Fluid, Electrolytes, Acid-Base, and Respiratory Care Practice Flashcards

Vocabulary practice flashcards covering key terms, definitions, diagnostics, electrolyte normal levels, acid-base imbalances, IV therapy complications, and respiratory disorders.

Percentage of total body weight represented by body fluids in an adult

Approximately $60\%$

Bronchoscopy

• BEFORE

• Verify informed consent

• NPO 4–8 hr

• Remove dentures/oral prostheses

• Baseline respiratory assessment

• AFTER

• NPO until cough/gag reflex returns

• Monitor SpO₂/respirations

• Monitor for AMS especially in older adults

• Monitor for bleeding, dyspnea, laryngospasm

• EXPECTED

• Small blood-tinged sputum

• Low-grade fever ≤24 h

Dehydration

Elevated BUN, Normal creatinine, poor skin turgor

Factors that influence the total amount of body fluid in an individual

Age, sex, and amount of body fat.

Proportion of body fluid in the ICF compartment and its predominant electrolyte

Represents approximately $\frac{2}{3}$ of total body fluid, with potassium ($\text{K}^+$) as its major electrolyte.

Proportion of body fluid in the ECF compartment, its subcompartments, and its predominant electrolyte

Represents approximately $\frac{1}{3}$ of total body fluid; includes intravascular, interstitial, and transcellular spaces, with sodium ($\text{Na}^+$) as its major electrolyte.

Third Spacing

Shift of fluid from intravascular space into areas like ascites, pleural effusion, or pericardial effusion, where the earliest sign is decreased urine output.

sodium Na+

Range is $135\text{--}145\,\text{mEq/L}$; functions in fluid balance, water distribution, and nerve/muscle impulse conduction.

potassium K+

Range is $3.5\text{--}5.0\,\text{mEq/L}$; critical for cardiac electrophysiology and neuromuscular conduction.

calcium Ca

Range is $8.5\text{--}10.5\,\text{mg/dL}$; functions in bone health, neuromuscular stability, and blood clotting.

magnesium Mg

$1.8\text{--}3.0\,\text{mg/dL}$ neuromuscular

chloride Cl

$98\text{--}106\,\text{mEq/L}$ fluid/ acid-base

bicarbonate HCO3

$24\text{--}31\,\text{mEq/L}$ acid base

Four mechanisms by which water and solutes move across membranes in the body

1. Osmosis: Water moves from low solute concentration to high solute concentration.

2. Diffusion: Solutes move from high concentration to low concentration.

3. Filtration: Fluid moves driven by hydrostatic pressure.

4. Oncotic Pressure: Osmotic pull exerted by proteins (albumin) drawing fluid into blood vessels.

isotonic IV fluids

Causes no major cellular fluid shift while expanding ECF volume; examples include $0.9\%$ NS, Lactated Ringer's & D5W initially.

hypotonic IV solutions

Shifts fluid from ECF into ICF causing cells to swell; contraindicated in elevated intracranial pressure (ICP), third spacing, and hemodynamic instability. .45%NS and .25% NS are common examples.

hypertonic IV solutions

Draws water out of ICF into ECF causing cells to shrink and intravascular volume to expand; risks include fluid overload and pulmonary edema. 3% and 5 % NaCl

Hypovolemia

Caused by N/V, GI suction, hemorrhage, burns, third spacing; leads to concentrated urine, elevated hemoglobin/hematocrit ($\text{Hgb/Hct}$), and an elevated $\text{BUN}:\text{creatinine}$ ratio. Give Isotonic.

