NUR 242 Exam 2 Notes
Medical/Surgical Nursing Concepts
(Galen College of Nursing)
100% Guarantee Pass
CONTENTS
Medsurg Exam 2
Anything Highlighted in Yellow = on test
Chapters 13, Chapter 14, Chapter 48, Chapter 49, Chapter 50, Chapter 56,
Chapter 59, Chapter 60, 61, Chapter 62, chapter 64, Chapter 67
,Medsurg Exam 2
Yellow on Exam
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, some
veggies, fruits 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 Absorption of Calcium requires Vitamin D
Calcium found in bone matrix
,High= hypercalcemia- hyperthyroidism, hyperparathyroidism
Low= Hypocalcemia- Vit D deficiency, hypothyroidism, hypoparathyroidism, kidney disease, fluid overload, excessive
vomiting and diarrhea, adrenal insufficiency, diuretic therapy
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
1
, Page 246 Dehydration (fluid volume deficient)
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
Teaching= Drink more water, reduce caffeine (increases fluid loss), reduce avoid alcohol
Priority problems for patient w/ dehydration =1. poor profusion,2. potential injury (muscle weakness, pressure
changes)
Nursing priority= fluid replacement, drug therapy, patient safety (orthostatic hypotension, dysrthmias, muscle
weakness, confusion OLDER ADULTS' CONSIDERATION: DUE TO LESS TOTAL BODY MASS, DECREASED THIRST
SENSATION, LESS MOBILITY TO OBTAIN FLUIDS, DUIRETICS, ANTIHYPERTENSIVES, LAXATIVES
Isotonic dehydration is the most common type of fluid loss problem u
Items that are liquid at body temp are considered liquids= ice cream gelatin, ice
1 L of water = 2.2 lbs changes in daily weights are the best indicator of fluid volume loss of gains, (1LB =500mL of
fluid loss)
Provide fluids PO, fluid needed in 24hr period, give fluid every 2 hours, infuse iv FLUIDS, MONITOR EVERY 2
HOURS, (PULSE, bp, OUTPUT, Weight every 8 hours) monitor for overload also, IV site check hourly, Give Rx
2 most important areas to monitor during rehydration are PULSE QUALITY and URINE OUTPUT (30ml an hour)
OLDER ADULT ASSESS SKIN TURGOR BY PINCHING SKIN OVER STERNUM OR FOREHEAD RATHER THAN BACK OF
HAND ( on hand tenting can
occur even if well hydrated because of lack of elasticity.)
For every degree Celsius increase in body temperature above normal, a min of about 500mL of body fluid is lost
URINE OUTPUT BELOW 500ML/ DAY FOR PATIENT WITHOUT KIDNEY DISEASE IS CAUSE FOR CONCERN.
Page 248 Best Practice Patient with dehydration= oral fluids (consider restrictions sugar frere, low NA, thickened;
ensure fluids(60-120mL ever hr) given on even schedule every 2 hrs throughout 24 hours; do not withhold fluid to
prevent incontinence; infuse IV fluids at rate consistent with needs ( consider heart, lung ,kidney issue); monitor
patient response every 2 hours ( consider pulse, difficulty breathing, neck veins distension in uprght position,
presence of DEPENDENT EDEMA); assess IV infusion site hourly for signs pf infiltration and phlebitis (swelling pain,
cordlike veins, reduced drip rate) Give prescribed rx for correct underlying case of dehydration ( antiemetics,
antidiarrhea , antibiotics, antipyretics)
When dehydration is severe patient cannot tolerate PO fluids = give IV
THE 2 MOST IMPORTANT AREAS TO MONITOR DURING REHYDRATION ARE PULSE RATE AND QUALITY AND URINE
OUTPUT
Indications fluid balanced properly managed: fluid intake maintained at 1500mL ( or drinks at least 500mL more than
daily urine; normal BP, moist mucous membranes; doesn’t fall; asks for assistance when ambulating, states
indications of dehydration, correctly follows treatment plans.
