Podcast
Questions and Answers
What is the primary mechanism by which the body controls water balance?
What is the primary mechanism by which the body controls water balance?
- Regulation of sodium excretion by the kidneys.
- Release of antidiuretic hormone (ADH) in response to pressure changes in the vascular system. (correct)
- Osmosis and diffusion across cell membranes.
- Thirst sensation triggered by decreased blood volume.
A patient with liver cirrhosis develops ascites. Which mechanism explains the fluid shift?
A patient with liver cirrhosis develops ascites. Which mechanism explains the fluid shift?
- Decreased osmotic pressure in the interstitial fluid.
- Increased osmotic pressure in the interstitial fluid. (correct)
- Decreased hydrostatic pressure in the capillaries.
- Increased hydrostatic pressure in the capillaries.
Which patient is at highest risk of developing dehydration?
Which patient is at highest risk of developing dehydration?
- A 45-year-old adult taking a potassium-sparing diuretic.
- A 6-month-old infant with diarrhea. (correct)
- An 80-year-old adult with heart failure on a fluid restriction.
- A 25-year-old athlete training for a marathon.
An older adult is admitted with dehydration. What is the most reliable indicator for assessing fluid loss?
An older adult is admitted with dehydration. What is the most reliable indicator for assessing fluid loss?
Which nursing intervention is most important for a patient with dehydration?
Which nursing intervention is most important for a patient with dehydration?
A patient receiving IV furosemide for fluid overload should be monitored for which electrolyte imbalance?
A patient receiving IV furosemide for fluid overload should be monitored for which electrolyte imbalance?
Which food should a nurse recommend to a patient who needs to increase their potassium intake?
Which food should a nurse recommend to a patient who needs to increase their potassium intake?
What is the expected outcome for a care plan addressing deficient fluid volume?
What is the expected outcome for a care plan addressing deficient fluid volume?
A patient with fluid excess is placed on a 1000 mL fluid restriction per day. How should the nurse implement this?
A patient with fluid excess is placed on a 1000 mL fluid restriction per day. How should the nurse implement this?
A patient with a history of heart failure is admitted with hypervolemia. Which assessment finding is most concerning?
A patient with a history of heart failure is admitted with hypervolemia. Which assessment finding is most concerning?
What dietary education should a nurse provide to a patient with fluid excess and a sodium restriction?
What dietary education should a nurse provide to a patient with fluid excess and a sodium restriction?
A nurse is caring for a patient with hyponatremia. What neurological assessment is most important?
A nurse is caring for a patient with hyponatremia. What neurological assessment is most important?
A patient with hypernatremia is likely to exhibit which of the following?
A patient with hypernatremia is likely to exhibit which of the following?
Which condition can cause hyperkalemia?
Which condition can cause hyperkalemia?
A nurse is administering IV potassium to a patient with hypokalemia. What precaution is most important?
A nurse is administering IV potassium to a patient with hypokalemia. What precaution is most important?
A patient with hypokalemia is also diagnosed with metabolic alkalosis. Which statement explains this?
A patient with hypokalemia is also diagnosed with metabolic alkalosis. Which statement explains this?
Which electrolyte imbalance can result from total thyroidectomy?
Which electrolyte imbalance can result from total thyroidectomy?
When assessing a patient for Chvostek's sign, the nurse should:
When assessing a patient for Chvostek's sign, the nurse should:
A patient with chronic kidney disease is at risk for hypocalcemia due to:
A patient with chronic kidney disease is at risk for hypocalcemia due to:
What patient education should the nurse provide to increase calcium absorption?
What patient education should the nurse provide to increase calcium absorption?
Which sign or symptom is associated with hypercalcemia?
Which sign or symptom is associated with hypercalcemia?
A patient with hypercalcemia also takes digoxin (Lanoxin). Why should the nurse closely monitor this patient
A patient with hypercalcemia also takes digoxin (Lanoxin). Why should the nurse closely monitor this patient
Which of the following is a common cause of hypomagnesemia?
Which of the following is a common cause of hypomagnesemia?
A patient with chronic kidney disease is at risk for hypermagnesemia due to:
A patient with chronic kidney disease is at risk for hypermagnesemia due to:
What is the best definition of an acid?
What is the best definition of an acid?
How do the lungs compensate for metabolic acidosis?
How do the lungs compensate for metabolic acidosis?
Which arterial blood gas (ABG) value indicates acidosis?
Which arterial blood gas (ABG) value indicates acidosis?
A patient with chronic obstructive pulmonary disease (COPD) is likely to develop which acid-base imbalance?
A patient with chronic obstructive pulmonary disease (COPD) is likely to develop which acid-base imbalance?
A patient experiencing hyperventilation and anxiety is at risk for which acid-base imbalance?
A patient experiencing hyperventilation and anxiety is at risk for which acid-base imbalance?
