Summary Galen College of Nursing NSG 3850: Adult Health II Exam 1 - Complete A+ Guide_ Updated 2026.

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RBC  4.2-6.1


Adult Health II
Exam 1
Unit 1: Fluid and Electrolytes
Fluid Imbalances
The ECF compartment is divided into the intravascular, interstitial, and transcellular fluid spaces:

Intravacular Space:
 3 L of the average 6 L of blood volume in adults is made up of plasma
 3 L is made up of erythrocytes (RBC), leukocytes, and thrombocytes
Interstitial Space:
 Contains the fluid that surrounds the cell and totals about 11 to 12 L in
an adult
 Lymph is an interstitial fluid
Transcellular Fluids:
 Smallest division of the ECF compartment and contains approximately
1L
 Examples:
o Cerebrospinal
o Pericardial
o Synovial
o Intraocular
o Pleural fluids
o Sweat
o Digestive secretions

Movement of Fluids
Cell Membrane
 Pumps used to exchange sodium (outside) and potassium (inside)
Capillary Walls
 Hydrostatic vs. osmotic pressure
 Normal movement of fluids through the capillary wall into the tissues depends on hydrostatic pressure (the
pressure exerted by the fluid on the walls of the blood vessel) at both the arterial and the venous ends of the
vessel and the osmotic pressure exerted by the protein of plasma
 The direction of fluid movement depends on the differences in these two opposing forces




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Hypovolemia (FVD)
Patho and Etiology
 When loss of ECF volume exceeds the intake of fluid
 Water and electrolytes are lost in the same proportion as they exist in normal body fluids
o The ratio of serum electrolytes to water remains the same
 FVD should not be confused with dehydration
o Which refers to loss of water alone, with increased serum sodium levels
 FVD may occur alone or in combination with other imbalances
o Unless other imbalances are present concurrently, serum electrolyte concentrations remain
essentially unchanged
 Causes of FVD include vomiting, diarrhea, GI suctioning, sweating, etc.
 Oral intake is controlled by the thirst center in the hypothalamus

Signs and Symptoms
 SUDDEN Weight loss (acute)  Flattened neck veins
 Decreased skin turgor  Muscle cramps
 Oliguria  Cool, clammy skin
 Decreased BP/increased pulse & temp  Lethargy

Diagnosis
Hemoglobin & Hematocrit
 Increased d/t decreased plasma volume
 Conditions that increase the hematocrit value  dehydration and polycythemia (a lot of RBC’s)
 Conditions that decrease hematocrits  overhydration anemia
BUN & Creatinine (kidney function)
 BUN elevated out of proportion of the serum creatinine Hgb 
Urine Specific Gravity
 Increased in relation to the kidneys’ attempt to conserve water Hct 
 More concentrated BUN 
Potassium & Sodium 10-20
 Reduced (hypokalemia, hyponatremia) or elevated (hyperkalemia, hypernatremia)
 Hypokalemia  GI and renal losses
Creanine
 Hyponatremia  increased thirst and ADH release  0.5-1.2
H&P Sodium
Medical Management
***Replace fluid needs
 PO preferred
o Is the patient nauseous or have mouth pain?
o Order for antiemetics
o Fluids with glucose and electrolytes
 Rehydrate, Elete, Cytomax
o Tube feeding (enteral fluids) considered with water flushes
 IV route – if severe loss to expand plasma volume – PRIORITY
o Isotonic electrolytes solutions
 LR & 0.9% sodium chloride (NS)  expand plasma volume
o Once normotensive  HYPOTONIC (1/2 NS)




Nursing Interventions




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 I/O  OUTPUT  0.5 mL/kg/hr or 30 mL/hour
 Daily weight
 LOC
o More volume = more perfusion
o They should have better perfusion to the brain
 Breath sounds
o We want to ensure we don’t overhydrate
o Crackles
 Skin color
 Mucous membrane
 VS q4 hours
o Pulse should be coming down
o BP – no more orthostatic hypotension
 Administer fluids 
o Isotonic  severe
o Normotensive/stable move to a hypotonic solution (0.45% NaCl)
 Monitor urine specific gravity  should start to stabilize (enough volume in and out)
 Evaluate plan of care
 Monitor for hypothermia (usually accompany each other)
 Skin turgor q8 hours




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Hypervolemia
***FVE  isotonic expansion in the ECF
Etiology
 Abnormal retention of water and sodium
o Secondary to increase in total body sodium content
o Leads to an increase in total body water
o The serum sodium remains the same
o Aldosterone chronically stimulated
 Remember the RAAS
 Contributing factors
o HF
o Kidney injury
o Cirrhosis of the liver
o Increase intake of sodium or table salt
o Increase sodium-containing IV fluids

Signs and Symptoms
 Acute weight gain
 Edema, distended neck veins
 Crackles
 Increased CVP
 Increased BP & RR (dyspnea from pulmonary edema)
 Increased urine output

Diagnosis
 Hemoglobin & Hematocrit – decreased
o Conditions that increase the hematocrit value are dehydration and polycythemia, and those that
decrease hematocrit are overhydration and anemia
 BUN – decreased
o D/t plasma dilution, low protein intake, anemia
 Creatinine
o Kidney disease – osmolality and sodium levels are decreased d/t excessive retention of water
 Serum osmolality
 Urine sodium and specific gravity (1.005-1.030)
o Measures the kidney’s ability to excrete or conserve water
o The larger the volume the urine, the lower the specific gravity
 Health history and assessment

Medical Management
***Treat the underlying cause
 Discontinue IVF
 PO fluid restriction (First shift  most & Second shift  less & Third shift  least)

Pharmacological Therapy:
 Loop diuretics: Furosemide (Lasix)
o Can cause a greater loss of both sodium and water because they block sodium reabsorption in the
ascending limb of Henle loop, where 20% to 30% of filtered sodium is normally reabsorbed
o For SEVERE HYPERVOLEMIA
 Thiazide Diuretics (Hydrochlorothiazide)
o Thiazide diuretics block sodium reabsorption in the distal tubule, where only 5% to 10% of
filtered sodium is reabsorbed
o For MILD to MODERATE HYPERVOLEMIA
 Dialysis

Nutrition Therapy: Sodium Restriction




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