Exam (elaborations) Summary NSG 533

Summary NSG 533 Exam 3 Study Guide | Fall 2025/26 with complete solutions – Wilkes University. define hypervolemic hyponatremia - ANSWER both TBW and sodium are increased, but TBW is more causes: CHF, cirrhosis of liver, nephrotic syndrome treatment for hyponatremia (Na 135mEq/L) - ANSWER fluid restriction causes of hyperkalemia - ANSWER s/s hyperkalemia (K 5.0 mEq/L) - ANSWER - bradycardia - muscle weakness - anxiety - peaked T waves - oliguria treatment for hyperkalemia - ANSWER - Kayexalate - glucose to stimulate insulin secretion (pushes K back to ICF) - dialysis causes of hypokalemia - ANSWER mostly GI and renal - GI (diarrhea/vomiting) - renal (diuretic use, low plasma Mg, excessive aldosterone secretion) s/s hypokalemia (K 3.5mEq/L) - ANSWER - lethargy - n/v - Flat T wave treatment for hypokalemia - ANSWER Potassium replacement 40-80mEq/day if renal function normal causes of hypercalcemia - ANSWER CHED Calcium ingestion, Hyperparathyroid, excess Vitamin D s/s hypercalcemia (Ca 10.5mg/dL) - ANSWER - loss of membrane excitability - lethargy - depressed T waves treatment for hypercalcemia - ANSWER - phosphate - calcitonin causes of hypocalcemia - ANSWER - inadequate internal absorption - decreased levels of PTH - decreased levels of Vitamin D s/s hypocalcemia (Ca 9.0mg/dL) - ANSWER Convulsions (Chvostek/Trousseau) Arrhythmias (long QT) Tetany Stridor treatment for hypocalcemia - ANSWER - 10% calcium gluconate - decrease phosphate intake difference between local vs generalized edema - ANSWER local edema is limited to the site of injury (cerebral, pulmonary and can be life threatening) generalized edema has a more uniform distribution of fluid in the interstitial spaces define dependent edema - ANSWER fluid accumulates in gravity-dependent areas of the body(feet, legs, butt) the total amount of sodium in the body is responsible for - ANSWER the extracellular fluid volume the total amount of water in the body is responsible for - ANSWER the extracellular sodium concentration what balances hormonal regulation of sodium - ANSWER aldosterone secreted from the adrenal cortex explain the Renin-Angiotensin-Aldosterone System - ANSWER low BP, decreased renal perfusion, or low sodium concentrations -- juxtaglomerular cells of the kidney are activated -- increase the release of renin -- stimulates the formation of Angiotensin 1 -- ACE in the pulmonary vessels converts Angiotensin 1 to Angiotensin II -- vasoconstriction -- increased BP, increased renal perfusion, increased sodium concentration function of Angiotensin II - ANSWER 1. vasoconstriction 2. stimulates secretion of aldosterone from adrenal cortex 3. stimulates secretion of ADH from posterior pituitary gland function of aldosterone is to - ANSWER retain sodium and promote renal excretion of potassium what are the three main systems that regulate total body sodium? - ANSWER 1. Renin Angiotensin Aldosterone System 2. Natriuretic Peptide System 3. Antidiuretic Hormone System what is the goal of RAAS? - ANSWER increase BP what is the goal of the Natriuretic Peptide System? - ANSWER decrease BP define solute - ANSWER A substance that is dissolved in a solution. define osmolality - ANSWER measurement of total solute concentration in fluid equation of calculating serum osmolality - ANSWER 2 x (sodium concentration) + (glucose concentration/18) + (BUN/2.8) define tonicity - ANSWER the ability of a solution to cause a cell to gain or lose water list the solutes that are capable of changing tonicity - ANSWER sodium, glucose, mannitol, sorbitol define effective osmoles - ANSWER solutes that are capable of changing tonicity why is urea known as an ineffective osmole? - ANSWER it easily crosses cell membranes and distributes evenly throughout total body fluids permeability what are the causes of pitting edema (fluid contains little protein)? - ANSWER increased capillary venous hydrostatic pressure, decreased capillary oncotic pressure why is