Fluid and Electrolyte Case Studies

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Fluid and Electrolyte Case Studies

• Nursing 2904
• Spring 2006
• Carol Isaac MacKusick, MSN,RN, CNN

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Donald R

• Donald R is a 75 year old and was admitted with
  severe dyspnea. Significant hx includes ETOH
  abuse and cirrhosis.
• Assessment findings include
• Thin, chronically ill male
• BP 108/62
• Pulse 118 / minute
• RR 26 / minute
• Temp 97.8 F

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Donald R

• Assessment findings
• 3 pitting, generalized edema
• Abdomen distended, tight
• Orthopneic
• c/o SOB
• Pt states I have been stuck on the couch for
  the last two weeks
• Investigation reveals that his dyspnea and
  fatigue have kept him bedridden

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Donald R

• Mr. Rs age and poor physical condition place him
  at risk for
• Hypertension
• Dehydration
• ARF
• CHF

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Donald R

• Mr. Rs edema is an example of fluid located in
  which space?
• ICF
• Intravascular
• Interstitial
• Transcellular

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Donald R

• Assuming Mr. Rs abdominal distention is ascites,
  the shift of intravascular fluid into his
  peritoneal cavity is referred to as
• Third spacing
• Congestive failure
• Edema
• peritonitis

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Donald R

• As Mr. Rs BP decreases, the baroreceptors will
  trigger
• Renal vasodilatation
• Increased HR
• Suppression of ACTH release
• Peripheral vasoconstriction

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Donald R

• Mr. Rs urine output has been 25 ml / hour for
  the past two hours. His most current serum
  osmolality is 315 mOsm / L. He is c/o extreme
  thirst.

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Donald R

• Based on the available data, his urine output and
  serum osmolality are most likely due to
• Renal failure
• Peripheral edema
• Suppressed ADH release
• Intravascular fluid deficit

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Donald R

• His thirst is activated by
• Hemodilution
• Release of aldosterone
• Increased osmolality
• ADH release

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Donald R

• Mr. R has a serum albumin drawn. The results
  show a significantly low albumin level.

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Donald R

• A low serum albumin directly alters the movement
  of solutes in what way?
• Fluids escape out of the capillaries
• Fluids are drawn into the capillaries
• Fluids escape out of the interstitial spaces
• Fluids are drawn into the interstitial spaces

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Donald R

• It is decided that Mr. R requires IV fluids

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Donald R

• Which type of IV solution would be best for
  treating intravascular fluid deficit?
• Hypertonic solutions
• Isotonic solutions
• Hypotonic solutions
• Colloid solutions

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Donald R

• Mr. R receives an IV fluid to increase his
  intravascular volume and increase his arterial
  blood pressure. The best IV fluid to accomplish
  this goal is
• 5 dextrose in NS
• 0.45 NS
• 5 dextrose in H2O
• 0.2 NS

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Donald R

• Mr. R has received a large volume of IV fluids.
  His serum electrolytes are now
• Na 128 mEq/L
• Cl 90 mEq/L
• Total Ca 11.2 mg/dL
• K 5.2 mEq/L
• Mg 3.2 mg/dL
• Po4 2.0 mg/dL

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Donald R

• Mr. Rs Na can cause body water to shift from the
  
• Extracellular into intravascular compartment
• Interstitial into intravascular compartment
• Extracellular into intracellular compartment
• Intracellular into extracellular compartment

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Donald R

• Mr. Rs Ca level is 11.2 mg/dL. This level is
  most likely caused by his
• Renal status
• Nutritional status
• Chloride status
• immobilization

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Donald R

• Should Mr. Rs K level approach 7 mEq/L, you
  would be most concerned with
• CV changes
• Respiratory changes
• Neurological changes
• Renal damage

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Donald R

• Why do you believe that Mr. R presents with
  hypomagnesemia?
• Hypercalcemia
• Chronic ETOH
• Starvation
• Acute pancreatitis

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Donald R

• Mr. Rs hypophosphatemia can affect his
  musculoskeletal system in which of the following
  ways?
• Muscle spasm
• Joint pain
• Muscle weakness
• Muscle cramping