Studydroid is shutting down on January 1st, 2019

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water is what percent of boy weight in adult
50-60
ICF accounts for how much of body water?
2/3
ECF is what kind of fluids?
interstitial
plasma lymph fluid
Normal intake for adult IN mL

fluids
solids
water from oxidation

total
1200

1000

300

2500
Normal output for adult in mL

insensible loss

in feces

urine
900
100
1500


2500 total
FLUID SPACING

First - normal distrib in the ____ and _____ comparts

Second - abnormal accumulation of ____ fluid, such as _____

Third - accumulated in portion from which it is ____ _____ exchanged with rest of ____. It 
Is it available? Given examples
-ICF, ECF

interstitial, edema

not easily exchanged w/ rest of ECF
it is trapped and unavailable, examples ascites, pertonitis, edema assoc w/ burns
HYPOVOLEMIA

is a volume _________.

can be d/t

Treatment goal is to _____ cause and replace  ____/____. Can be done w/....   
defecit

diarrhea, hemorrhage,polyuria

correct cause, replace water/elecs 

lactated ringer's, .9 NS, blood
NORMAL VALUES and aka FOR ELECS in MEQ

bicarb
chloride
phosphate
potassium
Mg
Na
Ca in mg/dL
hco3 22-26
cl- 96-106
PO43- 2.4.4.4
K+ 3.5.5
Mg2+ 1.5-2.5
Na+ 135-145     

Ca 8.6-10.2
HYPERVOLEMIA

is a ____ of fluid

r/t _____ of fluids, such as seen in what?    

there can be a shift in fluid

tx goal is to _____ fluid w/o producing abnormal changes in ________

what is primary therapy?
restrict ______
what may be needed?
volume excess

excessive intake, retention (heart/renal failure)

remove, electrolytes

primary therapy - diuretics and fluid therapy
restrict Na
paracentesis or thoracentesis
Sodium levels > ____ = HYPERNATREMIA

can result from...

Sodium levels < ____ = HYPONATREMIA

can be d/t..      
145 mEq/L

excess Na intake, inadequate water intake, excess water loss, disease states

135 mEq/L

excess Na loss, inadequate sodium intake, excess water gain, disease states
Dehydration refers to the loss of ______ without the loss of.
pure H20 without loss of Na
SS of dehydration
-behavioral
-mucous membs
-vitals
-urinary output
-strength
-orietation
-weight
-seizures, followed by...
-restless, drowsiness, lethargy, confusion
-thirst, dry muc memb
-^ pulse, decreased BP, ^RR
-dec UO
-weakness
-dizziness
-weight loss
-seizures and coma
S/S of HYPERNATREMIA w/ DEC ECF

-behavioral
-thirst
-muc membranes  
-weight...
-strenght level?
-energy level
-CVP inc or dec
-status
-restless, agitated, twitching
-INTENSE thirst, dry swollen tongue
-sticky MM
-weight loss
-weakness
-lethargic
-dec CVP
-seizure coma
S/S of HYPONAT w/ DEC ECF

-behavior
-orientation
-personality
-MM?
-seizures and what ending in what?
-HR and pulse
-skin
-CVP       
-irritable, apprehension
-confus, dizzy
-pers changes
-termors, seizures , coma
-DRY MM
-tachycard, thready pulse
-cold and clammy skin
-dec CVP    
HYPERNAT w/ INC ECF

-behavior
-thirst status
-skin status
-weight ....
-any edema
-BP, CVP
-restlessness, agitation, twitching
-intense thirst
-flushed skin
-weight gain
-perip and pulm edema
-INC BP and CVP
HYPONAT w/ INC ECF

-behavior and pains
-muscles
-can have what? go into?
-GI issues? 
-cramps where?
-weight
-BP and CVP
-HA, apathy, confusions
-muscle spasms
-seizures. coma.
-nausea vomit diarrhea
- -abdominal
-weight gain
-INC BP and CVP
HYPERNAT - GOALS
-treat...
-do what re: water loss?
-intake:
-infuse:
-also cna infuse
-administer drugs
-underlying cause
-prevent and replace
-PO fluids
-D5W
-Hypotonic saline sols
-diuretics
HYPONATREMIA GOALS
-restore...
-restrict intake of
-administer what solution
-drug given does what
-WHAT MUST BE MONITORED CLOSELY
-serum Na levels while body returning to equilib
-PO fluid
-3% NSS and hypoertonic
-vasopressin (blocks ADH)
-Na+ levels
Hyperkalemia is K levels > ____ mEq/L

can be d/t what? 

