NURSING 101 Complete Hurst Packet

Nursing 101 Complete Hurst Packet TABLE OF CONTENTS Fluids and Electrolytes 3 Acid-Base Balance 13 Burns… 16 Oncology… 22 Endocrine 38 Cardiac 52 Psychiatric Nursing… 71 Gastrointestinal 92 Neuro… 104 Maternity Nursing… 114 Respiratory… 139 Orthopedics… 144 Renal 150 Questions 158 Final Thoughts 178 Evaluations 186 Table of Contents for CD 188 Pediatric… 189 Hurst Review does not condone the discussion of the NCLEX-RN exam post- test. Thank you. NOTICE TO FACULTY All materials used during any Hurst Review Services seminar are copyrighted and are not for use without the sole permission of Marlene Hurst in any form or fashion. This material is not intended for lecture use by any School of Nursing without permission. NOTICE TO STUDENTS If you are a student who has obtained this book from a past participant of my workshops SHAME, SHAME, SHAME!!! Please understand that this book is written to accompany the live or video lectures presented in the class itself or my Internet Tutorials. This book is only an outline of what is needed to pass NCLEX. I hope you will join me in a live or video class or on the Internet to reap the full benefits of my materials. General Class Information - Please turn off ALL cell phones and pagers. -This class MAY NOT be recorded in any manner. (This included tape recording or videoing.) -Class Time: 8AM-4PM * Please note that each class is presented in a particular sequence if your instructor completes the material for that day, you may get out prior to 4 PM. FLUID VOLUME EXCESS: HYPERVOLEMIA Define: too much volume in the l. Causes: a. CHF: heart is , CO , decreased perfusion, UO *the volume stays in the b. RF: Kidneys aren't c. Alkaseltzer Fleets enemas All 3 have a lot of IVF with Na d. Aldosterone (steroid, mineralocorticoid) Where does aldosterone live? -Normal action: when blood volume gets low (vomiting, blood loss, etc.) →aldosterone secretion increases→ retain Na/water→ blood volume ** Diseases with too much aldosterone: -also seen with liver disease and heart disease 1. 2. **Disease with too little aldosterone: 1. e. ADH (anti-diuretic hormone) Normally makes you retain or diurese? Retain? 2 ADH problems Too Much Not enough Retain Lose (diuese) Fluid Volume Fluid Volume SIADH DI Syndrome of Inappropriate ADH Secretion Diabetes Insipidus Urine Urine Blood Blood *Concentrated makes #’s go up specific gravity, Na *Dilute makes #’s go down ADH lives in pituitary; key words to make you think potential ADH problem: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy *Another name for anti-diuretic hormone (ADH) is Vasopressin. The drug Vasopressin (Pitressin or DDAVP (Desmopressin acetate) may be utilized as an ADH replacement in Diabetes Insipidus. f. S/Sx of FVE: Distended neck veins/peripheral veins: vessels are Peripheral edema, third spacing: vessels can't hold anymore so they start to CVP: measured where? ; number goes More More Lung sounds: Polyuria: kidneys trying to help you Pulse: ; your heart only wants fluid to go If the fluid doesn't go forward it's going to go into the BP: move volume more Weight: any acute gain or loss isn't fat-it’s fluid g. Treatment: Low Na diet Diuretics Loop *Bumex® may be given when Lasix® doesn’t work. Thiazide (HCTZ) * Watch lab work with all diuretics *Dehydration and electrolyte problems K-sparing Bed rest induces *when you are supine you perfuse your kidneys more h. Interventions: Physical Assessment Give IVF’s slowly to elderly FLUID VOLUME DEFICIT: HYPOVOLEMIA Big Time Deficit=Shock l. Causes: Loss of fluids from anywhere Thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage Third spacing (when fluid is in a place that does you no good) *burns *ascites Polyuria- Diseases with polyuria Oliguric- Anuric- 2. Weight Decreased Skin Turgor Dry mucous membranes Decreased Urine Output kidneys either aren't being or they are trying to BP? (less , less ) Pulse? , heart is trying to pump what little is left around CVP? , less volume, less Peripheral Veins/Neck veins Cool Extremities (peripheral in an effort to shunt blood to ) Urine Specific Gravity , if putting out any urine at all it will be 3. Tx and Nursing Interventions: Mild Deficit: Severe Deficit: Quickie IV Fluid Lecture Isotonic: Go in the vascular space and stays there! Examples of Isotonic Solutions: , , Hypotonic: Go in the vascular space, hang out a little while and rehydrate, but they do not stay in the vascular space.....If they stayed in the vascular space they wouldn't be hypotonic they would be These solutions go in and hang out and rehydrate, then they move into the cell and the cell burns the remainder up in cellular metabolism. They are hydrating solutions, but they won't drive your pressure up because they do not stay in the vascular space. Hypertonic Solution: - Volume expander and solution that draws fluids into the vascular space. - Examples: D10W, 3% NaCl, 5% NaCl, D5 LR, D5 ½ NaCl, D5 NaCl, TPN Hypotonic Solution: - Causes a fluid shift from the vascular space into the cells. - Examples: D2.5 W, ½ NaCl, 0.33% NaCl