Ok, so I have an NCLEX question that I need help with:
When assessing a client with suspected left sided heart failure the nurse would expect to find: (choose all that apply)
a. Edema at the anterior tibias
b. Weight gain
c. Crackles on auscultation
d. Pleural effusion
e. Hepatomegaly
I think the answer would be C and D, but I'm not sure about weight gain. I know you would typically see weight gain with peripheral edema in right-sided failure, but would you see it with pulmonary congestion as well? Thanks in advance!!
I do not understand the 2 to 3 pounds being equivalent to 4 to 6 liters. I would think 2 to 3 liters would be 4 to 6 pounds. Conversion from liters to pounds, or kilos to pounds, is liters times 2.2. What do I miss?
You're trying too hard to do conversions. It's not a conversion - it's just weight. What she's saying is 4 to 6 liters of fluid weighs about 2 to 3 pounds. (But it also weighs 4 to 6 kilos, because liquid and solid states convert directly in metric. I'll try to explain.)
It's not a conversion. It's a comparison to make it easier for the patient (and us) to understand. It's putting it into context. You can't direct convert US liquids with metric weight because liquids are calculated by volume, and the volumes in the US system don't convert directly to weight.
Put it this way: in the US system, one ounce of water is not the same as an ounce of cheese. Liquid ounces and so-called solid ounces don't measure the same thing. Liquid is measuring amount (volume) and the solid is measuring weight - we know the cheese and the water don't have the same weight. (If you wanted to measure the volume of the cheese our way, you'd use cubic inches. Confusing, right?)
Metric measures MASS (ie, the amount of space something takes up) and not weight. Mass is interchangeable regardless of the state of the matter. Weight is not.
You're telling the patient how much that liquid weighs using pounds because the average American (and I'm American so I'm not slagging!) can't relate to liters, but they dang sure get how much is in a pound. Plus, the weight is noticeable right off the bat (hence the daily weights) - we won't actually see the fluid and its effects until the edema develops or we diurese off the excess.
(I just went through this with my mother, who had developed CHF without anyone really noticing the weight creep...when she was admitted, they diuresed off TWENTY ONE POUNDS of fluid. Now all her pants are huge and her shoes are too big - that's how insidious CHF can be. And she's a great patient - takes all meds, behaves herself, goes to the MD when she should. It literally crept up on us. She thought she was just putting on a few pounds since my dad died a few years ago. Uh, no - her heart was in serious trouble and it only looked like weight creep.)
Thank you for your explanation. I still need more, I still can not wrap my head around the liters and pounds.
I would say that 4 to 6 liters is roughly 1 to 1.5 gallons of fluid, which is a bit on the low side. Now how can I imagine such an amount of fluid in pounds? One gallon equals 8 pints. One pint is about one pound. And then I get at about 8 pounds (actually a little bit more) for one gallon of fluid.
I understand that you cannot just convert fluid into weight. On the other hand, if we a talking about the human body, then a liter of fluid is approximately 1 kilo. To measure on a day to day basis if someone is retaining fluid, it is close enough.
So, to get to the 2 to 3 pounds, I still feel I oversee something significant. Help.
Clivia's right. "A pint's a pound, the world around." One liter is about a quart, and a quart is two pints, so a liter is about 2 pounds (2.2, actually). My bad, typing too fast. I am sooooo embarrassed.
But you still do tell the patient to report a 2-3 lb weight gain, because fluid retention and wt gain is the very first sign of CHF.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I looked at this several times and I thought I was losing my mind......LOL I ahven't been feeling well..so.....Oh, Thank Goodness GrnTea....I can still do math!!!!!!!! xoxoxoxo
In nursing school, we were always told that weight was the greatest indicator of fluid balance. A weight gain of 2-3 pounds in a very short amount of time isn't normal unless you are holding to an abnormal amount of fluid. I never really worried about how much fluid-there are other indicators of the exact balance, weight just was an easy noninvasive way to see there could be a problem.
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Clivia
30 Posts
Hello,
I do not understand the 2 to 3 pounds being equivalent to 4 to 6 liters. I would think 2 to 3 liters would be 4 to 6 pounds. Conversion from liters to pounds, or kilos to pounds, is liters times 2.2. What do I miss?