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 9 99 99 99 99




(Chapters10,34,35,36,37) 99 99 99 99 99




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”
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i. Water makes up most of our bodies. An older adult’s water percentage (45% 99 99 99 99 99 99 99 99 99 99 99 99




forwomen and55% for men)isabout 10%lessthan ayoung adult.
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ii. theyhavelessbodyreserve(meaningthatinterruptions withbodyfluids are 9 9 99 9 99 9 99 99 99 9 99




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 99




i. Sodium and water regulation become less efficient w/ aging 99 99 99 99 99 99 99 99




ii. Kidneys (less abletoconcentrateurineandconserveH2Oand Na),Renal blood 99 99 9 99 99 9 99 9 9 99 99 99




flow and glomerular filtration decline 99 99 99 99 99




iii. ThirstMechanism(hypothalamusisthethirstcenterinbrain)Perception of 99 99 99 9 9 99 9 99 9 99




thirst decrease 99 99




c. Muscle mass 99




i. skeletal muscleretainsthemostwater (menhave moreskeletalmuscleso they 9 9 99 99 99 99 99 99 99 99 99 99 99




have a higher percentage than women [they hold more fat and adipose tissue
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does not retain much water]) 99 99 99 99 99




ii. In thispopulation:Leanmusclemassisdecreased, andbodyfatis 99 99 99 99 9 9 99 99 9 9 99




increased. 99




d. Increased risks (e.g. dehydration) 99 99 99




i. (Risk factors for FVD) Those with a: self-care deficit, confused, 99 99 99 99 99 99 99 99 99




depressed, tube fed on bed rest, in extremely hot weather, taking
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medications. 99




ii. Dehydration:can cause fever and further dehydration 99 99 99 99 99 99




iii. Functionalimpairments- (arthritisorstroke)canimpairabilitytoaccess 99 99 99 9 99 99 9 9 99




fluids 99




iv. Cognitive impairment-interfereswithrecognitionofthirstandabilityto 9 9 9 99 99 99 9 99 99 9




respond to it 99 99 99




v. Earlymanifestation for dehydration in older adult: change in mental status 9 99 99 99 99 99 99 99 99 99




2. Review thenatural compensatorymechanisms within the body asitattempts to shift fluids
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to maintain homeostasis
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a. ADH-
i. releasedbytheposteriorpituitarygland, regulateswaterexcretionfrom the 99 9 9 99 9 99 99 99 99 99




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 99 99 99 99 99 99 99 99 99




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 99 99 99 99 99 99 99 99 99 99 99




kidney, restoring blood volume. Pg 232 99 99 99 99 99 99




d. Vitalsigns and physical presentation 99 99 99 99




i. When blood pressure and blood volume are low → the body’s heart rate will 99 99 99 99 99 99 9 99 99 99 99 99 99




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
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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) 99 99 99 99 99 99 99 99 99




b. Clinicalmanifestations(itisimportantthat yourecognizesignsandsymptomsa 99 99 99 99 99 99 99 9 99 9 99




patient is having to correlate with disease and priority interventions)
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c. Possible treatment 99




d. Nursing responsibilities and intervention 99 99 99




e. Expand your knowledge on specific foods that are high and low in each electrolyte 99 99 99 99 99 99 99 99 99 99 99 99 99




so that you may choose the correct items to teach your patient. For example:high
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phosphoruscategoriesasidefromwhatislistedinthePowerPoint include protein-
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rich foods such as meats, chicken, fish, nuts, beans and dairy products.
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Electrolyte: Sodium ir
9 Hyponatremia <135 ir
99 Hypernatremia >145 ir
9




