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fluids and electrolytes mgccc Questions With Complete Solutions calcium Correct Answers 9 - 11 Causes of Dehydration Correct Answers ■■ Hyperventilation ■■ Diabetic ketoacidosis ■■ Enteral feeding without sufficient water intake causes of FVE Correct Answers CHF renal failure Cirrhosis excessive NaCI excessive sodium-containing IV (hypertonic) burns causes of hypertonic dehydration Correct Answers perspiration, hyperventilation, ketoacidosis, fevers, D, renal fail, diabetes insipidus causes of hypertonic overhydration Correct Answers Excessive sodium ingestion Rapid infusion of hypertonic saline
Excessive sodium bicarbonate therapy causes of hypotonic dehydration Correct Answers chronic illness, excessive fluid replacement (hypotonic), renal failure, chronic malnutrition causes of hypotonic overhydration Correct Answers Early renal failure Congestive heart failure Syndrome of inappropriate antidiuretic hormone secretion Inadequately controlled IV therapy Replacement of isotonic fluid loss with hypotonic fluids Irrigation of wounds and body cavities with hypotonic fluids Causes of Hypovolemia Correct Answers ■■ Abnormal gastrointestinal (GI) losses - Vomiting, nasogastric suctioning, diarrhea ■■ Abnormal skin losses - Diaphoresis
hypotension decreased cardiac output tachycardia low grade fever LOC WT loss dehydration interventions Correct Answers replace with isotonic fluids replace electrolytes treat underlying disease assess CV, R, NEURO, and SKIN monitor labs I&O, daily WTs replace sodium/potassium per protocol SHUNT place modified tendelerbergs oxygen FVD cardiovascular assessment Correct Answers • Thready, increased pulse rate
- Decreased blood pressure and orthostatic (postural) hypotension
- "ortho checks" - Lying BP first
- Flat neck and hand veins in dependent positions
- Diminished peripheral pulses
- Decreased central venous pressure
- Dysrhythmias FVD Gastrointestinal assessment Correct Answers • Decreased motility and diminished bowel sounds
- Constipation
- Thirst
- Decreased body weight FVD integumentary assessment Correct Answers • Dry skin
- Poor turgor, tenting
- Dry mouth COOL CLAMMY SKIN
positive inotropic medications, such as dobutamine (Dobutrex). FVD neuromuscular assessment Correct Answers • Decreased central nervous system activity, from lethargy to coma
- Fever, depending on the amount of fluid loss
- Skeletal muscle weakness FVD Renal assessment Correct Answers decreased urine (OLIGURIA) FVD respiratory assessment Correct Answers • Increased rate and depth of respirations
- Dyspnea FVE cardiovascular assessment Correct Answers • Bounding, increased pulse rate (TACHYCARDIA)
- Elevated blood pressure
- Distended neck and hand veins
- Elevated central venous pressure
- Dysrhythmias FVE gastrointesinal assessment Correct Answers • Increased motility in the gastrointestinal tract
- Diarrhea
- Increased body weight
- Liver enlargement
- Ascites FVE integumentary assessment Correct Answers • Pitting edema in dependent areas
- Pale, cool skin FVE interventions Correct Answers I/O, daily wts, labs, vitals semi fowlers and turn Q2hrs
- Visual disturbances
- Skeletal muscle weakness
- Paresthesias FVE renal assessment Correct Answers • Increased urine output if kidneys can compensate; decreased urine output if kidney damage is the cause FVE respiratory assessment Correct Answers • Increased respiratory rate (shallow respirations)
- Dyspnea
- Moist crackles on auscultation Generally, isotonic dehydration is treated with _____ fluid solutions, hypertonic dehydration with ________ fluid solutions, and hypotonic dehydration with _______ fluid solutions. Correct Answers isotonic hypotonic hypertonic
hco3 Correct Answers 22 - 26 hypercalcemia s/s Correct Answers N,V, constipation polyuria polydipsia flank bones LOC or coma hypotension tetany hypercalcemia treat Correct Answers NS, IV phosphate calcitonin lasix to drop level hyperkalemia s/s Correct Answers parasthesia colic cramps absent p waves ventricular dysrhythmia hyperkalemia treat Correct Answers ekg hemodialysis kayexalate
hyperphosphatemia s/s Correct Answers N,V tachycardia tetany weak calcified lungs, heart, kidney, cornea hyperphosphatemia treat Correct Answers loop diuretic forced diuresis saline dialysis calcitriol (binds phosphorus to gi) hypertonic dehydration Correct Answers fluid loss exceeds electrolyte loss Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces, causing cellular dehydration and shrinkage. hypertonic overhydration Correct Answers rare, and caused from excessive sodium Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.
hypocalcemia s/s Correct Answers numb tingling trousseau ( flex wrist with BP cuff on) chvostek's ( jaw twitch) seizure impaired clotting decreased prothrombin hypocalcemia treat Correct Answers calcium gluconate in D5W vitamin D, greens garden bed rest slow infusion hypokalemia s/s Correct Answers N, V polyuria paresthesias leg cramps decreased BP irregular pulse flat t waves st depression hypokalemia treat Correct Answers diet intake or IV fruit, milk, eggs, meat, potatoes, beans, coffee, tea, cocoa k+ obstruct the bowl ekg TELEMETRY
hypophosphatemia s/s Correct Answers LOC weak parasthesia hypoxia bone infection risk hypophosphatemia treat Correct Answers PREVENTION! diet: vegi, nut, legume, grain, seafood Po levels and TPN watch for calcium calcification if mixed with other electrolytes hypotonic dehydration Correct Answers electrolyte loss exceeds fluid loss Fluid moves from the plasma and interstitial fluid spaces into the cells, causing a plasma volume deficit and causing the cells to swell. hypotonic overhydration Correct Answers also called water intoxication The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
Electrolyte imbalances occur as a result of dilution. isotonic dehydration Correct Answers fluid and elctrolytes are lost equally Isotonic dehydration results in decreased circulating blood volume and inadequate tissue perfusion. most common type of dehydration and also called hypovolemia isotonic overhydration Correct Answers also called (hypervolemia) Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and intracellular compartments. Isotonic overhydration causes circulatory overload and interstitial edema; when severe or when it occurs in a client with poor cardiac function, congestive heart failure and pulmonary edema can result. K+ SPARING DRUGS Correct Answers ACEl- beta blockers (metaproproal end in all) nsaids- break down blood
low BP resp alkalosis Correct Answers < 35 co hypokalemia (diuretics) sodium Correct Answers 135 - 145 who has an increased risk for fluid problems? Correct Answers infants, women, and the elderly.
