NURS 1060 Fluid and Electrolyte Imbalances PDF

NURS 1060: Week 12-14 Fluid and Electrolyte Imbalances Outcomes: - Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. - Discuss critical thinking and clinical reasoning to provide quality pati...

NURS 1060: Week 12-14 Fluid and Electrolyte Imbalances Outcomes: - Describe principles of safe, patient-centered, evidence-based nursing care to adults at the basic level, guided by the Caritas philosophy. - Discuss critical thinking and clinical reasoning to provide quality patient care. Competency: - Describe factors that create a culture of safety related to medication administration. - Discuss critical thinking and clinical judgment used to provide accurate and safe medication administration. Concept: Fluid and Electrolyte **Directions: Complete the 5 Fluid and Electrolyte Activities below. The answers are in a separate file on Blackboard (1060 W12-13-14 Fluid and Electrolyte Answers)** **Electrolyte Imbalance** **[Sodium Imbalance]** 1\. Na is the main cation found in **the ECF** 2\. Cl is a/an (**anion**/cation) that appears in combination with the **Na** ion. 3\. If a client has an oral temperature of 104 degrees F there would be Na (**loss**/gain) 4\. The normal concentration of Na in the extracellular fluid is **135 - 145** mEq/L 5\. One (canFalse) the chief regulation of Na occurs within the Kidneys. 11\. (**True**/False) Cortisone and aldosterone stimulate the kidneys to absorb Na and excrete K 12\. When there is a body water deficit what occurs to the: Na and Cl levels (**increase**/decrease) Serum osmolality (**increase**/decrease) Body water (excreteddecreases) serum osmolality. 17\. **Hemodilution** of body fluids that can cause hyponatremia include: Drinking excessive plain water SIADH Gastric suction Hypervolemic state 18\. Vomiting and diarrhea can (increasehypernatremia) 23\. Dry oral membranes, restlessness, and elevated body temperature indicate (**hypernatremia**/hyponatremia) 24\. To restore Na balance due to Na deficit give (**0.9%NaCl**/D5W) IV. 25\. Steroids (**promote**/inhibit) sodium retention 26\. Following a surgical intervention your client has been receiving D5W for 5 days. One may expect a Na and Cl (excessanion). 3\. Normal serum K range is **3.5** to **5.3** mEq/L. 4\. (**True**/False) Either too much or too little K can cause a cardiac arrest. 5\. K is needed for transmission and conduction of **nerve** impulses and the contraction of **skeletal and smooth muscle and myocardium.** 6\. After ingestion of K the body shifts K (**into**/out of) cells and the **kidneys** excrete K. 7\. The daily K intake needed for body function is **40** to **60** mEq. 8\. List 4 foods rich in K: 1\. Meat 2. Bananas (Fruits In General) 3. Veggies 4. Nuts 9\. Insulin (**increases**/decreases) the sodium-potassium pump activity. 10\. Match the serum K levels with the type of K imbalance a\. Hypokalemia b. Hyperkalemia c. Normal 1.\_\_ **C** 3.7 2. **C** 4.8 3**. B** 5.9 4. **A** 2.7 5. **A** 3.1 6. **B** 6.8 11\. The production of aldosterone causes K to be (**excreted**/retained) and Na to be (excretedpotassium-sparing) diuretics. 14\. List three GI causes of hypokalemia. 1\. Vomiting 2. Diuretics/Laxatives 3. GI suctioning/NG to suction 15\. Potassium in IV fluids administered at a rate faster than 20 mEq/L per hour can result in (hypokalemiaFalse) Oral K supplements would not be recommended for a person with reduced kidney function. 22\. (**True**/False)The normal dose of IV K is 10 to 20 mEq per hour diluted in 500 to 1000 ml of fluid. 23\. Potassium (shoulddecrease) K intake. 25\. (**True**/False) To correct mild hyperkalemia, restriction of K intake is suggested. 26\. Which methods are used to correct moderate K excess a\. Potassium restriction diet b. IV sodium bicarbonate c\. Insulin and glucose d. Kayexalate and sorbitol 27\. Which electrolytes are lost when potassium-sparing diuretics are taken: K **Na** and **Cl** 28\. The K imbalance that occurs in clients taking potassium-sparing diuretic is (hypokalemiahyperkalemia). 30\. Identify the following classifications of diuretics as potassium-wasting (W) or potassium-sparing (S). Thiazides **W** loop diuretics **W** aldosterone antagonist **S** 31\. Corticosteroids and laxative can cause potassium (**deficit**/excess). 