NR I324 IExam I1 IStudy IGuide
*Make Isure Ithat Iyou Iunderstand Iall Iof Ithe Iterms Iyou Iare Istudying, Iif Iyou Idon’t Iknow Iwhat Ia Iterm Imeans,
Ilook Iit Iup Ibefore Iyou Icontinue Istudying. ITake Iyour Ithinking Ia Istep Ifurther Iby Iasking Iyourself I“why” Ias
IyouIare Ireviewing Imaterial Iyou Iare Istudying. IThis Iwill Ilead Ito Iunderstanding Iof Ithe Imaterial Iversus
Imemorization Iwhich Iwill Ibetter Ihelp Iyou Ianswer Iapplication Iquestions. I Remember, Ithis Istudy Iguide
Idoes Inot Imirror Ithe Iexam Iand Iyou Iare Iresponsible Ifor Iall Icourse Icontent; Iensure Ithat Iyou Ihave Ian
Iunderstanding Iof Iconcepts. IThat Ibeing Isaid, Iif Iyou Icomplete Iand Iunderstand Ithis Istudy Iguide, Iyou Iwill
IbeIwell Iprepared Ifor Ithe Inext Iexam.
Chapter I17: IFluid, IElectrolyte, Iand IAcid-Base IImbalances
1. What Iare Ipossible Icauses Iof Ihypervolemia?
Excessive Iintake Iof Ifluids, Iabnormal Iretention Iof Ifluids I(heart Ifailure, Irenal Ifailure), ISIADH,
Cushing’s.
2. What Iare Ithe Iclinical Imanifestations Iof Ihypervolemia?
Increased IBP, Ibounding
IpulseIEdema
HA
Polyuria
Crackles, Idyspnea
3. What Iare Iremarks Ithat Ia Ipatient Imight Isay Iif Ithey Iare Iexperiencing Ifluid Ivolume Ioverload?
4. What Iare Ithe Ivital Isigns Ichanges Iyou’ll Isee Iwith Ihypervolemia?
BP, Ipulse, IJVD Idistention, ILOC
5. What Iare Ispecific Inursing Iassessments Ito Iassess Ifor Ihypervolemia?
24-hour Iintake Iand Ioutput, Iassess Icardio Ichanges, IResp Ichanges, ILOC, IPEERLA, Idaily Iweights,
skin.
6. What Iis Ithe Itreatment Ifor Ithese Ipatients? IDiet, Ifluid/sodium Irestriction, Ifluids, Idiuretics
o What Iare Ithe Idifferent Itypes Iof
Idiuretics?ILoop Idiuretics: IFurosemide I–
ILasix IThiazides: IHydrochlorothiazide
Potassium Isparing: ISpiro
IlactoneIQuinzoline: Imetolazone
o How Iwould Iyou Ieducate Iyour Ipatient Iwith Ieach Itype?
Loop Idiuretics Icause Ithe Ikidneys Ito Iincrease Iflow Iof Iurine. IThis Ihelps Ireduce Ithe Iamount
of Iwater Iin Iyour Ibody Iand Ilower Iyour Iblood Ipressure. ITake Ithis Imed Iin Ithe Imorning.
IThiazides Ireduce Ithe Iamount Iof Isodium Iand Iwater Iin Ithe Ibody. IThiazides Iare Ithe Ionly
type Iof Idiuretic Ithat Idilates I(widens) Ithe Iblood Ivessels, Iwhich Ialso Ihelps Ito Ilower
bloodIpressure.
I
, Potassium-sparing Iused Ito Ireduce Ithe Iamount Iof Iwater Iin Ithe Ibody. IUnlike Ithe Iother
I diuretic Imedicines, Ithese Imedicines Ido Inot Icause Iyour Ibody Ito Ilose Ipotassium. IDo
notIincrease Ithe Ipotassium Iyou Ieat.
I
7. What Iare Ipossible Icauses Iof Ihypovolemia?
Fever, Iheatstroke, IDiabetes Iinsipidus, IGI Ilosses, IHemorrhage, Idehydration
8. What Iare Ithe Iclinical Imanifestations Iof Ihypovolemia?
Poor Iskin
IturgorILethargy
Thirst, Idry Imucous Imembranes
IDecreased Iurine Ioutput,
IconcentratedIIncreased Irespiratory
Irate
Orthostatic Ihypotension
9. What Iare Iremarks Ithat Ia Ipatient Imight Isay Iif Ithey Iare Iexperiencing Idehydration?
10. What Iare Ithe Ivital Isigns Ichanges Iyou’ll Isee Iwith Ihypervolemia?
Decreased IBP, IIncreased IHR, IIncreased IRR, Iflattened Ineck Iveins, Ithread Ipulse
