Corning Community CollegeNurse Education DepartmentHealth & Sciences Division

Spring 2013NURS 2992-001/Fluids & Electrolytes

(CRN 89901)Syllabus

Gail Ropelewski-Ryan MS, RNN308~962-9314~ryan@corning-cc.edu~Office hours posted on door

Revised1/13

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Student Withdrawal Policy / Last Day to Drop If for any reason a student must withdraw from this course, it is the student’s responsibility to do so by submitting an online drop form through MyCCC. A grade of “W” will be assigned if the withdrawal occurs before March 24, 2013, the official drop date for this course, and a grade of “F” thereafter. If a student simply stops attending rather than officially withdrawing, he or she will receive a grade of “F” for the course. The instructor may drop a student for non-attendance.

Academic Honesty Policy The act of academic dishonesty is one in which a student is trying to gain an unfair academic advantage or is avoiding actions required by a course, which have been designated to improve some aspect of the student’s education. Knowingly and willfully aiding or collaborating with a student in the violation of an Academic Honesty policy, even if not personally committing any violation is considered academic dishonesty.

Plagiarism occurs when a person presents another’s ideas, information, words, artwork, films, music, graphs, data or statistics as if they were his or her own creation. Plagiarism is a form of theft and is cheating. When a person copies material from a published source, such as a periodical, encyclopedia, or book, or downloads a passage from an Internet source and presents that information without proper documentation (reference or quotation) in a paper or project, then that person has committed plagiarism.

If a violation of this policy has occurred, the instructor will conduct an investigation. The result of this investigation may be a failing grade on the assignment, failing grade for the course, or expulsion from the class and/or the College.

Students with Disability Information Students with learning, physical, or psychological disabilities who wish to receive accommodations for this course must contact the Office of Student Disability Services in Room M152 in the Commons Building on the Spencer Hill Campus at 607-962-9262) or at sds@corning-cc.edu. Students are required to self-identify by making a formal request for services, and to provide current documentation that reflects the nature of the disability. Reasonable accommodations in the classroom will be provided for students with appropriately documented disabilities. Confidentiality will be maintained at all times.

Class Cancellation / Inclement Weather Class cancellations by the instructor will be posted via an announcement sent directly to your student email account.  Cancellations due to inclement weather will be posted on the CCC website and the main page of MyCCC. It is the student’s responsibility to check these sources on a regular basis.

TextFluid & Electrolytes Made Incredibly Easy, Lippencott, 5th edition

Grading1. Quizzes – 35%

2. Study Guides – 20%

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3. Final Exam – 45% must be completed on April 19th (on campus open note test)

A 95-100% C 75-70%

A- 90-94% D 74-70%

B+ 89-86%

B 80-85%

All quizzes & exams are open book. You may use any source to answer the quiz questions. A hard copy of the quiz must be turned into my mailbox by Noon of the day specified (There will be no exceptions). The final exam is comprehensive and will be administered Friday, April 19th. You may bring your study guide and note cards with you to the exam which will consist of multiple choice, short answer, and short essay.

Quizzes are open book, but you must do them on your own. No collaboration. Remember copying verbatim from any source constitutes plagiarism.

If there is a short _______, or it specifies to “list”, one or two words is sufficient. ALL other questions must be answered in complete sentences. Spelling & grammar will be taken into consideration.

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Quiz #1 (Based on Fluid & Electrolytes Made Incredibly Easy chapters 1-4 & 11 and MedCom Video “Normal Fluid & Electrolyte Balance”)

1. 2/3 of bodily fluid is _____________. 1/3 is ______________.

2. Fluid loss occurs form the: ________________

________________

________________

________________

3. Daily urinary output is approximately _________________.

4. The amount of fluid commonly taken in & excreted daily is _____________.

5. Extracellular fluid is found in 2 places: _________________

_________________

6. Fluid is also found in the: _______________________

_______________________

_______________________

7. Name: Cations Anions

______ ______

______ ______

______ ______

______

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8. Define osmosis: _________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

9. Define diffusion: _________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

10. Define active transport: __________________________________________________

__________________________________________________________________________

__________________________________________________________________________

11. An example of an isotonic solution is _________________

12. What is plasma colloid osmotic pressure? _________________________________________

___________________________________________________________________________

13. Name 3 hormones that effect fluid output then describe how each works

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

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14. Identify the function of various electrolytes and their normal values (ie: normal pH = 7.35-7.45)

Na+

Cl-

Ca++

K+

PO4- -

HCO3 –

Mg+ +

15. Identify systemic impact of prolonged acidosis on the human body:

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16. Identify systemic impact of prolonged alkalosis on the human body:

