hypotonic solution
a solution that causes a cell to swell because of osmosis
hypertonic solution
a solution that causes a cell to shrink because of osmosis
isotonic solution
A solution with the same concentration of water and solutes as inside a cell, resulting in the cell retaining its normal shape because there is no net movement of water.
normal sodium
135-145
normal potassium
3.5-5.0
normal chloride
95-105
normal calcium
8.5-10.5
Normal Magnesium
1.8-2.6
water
An older adult has less total body _________ than a younger adult.
True
T/F: An obese adult has less total water than a lean adult of the same weight because fat cells contain almost no water.
less
mostly water
little water
Women of any age have ________ total body water and a higher risk for dehydration than men of similar sizes and ages. This difference is because men tend to have more muscle mass than women and because women have more body fat. (Muscle cells contain _____
2300 mL
An adult takes in about how much fluid daily from food and liquids?
400 to 600 mL.
The minimum amount of urine per day needed to excrete toxic waste products is:
aldosterone
secreted by the adrenal cortex whenever sodium levels in the extracellular fluid (ECF) are low.
aldosterone
prevents both water and sodium loss. When it is secreted, it acts on the kidney nephrons, triggering them to reabsorb sodium and water from the urine back into the blood. This action increases blood osmolarity and blood volume. It also promotes kidney pot
isotonic
0.9% saline
hypotonic
0.45% saline
isotonic
5% dextrose in water (D5W)
hypertonic
10% dextrose in water (D10W)
hypertonic
5% dextrose in 0.9% saline
hypertonic
5% dextrose in 0.45% saline
isotonic
5% dextrose in 0.225% saline
isotonic
Ringer's lactate
hypertonic
5% dextrose in Ringer's lactate
fall risk
Assess any patient with a problem of fluid and electrolyte balance for:
UAP (unlicensed assistant personnel)
Supervise the oral fluid therapy and intake and output measurement aspects of care delegated to
fluid overload
Use a pump or controller to deliver IV fluids to patients with
20 mEq/hr
Do not give IV potassium at a rate greater than
Potassium
Never give __________________ supplements by the IM, subcutaneous, or IV push routes.
gait belt
Use a ________ ________ when assisting a patient with muscle weakness to walk or transfer.
Potassium
Use a pump or controller when giving IV ____________-containing solutions.
hourly
Assess the IV site __________ of an adult receiving IV solutions containing potassium and document its condition.
lift sheet
Use a ________ __________ to move or reposition a patient with chronic hypocalcemia.
sternum
Assess skin turgor on the forehead or _____________ of older patients.
fluid and electrolyte balance
Ask patients about the use of drugs such as diuretics, laxatives, salt substitutes, and antihypertensives that may alter what?
hour
Monitor the cardiac and pulmonary status at least every ________ when patients with dehydration are receiving IV fluid replacement therapy.
hyperkalemia
Assess all patients with ____________________ for cardiac dysrhythmias and ECG abnormalities, especially tall T waves, conduction delays, and heart block.
Hypokalemia
Assess the respiratory status of all patients with
C. Extracellular fluid (ECF) osmolarity is unchanged; body weight increases
What immediate response does the nurse expect as a result of infusing 1 L of an isotonic intravenous solution into a client over a 3-hour time period if urine output remains at 100 mL per hour?
A. Extracellular fluid (ECF) osmolarity increases; body weigh
A. Assess the skin turgor on the client's forehead.
When evaluating the hydration status of a new 84-year-old nursing home client, the nurse observes tenting of the skin on the back of the client's hand. What is the nurse's best action?
A. Assess the skin turgor on the client's forehead.
B. Ask the client
B. 42-year-old client who has diabetes insipidus
D. 68-year-old client with poorly controlled type 2 diabetes mellitus
E. 72-year-old client taking 80 mg of furosemide orally every day
F. 74-year-old undergoing a bowel preparation with multiple enemas bef
For which clients is it most important for the nurse to check frequently for dehydration? Select all that apply.
A. 24-year-old athlete who is NPO for 4 hours awaiting an appendectomy
B. 42-year-old client who has diabetes insipidus
C. 56-year-old client
D. Blood pressure has increased from 100/50 mm Hg to 112/70 mm Hg.
A client is receiving 250 mL of a 3% sodium chloride solution intravenously for severe hyponatremia. Which signs or symptoms indicate to the nurse that this therapy is effective?
A. The client reports hand swelling.
B. Bowel sounds are present in all four
B. Cantaloupe, broccoli, sweet potatoes
Which food items selected by a client who must restrict potassium because of a continuing risk for hyperkalemia indicates to the nurse that more teaching is needed?
