FLUID AND ELECTROLYTE
IMBALANCE EXAM 1
Normal lab values for sodium -
135-145 mEq
Normal lab values for potassium -
3.5-5.0 mEq
Normal lab values for calcium -
8.5-10.5 mg/dL
Normal lab values for phosphorus -
2.4-4.4 mEq
normal lab values for Cl -
96-106 mEq
normal lab values for magnesium -
1.7-2.7 mEq
Does an adult or infant have more fluid in their body? -
infant
males or females have more fluid in their body? Why? -
males, because water is in muscles not fat
Does ICF or ECF have more fluid? -
ICF
Volume problems mainly affect what area? Osmolarity problems affect what? -
heart; brain- CNS
Treatment of hypovolemia -
1. oral rehydration
2. IV replacement with Lactated Ringers or isotonic NaCl (0.9% or normal saline) or blood
Treatment for hypervolemia -
1. give diuretics
2. fluid restriction
3. abdominal para-or thoracentesis
Treatment for hyponatremia -
1. restrict fluids
2. Give lactated ringers or normal saline IV fluid
3. give 3 or 5% NaCl IV solutions slowly (only ICU setting)
4. give loop diuretics to decrease water or withhold diuretics
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,5. give oral rehydration fluids with electrolytes
treatment for hypernatremia -
1. dilute the sodium concentration
2. administer IV D5W or 0.4% NaCl
3. restrict sodium intake
4. give free water
5. give diuretics to excrete sodium
Fluid volume deficit does what to BUN, Na, and hct? -
increases
Fluid volume excess does what to BUN, Na, and hct? -
decreases
As a nurse, what should you assess if there is a fluid imbalance? -
1. daily weigh
2. I & O
3. lung sounds
4. vital signs
5. monitor lab results for BUN, Na, and hct
6. assess neurological changes
7. assess skin
treatment for hypokalemia -
1. give potassium orally or IV (drip only)
-Lidocaine for pain
-Liquid potassium by mouth can cause GI lesions
treatment for hyperkalemia -
1. eliminate potassium intake or restrict
2. dialysis
3. Kayexalate - a cation exchange resin given orally or rectally to bind with potassium
4. force potassium from ECF to ICF with IV insulin with dextrose- causes increase potassium
intake at cellular level, beta adrenergic agonists, NaHCO3- moves Na into cells
5. stabilize cardiac membranes with IV calcium chloride or gluconate - types of calcium
6. monitor EKG
sign to test for hypocalcemia in which you tap on facial nerve leading to facial contractions -
Chvostek's sign
sign to test for hypocalcemia in which you inflate BP cuff above systolic bp leading to carpal
spasms -
Trousseau's sign
treatment for hypocalcemia -
1. oral or IV calcium
2. promote CO2 retention- to control muscle spasms
treatment for hypercalcemia -
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, 1. IV or oral fluids with normal saline - flushes out excess calcium
2. IV phosphorus- opposes calcium
3. Calcitonin- lowers calcium
4. Biphosphonates- inhibits bone resorption
5. low calcium diet
6. dialysis
7. mobilization- enhances bone mineralization
What two electrolytes are inverse? -
Calcium and potassium
clear IV solutions -
crystalloids
blood and blood products IV -
colloids
3 categories of IV solutions- definition, osmolality, and types -
1. hypertonic: causes cells to swell
-<250
-0.45% NaCl (normal saline); D5W in patient
2. Isotonic: no loss or gain from the intracellular space
-250-350
-normal saline (NS or 0.9%); lactated ringers; blood
3. hypertonic: cells to shrink
->350
-10% dextrose; >10 % dextrose in central line; 3% or 5% NaCl
While obtaining an assessment and health history from a patient, which of the following
statements by the patient will alert the nurse to a possible fluid volume excess?
a. "I have been urinating a lot, and my urine is dark, almost brown"
b. "I get light-headed and dizzy when I stand up too fast after sitting or lying down."
c. "My heart feels like it is about to run away with me some of the time because it goes so
fast"
d. "I have been taking some salt tablets while working outdoors in the summer, but they sure
make me thirsty." -
d.
