Studying for Fluid & Electrolytes Test... HELP!!!

Nursing Students Student Assist

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Specializes in Critical Care, Trauma, Neuroscience.

OK I realize this topic has been asked a million times, and I've actually been helped out a lot by searching the previous posts on here and going through links and study help already been given by AN members!!! However, I thought I'd throw out another request for help/tips about how to focus on the actual fluid/electrolytes & acid/base imbalance test. I'm in my 2nd semester of clinical (first med-surg course), and our instructor basically gave us powerpoint handouts and told us to read the book (5 chapters), and we'd "do fine".

My main fear is that we are going to be given scenarios where the patient is presenting with signs/symptoms and we are going to have to figure out what electrolyte imbalance they have. That's all fine, except that all the signs/ symptoms and causes and interventions seem to overlap!! I mean, I have literally been sitting here studying this entire week trying to work out some sort of method to distinguish between hyper/hyponatremia, fluid overload, dehydration, hypo/hyperkalemia, hypo/hypercalcemia, etc. and it seems like it's the luck of the draw when it comes to answering sample NCLEX questions online even!

For instance, there was a scenario where the patient is having diarrhea, is tachycardic, has postural hypotension, muscle twitching, dry mucous membranes, weakness, and the family reports neurological changes. The answer is hyponutremia, with other options being hypernatremia, hypokalemia or hyperkalemia. However, it seems like the answer could have been hypokalemia as well since it can be 1) caused by diarrhea, 2) signs are:variable pulse rate - rapid, thready; with orthostatic hypotension, Skeletal muscle weakness, Anxiety, lethargy, confusion (neurological changes...)

Ahhhhhhhhhhhhhhhh I am having the toughest time figuring out how to distinguish between these imbalances and it's not for lack of studying or trying! Does anyone have any tips or tricks of how to identify what they are asking for on the test? Is there a certain distinguishing factor between electrolytes that I'm missing? Maybe in the etiology or in the sign/symptom? This is driving me NUTS!

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OK I realize this topic has been asked a million times, and I've actually been helped out a lot by searching the previous posts on here and going through links and study help already been given by AN members!!! However, I thought I'd throw out another request for help/tips about how to focus on the actual fluid/electrolytes & acid/base imbalance test. I'm in my 2nd semester of clinical (first med-surg course), and our instructor basically gave us powerpoint handouts and told us to read the book (5 chapters), and we'd "do fine".

My main fear is that we are going to be given scenarios where the patient is presenting with signs/symptoms and we are going to have to figure out what electrolyte imbalance they have. That's all fine, except that all the signs/ symptoms and causes and interventions seem to overlap!! I mean, I have literally been sitting here studying this entire week trying to work out some sort of method to distinguish between hyper/hyponatremia, fluid overload, dehydration, hypo/hyperkalemia, hypo/hypercalcemia, etc. and it seems like it's the luck of the draw when it comes to answering sample NCLEX questions online even!

For instance, there was a scenario where the patient is having diarrhea, is tachycardic, has postural hypotension, muscle twitching, dry mucous membranes, weakness, and the family reports neurological changes. The answer is hyponutremia, with other options being hypernatremia, hypokalemia or hyperkalemia. However, it seems like the answer could have been hypokalemia as well since it can be 1) caused by diarrhea, 2) signs are:variable pulse rate - rapid, thready; with orthostatic hypotension, Skeletal muscle weakness, Anxiety, lethargy, confusion (neurological changes...)

Ahhhhhhhhhhhhhhhh I am having the toughest time figuring out how to distinguish between these imbalances and it's not for lack of studying or trying! Does anyone have any tips or tricks of how to identify what they are asking for on the test? Is there a certain distinguishing factor between electrolytes that I'm missing? Maybe in the etiology or in the sign/symptom? This is driving me NUTS!

First thing - breath and relax. =D

Certain things go together so a person with hypernatremia will almost certainly have hypovolemia and a lot of signs and symptoms will be the same.

Also there are big things to look out for for certain excesses and deficits. For hyperkalemia you should know that the extra potassium causes bowel motility especially since patients are sometimes given potassium for this reason - be aware also that is causes heart arrhythmias.

