242 Med Surg Exam 2
1. Diabetic complications: ANS Macrovascular/microvascular problems; renal; infection;
amputation; heart at- tack; stroke
2. Dehydration: ANS decreased blood volume; daily weight ott bt 3 lbs; skin tenting; tachycardia;
weak pulse; postural hypotension; confusion; dry, skin and mycous membranes, thirsty, concentrated
urine
3. dehydration management: ANS I&Os; check electrolytes, CBC, urine specific gravity; assess
for Hypotension and weak pulses; assess respiratory system (fast, shallow) and tissue perfusion;
check orientation, vision, hearing, reflexes and strength; weight changes; skin breakdown and oral
care
4. fluid overload: ANS crackles; pitting edema; tachycardia; bounding pulse; JVD; wt gain; shallow
resp; SOA;
pale/cool skin; altered LOC; weakness
5. fluid overload management: ANS orthostatic hypotension;diuretics; prevent skin
breakdown; correct elec- trolyte imbalance; fluid restriction; low Na diet; mon wt
6. fluid overload suspects: ANS CHS, kidney Pts; liver Pts; pulmonary edema
7. Sodium (Na): ANS 135-145; important for acid-base balance
8. Hyponatremia: ANS lethargy, headache, confusion, apprehension, seizures, coma (irritability and
1/
19
, acid base bal-
ance firing ott plus nerve impulses) #2 of elderly presenting to ED
9. Hyponatremia management: ANS Treat
underlying condition Sodium replacement
Water restriction
Medication
Assessment: I&O, daily weight, lab values, CNS changes
Encourage dietary sodium
Monitor fluid intake
Ettects of medications (diuretics, lithium)
10. Hyponatremia suspects: ANS gastro suctioning; V/D; inadequate salt intake; change
from ICF to ECF solu- tions; diuretics (metabolic alkalosis)
11. Hypernatremia: ANS FRIED SALT: flushed; restless, anxious, irritable, confused; increased
BP and fluid retention; edema; decreased urine and dry mouth; skin flushed; agitation; low grade fever
and thirst
12. Hypernatremia suspects: ANS poor fluid intake; surgery; tube feedings; elderly or
infants; poorly controlled diabetes; impaired renal concentrating
13. Potassium (K): ANS 3.5-5 responsible for muscle contractility and critical to normal cardiac
function; can be life threatening if values ott; meat, fish, fruits and vegetables; 80% secreted by kidneys;
2/
19
, caution in patients on digitalis and diuretics
3/
19
1. Diabetic complications: ANS Macrovascular/microvascular problems; renal; infection;
amputation; heart at- tack; stroke
2. Dehydration: ANS decreased blood volume; daily weight ott bt 3 lbs; skin tenting; tachycardia;
weak pulse; postural hypotension; confusion; dry, skin and mycous membranes, thirsty, concentrated
urine
3. dehydration management: ANS I&Os; check electrolytes, CBC, urine specific gravity; assess
for Hypotension and weak pulses; assess respiratory system (fast, shallow) and tissue perfusion;
check orientation, vision, hearing, reflexes and strength; weight changes; skin breakdown and oral
care
4. fluid overload: ANS crackles; pitting edema; tachycardia; bounding pulse; JVD; wt gain; shallow
resp; SOA;
pale/cool skin; altered LOC; weakness
5. fluid overload management: ANS orthostatic hypotension;diuretics; prevent skin
breakdown; correct elec- trolyte imbalance; fluid restriction; low Na diet; mon wt
6. fluid overload suspects: ANS CHS, kidney Pts; liver Pts; pulmonary edema
7. Sodium (Na): ANS 135-145; important for acid-base balance
8. Hyponatremia: ANS lethargy, headache, confusion, apprehension, seizures, coma (irritability and
1/
19
, acid base bal-
ance firing ott plus nerve impulses) #2 of elderly presenting to ED
9. Hyponatremia management: ANS Treat
underlying condition Sodium replacement
Water restriction
Medication
Assessment: I&O, daily weight, lab values, CNS changes
Encourage dietary sodium
Monitor fluid intake
Ettects of medications (diuretics, lithium)
10. Hyponatremia suspects: ANS gastro suctioning; V/D; inadequate salt intake; change
from ICF to ECF solu- tions; diuretics (metabolic alkalosis)
11. Hypernatremia: ANS FRIED SALT: flushed; restless, anxious, irritable, confused; increased
BP and fluid retention; edema; decreased urine and dry mouth; skin flushed; agitation; low grade fever
and thirst
12. Hypernatremia suspects: ANS poor fluid intake; surgery; tube feedings; elderly or
infants; poorly controlled diabetes; impaired renal concentrating
13. Potassium (K): ANS 3.5-5 responsible for muscle contractility and critical to normal cardiac
function; can be life threatening if values ott; meat, fish, fruits and vegetables; 80% secreted by kidneys;
2/
19
, caution in patients on digitalis and diuretics
3/
19