32\. (**True**/False) A severe serum K deficit that is life threatening is a serum K level of \7.0mEq/L. 33\. Administering glucose and insulin may lead to rapid transfer of K from the extracellular fluid to the cell, causing the serum K to rapidly (increasehyperkalemia) Vomiting will cause K (increaseFalse) Unbound calcium from plasm protein is free calcium. This free calcium can cause a physiologic cellular response. 4\. **Vitamin D** is needed for Ca absorption from the GI tract. 5\. When serum Ca level is increased, the serum P level (increasesdecrease) serum Ca level. 7\. Calcitonin (increasesdecreases) Ca levels. 9\. PTH increases Ca levels by which of the following ways: **mobilizing Ca from the bone** decreasing renal absorption of Ca **increasing renal absorption of Ca** **promoting Ca absorption from the intestine with Vitamin D** 10\. Name 4 function of Ca 1\. NM-Nerve Impulse and muscle contraction 2\. Cardiac Muscle Contraction 3\. Blood Coagulation 4\. bone and teeth formation and maintenance 11\. Match the serum Ca levels with the type of Ca status: 9.0 mg/dl Normal Hypocalcemia 11.0 mg/dl Hypercalcemia Hypercalcemia 7.5mg/dl Hypocalcemia Normal 12\. Neuromuscular excitability of the skeletal, smooth, and cardiac muscles result from (**hypocalcemia**/hypercalcemia). 13\. Decrease in blood coagulation resulting in bleeding may be due to a serum Ca (**deficit**/excess). 14\. Decreased GI peristalsis may be due to serum Ca (deficitexcess). 17\. With hyperphosphatemia, (**hypocalcemia**/hypercalcemia) is more likely to occur. 18\. Prolonged immobilization (**increases**/decreases) serum Ca levels. 19\. Tetany symptoms are (**present**/absent) when the client is hypocalcemic. 20\. A positive test for Chvostek and /or Trousseau indicates a calcium (**deficit**/excess). 21\. (**True**/False) Carpopedal spasm occurs with Trousseau's sign. 22\. (**True**/False) Chvostek's sign consists of facial muscle twitching. 23\. Identify which occurs as a result of calcium deficit (CD) or calcium excess (CE) Muscles flabby (CE) Tetany symptoms (CD) Muscle cramps (CD) Positive Chvostek's sign (CD) Kidney stones (CE) Blood does not clot normally (CD) 24\. An elevated serum Ca level (**increases**/decreases) the risk of digitalis toxicity. 25\. Steroids (increasedecreased)? Identify a hypercalcemia renal/kidney health problem that can occur: Renal: **Kidney Stones** Mr. Bone has been on digoxin for 2 years. Should his Digoxin dosage be (increased/decreased) until the Ca state is normalized? If Mr. Bone's serum Ca became 7.5mg/dl he would be experiencing (**hypocalcemia**/hypercalcemia). Identify signs and symptoms of hypocalcemia. - Tetany - Muscle Cramps - Abdominal Cramps - Weak Cardiac Contractions - Positive Chvostek and Trousseau signs - decrease prothrombin convert to thrombin increasing clotting time **[Electrolyte Imbalance]** **[Phosphorus Imbalance]** 1\. The normal serum Phosphorus (P) range in adults is **2.5** to **4.5** mg/dL. 2\. (**True**/False) PTH stimulates the proximal renal tubules to increase phosphate excretion 3\. Functions of P include which of the following: **a. metabolism of carbohydrates, proteins, and fats** **b. muscle and nerve** **c. formation of ATP** **d. strong teeth and bones** 4\. Label the P imbalance based on the serum P level listed a\. Hypophosphatemia b\. Hyperphosphatemia c\. Normal **C.** 3.0 mg/dL **B.** 6.8 mg/dL **A.** 1.5 mg/dL 5\. Name two dietary variations that can cause a decreased serum P level. 1\. Malnutrition 2. Chronic Alcoholism 6\. (**True**/False) Alcoholism can cause severe hypophosphatemia as a result of diuresis. 7\. Name the vitamin that is necessary for P absorption via the small intestines. **Vitamin D** 8\. (**True**/False) Gastrointestinal abnormalities that may cause hypophosphatemia include vomiting and diarrhea. 9\. Increased PTH secretion causes a P (**loss**/excess). 10\. With a decrease in the serum Ca level, the serum P level (**increases**/decreases). 