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Questions and Answers
What does a high central venous pressure (CVP) typically indicate?
What does a high central venous pressure (CVP) typically indicate?
Which of the following lab values would most likely increase due to fluid volume excess?
Which of the following lab values would most likely increase due to fluid volume excess?
What are common manifestations of fluid volume excess?
What are common manifestations of fluid volume excess?
What percentage of body fluid is typically found in intracellular compartments?
What percentage of body fluid is typically found in intracellular compartments?
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Which diuretics are typically utilized for treating fluid volume excess?
Which diuretics are typically utilized for treating fluid volume excess?
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What physiological response is primarily triggered by increased serum osmolality?
What physiological response is primarily triggered by increased serum osmolality?
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Which of the following is NOT an assessment for fluid volume excess?
Which of the following is NOT an assessment for fluid volume excess?
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What condition could potentially lead to fluid volume excess?
What condition could potentially lead to fluid volume excess?
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How does fluid volume deficit manifest in patients?
How does fluid volume deficit manifest in patients?
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Which clinical sign is most indicative of fluid overload?
Which clinical sign is most indicative of fluid overload?
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Which of the following conditions can lead to a fluid volume deficit?
Which of the following conditions can lead to a fluid volume deficit?
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What is the significance of monitoring BUN in patients with fluid volume excess?
What is the significance of monitoring BUN in patients with fluid volume excess?
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What does the term 'third spacing' refer to in the context of fluid volume deficit?
What does the term 'third spacing' refer to in the context of fluid volume deficit?
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Which hormone is responsible for retaining fluid during a deficit?
Which hormone is responsible for retaining fluid during a deficit?
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Which of the following conditions is characterized by excessive water retention?
Which of the following conditions is characterized by excessive water retention?
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Which of the following findings is unlikely to be observed in a patient with significant fluid volume deficit?
Which of the following findings is unlikely to be observed in a patient with significant fluid volume deficit?
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What is a possible consequence of administering excessive fluids in patients with heart failure?
What is a possible consequence of administering excessive fluids in patients with heart failure?
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How should daily weights be managed in patients with fluid volume deficit?
How should daily weights be managed in patients with fluid volume deficit?
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Which of the following is a common cause of fluid volume deficit related to gastrointestinal issues?
Which of the following is a common cause of fluid volume deficit related to gastrointestinal issues?
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What is a critical assessment component when managing a patient with fluid volume deficit?
What is a critical assessment component when managing a patient with fluid volume deficit?
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What is the main characteristic of isotonic IV fluids?
What is the main characteristic of isotonic IV fluids?
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Which condition is NOT a potential cause of hyponatremia?
Which condition is NOT a potential cause of hyponatremia?
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What is the recommended action when administering hypotonic fluids?
What is the recommended action when administering hypotonic fluids?
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Which of the following does NOT typically manifest with hypokalemia?
Which of the following does NOT typically manifest with hypokalemia?
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What laboratory assessment is crucial for monitoring potassium replacement therapy?
What laboratory assessment is crucial for monitoring potassium replacement therapy?
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What clinical manifestation might indicate a severe case of hyponatremia?
What clinical manifestation might indicate a severe case of hyponatremia?
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Which of the following fluids is hypertonic?
Which of the following fluids is hypertonic?
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What is a potential risk associated with IV potassium replacement?
What is a potential risk associated with IV potassium replacement?
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What response indicates a possible diagnosis of hypokalemia?
What response indicates a possible diagnosis of hypokalemia?
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Which electrolyte imbalance would primarily cause excess thirst as a symptom?
Which electrolyte imbalance would primarily cause excess thirst as a symptom?
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Which of the following manifestations is associated with hyperkalemia?
Which of the following manifestations is associated with hyperkalemia?
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What is the primary risk of administering potassium-sparing diuretics?
What is the primary risk of administering potassium-sparing diuretics?
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Which condition is a common cause of hypomagnesemia?
Which condition is a common cause of hypomagnesemia?
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What emergency treatment is indicated for hypocalcemia?
What emergency treatment is indicated for hypocalcemia?
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Which of the following is a hallmark sign of hypomagnesemia?
Which of the following is a hallmark sign of hypomagnesemia?
