electrolyte imbalance questions

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LaurenFleming
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electrolyte imbalance questions
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2011-07-17 15:26:55
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electrolyte imbalance
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midterm
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  1. If a pt has hyponatremia and normal fluid volume use...
    water restiction and treat underlying cause
  2. If a pt has hyponatremia with hypovalemia use
    IV normal saline or lactated Ringers to correct ECF deficit
  3. if a pt has hyponatremia with hypertonic dehydration treat with
    fluid restriction and treat underlying cause
  4. if pt has hypernatremia and hypervolemia
    remove sources of sodium excess, administer diuretics and replace water as needed
  5. for a pt with hypokalemia and is not on fluid restriction encourage a
    high fiber diet and high fluid intake to prevent constipation
  6. For a pt with hyperkalemia give what as an enema??
    Kayexalate

    *can be given orally with an osmotic agent to decrease constipation
  7. for a pt with hyperkalemia what can be given to drive K+ into cells
    Give K+ wasting diuretics to eliminate via kidneys or 50% dextrose with regular insulin
  8. what can be given to a pt with hypocalcemia
    oral calcium supplements , or calcium gluconate by slow IV push or in infusion of D5W of NS
  9. a pt with hypocalcemia is given thiazide diuretics to
    decrease urinary excretion of calcium
  10. What emergencies should you be prepared for with a pt with hypocalcemia??
    tetany, seizures, laryngospasm, and respiratory and cardiac arrest
  11. What precautions do you want to initiate with a pt with hypocalcemia
    seizure precautions and maintain a quiet environment
  12. what emergency equipment should you have on hand for a pt with hypocalcemia who just had a thyroidectomy
    emergency tracheostomy kit and IV calcium gluconate at bedside
  13. What will promote calcium excretion for a pt with hypercalcemia
    loop diuretics-furosemide (lasix) or ethacrynic acid (Edecrin)
  14. How much and what kind of oral fluids should be given to a pt with hypercalcemia
    • 3000-4000mL fluid/day
    • oral fluids high in acid-ash (cranberry, prune juice)
  15. What kind of fluid should be infused for a pt with hypercalcemia
    infuse NS at 300-500mL/hr up to 6 L until volume status restored then 0.45% NaCl;

    Watch for fluid overload
  16. What can be given to a pt to decrease GI absorption of calcium for a pt with hypercalcemia
    Corticosteroids (prednisone)
  17. What precautions do you want to watch for for a pt with hypomagnesemia
    institute ECG monitoring

    seizure precautions
  18. What do you want to monitor for when a pt has hypomagnesemia
    Monitor stridor and/or difficulty swallowing
  19. Pitting edema reflects fluid in the
    interstitial spaces
  20. if there were excess fluid volume what would happen to you neck and hand veins
    they would remain full
  21. if there were excess fluid volume in a pt the pts peripheral pulses would be
    bounding
  22. Normal saline (0.9% NaCl) ia an
    isotonic fluid

    prevents fluid shifts into or out of the GI tract
  23. Normal BUN
    8-22mg/dL
  24. Normal Hct
    38-45%
  25. An excess response to diuretic therapy results in an excess of
    water and electrolytes in the urine, leaving the blood hemoconcentrated and casuses a high BUN and Hct
  26. 3% saline is
    very hypertonic
  27. Ringers solution contains
    sodium, potassium, calcium and potassium in similar concentrations to plasma,

    provides no calories or free water
  28. Lactated Ringers solution contains
    sodium, chloride, potassium, calcium and lactate in concentrations similar to normal plasma

    Provides no dextrose, magnesium, or free water
  29. Hypotonic IV fluids are used to prevent and treat
    cellular dehydration by providing free water to the cells or to restore renal functioning
  30. What triggers a release of ADH
    Drop in BP or blood volume

    Rise in blood osmolarity
  31. When ADH is released from a trigger what happens to the kidneys
    the kidneys reabsorb more water

    resulting in higher vascular volume and low output of concentrated urine
  32. What inhibits the release of ADH
    rise BP or blood volume

