Nursing Chapter 10: Fluid and Electrolytes

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Questions and Answers

Which clinical manifestation is specifically associated with hyponatremia?

Flushed skin

Decreased salivation (correct)

Increased blood pressure

Muscle weakness

What is a critical nursing management step before administering IV potassium?

Administer oral potassium supplements

Monitor blood glucose levels

Ensure adequate urine output (correct)

Assess the patient's diet preferences

Which condition could lead to hypernatremia?

Increased perspiration in cold weather

Excessive hydration

Decreased dietary sodium intake

Fluid volume deficit (correct)

What is a common clinical manifestation of hyperkalemia?

Muscle cramps Signup and view all the answers

Which electrolyte imbalance is characterized by ECG changes and muscle cramping?

Hypokalemia Signup and view all the answers

What should be avoided in patients with cerebral edema when administering IV fluids?

Hypotonic fluids Signup and view all the answers

What is a usual cause of fluid volume deficit (FVD)?

Prolonged vomiting Signup and view all the answers

What is a key clinical manifestation of metabolic acidosis?

Low plasma bicarbonate levels less than 22 mEq/L Signup and view all the answers

Which treatment is generally preferred for managing dehydration in patients?

Oral fluids using the patient's preferred beverages Signup and view all the answers

In the context of fluid volume excess, which factor can exacerbate this condition?

Heart failure Signup and view all the answers

What is the most common clinical manifestation of testicular cancer?

Painless lump or mass in the testis Signup and view all the answers

Which condition is characterized by narrowing of the foreskin?

Phimosis Signup and view all the answers

Which of the following symptoms indicates respiratory alkalosis?

pH greater than 7.45 Signup and view all the answers

What is the first nursing intervention for a patient with glomerulonephritis?

Assess fluid and electrolyte balance Signup and view all the answers

Which of the following is a complication associated with continuous bladder irrigation (CBI)?

Obstruction leading to bladder rupture Signup and view all the answers

What can decreased skin turgor and flat neck veins indicate in a clinical setting?

Severe dehydration Signup and view all the answers

Which factor contributes to the increased susceptibility of older adults to kidney injury?

Sclerosis of the glomerulus Signup and view all the answers

What is the most common causative agent of urinary tract infections?

Escherichia coli Signup and view all the answers

What is a key characteristic of stress incontinence?

Leakage due to increased intra-abdominal pressure Signup and view all the answers

Which intervention is NOT recommended for the prevention of urinary tract infections?

Wipe from back to front after using the toilet Signup and view all the answers

What is the correct sequence for assessing a patient who is unresponsive?

Check for pulse, call for help, assess breathing Signup and view all the answers

Which condition is most likely to occur due to urinary retention?

Kidney stones Signup and view all the answers

Which statement correctly differentiates between STEMI and NSTEMI?

STEMI patients show ECG evidence of acute MI with characteristic changes in contiguous leads Signup and view all the answers

What distinguishes Type 1 diabetes from Type 2 diabetes?

It is autoimmune in nature Signup and view all the answers

Which of the following is NOT a common clinical manifestation of an asthma attack?

Pallor Signup and view all the answers

What is a common side effect of Metformin?

Lactic acidosis Signup and view all the answers

What is the primary purpose of a stress test in the context of cardiac assessment?

To identify heart conditions by assessing myocardial demand and associated symptoms Signup and view all the answers

Which symptom is commonly associated with hyperglycemia?

Polyuria Signup and view all the answers

Which nursing intervention is appropriate for managing sinus bradycardia in a symptomatic patient?

Transcutaneous pacing and possible use of atropine Signup and view all the answers

Which of the following statements about aging and renal function is true?

GFR begins to decrease around age 35-40 Signup and view all the answers

What is an indicator of urinary retention in a patient?

Awareness of bladder fullness Signup and view all the answers

Which symptom is NOT associated with hypoglycemia?

Hyperactivity Signup and view all the answers

Which treatment option is appropriate for a patient who is unconscious due to hypoglycemia?

Inject glucagon subcutaneously Signup and view all the answers

What is a characteristic of long-acting insulin?

No peak and lasts 24-72 hours Signup and view all the answers

Which of the following is considered a macrovascular complication of diabetes?

Coronary artery disease Signup and view all the answers

In treating diabetic ketoacidosis (DKA), which is NOT a part of the treatment plan?

Encourage high carbohydrate intake Signup and view all the answers

What clinical manifestation is indicative of atelectasis?

Unilateral chest expansion Signup and view all the answers

What is the primary risk associated with thoracentesis?