Normal: 135-145
ir
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Symptoms Poor skin turgor, Dry mucosa, Headache,
ir
9 ir
9 ir
9 ir
9 ir
9 Thirst, Elevated temperature, Dry, swollen tongue, ir
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9 ir
9 ir
9 ir
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Decreased salivation, Decreased BP,
99 ir 99 ir 99 ir 99 ir Sticky mucosa, Neuro symptoms, Restlessness,
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99 ir
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Nausea, Abdominal cramping, Neuro
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99 Weakness, Seizures or coma
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changes, Muscle weakness
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Causes adrenal insufficiency, water intoxication, ir
99 ir
99 ir
99 Excess water loss, Excess Na admin. Diabetes ir
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vomiting, diarrhea, sweating, diuretics
ir
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99 insipidus, Heat stroke, Hypertonic IV
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solution
ir
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Treatment Water restriction, Sodium replacement
ir
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99 Hypotonic solution (0.45 NaCl, D5w) ir
99 99 ir 99 ir ir
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Responsibilities/Inter Monitor sodium, Assessment, prevent ir
99 99 ir 99 ir Assess OTC sodium, Mental status, Prevention, ir
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vention
ir
99 cerebral edema, Teach about effects of
99 ir ir
9 ir
9 ir
9 ir
9 ir
9 Encourage fluids, H20 via tube feeding
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medication and manifestations
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Foods Fresh, frozen or dried fruits: Berries,
99 ir 99 ir 99 ir 99 ir 99 ir Smoked, cured, salted, or canned meat, fish or 99 ir 99 ir 99 ir 99 ir ir
99 ir
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apples, bananas, pears, etc. Grains and
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99 poultry including bacon, cold cuts, ham,
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beans: Dried beans, brown rice, farro,
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99 99 ir 99 ir frankfurters, sausage, sardines, caviar and
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quinoa and whole wheat pasta. Starchy
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9 ir
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9 ir
9 anchovies. Frozen breaded meats and dinners, such
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vegetables: Potatoes, sweet potatoes,
99 ir 99 ir 99 ir 99 ir as burritos and pizza. Canned entrees, such as
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butternut squash and parsnips. Fresh or
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9 ir
9 ravioli, spam and chili. Salted nuts. Beans canned
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with salt added.
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2

, frozen meat and poultry: Chicken, turkey,
ir
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beef or pork.
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Electrolyte: Hypokalemia <3.5 ir
99 Hyperkalemia >5.3 ir
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Potassium
ir
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Normal: 3.5 - 5.3
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Symptoms Fatigue , N/V / anorexia Dysrhythmias, ir ir
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9 9 ir
9 Cardiac changes, Dysrhythmias, Possible cardiacir
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Muscle weakness, Leg cramps /
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99 99 ir 99 ir arrest, Potential respiratory impairment, Muscle
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paresthesia, Glucose intolerance, ↓
99 ir 99 ir 99 ir 99 ir weakness, Paresthesia, Tremors, twitching,
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muscle strength, ↓ cardiac output,
99 ir 99 ir 99 ir 99 ir 99 ir Anxiety, GI manifestations
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Polyuria / altered renal function
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99 99 ir Treatment-Monitor EKG, Kayexalate, IV sodium ir
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bicarbonate, IV calcium gluconate, Regular
ir
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insulin, D50 (hypertonic), b -2 agonists, Limit
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dietary K+
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Causes GI losses, Medications, Alterations of
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99 treatment related, Impaired renal fx, 99 ir 99 ir ir
99 ir
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acid-base balance,
99 ir 99 ir Hyperaldosteronism, Tissue trauma, Acidosis
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Hyperaldosteronism, Poor dietary
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intake
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Treatment Increase dietary K+, K+ replacement, ir
9 ir
9 ir
9 ir
9 Monitor EKG, Kayexalate, IV sodium bicarbonate, ir
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D5W
99 ir IV calcium gluconate, Regular insulin, D50
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(hypertonic), b -2 agonists, Limit dietary K+
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Responsibilities/Inter Assessment, health history, physical, ir
9 ir
9 ir
9 Assess serum K+, Monitor medication effects,
ir
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vention
ir
99 Monitor EKG, ABG’s, Dietary
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99 Initiate dietary K+ restriction, Dietary teaching
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K+, Watch IV site
ir
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Foods cherries, tangerine, lettuce, peppers, beef, ir
9 ir
9 ir
9 ir
9 Dried fruits (raisins, apricots), Beans, lentils,
ir
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egg, peanut butter, rice, tea, noodles
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99 Potatoes, Winter squash (acorn, butternut),
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Spinach, broccoli, Beet greens, Avocado, Bananas,
99 ir ir
9 ir
9 ir
9 ir
9 ir
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Cantaloupe, Oranges, orange juice, Coconut water,
99 ir ir
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9 ir
9 ir
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Tomatoes, Dairy and plant milks (soy, almond),
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Yogurt, Cashews, almonds, Chicken, Salmon
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Electrolyte: Calciumir
9 Hypocalemia <9 9ir Hyper
Normal: 9 - 11
ir
99 99 ir 99 ir ir
99




Symptoms Tetany (spasms), Circumoral numbness, ir
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99 ir
99 H/A – Anorexia, N/V, Dehydration, Constipation,
ir
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Paresthesia, Hyperactive DTR’s,
99 ir 99 ir 99 ir Abdominal/bone pain, Excessive urination, Severe
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Trousseau’s sign, Chvostek’s sign,
99 ir 99 ir 99 ir 99 ir thirst, Confusion, impaired memory, slurred
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Seizures, Respiratory symptoms,
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99 99 ir speech, lethargy, acute psychotic behavior or coma
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9 ir
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Dyspnea
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3

