FLUID, ELECTROLYTES, & ACID-BASE IMBALANCES
Causes
FLUID EXCESS Manifestations
• Kidney failure
• Dyspnea
o Can’t urinate
• ↓ lab values
• Liver failure
o hemodilution
o ↓ albumin
• ↑ urine output
o ↓ aldosterone
• ↑ BP
o Portal hypertension
• Bounding pulse (strong)
• ♡ failure
• Jugular vein distention (JVD)
o Unable to pump
o Visble, engored with
sufficiently to rest of body
excess fluid
o Fluid back ups
• Edema
• ↑ Na+ intake
o H2O follows
• IV fluids
• Blood transfusions
Causes
FLUID DEFICIT
• Excessive loss
• Inadequate intake
Risk factors
• Vomiting
• Diarrhea
• Excessive sweating
o Lose of Na + H2O
• ↓ H2O intake
• Hemorrhage
Causes
• ↑ capillary hydrostatic pressure
o Accumulation of excess
interstitial fluid
• ↓ capillary osmotic pressure
o Hypoalbuminemia
Manifestations
• Dry mucous membrane
• ↓ skin turgor
o Elasticity loss
• ↑ lab values
o Hemoconcentration
• ↓ urine output
o ↑ ADH = reabsorb H2O
• ↓ BP
o ↓ fluid volume in vessels
• Fast (tachycardia) & weak ♡ rate
o compensates
• Confusion
Complications
• Restriction in ROM at joints
• Pain
• ↓ arterial ⟳
• Skin breakdown/damage
o ↓ absorption
• ↑ capillary permeability
o Forces H2O out
o ↑ production of tissue fluid
• Obstruction of the lymphatic ⟳
o Blockage of lymph vessels
that drain fluid from tissue =
lymphedema
EDEMA
HYPONATREMIA
HYPERNATREMIA
Causes
<135 Causes
>145
+
+
• Na ↓
• intake of Na ↑
• ↑ H2O
• ↓ H2O
Risk factors
Risk factors
• Excessive sweating
• Excessive sweating
• Vomiting, diarrhea
• Vomiting, diarrhea
• Excessive H2O intake
• Inadequate H2O intake
o H2O intoxication
Manifestations
o Dilution hyponatremia
• Signs of fluid deficit
Manifestations
o Dry mucous membrane
• Muscle cramps, weakness + fatigue
o Skin tumor
o ↓ BP
• Abdominal cramps
o Tachycardia
• Lethargy, confusion, seizures
o ↓ urine
o ↑ intracellular water = cerebral
• Thirst
edema
• Headache, agitation
o H2O movement out brain cells
HYPOKALEMIA
Causes
• Diuretics
o Urinate more
• Inadequate K+ intake
• Excessive diarrhea
• NG tube suctioning
Manifestations
• Muscle fatigue/cramps
• parathesis
• Nausea/vomiting/constipation
o ↓ GI motility
• ♡ dysrhythmias
HYPOCALEMIA
HYPERKALEMIA
< 3.5 Causes
> 5.0
• K+ sparing diuretics
o Conserves K+
• Renal failure
o ∅ urinate
o Kidney ∅ K+
• Burns/crush injuries
o Cellular injury release extra K+ due
to damage in the blood
Manifestations
• Muscle weakness/paralysis
• Parathesis
• ♡ dysrhythmias
HYPERCALCEMIA
Causes
< 8.5 Causes
> 10.5
• Hypoparathyroidism
• Hyperparathyroidism
o Pulls Ca out of bone to bloodstream
o ↓ intestinal ca+ absorption
• Bone cancer
• Malabsorption issues
o Release Ca to blood
o ↓ Intestinal absorption of D
• Immobility
• Vitamin D deficiency
o Demineralize = release Ca in
o Difficulty promoting Ca movement from
bloodstream
bone/intestine to blood
Manifestations
Manifestations
• Muscle weakness
• Muscle twitching
o ↓ neuromuscular activity
o ↑ excitability of nerve membranes =
spontaneous skeletal muscle
• ↓ muscle tone
stimulation
o Depress neuromuscular activity
• Tetany
• Spontaneous fractures
o Muscle spasms
o ↓ bone density
o ↑ excitability of nerve membranes =
• Kidney stones
spontaneous skeletal muscle
o Excess amount of Ca in bloodstream
stimulation
• ♡ dysrhythmias
• Paresthesia
o ↑ strength of contractions
• Chvostek + Trousseau sign