17. Identify 3 Chemical buffers: __________________

__________________

__________________

18. Lungs excrete acid in the form of _________________________.

19. Which IV solutions are used for:

a. gastric fluid loss ________________

b. dehydration _______________

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c. shock ________________

d. hypernatremia _________________

e. DKA ___________________

20. Hypotonic solutions should not be used for patients with _____________________________

__________________________________________________________________________.

21. Compare and contrast respiratory alkalosis versus metabolic acidosis:

22. Compare & contrast metabolic versus respiratory acidosis:

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Turn in by Feb. 28

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Quiz 2(Chapters 5 & 6)

Match the descriptions in Column A with the appropriate electrolyte condition in Column B

Use more than 1 letter for each # if applicable

Column A Column B

a. Hypernatremia

1. caused by use of some diuretics

2. caused by excess salt intake

b. Hyponatremia 3. assess patient on Digoxin therapy

4. causes postural hypotension

c. Hyperkalemia 5. give normal saline IV (NaCl 0.9%)

6. may cause muscle cramps and spasticity

d. Hypokalemia 7. treat with IV 5% D/W

8. nurse uses water

9. give Kayexalate

10. above 5.5 meq/L

11. dialysis can be used to treat

12. corticosteroids cause

13. for extremely high levels IV insulin & glucose

are used

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Turn in by Mar. 28

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Quiz 3(Chapters 7, 8, 9, 10)

Match the descriptions in Column A with the appropriate electrolyte condition in Column B

Use more than 1 letter for each # if applicable

Column A Column B

a. Hypercalcemia 1. causes neuromuscular depression with

diminished reflexes

b. Hypocalcemia 2. causes neuromuscular irritability

c. Hypermagnesaemia 3. caused by prolonged immobility

d. Hypomagnesaemia 4. caused by antacids and laxatives containing

aluminum

e. Hyperphosphatemia 5. observe urine for renal stone

f. Hypophosphatemia 6. give aluminum hydroxide

g. Hypercholoremia 7. assess for signs of hypoxia

h. Hypochloremia 8. usually occurs with sodium imbalance

9. less than 95 meq/L

10. give Fleet’s Phosho-soda of Calcitonin

11. Dialysis can be used to treat

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Turn in by Mar. 28

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Quiz #4

1.  Hydrostatic pressure, which pushed fluid out of the capillaries, is opposed by colloid osmotic pressure, which involves:

a reduced rennin secretion.

b the pulling power of albumin to reabsorb water.

c an increase in ADH secretion.

d aldosterone production.

2.  When a person’s blood pressure drops, the kidneys respond by:

a secreting renin.

b producing aldosterone.

c slowing the release of ADH.

d increasing urine output.

3.  The main extracellular cation is: a calcium.

b potassium.

c magnesium.

d sodium.

4. Hypertonic solution cause fluids to move from the:

a interstitial space to the intracellular space.

b intracellular space to the extracellular space.

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c extracellular space to the intracellular space.

d extracellular space to the interstitial space.

5.  Extravasation of I.V. fluid is associated with administration of which solution?

a Hypertonic fluid

b D5W

c An antineoplastic

d Normal saline solution

6.  The nurse enters the room of the patient diagnosed with congestive heart failure. The patient lying in bed gasping for breath is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement first?

a Sponge the patient’s forehead.

b Obtain a pulse oximetry reading.

c Take the patient’s vital signs.

d Assist the patient to a sitting position.

7.  The nurse is assessing the patient diagnosed with congestive heart failure. Which signs/symptoms would indicate that the medical treatment has been effective?

a The patient’s peripheral pitting edema has gone from 3+ to 4+.

b The patient is able to take the radial pulse accurately.

c The patient is able to perform activities of daily living without dyspnea.

d The patient has minimal jugular vein distention.

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8.  The health-care provider has ordered an angiotensin-converting enzyme (ACE) inhibitor for the patient diagnosed with congestive heart failure. Which discharge instructions should the nurse include?

a Instruct the patient to take a cough suppressant if a cough develops.

b Teach the patient how to prevent orthostatic hypotension.

c Encourage the patient to eat bananas to increase potassium level.

d Explain the importance of taking medication with food.

9.  The nurse has written an outcome goal “demonstrates tolerance for increased activity” for a patient diagnosed with congestive heart failure. Which intervention should the nurse implement to assist the patient to achieve this outcome?

a Measure intake and output.

b Provide two (2)-g sodium diet.

c Weigh patient daily.

d Plan for frequent rest periods.

10.  The patient with pneumonia has the following arterial blood gases: pH 7.33, PaO2 94, PaCO2 47, HCO3 25. Which intervention should the nurse implement?

a Administer sodium bicarbonate.

b Administer oxygen via nasal cannula.

c Have the patient cough and deep breathe.

d Instruct the patient to breathe in a paper bag.

11.  When caring for the patient with hypoxia and hypercapnia, which

a Administer a respiratory treatment.

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intervention should the nurse implement first?

b Assess the patient’s pulses.

c Encourage the patient to breath slowly.

d Assess the patient’s capillary refill time.

