube fed on bed rest, in extremely hot weather, taking
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medications. c4




ii. Dehydration:can cause fever and further dehydration c4 c4 c4 c4 c4 c4




iii. Functionalimpairments-(arthritisorstroke)canimpairabilitytoaccess c4 c4 c4 c4 c4 c4 c4 c4 c4




fluids c4




iv. Cognitive impairment-interfereswithrecognitionofthirstandabilityto c 4 c4 c4 c4 c4 c4 c4 c4 c4




respond to it c4 c4 c4




v. Earlymanifestation for dehydration in older adult: change in mental status c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




2. Review thenatural compensatorymechanisms within thebodyasitattempts toshift fluids
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to maintain homeostasis
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a. ADH-
i. releasedbytheposteriorpituitarygland,regulateswaterexcretionfrom the c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




kidneys. Increased response to stress such as nausea, pain, surgery
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anesthesia.Inhibitedamountbyalcoholandmedicationslikephenytoin and
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increased blood volume and decreased osmolality. Pg 232
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b. Renin

, i.
angiotensin helps maintain intravascular fluid balance and blood pressure. A c4 c4 c4 c4 c4 c4 c4 c4 c4




decrease in blood flow or BP stimulates receptors to produce renin. Pg. 232
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c. Aldosterone
i. Aldosterone promotes sodium and water retention in the distal nephron of the c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




kidney, restoring blood volume. Pg 232 c4 c4 c4 c4 c4 c4




d. Vitalsigns and physical presentation c4 c4 c4 c4




i. When blood pressure and blood volume are low → the body’s heart rate will c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




increase and vessels will constrict to compensate for the depressed BP/BV
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so it increases to put out the little blood available to distribute c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




3. Memorize the information pertaining to each electrolyte posted to include the
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following: (all from the powerpoint)
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a. Possible causes of the deficit or excess (studythe slides) c4 c4 c4 c4 c4 c4 c4 c4 c4




b. Clinicalmanifestations(itisimportantthat yourecognizesignsandsymptomsa c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




patient is having to correlate with disease and priority interventions)
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c. Possible treatment c4




d. Nursingresponsibilities and intervention c4 c4 c4




e. Expand your knowledge on specific foods that are high and low in each electrolyte c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4 c4




so that you may choose the correct items to teach your patient. For example:high
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phosphoruscategoriesasidefromwhatislistedinthePowerPoint include protein-rich
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foods such as meats, chicken, fish, nuts, beans and dairy products.
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Electrolyte: Sodium ir
c4 Hyponatremia <135 ir
c4 Hypernatremia >145 ir
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Normal: 135-145
ir
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Symptoms Poor skin turgor, Dry mucosa, Headache,
ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 Thirst, Elevated temperature, Dry, swollen tongue, ir
c4 ir
c4 ir
c4 ir
c4 ir
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Decreased salivation, Decreased BP,
c4 ir ir
c4 c4 ir c4 ir Sticky mucosa, Neuro symptoms, Restlessness,
c4 ir c4 ir ir
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Nausea, Abdominal cramping, Neuro
c4 ir c4 ir c4 ir c4 ir Weakness, Seizures or coma
c4 ir c4 ir c4 ir ir
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changes, Muscle weakness
c4 ir c4 ir c4 ir




Causes adrenal insufficiency, water intoxication, c4 ir ir
c4 ir
c4 Excess water loss, Excess Na admin. Diabetes ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
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vomiting, diarrhea, sweating, diuretics
ir
c4 c4 ir c4 ir ir
c4 insipidus, Heat stroke, Hypertonic IV
c4 ir c4 ir ir
c4 ir
c4 ir
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solution
ir
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Treatment Water restriction, Sodium replacement
ir
c4 ir
c4 ir
c4 Hypotonic solution (0.45 NaCl, D5w) ir
c4 c4 ir ir
c4 c4 ir




