NR 324 Exam1 STUDY GUIDE (1)

NR 324 Exam1 STUDY GUIDE (1) Acid-Base, Fluid and Electrolytes Ch. 17~Respiratory System Ch. 26, 27, 28 & 29 Alternate Type Questions: Multiple Choice - Select all that Apply - Medication Calculation Total Number of Questions: Exam 1: 50 questions; 4 points each Topics Calculation of Fluid Gain or Loss • 1L of H2O = 2.2 lbs (1kg) Electrolyte Composition of Fluid Compartments • Extracellular fluid (ECF) Consists of interstitial fluid (fluid in the space between cells), plasma (the liquid part of the blood), and transcellular fluid (very small amount of fluid contained within specialized cavities in the body). Main cation is sodium. Primary anion is chloride. • Intracellular fluid (ICF) Main cation is potassium. Primary anion is phosphate. Normal Serum Electrolyte Values • Anions Bicarbonate (HCO3-) - 22-26 mEq/L Chloride (Cl-) - 96-106 mEq/L Phosphate (PO4-) - 2.4-4.4 mg/dL • Cations Magnesium (Mg+) ~ 1.5-2.5 mEq/L Potassium (K+) ~ 3.5-5.0 mEq/L Calcium (Ca+) ~ 8.6-10.2 mg/dL Sodium (Na+) ~ 135-145 mEq/L Fluid Volume Deficit – HYPOVOLEMIA - Shift of fluids from plasma into interstitial fluid. • Causes Increased insensible H2O loss or perspiration (high fever, heat stroke) Diabetes insipidus Osmotic diuresis Hemorrhage GI loss: vomit, NG suction, diarrhea, fistula drainage Overuse of diuretics (polyuria) Inadequate fluid intake 3rd space fluid shifts: burns, intestinal obstruction. • Clinical Manifestations Restlessness, drowsiness, lethargy, confusion Thirst, dry mucous membrane Decreased skin turgor, decreased cap refill Postural hypotension, increased pulse, decreased CVP (central venous pressure) Decreased urine output, concentrated urine Increased respiratory rate Weakness, dizziness Weight loss Seizures, coma • Collaborative care The goal is to address the underlying cause and to replace water and any needed electrolytes. Give balanced IV solutions such as Lactated Ringer’s or (0.9%) sodium chloride (isotonic). • Nursing Diagnoses Deficient fluid volume related to excessive ECF losses or decreased fluid intake Decreased cardiac output related to excessive ECF losses or decreased fluid intake Risk for deficient fluid volume related to excessive ECF losses or decreased fluid intake Potential complication: hypovolemic shock • Nursing Implementation 24 hr input and output measurements; input is oral, IV, tube feeding, & retained irrigants; output is urine, excessive sweating, wound or tube drainage, vomit, & diarrhea. Specific gravity for urine concentration is 1.025. (> 1.025 indicates concentrated urine). Check cardio changes; vasoconstriction and tachycardia try to compensate (why you can have a high heart rate but blood pressure can still be normal) if it is inadequate then hypotension will happen when recumbent (laying down); flatten neck veins & weak, thread pulse that is easily obliterated. Untreated can cause