Hypervolemia

Finding: Weight gain, peripheral edema, jugular venous distension (JVD), pulmonary crackles, dyspnea, elevated blood pressure, elevated CVP, and bounding pulse. Causes: HF, kidney dysfunction, cirrhosis, Na+, corticosteroids.

sodium level below $135\,\text{mEq/L}$ (Hyponatremia)

Caused by SIADH, diuretics, GI losses, or excess water; presents with cellular swelling causing headache, confusion, weakness, twitching, seizures, and coma. Hypertonic solution.

sodium level above $145\,\text{mEq/L}$ ( Hypernatremia)

Caused by diabetes insipidus (DI), water loss, diarrhea, or burns; presents with cellular dehydration causing thirst, dry mucosa, restlessness, twitching, hyperreflexia, and seizures. Hypotonic solutions.

potassium below $3.5\,\text{mEq/L}$ ( Hypokalemia)

Caused by: GI loss, diuretics, Presents: weakness/cramps, Dysrhythmias, low GI motility. Monitor ECG, never push potassium.

potassium above $5.0\,\text{mEq/L}$ ( Hyperkalemia)

Caused by kidney failure, tissue damage. Presents: weakness, GI symptoms and life-threatening dysrhythmias. Cardiac monitoring and stop K+ sources (spironolactone)

Key pharmacological interventions used to protect the heart and shift potassium into cells in severe hyperkalemia

Administration of Calcium Gluconate (protects the myocardium) and Insulin plus Glucose (shifts potassium from ECF into cells).

Key consequences of impaired potassium excretion in kidney failure

Potassium buildup leading to muscle weakness, slow/shallow respirations, paralytic ileus, and life-threatening cardiac dysrhythmias.

Two clinical physical assessment signs indicating latent tetany from low calcium

1. Chvostek's sign: Facial twitching when tapping the facial nerve.

2. Trousseau's sign: Carpopedal spasm induced by inflating a blood pressure cuff above systolic pressure for 3 minutes.

calcium below $8.5\,\text{mg/dL}$ (hypocalcemia)

Numbness, tingling, tetany, spasms, hyperactive reflexes, positive Chvostek's and Trousseau's signs, and seizures. Laryngospasms also occur, potentially leading to respiratory distress and arrhythmias. Monitor airway and ECG.

calcium above $10.5\,\text{mg/dL}$ (hypercalcemia)

Muscle weakness, constipation, hypoactive reflexes, kidney stones, bone pain, and lethargy. Monitor ECG and hydrate

magnesium below $1.8\,\text{mg/dL}$ (Hypomagnesemia)

Caused by: GI losses, alcohol, diuretics. Presents: Tremors, tetany, hyperreflexia, seizures, and cardiac dysrhythmias. Replace Mg, monitor ECG.

magnesium above $3.0\,\text{mg/dL}$ (Hypermagnesemia)

Caused by kidney dysfunction. Presents: Lethargy, hyporeflexia, hypotension, and respiratory depression. Stop Mg, monitor breathing.

phosphorus below $2.5\,\text{mg/dL}$ (Hypophosphatemia)

Caused by malnutrition, refeeding syndrome, alcohol use, and malabsorption; presents with muscle weakness, confusion, respiratory weakness, and bone problems.

Phosphate above 4.5mg/dL (Hyperphosphatemia)

Reciprocally associated with low calcium ($\downarrow \text{Ca}^{2+}$), presenting with tetany, muscle cramps, and soft tissue calcium deposits.

Normal reference ranges for arterial blood gas parameters (pH, $\text{PaCO}_2$, and $\text{HCO}_3^-$)

1. pH: $7.35\text{--}7.45$

2. $\text{PaCO}_2$: $35\text{--}45\,\text{mm Hg}$

3. $\text{HCO}_3^-$: $22\text{--}26\,\text{mEq/L}$

respiratory acidosis

Characterized by pH $< 7.35$ and $\text{PaCO}_2 > 45\,\text{mm Hg}$; caused by hypoventilation, COPD, opioid overdose, or airway obstruction.

respiratory alkalosis

Characterized by pH $> 7.45$ and $\text{PaCO}_2 < 35\,\text{mm Hg}$; caused by hyperventilation, anxiety, panic, pain, or hypoxemia.

metabolic acidosis

Characterized by pH $< 7.35$ and $\text{HCO}_3^- < 22\,\text{mEq/L}$ ; caused by DKA, lactic acidosis, shock, kidney failure, or severe diarrhea, Kussmaul respirations.

metabolic alkalosis

Characterized by pH $> 7.45$ and $\text{HCO}_3^- > 26\,\text{mEq/L}$; caused by loss of gastric acid (vomiting, NG suction), excess antacid intake, or diuretics.

