Fluid and Electrolytes

[Music] hi guys it's me professor d and welcome back to my youtube channel guys on this video i'm going to go over fluid and electrolyte imbalance here's what's so crazy this is going to be part one even though part two is already loaded okay so here's what happened i did a fluid electrolyte imbalance video and i thought i did one before so i just named it part two and apparently there was never part one sorry about that so it's about a year later and here i am i'm making the part one i'm so sorry guys i don't know what happened but better later than never and guys by the way it doesn't matter if you watch this first and the other one or the other one than this there's no chronological order it's just information that's very important for you to know okay guys so um one more thing i want to talk to you about before i jump into this video if you haven't done so already please do not forget to like and subscribe below guys that is what will eventually help me get to the point to making these videos for you all day every day right but until then guys i'm asking you please help my channel grow if i'm helping you please help my channel grow by supporting me how can you support me share my video share my videos on your social media with family members friends who are in the nursing program or you think may want to be in the nursing program or anyone you know studying for your boards i lied there's one more thing i want to talk to you about do not forget guys i'm also on tick tock i'm on instagram i'm on facebook okay and the material that i cover here on youtube is different than what i cover on my other platform so be sure to check those out as well i have more resources available on my website you can check me out at nexus nexusnursinginstitute.com okay without further ado and now let's get started first question why do older adults generally have less body water than younger adults a as functional cells die during the aging process less water is needed b the muscle mass of older adults is smaller than the muscle mass of younger adults see older adults have a smaller extracellular fluid to intracellular fluid ratio than younger adults or indeed the plasma volume of older adults is decreased due to reduce the size of excess fluid volume in heart failure and guys the correct answer is b the muscle mass of older adults is smaller than the muscle mass of younger adults and guys here's the thing those muscle cells hold lots of water so it makes sense that the smaller uh mass of muscle cells you have the less water you're going to be able to hold on to and guys as the adult gets older the muscle mass becomes less so that is the correct answer next question when evaluating the hydration status the nurse observes tenting of the skin on the back of the 87 year old's hand when testing skin target what is the nurse's best action a notified physician two examine dependent body areas three assess trigger on the client's forehead or d document the findings as the only action and guys the correct answer is c assess trigger on the client's forehead so whenever you're checking trigger on an older adult you want to do it on the bony prominence guys you want to do it on a bony prominence such as the forehead such as the chest why because there are no wrinkles there that's the whole point because you're checking for target and if you see the skin tense but the patient has wrinkles okay is it really tempting or is it wrinkles you're dealing with you want to do it on a bony prominence such as the forehead or the chest so that you can get this the the true uh reading of that skin turgor okay so that's why i see the correct answer now let's look at the wrong answer choices a notify the doctor and tell the doctor what tell the doctor what you haven't even done an assessment right so that's wrong b examine dependent body areas that doesn't give you that patient's um true status when you're checking uh skin turgor indeed document the fine oh ding ding ding only what did i tell you about all inclusives didn't i tell you all inclusive such as only always never to only choose them when you know that you know that you know that you know that's the answer right i told you that well we know that's not the answer because it's wrong so you should not have chosen that be very careful guys when you see all inclusives don't pick that as an answer choice unless you know beyond the shadow of a doubt that that is the correct answer so guys the correct answer is c next question what effect would an infusion of 200 milliliters of albumin have on a healthy client's plasma osmotic and hydrostatic pressures a increased osmotic pressure increased hydrostatic pressure b increased osmotic pressure decreased hydrostatic pressure c decreased osmotic pressure increased hydrostatic pressure or d decreased oxide pressure increased hydrostatic pressure and guys the correct answer is a increased osmotic pressure increased hydrostatic pressure okay so let me explain this to you first of all we're talking about albumin albumin is a part of the blood but what kind of part of the blood is it it's a protein okay it's a colloidal substance and guess what when you add albumin the osmotic pressure is going to be increased why what does albumin do it pulls the fluid and keeps it there so what happens is when you put that albumin into the blood vessel right it pulls fluid into the vessel and it keeps the fluid into the vessel it keeps that fluid from leaking back out that's why patients who've had major burns right a lot of times they'll get albumin because patients who have major burns they'll go through um a fluid shift and that patient will be dehydrated because all of the fluids