NCLEX Question on Fluid and Electrolyte Imbalances (Nursing)

00:00 Okay let's look at the question. "The nurse cares for a client in ER who is admitted with abdominal trauma following a motor vehicle accident." Okay, so what's particular about this patient? My setting is ER. They had an abdominal trauma after a motor vehicle accident. Okay, worst case scenario? Whoah, if they took a hit to the gut I'm worried about bleeding. The client's vital signs are heart rate 126, that's high; blood pressure 90/58, that's low; respirations 24, yeah I'm not that impressed with that, it's okay; and temperature 98.9. Okay, but what concerns me is I'm in ER for an abdominal trauma. My biggest concern from that would be bleeding and I know they've had a motor vehicle accident. Now their heart rate is fast, their blood pressure is low.

00:53 Yeah, those red flags are going up for me. So which of the following orders would be most important for the nurse to question? Well, I'm going to question anything that's going to put this particular patient, trauma from abdominal, worried about bleeding with vital signs that are pulse too high, blood pressure too low so they're showing me signs that it could be bleeding. So in this particular patient, this particular setting, what would keep them the safest? Oh, but wait a minute look at that line again. Which of the following orders would be most important for the nurse to question? Uhhhh, that question is asking me which of these orders would be unsafe for this patient? Okay, so I'm going to give 4 options for 0.45% normal saline at 100 mL/hour, normal saline at 150 mL/hour, Lactated Ringer's at 75 mL/hour, 1 unit packed red blood cells. What I want you to do is to walk to this question and eliminate 3 answers but make yourself say why. Now here's what I would do if I were you. I would go through each one of these IVs or these fluids and I would say "Is it hypotonic, isotonic, or hypertonic?" And then I would make a note to myself "Which way do I think that would cause fluid to shift?" So work your way through this question and then I'll come back and tell you the correct answer but don't take a shortcut. Make yourself with every solution, identified as iso, hypo, or hypertonic and ask yourself which way fluid would shift. Would it shift into the cell or out of the cell and what impact would it have on this patient. Okay, let's look at the answer choices. Now this patient's blood pressure is already low, heart rate is too high. I know for a fact I'm really concerned about them staying stable. Right? So, the worst possible IV fluid IV fluid I could give them if I think through, isotonic shouldn't cause to shift, hypertonic will cause fluid to shift out of the cells into the intravascular space, hypotonic will take fluid from the intravascular space and shove it into the cells. That's the one I'm going to follow up on.

03:26 Blood should not cause fluid volume to shift very much. Lactated Ringer's, normal saline. Did you identify what type of those solutions those were? See, that's not going to give us a problem but the 0.45% normal saline, that's the order I'm going to question because I want to keep this patient safe. It's a hypotonic solution. So that will cause fluid to shift from the intravascular space into the cells, meaning that blood pressure will drop even further. So that's why the correct answer is a most important for me to follow up on a. Okay, let's try another question. You did really well on that one, let's see how you're doing on this one. Without looking at your notes, I want you to name the 3 types of IV solution. Hint, think tonicity. Now I want you to name 2 IV fluids that cause fluid volume to shift from the cells into the vascular system. See if you can actually remember the names of the individual fluids, not just their tonicity but the names of the fluids.

04:45 Now here's a good one. First of all I want you to pick the IV solutions. This will be a good test live for you to think through what we just talked about but the name of the IV solution on the left, then think what type of patients it would be good for (that's the checkbox) and think of the X (patients that should not receive that type of solution). Work your way back to the presentation just to make sure you have each one of those patterns selling in your mind.