b.Cardiovascular system: The heart and blood
vessels are responsible for pumping and carry-
ing nutrients and water throughout the body.
c. Lungs: The lungs regulate oxygen and carbon
dioxide levels of the blood.
d.Thyroid: Thyroxine, released by the thyroid
gland, increases blood flow in the body. This in
turn increases renal circulation, which results
in increased glomerular filtration and urinary
output.
e.Parathyroid glands: The parathyroid glands
secrete parathyroid hormone, which regulates
the level of calcium in ECF.
f. Gastrointestinal tract: The GI tract absorbs
water and nutrients that enter the body
through this route.
g.Nervous system: The nervous system acts as a
switchboard and inhibits and stimulates mecha-
nisms that influence fluid balance.- a.Acidosis: Characterized by a high concentration
of hydrogen ions in ECF, which causes the pH
to fall below 7.35
b.Alkalosis: Characterized by a low concentration
of hydrogen ions in ECF, which causes the pH
to exceed 7.45 - a.Respiratory acidosis: An excess of carbonic acid
in ECF caused by decreased alveolar ventilation
and resulting in the retention of carbon diox-
ide. The lungs cannot compensate for the rise
in carbonic acid levels. As the carbonic acid
concentration increases, the kidneys retain
more bicarbonate and increase their excretion
of hydrogen.
b.Respiratory alkalosis: A deficit of carbonic acid
in ECF caused by increased alveolar ventilation
and resulting in a decrease in carbon dioxide.
Respiratory rate and depth increase because
carbon dioxide is being excreted faster than
normal; depression or cessation of respirations
can occur. The kidneys attempt to alleviate this
imbalance by increasing bicarbonate excretion
and hydrogen retention.
c. Metabolic acidosis: A deficit of bicarbonate in
ECF resulting from an increase in acidic compo-
nents or an excessive loss of bicarbonate. The
lungs attempt to increase the rate of carbon
dioxide excretion by increasing the rate and
depth of respirations; the kidneys attempt to
compensate by retaining bicarbonate and
excreting more hydrogen. May result in loss of
consciousness and death.
d.Metabolic alkalosis: An excess of bicarbonate in
ECF resulting from loss of acid or ingestion
or retention of base. The body attempts to
compensate by retaining carbon dioxide. Respi-
rations become slow and shallow, and periods
of apnea may occur. The kidneys excrete potas-
sium and sodium along with excess bicarbonate
and retain hydrogen within carbonic acid. - a.Increased hematocrit: Severe dehydration and
shock (when hemoconcentration rises consider-
ably)
b.Decreased hematocrit: Acute, massive blood
loss; hemolytic reaction following transfusion
of incompatible blood
c. Increased hemoglobin: Hemoconcentration of
the blood
d.Decreased hemoglobin: Anemia, severe hemor-
rhage, and following a hemolytic reaction - a.Urine pH and specific gravity: Specific gravity is
a measure of the kidney’s ability to concentrate
urine. Normal range: 1.005 to 1.030. Both may
be obtained by dipstick measurement on a fresh
voided specimen or through lab analysis.
b.Serum electrolytes: Indicates plasma levels of
select electrolytes
c. Arterial blood gases: Indicate the adequacy of
oxygenation and ventilation and acid–base status - a.Note the patient’s fluid and food intake, and
learn what the patient’s previous eating and
drinking patterns have been.
b.Note whether thirst is excessive or whether
patient experiences little or no thirst.
c. Note excessive losses of fluid from the body and
attempt to prevent losses when possible.
d.Physiologic changes that accompany the aging
process may affect the patient’s ability to main-
tain fluid balance. - a.Select a vein large enough to accommodate the
needle.
b.Select a site that is naturally splinted by bone,
such as the back of the hand or the forearm.
c. Select a site distal to the heart and move proxi-
mally, as necessary, to find the appropriate
injection site.
d.Select a site while moving toward the heart and
away from a damaged vein.
11.Handling all equipment, performing dressing
changes, assessing patient for evidence of
infection or other complications, and maintaining
the supplies necessary to continue home infusion
APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.Based on the data in this scenario, what body
systems are involved in Mr. Park’s fluid volume
excess? What interventions would be appropriate?
Fluid has accumulated in Mr. Park’s heart and lungs
as manifested by his bounding pulse, distended
neck veins, and abnormal lung sounds. The nurse
should make careful assessments of Mr. Park’s IV
infusion to ensure the proper flow rate. The nurse
should also be aware that fluid restriction may be
ordered and prepare the patient by explaining the
reason for the restriction and what foods to avoidCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:408 ANSWER KEY
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