Alterations in Fluids and Electrolytes

[vg1003]

A patient with cancer who can't eat and has lost 80 pounds. Let's add to his

assessment findings: let's say he has generalized edema and a serum protein of 4gm/dl (normal = 6.0 to 8.3 gm/dl ). Which is the most accurate mini-concept map linking low protein with edema?

a. hypoproteinemia - concentration in blood is now lower than the normal concentration of fluids inside cellsà fluid goes from B to T.

b. hypoproteinemia - concentration in blood is now higher than the normal concentration of fluids inside cellsà fluid goes from B to T

c. hypoproteinemia- blood is now hyperosmolar compared to the cells à fluid goes from T to B

d. hyperproteinemia -blood now has lower oncotic pressure than normalà fluid goes from T to B

I chose answer A. Is this correct?

[vg1003]

To go along with that question.

All of the following are accurate possible findings in the patient above EXCEPT

a. that he has confusion due swollen brain cells.

b. that he has crackles in his lungs from fluid in the alveoli (lung tissue).

c. that his serum osmolality is 302 (norm = 280- 295).

d. that he will need a hypertonic IV solution to return fluid status to normal.

I'm having a hard time getting to the correct answer because I believe the answer is either c or d but they both seem plausible. Can anyone tell me which one and why so I can understand better?

[newrngrad]

I am a new grad, hence the name, lol.... but here would be my answer......

We should always remember that protien helps to keep fluid in our C.Vascular. system...... so low protien means lower pulling of fluids back into our blood.....

So if fluids aren't being pulled back/ our drawn to stay in our C.V. sys. Where can they go? And this is how I would answer the second question.

Dependent edema, pitting edema? Crackles in lungs, maybe lower urine output? Labs maybe reveal hypernatremia? Im seriously just throwing ideas..... crackles for sure, third spacing in ble, sacral, bue.....

PLEASE others reply, and just take this response as simple brainstorming!

[AgentBeast, BSN, RN]

A is correct for the first question

C is the correct incorrect answer for the second question

Osmolarity would be 295 in this case. The hypoproteinemia causes the osmolarity of the blood to decrease not increase.

[vg1003]

Thanks Scott!!!

5. A patient is hospitalized in renal failure. Because of her kidneys’ inability to excrete water, she has generalized edema & a serum sodium of 129. Because the kidneys have also lost the ability to appropriately regulate potassium, she also has a serum potassium of 5.9. These lab results show:

a. hypernatremia & hypokalemia.

b. hyperkalemia & hyponatremia.

c. hyperosmolality & hypernatremia.

d. hypoosmolality & hypocalcemia.

I chose answer b for this one.

6. In the previous question, the edema is most likely due to fluid shifting from the intravascular space into interstitial spaces secondary to all the following EXCEPT:

a. hypertonicity of the plasma space.

b. hypotonicity of the plasma space.

c. hypoosmolality of the blood.

d. diminished osmotic pressure of the blood.

I chose a. (hopefully the right answer) Can I get some detail on this, please?

[AgentBeast, BSN, RN]

5.) It's technically dilutional hyponatremia and in response to that hyponatremia there is an extracellular potassium shift. But all the question is asking about is what the lab values indicate. B is the correct answer.

6.) A is the correct answer, but it's really worded funky. Usually it's inter-vascular space, interstitial space (third space), and inter-cellular space and not plasma space, but if the plasma were hyper-tonic it would be pulling fluid into the inter-vascular space raising blood pressure.

[vg1003]

Which of the following compatibility situations is most likely? A patient who is

a. B positive and receives B negative blood will have a transfusion reaction.

b. AB positive and receives B negative blood will do fine.

c. A negative and receives A positive blood will do fine.

d. A negative and receives O negative blood will have a transfusion reaction.

[Esme12, ASN, BSN, RN]

Which of the following compatibility situations is most likely? A patient who is

a. B positive and receives B negative blood will have a transfusion reaction.

b. AB positive and receives B negative blood will do fine.

c. A negative and receives A positive blood will do fine.

d. A negative and receives O negative blood will have a transfusion reaction.

This may give you your answer.....Google is your friend.

Blood Component ABO Compatibility Chart