Pneumothorax Signup and view all the answers

In a patient with obstructive sleep apnea (OSA), what is a common symptom?

Loud snoring Signup and view all the answers

Which factor does NOT contribute to the development of lung cancer?

Regular exercise Signup and view all the answers

Which precaution is necessary for a patient with suspected tuberculosis?

Placement in a negative pressure room Signup and view all the answers

Study Notes

Fluid and Electrolytes

Sodium normal range: 135-145 mEq/L; imbalances include hyponatremia (low sodium) and hypernatremia (high sodium).
Hyponatremia symptoms: headache, seizures, low blood pressure, nausea, cramping, decreased salivation, dry mucosa, poor skin turgor.
Hypernatremia can occur with normal, fluid volume deficit (FVD), or fluid volume excess (FVE). Symptoms: thirst, increased BP, irritability, edema.
Potassium normal range: 3.5-5 mEq/L; major imbalances include hypokalemia (low potassium) and hyperkalemia (high potassium).
Hypokalemia symptoms: muscle cramping, ECG changes, weakness. Management involves potassium replacement and monitoring.
Hyperkalemia often seen in older adults; symptoms include cardiac dysrhythmias, muscle weakness, GI manifestations.
Administer IV potassium carefully, ensuring adequate urine output to avoid toxicity.
Monitor for signs of fluid deficits and gains in patients, with attention to kidney and skin losses.

Fluid Volume Deficit/Dehydration

FVD occurs when loss of extracellular fluid exceeds water intake; electrolytes lost proportionally.
Causes of FVD: diarrhea, GI suctioning, osmotic diuresis, diabetes insipidus, adrenal insufficiency, hemorrhage.
Symptoms: dry skin, tachycardia, tachypnea, lethargy, oliguria, thirst, potential confusion.
Preferred treatment: oral fluids; IV fluids for severe cases, with isotonic, hypotonic, or hypertonic solutions based on the clinical scenario.
Dehydration differs from FVD; involves water loss alone, typically with elevated serum sodium levels.

Fluid Volume Excess

Caused by fluid overload or impaired homeostasis; related to heart failure, kidney injury, cirrhosis, excessive sodium intake.
Symptoms: edema, distended neck veins, crackles in lungs, low BP, and increased urine output.
Treatments include diuretics, dialysis, and dietary sodium restrictions.

Acid-Base Imbalances

Metabolic Acidosis: pH < 7.35, bicarbonate < 22 mEq/L; may cause hyperkalemia.
Metabolic Alkalosis: pH > 7.45, bicarbonate > 26 mEq/L; hypokalemia leads to this.
Respiratory Acidosis: pH < 7.35, PaCO2 > 45 mm Hg.
Respiratory Alkalosis: pH > 7.45, PaCO2 < 35 mm Hg.
Geriatric patients are at risk for imbalances in fluid and electrolytes.

Male Reproductive Disorders

Phimosis: narrowing of the foreskin; symptoms include purulent drainage, inflammation, and pain. Treatment may involve steroid cream or circumcision.
PDE5 medications (e.g., Sildenafil): contraindicated with nitroglycerin. Taken one hour before intercourse; common side effects include headache and flushing.
Testicular cancer: common in men aged 15-40; self-exams are essential for early detection, with unilateral painless lumps as key symptoms.

Kidney Disorders

Glomerulonephritis: often post-strep infection, leading to proteinuria and renal failure; symptoms include hypertension and edema.
Acute renal failure: classified by prerenal (blood flow), intrarenal (kidney damage), or postrenal (urine flow obstruction).

Urinary Function

Abnormal findings: hematuria, dysuria, proteinuria.
Aging impacts urine concentration and GFR; older adults are more prone to kidney injury due to several physiological changes.
Renal calculi: symptoms include severe pain radiating to the groin and hematuria.
UTIs: Most commonly caused by E. coli; prevention includes proper hygiene and hydration.

Diabetes Management

Type 1: autoimmune destruction of insulin-producing cells; symptoms include polyuria, polydipsia, and potential weight loss.
Type 2: insulin resistance with onset after age 30, often associated with obesity.
Metformin: used for Type 2 diabetes; contraindicated in renal and liver dysfunction.
Hypoglycemia: present with adrenergic and CNS symptoms; treatment involves fast-acting carbohydrates.
Insulin types vary by onset and duration; patient education on monitoring and administration is crucial.
Diabetic complications: include macrovascular and microvascular changes; regular screenings are necessary for prevention.