that were in the vessels are now out in the tissues and something like albumin which is a type of protein protein which will increase osmotic pressure will pull all of that fluid that leak back into the tissues and they'll pull it back into the vessels where it belongs that's why when the patient has hypo albumin emia which means they don't have enough albumin in the blood what we tend to see is they also tend to be dehydrated because all of the fluid that was in the blood vessel because the albumen was keeping it there because the albumin is low for whatever reason the fluid is like woohoo party time there's no albumin here to keep us in the vessel let's ditch this joint and all the fluid goes into the tissues okay so this is absolutely true increase osmotic pressure it pulls it and keeps it there and increase hydrostatic pressure think about it guys the more fluid that's in the vessel that's more pressure that's being pushed against the vessel wall so a is the correct answer guys next question which community dwelling healthy person has the greatest risk for dehydration when exposed to a hot dry environment for several hours a 50 year old man b 50 year old woman c 80 year old man or d 80 year old woman and guys before i tell you the answer i want you to think about this this is where your critical thinking comes in basically they're asking us who's more likely to be dehydrated who's more likely to have a fluid pulled from them right and remember in the first question i told you the person that has the most muscle mass will hold on to the most amount of water because those muscle cells hold on to fluids so think about who would have the least muscles the least muscle cells that would be holding on to the least amount of fluids think about it the older that you get the smaller those cells become they don't die off they just get smaller number one the mass um becomes less and number two they become smaller guess what that's less capacity that they have to hold on to fluids generally speaking okay guys generally speaking who will have more muscle mass of of the same age if you take a 30 year old man and a 30 year old woman who will have more muscle mass the man will have more muscle versus fat and the woman which will have more fat versus muscles okay so we already know before we even look at our list right if we're looking for the person who's going to be holding on to the least amount of fluid we we're going to be looking for a female right and we're going to be looking for an older female because we know that as that female gets older the muscle mass is going to be less which means she's going to be holding on to less of that water so who's going to be our answer d the 80 year old woman one 50 year old man more muscles b 50 or 50 year old woman okay she's a woman but guess what we have an older woman which is our d and that's why that's our answer and again see 80 year old man guys please don't be leaving any crazy comments in my comment section about this if you have a problem with it please go argue with your textbook don't argue with me i'm just trying to help you pass your next exam okay all right okay guys next question the client's serum sodium level is 128 and certain potassium is 2.8 which hormonal problem is most likely to have caused this clinical situation a increased aldosterone secretion b decreased aldosterone secretion c increased adh secretion or d decreased adh secretion and guys the correct answer is c increased adh secretion what is adh anti-diuretic hormone it's some it's a hormone that makes you what not urinate makes you hold on to all of your urine and so what happens is you're holding on to all that urine you're holding on to all those fluids those electrolytes those solutes that you have they get what diluted and so we'll see that potassium and the sodium we'll see it do what go down because it's diluted because of all the fluid and that's exactly what we're seeing happen um sodium sodium guys are supposed to be 135 to 145. this patient sodium is 128. potassium is supposed to be 3.5 to 5. this patient's potassium is 2.8 okay so what happens the patient's holding on to all this fluid and it's being diluted okay now let's look at the wrong answer choices a increased aldosterone secretion if this patient in fact had increased aldosterone secretion we would see the sodium go up and the potassium go down right decreased aldosterone secretion in this case we would have seen the opposite we would have seen the sodium go down and the potassium go up and last decrease antidiuretic hormone secretion with this one the patient would lose their fluids but guess what they're holding on to the solutes slash what osmolality okay so that's why guys c is the correct answer i need to get a new sand okay what problem is likely to occur when the client's fluid intake is so low that his or her urine output is less than 400 milliliters per day a cellular swelling and subsequent edema b reduct reduce excretion of body waste especially nitrogen c expansion of interstitial volume with reduced plasma volume or d dilution of cir sodium levels to the extent that excitable membranes can no longer depolarize and guys the correct answer is b reduce excretion of body waste especially nitrogen okay guys so patient at the minimum they're supposed to urinating they're supposed they're supposed to be urinating at least 30 ml per hour we expect for the patient to have about 46 um four to six hundred milliliters per day at the minimum okay what happens if they're not producing that well think about the job of the kidneys so you eat all these foods your body breaks them down your body produces all of this waste right nitrogenous waste well what your