Hypokalemia is K levels < ____ mEq/L

can be d/t?
5.0

excess K= intake, shift of K= out of cells, failure to eliminate K+

3.5

K+ loss, Shift of K+ into cells, lack of K+ intake
HYPERKALEMIA S/S
-behavioral
-abdomina...
-GI?
-weakness of what?
-skin paren...
-HR
-ultimately cardiac 
–Irritability –Anxiety –Abdominal
cramping –Diarrhea –BLE
weakness –Parethesias –Irreg
HR –Cardiac
arrest
HYPOKALEMIA
-energy and muscles
-GI?
-skin para...
-reflexes?
-HR
-urinary
-how about glucose levels?
–Fatigue,
muscle weakness, leg cramps –N/V,
soft flabby muscles, paralytic ileus –Parethesias,

reflexes –Weak,
irreg HR –Polyuria –Hyperglycemia
HYPERKAL

EKG CHANGES

-twave
-pr
-st
-p wave?
-QRS
-vintricular...
-ventricular...
•Tall peak T wave •Prolong PR interval •ST segment depression •Loss of P wave •Widening QRS •Ventricular fibrillation •Ventricular standstill
HYPOKAL EKG
-ST segment
-T
-presence of ___ wave
-ventricualr dysrhythmias
-HR
-ehnanced ____ effect
•ST segment depression •Flattened T wave •Presence of U wave •Ventricular dysrhythmias (PVCs) •Bradycardia Enhanced
digitalis effect
NURSING HYPERKA

-eliminate intake of what?
-do what to get what out of body?
-force K+ from ____ to ____ by administering
-reverse the effects of ____ _____ w/
-oral, parenteral K+
-diuretics, dialysis, kayexalate
-ECF to ICF - insulin socium bicarb IV
-inc ECF K+ via Ca Gluconate
NURSING HYPOKA

-give what re: intake of K+
-what is max dose?
-IV dose not to exceed ___ to ___ per hour and via IV pump
-KCL (IV or PO) and inc dietary intake of K
-40mEq/L
-10-20 mEq/L
KCL must be given via

-never give via ___ or in concentrated 

-mix with IVF well
IV

IVP or in concentrated amounts

mix well

never add to existing IVF
HYPERCALCEMIA is >___ mg/dl

d/t increased ____ Ca and increased ionized Ca which is due to
10.2

total, acidosis
HYPOCALCEMIA is < ___ mg/dl

d/t decreased ___ _____ or decreased _____ _____ caused by _______
8.6

total Ca, ionized Ca, alkalosis
HYPERCALCEMIA
-energy and strength
-reflexes?
-memory
-mental state?
-GI and eating
-bone
-urinary
-Kidneys
-stupor and coma         
–Lethargy,
weakness –Depressed
reflexes –↓ memory –Confusion, personality changes, psychosis –Anorexia, N/V –BONE PAIN, FRACTURES –Polyuria, dehydration -NEPHROLITH KIDNEY STONES –Stupor, coma
HYPOCALCEMIA S/S

-energy
-mental status
-sensations in extremities and oral circumference
-muscles
-Chvostek's sign-
-Trousseau's sign
-spasm of...
-tetany? seizing?
–Easily
fatigued –Depression,
anxiety, confusion –Numb/tingling
extremities and oral circumferentially –Hyperreflexia,
muscle cramps –Chvostek’s
sign –Trousseau’s
sign (pg 318) –Laryngeal
spasm (pg 318) –Tetany,
seizures
HYPERCALCEMIA EKG
-ST
-QT
Ventric dysrhythmias
-digitalis effect... inc or dec
-shortened ST
-shortened QT
-ventric dysrhythmias
-increased digitalis effect
HYPOCALCEMIA EKG
-ST
-QT
-ventricular tachy
ST seg elongated

