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NURS242 Galen College Of Nursing|Med surg|exam 2 study guide latest update
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NURS242 Galen College Of Nursing|Med surg|exam 2 study guide latest
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Chap 11
Fluid compartments
Intracellular 60%
Contained within the cell
body About 25L
Veins, arteries, capillaries, heart,
etc Extracellular 33%
Most important area of homeostasis, area outside of cells
Divided into intravascular space and interstitial space
Extracellular fluid volume is about 15L
In-between the cells
Fluid Balance
Closely linked to/affected by electrolyte concentrations
Fluid intake
2.3-3L a day
Fluid loss
Minimum urine amount needed to excrete toxic waste products= 400-600
mL/day
Insensible water loss-through skin, lungs, stool. Usually 500 to 1L a day
This increases during a fever, tachypnea and extreme stress
NURS242 Galen College Of Nursing|
Med surg|exam 2 study guide latest
update
,NURS242 Galen College Of Nursing|
Med surg|exam 2 study guide latest
update
Facts to remember
Any fluid imbalances that occur=continuous assessment of UOP
Urine output
Dehydrated pts, CHF, RF, Fluid volume deficient, and fluid volume overload
IV fluids, diuretics
Daily weights
1L of water weighs 2.2lb, equal to 1kg
Weight change of 1lb= fluid volume change of about 500 mL
Fluid volume deficit: Dehydration
Fluid intake/retention does not meet bodys fluid needs; results in fluid volume deficit
Assessment
Thread and increased pulse rate; decreased BP; lethargy; decreased UOP; dry
mucous membranes; constipation; thirst
Increased H&H (hemoconcentration), BUN, sodium, and urine specific
gravity Causes-vomiting, diarrhea, ileostomy, laxatives, burns, fever,
diuretics, GI
suctioning, and NPO
Interview/risk factors
Inquire about recent dietary
habits Use of OTC diuretics
Outdoor activities
Weight gain and weight loss
Who at risk: hemorrhage, vomiting, diaherra, excessive sweating, NPO, sustained burn
wounds, GI suction, Diuretics, uncontrolled diabetes, Poor intake
Flat neck and hand veins, increased RR, skin tenting, tongue wrinkles, dehydration, fever,
UOP concentrated,
Urine specific gravity concentrated (the higher the dryer)
BUN and Creatinine
BUN and Creatinine are kidney markers and are sensitive to decreased blood flow
BUN (10-20) and Creatinine (06-1.2) rise when nitrogenous wastes are found in
the
blood indicating kidney impairment
GFR (>65) typically has an inverse relationship (increased BUN and Creatinine with a
decreased GFR)- chronic renal failure
Elevations can be caused by dehydration
Fluid volume overload
NURS242 Galen College Of Nursing|
Med surg|exam 2 study guide latest
update
,NURS242 Galen College Of Nursing|
Med surg|exam 2 study guide latest
update
Assessment
Bounding and increase pulse; elevated BP; dyspnea, crackles on lung
auscultation; edema; decreased Hematocrit (hemodilution), decreased serum sodium and
urine specific gravity (dilute urine). Weight gain is the best indicator
Causes- ESRD, CHF, water intoxication, SIADH, corticosteroid therapy, and rapid
fluid replacement
Drug therapy
Diuretics (loop
diuretics) Nutrition therapy
Fluid restriction ( 1200
ml/day) Salt restriction
Monitoring of intake and
output Daily Weight!!!!
ESRD= End stage renal disease
SIADH= syndrome of inappropriate ADH
Edema- while standing ankles, feet, while laying down sacrum,
back Extreme cases it will be everywhere
Electrolyte imbalances:
etiology Hyponatremia
Due to sodium loss, water gain, or inadequate intake
Sodium loss: drugs; diuretics, anticonvulsants, SSRIs, antipsychotics, cancer meds
Hypernatremia
Dehydration, excessive Na intake (sodium polystyrene, sodium bicarb, renal
issue)
Hypokalemia
Not enough in too much out, depleting drugs, medical conditions
Not enough in: inadequate K intake
Too much out: GI fluid losses
Depleting drugs: diuretics, corticosteroids, insulin, excessive laxative use,
albuterol
Black licorice-acts like aldosterone
Hyperkalemia
Too much intake, blood products, drugs, not enough excreted, crush injury
NURS242 Galen College Of Nursing|
Med surg|exam 2 study guide latest
update
, NURS242 Galen College Of Nursing|
Med surg|exam 2 study guide latest
update
Too much intake: increased dietary intake,, salt substitutes, potassium
supplements
Donated blood
Drugs: K sparing diuretics, ACE inhibitors, ARBs, NSAIDs
Not enough excreted: renal failure ( low Na, K, protein
diet) Crush injury: intracellular K released
NURS242 Galen College Of Nursing|
Med surg|exam 2 study guide latest
update
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