NR324 Exam 1 Study Guide Fluid & Electrolyte Balance and
Respiratory Care
1. Hypovolemia (FVD - fluid volume deficit & Dehydration – urine
and blood recognition of symptoms)
a. Occur with abnormal loss of body fluid
i. ECF volume deficit
ii. Plasma to ICF fluid shift
iii. Inadequate fluid intake
iv. Ex: diarrhea, vomiting, hemorrhage, polyuria, severe burns
v. Hypovolemia (FVD) at risk individuals
● Mostly associate w/unconscious pt
● Damage to the hypothalamus, which controls the thirst center
● ↑ Insensible water loss or perspiration (high fever,
heatstroke)
● Diabetes insipidus
● Osmotic diuresis, Hemorrhage, ascites
● GI losses: vomiting, NG suction, diarrhea, fistula drainage
● Overuse of diuretics, Inadequate fluid intake
, ● Third-space fluid shifts: burns, pancreatitis
b. Dehydration: refers to loss of pure water alone without a
corresponding loss of sodium or other electrolytes.
c. S/S: confusion, lethargy, drowsiness, restlessness, weakness, dizziness
, i. ↑ pulse, ↓Central Venous Pressure, ↓urine output, concentrated
urine
ii. seizure , coma w/dehydration
iii. Low BP, Low perfusion , ↑ respiratory rate, postural hypotension
iv. Thirst, dry mucous membranes, cold clammy skin
v. Decreased skin turgor, cap refill,
vi. Weight loss
d. May be given Lactated Ringer’s (isotonic solution)
2. Prioritization of patients – who do you see/care for first?
a. ALWAYS the most unstable patient
b. ABCV
3. Hypervolemia (FVE- fluid volume excess) who is at risk?
a. Excess intake of fluid
i. Heart failure, renal failure, and Liver failure pt
ii. Excessive isotonic or hypotonic IV fluids
iii. Primary polydipsia
iv. SIADH
v. Cushing syndrome
vi. Long use of corticosteroids
vii. S/S:
● S3 heart sounds - pulmonary edema
● Headache, confusion, lethargy
● Peripheral edema
● dyspnea , crackles
● Muscle spasm, seizures, coma
● JVD
● Bounding pulse, ↑BP, ↑CVP
● Weight gain
● Polyuria (w/normal renal function)
4. Review the changes in COPD illnesses
a. First symptom is usually a Chronic intermittent cough, may be present every
day
i. Dyspnea is progressive + pts change behaviors to avoid
dyspnea (elevators> stairs) until dyspnea interferes with daily
activities (groceries)
ii. Then they have their first COPD exacerbation and seek medical help
iii. Late stages- dyspnea occurs at rest, diaphragm flattens
making the pt a chest breather using intercostal + accessory
muscles, there's wheezing (from laryngeal area or not
present upon auscultation) + chest tightness
, iv. In advanced- there's fatigue (in ADL), weight loss (with
adequate caloric intake) + anorexia, paroxysm of coughing
may be so severe pt may faint/ fractured ribs
b. (she said this was emphysema) In COPD various processes occurs such as
i. Airflow limitation
ii. Air trapping
iii. Gas exchange abnormalities,
iv. Mucus hypersecretion
Respiratory Care
1. Hypovolemia (FVD - fluid volume deficit & Dehydration – urine
and blood recognition of symptoms)
a. Occur with abnormal loss of body fluid
i. ECF volume deficit
ii. Plasma to ICF fluid shift
iii. Inadequate fluid intake
iv. Ex: diarrhea, vomiting, hemorrhage, polyuria, severe burns
v. Hypovolemia (FVD) at risk individuals
● Mostly associate w/unconscious pt
● Damage to the hypothalamus, which controls the thirst center
● ↑ Insensible water loss or perspiration (high fever,
heatstroke)
● Diabetes insipidus
● Osmotic diuresis, Hemorrhage, ascites
● GI losses: vomiting, NG suction, diarrhea, fistula drainage
● Overuse of diuretics, Inadequate fluid intake
, ● Third-space fluid shifts: burns, pancreatitis
b. Dehydration: refers to loss of pure water alone without a
corresponding loss of sodium or other electrolytes.
c. S/S: confusion, lethargy, drowsiness, restlessness, weakness, dizziness
, i. ↑ pulse, ↓Central Venous Pressure, ↓urine output, concentrated
urine
ii. seizure , coma w/dehydration
iii. Low BP, Low perfusion , ↑ respiratory rate, postural hypotension
iv. Thirst, dry mucous membranes, cold clammy skin
v. Decreased skin turgor, cap refill,
vi. Weight loss
d. May be given Lactated Ringer’s (isotonic solution)
2. Prioritization of patients – who do you see/care for first?
a. ALWAYS the most unstable patient
b. ABCV
3. Hypervolemia (FVE- fluid volume excess) who is at risk?
a. Excess intake of fluid
i. Heart failure, renal failure, and Liver failure pt
ii. Excessive isotonic or hypotonic IV fluids
iii. Primary polydipsia
iv. SIADH
v. Cushing syndrome
vi. Long use of corticosteroids
vii. S/S:
● S3 heart sounds - pulmonary edema
● Headache, confusion, lethargy
● Peripheral edema
● dyspnea , crackles
● Muscle spasm, seizures, coma
● JVD
● Bounding pulse, ↑BP, ↑CVP
● Weight gain
● Polyuria (w/normal renal function)
4. Review the changes in COPD illnesses
a. First symptom is usually a Chronic intermittent cough, may be present every
day
i. Dyspnea is progressive + pts change behaviors to avoid
dyspnea (elevators> stairs) until dyspnea interferes with daily
activities (groceries)
ii. Then they have their first COPD exacerbation and seek medical help
iii. Late stages- dyspnea occurs at rest, diaphragm flattens
making the pt a chest breather using intercostal + accessory
muscles, there's wheezing (from laryngeal area or not
present upon auscultation) + chest tightness
, iv. In advanced- there's fatigue (in ADL), weight loss (with
adequate caloric intake) + anorexia, paroxysm of coughing
may be so severe pt may faint/ fractured ribs
b. (she said this was emphysema) In COPD various processes occurs such as
i. Airflow limitation
ii. Air trapping
iii. Gas exchange abnormalities,
iv. Mucus hypersecretion