A patient is admitted with severe diarrhea. Arterial blood gases reveal a pH of 7.25, HCO3- of 18 mEq/L, and PaCO2 of 36 mm Hg. Which acid-base imbalance is present?
A patient is admitted with severe diarrhea. Arterial blood gases reveal a pH of 7.25, HCO3- of 18 mEq/L, and PaCO2 of 36 mm Hg. Which acid-base imbalance is present?
A young adult is found unconscious after overdosing on diazepam (Valium). Respiratory rate is shallow at 8/minute. Which acid-base imbalance should the nurse anticipate?
A young adult is found unconscious after overdosing on diazepam (Valium). Respiratory rate is shallow at 8/minute. Which acid-base imbalance should the nurse anticipate?
A construction worker is evaluated in the ER for heatstroke after profuse sweating caused him to become confused. Which imbalance is most likely causing the change in mental status?
A construction worker is evaluated in the ER for heatstroke after profuse sweating caused him to become confused. Which imbalance is most likely causing the change in mental status?
A 56-year-old is taking furosemide to lower her blood pressure. She reports muscle weakness and cramping. Which nursing action will address this?
A 56-year-old is taking furosemide to lower her blood pressure. She reports muscle weakness and cramping. Which nursing action will address this?
An elderly client experiencing constant diarrhea for three days is prescribed an IV solution containing potassium. Before initiating this treatment, the nurse's highest priority intervention should be:
An elderly client experiencing constant diarrhea for three days is prescribed an IV solution containing potassium. Before initiating this treatment, the nurse's highest priority intervention should be:
A client is diagnosed with a serum calcium level of 7.9 mg/dL, indicative of hypocalcemia. An appropriate nursing intervention would be to monitor for:
A client is diagnosed with a serum calcium level of 7.9 mg/dL, indicative of hypocalcemia. An appropriate nursing intervention would be to monitor for:
Following a thyroidectomy, a client reports numbness and tingling around the mouth. Which of the interventions is the priority:
Following a thyroidectomy, a client reports numbness and tingling around the mouth. Which of the interventions is the priority:
A 50-year-old male client with a history of alcohol abuse is admitted for malnutrition. On the third hospital day, he exhibits muscle tremors, confusion, and a positive Chvostek's sign. The nurse should suspect:
A 50-year-old male client with a history of alcohol abuse is admitted for malnutrition. On the third hospital day, he exhibits muscle tremors, confusion, and a positive Chvostek's sign. The nurse should suspect:
A client with end-stage renal disease is receiving hemodialysis. The nurse recognizes that this treatment is essential in managing which acid-base imbalance?
A client with end-stage renal disease is receiving hemodialysis. The nurse recognizes that this treatment is essential in managing which acid-base imbalance?
A client is diagnosed with metabolic alkalosis due to prolonged vomiting. The nurse anticipates which of the following interventions to correct the acid-base imbalance?
A client is diagnosed with metabolic alkalosis due to prolonged vomiting. The nurse anticipates which of the following interventions to correct the acid-base imbalance?
Which of the following accurately describes the role of antidiuretic hormone (ADH) in fluid balance?
Which of the following accurately describes the role of antidiuretic hormone (ADH) in fluid balance?
A patient is prescribed an intravenous (IV) solution that has the same osmolarity as blood. What type of solution is this?
A patient is prescribed an intravenous (IV) solution that has the same osmolarity as blood. What type of solution is this?
An adult patient reports experiencing increased thirst. Based on the information provided, which of the following physiological processes is most likely occurring?
An adult patient reports experiencing increased thirst. Based on the information provided, which of the following physiological processes is most likely occurring?
Which of the following findings would the nurse expect to observe in a patient experiencing fluid volume deficit (FVD)?
Which of the following findings would the nurse expect to observe in a patient experiencing fluid volume deficit (FVD)?
A patient with dehydration has an elevated blood urea nitrogen (BUN) level and elevated hematocrit. What is the underlying cause for these laboratory findings?
A patient with dehydration has an elevated blood urea nitrogen (BUN) level and elevated hematocrit. What is the underlying cause for these laboratory findings?
The nurse is caring for a patient with moderate dehydration. What type of intravenous (IV) fluids are typically administered?
The nurse is caring for a patient with moderate dehydration. What type of intravenous (IV) fluids are typically administered?
The nurse is caring for a patient with a 1000 mL fluid restriction. Which intervention is appropriate for distributing the patient's fluid intake throughout the day?
The nurse is caring for a patient with a 1000 mL fluid restriction. Which intervention is appropriate for distributing the patient's fluid intake throughout the day?
A patient is admitted with fluid volume excess. Which of the following is a priority nursing intervention?
A patient is admitted with fluid volume excess. Which of the following is a priority nursing intervention?
Which assessment finding indicates a patient is experiencing severe fluid volume excess?