Classic physical assessment findings of IV solution leakage into subcutaneous tissue

Tissue surrounding the IV site is cool, pale, and swollen.

Extravasation

IV complication involving inadvertent leakage of vesicant solution into surrounding tissue. causes severe pain, burning, blistering, and tissue necrosis.

Infiltration

IV complication where non-vesicant solution leaks into surrounding tissue, causing swelling and discomfort.

Phlebitis

inflammation of a vein, often characterized by redness, warmth, and tenderness along the vein, which can occur with or without a thrombus.

Infection

is the invasion of the body by pathogenic microorganisms, which can lead to inflammation and systemic illness if not treated. Redness, drainage, fever.

Occlusion

is the blockage of blood flow in a vein or artery, often leading to swelling and pain. It can occur due to the presence of a thrombus or external compression.

IV fluid overload

occurs when there is an excessive administration of intravenous fluids, leading to an accumulation of fluid in the body. This can result in symptoms such as edema, elevated blood pressure, and respiratory distress, JVD, Crackles, high BP,. Need to decrease IV rate, place in high fowlers, assess lungs and VS, notify provider.

air embolism

Signs: sudden dyspnea, chest pain, cough, cyanosis, low bp, weak pulse, altered LOC. Clamp the IV line, position the patient on their left side in Trendelenburg position, and administer oxygen, assess ABC’s, notify rapid response.

Primary physiological role of the upper vs. lower respiratory tract

Upper tract (nose, pharynx, larynx) warms, humidifies, and filters air; lower tract (trachea, bronchi, lungs, alveoli) is the primary site of gas exchange.

Airway resistance

Impedance to airflow in respiratory passages and conditions that increase it: ; increased by narrowed/obstructed airways such as in asthma, chronic bronchitis, excess mucus, or foreign bodies.

Definition of lung compliance and conditions where it is increased vs. decreased

Elasticity and expandability of lungs; increased in emphysema, decreased in pulmonary edema, atelectasis, pulmonary fibrosis, and ARDS.

Definition and average normal adult volume for Tidal Volume

The volume of air inhaled and exhaled with each normal breath, averaging approximately 500 ml

Residual Volume (RV)

Volume of air remaining after maximum exhalation and condition where it increases; increased in obstructive lung diseases like COPD.

Vital Capacity (VC)

Maximum volume of air exhaled following maximum inspiration; decreased in respiratory and neuromuscular diseases.

Total Lung Capacity (TLC)

Total air volume after maximum inspiration and variations in disease states; increased in obstructive disease (COPD) and decreased in restrictive disease.

Key physiological respiratory changes associated with aging

Decreased cilia function, decreased physiological response to hypoxemia, decreased chest wall compliance, decreased respiratory muscle strength, and decreased cell-mediated immunity.

Respiratory Assessment — Key Symptoms

• ASSESS FOR

• Dyspnea

• Cough/sputum

• Chest pain

• Wheezing

• Hemoptysis

• ASK ABOUT

• Sudden vs. gradual onset

• Triggers/relieving factors

• Severity

• Activity tolerance

• Smoking/exposure history

sudden dyspnea

Pulmonary embolism (PE), pneumothorax, acute airway obstruction, or severe allergic reaction.

Orthopnea

Difficulty breathing when lying flat that is relieved by sitting or standing upright; commonly associated with heart disease and heart failure.

Cause and clinical urgency of stridor

Harsh, high-pitched upper airway sound caused by upper airway narrowing or obstruction; represents an immediate medical emergency requiring airway protection.

COUGH

• Night → asthma/heart failure

• Morning + sputum → bronchitis

• After eating → aspiration/reflux

• Dry → viral illness/medications

Clinical significance of yellow/green, rust-colored, pink/frothy, and foul-smelling sputum

1. Yellow/green: Infection

2. Rust-colored: Pneumonia

3. Pink/frothy: Pulmonary edema

4. Foul-smelling: Lung abscess or severe infection

Hemoptysis

Coughed up from respiratory tract, bright red, frothy, mixed with sputum

Hematemesis

Vomited from GI tract, dark red or coffee-ground appearance, may contain food.