o C: flick facial nerve: spasm
o T: pump BP cuff, wrist spasm
•
♡
dysrhythmias
Cause
• Hypercapnia
• Hypoventilation
Compensation
• Lungs: x
• Kidney: excrete acid, retain bicarb
Risk factors
• Opiate overdose
• Resp. diseases
• Sleep apnea
• Airway obstruction
• Anesthetics
• COPD
RESPIRATORY ACIDOSIS
Manifestations
• Headache → confusion → lethargy → coma
• Tremors
• Paralysis
Cause
• Hypocapnia
• Hyperventilation
Compensation
• Lungs: x
• Kidney: retain acid, excrete bicarb
Risk factors
• Anxiety/Panic attacks
• High Fever
• Brain injuries
• Mechanical ventilation
Manifestations RESPIRATORY ALKALOSIS
• Agitated/Irritable
• Light-headedness
• Tetany
• Paresthesia
• Seizures/comas
Cause
• Gain acid
• Loss of bicarb
Compensations
• Lungs: kussmaul’s resp.
• Kidney: excrete acid, retain bicarb
METABOLIC ACIDOSIS
ABG
• pH < 7.35
• CO2 > 35
• HCO3
ABG
• pH > 7,45
• CO2 < 35
• HCO3
ABG
• pH < 7.35
• CO2
• HCO3 < 22
Risk factors
• ↑ in acid
o Salicylate toxicity
§ aspirin
o Diabetic
ketoacidosis
o Renal failure
o Strenuous
exercise/sepsis
§ Buildup of
lactic acid
• ↓ of bicarb
o diarrhea
Manifestations
• Headache → confusion → lethargy →
coma
• Kussmaul’s resp.
o ↑ rate + depth of breathing
• Nausea, vomiting, abdominal pain
• ♡ dysrhythmias
Cause
• Loss of acid
• Gain of bicarb
Compensation
• Lungs: ↓ rate + depth of breathing
• Kidney: retain acid, excrete bicarb
METABOLIC ALKALOSIS
Risk factors
Manifestations
• ↓in acid
• Agitation/irritable
o Vomiting
• Light-headedness
o NG tube suctioning
• Tetany
o Diuretics
• Paresthesia
• ↑ of bicarb
• Seizures
o Excess intake of
antacids
ABG
• pH > 7.45
• CO2
• HCO3 > 26
2: Fluid
1. A nurse is teaching a client about causes of fluid excess. Which cause indicates a new for further
instruction?
a. Renal failure
b. Administration of IV fluids
c. Excess sweating
d. Heart failure
2. A nurse is teaching a client about manifestations of fluid excess. Which manifestations indicate education
was successful?
a. Dyspnea
b. Weak pulse
3.
4.
5.
6.
1.
2.
3.
c. Hyponatremia
d. ↑ BP
e. ↓ urine output
A nurse is teaching client about manifestations of fluid excess. Which manifestations indicates a need for
further education?
a. Dry mucous membrane
b. Bound pulse
c. ↓ BUN
d. Edema
A nurse is teaching a client about the cause of edema. Which indicates a need for further instruction>
a. ↑ capillary hydrostatic pressure
b. ↓ capillary osmotic pressure
c. ↑ capillary permeability
d. ↓ capillary hydrostatic pressure
A nurse is teaching a client about risk factors for fluid deficit. Which indicate understanding of teaching?
a. Vomiting
b. Kidney failure
c. Insufficient H2O intake
d. Diarrhea
e. Tachycardia
A nurse is teaching a client manifestations of fluid deficit. Which indicate a need for further education?
a. Dry mucous membranes
b. ↑ lab values
c. Hypotension
d. ↑ urine output
2: Electrolyte imbalance
A nurse is teaching a student about the risk factors for hyponatremia. Which indicates teaching was
effective?
a. ↓ ADH secretion
b. ↓ fluid intake
c. ↑ H2O intake
d. ↑ aldosterone secretion
A nurse is teaching a student about the manifestations of hyponatremia. Which indicate a need for further
teaching?
a. Confusion
b. Abdominal cramps
c. Thirst
d. Muscle weakness
A nurse would suspect hypernatremia in which client?