Which assessment finding indicates a patient is experiencing severe fluid volume excess?
A patient with fluid excess is prescribed a diuretic medication. What electrolyte imbalance should the nurse monitor for?
A patient with fluid excess is prescribed a diuretic medication. What electrolyte imbalance should the nurse monitor for?
A patient is diagnosed with hyponatremia. The nurse understands that this electrolyte imbalance is characterized by which of the following?
A patient is diagnosed with hyponatremia. The nurse understands that this electrolyte imbalance is characterized by which of the following?
The nurse is caring for a patient with hyponatremia. Which neurological assessment is most important?
The nurse is caring for a patient with hyponatremia. Which neurological assessment is most important?
A patient with a serum sodium level of 152 mEq/L is exhibiting signs of agitation and confusion. What electrolyte imbalance is most likely present?
A patient with a serum sodium level of 152 mEq/L is exhibiting signs of agitation and confusion. What electrolyte imbalance is most likely present?
The nurse is caring for a patient with hypernatremia secondary to dehydration. Which intervention is appropriate?
The nurse is caring for a patient with hypernatremia secondary to dehydration. Which intervention is appropriate?
A patient with hypokalemia is receiving intravenous potassium supplementation. Which nursing action is necessary?
A patient with hypokalemia is receiving intravenous potassium supplementation. Which nursing action is necessary?
A patient taking furosemide reports muscle weakness and cramping. The nurse anticipates the need for which electrolyte supplement?
A patient taking furosemide reports muscle weakness and cramping. The nurse anticipates the need for which electrolyte supplement?
Which of the following assessment findings indicates hyperkalemia?
Which of the following assessment findings indicates hyperkalemia?
A patient with chronic kidney disease is prescribed sodium polystyrene sulfonate for hyperkalemia. What is the desired outcome of this medication?
A patient with chronic kidney disease is prescribed sodium polystyrene sulfonate for hyperkalemia. What is the desired outcome of this medication?
A postmenopausal woman is at risk for hypocalcemia. Which mechanism explains this risk?
A postmenopausal woman is at risk for hypocalcemia. Which mechanism explains this risk?
What is the recommended daily calcium intake for women over the age of 50?
What is the recommended daily calcium intake for women over the age of 50?
The nurse inflates a blood pressure cuff on a patient's arm and observes carpal spasm. This indicates a positive result for which electrolyte imbalance?
The nurse inflates a blood pressure cuff on a patient's arm and observes carpal spasm. This indicates a positive result for which electrolyte imbalance?
Following a thyroidectomy, a patient develops a sudden laryngospasm. The nurse suspects which electrolyte imbalance?
Following a thyroidectomy, a patient develops a sudden laryngospasm. The nurse suspects which electrolyte imbalance?
A patient with kidney failure is prescribed aluminum hydroxide. What is the intended effect of this medication related to calcium balance?
A patient with kidney failure is prescribed aluminum hydroxide. What is the intended effect of this medication related to calcium balance?
The nurse is providing dietary teaching for a patient with hypocalcemia. Which food is the best source of calcium?
The nurse is providing dietary teaching for a patient with hypocalcemia. Which food is the best source of calcium?
A patient with heart failure is experiencing hypercalcemia. What cardiovascular manifestation should the nurse monitor for?
A patient with heart failure is experiencing hypercalcemia. What cardiovascular manifestation should the nurse monitor for?
The nurse is caring for a patient with hypercalcemia. Which treatment is used to promote calcium excretion?
The nurse is caring for a patient with hypercalcemia. Which treatment is used to promote calcium excretion?
A patient with chronic alcoholism is admitted with hypomagnesemia. Which of the following contributes to this electrolyte imbalance?
A patient with chronic alcoholism is admitted with hypomagnesemia. Which of the following contributes to this electrolyte imbalance?
The nurse is caring for a patient with hypomagnesemia. What assessment findings would the nurse expect to find?
The nurse is caring for a patient with hypomagnesemia. What assessment findings would the nurse expect to find?
A patient with kidney failure is at risk for hypermagnesemia. Which physiological factor contributes to this risk?
A patient with kidney failure is at risk for hypermagnesemia. Which physiological factor contributes to this risk?
A patient's arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 50 mm Hg, and HCO3- of 24 mEq/L. What acid-base imbalance is present?
A patient's arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 50 mm Hg, and HCO3- of 24 mEq/L. What acid-base imbalance is present?
A patient experiencing hyperventilation has a decreased PaCO2 level. What acid-base imbalance is the patient at risk for?
A patient experiencing hyperventilation has a decreased PaCO2 level. What acid-base imbalance is the patient at risk for?
The body has several ways in which it compensates for changes in the serum pH. Which mechanism is the slowest to respond?
The body has several ways in which it compensates for changes in the serum pH. Which mechanism is the slowest to respond?
A patient with uncontrolled diabetes mellitus is likely to develop which acid-base imbalance?
