Fundamentals HESI Remediation
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Hypotonic fluid imbalances Ans: Osmolality of ECF is less
than 280 mOsm
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Caused by sodium deficit or water excess
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Sodium deficit: Causes cellular edema and decrease of ECF
volume, causing symptoms of hypovolemia
Water excess: ICF and ECF increase and causes symptoms of
hypervolemia and pulmonary edema and cerebral edema.
Hyponatremia Ans: A serum sodium level less than 135
mEq/L
Caused by low intake of sodium, sodium loss, or excess water
intake.
Isovolemic hyponatremia Ans: loss of sodium without a
significant loss of water (pure sodium deficit)
Happens with SIADH, hypothyroidism, pneumonia, and
glucocorticoid deficiency. Can rarely be caused by deficient
sodium intake on low sodium diets or diuretic therapy.
Hypervolemic hyponatremia Ans: Total body sodium
increases, leading to water retention and dilution of sodium in
extracellular space.
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Edema is present
Caused by congestive heart failure, liver cirrhosis, and
nephrotic syndrome
Hypovolemic hyponatremia Ans: Water and sodium are both
lost but the sodium loss is greater, leading to decreased ECF.
Caused by excessive vomiting, diarrhea, inadequate
aldosterone secretion (adrenal insufficiency), and kidney
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losses with diuretic use.
Dilutional hyponatremia (water intoxication) Ans: Caused by
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intake of large amounts of water or infusions of dextrose 5%
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water as glucose is metabolized to CO2 and water, causing
hypotonic environment.
Occurs in excessive water intake by endurance athletes,
compulsive water intake, near drowning in fresh water, tap
water enemas, and SSRI use.
Almost impossible with normal body function.
Hypochloremia Ans: Low serum chloride levels , <97 mEq/L
Happens with hyponatremia or increase bicarb levels , such as
metabolic alkalosis.
Can happen with cystic fibrosis, restricted intake, diuretics,
vomiting, or NG suction.
Clinical manifestations of hyponatremia Ans: Decreased
hematocrit
Serum sodium <135 mEq/L
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Life-threatening cerebral edema with increased intracranial
pressure
Lethargy, confusion, apprehension, seizures, coma, muscle
twitching, decreased reflexes, weakness
Nausea and vomiting with less severe hyponatremia
Major cause of morbidity and mortality in ICUs and with the
elderly.
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Most common electrolyte disorder and especially prevalent in
the elderly
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Treatments of hyponatremia Ans: Small amounts of
hypertonic sodium chloride solution (3%) given for severe
neurological manifestations.
Water restriction with dilutional problems
ADH antagonists (vaptans)
Interventions for imminently dying patients Ans: Gentle
bathing as tolerated, oral care, moistening of lips and
surrounding area, repositioning, reducing environmental
stimuli and playing soothing music if agitated, administering
analgesic medications (sublingual/suppository) , repositioning
often, supplemental oxygen to ease breathing, medication for
nausea or vomiting, and alternative therapies ie massage or
guided imagery. Medications to decrease secretions and
suctioning if tolerated.
1 kg of weight equals how many L? Ans: 1 L of fluid