CMSRN Exam with complete solutions

Examples of third spacing Ascites, edema, burn Dilutional Hyponatremia Excessive fluid intake Edema, confusion, weight gain Treatment: decrease fluid intake "swells, rings tight" True Hyponatremia Loss of fluid and Na Weight loss, DRY, hypotensive, tachy, DEHYDRATED Tx: replace both sodium and water Hypernatremia Causes Fevern unresponsive to traditional interventions, Na IV fluids, DI, tube feeds Hypernatremia Symptoms DRY, thirst, tachy, oliguria(compensating) Hypernatremia treatment Decrease Na and replace fluids Cl Acts like Na Buffer to maintain pH Hyperkalemia Causes Cell wall destruction Increased intake K sparing diuretics Renal failure Acidosis Hyperkalemia symptoms Irritable muscles Dysrhythmias Hyperactive bowels/bladder- diarrhea, frequency, urgency Hyperkalemia tx Limit intake Kayexalate Ca gluconate IV glucose Dialysis Hypokalemia Causes Vomiting Diarrhea NG suction Decreased PO Burns K wasting diuretics Hypokalemia Symptoms Muscle flaccidity- not there to stimulate Weakness Constipation Alkalosis-resps Shallow Resps Cardiac arrest Hypokalemia Tx Supplement Foods high in potassium Citrus fruits and dried fruits, bananas, watermelon, potatoes, legumes, tea and peanut butter, avocado Calcium purpose Sedative at nerve level Coagulation- look at level with invasive procedures!! Bone/teeth strength Hypercalcemia Causes Cancer Metastatic bone disease hyperparathyroidism Thiazide diuretics Excessive vitamin D Hypercalcemia Symptoms Sedation Lethargy Hypoactive reflexes Slurred speech Impaired memory Hypercalcemia Tx Decrease intake Fluids Loop diuretics Give phosphate Hypocalcemia Causes Decrease PO of Ca and Vitamin D Increased Phosphate Renal disease Alcoholism Pregnancy POST PARATHYROIDECTOMY Hypocalcemia Symptoms Tetany Trousseaus- BP cuff Chvostek's- facial nerve "Pins and needles, lips burning, numbness" Hypocalcemia Tx Increase Ca and vitamin D intake TUMS- phosphate binding antacid IV Ca Gluconate Phosphate Bone/teeth strength Metabolism of carbs, fats, proteins Acid base balance INVERSE W/ CA Ex: hypophos looks like hypercal Magnesium metabolism of carbohydrates and proteins and fats muscle contraction If levels off- torsades DO NOT GIVE TO PATIENTS WITH RENAL IMPAIRMENT Isotonic Solutions Volume expander- cell stays same size NS, LR Hypertonic Solutions Cells Shrink- fluid leaves cell and goes to vascular space Correctional fluid D5LR D5NS Traumas, surgeries Never for dehydrated its Hypotonic Solutions Cell Swells Dehydrated pts 1/2 NS or 1/4 NS Gallbladder location RUQ Appendix location RLQ Stomach location LUQ Bowel pain location LLQ GERD Symptoms Dyspepsia Heartburn Hoarse voice GERD Dx Barium swallow- teaching- chalky BM, Increase PO fluids after Endo GERD tx PPI H2 blockers Gastric Ulcer Pain right after eating High epigastric area Pain with empty stomach if erosion through mucosa Duodenal Ulcer Pain at night or 2-4 hrs after eating Chronic may be asymptomatic Pain waxes and wanes Peptic Ulcer Tx Milk makes worse PPI, H2 blockers Lifestyle changes Flagyl- h pylori PPI- short term, long term increases osteoporosis risk Crohn's Entire bowel system Cobblestone ALL LAYERS No rectal bleeding Ulcerative Colitis Left colon Starts at rectum and ascends Bloody diarrhea Shallow ulcers Diet for inflammatory bowel disease low residue low fiber low fat low processed high protein and carbs