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NUR242 / NUR 242 Exam 2 Study Guide
ss ss ss ss ss ss ss ss ss ss
Medical-Surgical Nursing Concepts ss ss
100% Correct | Grade A Galen
ss ss ss ss ss ss
Med Surge Exam #2 Study Guide
ss ss ss ss ss
ss Fluid & Electrolytes & ABG’s
ss ss ss ss
o Homeostasis:
● Water ssis ssthe ssmost sscommon ssfluid, ssmakes ssup ss50-60% ssof sstotal ssweight
▪ Needed ssto ssdeliver ssdissolved ssnutrients, sselectrolytes, ssand ssall
sssubstances ssto s s all ssorgans, sstissues, ssand sscells
● Water ssis ssdivided ssinto ss2 ssmain sscompartments:
▪ Extracellular ss– ssfluid ssoutside ssthe sscell
◆ Also ssincludes ssinterstitial ssfluid ssbetween ssthe sscells
▪ Intracellular ss– ssfluid ssinside ssthe sscell
o Filtration
● The ssmovement ssof ssfluid ss(water) ssthrough ssa sscell ssor ssblood ssvessel
ssmembrane s s because ssof sswater sspressure ss(hydrostatic sspressure)
ssdifferences sson ssboth sssides ssof s s the ssmembrane
● The sshuman ssbody ssconstantly ssseeks ssequilibrium
▪ Water ssmovement ssoccurs ssuntil sshydrostatic sspressure ssis ssequal sson
ssboth s s sides ssof ssmembrane
▪ Blood sspressure ssis ssan ssexample ssof sshydrostatic ssfiltration. ssIt ssmoves
sswhole s s blood ssfrom ssthe ssheart ssto sscapillaries sswhere ssfiltration
sscan ssoccur ssto s s exchange sswater, ssnutrients, ssand sswaste ssproducts
ssbetween ssthe ssblood s s and ssthe sstissues
, o Fluid ssBalance
● Fluid ssbalance ssis ssclosely sslinked ssand ssaffected ssby sselectrolytes
● Fluid ssintake ssis ssregulated ssthrough ssthe ssthirst ssdrive
● Fluid ssloss ssoccurs ssvia ssthe sskidney, ssskin, sslungs, ssand ssthe ssintestinal sstract
▪ Kidneys ss– ssthe ssmost ssimportant ssand sssensitive sswater ssloss ssroute ssd/t
ssbeing s s regulated ssand ssadjustable. ssVolume ssexcreted ssvaries ssbased
sson ssintake ssand s s body’s ssneed ssto ssconserve ssfluids
o Minimum ssamount ssof ssurine ssper ssday ssto ssexcrete sstoxic sswaste
ss(400-600 s s ml)
o The sskidney sscan ssmake sseither ssdiluted ssor ssconcentrated
ssurine ssto s s maintain ssbalance
● Insensible ssloss ssoccurs ssvia ssthe ssskin, sslungs, ssand ssstool ssas ssthis ssis ssnot
ssregulated ssor s s controlled
● **Normal ssurine ssoutput ssis ss30cc/hr**
o Renin-Angiotensin
● Most sscritical ssfluid ssbalance ssis ssto ssmaintain ssblood ssvolume ssto ssperfuse
sstissues/organs
▪ Requires ssspecific sshormone sslevels, sskidney ssfunction, ssand ssblood
ssvessel s s responses ssto ssbalance sswater ssand sssodium
● If ssthe sskidneys sssense ssBP ssis sslow, ssthey sssecrete ssRenin ssthat ssstarts sshormonal
ssand ssblood s s vessel ssresponses ssto ssraise ssthe ssBP ssto ssnormal
, ● Renin ssactivates ssangiotensin ssthat sscauses ssvasoconstriction ssof sssmall ssarteries
ssand s s veins sswhich ssraise ssBP sswithout ssthe ssuse ssof ssextra ssblood ssvolume
ss(Compensatory s s Mechanism)
▪ This ssalso ssdecreases ssurine ssoutput ssincreasing ssblood ssosmolality ssand
ssprevents s s further sswater ssloss
o Top ss5 ssFluids
● NS ss0.9% ss(NaCl) ss- ssIsotonic
▪ Used ssto ssexpand ssvolume, ssdilute ssmedications ssand ssto sskeep ssthe ssvein
ssopen
● Lactated ssRingers ss- ssIsotonic
▪ Used ssfor ssfluid ssresuscitation
● D5W
▪ Isotonic ssuntil ssinside ssthe ssbody ss(metabolize ssglucose ssand ssbecome
sshypotonic)
● D5 ss½ ssNS ss(D5NS)
▪ Used ssfor ssNa ssand ssvolume ssreplacement. ssGo ssSlow, ssmonitor ssBP,
sspulse, ssand s s quality ssof sslung sssounds ssas sswell ssas ssserum ssNa ssand
ssurine ssoutput
o Dehydration
● Fluid ssintake ssor ssretention ssis ssless ssthan sswhat ssis ssneeded ssto ssmeet ssthe ssbody’s
ssneeds
● Can ssbe sscaused ssby sseither sstoo sslittle ssintake ssor sstoo ssgreat ssa ssloss ssof ssfluid
● When sscirculating ssblood ssvolume ssis ssdecreased ss(hypovolemia) ssit sscauses sspoor
sstissue s s perfusion
● Change ssin ssdaily ssweight ssare ssbest ssindication ssof ssfluid ssloss ssor ssgain
▪ 1L ssof ssH2O ss= ss2.2lb
● What ssdoes ssit sslook sslike?