12.  Which nursing interventions should the nurse implement for the patient who has a respiratory failure? Select all that apply.

a Administer oxygen via ventimask.

b Assess the patient’s lung sounds.

c Encourage the patient to cough and deep breathe.

d Monitor the patient’s pulse oximeter reading.

e Force fluids.

13.  Which statement made by the patient admitted with electrolyte imbalance from frequent cathartic use demonstrates an understanding of the discharge teaching?

a “In the future I will eat a banana every time I take the medication.”

b “I don’t have to have a bowel movement every day.”

c “I should limit the fluids I drink with my meals.”

d “If I feel sluggish, I will eat a lot of cheese and dairy products.”

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14.  The patient diagnosed with AIDS is experiencing voluminous diarrhea. Which interventions should the nurse implement? Select all that apply.

a Monitor diarrhea, charting amount, character, and consistency.

b Assess the patient’s tissue turgor every day.

c Encourage the patient to drink carbonated soft drinks.

d Weigh the patient daily in the same clothes and at the same time.

e Assist the patient with a warm sitz bath PRN.

15.  Electrolyte imbalances that are caused by GI fluid loss include all of the following except:

a hypokalemia

b hyponatremia

c hypochloremia

d hypophophatemia

16.  Systemic symptoms of GI fluid loss include

a altered mental status.

b bradycardia.

c cool moist skin.

d decreased hematocrit.

17.  The patient is diagnosed with ARF. Which laboratory values are most

a BUN and creatinine.

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significant for diagnosing ARF? b WBC and hemoglobin.

c Potassium and sodium.

d Bilirubin and ammonia level.

18.  The patient diagnosed with ARF has a serum pH of 7.08. Which collaborative treatment would the nurse anticipate for the patient?

a Administer a phosphate binder.

b Administer IV sodium bicarbonate.

c Assess the patient for leg cramps.

d Prepare the patient for dialysis.

19.  The patient with ESRD is placed on fluid restriction of 1500 milliliters per day. On the 7 a.m. to 7 p.m. shift the patient drank an eight (8)-ounce cup of coffee, 4 ounces of juice, 12 ounces of tea, and 2 ounces of water with medications. What amount of fluid can the 7 p.m. to 7 a.m. nurse give to the patient?

________________________________

20.  The patient has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor?

a Serum calcium

b Serum phosphorus

c Serum potassium

d Serum sodium

Turn in by April 11

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Study Guide (Chapter 5-10)

Imbalance Causes of Imbalance Signs/Sx Treatment (and what do you do if the treatment doesn’t work)

Nursing Intervention

Hyponatremia

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Hypernatremia

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Imbalance Causes of Imbalance Signs/Sx Treatment (and what do you do if the treatment doesn’t work)

Nursing Intervention

Hypokalemia

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Hyperkalemia

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Imbalance Causes of Imbalance Signs/Sx Treatment (and what do you do if the treatment doesn’t work)

Nursing Intervention

Hypocalcemia

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Hypercalcemia

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Imbalance Causes of Imbalance Signs/Sx Treatment (and what do you do if the treatment doesn’t work)

Nursing Intervention

Hypomagnesaemia

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Hypomagnesaemia

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Imbalance Causes of Imbalance Signs/Sx Treatment (and what do you do if the treatment doesn’t work)

Nursing Intervention

Hypochloremia

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Hyperchloremia

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Imbalance Causes of Imbalance Signs/Sx Treatment (and what do you do if the treatment doesn’t work)

Nursing Intervention

Hypochloremia

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Hyperchloremia

Turn in by April 11Study Guides

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This is an example of what I want:

Disorder Imbalances caused by this disorder Nursing Actions (must relate to specific imbalance in Column #2)

Rationale – (there should be a great deal of detail in this section. I need to know that you understand why you are assessing, monitoring, administering, & teaching)

Heart Failure Hypo/Hypervolemia Assess

-edema (pulmonary & peripheral)

-liver enlargement

-vital signs

Monitor

I & O

Weight

-uncontrolled lt sided heart failure results in pulmonary edema, rt sided – peripheral edema

-may be indicative of right sided HF

-tachycardia may indicate fluid volume overload

-decreased cardiac output can negatively impact the kidneys (output reflects kidney function)

-weight is the most sensitive indicator of fluid retention

-Nat & K+ levels can drop due to diuretics & potentiate digoxin toxicity

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Electrolyte imbalances

Acidosis/Alkalosis

Electrolytes

Administer

diuretics

K+ supplements

Teach

about prescribed medications

-to decrease fluid volume overload

-to prevent hypokalemia

-find out what patient knows – compliance will keep the patient out of the hospital

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Study Guides

Imbalances Nursing Actions Rationale

Respiratory Failure

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Imbalances Nursing Actions Rationale

Excessive GI fluid loss

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Imbalances Nursing Actions Rationale

Renal Failure

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Imbalances Nursing Actions Rationale

Burns

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