Fluid and Electrolytes....

1. A client has hypernatremia. What sodium levels should the nurse

anticipate?

146+

2. Explain hypernatremia in relation to total body water. What are some

causes of hypernatremia?

Hypernatremia is a greater than normal concentration of sodium in the blood.

When water is lost through diuretics or not enough is ingested d/t reduced thirst
sensation/sickness, hypernatremia can occur. Other causes of hypernatremia
are diabetes insipidus or conditions of the hypothalamus or pituitary.

3. What IV fluids should the nurse anticipate administering if the client has
too much sodium (Na) in the blood and the client’s total body water is low?

A hypotonic electrolyte solution (0.2% or .45% sodium chloride) or a salt free

solution. 5% dextrose in water would not be ordered because this would
encourage diuresis. Anticipate the IV fluids to be administered slowly to
decrease risk of cerebral edema.

Endocrine….
4. What is diabetes insipidus (DI)? What happens with the Na level and the
total body water with DI? How is DI treated?

DI is caused by too little ADH. This is usually because of a defect in the

hypothalamus or pituitary such as trama, irradiation, or cranial surgery. The
serum sodium will increase and the total body water will decrease. It is treated
with IV therapy to match output and correct electrolytes, monitoring i&o’s, weight,
sp gravity, hypotension, and avoiding caffeine and tea. Medications such as
desmopressin and vasopressin are given to replace ADH. Patients will need to
understand that the medication will be taken life long.

5. What role does hyperaldosteronism and Cushing’s syndrome play in

total body water and Na levels?

Hyperaldosteronism is caused by a high production of aldosterone by the adrenal

gland. This hormone controls sodium and potassium balance which controls
water balance which maintains bp and blood volume. Hyperaldosteronism
causes high blood pressure and a low serum potassium level. Spironolactone is
usually given for this condition.

Cushing’s syndrome occurs with high levels of cortisol. Cushing’s syndrome can
be caused by glucocorticoids. Sometimes Cushing’s is causes by the cortex of
one or both of the adrenal glands producing to much hydrocortisone. This can
be caused by a tumor in the gland or in the pituitary gland. If the tumor is in the
pituitary this condition is called Cushing’s disease. Cushing’s syndrome causes
increased water retension and sodium levels.

6. What are the expected abnormal lab values associated with the
followingendocrine disorders:

Diabetes mellitus-high serum glucose and high A1c, Cushing’s disease-high

cortisol and sodium, Addison’s disease-high plasma ACTH and low plasma
cortisol, and Hypothyroidism- low T4 and high tsh.

Renal…

7. A client is in acute renal failure (ARF). What should the nurse anticipate
the client’s creatinine, BUN and potassium levels to be?

The serum creatinine will increase, the GFR will decrease, BUN will increase,
and potassium will be high.

8. Will the client in acute renal failure be in metabolic acidosis or alkalosis?

Why?

It will be metabolic acidosis because of the kidney’s inability to secrete H+ and a

loss of bicarb from the kidneys.
9. What education should be provided to the client following hemodialysis?

Kidney failure results in the build-up of fluids and wastes in the body.
Hemodialysis is a way to clean these wastes from the blood. The nurse will be
accessing your blood through a fistula connecting a vein to a nearby artery in the
arm. One needle will be inserted into the artery and another one into the vein.
Your blood will travel outside your body through tubing into a dialysis machine.
This is the filter that cleans your blood. The blood is then returned to your body
through another tube.

10. Explain how the following medications are useful in the treatment of
acute renal failure:

dopamine-improve renal perfusion, lasix-reduce fluid retention and makes the

body excrete potassium, kayexalate-decreases potassium levels, calcium-
antagonizes membrane effects of potassium, and clonidine-reduces tubular
blockages and decreases blood pressure.

Gastrointestinal….

11. Fill in the blanks:

With appendicitis, the first symptom is usually pain around the client’s
____belly button_____ . The pain initially may be vague, but becomes
increasingly sharp and severe. The client may have reduced
___appetite______, nausea, vomiting, and a low‐grade __fever____. As the
inflammation in the appendix increases, the pain tends to move into the
_right lower_____ abdomen and focuses directly above the appendix at a
place called _McBurney’s point___ . If the appendix ruptures, the pain may
lessen briefly.
However, then the lining of the abdominal cavity becomes inflamed and
infected. This is called peritonitis.

12. What should the nurse teach a client newly diagnosed with liver
cirrhosis to prevent further complications?

Patients need to reduce salt intake, stop drinking alcohol, and eat a nutritious
diet. Their doctor may have them take diuretics, or antibiotics depending on the
cause. When cirrhosis progressis to end-stage liver disease, patient’s will need a
liver transplant.

Integumentary….

13. A middle adult client weighing 60 kg (132 lbs) is brought to the

emergency department after being pulled from a house fire. The client has
full thickness burns to the face, chest, bilateral arms, a total body surface
area of 36%. What is the fluid replacement using the Parkland formula for
24 hours? For the first 8 hours? How much is that per hour for the first 8
hours?

24 hours: 8.6 Liters

8 hours: 4.3 liters.

