NRSG 110 Study Guide Fluid and Electrolyte 1.

List treatment for clients who are hypovolemic and are hypotensive. --Isotonic electrolyte solutions (Lactated Ringers (LR) and 0.9% Sodium Chloride (NS) 2. What would be the preferred method of fluid replacement of hypovolemic clients? --Hypotonic electrolyte solution (0.45% Sodium Chloride ( NS) 3. Define Third Spacing. 4. List signs and symptoms of third spacing. 5. What are signs and symptoms of fluid overload? 6. What is the purpose of fluid challenge and what could you interpret by the results? ---Fluid Challenge may be ordered to determine cause of decreased urine output, Example: administer 100 to 200 mL of NS over 15 minutes. Patient with FVD and normal renal function will respond by increased urine output and increased blood pressure 7. 2.2 lbs. equal how much fluid? --1 liter 8. List treatment of fluid volume excess. ---Find and treat cause, If related to giving sodium-containing fluids D/C fluid, Sodium Restriction, Fluid Restriction, Diuretics 9. List medications used for mild hypervolemia. ---Thiazide diuretics- block Na absorption in the distal tubules HydroDIURIL, Zaroxolyn 10. List medications used for severe hypervolemia. ---Loop diuretics block Na absorption in the Loop of Henle - Lasix, Bumex, Demadex 11. List precautions for clients who use diuretics.

----?hypokalemia 12. List dietary consideration for clients with hypervolemia. ---Sodium Restriction, Fluid Restriction 13. List precautions for clients using salt substitutes. ---Commercial salt substitutes usually contain potassium, contraindicated in patient taking potassium sparing diuretics or patients with potassium retention advance renal disease. Watch substitutes which contain ammonium chloride with patients which have liver damage

14. What is an accurate indicator of fluid volume status? --daily weight 15. List treatment of clients with hyponatremia. ---Administration of Na per mouth , N/G or parenteral route, Easily replaced by diet, IV if not able to eat 16. Know the rate at which Na should be replaced in clients with hyponatremia. ---Must not be increased by more than 12 mEq in 24 hour period to avoid neurologic damage related to osmotic demyelination 17. Know treatment for clients with hypernatremia. ---Hypotonic solutions given 0.3& N/S or D5W, Desmopressin DDAVP is used if Diabetes Insipidus is the cause 18. Why must the content of Na be reduced gradually? ---Gradual reduction decreases risk of cerebral edema 19. How is Hypernatremia prevented? ---Provide fluid at intervals particular in patients who do not respond to thirst sensation, May need enteral feeding or parenteral fluids, May need increased H2O supplemental with high osmolality enteral feedings 20. Know methods of treatment for clients with hypokalemia. ---Increase diet intake of potassium 50 to 100 mEq/day fruits, vegetables, legumes, bananas, potatoes whole grain, milk, meat, Oral potassium replacement, IV therapy very cautiously monitor potassium level

21. Which acid base imbalance can be associated with hypokalemis? ---increased Bicarbonate and increased pH 22. Know signs & symptoms of Digitalis (Digoxin) Toxicity & Therapeutic level of Digoxin. ---anorexia, N & V, fatigue, irregular rhythm, AV block; 0.5 mg 2.0 mg/mL 23. How is IV potassium infused & what laboratory values should be monitored? ---Potassium NEVER given IV push, Must be given by IV pump, Maximum concentration on Medical Surgical Unit through a peripheral IV line is 20 mEq/100 mL and no faster than 10 to 20 mEq/Hr., Renal function should be monitored BUN, creatinine & urine output 24. List treatment of Hyperkalemia. ---Restrict foods with potassium, Watch meds with potassium 25. List how cation exchange resin should be given and precautions taken during delivery of this Medication. ---Give (Kayexalate) oral or enema cation exchange resin 26. Which acid base imbalance can occur with hyperkalemia? ---acidosis 27. List treatment of clients with hypocalcemia; include medication precautions. ---Can give Ca Calcium gluconate Calcium chloride Calcium gluceptate, Rapid administration of Ca can cause bradycardia and lead to cardiac arrest ---Ca diluted in D5W given slow IV infusion with IV pump N/S not used will increase renal Ca loss Extravasation increase risk of cellulitis and necrosis 28. List treatment options for Clients with hypercalcemia and precautions needed. ---Treat underlying cause chemotherapy for cancer, Partial parathyroidectomy for hyperparathyroidism, Give fluids dilute calcium and promote excretion, Mobilize patient, Restrict calcium in foods 29. Know treatment options for Hypomagnesemia and precautions needed. ---Diet management green leafy vegetables, nuts, seeds, legumes, whole grain,

seafood, peanut butter & cocoa Magnesium salts can be given but can produce diarrhea IV Magnesium sulfate by infusion pump at a rate not to exceed 150 mg/min or 67 mEq over 8 hours Magnesium sulfate given too rapidly can produce alteration in cardiac conduction leading to heart block or asystole observe cardiac rate, rhythum, hypotension & respiratory distress 30. Know treatment options for Hypermagnesemia and precautions needed. ---IV calcium gluconate can be given in emergencies such as respiratory depression or cardiac conduction problems along with hemodialysis and ventilator suppport Lasix and N/S or Lactated Ringers may enhance magnesium excretion 31. Know how to determine acid base imbalance from an ABG and treatment for clients experiencing each acid-base imbalance ---Respiratory acidosis Improve ventilation Bronchodilators for bronchospasm Antibiotics for infection Thrombolytics and/or anticoagulants for Pulmonary Embolism Adequate hydration O2 ---Respiratory Alkalosis - hyperventilation Treat underlying problem Decreased rapid breathing Breathe into paper bag Sedatives may help anxiety ---Metabolic Acidosis Correct metabolic disorder

Eliminate source of chloride if excessive intake was the cause Bicarbonate can be administered Hyperkalemia can occur with acidosis so watch for hypokalemia with reversal of acidosis Monitor KCL level ---Metabolic Alkalosis Correct metabolic imbalance Strict I & O Administration of N/S Monitor KCL level patient may be hypokalemic if so KCL replacement H2 receptor antagonists may help to reduce gastric HCL (Hydrochloric acid) and reduce alkalosis associated with gastric suction