A patient with uncontrolled diabetes mellitus is likely to develop which acid-base imbalance?
A patient is admitted with prolonged vomiting. The nurse monitors for which acid-base imbalance?
A patient is admitted with prolonged vomiting. The nurse monitors for which acid-base imbalance?
Which of the following arterial blood gas (ABG) values indicates alkalosis:
Which of the following arterial blood gas (ABG) values indicates alkalosis:
A COPD patient with chronic hypercapnia is admitted. What acid-base imbalance is likely to develop?
A COPD patient with chronic hypercapnia is admitted. What acid-base imbalance is likely to develop?
A patient taking thiazide diuretics reports muscle cramping. Which food provides the best source of potassium to recommend?
A patient taking thiazide diuretics reports muscle cramping. Which food provides the best source of potassium to recommend?
A patient with a serum calcium level of 12 mg/dL is at risk for:
A patient with a serum calcium level of 12 mg/dL is at risk for:
A patient with end-stage renal disease is at risk for developing:
A patient with end-stage renal disease is at risk for developing:
A patient is found unresponsive. The nurse reviews the medication list and finds that the patient takes spironolactone daily. The nurse should assess for:
A patient is found unresponsive. The nurse reviews the medication list and finds that the patient takes spironolactone daily. The nurse should assess for:
A patient exhibits confusion, muscle tremors, and a positive Chvostek's sign. Based on these findings, the nurse should suspect:
A patient exhibits confusion, muscle tremors, and a positive Chvostek's sign. Based on these findings, the nurse should suspect:
Which dietary modification is appropriate for a patient experiencing fluid excess and placed on a sodium restriction?
Which dietary modification is appropriate for a patient experiencing fluid excess and placed on a sodium restriction?
Which physiological process relies on a pressure difference to move fluid and smaller molecules across a semipermeable membrane?
Which physiological process relies on a pressure difference to move fluid and smaller molecules across a semipermeable membrane?
Why are older adults more susceptible to dehydration compared to younger adults?
Why are older adults more susceptible to dehydration compared to younger adults?
What observation is the most reliable indicator of fluid loss or gain?
What observation is the most reliable indicator of fluid loss or gain?
A patient with heart failure is prescribed a sodium-restricted diet. Which food should the patient most avoid?
A patient with heart failure is prescribed a sodium-restricted diet. Which food should the patient most avoid?
A patient is receiving IV furosemide for fluid overload. What electrolyte imbalance is the most important for the nurse to monitor during this treatment?
A patient is receiving IV furosemide for fluid overload. What electrolyte imbalance is the most important for the nurse to monitor during this treatment?
The nurse is caring for a patient receiving IV fluids. Which assessment finding is the earliest indicator of fluid volume excess?
The nurse is caring for a patient receiving IV fluids. Which assessment finding is the earliest indicator of fluid volume excess?
A patient with a history of heart failure is admitted with shortness of breath and edema. Which nursing intervention is most appropriate?
A patient with a history of heart failure is admitted with shortness of breath and edema. Which nursing intervention is most appropriate?
What physiological change occurs in the body in response to a decrease in fluid pressures within the vascular system?
What physiological change occurs in the body in response to a decrease in fluid pressures within the vascular system?
A patient with chronic kidney disease is prescribed aluminum hydroxide. What is the intended effect of this medication related to electrolyte balance?
A patient with chronic kidney disease is prescribed aluminum hydroxide. What is the intended effect of this medication related to electrolyte balance?
Which electrolyte imbalance is most likely to result from excessive nasogastric suctioning?
Which electrolyte imbalance is most likely to result from excessive nasogastric suctioning?
A patient is prescribed spironolactone. Nurses should include which of the following in their plan of care?
A patient is prescribed spironolactone. Nurses should include which of the following in their plan of care?
A nurse is caring for a client with a serum calcium level of 7.9 mg/dL. Which of the following is an appropriate nursing intervention?
A nurse is caring for a client with a serum calcium level of 7.9 mg/dL. Which of the following is an appropriate nursing intervention?
A patient is experiencing metabolic alkalosis. Which of the following compensatory mechanisms is the body most likely to use?
A patient is experiencing metabolic alkalosis. Which of the following compensatory mechanisms is the body most likely to use?
A patient is experiencing severe diarrhea. Arterial blood gases reveal a pH of 7.25 and HCO3- of 18 mEq/L. What acid-base imbalance is present?
A patient is experiencing severe diarrhea. Arterial blood gases reveal a pH of 7.25 and HCO3- of 18 mEq/L. What acid-base imbalance is present?
Which of the following factors places a patient at increased risk for hypermagnesemia?
Which of the following factors places a patient at increased risk for hypermagnesemia?
A patient who is NPO and is receiving gastrointestinal suctioning is most at risk for which acid-base imbalance?
