Fluid and Electrolytes practice

Practice Time!!!!

A patient with heart failure is ordered furosemide (Lasix) 20 mEq orally twice daily.

What assessment data should the nurse have readily available prior to administering the medication?

A patient is ordered K+ IVPB replacement 20Meq in 250 mL of saline (20Meq in 250 mL).• What is the safe rate(amount of K+) at which this

replacement can run? How long will it take to run this replacement?

• What are some nursing responsibilities while the K+ is infusing? After the infusion is completed?

• Prior to starting the infusion? What must the nurse take into consideration and why?

Your patient is about to be discharged to home on Lasix

• What are some areas of teaching you need to consider?

• What type of dietary measures does this patient need to take while on Lasix?

• What foods will you encourage the patient to consume?

The nurse is preparing to administer Spironolactone (Aldactone) to a patient with heart failure

• The nurse obtains the morning labs and they reveal a K+ level of 5.8 mEq/l, Na+ 138 mEq/l, and a BP of 118/72.

What should the nurse do? Defend your answer with a rationale.

A patient is admitted to the cardiac floor with fluid excess due to an excacerbation of congestive heart failure (CHF)

• What systems will you focus on assessing?

• What assessment findings may you discover after completing your assessment?

• What will you anticipate will be ordered i.e. diet, meds for this patient? List as many as possible.

A patient is ordered both Lasix and Digoxin for treatment of CHF

Morning labs are obtained:

Na+ 135 mEq/L

Mg++ 1.8 mEq/L

Digoxin level 1.8 ng/dL

K+ 2.8 mEq/L

• Is it safe to administer both medications? Explain your answer with a rationale.

• In addition to labs, what other data is needed to administer the meds safely?

You enter a patient’s room and find him hooked up to NGT suction. He has no IV infusing and is NPO.• What electrolyte imbalance(s) is he at risk for?

• What assessment data would be present based on your answer above?

• What labs may support your findings?

• What would you suggest to the physican?

A patient with kidney disease has urine output of 160 mL in 8 hours

• Is the amount of urine in the 8 hour shift acceptable. Defend your answer

• What is some of the collaborative care that might be ordered for this patient?

• What type of dietary restrictions may this patient have? Defend your response(s)

• What labs may be altered due to Kidney Disease?

Identify the potential imbalances with the following therapies:• Linsinopril

• Aldactone

• Lasix

• NGT suction

• IV Fluids

• Prednisone (corticosteroids)

Which of the above may cause an acid/base imbalance?? Any drug interactions?

A patient with a history of ETOH is admitted for alcohol withdrawl.

• The doctor has ordered magnesium (mg++) sulfate 2gm in 250 mL to run over 2 hours for a mg++ of 1.3 mEq/L. The tubing is a 10gtt/mL. How many drops per minute should this replacement run??

• Why is the mg++ level low?

• Identify the causes of low mg++ levels

• What are some nursing considerations when administering mg++?

You admitted a patient to your unit with a Calcium level of 7.0 mg/dL

• What assessment finding(s) may be present with the above value? Also include other labs if possible.

• What type of dietary needs does this patient require? Give some sample foods to teach the patient to include in his/her diet.

• What hazards may the patient encounter with this level without intervention?

• What may have led to this level?

You admit an 88 year old male patient for dehydration and confusion

• Why is the patient confused?

• Would age put this patient at risk for the above? Any meds possibly??

• What type of IVF may be ordered?

• What lab will you check after labs are obtained to make sure it is the correct IVF tonicity? The IVF odered is .9NS at 150mL/hr

• What ongoing assessment will be necessary while the IVF is infusing? Concerns???

A patient is ordered aldactone as part of his heart failure management

• Identify the area of teaching this patient will need as it relates to his heart failure– Diet, S/S of a CHF flare up

• What additional teaching will this patient need specific to taking of aldactone? He is also on Enapril. Include dietary needs specific to these drugs ordered. Give sample foods.

Identify the Acid/Base & Electrolyte Imbalances that may occur with the following:

• Vomiting

• Diarrhea

• Loop diuretic use

• K+ sparing use

• Burn patients

• CHF patients

• Renal failure patients

• Infection

• Ileostomy

• NGT suction

• Bone cancer

• Head injury

• Elderly patients

• Lisinopril (ace inhibitor)

• Prednisone

• Uncontrolled diabetes

Questions?• Don’t forget

– Hesi case studies

– Iggy work book practice activities

– NCLEX book practice questions (read rationales!)

– Make a chart of the causes, S/S, treatment of each imbalance in module

– Read the chapter in IGGY. Also read Berman & Snyder