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Exam (elaborations)

PN 4003 EXAM STUDY SET

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PN 4003 EXAM STUDY SET ...

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  • September 11, 2024
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  • 2024/2025
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  • PN 4003
  • PN 4003
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PN 4003 EXAM STUDY SET 2024-2025


Arterial Blood Gasses

pH: 7.35 - 7.45

PaCO235

HCO3

- 45 mmHg 22-26 mEq/L

Sensible losses

Urination

Defecation

Wound drainage

Insensible losses

Evaporation from skin

respiratory loss through lungs

isotonic solution

No fluid shift because solutions are equally concentrated

* Normal saline solution (0.9% NaCl)

Hypotonic solution

Lower solute concentration

* Fluid shifts from hypotonic solution into the more concentrated solution to create
a balance (cells swell)

* Half-normal saline solution (0.45% NaCl)

Hypertonic solution

,Higher solute concentration

* Fluid is drawn into the hypertonic solution to create a balance (cells shrink)

* 5% dextrose in normal saline (D5/0.9% NaCl)

Regulatory mechanisms

Baroreceptor reflex

Volume receptors

Renin-angiotensin-aldosterone mechanism

Antidiuretic hormone

Baroreceptor reflex

The primary reflex pathway for homeostatic control of blood pressure

Respond to a fall in arterial blood pressure

Located in the atrial walls, vena cava, aortic arch

and carotid sinus

Constricts afferent arterioles of the kidney resulting in retention of fluid

Renin-Angiotensin-Aldosterone

Renin

*Enzyme secreted by kidneys when arterial pressure or volume drops

* Interacts with angiotensinogen to form angiotensin I (vasoconstrictor)

Angiotensin

* Angiotensin I is converted in lungs to angiotensin II using ACE (angiotensin
converting enzyme)

* Produces vasoconstriction to elevate blood pressure

* Stimulates adrenal cortex to secrete aldosterone

Aldosterone

,* Mineralocorticoid that controls Na+ and K+ blood levels

* Increases Cl- and HCO3- concentrations and fluid volume

Aldosterone Negative Feedback Mechanism

* ECF & Na+ levels drop → secretion of ACTH by the anterior pituitary → release
of aldosterone by the adrenal cortex → fluid and Na+ retention

Antidiuretic hormone

Also called vasopressin

Released by posterior pituitary when there is

a need to restore intravascular fluid volume

* Release is triggered by osmoreceptors in the thirst center of the hypothalamus

* Fluid volume excess ⇒ decreased ADH

* Fluid volume deficit ⇒ increased ADH

Dehydration

Loss of body fluids ⇒ increased concentration of solutes in the blood and a rise in
serum Na+ levels

* Fluid shifts out of cells into the blood to restore balance

* Cells shrink from fluid loss and can no longer function properly

risk:

Confused, Comatose, Bedridden, Infants, Elderly, Enterally fed.

s/s

Irritability, Confusion, Dizziness, Weakness, Extreme thirst, ⇓ urine output, Fever,
Dry skin/mucous

membranes, Sunken eyes, Poor skin turgor, Tachycardia.

Hypovolemia

, Fluid Volume deficit

can be caused by:

bleeding, GI upset, trauma, fluid aspiration or removal.

s/s

decreased urine output

dry skin

tachycardia

hypotension

concentrated urine with increased specific gravity.

nursing considerations:

rehydrate, increased fall risk precautions (decreased bp) measure I+o

Hypervolemia

Fluid volume excess

can be caused by:

heart failure, kidney failure, liver cirrhosis, high sodium intake.

s/s

increased weight

increased blood pressure

wet lung sounds

edema

nursing considerations:

low sodium diet, raise HOB (Breathing) I+O chart, daily weights, diuretics

Shock

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