Insensible water loss= sweat, salivation, diarrhea, vomit, wound drainage
Page 249 Fluid overload
causes- excessive fluid replacement, kidney failure (late phase), heart failure, long term corticoid therapy, too
much SIADH, Psychiatric disorders with polydipsia (thirst), water intoxication; CHF, IV hydration high rate, renal
Medical/Surgical Nursing Concepts
(Galen College of Nursing)
100% Guarantee Pass
CONTENTS
Medsurg Exam 2
Anything Highlighted in Yellow = on test
Chapters 13, Chapter 14, Chapter 48, Chapter 49, Chapter 50, Chapter 56,
Chapter 59, Chapter 60, 61, Chapter 62, chapter 64, Chapter 67
,Medsurg Exam 2
Yellow on Exam
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, some
veggies, fruits 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 Absorption of Calcium requires Vitamin D
Calcium found in bone matrix
,High= hypercalcemia- hyperthyroidism, hyperparathyroidism
Low= Hypocalcemia- Vit D deficiency, hypothyroidism, hypoparathyroidism, kidney disease, fluid overload, excessive
vomiting and diarrhea, adrenal insufficiency, diuretic therapy
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
1
, Page 246 Dehydration (fluid volume deficient)
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
Teaching= Drink more water, reduce caffeine (increases fluid loss), reduce avoid alcohol
Priority problems for patient w/ dehydration =1. poor profusion,2. potential injury (muscle weakness, pressure
changes)
Nursing priority= fluid replacement, drug therapy, patient safety (orthostatic hypotension, dysrthmias, muscle
weakness, confusion OLDER ADULTS' CONSIDERATION: DUE TO LESS TOTAL BODY MASS, DECREASED THIRST
SENSATION, LESS MOBILITY TO OBTAIN FLUIDS, DUIRETICS, ANTIHYPERTENSIVES, LAXATIVES
Isotonic dehydration is the most common type of fluid loss problem u
Items that are liquid at body temp are considered liquids= ice cream gelatin, ice
1 L of water = 2.2 lbs changes in daily weights are the best indicator of fluid volume loss of gains, (1LB =500mL of
fluid loss)
Provide fluids PO, fluid needed in 24hr period, give fluid every 2 hours, infuse iv FLUIDS, MONITOR EVERY 2
HOURS, (PULSE, bp, OUTPUT, Weight every 8 hours) monitor for overload also, IV site check hourly, Give Rx
2 most important areas to monitor during rehydration are PULSE QUALITY and URINE OUTPUT (30ml an hour)
OLDER ADULT ASSESS SKIN TURGOR BY PINCHING SKIN OVER STERNUM OR FOREHEAD RATHER THAN BACK OF
HAND ( on hand tenting can
occur even if well hydrated because of lack of elasticity.)
For every degree Celsius increase in body temperature above normal, a min of about 500mL of body fluid is lost
URINE OUTPUT BELOW 500ML/ DAY FOR PATIENT WITHOUT KIDNEY DISEASE IS CAUSE FOR CONCERN.
Page 248 Best Practice Patient with dehydration= oral fluids (consider restrictions sugar frere, low NA, thickened;
ensure fluids(60-120mL ever hr) given on even schedule every 2 hrs throughout 24 hours; do not withhold fluid to
prevent incontinence; infuse IV fluids at rate consistent with needs ( consider heart, lung ,kidney issue); monitor
patient response every 2 hours ( consider pulse, difficulty breathing, neck veins distension in uprght position,
presence of DEPENDENT EDEMA); assess IV infusion site hourly for signs pf infiltration and phlebitis (swelling pain,
cordlike veins, reduced drip rate) Give prescribed rx for correct underlying case of dehydration ( antiemetics,
antidiarrhea , antibiotics, antipyretics)
When dehydration is severe patient cannot tolerate PO fluids = give IV
THE 2 MOST IMPORTANT AREAS TO MONITOR DURING REHYDRATION ARE PULSE RATE AND QUALITY AND URINE
OUTPUT
Indications fluid balanced properly managed: fluid intake maintained at 1500mL ( or drinks at least 500mL more than
daily urine; normal BP, moist mucous membranes; doesn’t fall; asks for assistance when ambulating, states
indications of dehydration, correctly follows treatment plans.
Insensible water loss= sweat, salivation, diarrhea, vomit, wound drainage
Page 249 Fluid overload
causes- excessive fluid replacement, kidney failure (late phase), heart failure, long term corticoid therapy, too
much SIADH, Psychiatric disorders with polydipsia (thirst), water intoxication; CHF, IV hydration high rate, renal