▪ **When ssI’m ssDry, ssmy ssLabs ssare ssHIGH**
▪ Dy ssmucous ssmembranes
▪ (Weakspulse)ss sHR,ss sBP,ss sRR
▪ Postural ssHypotension ss(due ssto sslow ssvolume)
▪ Confusion
▪ Assess ssskin ssfor sscolor ssand ssmoisture
▪ Assess ssSkin ssTurgor
◆ **Pinch ssskin ssover ssthe sssternum ssor ssthe ssforehead**
● Interventions
▪ Strict ssI’s ssand ssO’s ss(q8hr) ss**Urine ssoutput ssshould ssbe ss240cc/8hr**
▪ Monitor ssElectrolytes ss(Urine ssspecific ssgravity ss& ssCBC)
● (**USG sswould ssbe sselevated**)
▪ Provide ssoral ssfluids ssthat ssmeet ssdietary ssrequirement ss(sugar ssfree, sslow
ssNa ss& s s thickened)
▪ Offer ssfluids ssat ssleast ssq2hr
▪ Ensure sseducation ssto ssassistive sspersonnel ssto ssnot sswithhold ssfluids
▪ Monitor sspt. ssresponse ssto ssfluid sstherapy ssq2hr
● Pulse ssquality ssand sspressure
● Urine ssoutput
● Weight ss(q8hr)
NUR242 / NUR 242 Exam 2 Study Guide
ss ss ss ss ss ss ss ss ss ss
Medical-Surgical Nursing Concepts ss ss
100% Correct | Grade A Galen
ss ss ss ss ss ss
Med Surge Exam #2 Study Guide
ss ss ss ss ss
ss Fluid & Electrolytes & ABG’s
ss ss ss ss
o Homeostasis:
● Water ssis ssthe ssmost sscommon ssfluid, ssmakes ssup ss50-60% ssof sstotal ssweight
▪ Needed ssto ssdeliver ssdissolved ssnutrients, sselectrolytes, ssand ssall
sssubstances ssto s s all ssorgans, sstissues, ssand sscells
● Water ssis ssdivided ssinto ss2 ssmain sscompartments:
▪ Extracellular ss– ssfluid ssoutside ssthe sscell
◆ Also ssincludes ssinterstitial ssfluid ssbetween ssthe sscells
▪ Intracellular ss– ssfluid ssinside ssthe sscell
o Filtration
● The ssmovement ssof ssfluid ss(water) ssthrough ssa sscell ssor ssblood ssvessel
ssmembrane s s because ssof sswater sspressure ss(hydrostatic sspressure)
ssdifferences sson ssboth sssides ssof s s the ssmembrane
● The sshuman ssbody ssconstantly ssseeks ssequilibrium
▪ Water ssmovement ssoccurs ssuntil sshydrostatic sspressure ssis ssequal sson
ssboth s s sides ssof ssmembrane
▪ Blood sspressure ssis ssan ssexample ssof sshydrostatic ssfiltration. ssIt ssmoves
sswhole s s blood ssfrom ssthe ssheart ssto sscapillaries sswhere ssfiltration
sscan ssoccur ssto s s exchange sswater, ssnutrients, ssand sswaste ssproducts
ssbetween ssthe ssblood s s and ssthe sstissues
, o Fluid ssBalance
● Fluid ssbalance ssis ssclosely sslinked ssand ssaffected ssby sselectrolytes
● Fluid ssintake ssis ssregulated ssthrough ssthe ssthirst ssdrive
● Fluid ssloss ssoccurs ssvia ssthe sskidney, ssskin, sslungs, ssand ssthe ssintestinal sstract
▪ Kidneys ss– ssthe ssmost ssimportant ssand sssensitive sswater ssloss ssroute ssd/t
ssbeing s s regulated ssand ssadjustable. ssVolume ssexcreted ssvaries ssbased
sson ssintake ssand s s body’s ssneed ssto ssconserve ssfluids
o Minimum ssamount ssof ssurine ssper ssday ssto ssexcrete sstoxic sswaste
ss(400-600 s s ml)
o The sskidney sscan ssmake sseither ssdiluted ssor ssconcentrated