If you know one side, i.e. "hyper", then you most probably know the opposite side as well, i.e. "hypo" because most of the time the signs and symptoms are just the opposite of each other. So for hyperkalemia you are looking for increased bowel motility for hypokalemia you are looking for decreased bowel motility.

When it comes to tackling questions try to porifice out the big symptoms - if you see something related to cardiac problems, you are dealing with a kalemia of some sort; if the question also says diarrhea, then the answer is hyperkalemia; if the questions says something about constipation, hypokalemia.

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For instance, there was a scenario where the patient is having diarrhea, is tachycardic, has postural hypotension, muscle twitching, dry mucous membranes, weakness, and the family reports neurological changes. The answer is hyponutremia, with other options being hypernatremia, hypokalemia or hyperkalemia. However, it seems like the answer could have been hypokalemia as well since it can be 1) caused by diarrhea, 2) signs are:variable pulse rate - rapid, thready; with orthostatic hypotension, Skeletal muscle weakness, Anxiety, lethargy, confusion (neurological changes...)

If the patient was hypokalemic, he would be constipated and not have diarrhea. Yes - hypokalmia is caused by diarrhea but if the patient is currently having diarrhea then it's not hypokalemia because there is enough potassium for them to defecate.

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Specializes in LDRP.

make a chart with all the electrolytes and their symptoms... highlight the symptoms that are specific and common to that electrolyte (the ones that stand out that arent the same for all the imbalances)..

and always know the primary intervention for someone with potassium imbalance is throw a cardiac monitor on them right away...

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Specializes in ICU Surgical Trauma.

Many of signs and symptoms will be the same but there is at least one that doesn't apply to all of the imbalances. If you understand why the patient would present with certain signs and symptoms then you can probably recall instead of just memorizing the signs and symptoms

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Specializes in Neuro/ MS.

Acid Based explained that made sense to me:

Trick: if pH and Bicarb are Both in the same direction then it is metaBolic

As the pH goes so does the pt. Except for K+

if pH is high then body is excited/ Hi (alkalosis)

Tachy, HYPERventilation, HYPERreflexes, Diarrhea, seizure

if pH is LOW body is in a depressed or slow state (acidosis)

HYPOventilation, constipation, decreased body functions

Lung is Respiratory

Kidney is Metabolic

If you dont know pick Metabolic Acidosis

ELECTROLYTES

Potassium or Kalemias do the same as the prefix

HYPER- BODY goes up HYPO- body goes down

Calcium: Opposite

Hyper- body goes DOWN Hypo- body goes UP....remember Chvostek's (face) and Trousseau's(arm)

Magnesemias: OPPOSITE

HYPER-DOWN HYPO- UP

HyperNAtremia: dehydration HYponatremia-Overload

EARLIEST SIGN OF ANY is numbness and tingling

Universal sign of any is muscle weakness

Good luck on your test. Hope this helps

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Specializes in Critical Care, Trauma, Neuroscience.

Thank you so much everyone!!!! I especially love your trick, NENE916! All of this helps a lot! I've been trying to understand the underlying patho because that's usually how I do well on tests - I'm horrible at just memorizing, and I like to understand the big picture. However, I seem to have a mental block on this for some reason!

The Acid-Base imbalance seems to come very easy, and I am doing well with understanding the concept of pH and how to figure out what type of acidosis or alkalosis it is. But obviously I need to put togehter the idea of how to combine it with the electrolyte imbalances. I think that's what Iv'e been missing - we've been taught it separately and to look at the symptoms separately, even though I keep seeing in the book that alkalosis can cause low potassium, and that in acidosis there will be High potassium!

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Specializes in Med/Surg.

Hi everyone, I have a question regarding the osmolality level. As the osmolality level of ECF is High, it means the water will shift from the cells to the plasma then it will increase the intravascular valume. Does it cause water overload ? if the water shift from the cell then the cell become dehydrate, so Hypothalamus will release ADH to preserve the water from Kidneys excretion. if so then it will exacerbate the hypervolume in intravascular level. .... Im confused!!!! Please helpl me to clarify! thanks million thanks.

P.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

This may help....Third-spacing: Where has all the fluid gone?

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