11. What Iare Ispecific Inursing Iassessments Ito Iassess Ifor Ihypovolemia?
Skin Iturgor, Iskin I(dry, Ibreakdown), Idaily Iweights, Iintake Iand Ioutput
12. What Iis Ithe Itreatment Ifor Ithese Ipatients?
Increase Ifluids
13. What Iare Iway’s Ito Imeasure Ifluid Ivolume Istatus?
Intake Iand Ioutput, Idaily Iweight
14. Which Imeasurement Iis Ithe Ibest Iway Ito Imeasure Itotal Ibody Ifluid Igains/loss?
Daily Iweight
15. What Iare Ilab Ivalue Iranges, Iaction Iin Ithe Ibody, Iclinical Imanifestation Iand Itreatments Iof Ithe
following:
o Sodium I(NA) I: I135-145
Maintains Ithe Iconcentration Iand Ivolume Iof IECF Iand Iinfluences Iwater Idistribution.
Where Iwater Igoes Isodium
Ifollows.IHypernatremia
Manifestations: IRestlessness, Iagitation Itwitching, Iseizures, Icoma
ITreatments: Itreat Iunderlying Icause, Ihypotonic Isolution I(5%
Idextrose)IHyponatremia:
Manifestation: ILethargy, Iconfusion, Idecreased Ireflexes, Iseizures, Iand Icoma
Treatments: Itreat Iunderlying Icause, Ifluid Irestriction, Ihypertonic Isaline Iin Ismall Iamounts
o Potassium I(K): I3.5-5.0 I HEART
Regulates Iintracellular Iosmolality Iand Ipromotes Icellular Igrowth. INeuromuscular Iand
cardiac Ifunction Iare Icommonly
Iaffected.IHyperkalemia I(renal Ifailure,
Irapid ITPN)
Manifestations: Iirregular Ipulse, Iparesthesia, Iweakness, Iirritability
Treatments: IKayexalate, IIV Iinsulin Iand Iglucose I(pushes IK+ Iinto Icells),
IHemodialysisIHypokalemia I(GI Ilosses, Idiarrhea, Ivomiting, ING Isuction)
Manifestations: Imuscles Iweakness, Iirregular Ipulse, Ifatigue, Ihyperglycemia
Treatments: Itreat Iwith Ioral Ior IIV IK+ I(needs Ito Ibe Ion Ipump Iand Icannot Iexceed I10-20
mEqIper Ihour
I
*Make Isure Ithat Iyou Iunderstand Iall Iof Ithe Iterms Iyou Iare Istudying, Iif Iyou Idon’t Iknow Iwhat Ia Iterm Imeans,
Ilook Iit Iup Ibefore Iyou Icontinue Istudying. ITake Iyour Ithinking Ia Istep Ifurther Iby Iasking Iyourself I“why” Ias
IyouIare Ireviewing Imaterial Iyou Iare Istudying. IThis Iwill Ilead Ito Iunderstanding Iof Ithe Imaterial Iversus
Imemorization Iwhich Iwill Ibetter Ihelp Iyou Ianswer Iapplication Iquestions. I Remember, Ithis Istudy Iguide
Idoes Inot Imirror Ithe Iexam Iand Iyou Iare Iresponsible Ifor Iall Icourse Icontent; Iensure Ithat Iyou Ihave Ian
Iunderstanding Iof Iconcepts. IThat Ibeing Isaid, Iif Iyou Icomplete Iand Iunderstand Ithis Istudy Iguide, Iyou Iwill
IbeIwell Iprepared Ifor Ithe Inext Iexam.
Chapter I17: IFluid, IElectrolyte, Iand IAcid-Base IImbalances
1. What Iare Ipossible Icauses Iof Ihypervolemia?
Excessive Iintake Iof Ifluids, Iabnormal Iretention Iof Ifluids I(heart Ifailure, Irenal Ifailure), ISIADH,
Cushing’s.
2. What Iare Ithe Iclinical Imanifestations Iof Ihypervolemia?
Increased IBP, Ibounding
IpulseIEdema
HA
Polyuria
Crackles, Idyspnea
3. What Iare Iremarks Ithat Ia Ipatient Imight Isay Iif Ithey Iare Iexperiencing Ifluid Ivolume Ioverload?
4. What Iare Ithe Ivital Isigns Ichanges Iyou’ll Isee Iwith Ihypervolemia?
BP, Ipulse, IJVD Idistention, ILOC
5. What Iare Ispecific Inursing Iassessments Ito Iassess Ifor Ihypervolemia?
24-hour Iintake Iand Ioutput, Iassess Icardio Ichanges, IResp Ichanges, ILOC, IPEERLA, Idaily Iweights,
skin.
