Fluid and electrolyte earn back points worksheet

1. Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following: Serum glucose 412 mg/dl Serum sodium (Na+) 156 mEq/l Serum potassium (K+) 5.6 mEq/l Serum chloride (Cl–) 115 mEq/l Arterial blood gases (ABGs): pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3– 20 mEq/l a. What type of water and solute imbalance does Ms. Brown have? b. What symptoms would you expect to find? c. What would be the appropriate treatment? d. What do her ABG results indicate? 2. Mr. Appel has severe chronic obstructive pulmonary disease (COPD). He is admitted to the hospital with a respiratory infection and increased dyspnea; yellow, purulent sputum; anxiety; and diaphoresis. He states he feels weak and tired. He routinely takes a diuretic (furosemide) and his pulmonary medications. The following laboratory values are obtained: Arterial blood gases: pH 7.25; PaO2 60 mmHg; PaCO2 78 mmHg; HCO3– 34 mEq/l Serum sodium (Na+) 140 mEq/L Serum potassium (K+) 2.0 mEq/L Serum chloride (Cl–) 105 mEq/L a. What type of electrolyte imbalance does Mr. Appel have? b. Interpret his ABGs. 3. Mr. Jones is admitted to the hospital with an exacerbation of heart failure. He has +3 peripheral edema of the lower extremities. What are the possible causes of his peripheral edema? 4. Carl is a 15-year-old admitted to the hospital following a closed head injury during a motor vehicle crash. He is diagnosed with syndrome of inappropriate anti-diuretic hormone (SIADH). You would monitor him for what signs and symptoms? 5. Identify the intracellular and plasma buffer systems and discuss how they function. 6. The patient is a 75-year-old man with a history of emphysema. He comes to the emergency department (ED) reporting a productive cough that causes chest pain and fatigue. “I am having more problems breathing that usual.” a. What should the nurse include in the initial history when a patient is suspected of having an acid-base imbalance? b. Which assessment indicates that this patient has impaired gas exchange? 1. Decreased urine output 2. Bradycardia 3. Decreased chest expansion 4. Hypotension c. Which ABG value indicates that this patient is retaining CO2? 1. PaCO2 = 40 mm Hg 2. PaCO2 = 60 mm Hg 3. Bicarbonate = 43 4. PaO2 = 60 mm Hg d. The patient’s baseline ABG values are pH 7.36; PaCO2 60 mm Hg; PaO2 53 mm Hg; bicarbonate 43 mEq/L. Which ABG result would most likely indicate that he is having a negative response to the administration of oxygen? 1. pH 7.35; PaCO2 64, PaO2 60, Bicarbonate 42 mEq/L 2. pH 7.36; PaCO2 60, PaO2 60, Bicarbonate 42 mEq/L 3. pH 7.36; PaCO2 58, PaO2 58, Bicarbonate 38 mEq/L 4. pH 7.33; PaCO2 66, PaO2 66, Bicarbonate 42 mEq/L e. Based on the answer for question d, is the patient’s respiratory acidosis compensated or uncompensated? Explain your answer. 7. A patient is admitted to the hospital with decreased serum osmolality and serum sodium of 126 mEq/L. The nurse recognizes that dehydration or overhydration may accompany hypotonic conditions. a. What other information would you assess for? b. Which of the following assessments would indicate that the patient has fluid volume excess? (Select all that apply) 1. Increased, bounding pulse 2. Jugular venous distention 3. Presence of crackles 4. Elevated blood pressure 5. Skin pale and cool to touch. c. What does the nurse monitor for as evidence of a worsening hypotonic condition? 1. Mental status 2. Urine output 3. Skin changes 4. Bowel sounds 8. The patient with a history of vomiting and diarrhea from the flu presents with a rapid pulse, orthostatic hypotension, urine output of 20 ml/hr, skin turgor poor with tenting, and increased respiratory rate. a. In evaluating the patient’s laboratory values, indicate whether the following values are likely to be normal, elevated, or decreased. 1. Urine specific gravity 2. Urine volume 3. Serum Sodium 4. Serum hematocrit and hemoglobin 5. Blood urea nitrogen (BUN) 6. Serum osmolality b. What would indicate that the patient is having a negative response to fluid resuscitation? 1. Increased blood pressure 2. Urinary output of 40ml/hr 3. Presence of crackles 4. Widening of pulse pressure 9. The nurse is caring for a 77-year-old woman who was admitted after gardening on a hot summer day. Her daughter found her lying on the couch slightly confused, and unable to get up to go to the bathroom. She is weak, anxious, and slightly confused to time and place. Her pulse is 110 beats/min; blood pressure is 108/58. Her skin is dry and urine specific gravity is 1.028. a. Discuss whether this patient’s serum sodium would be elevated, decreased, or normal and why? b. What are the signs and symptoms that will occur with hypernatremia? 10. A 65-year-old woman with a recent history of cellulitis is admitted to the hospital with fever, shortness of breath, and hypotension. She has had a 2-day history of diarrhea. Her ABG reveals a pH of 7.30, PaCO2 of 28, PaO2 of 88, and bicarbonate of 17 mEq/L. a. The patient’s symptoms are most likely a result of which condition? 1. Metabolic acidosis 2. Metabolic alkalosis b. The bicarbonate level of 17 mEq/l is the result of which factor? 1. Respiratory hypoventilation 2. Overelimination of bicarbonate 3. Respiratory compensation 4. Underelimination of hydrogen ions c. What other laboratory value would be important to monitor at this time? Explain your answer.    

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