    Drop in blood osmolarity
  33. When ADH is inhibited what happens to the kidneys
    the kidneys excrete more water in the urine

    resulting in lower vascular volume and high output of dilute urine
  34. Aldosterone release is triggered by
    • Drop in BP
    • Drop in Sodium
    • Rise in Potassium
  35. Aldosterone causes the kidneys to
    • reabsorb more sodium into the blood
    • increasing sodium levels
  36. Aldosterone release is inhibited by a
    • Rise is BP
    • Rise in Sodium
    • Drop in Potassium
  37. Decreasing aldosterone levels cause the kidneys to
    • excrete more sodium in the urine,
    • decreasing sodium levels
  38. Glucocorticoids promote
    renal retention or sodium and water
  39. The minimum normal urine output in the average adult is
    30 mL/hr
  40. 1L equals
    1 kg (2.2 lbs)
  41. if a person had a head injury which IV fluid would you not want to give the pt?
    5% dextrose it has a hypotonic effect when infused

    it puts free water into cells which would worsen the pts cerebral edema
  42. Which two electrolyte imbalances would the nurse assess for in a client with a high fever and severe dehydration
    Hypernatremia and Hyperchloremia
  43. SIADH is caused by
    excessive production of ADH or an ADH-like substance, resulting in decreased sodium and hypervolemia
  44. Loop diuretics are given to promote
    diuresis
  45. What are the clinical presentations when a pt is hyponatremia and hypervolemic state
    CHF, cirrhosis, nephrotic syndrome, and renal failure
  46. What are the clinical presentations when a pt is hyponatremia and hypovolemic state
    GI fluid loss, diuretic therapy, osmotic diuresis, adrenal insufficiency, burns, and sweating, hypotonic dehydration
  47. Lactated Ringer or 0.9% sodium chloride(NS) can be used to treat
    hyponatremia with isotonic dehydration
  48. What two diseases are more prone to develop hypernatremia
    • Cushings syndrome
    • Diabete insipidus
  49. HCTZ and Lasix are diuretics that increase
    the excretion of potassium
  50. Calcium gluconate is given to
    antagonize the effects of the potassium on the conduction system of the heart

    Not given to promote excretion of potassium
  51. A client who has diarrhea or nasogastric suctioning will be more likely to develop
    Hypokalemia
  52. A pt with elevated calcium levels and PTH is the cause of
    Hyperparathyroidism
  53. Large doses of corticosteroids decrease
    calcium absorption in the intestines, leading to further decrease in calcium levels
  54. The overall effect of PTH is to increase______and decrease______
    • increase calcium
    • decrease phosphorus
  55. calcitonin is directly secreted when calcium is
    high
  56. If magnesium is low, PTh release is _____
    impaired, lowering the calcium level
  57. Hypomagnesemia is also seen with
    hyperkalemia and hypocalcemia
  58. Chocolate has a small amount of _____
    Magnesium
  59. Decreased magnesium levels also contribute to reduction in
    • potassium
    • calcium
    • phosphate
  60. Magnesium decreases the amount of _________activity
    Acetylcholine, causing muscle relaxation
  61. Hyperactive reflexes are early signs of
    tetany

    Low magnesium level could lead to tetany and seizures
  62. sources of magnesium in the diet include
    • green leafy veggies
    • nuts
    • legumes
    • whole grains
    • seafood
    • bananas
    • oranges
    • chocolate
  63. depressed Deep tendon reflexes indicate an elevated
    magnesium level
  64. Increased use of sodium bicarbonate causes excretion of
    chloride or hypochloremia

    it would be appropriate to have chloride levels monitored for potential deficits
  65. Foods high in chloride are
    • canned veggies
    • dates
    • bananas
    • cheese
    • spinach
    • milk
    • eggs
    • celery
    • crabs
    • fish
    • olives
    • rye
  66. Predisposing fluid and electrolyte imbalances for hypochloremia
    • Hyponatremia
    • Hypokalemia
    • prolonged administration of D5W IV therapy
    • metabolic alkalosis
  67. Predisposing fluid and electrolyte imbalances for Hyperchloremia
    • Hypernatremia
    • Metabolic acidosis
  68. What is an anticipated manifestation for a pt with a high level of chloride
    Weakness and lethargy
  69. When a client is admitted with a chloride level of 80 the nurse anticipates administration of which of the following IV solutions
    0.45% sodium chloride with 20 mEq of potassium
  70. Normal Saline is an _______solution
    isotonic solution that will replace lost vascular volume and promote perfusion
  71. the loss of Sodium, potassium, chlorides, hydrogen is from
    vomiting
  72. The loss of Sodium, potassium, bicarb is from
    diarrhea
  73. Steroid make people ________fluids in
    HOLD
  74. For a protein deficiency what kind of diet is given
    high carbs and high protien
  75. Plasma to interstitial causes
    Increased capillary hydrostatic pressure

