NSG 3800 Exam 1 Med Surg 2

me
& here !

of ice
= 25mL of
water
50mL

UNIT 1
Est
ECF:
● Intravascular: plasma, erythrocytes, leukocytes, thrombocytes
● Interstitial: lymph
● Transcellular: CSF, Pericardial, synovial
● Muscular ppl retain more water thean the elderly and obese
Hydrostatic pressure vs. Osmotic pressure:
● HP: more volume/exerted on walls of blood vessels
● OP: exerted by protein in plasma (pulls from the vascular system)
Normal urine output
● 1mL/kg/hr NFL
> give Sotonic
-
FLUID VOLUME DEFICIT(FVD)

f
● DO NOT CONFUSE WITH dehydration (dehydration is only water loss alone with
IX :

increased sodium levels which is cellular dehydration) ↳ clinical dehydration
● Causes: fluids
↳ give hypotonic
abs
/ not
kiluted
○ Vomiting, siarrhea, GI suctioning, sweating 0 3 % NaCI(NS).




○ Decreased intake of water/lack of access
○ Thirdspacing from burns or ascites
○ Diabetes insipidus, adrenal insufficiency, hemorrhage, osmotic diuresis(lots
of urine)


~
● Diagnostic findings:



aund
○ Elevated BUN: >20
○ Elevated Hct: >52m >47f
○ Elevated Creatnine: >1.2m >1.1f
○ Elevated specific gravity: >1.030 excessive peeing
● Manifestations:
○ Weight loss (1-2lbs/day=water loss) > 0 9 % Ns
- .
Lisotoni)
X

○ Decrease in body temp don't mess
wh electrolytes
○ Decreased Skin turgor
○ Oliguria
○ Long capillary refill
○ dizzy/weak
○ thirsty/confused
○ Low BP(ortho hypotension) buuuut High HR
○ cold/clammy
○ Sunken eyes
○ Decreased urine sodium
● Management:
○ I&O q8hrs/or every hr
○ Daily weight
○ VS (BP and HR)
○ Skin and tongue(extra furrows) tugo, mucosa, urine output, mental status
○ Admin oral fluids if possible first!
○ Parentaral fluids(LR, 0.9%NaCl) ↑ #

labs look at
to

FLUID VOLUME EXCESS(FVE)
sotonic in fluid imbalance
i
f ● Causes:
○ Heart failure, kidney injury, cirrhosis of the liver
/* BUN Creatine Hgb
,
,
,
Het

sodium specific gravity
abst diluted ○ Excess concumption of Na through foods or salt tablets
lis -
,

, ○ Excess admin of sodium containing fluids
● Manifestations:
○ edema( dependent) can be found also in the ankles of ambulatory pts and sacrum
of BB patients
○ Distended neck veins(JVD)
○ Crackles in the lungs fluid volume stairs
○ SOB/cough/ increased RR ~
○ Increased urine output 1-1 lbs weight gain
hi
○ Bounding pulse
7lbs gain in
k
○ Acute weight gain
● Diagnostic findings:
time scace
[same ,
,

clothe

!
○ Decreased BUN: <10
○ Decreased Hct: <42m <37f

a
G
○ Decreased Sodium: <135
○ Secreased Hgb:<14m <12f
○ Decreased specific gravity: <1.005 vomiting (diarrhea
● Management:
○ Loop diuretics for severe FVE (-ide meds like furosemide)
)
↳
givenic
○ Thiazide diuretics for moderate FVE (HTZ)
○ I&O/daily weights/edema
○ Monitor response to fluids and diuretics fluid volume
Na + normal
○ fluid/sodium restrictions hyper fluids ( 3
- hypotonic
.




○ REST! give -




ELECTROLYTE IMBALANCE and Ina po intave

HYPONATREMIA <135 extracell HYPERNATREMIA >145 extracell

● Chronic has not as serious neuro ● Retain more sodium than water 2
alterations
Causes:
● Mainly the very old, very young, and
cognitively impaired(enteral 40g
hyp
-




● Fluid overload (D5W) feedings)
● Head trauma Causes:


a
● Hypertonic enteral feedings


⑪ecomin
● Exercise associated in short women
(mainly sweat/water loss) ● heatstroke/drowning
● Adrenal insufficiency ● Hyperventilation
● Hypotonic tube feedings ● Burns give
● Polydipsia ● Excess steroids/bicarb
● CHF/diabetes ● Pts that cant respond to thirst

a
inte
Manifestations: Manifestations;
● Anorexia ● HA/delirium(restless, lethargic,
● N/V disoriented)
O● HA/lethargy
● dizzy/confusion
● Seizures (tonic clonic)
● Coma
↑ LOCAs a
● Muscle cramps/weakness/twitching ● hyperreflexia/twitching
g● Papilledema ● Dry mucous membrane
● Dry skin ● Increased HR
● Increased HR ● Increased BP
● Decreased BP Management:
● Decreased sp gravity: <1.005 ● NO alka-seltzer
Management: -otonic > Slow hypertonic
-
● Watch for changes in behavior
down
● Replace NA (0.9%NaCl) or PO foods ● Diuretics > need the Nat to go
-



OR 2-23%NaCl if head trauma ● Seizure precautions ↳ + NS bolus
volume
w/ Norm


Diuretic effects
A2-
↑ Ca ↓K ,
↓Na
V
bed alarm + fall percautions
,



sls
for neuro
-