A patient who is NPO and is receiving gastrointestinal suctioning is most at risk for which acid-base imbalance?
A patient taking thiazide diuretics reports muscle cramping. What food would be most appropriate for the nurse to recommend?
A patient taking thiazide diuretics reports muscle cramping. What food would be most appropriate for the nurse to recommend?
Which of the following patients is most predisposed to developing hypernatremia?
Which of the following patients is most predisposed to developing hypernatremia?
When administering IV potassium, a nurse should prioritize which action?
When administering IV potassium, a nurse should prioritize which action?
The nurse is assessing a patient with potential fluid volume overload. Which location is best to assess dependent edema in a bedridden patient?
The nurse is assessing a patient with potential fluid volume overload. Which location is best to assess dependent edema in a bedridden patient?
Flashcards
Solutes
Solutes
Dissolved solid substances in body fluids, some are electrolytes and some are nonelectrolytes.
Electrolytes
Electrolytes
Chemicals that can conduct electricity when dissolved in water.
Intracellular Fluid (ICF)
Intracellular Fluid (ICF)
Fluid located inside the cells.
Extracellular Fluid (ECF)
Extracellular Fluid (ECF)
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Interstitial Fluid
Interstitial Fluid
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Intravascular Fluid
Intravascular Fluid
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Transcellular Fluids
Transcellular Fluids
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Antidiuretic Hormone (ADH)
Antidiuretic Hormone (ADH)
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Diffusion
Diffusion
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Filtration
Filtration
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Osmosis
Osmosis
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Osmolarity
Osmolarity
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Isotonic Solution
Isotonic Solution
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Hypotonic Solution
Hypotonic Solution
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Hypertonic Solution
Hypertonic Solution
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Dehydration
Dehydration
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Hypovolemia
Hypovolemia
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Third Spacing
Third Spacing
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Fluid Excess
Fluid Excess
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Hypervolemia
Hypervolemia
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Ascites
Ascites
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Hyponatremia
Hyponatremia
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Hypernatremia
Hypernatremia
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Hypokalemia
Hypokalemia
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Hyperkalemia
Hyperkalemia
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Arrhythmia
Arrhythmia
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Hypocalcemia
Hypocalcemia
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Osteoporosis
Osteoporosis
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Trousseau Sign
Trousseau Sign
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Chvostek Sign
Chvostek Sign
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Tetany
Tetany
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Hypercalcemia
Hypercalcemia
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Hypomagnesemia
Hypomagnesemia
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Hypermagnesemia
Hypermagnesemia
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Acid
Acid
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Base
Base
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Alkali
Alkali
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Acidosis
Acidosis
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Alkalosis
Alkalosis
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Study Notes
- Fluids are essential for cellular metabolism, blood volume, body temperature regulation, and solute transport.
- Electrolytes are chemicals that conduct electricity when dissolved in water, existing as either positively charged cations or negatively charged anions.
Fluid Balance
- Intracellular fluid (ICF) is inside cells, while extracellular fluid (ECF) is outside cells.
- ECF includes interstitial fluid (surrounding cells), intravascular fluid (blood plasma), and transcellular fluid (e.g., cerebrospinal fluid, digestive juices).
- Antidiuretic hormone (ADH) regulates water balance by controlling kidney fluid retention; increased ADH leads to fluid retention and vice versa.
- Active transport requires energy (ATP) to move substances across cell membranes, exemplified by sodium-potassium pumps.
- Passive transport, including diffusion, filtration, and osmosis, doesn't require energy expenditure.
- Diffusion involves movement from high to low concentration areas.
- Filtration is the movement of water and small molecules across a semipermeable membrane from high to low pressure.
- Hydrostatic pressure drives filtration, crucial for nutrient and waste exchange in capillaries.
- Osmosis involves water movement from low to high substance concentration across a semipermeable membrane.
- Osmolarity measures the concentration of substances in body fluids, with normal blood osmolarity between 270 and 300 mOsm/L.
- Isotonic fluids have the same osmolarity as blood (e.g., 0.9% saline).
- Hypotonic solutions have lower osmolarity than blood, causing water to enter cells.
- Hypertonic solutions have higher osmolarity than blood, causing water to leave cells.
- The body loses about 2,500 mL of fluid daily through sensible (urine) and insensible (perspiration, respiration, stool) losses.
- Diminished thirst reflex and reduced kidney function increase older adults' risk of fluid deficits.
Fluid Imbalances
- Older adults face higher risks of complications from fluid deficits (dehydration) or excess.
- Reduced total body water increases older adults' risk for dehydration and may manifest as confusion, lightheadedness, and syncope.
- Infants are prone to fluid deficits due to high fluid turnover.
Dehydration (Fluid Deficit)
- Hypovolemia, decreased blood volume, is the primary characteristic of dehydration
- Hypovolemia can result from fluid loss (hemorrhage, vomiting, diarrhea, diaphoresis) or third spacing (fluid shift into interstitial spaces).
