Nclex - Fluid Volume, Acid-Base, Labs

Front 1

Fluid Volume Deficit

Back 1

- thready, increased pulse rate, decreased BP and orthostatic hypotension
- flat neck and hand veins in dependent positions, diminished peripheral pulses, decreased CVP, dysrhythmias
- increased rate and depth of respirations, dyspnea (labored breathing)
- decreased CNS activity (from lethargy to coma), fever (fluid loss dependent), skeletal muscle weakness, decreased urine output
- dry skin, poor turgour, tenting, dry mouth
- decreased motility and diminished bowel sounds, constipation, thirst, decreased body weight

Hint 1

LABORATORY FINDINGS:
- increased serum osmolality
- increased hematocrit
- increased BUN levels
- increased sodium levels
- increased urine specific gravity

Front 2

Fluid Volume Excess

Back 2

- bounding, increased pulse rate, elevated BP, distended neck and hand veins, elevated CVP, dysrhythmias
- increased (shallow) respiratory rate, dyspnea (labored breathing), moist crackles on auscultation
- altered LOC, headache, visual disturbances, skeletal muscle weakness, parasthesias (prickling, tingling, numbness)
- increased urine output (if kidneys can compensate), decreased urine output (if kidney damage is the cause)
- pitting edema (dependent areas), pale and cool skin
- increased motility in GI tract, diarrhea, increased body weight, liver enlargement, ascites (fluid in peritoneal cavity - abdominal swelling)

Hint 2

LABORATORY FINDINGS:
- decreased serum osmolality
- decreased hematocrit
- decreased BUN level
- decreased sodium levels
- decreased urine specific gravity

Front 3

Isotonic Overhydration

Back 3

- inadequately controlled IV therapy
- renal failure
- long-term corticosteroid therapy

Front 4

Hypertonic Overhydration

Back 4

- excessive sodium ingestion
- rapid infusion of hypertonic saline
- excessive sodium bicarbonate therapy

Front 5

Hypotonic Overhydration

Back 5

- early renal failure
- congestive heart failure
- syndrome of inappropriate ADH secretion
- inadequately controlled IV therapy
- replacement of isotonic fluid loss with hypotonic fluids
- irrigation of wounds and body cavities with hypotonic fluids

Front 6

Serum Calcium

Back 6

8.6 - 10.0 mg/dL

Hint 6

COMMON FOOD SOURCES
- cheese, collard greens, milk and soy milk, rhubarb, sardines, spinach, tofu, yogurt

Front 7

Hypocalcemia

Back 7

INHIBITION OF CALCIUM ABSORPTION FROM THE GI TRACT
- inadequate oral intake of calcium
- lactose intolerance
- malabsorption syndromes such as celiac sprue or Crohn's disease
- inadequate intake of Vitamin D
- end-stage renal disease
INCREASED CALCIUM EXCRETION
- renal failure, polyuric phase
- diarrhea
- steatorrhea (presence of excess fat in feces)
- wound drainage (especially GI)
CONDITIONS THAT DECREASE THE IONIZED FRACTION OF CALCIUM
- hyperproteinemia
- alkalosis
- medications such as calcium chelators or binders
- acute pancreatitis
- hyperphosphatemia
- immobility
- removal or destruction of the parathyroid glands

Hint 7

CARDIOVASCULAR:
- decreased heart rate; hypotension; diminished peripheral pulses
RESPIRATORY:
- not directly affected; however, respiratory failure or arrest can result from decreased respiratory movement because of muscle tetany (intermittent muscular spasms) or seizures
NEUROMUSCULAR:
- irritable skeletal muscles: twitches, cramps, tetany, seizures
- painful muscle spasms in the calf or foot during periods of inactivity
- positive Trousseau's (carpal spasm) and Chvostek's (contraction of facial muscles) signs
- hyperactive deep tendon reflexes; anxiety; irritability
RENAL:
- urinary output varies depending on the cause
GI:
- increased gastric motility; hyperactive bowel sounds; cramping; diarrhea
LABS:
- serum calcium level <8.6 mg/dL
ECG CHANGES:
- Prolonged ST Interval
- Prolonged QT Interval

Front 8

Hypercalcemia

Back 8

INCREASED CALCIUM ABSORPTION
- excessive oral intake of calcium
- excessive oral intake of Vitamin D
DECREASED CALCIUM EXCRETION
- renal failure
- use of thiazide diuretics
INCREASED BONE REABSORPTION OF CALCIUM
- hyperparathyroidism
- hyperthyroidism
- malignancy (bone desctruction from metastatic tumors)
- immobility
- use of glucorticoids
HEMOCONCENTRATION
- dehydration
- use of lithium
- adrenal insufficiency

Hint 8

CARDIOVASCULAR:
- increased HR in the early phase; bradycardia that can lead to cardiac arrest in the late phase
- increased BP; bounding, full peripheral pulses
RESPIRATORY:
- ineffective respiratory movement as a result of profound skeletal muscle weakness
NEUROMUSCULAR:
- profound muscle weakness; diminished or absent deep tendon reflexes; disorientation; lethargy; coma
RENAL:
- urinary output varies depending on the cause
- formation of renal calculi; flank pain
GI:
- decreased motility and hypoactive bowel sounds; anorexia; nausea; abdominal distention; constipation
LABS:
- serum calcium level >10 mg/dL
ECG CHANGES:
- Shortened ST segment
- Widened T Wave

Front 9

Serum Magnesium

Back 9

1.6 - 2.6 mg/dL

Hint 9

COMMON FOOD SOURCES:
- avocado, canned white tuna, cauliflower, green leafy vegetables (spinach, broccoli), milk, oatmeal, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt

Front 10

Hypomagnesemia

Back 10

INSUFFICIENT MAGNESIUM INTAKE
- malnutrition and starvation
- vomitting or diarrhea
- malabsorption syndrome
- Celiac disease
- Crohn's disease
INCREASED MAGNESIUM SECRETION
- medications such as diuretics
- chronic alcoholism
INTRACELLULAR MOVEMENT OF MAGNESIUM
- hyperglycemia
- insulin administration
- sepsis

Hint 10

CARDIOVASCULAR:
- tachycardia; hypertension
RESPIRATORY:
- shallow respirations
NEUROMUSCULAR:
- twitches; parasthesias; positive Trousseau's and Chvostek's signs; hyperreflexia; tetany; seizures
CNS:
- irritability; confusion
LABS:
- serum magnesium levels <1.6 mg/dL
ECG CHANGES:
- Tall T Waves
- Depressed ST Segment