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Questions and Answers
What is the normal range for hematocrit in men?
What is the normal range for hematocrit in men?
In a patient with suspected fluid volume deficit, what would you expect to see on a urinalysis?
In a patient with suspected fluid volume deficit, what would you expect to see on a urinalysis?
What is the correct term for fluid volume deficit?
What is the correct term for fluid volume deficit?
Which of the following is NOT a common cause of fluid volume excess (FVE)?
Which of the following is NOT a common cause of fluid volume excess (FVE)?
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What is the expected effect of diuretics on urine specific gravity?
What is the expected effect of diuretics on urine specific gravity?
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Which of the following is NOT a sign or symptom of FVE?
Which of the following is NOT a sign or symptom of FVE?
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Which of the following is NOT a clinical manifestation of fluid volume deficit (FVD)?
Which of the following is NOT a clinical manifestation of fluid volume deficit (FVD)?
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What type of fluid replacement is MOST appropriate for mild to moderate dehydration?
What type of fluid replacement is MOST appropriate for mild to moderate dehydration?
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Which of the following is a common cause of fluid volume deficit (FVD)?
Which of the following is a common cause of fluid volume deficit (FVD)?
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What is the expected effect of FVE on urine specific gravity?
What is the expected effect of FVE on urine specific gravity?
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A patient with an elevated potassium level (hyperkalemia) is being treated with Kayexalate. What is the primary mechanism of action of Kayexalate in this situation?
A patient with an elevated potassium level (hyperkalemia) is being treated with Kayexalate. What is the primary mechanism of action of Kayexalate in this situation?
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Which of the following interventions is NOT typically used to correct hypokalemia?
Which of the following interventions is NOT typically used to correct hypokalemia?
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While assessing a patient with hyponatremia, which of the following is NOT a typical neurological finding?
While assessing a patient with hyponatremia, which of the following is NOT a typical neurological finding?
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A patient presents with signs of dehydration. Which of the following would NOT be a typical nursing intervention?
A patient presents with signs of dehydration. Which of the following would NOT be a typical nursing intervention?
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An elderly patient with a history of urinary incontinence often restricts fluid intake to avoid accidents. What is a major concern related to this behavior?
An elderly patient with a history of urinary incontinence often restricts fluid intake to avoid accidents. What is a major concern related to this behavior?
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A patient with fluid volume deficit (FVD) has a sodium level of 130 mEq/L. What is the most appropriate intravenous fluid therapy?
A patient with fluid volume deficit (FVD) has a sodium level of 130 mEq/L. What is the most appropriate intravenous fluid therapy?
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A patient is admitted with signs of dehydration and a history of diuretic use. Which of the following interventions should be prioritized?
A patient is admitted with signs of dehydration and a history of diuretic use. Which of the following interventions should be prioritized?
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Which of the following is a common challenge in assessing hydration status in elderly patients?
Which of the following is a common challenge in assessing hydration status in elderly patients?
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A patient with a history of heart failure is admitted with hyponatremia. The healthcare provider orders a fluid restriction. Which of the following nursing interventions is MOST important to implement?
A patient with a history of heart failure is admitted with hyponatremia. The healthcare provider orders a fluid restriction. Which of the following nursing interventions is MOST important to implement?
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Which of the following situations would INCREASE the risk of electrolyte imbalances?
Which of the following situations would INCREASE the risk of electrolyte imbalances?
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Study Notes
Fluid & Electrolyte Imbalance
- Total body water is 60% of body weight
- Intracellular water is 40% of body weight
- Extracellular water is 20% of body weight
- Interstitial fluid - 28 liters
- Plasma - 3.5 liters
- Transcellular fluid - 1 liter
- Daily water gain = ~2500 mL
- Daily water loss = ~2500 mL
Fluid Volume Deficit (Hypovolemia, Isotonic Dehydration)
- Common causes: Hemorrhage, vomiting, diarrhea, burns, diuretic therapy, fever, impaired thirst
- Clinical manifestations: Weight loss, thirst, orthostatic changes in pulse rate and blood pressure, weak rapid pulse, decreased urine output, dry mucous membranes, poor skin turgor
- Orthostatic hypotension: blood pressure drop over 20 mm Hg systolic or 10 mg Hg diastolic when moving from sitting to standing position
- Lab findings: Increased HGB, HCT, urine specific gravity, BUN, and creatinine
Fluid Volume Excess (FVE)
- Common causes: Congestive heart failure, early renal failure, IV therapy, excessive sodium ingestion, SIADH, Corticosteroid use
- Clinical manifestations: Increased blood pressure, edema, weight gain, bounding pulse, venous distention, pulmonary edema, dyspnea, orthopnea, crackles
- Lab findings: Decreased HGB, HCT, and urine specific gravity
Urine Specific Gravity
- Normal range: 1.002 - 1.030
- High specific gravity (>1.030) indicates dehydration.
- Low specific gravity (<1.002) suggests kidney's inability to concentrate urine, often associated with fluid volume excess.
Treatment Fluid Volume Deficit (FVD)
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Fluid Management:
- Mild to moderate dehydration: Correct by oral fluid replacement
- Oral rehydration therapy: Solutions containing glucose and electrolytes (e.g., Pedialyte)
- IV therapy: Type of fluid depends on the type of dehydration and the client's cardiovascular status
Treatment Fluid Volume Excess (FVE)
- Drug therapy: Diuretics (if renal failure is not the cause)
- Restriction of sodium and saline intake
- Strict I/O
- May restrict PO fluids
- Daily weight monitoring
More to Consider
- Age (infants, older adults)
- Prior medical history (acute, chronic illnesses)
- Environmental factors (diet, lifestyle, medications)
Physical Assessment
- Body systems assessment
- I&O monitoring
- Weight monitoring
- Lab values
Gerontological Considerations
- The elderly are more sensitive to fluid volume changes.