A. Strawberries, Cheerios, eggs
B. Cantaloupe, broccoli, sweet potatoes
C. Apple pie, blac
7.35-7.45
normal ph
80-100
normal PaO2
35-45
normal PaCO2
21-28
normal bicarbonate
3-7
normal lactate
bicarbonate and ICF
The two most common chemical buffers are
albumin and globulins
Protein buffers are the most common buffers. Extracellular protein buffers are
hemoglobin
A major intracellular protein buffer is:
respiratory system
When chemical buffers alone cannot prevent changes in blood pH, the _____________ _____________is the second line of defense against changes.
kidneys
The ____________ are the third line of defense against wide changes in body fluid pH.
compensation
In the process of __________________, the body adapts to attempt to correct changes in blood pH and maintain ACID-BASE BALANCE.
cardiovascular; cardiac arrest
Assess the _____________________ system first in any patient at risk for acidosis because acidosis can lead to ___________ ___________ from the accompanying hyperkalemia. If cardiac changes are present, respond by reporting these changes immediately to th
tall and peaked; widened
With worsening acidosis or with acidosis and hyperkalemia (elevated blood potassium levels), heart rate decreases, T waves become ________ ______ ___________, and QRS complexes are ______________.
Kussmaul respirations
If acidosis is metabolic in origin, the rate and depth of breathing increase as the hydrogen ion level rises. Breaths are deep and rapid and not under voluntary control, a pattern called
D. Blood hydrogen ion levels and blood carbon dioxide levels are directly related so, when the level of one increases, the level of the other increases to the same degree.
How are blood hydrogen ion levels and blood carbon dioxide levels related?
A. These two blood values are negatively related to the extent that, as carbon dioxide levels rise, the concentration of hydrogen ions decreases.
B. Carbon dioxide is attached to a
B. HCO3
D. PaCO2
E. PaO2
Which blood laboratory values does the nurse need to evaluate to determine whether the client's acidosis has a respiratory origin or a metabolic origin? Select all that apply.
A. Calcium
B. HCO3?
C. Lactic acid (lactate)
D. PaCO2
E. PaO2
F. pH
G. Potassiu
bronchodilators, anti-inflammatories, and mucolytics.
Drug categories useful for respiratory acidosis include:
metabolic alkalosis
an acid-base imbalance caused by either an increase of bases (base excess) or a decrease of acids (acid deficit). Base excesses are caused by excessive intake of bicarbonates, carbonates, acetates, and citrates.
respiratory alkalosis
usually caused by an excessive loss of CO2 through hyperventilation (rapid respirations). Patients may hyperventilate in response to anxiety, fear, or improper settings on mechanical ventilators.
B. "When you breathe fast, you can lose too much carbon dioxide, and rebreathing this air keeps you from becoming dizzy and falling.
A client asks why the provider has recommended that he breathe into a paper bag for several minutes when his anxiety disorder causes him to hyperventilate. What is the nurse's best response?
A. "Even your exhaled breath still has some oxygen in it, and re
airway
Assess the ___________ of any patient who has acute respiratory acidosis.
2 hours
Assess heart rate and rhythm at least every _____________ for any patient with an acid-base imbalance.
fall precautions
Use what precautions for any patient with a problem in ACID-BASE BALANCE.
2 hours
Monitor the neurologic status at least every _____________ in patients being treated for a problem with ACID-BASE BALANCE.
acid base balance
Assess the ________ ________ _________ of any patient with new-onset muscle weakness.
ph
Anything that increases the CO2 level in the blood increases the hydrogen ion content and lowers the what?
smoking
Instruct patients at continuing risk for respiratory acidosis to stop what:
acidosis; alkalosis
pH values below 7.35 indicate ___________; pH values above 7.45 indicate ____________.
gas exchange
Assess the ______ _________ status of any patient with acute confusion.
acidic; alkaline
The more hydrogen ions present, the more _________ the fluid; the fewer hydrogen ions present, the more ____________ the fluid.
Chemical
______________ blood buffers are the immediate way that acid-base imbalances are corrected.
Kidneys
The ___________ regulate the amount of hydrogen and bicarbonate ions that are retained or excreted by the body.
bicarbonate
If a lung problem causes retention of carbon dioxide, the healthy kidney compensates by increasing the amount of _____________ that is produced and retained.
Acidosis
______________ reduces the excitability of cardiovascular muscle, neurons, skeletal muscle, and GI smooth muscle.
Alkalosis
________________ increases the sensitivity of excitable tissues, allowing them to over-respond to normal stimuli and respond even without stimulation.
isotonic
Parenteral solutions within that normal range are
hypertonic
fluids greater than 300 mOsm/L are
hypotonic
fluids less than 270 mOsm/L are
Phlebitis
the inflammation of a vein caused by mechanical, chemical, or bacterial irritation.
infiltration
occurs when IV solution leaks into the tissues around the vein.