Responsibilities/Inter Monitor sodium, Assessment, prevent c4 ir c4 ir c4 ir Assess OTC sodium, Mental status, Prevention, ir
c4 ir
c4 ir
c4 ir
c4 ir
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vention
ir
c4 cerebral edema, Teach about effects of
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 Encourage fluids, H20 via tube feeding
c4 ir c4 ir c4 ir ir
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medication and manifestations
c4 ir c4 ir c4 ir




Foods Fresh, frozen or dried fruits: Berries,
c4 ir ir
c4 ir
c4 c4 ir c4 ir Smoked, cured, salted, or canned meat, fish or c4 ir c4 ir c4 ir c4 ir c4 ir c4 ir c4 ir


apples, bananas, pears, etc. Grains and
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 poultry including bacon, cold cuts, ham,
c4 ir c4 ir c4 ir ir
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beans: Dried beans, brown rice, farro,
c4 ir c4 ir c4 ir c4 ir c4 ir c4 ir frankfurters, sausage, sardines, caviar and
c4 ir c4 ir ir
c4 c4 ir c4 ir


quinoa and whole wheat pasta. Starchy
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 anchovies. Frozen breaded meats and dinners, such
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
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vegetables: Potatoes, sweet potatoes,
c4 ir c4 ir c4 ir c4 ir as burritos and pizza. Canned entrees, such as
c4 ir ir
c4 c4 ir ir
c4 c4 ir ir
c4 ir
c4 c4 ir


butternut squash and parsnips. Fresh or
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ravioli, spam and chili. Salted nuts. Beans canned
c4 ir ir
c4 c4 ir c4 ir c4 ir c4 ir c4 ir c4 ir


with salt added.
c4 ir c4 ir c4 ir




2

, frozen meat and poultry: Chicken, turkey,
ir
c4 ir
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beef or pork.
c4 ir c4 ir c4 ir




Electrolyte: Hypokalemia <3.5 ir
c4 Hyperkalemia >5.3 ir
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Potassium
ir
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Normal: 3.5 - 5.3
ir
c4 ir
c4 ir ir
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Symptoms Fatigue , N/V / anorexia Dysrhythmias, ir ir
c4 c4 ir ir
c4 c4 ir
c4 Cardiac changes, Dysrhythmias, Possible cardiac ir
c4 ir
c4 ir
c4 ir
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Muscle weakness, Leg cramps /
c4 ir ir
c4 c4 ir c4 ir c4 ir arrest, Potential respiratory impairment, Muscle
c4 ir c4 ir c4 ir c4 ir ir
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paresthesia, Glucose intolerance, ↓
c4 ir c4 ir c4 ir c4 ir weakness, Paresthesia, Tremors, twitching,
c4 ir c4 ir ir
c4 c4 ir


muscle strength, ↓ cardiac output,
c4 ir ir
c4 c4 ir c4 ir ir
c4 Anxiety, GI manifestations
c4 ir c4 ir c4 ir


Polyuria / altered renal function
c4 ir c4 ir c4 ir c4 ir ir
c4 Treatment-Monitor EKG, Kayexalate, IV sodium ir
c4 ir
c4 c4 ir ir
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bicarbonate, IV calcium gluconate, Regular
ir
c4 c4 ir c4 ir c4 ir ir
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insulin, D50 (hypertonic), b -2 agonists, Limit
c4 ir c4 ir c4 ir ir
c4 c4 ir ir
c4 c4 ir


dietary K+
c4 ir c4 ir




Causes GI losses, Medications, Alterations of
c4 ir c4 ir c4 ir c4 ir treatment related, Impaired renal fx, ir
c4 ir
c4 ir
c4 ir
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acid-base balance,
c4 ir ir
c4 Hyperaldosteronism, Tissue trauma, Acidosis
c4 ir c4 ir c4 ir c4 ir