4.
5.
6.
7.
8.
9.
10.
a. A client following a ↓ NA diet
b. A client w/ hypoaldosteronism
c. A client admitted for dehydration
d. A client w/ heart failure
A nurse is teaching a student about causes of hypokalemia. Which indicates a need for further
education?
a. Diuretics
b. Crush injuries
c. Diarrhea
d. NG suctioning
A nurse is teaching a student about causes of hyperkalemia. Which indicates education was effective?
a. Vomiting
b. Renal failure
c. Inadequate potassium intake
d. Inadequate fluid intake
What is your priority concern in both potassium imbalance?
a. Cardiac dysrhythmias
Which of the following is a cause of hypocalcemia?
a. Hypoparathyroidism
b. Bone cancer
c. Immobility
d. ↑ Vitamin D intake
A nurse is teaching a client about the manifestations of hypocalcemia. Which are correct?
a. Tetany
b. Paresthesia
c. Chvostek sign
d. Trousseau sign
e. Kidney stones
A nurse is teaching a client about the cause of hypercalcemia. Which are correct?
a. Immobility
b. Hypoparathyroidism
c. Malabsorption issues
d. Bone cancer
e. Lack of exercise
A nurse is teaching a client about the manifestations of hypercalcemia. Which indicate a need for further
instruction?
a. Spontaneous fractures
b. Kidney stones
c. Numbness and tingling
d. Constipation
CHAPTER 2
1. A nurse is teaching a client about the manifestations of hypokalemia. Which
manifestation, if stated by the client, indicates teaching was effective?
a. Cardiac dysrhythmias
2. The movement of water from the interstitial space to the vascular space is known as
what?
a. Osmosis
3. What is the role of ADH in maintaining fluid balance?
a. Reabsorption of water
4. A client comes in with fluid excess. Which manifestations does the nurse expect?
a. High blood pressure
5. Which manifestations of fluid deficit by the nurse requires further teaching?
a. Bounding pulse
b. Low blood pressure
c. Tachycardia
d. Decreased urine output
6. A client has been profusely sweating and is complaining of being thirsty. What
electrolyte imbalance does the nurse suspect?
a. Hypernatremia
i. Due to loss of water through sweat, and showing manifestations of fluid
deficit
7. What is a manifestation of hyponatremia?
a. Seizures
8. A client comes in with bone cancer. What electrolyte imbalance does the nurse suspect?
a. Hypercalcemia
i. Due to the destruction of the bone & release of calcium into the blood
stream.
9. How does the respiratory system maintain acid base balance?
a. Retaining or excreting CO2
10. What is the cause of respiratory acidosis?
a. Hypercapnia
i. Elevated CO2 (acid) which results in respiratory acidosis. Risk factors:
pulmonary problems- pneumonia, sleep apnea, asthma, COPD. Airway
obstruction- hypoventilation & accumulation of CO2.
11. What is a normal ABG?
a. pH. 7.40
b. CO2 35
c. HCO3 22
12. A client comes in with sepsis. For which acid-base imbalance does the nurse monitor?
a. Metabolic acidosis
13. A client has been taking a diuretic medication. What acid base imbalance does the nurse
expect?
a. Metabolic alkalosis
14. Which ABG result is indicative of respiratory acidosis?
a. pH 7.22
b. CO2 60
c. HCO3 26
15. What is the cause of hyponatremia?
a. Taking in too much water
i. Causes dilution of the sodium in the body