- Third spacing is common in burns, liver cirrhosis, and trauma.
- Prevention includes identifying high-risk patients and ensuring adequate hydration (30 mL/kg/day for adults).
- Early symptoms include thirst, rapid weak pulse, rapid shallow respirations, and low blood pressure.
- Dehydration manifests as decreased skin turgor (tenting) over the sternum or inner thigh; dry skin and mucous membranes; increased temperature; decreased, concentrated urine output (less than 30 mL/hour); and constipation.
- Monitor daily weights to assess fluid loss; 1 lb corresponds to approximately 1 pint (473 mL) of fluid.
- Untreated dehydration can cause organ failure (brain, kidneys, heart) and death.
- Diagnostic tests reveal elevated BUN, hematocrit, and urine-specific gravity.
- Treatment involves fluid replacement, typically with isotonic fluids like normal saline.
Nursing Process for Dehydration
- Monitor for dehydration signs (though classic signs may not always be present)
- Assess skin turgor on the forehead or sternum for older patients.
- Monitor mucous membranes for dryness.
- Daily weights are key; a loss of 1-2 lb/day suggests water loss.
- Nursing diagnoses: Risk for Deficient Fluid Volume related to fluid loss or inadequate intake.
- Monitor daily weights and I&O.
- Offer fluids frequently, especially to confused patients.
- Correct the underlying cause of the deficit, avoiding overhydration.
Maintaining Oral Hydration in Older Adults
- Use a fluid intake sheet for monitoring.
- Urine-specific gravity is a simple, accurate hydration indicator.
- Signs like dry tongue, sunken eyes, confusion, and muscle weakness indicate dehydration.
Evaluation and Patient Education
- Effectiveness is shown by elastic skin turgor, moist membranes, and stable weights.
- Report signs/symptoms of dehydration.
- Encourage low-sugar fluids, replacing fluids lost through perspiration, vomiting, or diarrhea.
Fluid Excess (Overhydration/Hypervolemia)
- Results from excessive fluid in the intravascular space, leading to electrolyte dilution.
- Healthy kidneys compensate for mild hypervolemia by increasing urine output.
- Causes include excessive fluid intake (poorly controlled IV therapy, water ingestion), excessive sodium intake, adrenal gland dysfunction, corticosteroid use, kidney/heart failure, and syndrome of inappropriate ADH.
- Prevention: avoid excessive fluid intake and use electronic controllers for IV infusions.
- Monitor fluid used for irrigations to prevent excessive absorption.
- Elevated blood pressure, bounding pulse, increased labored respirations, neck vein distention, and pitting dependent edema can occur.
- The skin is pale and cool.
- Increased urine output (dilute).
- Rapid weight gain.
- Severe: moist crackles, dyspnea, ascites.
- Acute fluid excess can lead to congestive heart failure and pulmonary edema (fluid in lungs).
- Diagnostic tests: decreased BUN, hematocrit, and urine-specific gravity.
- Treatment involves supporting breathing, removing excess fluid, and correcting the underlying cause.
Therapeutic Measures
- Positioning: semi- or high-Fowler position promotes lung expansion.
- Oxygen therapy to ensure organ perfusion and minimize dyspnea.
- Administer diuretics (loop diuretics like furosemide) to eliminate excess water and sodium; monitor potassium levels.
- Implement fluid restriction and sodium-restricted diet (e.g., 1-2 g sodium restriction).
Nursing Process for Fluid Excess
- Observe high-risk patients, monitor fluid, and report urinary output below 30 mL/hour.
- Check for edema (pitting, sacral in bedridden patients) and auscultate lung sounds.
- Weigh at-risk patients daily; a gain of 1-2 lbs/day indicates fluid retention.
- Nursing diagnoses: Excess Fluid Volume related to excessive intake or inadequate excretion.
- Report weight gain to the HCP.
- Implement/manage fluid restrictions, administer diuretics, monitor potassium, and report low urine output.
Evaluation and Patient Education
- Effectiveness is shown by a return to normal weight, clear lung sounds, and absence of edema.
- Reinforce fluid/sodium restrictions, suggest foods high in potassium if on potassium-wasting diuretics (sweet potatoes, yogurt, bananas, orange juice), and report signs/symptoms of fluid excess and weight gain.
Nutrition Notes: Reducing Sodium Intake
- The upper tolerable intake level (UL) for sodium is 2,300 mg daily.
- Prepackaged/prepared foods are the dominant source of sodium.
- Low-sodium food definitions: salt/sodium-free (less than 5 mg/serving), very low sodium (less than 35 mg/serving), and low sodium (less than 140 mg/serving).
Electrolyte Imbalances
- Electrolytes (ions) are measured in mEq/L or mg/dL and are either cations (positive charge) or anions (negative charge).