kidneys do is help to filter those waste and turn those waste into what urine and then you get rid of that urine through the bladder you urinate but if for whatever reason you're not getting an adequate amount of um fluid intake for whatever reason your urine output goes down that means you're what you're going to be dehydrated i want you to think about this guys your body is meant to survive no matter what okay so you think if you don't you're losing these fluids fluids that you need what do you think your kidneys are going to do they're going to shut down because your body's trying to protect itself your kidneys are saying whoa i don't know what's going on but i'm going to go ahead and hold to hold on to the little bit of fluid that i have left because i don't want professor d to die right your kidneys are going to shut down look at b reduce excretion of body waste that body waste is where in the urine guys especially nitrogen those are the weights that were in your blood that now has turned into nitrogen and is going through the urine to be excreted okay now choices a c and d are absolutely wrong what we will see in this kind of situation where the urine output is less than 400 ml per hour and when you see the urine output this low something's going on that this patient does not have enough fluids and the body's trying to hold on to what's left okay so the kidneys shut down you see urine output down gfr down b-u-n up creatinine up why kidneys are in trouble some way somehow kidneys are saying something is wrong and you need to figure it out okay next question why is it important to keep the sodium level of the plasma volume so much higher than the sodium level of the intracellular volume a intracellular uh intracellular sodium is toxic to living human cells b excess sodium displaces oxygen on the hemoglobin of the red blood cells c high plasma levels of sodium are needed to balance the high plasma levels of magnesium excitable membranes are dependent on sodium concentration differences for depolarization and guys the only the only correct answer here guys is d excitable membranes are dependent on sodium concentration differences for depolarization let me tell you something if the sodium concentration was the same in the extracellular fluid and the intracellular fluid there would be no depolarization okay how are your muscles going to move how are nerve impulses going to happen if there's no depolarization that's why it's so important so there must be a difference in concentration there must be that gradient okay d is the correct answer what is the nurse's best action for the client whose serum chloride level is 101 a document the finding is the only action b assess the client's deep tendon reflexes c urge a client to drink more water or d notify the doctor and guys the correct answer is a document the finding as the only action well i know what you're thinking professor d you just told me to never choose an all cluster such as only always never unless you know that you know that you know that you know that's the answer but guess what for this question we know that we know that we know that's the answer choice guys look at it they're talking about serum chloride what's your normal level about 98 to 106. this patient's 101 there's nothing wrong there's nothing wrong so we're just going to document this as the only action and whenever you see an answer choice of document this as the only action you only do this when everything is a okay and everything's fine in here okay assess deep tendon reflexes urge the doc patient to drink more water notify the doctor all of those you do if something was wrong there's nothing wrong this is the sodium chloride is well within the normal limits by the way guys if you see the sodium chloride if it's high it may mean that the patient has dehydration going on if it's low it might meet the patient may have some kind of cardiac issues either way high or low it needs to be investigated further but this patient's chloride level is within normal limits which statement by the 74 year old client should the nurse should alert the nurse to the possibility of fluid and electrolyte imbalance a my skin's always so dry especially here in the southwest b i often use a glycerin suppository for constipation c i don't drink liquids after 5 pm so i don't have to get up at night or d in addition to coffee i drink at least one glass of water with each meal and guys the correct answer is see i don't drink liquids after five so i don't have to get up at night this patient is restricting their fluid intake 5 pm they're restricting their fluid intake in patients who restrict their fluid intake they're at risk for what dehydration especially older adults this patient's 74 years old now we don't want the patient drinking you know nine o'clock at night but 5 p.m no they're restricting fluids and remember guys the older adult not only has their muscle mass decreased so they're not holding to as many holding on to as many fluids as they used to what do they tend to lose their sense of thirst that's why you have to always remind them oh mr such as says don't forget to take a sip of water because they just don't get thirsty so they're already at risk for dehydration and now they're putting themselves on fluid restriction no by the way just so you know um when the patient does something like this and um we'll just say i don't drink liquids after five so i don't uh get up at night okay so when a patient does this and they're restricting their fluids what that does is it concentrates those solutes in the urine and that causes irritation to the bladder which will make the patient what to do want to do what urinate all right so what do you