Hyperaldosteronism, Poor dietary
c4 ir c4 ir c4 ir


intake
c4 ir



Treatment Increase dietary K+, K+ replacement, ir
c4 ir
c4 ir
c4 ir
c4 Monitor EKG, Kayexalate, IV sodium bicarbonate, ir
c4 ir
c4 ir
c4 ir
c4 ir
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D5W
c4 ir IV calcium gluconate, Regular insulin, D50
c4 ir c4 ir c4 ir c4 ir ir
c4 c4 ir


(hypertonic), b -2 agonists, Limit dietary K+
c4 ir c4 ir ir
c4 ir
c4 c4 ir c4 ir ir
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Responsibilities/Inter Assessment, health history, physical, ir
c4 ir
c4 ir
c4 Assess serum K+, Monitor medication effects,
ir
c4 ir
c4 c4 ir ir
c4 ir
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vention
ir
c4 Monitor EKG, ABG’s, Dietary
c4 ir ir
c4 ir
c4 c4 ir Initiate dietary K+ restriction, Dietary teaching
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
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K+, Watch IV site
ir
c4 ir
c4 c4 ir c4 ir




Foods cherries, tangerine, lettuce, peppers, beef, ir
c4 ir
c4 ir
c4 ir
c4 Dried fruits (raisins, apricots), Beans, lentils,
c4 ir c4 ir c4 ir c4 ir c4 ir


egg, peanut butter, rice, tea, noodles
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 c4 ir Potatoes, Winter squash (acorn, butternut),
c4 ir c4 ir c4 ir c4 ir c4 ir


Spinach, broccoli, Beet greens, Avocado, Bananas,
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
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Cantaloupe, Oranges, orange juice, Coconut water,
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
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Tomatoes, Dairy and plant milks (soy, almond),
c4 ir c4 ir c4 ir c4 ir c4 ir c4 ir c4 ir


Yogurt, Cashews, almonds, Chicken, Salmon
c4 ir ir
c4 c4 ir ir
c4 c4 ir




Electrolyte: Calciumir
c4 Hypocalemia <9 ir
c4 Hyper
Normal: 9 - 11
ir
c4 c4 ir c4 ir c4 ir




Symptoms Tetany (spasms), Circumoral numbness, ir
c4 ir
c4 ir
c4 H/A – Anorexia, N/V, Dehydration, Constipation,
ir
c4 c4 ir c4 ir c4 ir ir
c4




Paresthesia, Hyperactive DTR’s,
c4 ir c4 ir c4 ir Abdominal/bone pain, Excessive urination, Severe
c4 ir ir
c4 ir
c4 ir
c4 ir
c4




Trousseau’s sign, Chvostek’s sign,
c4 ir c4 ir c4 ir c4 ir thirst, Confusion, impaired memory, slurred
c4 ir c4 ir c4 ir c4 ir c4 ir


Seizures, Respiratory symptoms,
c4 ir c4 ir c4 ir speech, lethargy, acute psychotic behavior or coma
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
c4




Dyspnea
c4 ir




3

, Causes Hypoparathyroidism, Malabsorption, c4 ir Malignancies, Hyperparathyroidism, Tumors, c4 ir ir
c4




Pancreatitis, Alkalosis, Massive
c4 ir c4 ir c4 ir Immobilization, Thiazide diuretics, Vitamin A &
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4




transfusion of citrated blood, Renal
c4 ir c4 ir c4 ir ir
c4 c4 ir D intoxication, Lithium and theophylline
c4 ir ir
c4 ir
c4 c4 ir ir
c4




failure, Medications
c4 ir c4 ir toxicity
ir
c4




Treatment Oral calcium, Vitamin D, Diet with
ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 Treat underlying cause, Volume expansion and
ir
c4 c4 ir ir
c4 ir
c4 ir
c4




calcium
c4 ir saline diuresis, Phosphates, Bisphosphonates,
ir
c4 c4 ir c4 ir ir
c4