ssurine ssto s s maintain ssbalance
● Insensible ssloss ssoccurs ssvia ssthe ssskin, sslungs, ssand ssstool ssas ssthis ssis ssnot
ssregulated ssor s s controlled
● **Normal ssurine ssoutput ssis ss30cc/hr**
o Renin-Angiotensin
● Most sscritical ssfluid ssbalance ssis ssto ssmaintain ssblood ssvolume ssto ssperfuse
sstissues/organs
▪ Requires ssspecific sshormone sslevels, sskidney ssfunction, ssand ssblood
ssvessel s s responses ssto ssbalance sswater ssand sssodium
● If ssthe sskidneys sssense ssBP ssis sslow, ssthey sssecrete ssRenin ssthat ssstarts sshormonal
ssand ssblood s s vessel ssresponses ssto ssraise ssthe ssBP ssto ssnormal
, ● Renin ssactivates ssangiotensin ssthat sscauses ssvasoconstriction ssof sssmall ssarteries
ssand s s veins sswhich ssraise ssBP sswithout ssthe ssuse ssof ssextra ssblood ssvolume
ss(Compensatory s s Mechanism)
▪ This ssalso ssdecreases ssurine ssoutput ssincreasing ssblood ssosmolality ssand
ssprevents s s further sswater ssloss
o Top ss5 ssFluids
● NS ss0.9% ss(NaCl) ss- ssIsotonic
▪ Used ssto ssexpand ssvolume, ssdilute ssmedications ssand ssto sskeep ssthe ssvein
ssopen
● Lactated ssRingers ss- ssIsotonic
▪ Used ssfor ssfluid ssresuscitation
● D5W
▪ Isotonic ssuntil ssinside ssthe ssbody ss(metabolize ssglucose ssand ssbecome
sshypotonic)
● D5 ss½ ssNS ss(D5NS)
▪ Used ssfor ssNa ssand ssvolume ssreplacement. ssGo ssSlow, ssmonitor ssBP,
sspulse, ssand s s quality ssof sslung sssounds ssas sswell ssas ssserum ssNa ssand
ssurine ssoutput
o Dehydration
● Fluid ssintake ssor ssretention ssis ssless ssthan sswhat ssis ssneeded ssto ssmeet ssthe ssbody’s
ssneeds
● Can ssbe sscaused ssby sseither sstoo sslittle ssintake ssor sstoo ssgreat ssa ssloss ssof ssfluid
● When sscirculating ssblood ssvolume ssis ssdecreased ss(hypovolemia) ssit sscauses sspoor
sstissue s s perfusion
● Change ssin ssdaily ssweight ssare ssbest ssindication ssof ssfluid ssloss ssor ssgain
▪ 1L ssof ssH2O ss= ss2.2lb
● What ssdoes ssit sslook sslike?
▪ **When ssI’m ssDry, ssmy ssLabs ssare ssHIGH**
▪ Dy ssmucous ssmembranes
▪ (Weakspulse)ss sHR,ss sBP,ss sRR
▪ Postural ssHypotension ss(due ssto sslow ssvolume)
▪ Confusion
▪ Assess ssskin ssfor sscolor ssand ssmoisture
▪ Assess ssSkin ssTurgor
◆ **Pinch ssskin ssover ssthe sssternum ssor ssthe ssforehead**
● Interventions
▪ Strict ssI’s ssand ssO’s ss(q8hr) ss**Urine ssoutput ssshould ssbe ss240cc/8hr**
▪ Monitor ssElectrolytes ss(Urine ssspecific ssgravity ss& ssCBC)
● (**USG sswould ssbe sselevated**)
▪ Provide ssoral ssfluids ssthat ssmeet ssdietary ssrequirement ss(sugar ssfree, sslow
ssNa ss& s s thickened)
▪ Offer ssfluids ssat ssleast ssq2hr
▪ Ensure sseducation ssto ssassistive sspersonnel ssto ssnot sswithhold ssfluids
▪ Monitor sspt. ssresponse ssto ssfluid sstherapy ssq2hr
● Pulse ssquality ssand sspressure
● Urine ssoutput
● Weight ss(q8hr)
