NUR242 Medsurg Exam 2
Prof Milhome
Medical Surgical Nursing: Ignatavicius, Workman, Rebar, Heimgarterner 10 th edition
Chapters 13 (pages 237-260), Chapter 14(pages 261-274); Chapter 48 (1057-1072 ); Chapter 49 ( 1081-1085; 1085-1088) Chapter 50 (page 1094-
Chapter 56( page 1218-1229) ,Chapter 59( page 1265-1300) Chapter 60 (page 1301-1323), 61( page 1325-1336; 1336-1343; 1343-1344; 1344-1349) Chapter 62
(1363-1366; 1355-1359; 1359-1361; 1361-1362; 1366-1367; 1362-1363; 1367-1368; 1370-1370), chapter 64 (1413-1428),Chapter 67(1469-1479; 1488)
Chapter 13 Fluid and electrolyte page 240
-1L of water= weighs 1 kg
-Normal Osmolarity= 270- 300mOsm/L
-Risk of electrolyte imbalance= older adults, chronic kidney disorder, endocrine disorder= ALL ILL ADULTS ARE AT RISK FOR ELECTROLYTE
IMBALANCE
-Women of any age have less total body water and higher risk for dehydration than men of similar sizes and ages. This difference is because men
tend to have more muscle mass than women and because women have more body fat. ( muscles cells contain muscle mostly water and fat cells
have little water.
Excretion of Fluids Measurable= oral fluid thru urine; Parenteral fluids thru emesis; enemas thru feces; irrigation fluids thru drainage from body
cavities
Excretion of Fluids NOT measurable= solid foods thru perspiration; metabolism thru vaporization thru the lungs
Fluid volume and electrolyte balance includes= regulation of body fluids and electrolytes (body fluid body volume, osmolarity, composition =
electrolytes, (filtration, diffusion, osmosis and selective secretion
EFC extracellular fluid is 1/3 of of total body water
-filtration- movement of fluid thru hydrostatic pressure
Osmosis- movement of fluid thru seleceltive semipermeable membrane
-The min amt of urine output per day needed to excrete toxic waste is 400ml- 600mL if less than this amount of urine is excreted then lethal
electrolyte imbalances, acidosis and toxic build of nitrogen occur,
Insensible water loss- no mechanism controls (skin, lungs, GI tract)
Isotonic= 0.9% saline, 5%dextrose in .2255 SALINE, ringers' lactate
Hypotonic- .45% saline,
Hypertonic- 10% dextrose in water, 5% dextrose in saline, 5% dextrose in 0.45 saline,
Page 245 Potassium K+ cation= 3.5-5.0 (arrythmias)
“ comes from any orifices”
Most K= Found in meat, fish
Lowest K = eggs, bread, cereal grains
Typical intake 2/20grams/daily
Low mg= Low Potassium
Before giving potassium make sure urine output is 30ML / hour
High= Hyperkalemia= dehydration, kidney disease, acidosis, adrenal insufficiency, crush injuries
Low= Hypokalemia= fluid overload, diuretic therapy. Alkalosis, insulin admin, hyperaldosteronism
=Exactilate, insulin, duiretic to treat hyperkalemia
Page 246 Calcium- Ca2+= 9.0-105 (found in bone matric) (arrythmias
Page 246 Magnesium-Mg2+ ion= 1.8-2.6 9 ( arrythmias
Mg found in bones and cartilage
Importance in skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation, blood coagulation, cell
growth
High= hypermagnesemia= kidney disease, hypothyroidism, adrenal insufficiency,
Low= Hypomagnesemia= malnutrition, alcoholism, ketoacidosis
-------------------------------------------------------------------------------------------------------------------------------------
-Muscles cells carry more water
-Fat cells carry very little water
-Kidney is the organ most sensitive to water loss / gain
-3 Hormones that help regulate Aldosterone, Antidiuretic ADH, Natriuretic peptide hormone NP
Aldosterone= prevents water and Na loss; promotes excretion of potassium
Antidiuretic hormone aka vasopressin- retains water (indirectly regulates electrolyte retention or excretion)
Natriuretic peptides- kidney reabsorption of Sodium
-----------------------------------------------------------------------------------------------------------------------------
Page 246 Dehydration (fluid volume deficient)
1
, causes- hemorrhage, vomiting, diarrhea, profuse salivation, fistulas, ileostomy, Profuse diaphoresis, burns, severe wounds, long term NPO
status, diuretic therapy, GI suction, hyperventilation, diabetes insipidus, difficulty swallowing, impaired thirst, unconsciousness, fever, impaired
motor function, weight loss, hyperemesis gravida, NV, draining wound,heat stroke
Signs& symptoms= Poor skin turgor, hypotensive, tachycardia, flat neck and hand veins, dry skin “tenting”, dry mucous membranes,
hypovolemia, deep furrow tongue, low grade fever, concentrated urine (dark amber color , strong odor )
Usual labs for dehydration= elevated hemoglobin, hemocrit, serum osmalority, glucose protein BUN, electrolytes; increase in blood
concentration
Treatment: Oral rehydration with electrolyte ( gatorade), if cannot handle PO give IV
FLUIDS,
TPUT,
enting can
120mL
rate
thing,
d phlebitis
arrhea ,
ormal BP,
atment
Pa
ric
iuretics,
on
Assess- food and liquid intake, intake and output daily weights, kidney and endocrine diseases
L
AR SPACE)
pressure, ^ weight gain, bounding pulse,
iction
DEMA (OCCURS QUICKLY; CAN CAUSE
ased peripheral edema, reduced urine
2
Prof Milhome
Medical Surgical Nursing: Ignatavicius, Workman, Rebar, Heimgarterner 10 th edition
Chapters 13 (pages 237-260), Chapter 14(pages 261-274); Chapter 48 (1057-1072 ); Chapter 49 ( 1081-1085; 1085-1088) Chapter 50 (page 1094-
Chapter 56( page 1218-1229) ,Chapter 59( page 1265-1300) Chapter 60 (page 1301-1323), 61( page 1325-1336; 1336-1343; 1343-1344; 1344-1349) Chapter 62
(1363-1366; 1355-1359; 1359-1361; 1361-1362; 1366-1367; 1362-1363; 1367-1368; 1370-1370), chapter 64 (1413-1428),Chapter 67(1469-1479; 1488)
Chapter 13 Fluid and electrolyte page 240
-1L of water= weighs 1 kg
-Normal Osmolarity= 270- 300mOsm/L
-Risk of electrolyte imbalance= older adults, chronic kidney disorder, endocrine disorder= ALL ILL ADULTS ARE AT RISK FOR ELECTROLYTE
IMBALANCE
-Women of any age have less total body water and higher risk for dehydration than men of similar sizes and ages. This difference is because men
tend to have more muscle mass than women and because women have more body fat. ( muscles cells contain muscle mostly water and fat cells
have little water.