do you teach the patient well about you know an hour before bed you want to stop drinking um liquids because if that is a concern okay we can understand that but not this early at 5 00 pm okay um if the patient's restricting their fluids that long before bedtime um they may be doing a disservice to themselves because like i said they're restricting their fluids those solutes get concentrated those concentrated solutes irritate the bladder and it's a vicious cycle okay and that irritated bladder is going to make them want to urinate okay so it defeats the purpose anyhow next question okay guys if you've been following me for any amount of time i know you're going to get this one right easy peasy clients receiving 150 milliliters a five percent uh saline intravenously excuse me guys in the next two hours what response should the nurse expect as a result of this therapy a increased blood pressure b increased dependent edema c increased urine concentration potassium or d increased h h hematocrine hemoglobin and guys the correct answer is a increased blood pressure it just says in this question guys patients getting 150 ml of 5 saline going where within the vessel i just talked to you guys about this a few questions ago the more fluid that goes inside of a vessel the more pressure that's being exerted against the vessel walls the more pressure that's being exerted against the vessel wall what you think high blood pressure is that's what it is hypertension so you know the more fluid we expect that blood pressure to go up that's why if a patient if patients blood pressure is very low we're worried about that patient going through shock what are we going to do we're going to make sure that we get fluids within the vessel to what bring up their blood pressure that's why is the correct answer now be um increase dependent edema that could be cardiac issues it could be lots of things right but um we don't expect to see that if um we give that patient 150 ml of normal saline c and d the increase urine concentration and the increased h we expect to see that in dehydration but we don't expect to see the patient having those signs of symptoms of dehydration if we're putting fluids within the vessels what we expect to see is one an increase in the patient's blood pressure which protein source should the nurse recommend for a client who needs to restrict dietary potassium intake a raw broccoli b grilled salmon c poached eggs or d baked chicken and guys the correct answer is c poached eggs so guys key word they're looking for what protein source protein source but also low in potassium well meat and fish they are protein sources but they're also high in potassium but eggs eggs are protein source but they also happen to be low in potassium that's why we're choosing c look at a guys ace high raw broccoli that's high in what fiber okay that's not a rich protein source that's a rich fiber source so our correct answer is c poached eggs which dietary supplement should the nurse suggest to the client who needs to increase his or her intake of calcium a vitamin a b vitamin b c vitamin c or d vitamin d and the correct answer guys is d vitamin d so they're asking us about calcium well calcium we know calcium is good for bone health and bone growth and to make the bone nice and strong so it's not porous so the patient doesn't have osteoporosis great but guess what vitamin d is what helps you absorb the calcium so what's the point of taking all this calcium if you can't absorb it through what your gi tract vitamin d is what helps it be absorbed excuse me now let's look at the wrong answer choices vitamin e that's really good for vision vitamin b is really good for like energy metabolism vitamin c wound healing right tissue repair so the correct answer for this question guys is d vitamin d which electrolyte should the nurse most closely monitor in the client who has decreased parathyroid function a sodium b potassium c calcium or d chloride and guys the correct answer is c calcium if i said it once i said it to you a million times guys when it comes to your thyroid gland you're going to think of metabolism energy but when it comes to your parathyroid glands you're going to think of calcium calcium wear in the blood so if the patient has hyper parathyroidism their calcium is high in the blood if they have hypo parathyroidism the calcium is low in the blood okay next question which intervention is most important for the neurostatic client who has lymphedema in her right arm from a mastectomy one year ago a exercise your arm and use it during tasks that occur at the level of your chest or higher b be sure to use sunscreen or protective clothing to reduce the risk of injuring this arm c reduce your salt intake to prevent excess water retention or d do not expose the right arm to temperature extremes and guys the correct answer is a so this patient had a mastectomy a year ago and now they have lymphedema right what do we want them to do we want them to move the muscles contract the muscles in that area right and keep that arm elevated why we want gravity to help first of all when they're moving that muscles in that area when they're using the muscles in that area the contraction of that muscle will help fluid to shift and it will help fluid the move and when that arm is elevated it helps fluid to what drain we want gravity to help us and that's why a is the correct answer by the way that's a famous test question on nclex which is which assessment finding obtained while taking the history of an older client should alert the nurse to the possibility of fluid or electrolyte imbalance a i'm too cold and need to wear sweater even when other people are warm b i seem to urinate more