Fluid Requirements = TBSA burned(%) x Wt (kg) x 4mL Give 1/2 of total

requirements in 1st 8 hours, then give 2nd half over next 16 hours.

14. What should the nurse do if a client’s wound suddenly “gives”? What
are the priority interventions and assessments?

The nurse would need to remain calm, place sterile saline soaked towels over
the wound, lower the head of the bed, maintain patient NPO, monitor for signs of
shock (tachycardia and hypotension), and take vital signs every 5 minutes.
Cardiovascular….

15. What are the warning signs of an MI?

Uncomfortable pressure, fullness, squeezing pain in the center of the chest

lasing more than a few minutes, pain spreading to the shoulders, anxiety,
paleness, increased or irregular heart beat, feeling of impending doom, pain in
upper abdomen, neck, jaw, or inside the arms or shoulders.

16. What are anticoagulants typically used to treat or prevent? What lab
measures the therapeutic level of Coumadin? Of Heparin? What are the
antidotes?

Anticoagulants are used to prevent blood clots. Coumadin lab value is INR: 2-3
/ antidote is Vit K. / Heparin lab value is aptt: 42-56 / antidote: protamine
sulfate.

17. What is a normal central venous pressure (CVP) reading? What would
cause the CVP to increase? What would cause the CVP to decrease?

2-8 in normal CVP. CVP increases with hypervolemia, forced exhalation, tension
pneumothorax, heart failure, pleural effusion, decreased cardiac output, cardiac
tamponade, mechanical ventilation and application of PEEP. Factors that
decrease CVP include hypovolemia, deep inhalation and distributive shock.

18. What could go wrong during a blood transfusion? What should the
nurse do if a transfusion reaction is suspected?

The patient could have a transfusion reaction. The signs/symptoms include

fever, chills, hives, itching, dyspnea, and hypotension. If a reaction is suspected
stop the transfusion immediately. Assess and stabilize the patient, monitor vital
signs and urine output. You or another nurse should remain with him
continuously. Keep the IV line open with NS in case treatment is needed. Save
the tubing for analysis. Report the reaction to the physician. Document
EVERYTHING.

Neurosensory…..

19. What are some nursing interventions that can decrease intracranial
pressure (ICP)? What can cause an increase in ICP (so that the nurse can
anticipate the potential increases and respond appropriately)?
A CSF leak can decrease ICP. Commonly this is a result of a lumbar puncture or
another medical procedure involving the brain or spinal cord.

Increased ICP is usually because of brain trauma.

20. What labs should the nurse monitor if a cerebrospinal infection is

suspected?

CSF for increased protein, increased glucose, and increased wbcs.

Immune….

21. What are the diagnostic criteria for AIDS?

When CD4 cells fall below 200. This is when the immune system can no longer
prevent aids defining illnesses such as candidiasis, herpes simiplex,
histoplasmosis, lymphoma, tuberculosis, wasting syndrome, etc.

22. What are the types of viral hepatitis and how are these transmitted?

There are types ABCDEF (not confirmed), and G. The most common viruses are
A, B, and C. A is commonly spread the oral-fecal route. B is spread through
blood or serum. C is usually spread through shared needles, blood transfusion,
hemodialysis, and needle sticks.

Reproductive….
23. Explain what the priority care would be for a client who recently had a

Transuretheral resection of the prostate (TURP).

Monitor for hemorrhage

Respiratory…

24. A client has a chest tube with continuous bubbling in the water seal
chamber.What does this mean and what actions should the nurse take?
What actions should the nurse take if the chest tube becomes
disconnected from the closed drainage system or pulled out?

This means that there might be a leak in the tube or connections and the nurse
should check for the leak. If the chest tube is pulled out a petroleum gauze
dressing and a 4x4 covered with an occlusive tape should be placed over the
hole in the chest. The physician should be contacted immediately. Patient
should be assessed.

25. Explain the manifestations of pulmonary edema and two possible

causes for this condition.

Pulmonary edema is an abnormal build up of fluid in the air sacs of the lungs
which leads to a shortness of breath. This is usually caused by heart failure.
As the heart fails, pressure in the veins going through the lungs starts to rise.
Because of the increased pressure in the vessels, fluid is pushed into the air
spaces in the lungs which causes shortness of breath.

This can also be caused by a heart attack or fluid overload.

26. A client who is having an asthmatic attack enters the ED. Explain the
priority actions that should be taken to assist this client.

Administer o2 as ordered, place client in high fowler’s position to facilitate air

exchange, monitor heart rate and rhythm, initiate IV access, gives meds as
prescribed, CALL RESPIRATORY!!, and remain calm.

ABGs Interpretation….

27. pH 7.36, PaCO2 67, PaO2 47, HCO3 37, What is this?

Resp acidosis

28. pH 7.18, PaCO2 38, PaO2 70, HCO3 15. What is this?

Metabolitc acidosis

What could have caused it?

Chronic renal failure, longstanding diarrhea through bicarb loss.

29. pH 7.60, PaCO2 30, PaO2 60, HCO3 22 What is this?

Resp alkalosis

What could have caused it?

hyperventilation

30. pH 7.58, PaCO2 35, PaO2 75, HCO3 50, What is this?

metabolic alkalosis

What could have caused it?

Excessive diuretic use