Summary NURS 303 Med surg final exam study guide; A+ guide.

Unit 1 1 FLUID & ELECTROLYTES (8 QUESTIONS) • S/S FVE and FVD (dehydration & overload) • FVD: dehydration o Skin: flushed, dry, poor turgor, tenting o Mouth: dry, sticky mucous membranes o Eyes: decrease in tears, soft sunken eyeballs o CNS: Apprehension, weakness, restlessness, confusion, eyes get sunken looking o Blood: Increased Na+ , BUN, Hct, osmolality (>300); generally, the K+ is not elevated with dehydration because kidneys excrete it) o Urine: decreased output, high osmolality and specific gravity (concentrated urine) o Other: thirst, weight loss, fever (up to 100-101 is caused by not enough water for cooling), constipation o CV: orthostatic or postural hypotension (dizziness when standing because body cannot compensate), tachycardia, increased respirations, depressed fontanels in babies. o Hypovolemia (shock) is a major complication of dehydration (i.e. heat stroke, which is associated with high temperature); loss of water causes low volume in blood; blood vessels constrict, maintaining a low normal BP (controlled by baroreceptors); heart rate increases to make up for low volume. If a person is exposed to excess heat, maintaining a constant temperature is a good outcome. . o HYpovolemia; heart rate increases to make up for low volume – sx; tachycardia, low BP, increased respirations • FVE: o Lab - decreased: Na+ (dilutional), low Hematocrit, sp. gr., osmolality o Skin: Dependent edema (tight, cool, shiny, pale skin) o Respiratory- pulmonary edema, Shortness Of Breath (SOB), cough, crackles, increased respirations, frothy sputum o CNS: Lethargy, confusion, convulsions (due to increased ICP), coma o GI: anorexia, N/V S - The Marketplace to Buy and Sell your Study Material 2 o Blood: dec. Na+, Hct, low osmolality, dec. BUN o Urine: decreased in relation to intake, decreased osmolality and SG – the reason you become fluid overloaded so daily weights the best way to determine fluid balance o Other: sudden weight gain (>5% TBW = puffy); anasarca = generalized edema. Daily weights are the best way to determine fluid balance. Much better than I & • Identify s/s by category: Isotonic, Hypertonic, hypotonic • Isotonic Volume Deficit: same as above; lab work is normal • Hypotonic Volume Excess: what is listed above • Isotonic Volume Excess: Signs and symptoms- same; except lab values will be WNL – distended neck veins, increased BP, edema (pulmonary, peripheral, organ), hepatomegaly (enlarged liver) • Specific types of Edema: • Edema caused by increased hydrostatic pressure in blood that causes fluid to shift into tissues o Pitting edema aka ankle or dependent edema (CHF; in pregnancy caused by increased hydrostatic pressure of baby on venous return from legs); treatment with diuretics, fluid restriction, elevation of legs, sodium restriction, etc; everyone with CHF and hypertension should be on low sodium diet. Remove the water pitcher and salt shaker; having ankle edema after sleeping all night is a sign of CHF o Pulmonary edema aka CHF, crackles- lasix, oxygen, HOB up – not pushing out of left ventricle it backs up in right atrium o Ascites (cirrhosis, 3 rd spacing)- scarring in liver prevents portal blood from going into liver, this increases the hydrostatic pressure in portal circulation and fluid collects; paracentesis is done to remove fluid – circulation that goes around intestines and into liver is portal transport – cirrhosis (liver all scarred up) the BV can’t enter the liver so they get backed up and water diffuses out o DVT and blockage of venous system can cause increased hydrostatic pressure and leg edema • Edema caused by: electrolyte imbalance o Cerebral edema caused by hyponatremia-(fluid shifts from blood into brain); treated with steroids, mannitol or 3% Saline, seizure precautions; a stroke causes inflammation and swelling and cerebral edema (from a clot); excessive use of D5W without sodium can cause hyponatremia and cerebral edema. Severe hyponatremia is usually seen with SIADH • Edema caused by: Low Protein o Non-pitting or brawny edema often caused by low albumin- same treatment, + increased protein in diet; seen in malnourished or burn victims; usually seen in the legs- can be anasarca (all over the body) • Edema caused by: lymphatic problems o Lymphedema caused by removal of lymphatics- elevate the body part; sometimes bed is elevated on blocks to keep from bending vessels o Primary lymphedema- congenitally missing lymphatic system S - The Marketplace to Buy and Sell your Study Material 3 o Edema from low protein malnourished patients aka brawny edema – can’t pull water back into his tissues • IVF Chart: what fluids belong in each category, patients that are appropriate or inappropriate for each category, what each fluid is typically used for • Hypertonic: o D51/2NS: (5% Dextrose and .45% NS): draws fluid into vasculature from interstitial and intracellular compartments, hypertonic when infusing but becomes hypo when dextrose is metabolized so commonly used for hydration o 3% NS: prevents seizures from severe hyponatremia, only used when risk of seizures from brain edema; monitor for pulmonary edema; Excess ADH production (SIADH) causes water retention, hyponatremia, and cerebral edema when serum sodium is <120, at risk for seizures o D5LR (5% Dextrose and Lactated Ringers): electrolyte formula used for patients with draining wounds o D5NS: provides calories to prevent catabolism when NPO o D10/W: persistent hypoglycemic episodes, used to taper off TPN o Dextrose 50%; tx single episode of hypoglycemia • Hypotonic: o .45% NS: treats cellular dehydration, promotes waste elimination by kidneys, for dehydration IF BP is adequate, monitor adults for confusion with administration • Isotonic: o Lactated Ringers; balanced electrolyte formula (commonly used for surgical patients), caution in use with renal patients bc contains potassium, lactated: helps reverse acidosis after surgery o 0.9% NS: used for vascular volume expansion and fluid resuscitation, stays in blood and is used for SHOCK, common in ER and for BP elevation o 5% Dextrose: D5W; becomes free water when dextrose metabolizes, expands intracellular and interstitial fluids, short term only!! – eventually cause low serum sodium b/c gets “washed out” and RBCs will lyse. Pt will get edema to brain and have seizures • Plasma expanders o Patho- Unlike crystalloids, colloids contain molecules too large to pass through semipermeable membranes, such as capillary walls. Because they remain in the intravascular compartment, they're also known as volume expanders or plasma expanders; last longer than crystalloids. Examples include albumin, dextrans, and hydroxyethylstarches. Colloids expand intravascular volume by drawing fluid from the interstitial spaces into the intravascular compartment through their higher oncotic pressure; have the same effect as hypertonic crystalloids of increasing intravascular volume, but require administration of less total volume compared with crystalloids. Colloids are indicated for patients exhibiting hypoproteinemia, and malnourished states, as well as for those who require plasma volume expansion but who can't tolerate large infusions of fluid. Interfere with platelet function.