Hypertonic
________________ solutions are used to correct altered FLUID AND ELECTROLYTE BALANCE and acid-base imbalances by moving water out of the body's cells and into the bloodstream.
fluid overload
When an isotonic solution (solution that is infused into the body) is used, water does not move into or out of the body's cells. Therefore patients, especially older adults, receiving isotonic solutions are at risk for
hypotonic
__________- solutions move water into cells to expand them. Patients receiving either hypertonic or hypotonic fluids are at risk for phlebitis and infiltration.
thrombosis
blood clot in the vein
Phlebitis
Drugs such as amiodarone (Cordarone), vancomycin (Vancocin), and ciprofloxacin (Cipro IV) are venous irritants that have a pH less than 5.0. __________ occurs when patients require long-term infusion of these drugs in peripheral circulation.
unique facility identifier
lot number related to donor
product code
ABO and Rh group of the donor
Most organizations use the International Society of Blood Transfusion (ISBT) universal bar-coding system to ensure the right blood for the right patient (Fig. 13-1). The ISBT system includes four components that must be present on the blood label both in
Blood transfusion
__________ _________________ is given by using packed red blood cells, created by removing a large part of the plasma from whole blood. Other available blood components include platelets, fresh frozen plasma, albumin, and several specific clotting factors
rate of infusion
Determine that the IV prescription is appropriate for the patient and clarify any questions with the primary health care provider before administration. Be sure to check for the accuracy and completeness of the treatment prescription. An example of an inc
Drug name
Dose route
Frequency of administration
Time of administration
Length of time for infusion
Purpose (required in some health care facilities, especially nursing homes)
Complete IV therapy prescription includes what 6 things?
D. Stop the infusion of the drug immediately.
A client receiving gentamycin intravenously reports that the peripheral IV insertion site has become painful and reddened. What action will the nurse take first?
A. Report the client's problem to the primary health care provider.
B. Document findings and
Acidosis
1. An 85-year-old patient has been experiencing diarrhea for the past 3 days. The client has only been able to drink small sips of water with no other intake. You are the nurse on this case and you suspect that this client is experiencing an acid-base imb
Symptoms of the body's attempt to decrease hydrogen ion retention
If the pH of the blood is below 7.30, what should the nurse monitor the patient for?
Symptoms of the body's attempt to increase hydrogen ion retention
Symptoms of the body's attempt to retain CO2
Symptoms of the body's attempt to decrease hydrogen ion ret
Respiratory alkalosis
occurs as a result of excessive exhalation of CO2 as a result of hyperventilation.
metabolic acidosis
occurs due to excess hydrogen ions in the blood and little bicarb.
respiratory alkalosis
The following are conditions which may cause what:
Fear
Anxiety
Mechanical ventilation
Hiking at high altitudes
Pain
Salicylate overdose
Nicotine overdose
Increased metabolic states
Serum potassium 5.7 mEq/L
The nurse is evaluating the laboratory work of a patient who has uncontrolled metabolic acidosis. Which outcome would result from this condition?
pH 7.40
PaO2 98 mm Hg
Bicarbonate 38 mEq/L
Serum potassium 5.7 mEq/L
Alkalosis
A person experiencing heartburn may take excessive bicarbonate of soda, resulting in what condition?
Low blood pH level
Alkalosis
Acidosis
High hydrogen level
Patient complains of numbness or paresthesia
A 50-year-old patient is admitted to the ED with crushing pain of his chest. He is experiencing increased anxiety and states he is "really scared," Respiratory rate is 55 breaths/minute, and the breaths are deep. The nurse is unsuccessful in calming the p
base
a substance that binds (reduces) free hydrogen ions in solution. Strong bases bind hydrogen ions easily; weak bases bind less readily.
alkalosis
an acid-base imbalance in which blood pH is above normal.
acid
a substance that releases hydrogen ions when dissolved in water. The strength of an acid is measured by how easily it releases hydrogen ions in solution.
acidosis
an acid-base imbalance in which blood pH is below normal.
hypoventilation
is a state in which gas exchange at the alveolar-capillary membrane is inadequate so that too little oxygen reaches the blood and carbon dioxide is retained.
hypocalcemia
A total serum calcium level below 9.0 mg/dL or 2.25 mmol/L
hypokalemia
A decreased serum potassium level; a common electrolyte imbalance.
tetany
Continuous contractions of muscle groups; hyperexcitability of nerves and muscles.
hyperkalemia
An elevated level of potassium in the blood.
hyperventilation
A state of increased rate and depth of breathing.
anaeroboic
Lacking adequate oxygen.
smallest; shortest- 24-26 gauge- 3/4 inch
Which catheter gauge? Not ideal for viscous infusions
Expect blood transfusion to take longer
Preferred for infants and small children
18 gauge
Which catheter gauge? Preferred size for surgery
Vein needs to be large enough to accommodate the catheter
14-16 gauge
Which catheter gauge? For trauma and surgical patients requiring rapid fluid resuscitation
Needs to be in a vein that can accommodate it
22 gauge
Which catheter gauge? Adequate for most therapies; blood can infuse without damage
20 gauge (1-1 1/4 inch)
Which catheter gauge? Adequate for all therapies
Most providers of anesthesia prefer not to use a smaller size than this for surgery cases