Calcitonin
c4 ir




Responsibilities/Inter Assessment, Teach weight bearing c4 ir c4 ir ir
c4 Assessment (crisis has high mortality rate), c4 ir c4 ir c4 ir c4 ir ir
c4




vention
ir
c4 exercises, Education on meds and diet,
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 encourage ambulation, Fluids 3-4 liters/day,
c4 ir ir
c4 ir
c4 ir
c4 ir
c4




IV calcium administration, Observe
c4 ir c4 ir c4 ir c4 ir Provide fluids containing Na (unless
ir
c4 c4 ir c4 ir c4 ir c4 ir


airway (r/t potential laryngospasm)
c4 ir c4 ir ir
c4 c4 ir contraindicated), Fiber (constipation)
c4 ir c4 ir ir
c4




Foods Bok choy, Chicory, Collard greens, Corn,
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 Dairy products. Products like milk, yogurt, cheese,
ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
c4




Dandelion greens, Kale
c4 ir c4 ir c4 ir Soybeans, Dark Green, Leafy Vegetables, Figs,
c4 ir ir
c4 c4 ir ir
c4 ir
c4 c4 ir


Flour Tortillas, Canned Baked Beans
c4 ir ir
c4 c4 ir ir
c4 c4 ir




Electrolyte: Hypomagnesemia <1.8 ir
c4 Hypermagnesemia >3 ir
c4




Magnesium
ir
c4




Normal: 1.8 - 3
ir
c4 ir
c4 ir ir
c4 c4




Symptoms Mood changes, Neuromuscular c4 ir c4 ir Flushing; NV, low BP, Diminished DTRs, c4 ir c4 ir c4 ir c4 ir c4 ir


irritability (seizures), Muscle
c4 ir c4 ir c4 ir Drowsiness, Muscle weakness, Depressed
c4 ir c4 ir ir
c4 c4 ir


weakness, Tremors, EKG changes,
c4 ir ir
c4 ir
c4 ir
c4 respirations, EKG changes, Dysrhythmias, Coma /
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4




Dysrhythmias, HTN, tachycardia,
ir
c4 c4 ir c4ir cardiac arrest
c4 ir c4 ir


Positive Babinski, Chvostek and
c4 ir c4 ir c4 ir ir
c4




Trousseau
c4 ir




Causes Alcoholism, GI losses, Enteral/parenteral ir
c4 ir
c4 ir
c4 Renal failure, Diabetic ketoacidosis, Excessive
ir
c4 ir
c4 ir
c4 ir
c4




feeding deficient in Mg, Medications,
c4 ir c4 ir ir
c4 c4 ir c4 ir MgSO4
c4 ir


Rapid administration of citrated blood,
c4 ir c4 ir c4 ir c4 ir c4 ir


Diabetic ketoacidosis, Sepsis,
c4 ir c4 ir ir
c4




Burns/hypothermia
c4 ir




Treatment Diet, Oral Mg, MgSO4 IV ir
c4 c4 ir ir
c4 c4 ir IV calcium gluconate, Loop diuretics, IV NS or
ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
c4




RL, Hemodialysis (if renal patient)
c4 ir ir
c4 c4 ir ir
c4 ir
c4




Responsibilities/Inter Assessment, Ensure safety, Pt teaching r/t ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 Assessment, Avoid MgS04 meds and/or c4 ir c4 ir c4 ir c4 ir


vention
ir
c4 diet, medications, ETOH, IV site care,
c4 ir ir
c4 c4 ir c4 ir c4 ir c4 ir compounds, Pt teaching r/t OTC medications with
c4 ir ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
c4




Monitor/tx potential hypocalcemia
c4 ir ir
c4 c4 ir MgSO4
c4 ir




Foods fresh fruit and veggies, chicken
c4 ir ir
c4 c4 ir ir
c4 greens, nuts, seeds, dry beans, whole grains, wheat
ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
c4 ir
c4




germ, wheat and oat bran.
c4 ir c4 ir ir
c4 c4 ir ir
c4




Electrolyte: Hypophosphatemia < 2.5 ir
c4 ir
c4 Hyperphosphatemia >4.5 ir
c4




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