11\. Indicate which of the following signs and symptoms relate to hypophosphatemia: a\. **Muscle weakness** b\. **Bone pain** c\. **Tissue hypoxia** d\. Tachycardia e\. **Hyporeflexia** 12\. Indicate which of the following signs and symptoms related to hyperphosphatemia: a\. **Tetany** b\. **Hyperreflexia** c\. **Tachycardia** d\. Bone pain 13\. Hypophosphatemia is present when the serum P level is \< 2.5 mg/dL. Hyperphosphatemia is present when the serum P level is \> **4.5** mg/dL. 14\. (**True**/False) Prolonged intake of aluminum antacids decreases the serum P level. 15\. Aluminum antacids may be ordered for hyperphosphatemia because the aluminum binds with **Phostphate** to decrease the serum P level. 16\. CASE STUDY Mrs. Pet had a history of alcohol abuse. She was admitted for gastrointestinal bleeding. "I have not eaten a balanced diet for two months and I've been taking Amphojel to relieve my upset stomach." Mrs. Pet complained of tremors and muscle weakness. Mrs. Pet has (**hypo**/hyper) phosphatemia. The normal serum P range is **2.5** to **4.5**mg/dL. (**True**/False) Mrs. Pet's imbalance is caused by poor diet/malnutrition and ingestion of Amphojel an aluminum hydroxide antacid. Which of Mrs. Pet's signs and symptoms indicate a P deficit. 1.Tremors 2.Muscle Weakness Explain how aluminum hydroxide lowers the serum phosphorus level. **bind aluminum with P which decreases GI absorption of P: This causes a decrease serum P** Name one oral phosphate drugs. 1. **Neutra-Phos Oral** **[Electrolyte Imbalance]** **[Magnesium Imbalance]** 1\. List four foods rich in Mg: 1\. Leafy Greens 2. Nuts 3. Whole Grains 4. Sea Food 2\. A serum Mg level \ 2.5 mEq/L is called **Hypermagnasemia** 3\. Indicate which of the following are functions of Mg. a\. **Neuromuscular activity** b **contraction of the myocardium** c\. **enzyme activity** d\. **responsibility for Na and K crossing cell membranes.** 4\. Match the serum Mg levels with the type of Mg imbalance: 1.2 mEq/L **B** A. Normal 2.0 mEq/L **A** B. Hypomagnesemia 2.9 mEq/L **C** C. Hypermagnesemia 5\. With decreased Ca absorption there is a/an (increase/decrease) in Mg absorption. 6\. Mg inhibits the release of the PTH. A decrease in the PTH (increases/**decreases**) the amount of Ca released from the bone. This can cause a serum Ca (excess/**deficit**). 7\. Match the Mg imbalance with the neuromuscular assessment: **A.** hypomagnesemia A. Hyperexcitability **B.** hypermagnesemia B. Inhibition 8\. Place a D for Mg deficit and an E for Mg excess: **E.** renal insufficiency **D**. prolonged diuresis **D.** chronic alcoholism **D.** malnutrition **D.** prolonged inadequate nutrient intake **D.** severe diarrhea **E.** constant use of antacids with Mg hydroxide 9\. Place a D for Mg defect and an E for Mg excess: D -- Hyperirritability\ E -- CNS depression E -- Lethargy\ D -- Tremors D -- Twitch of the face E -- Loss of deep tendon reflex\ D -- Ventricular fibrillation E -- Complete heart block 10\. For [severe] hypomagnesemia the ordered Mg replacement should be administered (orally/intravascularly/**intravenously**). 11\. For correction of serum Mg excess, intravenous **Normal Saline** or **Lasix** can be prescribed. 12\. If renal failure is the cause of severe hypermagnesemia, what is the course to correct this imbalance? **Dialysis** 13\. The kidneys regulate the concentration of Mg in the body. When there is a slight increase in the Mg concentration, the kidneys excrete the excess. When there is a decreased serum Mg level the kidneys (excrete/**reabsorb**) Mg. 14\. CASE STUDY Mrs. Las has had diuresis for several days. In the hospital her diagnoses were prolonged diuresis, severe dehydration, and malnutrition. She received 3 liters of 5% dextrose in ½ normal saline. Her serum Mg was 1.3 mEq/L. What is the normal range for Mg. **1.5** to **2.5** mEq/L. Name the type of magnesium imbalance present. **Hypomagnasemia** Name two clinical causes of Mrs. Las hypomagnesemia 1\. Malnutrition 2. Dehydration Mrs. Las's pulse was irregular. She developed tremors and twitching of the face. The physician ordered Mg sulfate IV. Lasix can cause (**hypomagnesemia** / hypermagnesemia). List clinical signs and symptoms of Hypomagnesemia Hypomagnesemia produces neuromuscular and CNS hyperirritability Confusion, Hyperactive deep tendon reflexes, Muscle cramps, Tremors, Seizures, Cardiac dysrhythmias