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In cases of hypermagnesemia, what is a typical clinical manifestation?
In cases of hypermagnesemia, what is a typical clinical manifestation?
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What dietary intervention should be emphasized for a patient with hypocalcemia?
What dietary intervention should be emphasized for a patient with hypocalcemia?
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Which of the following treatments is appropriate for managing hypercalcemia?
Which of the following treatments is appropriate for managing hypercalcemia?
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Which ECG change is associated with elevated potassium levels?
Which ECG change is associated with elevated potassium levels?
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For a patient experiencing muscle spasms due to hypocalcemia, which sign is likely to be positive?
For a patient experiencing muscle spasms due to hypocalcemia, which sign is likely to be positive?
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Study Notes
Disrupted Homeostasis (Fluid and Electrolytes)
- This chapter focuses on disruptions in fluid and electrolyte balance.
Body Fluid Compartments
- Extracellular fluid (outside cells):
- Plasma (5% of body weight), also called intravascular fluid
- Interstitial fluid (15% of body weight), located between cells
- Total extracellular fluid accounts for 60% of body weight
- Intracellular fluid (inside cells):
- Accounts for 40% of body weight
- Represents 2/3 of total body fluid
Fluid Regulation
-
Osmolality (serum concentration of solutes):
- Indicates water balance
- Normal range is <275 mOsm/kg for water excess, ~275 mOsm/kg for balance
- Higher values indicate greater water-pulling power.
-
Regulation mechanisms:
- Thirst: triggered by increased serum osmolality or decreased blood volume
- Kidneys: Renin-Angiotensin-Aldosterone System (RAAS) and Antidiuretic Hormone (ADH) to regulate water and sodium reabsorption.
Fluid Volume Deficit
-
Causes:
- Vomiting and diarrhea
- GI suctioning and intestinal fistulas
- Diuretics
- Renal disorders
- Endocrine disorders
- Burns
- Hemorrhage
- Hot environments
-
Manifestations:
- Weight loss
- Thirst
- Concentrated urine
- Low urine volume
- Dry skin and diminished skin turgor
- Sunken eyeballs
- Sunken or depressed fontanels
- Hypotension
- Decreased cardiac output
- Tachypnea (rapid breathing)
- Low-grade fever
- Mental status changes.
Fluid Volume Excess
-
Causes:
- Heart or renal failure
- Cirrhosis
- Adrenal gland disorders
- Corticosteroids
- Stress conditions
- Excessive sodium intake
- Medications (side effects)
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
-
Manifestations:
- Peripheral edema
- High CVP (central venous pressure)
- Pulmonary edema
- Acute rapid weight gain
- Altered urine output/concentration
- Distended neck veins
- Crackles
- Tachycardia
- Shortness of breath
- Wheezing
Types of IV Fluids
- Isotonic: (e.g. 0.9% NaCl, Lactated Ringers (LR))
- Fluid does not shift between compartments – “fills the tank evenly”.
- Hypotonic: (e.g. 0.45% NaCl)
- Moves fluid from intravascular and interstitial spaces into cells
- Hypertonic: (e.g. D5NS, D5LR, D10, D50, 3% and 5% NaCl, albumin)
- Moves fluid from cells to intravascular space
Sodium Disorders
-
Hyponatremia (Na+ < 135 mEq/L):
- Causes: Water gain or sodium loss
- Manifestations: Osmolality changes, muscle cramps, weakness, HA, irritability, neurological changes, seizures, N/V, hypotension, shock
- Medical Interventions: Fluid replacement, sodium replacement (hypertonic solutions), treat underlying cause
- Nursing Interventions: Monitoring sodium levels, safety precautions (confusion), administering hypertonic solutions, monitoring neurological status, monitor pulmonary edema, monitor urine output.
-
Hypernatremia (Na+ > 145 mEq/L):
- Causes: Excess water loss, diabetes insipidus, osmotic diuretic, excess sodium intake
- Manifestations: Dry, swollen tongue, sticky mucosa, oliguria, lightheadedness, weakness, seizures, coma, irritability, altered LOC
- Medical Interventions: Labs, sodium, osmolality, oral rehydration, hypotonic solution
- Nursing Interventions: Assess mental/neuro status, encourage fluids, H2O via tube feeding, administer hypotonic fluids slowly, sodium restriction, teach about low sodium foods.
