What are the s/s of fluid overload? - ANSWER - poor skin turgor
- flat neck veins?
- hypotension
- tachycardia
- weak threads pulse
- crackles in the lungs
- weight gain
- bounding pulses
What diagnostic test will the nurse anticipate for a patient with suspected fluid overload? -
ANSWER - chest x-ray
- lab draw (CBC, CMP, BNP)
- possible ABG
THINK:
- edema, possible HF, sedentary lifestyle
What is the interpretation for the following:
- pH 7.47
- CO2 36
HCO3 28 - ANSWER Metabolic alkalosis
What are the parameters for a IV fluid order? - ANSWER
What fluid is hypotonic? (0.45% NS, 0.9% NS, or 3% NS) - ANSWER 0.45% NS
1
,You have the following order:
- infuse 1200 ml 0.9% NaCl over 5hrs IV
What is the hourly rate? - ANSWER 240ml/hr
What is the interpretation of the following:
- pH 7.28
- CO2 42
- HCO3 18 - ANSWER Metabolic acidosis
What do you anticipate to do when a client has hypovolemia? - ANSWER - start IV (iso-
tonic solution)
- give fluid bolus to rehydrate (maybe 250ml bolus)
- NS or LR (abt a L)
- monitor UO
REMEMBER: pt most likely a fall risk
What is the interpretation of the following:
- pH 7.32
- CO2 47
- HCO3 24 - ANSWER Respiratory acidosis
Which foods contain high potassium? - ANSWER - Green leafy veggies (spinach)
- bananas
- prawns
- oranges
- potatoes
2
,What type of acid-base imbalance would you expect when the client has NG tube suction in-
termittently? - ANSWER
What are your PRIORITY actions for a client with the following lab results?
- K 3.2 mEq/L
- Na 128 mEq/L - ANSWER - notify the provider, they are both low
- patient needs K and fluid restriction (don't want to dilute already low Na)
THINK:
- normal K+ = 3.5-5.3, normal Na = 135.145
- low K+ (more sensitive) & slightly low Na
- are they malnourished and not eating well? On a diuretic?
- educate pt on importance of daily K+
Which client has a high risk of hypokalemia? - ANSWER - client with NG suction
- client with diarrhea & vomiting
THINK:
- pt possibly on diuretic
What should the nurse asses for a pt with suspected fluid overload? - ANSWER - auscul-
tate lung sounds & assess respiratory status (incentive spirometer recommended to avoid
pneumonia)
- check peripheral pulses (bc furthest away)
- assess for edema
- vital signs
Which fluid is HYPERtonic? (0.9% NaCl, 0.45% NaCl, 3% NaCl) - ANSWER 3% NaCl
Name an isotonic intravenous fluid. - ANSWER Lactated Ringer's or 0.9% NS
3
, What type of acid-base imbalance would you expect when the client has opioid overdose? -
ANSWER Respiratory acidosis
THINK:
- CNS depression = less breaths, not exhaling CO2 and can lead to acidosis
- need to open up alveoli with use of incentive spirometer
- panic attack = respiratory alkalosis = hyperventilating/too many breaths/not enough O2 &
too little CO2 — hands begin cramping due to lack of O2 — PAPER BAG
What are some of the neuromuscular effects of hypvolemia ? - ANSWER Confusion
Weakness
Seizures
Syncope
Dizziness
What's are some of the complications of IV therapy? - ANSWER Fluid overload, phlebitis ,
infiltration (fluid going out of vein and into surrounding area)
THINK:
Infection (break of skin integrity), vesication (depending on solution — vancomycin irrita-
tion), extravasation (can be emergent)
What are the causes of respiratory alkalosis? - ANSWER hyperventilation
gas exchange result in a carbon dioxide (CO2) deficit
common symptoms associated with respiratory alkalosis - ANSWER rapid, deep respira-
tions
hypokalemia
tetany, paresthesia, hyperreflexia
Chvostek and Trousseau's sign
4
- flat neck veins?