more when i drink coffee see in the summer i feel thirsty more often or d my rings are tighter this month and the correct answer is d my rings are tighter this month alright guys so let me ask you something what's more likely the ring shrinking or the person's finger swelling up the person's finger's swelling up right so that is the correct answer that is correct answer why are their fingers swelling up maybe the patient's um holding on to too much sodium with the sodium pull water fluid right and so now this patient has fluid overload that finger's swollen up they can't get the ring off now let's look at our wrong answer choices a i'm often cold and need to wear sweater even when other people are warm that could be many things but not fluid imbalance it could be maybe the patient's anemic maybe they have hypothyroidism it could be a number of things um b i seem to urinate more often when i drink coffee well duh coffee's a bladder irritant and you should feel like you need to urinate more when you drink coffee right see in the summer i feel more thirsty well duh because in the summer it's hotter so your body is going to require more fluids so the correct answer here guys is d my rings are tighter this month i doubt that all of this person's greens have shrunken no their fingers have swollen up all right we are down to our last question guys the client at risk for dehydration is on strict ino in addition the client has a large draining wound what action should the nurse take regarding fluid regarding fluid loss through wound drainage a no action needs to take be taken because wound drainage is considered insensible loss and is of no consequence b estimate the amount of wound drainage by the color of the stains on the dressing see when the dressing materials before and after the dressing change or d weigh the client before and after the dressing change and guys the correct answer is c weigh the dressing materials before and after the dressing change we want to know about the wound drainage and its weight by the way guys um when you're weighing um that type of drainage so one milligram is equal to one milliliter okay of body fluid um let's look at the wrong answer choices a no actions needed well yes and actions needed they just told you that we we have to do strict not just ironos strict irons that means we need to that means we need to know everything we need to measure everything so a is wrong and let me keep going to a because look at the end and is of no consequence let me tell you something oh my gosh i just realized that um i'm so sorry guys i just realized that the jacket i'm wearing hopefully you can't see it never mind okay um back to what i was saying of no consequence don't ever choose the answer choice that says it's not a big deal because in a where it says it's of no consequence that's another way of saying it's not a big deal everything is a big deal in nclex if something's wrong it's a big deal okay so don't ever choose the answer there's a difference between nothing being wrong and so you're just going to document because nothing's wrong and something actually being wrong and you saying oh something's wrong but it's not a big deal don't ever do that so a's wrong b estimate did not question just tell us strict i you know so how we're going to estimate when they want strict i know they want us to measure everything so no we're not estimating anything that's wrong d weigh the client before and after the dressing change guys we want to measure what the drainage to include that in the ino okay so you're not going to be measuring the patient when the question's asking us about the drainage what you're going to do is you're going to weigh all of you know you know your your gauze everything you used on that patient you're going to weigh it before you put it on the patient and then afterwards so you can find out how much they truly lost and don't forget guys when it comes to body fluids one milligram equals about an ml okay um guys i hope you found this video to be helpful and i'm so sorry it took me so long to come up with a part a true part one for you but my list from you guys just keeps getting longer and longer of the videos that you want to see so i've been trying to make newer content for you before i went back to this because at least i covered some of it so guys this is your part one if you want to see more fluid and electrolyte imbalance please do not hesitate let me know in the comment section or if there's something else you want to see me cover let me know in the comments section guys please go ahead and help out my algorithm with youtube say hello to me in the comment section don't forget to share my content with your classmates oh guys thank you so much to all the instructors who are playing my videos from california to oklahoma i got instructors playing my videos in canada in australia scotland i can't believe it thank you so much thank you thank you thank you guys don't forget to check out my uh content on nexusnursinginstitute.com um don't forget to check me out on my other social media platforms tik tok instagram facebook and please guys do not forget to like and subscribe below and you'll be seeing me on the next video

Channel: Nexus Nursing

Views: 32,430

Keywords: Fluid and Electrolytes, fluid adn electrolytes, fluid and electrolytes for nursing students, fluid and electrolytes registered nurse rn, fluid and electrolytes med surg, fluid and electrolytes nexus nursing, fluid adn electrolytes for nursing students, nclexreview, nclex, ati, hesi, nclex answers, ati review, ati answers, hesi review, hesi answers, nursing school help

Id: So0FF5IIyck

Length: 32min 32sec (1952 seconds)

Published: Sun Dec 19 2021