Excretion of Fluids Measurable= oral fluid thru urine; Parenteral fluids thru emesis; enemas thru feces; irrigation fluids thru drainage from body
cavities
Excretion of Fluids NOT measurable= solid foods thru perspiration; metabolism thru vaporization thru the lungs
Fluid volume and electrolyte balance includes= regulation of body fluids and electrolytes (body fluid body volume, osmolarity, composition =
electrolytes, (filtration, diffusion, osmosis and selective secretion
EFC extracellular fluid is 1/3 of of total body water
-filtration- movement of fluid thru hydrostatic pressure
Osmosis- movement of fluid thru seleceltive semipermeable membrane
-The min amt of urine output per day needed to excrete toxic waste is 400ml- 600mL if less than this amount of urine is excreted then lethal
electrolyte imbalances, acidosis and toxic build of nitrogen occur,
Insensible water loss- no mechanism controls (skin, lungs, GI tract)
Isotonic= 0.9% saline, 5%dextrose in .2255 SALINE, ringers' lactate
Hypotonic- .45% saline,
Hypertonic- 10% dextrose in water, 5% dextrose in saline, 5% dextrose in 0.45 saline,
Page 245 Potassium K+ cation= 3.5-5.0 (arrythmias)
“ comes from any orifices”
Most K= Found in meat, fish
Lowest K = eggs, bread, cereal grains
Typical intake 2/20grams/daily
Low mg= Low Potassium
Before giving potassium make sure urine output is 30ML / hour
High= Hyperkalemia= dehydration, kidney disease, acidosis, adrenal insufficiency, crush injuries
Low= Hypokalemia= fluid overload, diuretic therapy. Alkalosis, insulin admin, hyperaldosteronism
=Exactilate, insulin, duiretic to treat hyperkalemia
Page 246 Calcium- Ca2+= 9.0-105 (found in bone matric) (arrythmias
Page 246 Magnesium-Mg2+ ion= 1.8-2.6 9 ( arrythmias
Mg found in bones and cartilage
Importance in skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation, blood coagulation, cell
growth
High= hypermagnesemia= kidney disease, hypothyroidism, adrenal insufficiency,
Low= Hypomagnesemia= malnutrition, alcoholism, ketoacidosis
-------------------------------------------------------------------------------------------------------------------------------------
-Muscles cells carry more water
-Fat cells carry very little water
-Kidney is the organ most sensitive to water loss / gain
-3 Hormones that help regulate Aldosterone, Antidiuretic ADH, Natriuretic peptide hormone NP
Aldosterone= prevents water and Na loss; promotes excretion of potassium
Antidiuretic hormone aka vasopressin- retains water (indirectly regulates electrolyte retention or excretion)
Natriuretic peptides- kidney reabsorption of Sodium
-----------------------------------------------------------------------------------------------------------------------------
Page 246 Dehydration (fluid volume deficient)
1
, causes- hemorrhage, vomiting, diarrhea, profuse salivation, fistulas, ileostomy, Profuse diaphoresis, burns, severe wounds, long term NPO
status, diuretic therapy, GI suction, hyperventilation, diabetes insipidus, difficulty swallowing, impaired thirst, unconsciousness, fever, impaired
motor function, weight loss, hyperemesis gravida, NV, draining wound,heat stroke
Signs& symptoms= Poor skin turgor, hypotensive, tachycardia, flat neck and hand veins, dry skin “tenting”, dry mucous membranes,
hypovolemia, deep furrow tongue, low grade fever, concentrated urine (dark amber color , strong odor )
Usual labs for dehydration= elevated hemoglobin, hemocrit, serum osmalority, glucose protein BUN, electrolytes; increase in blood
concentration
Treatment: Oral rehydration with electrolyte ( gatorade), if cannot handle PO give IV
FLUIDS,
TPUT,
enting can
120mL
rate
thing,
d phlebitis
arrhea ,
ormal BP,
atment
Pa
ric
iuretics,
on
Assess- food and liquid intake, intake and output daily weights, kidney and endocrine diseases
L
AR SPACE)
pressure, ^ weight gain, bounding pulse,
iction
DEMA (OCCURS QUICKLY; CAN CAUSE
ased peripheral edema, reduced urine
2