Potassium Disorders
-
Hypokalemia (K+ < 3.5 mEq/L)
- Causes: GI loss, medications, metabolic alkalosis, sweating
- Manifestations: Muscle weakness, nausea, vomiting, abdominal distension, muscle cramps, impaired renal function, constipation, ECG changes.
- Medical Interventions: Potassium replacement (IV or PO), higher acuity setting for IV potassium replacement, eliminate cause
- Nursing Interventions: Cardiac monitoring, Analyze ABGs, Potassium replacement therapy, monitor IV site, monitor kidney function
-
Hyperkalemia (K+ > 5.3 mEq/L)
- Causes: Metabolic acidosis, potassium-sparing diuretics, type I diabetes
- Manifestations: ECG changes, chest pain, palpitations, muscle weakness, muscle cramping, diarrhea, anxiety or jitters, paresthesia, GI manifestations
- Medical Interventions: Serial serum potassium, Kayexalate/diuretics, calcium gluconate, limit potassium, IV dextrose+insulin, dialysis
- Nursing Interventions: Monitor ECGs, monitoring medications, educating on foods high in potassium
Magnesium Disorders
-
Hypomagnesemia (Mg < 1.8 mg/dL):
- Causes: Alcoholism, decreased absorption, medications
- Manifestations: Neurological excitability, Chvostek’s sign, Trousseau’s sign, seizures, hypertension, tachycardia, dysrhythmias, personality changes
- Medical Interventions: MgSO4 IV, oral magnesium, diet (increase magnesium intake)
- Nursing Interventions: Assessment of neuro, respiratory, cardiovascular status, monitor labs, ensure patient safety, IV site care, patient education
-
Hypermagnesemia (Mg > 3.0 mg/dL):
- Causes: Excessive use of laxatives/antacids, renal failure, decreased renal function.
- Manifestations: Lethargy, drowsiness, confusion, dizziness, decreased DTRs and decreased respiration, dysrhythmias
- Medical Interventions: IV Calcium chloride, IV calcium gluconate, loop diuretics, isotonic fluids, hemodialysis
- Nursing Interventions: Assessment of DTRs, respiratory rate, patient safety, teaching foods/medications high in magnesium
Calcium Disorders
-
Hypocalcemia (Ca < 9 mg/dL):
- Causes: Hypoparathyroidism, osteoporosis, kidney failure, bariatric surgery, malabsorption
- Manifestations: Tetany, Seizures, circumoral numbness, muscle spasms, Chvostek’s sign, Trousseau’s sign, increased DTRs, dysrhythmias
- Medical Interventions: IV calcium chloride, calcium gluconate, oral calcium/vitamin D, Calcium level labs, magnesium, phosphorus, vitamin D
- Nursing Interventions: Assessment, medication administration, patient education (weight-bearing exercises, foods high in calcium).
-
Hypercalcemia (Ca > 11 mg/dL):
- Causes: Hyperparathyroidism, malignancies, lack of weight bearing, immobilization, renal failure, excess vitamin D, medications, hypophosphatemia.
- Manifestations: Muscle weakness, fatigue, GI manifestations, decreased muscle tone, dysrhythmias, bone pain, kidney stones, depression
- Medical Interventions: Phosphates, biphosphates, calcitonin, labs (ionized calcium), Isotonic solution, check current meds
- Nursing Interventions: Assessment, encourage ambulation, increased fluids/UO monitoring, teaching about fiber, dietary limitations
Other Important Information
- Chest X-ray: Used to assess for pulmonary congestion and treatment effectiveness (daily comparisons).
- Other tests: Echocardiogram, ECG, CBC, electrolytes, LFT, ABGs.
- Assessment: Vital signs (VS), especially peripheral pulse, peripheral volume, CVP, and signs/symptoms; hydration status; mental status, and overall care to identify fluctuations, hydration status, and fluid imbalances
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Description
This quiz explores the concepts of fluid and electrolyte balance, focusing on disruptions that can occur in homeostasis. It covers body fluid compartments and the regulatory mechanisms that maintain osmolality. Test your knowledge on how these systems work together to ensure proper hydration and electrolyte levels.