, Causes Hypoparathyroidism, Malabsorption, 99 ir Malignancies, Hyperparathyroidism, Tumors, 99 ir 99 ir


Pancreatitis, Alkalosis, Massive
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99 Immobilization, Thiazide diuretics, Vitamin A &
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9 ir
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transfusion of citrated blood, Renal
99 ir 99 ir 99 ir ir
99 99 ir D intoxication, Lithium and theophylline
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99 ir
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failure, Medications
99 ir 99 ir toxicity
ir
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Treatment Oral calcium, Vitamin D, Diet with
ir
9 ir
9 ir
9 ir
9 ir
9 Treat underlying cause, Volume expansion and
ir
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calcium
99 ir saline diuresis, Phosphates, Bisphosphonates,
ir
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Calcitonin
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Responsibilities/Inter Assessment, Teach weight bearing 99 ir 99 ir 99 ir Assessment (crisis has high mortality rate), 99 ir 99 ir 99 ir 99 ir ir
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vention
ir
99 exercises, Education on meds and diet,
99 ir ir
9 ir
9 ir
9 ir
9 ir
9 encourage ambulation, Fluids 3-4 liters/day,
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99 99 ir


IV calcium administration, Observe
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99 99 ir 99 ir Provide fluids containing Na (unless
ir
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airway (r/t potential laryngospasm)
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99 99 ir 99 ir contraindicated), Fiber (constipation)
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Foods Bok choy, Chicory, Collard greens, Corn,
ir
99 ir
99 ir
99 99 ir ir
99 Dairy products. Products like milk, yogurt, cheese,
ir
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Dandelion greens, Kale
99 ir 99 ir 99 ir Soybeans, Dark Green, Leafy Vegetables, Figs,
99 ir 99 ir ir
99 ir
99 99 ir 99 ir


Flour Tortillas, Canned Baked Beans
99 ir 99 ir 99 ir 99 ir ir
99




Electrolyte: Hypomagnesemia <1.8 ir
99 Hypermagnesemia >3 ir
9




Magnesium
ir
99




Normal: 1.8 - 3
ir
99 ir
9 ir ir
9 9




Symptoms Mood changes, Neuromuscular 99 ir 99 ir Flushing; NV, low BP, Diminished DTRs, 99 ir 99 ir ir
99 99 ir 99 ir


irritability (seizures), Muscle
99 ir 99 ir ir
99 Drowsiness, Muscle weakness, Depressed
99 ir 99 ir 99 ir 99 ir


weakness, Tremors, EKG changes,
99 ir ir
99 ir
9 ir
9 respirations, EKG changes, Dysrhythmias, Coma /
99 ir ir
9 ir
9 ir
9 ir
9 ir
9




Dysrhythmias, HTN, tachycardia,
ir
9 ir
99 99 ir cardiac arrest
99 ir ir
99




Positive Babinski, Chvostek and
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Trousseau
99 ir




Causes Alcoholism, GI losses, Enteral/parenteral 99 ir ir
99 ir
99 Renal failure, Diabetic ketoacidosis, Excessive
ir
9 ir
9 ir
9 ir
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feeding deficient in Mg, Medications,
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99 99 ir ir
99 MgSO4
99 ir


Rapid administration of citrated blood,
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99 99 ir ir
99




Diabetic ketoacidosis, Sepsis,
99 ir ir
99 ir
99




Burns/hypothermia
99 ir




Treatment Diet, Oral Mg, MgSO4 IV ir
99 99 ir 99ir 99 ir IV calcium gluconate, Loop diuretics, IV NS or
ir
9 ir
9 ir
9 ir
9 ir
9 ir
9 ir
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RL, Hemodialysis (if renal patient)
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99 99 ir




Responsibilities/Inter Assessment, Ensure safety, Pt teaching r/t ir
9 ir
9 ir
9 ir
9 ir
9 Assessment, Avoid MgS04 meds and/or 99 ir 99 ir 99 ir 99 ir


vention
ir
99 diet, medications, ETOH, IV site care,
99 ir 99 ir 99 ir 99 ir 99 ir ir
99 compounds, Pt teaching r/t OTC medications with
99 ir ir
9 ir
9 ir
9 ir
9 ir
9 ir
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Monitor/tx potential hypocalcemia
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99 MgSO4
99 ir




Foods fresh fruit and veggies, chicken
99 ir ir
99 99 ir ir
99 greens, nuts, seeds, dry beans, whole grains, wheat
ir
9 ir
9 ir
9 ir
9 ir
9 ir
9 ir
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germ, wheat and oat bran.
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Electrolyte: Hypophosphatemia < 2.5 ir
9 ir
99 Hyperphosphatemia >4.5 ir
9




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