- The most important electrolytes are sodium, potassium, calcium, and magnesium.
- Prevent and recognize electrolyte imbalances through vigilance and regular monitoring in high-risk patients.
Sodium Imbalances (Normal: 135-145 mEq/L)
- Sodium helps maintain serum osmolarity and is vital for cell function, especially in the central nervous system.
Hyponatremia (Sodium Deficit: < 135 mEq/L)
- Hyponatremia may result from inadequate sodium intake/excessive loss or relative decrease (third spacing, fluid excess/dilution).
- High-risk conditions include NPO status, excessive diaphoresis, diuretics, GI suction, syndrome of inappropriate ADH, hypotonic fluid ingestion, freshwater near-drowning, and decreased aldosterone.
- Manifestations: dehydration or fluid excess symptoms; mental status changes (disorientation, confusion, agitation) due to cerebral edema; weakness, elevated temperature, tachycardia, nausea, vomiting, and diarrhea.
- Complications: seizures, respiratory arrest, coma, pulmonary edema.
- Diagnostic tests: serum sodium level.
- Treatment involves resolving the cause and replacing lost sodium with IV saline (for deficits); fluid restriction and non-sodium-wasting diuretics (for fluid excess); steroids for cerebral edema.
- Implement safety interventions and monitor I & Os.
Hypernatremia (Sodium Excess: > 145 mEq/L)
- Hypernatremia can result from excessive sodium intake/inability to excrete or relative increase (fluid deficit).
- Stimulation of muscle and neurons of the brain.
- Manifestations: thirst, mental status changes (agitation, confusion, personality changes) due to too little fluid in brain tissues, seizures, muscle twitches/contractions, and skeletal muscle weakness leading to respiratory failure.
- Complications: coma, respiratory arrest.
- Diagnostic tests: serum sodium level.
- Treatment involves addressing fluid imbalances first (e.g., fluid replacement without sodium), diuretics (if kidneys function), dialysis (if kidneys fail), and a sodium-restricted diet.
Potassium Imbalances (Normal: 3.5-5.3 mEq/L)
- Potassium is critical for cardiac, skeletal, and smooth muscle function
- Changes in potassium levels can cause major changes in the body
Hypokalemia (Potassium Deficit: < 3.5 mEq/L)
- Results from inadequate intake or excessive loss through kidneys/GI tract.
- Causes include potassium-wasting diuretics, corticosteroids, severe vomiting/diarrhea, prolonged GI suction, major surgery, and hemorrhage.
- Prevention: potassium supplements with surgery, drugs known to cause hypokalemia, or potassium-rich foods.
- Manifestations: muscle cramping/fatigue, shallow ineffective respirations, weak/irregular pulse, arrhythmia, orthostatic hypotension, mental status changes/lethargy, nausea, vomiting, abdominal distention, and constipation.
- Complications: arrhythmia, respiratory failure/arrest.
- Diagnostic tests: serum potassium level, ECG, metabolic alkalosis (increased serum pH).
- Treatment involves potassium replacement (oral supplements for mild cases, IV supplements for severe cases); ensure adequate kidney function before administration; administer potassium slowly/carefully via IV (never IV push).
- Adverse effects should be reported such as nausea, vomiting, diarrhea, and abdominal cramping to the HCP.
Tips for Patients Taking Oral Potassium Supplements
- Do not substitute one potassium supplement for another.
- Take all forms of potassium with a full glass of water or juice.
- Do not crush extended-release potassium tablets.
- Take potassium supplements with meals.
Hyperkalemia (Potassium Excess: > 5.3 mEq/L)
- Usually caused by increased intake or movement of intracellular potassium into the blood, coupled with decreased renal excretion.
- Causes include overuse of potassium-based salt substitutes, excessive oral/IV potassium supplements, potassium-sparing diuretics (e.g., spironolactone), kidney failure, massive tissue trauma, and metabolic acidosis.
- Prevention involves monitoring serum electrolyte values and patient symptoms with potassium supplements.
- Manifestations: muscle twitches/cramps followed by muscle weakness, diarrhea, slow/irregular heart rate, weak pulse, and decreased blood pressure.
- Complications: cardiac arrhythmias and respiratory failure.
- Diagnostic tests: elevated serum potassium level, ECG changes, metabolic acidosis (decreased serum pH).
- Treatment involves dietary potassium limitation, discontinuation of supplements, potassium-wasting diuretics, cation exchange resins (e.g., sodium polystyrene sulfonate), and glucose/insulin administration (to move potassium back into cells).
Calcium Imbalances (Normal: 8.2-10.2 mg/dL, or 2.1-2.6 mmol/L)
- Calcium affects the excitability of different tissues, especially cardiac muscle
Hypocalcemia (Calcium Deficit: < 8.2 mg/dL, or 2.1 mmol/L)
- Results from chronic disease, poor intake, postmenopausal status, inadequate absorption, insufficient vitamin D, impaired parathyroid hormone production, and hyperphosphatemia.