- Skin turgor is less reliable in elderly patients.
- Elderly patients may restrict fluid intake to prevent incontinence.
- Fluid loss needs to be replaced more slowly and cautiously in the elderly.
Electrolyte Imbalance
Potassium
- Regulates muscle contraction, especially the heart
- Normal levels: 3.5-5.2 mEq/L in adults
Hypokalemia (<3.5 mEq/L)
- Pathophysiology: Decrease in potassium causes decreased cell excitability and responsiveness to normal stimuli.
- Contributing Factors: Diuretics, shift into cells, digoxin, water intoxication, corticosteroids, diarrhea, vomiting
- Clinical manifestations: Shallow respirations, irritability, confusion, weakness, arrhythmias, lethargy, thready pulse, decreased intestinal motility
Hyperkalemia (>5.2 mEq/L)
- Pathophysiology: Increased potassium causes increased cell excitability.
- Contributing factors: Increase in K+ intake, renal failure, K+ sparing diuretics, shift of K+ out of cells
- Clinical manifestations: Muscle cramps, weakness leading to paralysis, drowsiness, EKG changes, dysrhythmias, abdominal cramping, diarrhea, oliguria
Hypocalcemia (<9 mg/dL)
- Contributing factors: Decreased oral intake, lactose intolerance, decreased vitamin D intake, end-stage renal disease, diarrhea, acute pancreatitis, hyperphosphatemia, immobility, removal or destruction of parathyroid gland
- Clinical Manifestations/Assessment findings: Irritable muscle twitches, positive Trousseau's sign, positive Chvostek's sign, respiratory failure due to muscle tetany, decreased heart rate, decreased blood pressure, diminished peripheral pulse, increased motility, increased bowel sounds, diarrhea
- Interventions/Treatment: Calcium supplements, vitamin D, high calcium diet, and seizure precautions.
Hypercalcemia (>10.5 mg/dL)
- Contributing factors: Excessive calcium intake, excessive vitamin D intake, renal failure, hyperparathyroidism, malignancy, hyperthyroidism
- Clinical Manifestations/Assessment findings: Disorientation, lethargy, coma, profound muscle weakness, ineffective respiratory movement, increased heart rate, increased blood pressure, bounding peripheral pulses, positive Homan's sign, decreased motility, decreased bowel sounds, constipation, increased urine output, formation of renal calculi
- Interventions/Treatment: Eliminate calcium administration, isotonic NaCl (increase excretion of calcium), diuretics, calcium reabsorption inhibitors (phosphorus), cardiac monitoring
Hypomagnesemia (<1.4 mEq/L)
- Contributing factors: Malnutrition, starvation, diuretics, aminoglycoside antibiotics, hyperglycemia, insulin administration
- Clinical findings: Positive Trousseau's sign, positive Chvostek's sign, hyperreflexia, seizures, ECG changes, dysrhythmias, high blood pressure, shallow breathing, decreased motility, anorexia, nausea
- Interventions: Eliminate contributing drugs, IV magnesium sulfate, assess Deep Tendon Reflexes (DTRs) hourly with magnesium sulfate, diet therapy
Hypermagnesemia (>2.0 mEq/L)
- Contributing factors: Increased magnesium intake, decreased renal excretion
- Clinical findings: Reduced or weak deep tendon reflexes (DTRs), weak voluntary muscle contractions, drowsiness, bradycardia, peripheral vasodilation, hypotension, ECG changes
- Interventions: Eliminate contributing drugs, administer diuretics, calcium gluconate to reverse cardiac effects, diet restrictions
Sodium (Na)
- Normal levels: 135-145 mEq/L
Hyponatremia (<135 mEq/L)
- Contributing factors: Excessive diaphoresis, wound drainage, NPO status, CHF, low salt diet, renal disease, diuretics
- Clinical findings: Generalized skeletal muscle weakness, headache, personality changes, shallow respirations, cardiac changes (depending on fluid volume), increased gastrointestinal motility, nausea, explosive diarrhea, increased urine output
- Interventions/Treatment: Restore Na levels to normal, increase oral sodium intake, restrict oral fluid intake, dont correct too quickly (12 mEq in 24 hours). If excess fluid, restrict fluids.
Hypernatremia (>145 mEq/L)
- Contributing factors: Hyperaldosteronism, renal failure, corticosteroids, increase in oral Na intake, Na containing IV fluids, decreased urine output with increased urine concentration, diarrhea, dehydration, fever, hyperventilation.
- Clinical findings: Spontaneous muscle twitches, irregular contractions, skeletal muscle weakness, diminished deep tendon reflexes, pulmonary edema, heart rate and blood pressure depending on vascular volume, dry flaky skin, edema related to fluid volume changes, Decreased urine output, Increased urine specific gravity
- Interventions/Treatment: Fluid volume deficit (FVD): .45% NSS. if caused by both Na and fluid loss: administer NaCl, if inadequate renal excretion of sodium, administer diuretics. Mild: Ensure water intake.
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Description
Test your knowledge on fluid and electrolyte imbalances, including causes, symptoms, and clinical manifestations. This quiz covers key concepts like hypovolemia and fluid volume excess, which are critical for medical professionals. Assess your understanding of body fluid composition and related lab findings.