Upper Respiratory Tract Disorders

URIs are commonly managed with symptomatic care; education on hydration, rest, and symptom management is crucial.
Epistaxis (nosebleeds) management includes head positioning and tissue compression; advice on avoiding certain activities post-bleeding.

Chest and Lower Respiratory Tract Disorders

Tuberculosis: presents with night sweats and cough; requires airborne precautions.
Pneumothorax symptoms include deviated trachea and absent breath sounds; monitored for potential complications.
Bronchoscopy requires monitoring post-procedure for airway patency and complications.

Chronic Pulmonary Disease

Obstructive Sleep Apnea (OSA): characterized by obstructed airflow during sleep; managed with CPAP therapy.
COPD symptoms vary based on type, with emphasis on smoking cessation and monitoring for complications.
Proper care and monitoring for patients with tracheostomies and urinary catheters are essential for preventing complications.### Adventitious Sounds and Respiratory Rate
Adventitious sounds indicate respiratory issues such as gurgling, crackles, or hoarse sounds.
Increased respiratory rate can signal underlying respiratory distress.

Asthma

Clinical manifestations include wheezing, tachypnea, and dyspnea.
Albuterol serves as an inhaled bronchodilator and is a beta-2 adrenergic agonist.

Cardiac Output

Defined as the total blood ejected by one ventricle per minute.
Calculated using stroke volume + heart rate.

Stress Test

Designed to evaluate heart conditions by inducing myocardial demand.
Monitors changes in ECG, vital signs, and assesses patient stability; may need intervention if symptoms arise.

Heart Conduction System

Key components: SA node, AV node, bundle of HIS, left/right bundle branches, Purkinje fibers.
EKG waves indicate electrical activity: P wave (atrial depolarization), QRS (ventricular depolarization), T wave (ventricular repolarization).

Sinus Bradycardia

Characterized by a heart rate of less than 60 bpm with a regular P wave before each QRS.
Management focuses on symptoms; atropine or pacing may be necessary if symptomatic.

Sinus Tachycardia

Defined by a heart rate over 100 bpm.
Symptomatic cases may require synchronized cardioversion or medications like adenosine.

Myocardial Infarction (MI)

Clinical manifestations include worsening angina, substernal chest pain often described as an "elephant on chest."
Differentiated into STEMI (with characteristic ECG changes) and NSTEMI (elevated cardiac biomarkers without significant ECG changes).
Initial treatments include oxygen, nitroglycerin, morphine, and aspirin.

Post-Care for Cardiac Catheterization

Monitor the puncture site for bleeding or hematomas.
Ensure distal circulation; assess pedal pulses post-op.

Coronary Artery Disease (CAD) Risk Factors

Modifiable: hyperlipidemia, smoking, diabetes, hypertension, obesity, inactivity.
Nonmodifiable: age, family history, gender, race, history of pregnancy-associated disorders.

Types of Angina

Stable angina: relieved by rest, typically triggered by exertion.
Unstable angina: unpredictable, can occur at rest or worsen over time.
Variant angina: caused by coronary artery spasm.

Heart Failure

Key manifestations differ by type: Right failure presents with edema and distended neck veins, Left failure shows dyspnea and orthopnea.
Patient education should focus on low sodium diets and daily weight monitoring.

Pulmonary Edema

Clinical signs include pink frothy sputum and crackles in lungs.
Nursing interventions include positioning the patient upright and administering diuretics.

Left Ventricular Assist Device (LVAD)

A mechanical device that supports heart function in severe heart failure patients, serving as a bridge to transplant.

Hypertension

Defined as blood pressure > 130/80; categorized into prehypertension and stages 1 and 2.
Primary hypertension lacks identifiable causes, whereas secondary hypertension relates to identifiable conditions.

Complications of Hypertension

Can lead to severe outcomes like stroke, heart failure, chronic kidney disease, and retinal hemorrhage.

Hypertensive Crisis

Elevated BP > 180/100; divided into Emergency (target organ damage) and Urgency (no immediate evidence of damage).
Emergency management includes IV vasodilators, while Urgency can often be managed with oral medications.

Patient Education on Hypertension

Emphasize understanding the disease, lifestyle changes, and adhering to prescribed medications.
Dietary modifications focus on reducing sodium and fats for better control of BP.

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Description

Explore the critical aspects of fluid and electrolyte balance, focusing on sodium and potassium imbalances. This quiz covers clinical manifestations, treatments, and the differences between hyponatremia and hypernatremia. Perfect for nursing students looking to deepen their understanding of electrolyte management.