Fluid Electrolyte and Acid Base Questionnaire

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Fluid Electrolyte and Acid Base Questionnaire

Fluid Electrolyte and Acid Base Questionnaire

Fluid Electrolyte and Acid Base Questionnaire

CRITICAL THINKING EXERCISES

  1. A client is admitted to the emergency department after an automobile accident and complains of severe pain. Although there is no evidence of bleeding, there is extreme anxiety. Respirations are very rapid and the pulse is 110. Would the acid-base balance most likely to develop be acidosis or alkalosis, and would the cause be respiratory or metabolic? Explain.

 

 

 

 

  1. A client has several days of severe vomiting and diarrhea. ABGs reveal a pH of 7.3, PCO2 of 35, and HCO3 of 20. What acid-base imbalance is present? What assessments could you make to detect compensation efforts by the body?

 

 

 

 

 

  1. An older adult client has been living alone in an apartment. During your home health visit, the client demonstrates the following: weight loss of 5 pounds in 3 days; weak pulse; blood pressure 90/50 (baseline 115/80); oliguria with dark, tea-colored urine; weakness; and dry lips and mucous membranes. What additional data would you need to determine whether the condition is caused by decreased intake, excessive losses, or both?

 

 

 

 

 

 

 

 

 

  1. A client with a known history of congestive heart failure becomes very short of breath, anxious and diaphoretic. BP – 130/70, P – 114, RR – 36, T – 99º F. What fluid and electrolyte disturbance would be most likely, and what are the complications to anticipate? What other assessment data are needed? What aspects of nursing care, if any, could be delegated to assistive personnel?

 

 

 

 

 

CRITICAL THINKING CHALLENGE 1

The client is a 45-year-old, obese woman with type 1 diabetes who is brought to the emergency department in a coma. Her daughter tells you that the client has had pain and burning on urination for the past 3 days and that she stopped drinking fluids so that she would not have to go to the bathroom as often. The daughter also tells you that the client has not taken her insulin for at least 2 days. The client’s laboratory results are as follows: Blood glucose level is 540 mg/dL, white blood cell count (WBC) is 22,000/mm3, hematocrit is 52%, serum potassium is 7 mmol/L, serum sodium is 140 mmol/L, blood osmolarity is 380 mOsm/L, and her urine is positive for ketones.

  1. What type of dehydration does she have?

 

 

 

 

  1. What is the relationship between this type of dehydration and diabetes? (See Chapter 68)

 

 

 

 

  1. Would you expect her to have poor skin turgor or pitting edema? Why or why not?

 

 

 

 

 

  1. Would you expect her to have hypotension? Why or why not?

 

 

 

 

 

 

CRITICAL THINKING CHALLENGE 2

The client with diabetic ketoacidosis and dehydration is prescribed to receive intravenous normal saline (0.9% sodium chloride) at 1000 mL/hr for the first two hours. Ten (10) units of regular insulin are given immediately IV push and a continuous insulin infusion of 10 units/hr is prescribed until the ketosis has stopped.

  1. What is the osmolarity of the normal saline solution? Is this considered hypotonic, isotonic, or hypertonic?

 

 

 

 

  1. What would be the rationale for giving this client saline when her serum sodium level is in the normal range?

 

 

 

  1. Why is the client not prescribed oral replacement fluids?

 

 

 

 

  1. Should the care of this client be assigned to an RN, LPN/LVN, or assistive nursing personnel? (Explain your rationale for the caregiver assignment.)

 

 

 

  1. What criteria would you use to determine whether the fluid replacement is adequate?

 

  1. How often should this client be assessed? Why?

 

 

CRITICAL THINKING CHALLENGE 3

Your diabetic client has had her dehydration and diabetic ketoacidosis corrected. She is going home and will be managed at the diabetes clinic.

  1. What specific areas of teaching will you emphasize to her?

 

 

 

 

  1. What fluids would be most useful in preventing a recurrence of the dehydration?

 

 

 

 

 

 

CRITICAL THINKING CHALLENGE 4

The 75 year-old client with hypokalemia tells you that she took two doses of Diuril today because she and her friend were going to a Chinese restaurant after the concert and she was afraid the salty food would make her hypertension worse. She has not eaten in the last 7 hours and has only had one cup of coffee in the past 4 hours. She says she last saw her doctor 6 months ago and that the blood work done at that time was “okay.”

  1. Is she at risk for any other fluid or electrolyte imbalance?

 

 

 

  1. If so, what specific imbalance is she at risk for and why?

 

 

 

 

CRITICAL THINKING CHALLENGE 5

Your client’s serum potassium level is 2.4 mEq/L and her serum sodium is 142 mEq/L. In addition, her hematocrit is 47%. She is prescribed to receive 1 L of normal saline (0.9% sodium chloride) with 40 mEq of potassium added. The rate of administration prescribed is 200 mL/hr.

  1. What vein should you choose to start this IV? Why?

 

 

  1. How many mEq of potassium will she be receiving per hour at this infusion rate?

 

 

  1. What safety precautions should you take with this prescription and why?

 

 

  1. Should the care of this client be assigned to an RN, LPN/LVN, or assistive personnel? (Explain your rationale for the caregiver assignment.)

 

 

  1. What assessment data would you need to determine if the interventions are effective?

CRITICAL THINKING CHALLENGE 6

After restoration of fluid volume and serum potassium levels, your client with hypokalemia is discharged to home and advised to make an appointment with her usual health care provider. She tells you that years ago she tried taking potassium supplements but found the taste too unpleasant to continue.

  1. What should you teach this client to prevent a recurrence of the imbalance?

 

 

  1. What should you teach this client to reduce her risk for falling?

 

 

  1. How could this client increase her intake of potassium without using potassium supplements?

 

 

Interventions for Clients with Acid-Base Imbalances

CRITICAL THINKING CHALLENGE 1

The client is a 65 year-old woman with type 1 diabetes mellitus and pneumonia. Her vital signs on admission are as follows: T 103.4 F; P 122, thready; R 34, shallow.

Her urine is positive for ketones. Her arterial blood gases (ABGs) are as follows: pH 7.21; HCO3- 22 mEq/L; PaCO2 50 mm Hg; PaO2 78 mm Hg.

  1. What type of acid-base imbalance is present?

 

 

  1. 2. Is the origin of the imbalance metabolic or respiratory? Explain your answer.

 

 

 

  1. Is compensation present or not present? Explain your answer.

 

 

CRITICAL THINKING CHALLENGE 2

The diabetic client with ketoacidosis and respiratory acidosis caused by pneumonia is started on insulin therapy and antibiotic therapy.

  1. Should this client receive oxygen therapy? Why or why not?

 

 

  1. Should this client receive intravenous bicarbonate? Why or why not?

 

 

  1. What electrolyte imbalance should you be alert for with this client?

 

 

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