- hypotension
- tachycardia
- weak threads pulse
- crackles in the lungs
- weight gain
- bounding pulses
What diagnostic test will the nurse anticipate for a patient with suspected fluid overload? -
ANSWER - chest x-ray
- lab draw (CBC, CMP, BNP)
- possible ABG
THINK:
- edema, possible HF, sedentary lifestyle
What is the interpretation for the following:
- pH 7.47
- CO2 36
HCO3 28 - ANSWER Metabolic alkalosis
What are the parameters for a IV fluid order? - ANSWER
What fluid is hypotonic? (0.45% NS, 0.9% NS, or 3% NS) - ANSWER 0.45% NS
1
,You have the following order:
- infuse 1200 ml 0.9% NaCl over 5hrs IV
What is the hourly rate? - ANSWER 240ml/hr
What is the interpretation of the following:
- pH 7.28
- CO2 42
- HCO3 18 - ANSWER Metabolic acidosis
What do you anticipate to do when a client has hypovolemia? - ANSWER - start IV (iso-
tonic solution)
- give fluid bolus to rehydrate (maybe 250ml bolus)
- NS or LR (abt a L)
- monitor UO
REMEMBER: pt most likely a fall risk
What is the interpretation of the following:
- pH 7.32
- CO2 47
- HCO3 24 - ANSWER Respiratory acidosis
Which foods contain high potassium? - ANSWER - Green leafy veggies (spinach)
- bananas
- prawns
- oranges
- potatoes
2
,What type of acid-base imbalance would you expect when the client has NG tube suction in-
termittently? - ANSWER
What are your PRIORITY actions for a client with the following lab results?
- K 3.2 mEq/L
- Na 128 mEq/L - ANSWER - notify the provider, they are both low
- patient needs K and fluid restriction (don't want to dilute already low Na)
THINK:
- normal K+ = 3.5-5.3, normal Na = 135.145
- low K+ (more sensitive) & slightly low Na
- are they malnourished and not eating well? On a diuretic?
- educate pt on importance of daily K+
Which client has a high risk of hypokalemia? - ANSWER - client with NG suction
- client with diarrhea & vomiting
THINK:
- pt possibly on diuretic
What should the nurse asses for a pt with suspected fluid overload? - ANSWER - auscul-
tate lung sounds & assess respiratory status (incentive spirometer recommended to avoid
pneumonia)
- check peripheral pulses (bc furthest away)
- assess for edema
- vital signs
Which fluid is HYPERtonic? (0.9% NaCl, 0.45% NaCl, 3% NaCl) - ANSWER 3% NaCl
Name an isotonic intravenous fluid. - ANSWER Lactated Ringer's or 0.9% NS
3
, What type of acid-base imbalance would you expect when the client has opioid overdose? -
ANSWER Respiratory acidosis
THINK:
- CNS depression = less breaths, not exhaling CO2 and can lead to acidosis
- need to open up alveoli with use of incentive spirometer
- panic attack = respiratory alkalosis = hyperventilating/too many breaths/not enough O2 &
too little CO2 — hands begin cramping due to lack of O2 — PAPER BAG
What are some of the neuromuscular effects of hypvolemia ? - ANSWER Confusion
Weakness
Seizures
Syncope
Dizziness
What's are some of the complications of IV therapy? - ANSWER Fluid overload, phlebitis ,
infiltration (fluid going out of vein and into surrounding area)
THINK:
Infection (break of skin integrity), vesication (depending on solution — vancomycin irrita-
tion), extravasation (can be emergent)
What are the causes of respiratory alkalosis? - ANSWER hyperventilation
gas exchange result in a carbon dioxide (CO2) deficit
common symptoms associated with respiratory alkalosis - ANSWER rapid, deep respira-
tions
hypokalemia
tetany, paresthesia, hyperreflexia
Chvostek and Trousseau's sign
4
