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NUR242 / NUR 242 Exam 2 Study Guide
Medical-Surgical Nursing Concepts
100% Correct | Grade A Galen
Med Surge Exam #2 Study Guide
Fluid & Electrolytes & ABG’s
o Homeostasis:
● Water is the most common fluid, makes up 50-60% of total weight
▪ Needed to deliver dissolved nutrients, electrolytes, and all
substances to all organs, tissues, and cells
● Water is divided into 2 main compartments:
▪ Extracellular – fluid outside the cell
◆ Also includes interstitial fluid between the cells
▪ Intracellular – fluid inside the cell
o Filtration
● The movement of fluid (water) through a cell or blood vessel
membrane because of water pressure (hydrostatic pressure) differences
on both sides of the membrane
● The human body constantly seeks equilibrium
▪ Water movement occurs until hydrostatic pressure is equal on
both sides of membrane
▪ Blood pressure is an example of hydrostatic filtration. It moves
whole blood from the heart to capillaries where filtration can
occur to exchange water, nutrients, and waste products
between the blood and the tissues
, o Fluid Balance
● Fluid balance is closely linked and affected by electrolytes
● Fluid intake is regulated through the thirst drive
● Fluid loss occurs via the kidney, skin, lungs, and the intestinal tract
▪ Kidneys – the most important and sensitive water loss route d/t
being regulated and adjustable. Volume excreted varies based on
intake and body’s need to conserve fluids
o Minimum amount of urine per day to excrete toxic waste
(400-600 ml)
o The kidney can make either diluted or concentrated
urine to maintain balance
● Insensible loss occurs via the skin, lungs, and stool as this is not
regulated or controlled
● **Normal urine output is 30cc/hr**
o Renin-Angiotensin
● Most critical fluid balance is to maintain blood volume to perfuse
tissues/organs
▪ Requires specific hormone levels, kidney function, and blood
vessel responses to balance water and sodium
● If the kidneys sense BP is low, they secrete Renin that starts hormonal and
blood vessel responses to raise the BP to normal
, ● Renin activates angiotensin that causes vasoconstriction of small
arteries and veins which raise BP without the use of extra blood
volume (Compensatory Mechanism)
▪ This also decreases urine output increasing blood osmolality and
prevents further water loss
o Top 5 Fluids
● NS 0.9% (NaCl) - Isotonic
▪ Used to expand volume, dilute medications and to keep the vein
open
● Lactated Ringers - Isotonic
▪ Used for fluid resuscitation
● D5W
▪ Isotonic until inside the body (metabolize glucose and become
hypotonic)
● D5 ½ NS (D5NS)
▪ Used for Na and volume replacement. Go Slow, monitor BP,
pulse, and quality of lung sounds as well as serum Na and
urine output
o Dehydration
● Fluid intake or retention is less than what is needed to meet the body’s
needs
● Can be caused by either too little intake or too great a loss of fluid
● When circulating blood volume is decreased (hypovolemia) it causes poor
tissue perfusion
● Change in daily weight are best indication of fluid loss or gain
▪ 1L of H2O = 2.2lb
● What does it look like?