Early clinical manifestations of oxygen deprivation (early hypoxia)

Restlessness, anxiety, tachypnea, tachycardia, accessory muscle use, nasal flaring, and decreased $\text{SpO}_2$.

Worsening or severe manifestations of oxygen deprivation (late hypoxia)

Confusion, lethargy, cyanosis, bradypnea, bradycardia, and decreased level of consciousness (LOC).

Eupnea

Normal, regular, unlabored breathing; 12–20/min in adults

Bradypnea

Slow breathing <12/min; seen with opioids, CNS depression, neurologic injury

Apnea

Complete absence of breathing; may occur with airway obstruction, overdose, or respiratory arrest

Cheyne-Stokes respirations

Periodic breathing pattern with gradual increase/decrease in depth followed by apnea, seen in severe heart failure, stroke, brain injury, or end of life.

Biot's respirations

Irregular breathing pattern with groups of quick inspirations followed by unpredictable apnea; associated with brainstem/medulla damage or elevated ICP.

1. Crackles: Popping sounds from fluid or collapsed alveoli.

2. Wheezes: High-pitched musical sounds from narrowed airways.

3. Rhonchi: Low-pitched snoring/rumbling from secretions in large airways.

4. Pleural rub: Grating/rubbing from inflamed pleura.

Acoustic characteristics of crackles, wheezes, rhonchi, and pleural friction rub

Pleural rub

Grating/rubbing from inflamed pleura.

Rhonchi

Low-pitched snoring/rumbling from secretions in large airways.

Wheezes

High-pitched musical sounds from narrowed airways.

Key nursing priorities before and after a bronchoscopy procedure

1. Before: Verify consent, NPO 4–8 hours, remove dentures.

2. After: Maintain NPO status until cough/gag reflex returns, monitor for bleeding/laryngospasm; blood-tinged sputum and low-grade fever ($\le 24\,\text{hr}$) are expected.

Thoracoscopy

• PURPOSE

• Visualize pleural cavity

• Obtain fluid/tissue samples

• Biopsy lesions

• Evaluate pleural disease/tumors

• AFTER PROCEDURE

• Chest tube may be inserted

• Monitor respiratory status

• Assess incision/chest tube

• Promote lung re-expansion

Upper Respiratory Infections

• COMMON SITES

• Nose/sinuses

• Pharynx

• Larynx

• Upper trachea

• COMMON CAUSES

• Viruses most common

• Bacterial infections possible

• Spread through respiratory secretions

• GENERAL NURSING CARE

• Hydration/rest

• Humidification

• Manage secretions

• Pain/fever control

• Hand hygiene

Key differences in etiology and manifestations between allergic and nonallergic rhinitis

Allergic rhinitis is allergen-triggered with sneezing, pruritus, rhinorrhea, and watery eyes; nonallergic rhinitis is often viral or irritant-triggered without systemic allergic signs. Treatment: figure out cause, avoid triggers, antihistamines, nasal saline.

Common Cold — Viral Rhinitis

• MANIFESTATIONS

• Nasal congestion/rhinorrhea

• Sneezing

• Sore throat

• Malaise

• Headache/body aches

• Cough may develop

• TREATMENT

• Rest + fluids

• Analgesics/NSAIDs

• Antihistamines

• Guaifenesin

• Symptom management

• IMPORTANT

• Antibiotics do NOT treat viral colds

• Hand hygiene prevents spread

Clinical timeline and findings distinguishing viral from bacterial rhinosinusitis

Viral lasts $< 10$ days without worsening; bacterial lasts $\ge 10$ days or worsens, with purulent drainage, facial pain/pressure, and high fever ($\ge 102^\circ\text{F}$).

Signs indicating severe intracranial or orbital complications from rhinosinusitis

Periorbital edema, severe facial pain, severe headache, nuchal rigidity, and neurologic changes.