QT interval prolonged 

- bentric tachy 
NURS IMPLEMENTATION HYPERCALCEMIA
-goal is to promote excretion of ____ via _____ by administering a _____ _____
-hydrate patient with _____tonic fluids
-PO intake of ____ - ______ to avoid formation of what and to excrete Ca+
Ca+, urine, loop diuretics (lasix)

-Isotonic

3000-4k mL
HYPOCALCEMIA NURS IMPLEMENTATION

-Goal is to treat....
-Administer supplements via...
-initiate a diet rich in ____ and ______ __.
-cause
-oral and IV
-Ca+, vit D  
What kind of activity enhances bone mineralization?
weight bearing activity w/ mobility
HYPERPHOS is > ___ mg/dL
-d/t ___ failure...
-chemotherapeutic agents
-_____s containing phos
-excessive intake
-large intake of vitamin _
-hyper______ism
4.4
renal
enemas
vitD
hyperparathyroidism
HYPOPHOS is < _____ mg/dL
-d/t what synd?
-reversal or tx of...
-administration of....
-use of...
-______ withdrawal
-resp _____
-recovery from
-2.4
-malabsorption
-starvation
-TPN
-glucose admin
-ETOH
-ANTACIDS that bind phosphate
-resp alkalosis
-DKA recovery
HYPERPHOS S/S
-hypo____
-muscles?
-deposition of___`
calcemia
-muscle probs, tetany
-Ca+
HYPOPHOS S/S
-dysfunction of ____
-muscles ______
-resp muscle ____
-renal and tubular ______
-cardiac?
-rhabdo...
-osteo...
–CNS
dysfunction –Muscle weakness –Resp.
muscle weakness –Renal, tubular wasting –Cardiac
Problems –Osteomalacia –Rhabdomyolysis
HYPERPHOS NURS IMPLEMENTATION
-restrict foods high in_____ such as
-adequate hydration and levels of what?  
-in renal pats, as ___ levels rise, phos fall
-phosphate, dairy
-Ca+
-Ca+
HYPERMAG is > ____ mEq/L

d/t...

HYPOMAG is < _____ mEq/L

d/t....
2.5

renal failure (and admin Mg), excess Mg asmin for eclamps treat, adrenal insufficiency

1.5

D/V, alch, impaired absorpt, prolonged malnutrition, large UO, NG SUCTION, POORLY CONTROLLED DM, Hyperaldosteronism
HYPERMAG S/S
-energy
-wakefulness
-GI?
-how about DTR
-resp and card status
–Lethargy –Drowsiness –N/V –Loss of DTR –Somnolence –Resp/cardiac
arrest
HYPOMAG S/S
-mental
-DTR?
-muscles?
-events?
-cardiac?
–Confusion –Hyperactive
DTR –Tremors –Seizures –Cardiac
dysrhythmias
HYPERMAG NSG IMPLEMENTATIONS

-focus on
-renal pts avoid meds wi/ _____
-emergent tx includes Ca____ or Ca ____opposing effects on what muscle?
-prevention
-Mg
-chloride, gluconate, cardiac muscle
HYPOMAG

-administer
-increase dietary intake via
-admin MgSO4 via
-too rapid admin can lead to...    
-oral supp
-grees, nuts, bananas, oranges, pb, choc
-IV,IM
-card/resp arrest
ELEC patients NEURO ASSESSMENT
–Profound
volume depletion –LOC,
PERRLA –Response
to painful/verbal stimuli –Voluntary
movement of extremities –Degree
of muscle strength –Degree
of DTR
SKIN CARE and ASSESSMENT
–Check
turgor (tenting) and mobility –Assess
color, temperature & mucous membranes –Provide
oral care and inspect the mouth for bleeding, cracking, dryness –Check
for edema (+1 to +4 scale) –Inspect
for prolonged pressure/breakdown
Fluids if

HYPERTONIC

ISO

HYPO
–Hypertonic •D10W, 3%m NSS, D5 ½ NSS, D5 NSS –Isotonic •D5W,.9% NSS, D5 ¼ NSS, LR, Ringer’s
Soln. –Hypotonic •.45% NSS, D5W
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