NFDN 2003 Final Exam Study Guide Graded A 2024 With Verified Solutions 100%

Fluid & Electrolyte Needs - - Homeostasis - Affected by digestion, absorption, metabolism of nutrients and excretion of waste Functions of Body Fluids - - Need 1.5 L - 2.5L per day - 60-70% body weight is fluid [70% intracellular, 30% extracellular] - Transport nutrients and wastes to and from cells - Maintain body temp., acid-base balance, aids in digestion and elimination Assessment of Fluid Balance - - Health history [age, acute illness, environmental factors, diet, medications] - Physical exam [head to toe, weight [1kg gain = 1L fluid gain], intake/output, assess edema, diagnostic tests] Problems of Fluid Imbalances - - Electrolyte imbalance - Acid-Base imbalance - Deficient fluid volume - Excess fluid volume [edema] Common Fluid Imbalances - - Dehydration {hypovolemia}: burn victims [3rd degree] are most at risk Hypovolemia - - Acute weight loss - Rapid & weak pulse - Hypotension [bp] - Dry, sticky mucous membrane - U/O <30ml/h and constipation - Thirst and weakness - Increase Hgb, Hct, urine osmol Hypervolemia - - Acute weight gain - Bounding full pulse - Hypertension [bp] - Moist mucous membrane - U/O increased, specific gravity <1 - Cough/Dyspnea - Decreased Hgb, Hct, urine osmol Electrolytes - - Sodium [135-145 mEq/L] - Potassium [3.5-5 mEq/L] - Calcium [4.5-5.5 mEq/L] - Magnesium [1.5-2.5 mEq/L] - Chloride [98-106 mEq/L] - Phosphorus [1.2-3 mEq/L] Hyponatremia - - Na maintains extracellular osmolality, controls body fluids, influences acid-base balance - Cause: Excess sweating and increased water intake, GI suction, excess IV, use of diuretics Hypernatremia - - Causes: Decreased water intake, excess saline/salt, profuse diarrhea, diabetes insipidus, heatstroke, hyperventilation Fluid Diagnostic Tests - - Plasma sodium, potassium, chloride, calcium, magnesium - Hematocrit - BUN - Osmolality - Urine specific gravity - ECG - ABG Acid-Base Imbalances - - ABG - Based on the carbonic-acid buffer system - Measures 6 components - pH, PaCO2, PaO2, oxygen saturation, base excess, bicarbonate - Deviation from a normal level is indicated by acid-base imbalance Acid-Base Balance - - Normal pH 7.35 - 7.45 - < 7.30-7.35 acidotic state - > 7.45 alkalotic state PaCO2 - - Partial pressure of carbon dioxide in ARTERIAL blood - Normal range 35-45mmHg - Less than 35mmHg = hyperventilation - Greater then 45mmHg = hypoventilation [rate and depth of reps. decreases, less carbon dioxide is exhaled, more is retained increasing the concentration PaO2 - - Partial pressure of oxygen in ARTERIAL blood - Normal range 80-100mmHg - No real role in acid base imbalance - Less than 60mmHg can lead to anaerobic metabolism, leading to lactic acid production and metabolic acidosis - Reduction in vital capacity can lead to reduction Oxygen Saturation - - Normal range 95-99% - Hemoglobin saturation - Clients become hypoxic getting the reserve O2 stored in the Hgb, to provide tissue w/ O2 - O2 can be affected by pH and PaCO2 - When PaO2 falls below 60mmHg a large saturation results Base Excess - - Normal range of +2 / -2 - Base excess reflects deviations of pH [7.4 neutral] - Higher values of base excess indicate alkalosis - Negative values of base excess indicates acidosis which may result in elimination of too many bicarbonate ion Bicarbonates - - Normal range 22-26 mmol/L - Excreted/retained by the kidneys to maintain normal acid base environment - Also the principle buffer of the ECF's of body - A normal pH is maintained w/ a bicarbonate ratio 20 times that of the fluid concentration of carbonic acid Buffering System - - Plasma - Respiratory system - Renal system Respiratory Acidosis - - Results from retention of CO2 and decrease in pH - Pulmonary insufficiency because of respiratory depression causing CO2 build up - S&S: Increased Pulse, resp, & BP, Mental cloudiness, Fullness in the head, Ventrical Arrythmias - Treatment: improve ventilation, bronchodilators to reduce bronco spasm - Thrombolytics or anticoagulants for PE - Antibiotics for pneumonia - Place pt. in semi-fowlers for chest wall expansion Respiratory Alkalosis - - Rapid or excess elimination of CO2 result in increase pH - Causes: hyperventilation - S&S: Dizziness, Light-headedness, Inability to concentrate, Numbness & Tingling of extremities - Treatment: If cause is anxiety, instruct to breath slowly, breath into paper bag, Sedatives sometimes reduce anxiety Metabolic Acidosis - - Decrease in bicarbonate concentration - pH less than 7.35 - S&S:Headache, Confusion, Drowsiness, Increased respiratory rate, Decreased BP, Dysrhythmias Cold & Clammy skin - Clients at risk: Renal disease, Diabetic Ketoacidosis, Starvation, Shock - Treatment: Give bicarbonate, if severe may need dialysis Metabolic Alkalosis - - Caused by increase in bicarbonate concentration