6. What Iis Ithe Itreatment Ifor Ithese Ipatients? IDiet, Ifluid/sodium Irestriction, Ifluids, Idiuretics
o What Iare Ithe Idifferent Itypes Iof
Idiuretics?ILoop Idiuretics: IFurosemide I–
ILasix IThiazides: IHydrochlorothiazide
Potassium Isparing: ISpiro
IlactoneIQuinzoline: Imetolazone
o How Iwould Iyou Ieducate Iyour Ipatient Iwith Ieach Itype?
Loop Idiuretics Icause Ithe Ikidneys Ito Iincrease Iflow Iof Iurine. IThis Ihelps Ireduce Ithe Iamount
of Iwater Iin Iyour Ibody Iand Ilower Iyour Iblood Ipressure. ITake Ithis Imed Iin Ithe Imorning.
IThiazides Ireduce Ithe Iamount Iof Isodium Iand Iwater Iin Ithe Ibody. IThiazides Iare Ithe Ionly
type Iof Idiuretic Ithat Idilates I(widens) Ithe Iblood Ivessels, Iwhich Ialso Ihelps Ito Ilower
bloodIpressure.
I
, Potassium-sparing Iused Ito Ireduce Ithe Iamount Iof Iwater Iin Ithe Ibody. IUnlike Ithe Iother
I diuretic Imedicines, Ithese Imedicines Ido Inot Icause Iyour Ibody Ito Ilose Ipotassium. IDo
notIincrease Ithe Ipotassium Iyou Ieat.
I
7. What Iare Ipossible Icauses Iof Ihypovolemia?
Fever, Iheatstroke, IDiabetes Iinsipidus, IGI Ilosses, IHemorrhage, Idehydration
8. What Iare Ithe Iclinical Imanifestations Iof Ihypovolemia?
Poor Iskin
IturgorILethargy
Thirst, Idry Imucous Imembranes
IDecreased Iurine Ioutput,
IconcentratedIIncreased Irespiratory
Irate
Orthostatic Ihypotension
9. What Iare Iremarks Ithat Ia Ipatient Imight Isay Iif Ithey Iare Iexperiencing Idehydration?
10. What Iare Ithe Ivital Isigns Ichanges Iyou’ll Isee Iwith Ihypervolemia?
Decreased IBP, IIncreased IHR, IIncreased IRR, Iflattened Ineck Iveins, Ithread Ipulse
11. What Iare Ispecific Inursing Iassessments Ito Iassess Ifor Ihypovolemia?
Skin Iturgor, Iskin I(dry, Ibreakdown), Idaily Iweights, Iintake Iand Ioutput
12. What Iis Ithe Itreatment Ifor Ithese Ipatients?
Increase Ifluids
13. What Iare Iway’s Ito Imeasure Ifluid Ivolume Istatus?
Intake Iand Ioutput, Idaily Iweight
14. Which Imeasurement Iis Ithe Ibest Iway Ito Imeasure Itotal Ibody Ifluid Igains/loss?
Daily Iweight
15. What Iare Ilab Ivalue Iranges, Iaction Iin Ithe Ibody, Iclinical Imanifestation Iand Itreatments Iof Ithe
following:
o Sodium I(NA) I: I135-145
Maintains Ithe Iconcentration Iand Ivolume Iof IECF Iand Iinfluences Iwater Idistribution.
Where Iwater Igoes Isodium
Ifollows.IHypernatremia
Manifestations: IRestlessness, Iagitation Itwitching, Iseizures, Icoma
ITreatments: Itreat Iunderlying Icause, Ihypotonic Isolution I(5%
Idextrose)IHyponatremia:
Manifestation: ILethargy, Iconfusion, Idecreased Ireflexes, Iseizures, Iand Icoma
Treatments: Itreat Iunderlying Icause, Ifluid Irestriction, Ihypertonic Isaline Iin Ismall Iamounts
o Potassium I(K): I3.5-5.0 I HEART
Regulates Iintracellular Iosmolality Iand Ipromotes Icellular Igrowth. INeuromuscular Iand
cardiac Ifunction Iare Icommonly
Iaffected.IHyperkalemia I(renal Ifailure,
Irapid ITPN)
Manifestations: Iirregular Ipulse, Iparesthesia, Iweakness, Iirritability
Treatments: IKayexalate, IIV Iinsulin Iand Iglucose I(pushes IK+ Iinto Icells),
IHemodialysisIHypokalemia I(GI Ilosses, Idiarrhea, Ivomiting, ING Isuction)
Manifestations: Imuscles Iweakness, Iirregular Ipulse, Ifatigue, Ihyperglycemia
Treatments: Itreat Iwith Ioral Ior IIV IK+ I(needs Ito Ibe Ion Ipump Iand Icannot Iexceed I10-20
mEqIper Ihour
I