- Prevention: consume calcium-rich foods, take calcium supplements (calcium carbonate), and ensure adequate vitamin D intake.
- Manifestations: changes in heart rate, decreased blood pressure, mental status changes, hyperactive reflexes, increased GI motility (diarrhea/cramping).
- Trousseau sign- hand/fingers become spastic when blood pressure cuff is inflated.
- Chvostek sign- facial twitching when tapping face below and in front of the ear.
- Complications: tetany, laryngospasm, seizures, respiratory/cardiac failure.
- Diagnostic tests: low serum calcium level, abnormal ECG, increased parathyroid hormone level.
- Treatment involves calcium replacement (oral supplements with vitamin D for mild/chronic cases, IV calcium gluconate/chloride for acute/severe cases); address hyperphosphatemia with aluminum hydroxide.
Food Sources of Calcium
- Fortified ready-to-eat cereals
- Parmesan Cheese
- Tofu
- Soymilk
- Chia seeds
- Skim Milk
- Cheddar Cheese
Hypercalcemia (Calcium Excess: > 11 mg/dL, or 5.5 mEq/L)
- Can be caused by excessive calcium/vitamin D intake, kidney failure, hyperparathyroidism, cancers, and thiazide diuretics.
- Prevention: monitor calcium supplements and educate about proper intake amounts.
- Manifestations: no obvious signs in mild/slow-progressing cases; in acute hypercalcemia: increased heart rate/blood pressure, skeletal muscle weakness, and decreased GI motility.
- Complications: kidney/urinary calculi (stones), respiratory failure, cardiac failure.
- Treatment involves hospitalization with cardiac monitoring; IV fluids (saline) to promote diuresis; discontinuation of thiazide diuretics; diuretics (furosemide) to promote calcium excretion; drugs (pamidronate, zoledronic acid, calcitonin) to slow calcium movement from bones to blood; and dialysis/ultrafiltration if cardiac problems are present.
Magnesium Imbalances (Normal: 1.6-2.2 mg/dL, 0.66-0.91 mmol/L)
- Magnesium and calcium work together for the proper functioning of excitable cells
Hypomagnesemia (Magnesium Deficit: < 1.6 mEq/L)
- Results from decreased intake or excessive loss of magnesium.
- Causes include malnutrition/starvation diets, diarrhea, Crohn disease, alcoholism (decreased intake/increased renal excretion), loop/osmotic diuretics, aminoglycosides (e.g., gentamicin), and some anticancer agents.
- Manifestations are similar to hypocalcemia, including positive Trousseau and Chvostek signs.
- Management involves treating the cause and replacing magnesium (IV magnesium sulfate, oral magnesium oxide/antacids).
- Calcium replacement may also be needed.
- Treatment includes cardiac monitoring because of magnesium’s effect on the heart (life-threatening arrhythmias).
Hypermagnesemia (Magnesium Excess: > 2.2 mEq/L)
- The most common cause is increased intake coupled with decreased renal excretion (kidney failure).
- Manifestations (usually not apparent until levels are greater than 4 mEq/L): bradycardia, hypotension, lethargy/drowsiness, and skeletal muscle weakness.
- If untreated, coma, respiratory failure, or cardiac failure may result.
- Loop diuretics such as furosemide and IV fluids can increase magnesium excretion (if kidneys function properly).
- Dialysis may be required.
Acid-Base Balance
- The pH measures the strength of acids and bases.
- Normal serum pH is 7.35-7.45 (slightly alkaline).
- Acidosis is when the serum pH is <7.35.
- Alkalosis is when the serum pH is >7.45.
- Cellular buffers (proteins, hemoglobin, bicarbonate, phosphates) bind or release hydrogen ions to maintain pH
- The lungs regulate carbon dioxide levels (increased respiration in acidic states, decreased respiration in alkaline states).
The kidneys will:
- Reabsorb bicarbonate (if the serum pH lowers and becomes too acidic)
- Excrete bicarbonate (if the serum pH increases and becomes too alkaline)
- Form acids and ammonium (a base)
Acid-Base Imbalances
- Arterial blood gases (ABGs) are used to evaluate acid–base balance.
The two broad types of acid–base imbalance:
- Acidosis: The serum pH level falls below 7.35
- Alkalosis: the serum pH level increases above 7.45
ABG values and changes in acid-base imbalances
| pH | PCO2 | HCO3- | |
|---|---|---|---|
| Normal Values | 7.35-7.45 | 32-45 mm HG | 20-26 mEq/L |
ROME
- Respiratory Opposite, Metabolic Equal
- In respiratory imbalances, the arrows are pointing in opposite directions.
- In metabolic imbalances, the arrows are pointing in the same or equal directions.
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