the balance of ICF K and ECF K so important? - ANSWER - conduction and transmission of nerve impulses - maintenance of cardiac rhythms - contraction of skeletal and smooth muscles where is most K found? - ANSWER ICF what are a few reasons Potassium may leave the cell? - ANSWER - cell lysis - insulin deficiency - aldosterone deficiency - strenuous exercise what is the effect of insulin on blood plasma Potassium concentration? - ANSWER insulin decreases the amount of potassium in the bloodstream by facilitating potassium to enter the cell treatment for severe hyperkalemia - ANSWER insulin with dextrose (to prevent hypoglycemia) Constipation - ANSWER Approach to treatment should begin with determination of cause(including medications a patient may be on table 21-1)OpiatesAnticholinergics (eg. tricyclic antidepressant (amitryptiline), diphenhydramine, benztropine, etc.)NDHP-CCB (eg verapamil)Oral iron preparationsCalcium or aluminum antacidsNSAIDsClonidineDiuretics Constipation treatment - ANSWER Non-pharmacological interventions first (diet (fiber), exercise, fluids)Probiotics - limited data Best Pract Res Clin Gastroenterol. 2011;25:119-126 PharmacologicalBulk forming agents (eg. methylcellulose (Citrucel*))Administer 240 mL of water with each dose to prevent esophageal / GI obstruction and worsening symptomPhysical binding of other substances including medicationsSafe in pregnancyEmollients (softeners) (eg. docusate (Colace*)Facilitate mixing of aqueous and fatty materials in the intestinal tractUsed for prevention, NOT treatment. Commonly prescribed with medications that may cause constipation (chronic opiate use, iron supplementation)Safe in pregnancyLubricant laxative (mineral oil / castor oil)Coats stool to allow easy passage / Prevents colonic water absorptionSystemic absorption - can generate immune responseAspiration - may lead to lipoid pneumoniaDecreases absorption of fat-soluble vitamins à DO NOT use in pregnancyHyperosmotics (eg. polyethylene glycol (Miralax*))Osmotic effects to retain fluid in GI tractSafe in pregnancySaline laxatives - Composed of relatively poorly absorbed ions (Mg+ - sulfate, - phosphate, - citrate)(eg. MOM*)Osmotic effects to retain fluid in GI tractMay be used occasionally to treat constipation in otherwise healthy adultADRs: fluid and electrolyte disturbances: Mg (renal dysfunction) or Na (CHF) accumulationStimulant laxatives (Senna, Bisacodyl) (eg Sennokot*, Dulcolox*)Only recommended for intermittent use - daily use strongly discouragedNew agents available for specific use ONLY (eg. IBS-C, OIC)NOT discussed in this course Summary of constipation recommendations - ANSWER Slow Transit ConstipationHyperosmotic laxativesSenna, Bisacodyl and other stimulants are second line Those who need to avoid straining (eg hemorrhoids, hernia, MI)Stool softeners or PEG ChildrenDiet, fluid exerciseAvoid under 6 years without evaluationGlycerin suppository, docusate Goal of diarrhea treatment - ANSWER Goal of treatment: Identify and Treat primary cause, Manage secondary causes, prevent electrolyte & acid/base disturbances & dehydration , provide symptomatic relief , Note the primary goal is NOT ALWAYS to stop diarrhea (see below, Infectious diarrhea)! Non-pharmacologicalRehydration , oral preferredAvoid Soda products, Gatorade*, Chicken broth, TeaDietResume age-appropriate diet once rehydratedSecondary causes can include medications. An evaluation of medications an possible substitution of offending medications should be considered (if possible)Magnesium containing antacids, metformin (1/3 of patients), antibiotics (25% incidence), anti-inflammatory / anti-gout agents (eg. colchicine), etc. Pharmacological agents for diarrhea: - ANSWER Opiates and derivatives - Acts on peripheral (eg loperamide (Imodium*)) and central (eg diphenoxylate/atropine (Lomotil*)) opioid receptors depending on the agent. Those that act on central mu receptors are control substances and prescription onlyNoninfectious diarrhea (acute & chronic)Adverse effects: constipation, fatigue, dizziness Adsorbents = Works through non-selective adsorption, providing bulk in digestive tractNot systemically absorbedBinds 60 times its weight in waterAlso used for constipation (absorbs water / fluids)Can also bind drugs leading to altered drug bioavailability Bismuth subsalicylate - see GERDContraindicationsASA allergyNursing or pregnant womenGI bleedingImmunocompromised patientsDrug interactionsDecrease protein binding of warfarinDecrease absorption of TCN, quinolones Octreotide - Prevents the release of secretory substances, Stimulates intestinal absorptionSymptomatic treatment of carcinoid tumors & VIPomas that produce violent watery diarrheaAdverse effects:Nausea , abdominal pain, QT prolongationCholelithiasis (d/t inhibition of gall bladder activity)Hyper - / Hypoglycemia ( d/t altered insulin, glucagon GH balance) Crofelemer - FDA approved for symptomatic relief of non-infectious diarrhea in patients with HIV/AIDS on anti-retroviral therapy Probiotics - Help maintain normal GI flora, reduce colonization of disease-causing bacteriaEvidence - Vary based on intended use (acute treatment, prevention, antibiotic associated, adults, children), strain of bacterium and timing of administration Digestive enzymes (lactaid)Use in patients with lactase deficiency who are lactose intolerant We do not routinely use empiric antibiotics in patients with acute diarrhea. Infectious diarrhea: C diff - - ANSWER The initial step in the treatment of Clostridium difficile infection (CDI) is cessation of the inciting antibiotic as soon as possible Therapy for non-severe difficile infection (CDI) consists of oral metronidazole oral vancomycinLimitations of metronidazole include dose-dependent peripheral neuropathy and side effects of nausea and metallic taste.Use of oral vancomycin is appropriate for initial therapy of non-severe disease in patients who are pregnant, breastfeeding, or intolerant/allergic to metronidazoleRifaximin— Small case series have suggested that sequential therapy with vancomycin followed by Rifaximin may be effective for the treatment of recurrent CDI Pharmacotherapy menopause - ANSWER Pharmacotherapy - hormone therapy remains the most effective treatment for vasomotor symptoms and vulvovaginal atrophy, especially in women with moderate to severe symptoms, provided there is not CHD, significant CHD risk factors or history of breast cancer what should be a concern if you give a hyperglycemic patient insulin? - ANSWER low plasma potassium levels list a few factors that may lead to HYPOKALEMIA - ANSWER - insufficient intake of K - increased movement of K into the cell - increased excretion of K (laxatives, inc consumption of black licorice, diarrhea, diuretics, inc aldosterone) - insulin administration - treatment of pernicious anemia w/ vitamin b12/folate - spurious hypokalemia (false reading due to insulin admin right before blood draw) serum potassium falls 0.3 for each 0.1 ________________ - ANSWER increase in pH (alkalosis) serum potassium rises 0.3 for each 0.1 _______________ - ANSWER decrease in pH in respiratory acidosis serum potassium rises 0.7 for each 0.1 __________ - ANSWER decrease in pH in metabolic acidosis where is calcium found in the body? - ANSWER bound form - bones and teeth (99%) ionized form - blood plasma (1% blood clotting and hormone secretion) what other ion works in conjunction with calcium? - ANSWER phosphate what hormones are calcium and phosphate regulated by? - ANSWER 1. Parathyroid hormone 2. calcitonin 3. vitamin D where is calcium primarily absorbed? - ANSWER duodenum in the small intestine what are two clinical manifestations of neuromuscular excitability related to hypocalcemia? - ANSWER 1. trousseau sign 2. Chvostek sign most common cause of hypercalcemia - ANSWER hyperparathyroidism s/s of hypercalcemia - ANSWER fatigue, weakness, nausea (FWN) define acidosis - ANSWER an increase in hydrogen ion or loss of a base