A patient at risk for hypernatremia is one who
a. has a deficiency of aldosterone
b. has prolonged vomiting and diarrhea
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IMBALANCE EXAM 1
Normal lab values for sodium -
135-145 mEq
Normal lab values for potassium -
3.5-5.0 mEq
Normal lab values for calcium -
8.5-10.5 mg/dL
Normal lab values for phosphorus -
2.4-4.4 mEq
normal lab values for Cl -
96-106 mEq
normal lab values for magnesium -
1.7-2.7 mEq
Does an adult or infant have more fluid in their body? -
infant
males or females have more fluid in their body? Why? -
males, because water is in muscles not fat
Does ICF or ECF have more fluid? -
ICF
Volume problems mainly affect what area? Osmolarity problems affect what? -
heart; brain- CNS
Treatment of hypovolemia -
1. oral rehydration
2. IV replacement with Lactated Ringers or isotonic NaCl (0.9% or normal saline) or blood
Treatment for hypervolemia -
1. give diuretics
2. fluid restriction
3. abdominal para-or thoracentesis
Treatment for hyponatremia -
1. restrict fluids
2. Give lactated ringers or normal saline IV fluid
3. give 3 or 5% NaCl IV solutions slowly (only ICU setting)
4. give loop diuretics to decrease water or withhold diuretics
1|Page
,5. give oral rehydration fluids with electrolytes
treatment for hypernatremia -
1. dilute the sodium concentration
2. administer IV D5W or 0.4% NaCl
3. restrict sodium intake
4. give free water
5. give diuretics to excrete sodium
Fluid volume deficit does what to BUN, Na, and hct? -
increases
Fluid volume excess does what to BUN, Na, and hct? -
decreases
As a nurse, what should you assess if there is a fluid imbalance? -
1. daily weigh
2. I & O
3. lung sounds
4. vital signs
5. monitor lab results for BUN, Na, and hct
6. assess neurological changes
7. assess skin
treatment for hypokalemia -
1. give potassium orally or IV (drip only)
-Lidocaine for pain
-Liquid potassium by mouth can cause GI lesions
treatment for hyperkalemia -
1. eliminate potassium intake or restrict
2. dialysis
3. Kayexalate - a cation exchange resin given orally or rectally to bind with potassium
4. force potassium from ECF to ICF with IV insulin with dextrose- causes increase potassium
intake at cellular level, beta adrenergic agonists, NaHCO3- moves Na into cells
5. stabilize cardiac membranes with IV calcium chloride or gluconate - types of calcium
6. monitor EKG
sign to test for hypocalcemia in which you tap on facial nerve leading to facial contractions -
Chvostek's sign
sign to test for hypocalcemia in which you inflate BP cuff above systolic bp leading to carpal
spasms -
Trousseau's sign
treatment for hypocalcemia -
1. oral or IV calcium
2. promote CO2 retention- to control muscle spasms
treatment for hypercalcemia -
2|Page
, 1. IV or oral fluids with normal saline - flushes out excess calcium
2. IV phosphorus- opposes calcium
3. Calcitonin- lowers calcium
4. Biphosphonates- inhibits bone resorption
5. low calcium diet
6. dialysis
7. mobilization- enhances bone mineralization
What two electrolytes are inverse? -
Calcium and potassium
clear IV solutions -
crystalloids
blood and blood products IV -
colloids
3 categories of IV solutions- definition, osmolality, and types -
1. hypertonic: causes cells to swell
-<250
-0.45% NaCl (normal saline); D5W in patient
2. Isotonic: no loss or gain from the intracellular space
-250-350
-normal saline (NS or 0.9%); lactated ringers; blood
3. hypertonic: cells to shrink
->350
-10% dextrose; >10 % dextrose in central line; 3% or 5% NaCl
While obtaining an assessment and health history from a patient, which of the following
statements by the patient will alert the nurse to a possible fluid volume excess?
a. "I have been urinating a lot, and my urine is dark, almost brown"
b. "I get light-headed and dizzy when I stand up too fast after sitting or lying down."
c. "My heart feels like it is about to run away with me some of the time because it goes so
fast"
d. "I have been taking some salt tablets while working outdoors in the summer, but they sure
make me thirsty." -
d.
A patient at risk for hypernatremia is one who
a. has a deficiency of aldosterone
b. has prolonged vomiting and diarrhea
3|Page