    Decrease plasma protein

    Increase cap. permeability

    • everything is pushed out
    • everything stays in tissue
  76. Ascities can be called
    Edema
  77. Anasarca
    generalized edema
  78. Interstitial to Plasma Shift
    Decrease in cap. hydrostatic pressure

    Increase in colloidal osmotic pressure

    Re-mobilization of fluid following burns or trauma
  79. What would the nurse expect to assess in a pt with interstitial to plasma
    Bp is going to be high, HR(quality will be bounding), kidney will try to get rid of it and urine will be dilute

    Pulmonary edema: crackles, sob, coughing, activity intolerance, Hr increases becaouse of hypoxia,
  80. When the amount of water decreases in relation to # particles, the osmolality
    osmolality increases and becomes concentrated
  81. When the amount of water increases relative to solutes the osmolality
    decreases and becomes more diluted
  82. Hyper-Osmolar
    Too much particles or too little water

    Results in cell shrinking

    Causes:Decrease water intake and Extracellular solute excess
  83. What condition and manifestations would the nurse expect to find in this patient (Hyper-Osmolar)
    Dry skin, sry mucous membrane, pour skin turgor, increase HR, decreased weight

    Affect of brain cells skrinking: confuesion
  84. HYPO-Osmolar
    Too little particles or too much water

    Results in cellular swelling

    Causes: Replacing H20 and Na+ loss with only water

    Inability to excrete urine (CRF)

    Brain cells swelling can burst and get cerebral edema
  85. What manifestations would the nurse expect with a pt with hypO-Osmolar
    Increased output (urine will be clear), skin moist, HR stronger,

    • Interventions
    • Replace loss with Na+ and H20 (isotonic)

    Utilize oral liquids with electrolytes

    Give Isotonic fluids
  86. Isotonic Imbalances
    Na+ and H20 increase or decrease together in the same proportion

    Cells do not shrink or swell

    Volume of ECF changes but the concentration of the solutes remains the same
  87. Isotonic Deficits
    Decrease Bp, weak, hypoxic,

    Treatment:

    Treat underlying cause

    Careful administration of isotonic solutions
  88. What would the nurse asses with a pt with Isotonic excess
    Assess lungs in fluid overload, HR will be bounding, kidneys (put out more urine),

    • Treatment:
    • Restrict fluids
    • Careful monitoring of fluids
    • diuretics
  89. The pt is experiencing isotonic dehydration. When chekcing the serum lab values, the nurse expects to find the pts sodium level to be
    Within normal limits
  90. First spacing
    normal distribution of ICF and ECF

    pt is healthy
  91. Second spacing
    abnormal accumulation in interstitial space (edema)

    pt has edema
  92. Third spacing
    • is trapped fluid and essentially unavailable. It is
    • distributional shift of fluid in a space that is not easily exchanged with the ECF (peritonitis)

    Thoracentesis
  93. Ascitis can be third spacing but is usually
    second
  94. Hyperosmolar is close to
    to hypernatremia : will hav signs of dehydration

    results from cells shrinking and fluid shifting
  95. Hyponatremia
    OVer hydration

    • Interventions
    • Isotonic or Hypertonic solution

    Restriction of water
  96. K sparing diuretics: makes pt
    hold potassium
  97. Pseudohyperkalemia
    false high potassium hemolized means false

    *Assess pt and check Heart
  98. Burns can cause
    hyperkalemia
  99. Calcium gluconate will not lower K, it
    is for
    heart dysrhythmias
  100. The nurse recognizes that the pt is experiencing hyperkalemia whne the pt is manifesting
    Bradycardia, diarrhea, muscle twitching
  101. Hyperphoshatemia can be caused by
    CRF

    Excessive intake of phosphorus

    Hypoparathyroidism (which is causes hypocalcemia)
  102. Hypophoshatemia is caused by
    hyperparathyroidism which is caused by hypercalcemia
  103. Calcium and bicarb are low
    renal failure
  104. BUN
    urea nitrogen are by products of metabolites and are waste products