Pharyngitis and Tonsillitis

Viral Inflammation of the pharynx and tonsils, often caused by viral or bacterial infections, characterized by sore throat, difficulty swallowing, and swollen lymph nodes.

Key clinical signs alerting the nurse to postoperative bleeding after tonsillectomy

Frequent swallowing, throat clearing, tachycardia, restlessness, and bright-red blood in the mouth or vomitus.

Laryngitis

• CAUSES

• Viral infection

• Voice overuse

• Irritants/smoking

• GERD

• MANIFESTATIONS

• Hoarseness

• Voice loss

• Sore throat

• Dry cough

• TREATMENT

• Voice rest

• Hydration

• Humidification

• Treat underlying cause

Major risk factors and hallmark symptom triad of Obstructive Sleep Apnea (OSA)

Risks include obesity, large neck circumference, male sex, alcohol, sleeping supine

3 S’s of sleep apnea

Snoring, Sleepiness, Significant other reports apnea

Gold standard diagnostic test for obstructive sleep apnea

Polysomnography (sleep study), can be sent home with a cpap or bipap.

Immediate first-aid positioning and intervention for epistaxis

Position patient sitting upright and leaning forward, and apply continuous direct pressure by pinching the soft portion of the nose for 10–15 minutes. Do not tilt head back or swallow blood. If bleeding continues give vasoconstrictor, cauterize, nasal packing.

Laryngeal Obstruction — EMERGENCY

• CAUSES

• Anaphylaxis/angioedema

• Foreign body

• Infection/edema

• Tumor

• Trauma

• WARNING SIGNS

• Stridor

• Retractions/accessory muscles

• Dyspnea

• ↓ SpO₂

• Respiratory distress

• PRIORITY

• SECURE THE AIRWAY

Top risk factors and primary early warning sign of laryngeal cancer

Tobacco and heavy alcohol use; early finding is persistent hoarseness lasting longer than 2 weeks.

partial laryngectomy

Portion of larynx removed, Airway remains intact, Swallowing generally preserved, Voice may be hoarse/altered

total laryngectomy

Larynx is completely removed, resulting in a permanent neck stoma, total loss of natural voice, and complete separation of the airway from the digestive tract.

Safety instructions for patients living with a permanent laryngectomy stoma

Use humidification, protect stoma during showering, prevent water from entering the stoma, and avoid swimming.

Etiology and conservative management measures for acute tracheobronchitis

Usually follows viral URI; managed with fluids, humidification, directed coughing, and antibiotics only if secondary bacterial infection is present, suction/bronchoscopy if necessary.

Manifestations of tracheobronchitis

• Dry irritating cough → productive cough

• Sternal soreness

• Fever/chills

• Wheeze/stridor

• Purulent sputum

Conditions placing patients at high risk for aspiration of oral or gastric contents

Decreased level of consciousness/sedation, stroke/brain injury, seizures, dysphagia, flat supine positioning, and recent prolonged intubation.

Nursing strategies to reduce aspiration risk during feedings and positioning

Maintain head of bed elevated $30\text{--}45^\circ$, perform swallow screening, feed upright, instruct on chin tuck maneuver, and avoid bolus feeds in high-risk patients.

Underlying causes and physical assessment findings in atelectasis

Caused by shallow breathing, immobility, pain, or mucus plugs; presents with dyspnea, decreased breath sounds, crackles, tachypnea, and decreased $\text{SpO}_2$.

Interventions to promote lung expansion and clear secretions in atelectasis

Repositioning, early ambulation, coughing and deep breathing exercises, incentive spirometry, hydration, suction PRN, and chest physiotherapy. If severe use CPAP or bronchoscopy.

CAP (Community acquired pneumonia)

Community or ≤48 hr after admission

HAP (hospital acquired pneumonia)

Develops $\ge 48\,\text{hr}$ after hospital admission.

VAP (Ventilator associated pneumonia)

Develops $\ge 48\,\text{hr}$ after endotracheal intubation.