Fluids
What type of fluid is 0.9% normal saline and lactated ringers considered to be?
Isotonic
What is the normal potassium level
3.5-5.0 mmol/L
What electrolyte are you most concerned about for a patient experiencing vomiting and diarrhea
Potassium (specifically causing hypokalemia)
Name two nursing interventions if you suspect a patient has an air embolism from an IV
Øplace patient on left side with head and shoulders lowered
Øprevent further entrance of air
Ønotify physician immediately
Øadminister supplemental oxygen as ordered
Ømonitor VS
Name 1 out of 3 acid base buffer systems
Buffer systems- Helps to neutralize pH
Respiratory system
Renal system
What are two signs/symptoms of fluid deficiency/ dehydration
Ømarked thirst
Ødry MM
Øpoor skin turgor >3 sec
Øtemperature (low-grade)
Øtachycardia > 100 bpm
Ørespiration > 28 bpm
Øsystolic BP 10 – 15 mmHg drop in standing position
Øurine volume < 25 ml/hour
Øspecific gravity > 1.030
ØHct ↑, Hgb ↑, BUN ↑, K+ ↑
What urine test will help determine a patients hydration status
Urine specific gravity
> 1.030 indicates severe dehydration
What is Chvostek sign and what electrolyte imbalance does a positive test indicate
hypocalcemia
Chvostek sign is when you tap face over facial nerve, 2 cm anterior to earlobe, positive test results when facial muscle twitches
A patient who has IV site that is red, warm, with an oozing drainage is suspect for what condition
phlebitis
A nurse is caring for a client with a diagnosis of COPD. The nurse monitors the client for which acid-base imbalance that most likely occurs in clients with this condition?
Respiratory acidosis
Give me an example of a hypotonic fluid solution
ØHalf-strength normal saline, 0.45% (1/2 NS)
ØOne-third sodium chloride, 0.3%
What is the best/most accurate way to detect fluid balance especially in the elderly
daily weights
What electrolyte imbalance can cause cardiac dysrhythmias?
Hypo or Hyperkalemia
What does an allergic reaction at an IV site look like and what is your nursing intervention for it
Øredness
Øhives or rash
Øswelling
Ødiscomfort
Øitch in some instances
Remove IV site, use different cleaning solution and different dressing material (paper tape) if possible
A nurse is caring for a client with severe diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which acid-base disorder?
Metabolic acidosis
Give me two examples of a hypertonic solution
Ø0.45 normal saline (1/2 NS)
ØDextrose 5% in normal saline 0.9% (D5W NS)
ØDextrose 5% in 1/2 normal saline (D5W 0.5 NS)
ØDextrose 5% in 1/4 normal saline (D5W 0.25 NS)
ØDextrose 5% in Lactated Ringer’s (D5W LR)
ØAlbumin 25%
What is the normal pH range?
What is considered alkalotic and acidotic
range is Ø7.35 to 7.45.
Basic is above 7.45
acidic is below 7.35
Name the most common clinical manifestation of hyponatremia.
Mental status changes (confusion)
Describe what you would see if a patient has an infiltrated IV site
leakage of infused fluid into surrounding tissues characterized by a burning sensation and swelling
Hyperventilation would result in what acid base imbalance
Respiratory Alkalosis
How does the Antidiuretic hormone (ADH) help regulate body fluid levels
released by the posterior pituitary controls how much fluid leaves the body in the urine and causes reabsorption of water from the kidney tubules.
What is the normal HCO3- range for acid base balance
22 to 26 mEq/L
What electrolyte imbalance is a patient most at risk for when taking booth a loop diuretic and digoxin therapy
hypokalemia (digoxin toxicity)
Name 2 ways you can affect flow rate of fluids that are not on an IV pump
ØHigher containers (above the level of the patient’s heart) have faster flow rates.
ØFuller containers flow faster.
ØViscous fluids flow slower. For example, packed red blood cells will flow more slowly than 5% dextrose in water.
ØLarger needle diameter and tubing flow faster.
ØThe higher the pressure within the vein, the slower the flow. As an infusion progresses and the veins become fuller, the IV solution may drip more slowly.
Fluid will pass through a straight tube faster than through one that is coiled or hanging below the level of the cannula
ØVomiting
ØExtensive gastrointestinal suction
ØHypokalemia
ØExcessive use of antacids with bicarbonate