    • elevated BUN is dehydration and kidney
    • failure




    • Check
    • creatine to see if it isbecause it will be renal
    • failure
  105. Creatine normal values
    0.5- 1.2
  106. Elevated bun and normal creatine is
    dehydration
  107. Decreased BUN is
    overhydration
  108. Normal BUN
    (10-20mg/dl)
  109. Urinalysis tests for
    • ketones (none in urine diabetics will hav them) ketones breakdown fat and protien, glucose, protien, WBCs (almost none),
    • blood,
    • specific gravity (particles per solution and is measureing the concentration of
    • urine),
    • Ph (4-7)
  110. if Specific gravity stays the same
    that is not good it should change depending on what isbeing drank or eatin
  111. Bicarbonate
    made by the kidneys and primary role is our main buffer (acid base), loose a lot of bicarb by diahrrea,
  112. Venous spasms
    vessel are vasoconstriction (cold)
  113. 3% NaCl is
    Hypertonic
  114. What would you find in a pt with fluid volume excess
    • increased bounding pulse
    • jugular venous distention
    • presence of crackles
    • elevated BP
    • skin pale and cool to touch
  115. a Pt who loses potassium and water will have a________aldosterone secretion
    Increased
  116. Pt at great risk for deficient fluid volume
    • fever 103
    • extensive burns
    • thyroid crisis
    • continuous fistula drainage
    • diabetes insipidus
  117. What chardovascular changes will the nurse asses in a dehydrated pt
    tachycardia with weak peripheral pulses
  118. a pt with hypovolemia and severe diarrhea will have (respiratory system)
    increased RR

    because the body perceives hypovolemia as hyoxia
  119. a pt with bounding pulse, neck vein distention when supine, presence of crackles in lungs and increasing peripheral edema. the nurse will suspect
    fluid excess
  120. how does ADH affect urine output
    increases permeability to water in the tubules causing a decrease in urine output
  121. a pt with low sodium will have what GI changes
    hyperactive bowel sounds and abdominal cramps
  122. postoperative pt who has been NPO for 24 hr is at risk for developing
    hyponatremia
  123. pt with excessive intake of 5% dextrose solution is at risk for developing
    hyponatremia
  124. Decreased sodium excretion can lead to
    primary hyperaldosteronism
  125. what diuretic is best for a pt with low sodium and signs of fluid volume excess
    Conivaptan (vaprisol)
  126. pt with early signs of increased sodium level will show
    muscle twitching and irregular muscle contractions
  127. pt with low sodium around 126 will have
    watery diarrhea with abdominal cramping
  128. What can result from a pt with a NPO status for a prolonged period
    hypernatremia
  129. an older adult with a sodium level of 150 may have a common result of
    altered cerebral fucntioning
  130. what are conditions that cause a pt to be at risk for hypernatremia
    • renal failure
    • use of corticosteroids
    • watery diarrhea
    • cushings syndrome
  131. a pt with low potassium will have
    • general skeletal muscle weakness
    • lethargy
    • and weak hand grasps
  132. what can happen to a pt that is taking potassium and digoxin
    digoxin toxicity can result if hypokalemia is present
  133. what assessment findings are associated with hyperkalemia
    • numbness in hands, feet, and around the mouth
    • frequent explosive diarrhea stools
    • irregular HR
    • hypotension
  134. a pt with hyperkalemia resulting from dehydration will have which lab results
    increased hematocrit and hemoglobin
  135. What surgical procedure will produce hypocalcemia
    thyroidectomy
  136. what condition may require the pt the be put on seizure precaution
    Hypocalcemia
  137. clinical condition that can result from hypocalcemia
    increased intestinal and gastric motility
  138. what pt is at risk for developing hypocalcemia
    recent ilestomy
  139. The pt with chronic renal failure associated with hypocalemia will monitor what electrolyte imbalance
    Hyperphosphatemia
  140. What medications can be ordered for hypercalcemia
    • calcitonin (calcimar)
    • furosemide (lasix)
    • plicamycin (mithracin)
  141. A pt with severe hypermagnesemia will have what kind of HR and BP
    • bradycardia
    • hypotension
  142. the nurse monitors the effectiveness of magnesium sulfate by assessing which factor ever hour
    deep tendon reflexes
  143. what condition places the pt at risk for hypocalcemia, hyperkalemia, and hypernatremia
    Chronic renal failure
  144. The pt CHF is receiving loop diuretic. what electrolytes will the nurse monitor
    • hypocalcemia
    • hypokalemia
    • hyponatremia
  145. Why does the nurse infuse 10% dextrose through a central line
    osmolarity of the solution cold cause phlebitis or thrombosis

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