▪ **When I’m Dry, my Labs are HIGH**
▪ Dy mucous membranes
▪ (Weak pulse) HR, BP, RR
▪ Postural Hypotension (due to low volume)
▪ Confusion
▪ Assess skin for color and moisture
▪ Assess Skin Turgor
◆ **Pinch skin over the sternum or the forehead**
● Interventions
▪ Strict I’s and O’s (q8hr) **Urine output should be 240cc/8hr**
▪ Monitor Electrolytes (Urine specific gravity & CBC)
● (**USG would be elevated**)
▪ Provide oral fluids that meet dietary requirement (sugar free, low
Na & thickened)
▪ Offer fluids at least q2hr
▪ Ensure education to assistive personnel to not withhold fluids
▪ Monitor pt. response to fluid therapy q2hr
● Pulse quality and pressure
● Urine output
, ● Weight (q8hr)
▪ Monitor for fluid overload
NUR242 / NUR 242 Exam 2 Study Guide
Medical-Surgical Nursing Concepts
100% Correct | Grade A Galen
Med Surge Exam #2 Study Guide
Fluid & Electrolytes & ABG’s
o Homeostasis:
● Water is the most common fluid, makes up 50-60% of total weight
▪ Needed to deliver dissolved nutrients, electrolytes, and all
substances to all organs, tissues, and cells
● Water is divided into 2 main compartments:
▪ Extracellular – fluid outside the cell
◆ Also includes interstitial fluid between the cells
▪ Intracellular – fluid inside the cell
o Filtration
● The movement of fluid (water) through a cell or blood vessel
membrane because of water pressure (hydrostatic pressure) differences
on both sides of the membrane
● The human body constantly seeks equilibrium
▪ Water movement occurs until hydrostatic pressure is equal on
both sides of membrane
▪ Blood pressure is an example of hydrostatic filtration. It moves
whole blood from the heart to capillaries where filtration can
occur to exchange water, nutrients, and waste products
between the blood and the tissues
, o Fluid Balance
● Fluid balance is closely linked and affected by electrolytes
● Fluid intake is regulated through the thirst drive
● Fluid loss occurs via the kidney, skin, lungs, and the intestinal tract
▪ Kidneys – the most important and sensitive water loss route d/t
being regulated and adjustable. Volume excreted varies based on
intake and body’s need to conserve fluids
o Minimum amount of urine per day to excrete toxic waste
(400-600 ml)
o The kidney can make either diluted or concentrated
urine to maintain balance
● Insensible loss occurs via the skin, lungs, and stool as this is not
regulated or controlled
● **Normal urine output is 30cc/hr**
o Renin-Angiotensin
● Most critical fluid balance is to maintain blood volume to perfuse
tissues/organs
▪ Requires specific hormone levels, kidney function, and blood
vessel responses to balance water and sodium
● If the kidneys sense BP is low, they secrete Renin that starts hormonal and
blood vessel responses to raise the BP to normal
, ● Renin activates angiotensin that causes vasoconstriction of small
arteries and veins which raise BP without the use of extra blood
volume (Compensatory Mechanism)
▪ This also decreases urine output increasing blood osmolality and
prevents further water loss
o Top 5 Fluids
● NS 0.9% (NaCl) - Isotonic
▪ Used to expand volume, dilute medications and to keep the vein
open
● Lactated Ringers - Isotonic
▪ Used for fluid resuscitation
● D5W
▪ Isotonic until inside the body (metabolize glucose and become
hypotonic)
● D5 ½ NS (D5NS)
▪ Used for Na and volume replacement. Go Slow, monitor BP,
pulse, and quality of lung sounds as well as serum Na and
urine output
o Dehydration
● Fluid intake or retention is less than what is needed to meet the body’s
needs
● Can be caused by either too little intake or too great a loss of fluid
● When circulating blood volume is decreased (hypovolemia) it causes poor
tissue perfusion
● Change in daily weight are best indication of fluid loss or gain
▪ 1L of H2O = 2.2lb
● What does it look like?
▪ **When I’m Dry, my Labs are HIGH**
▪ Dy mucous membranes
▪ (Weak pulse) HR, BP, RR
▪ Postural Hypotension (due to low volume)
▪ Confusion
▪ Assess skin for color and moisture
▪ Assess Skin Turgor
◆ **Pinch skin over the sternum or the forehead**
● Interventions
▪ Strict I’s and O’s (q8hr) **Urine output should be 240cc/8hr**
▪ Monitor Electrolytes (Urine specific gravity & CBC)
● (**USG would be elevated**)
▪ Provide oral fluids that meet dietary requirement (sugar free, low
Na & thickened)
▪ Offer fluids at least q2hr
▪ Ensure education to assistive personnel to not withhold fluids
▪ Monitor pt. response to fluid therapy q2hr
● Pulse quality and pressure
● Urine output
, ● Weight (q8hr)
▪ Monitor for fluid overload
