1
NUR2571: Professional Nursing II / PN2 Final Exam Review
s/s of fluid overload - Hypervolemia or Over Hydration
Cardiovascular Changes
• Increased pulse rate
• Bounding pulse quality
• Elevated blood pressure
• Decreased pulse pressure
• Elevated central venous pressure
• Distended neck and hand veins
• Engorged varicose veins
• Weight gain
Respiratory Changes
• Increased respiratory rate
• Shallow respirations
• Shortness of breath
• Moist crackles present on auscultation
Skin and Mucous Membrane Changes
• Pitting edema in dependent areas
• Skin pale and cool to touch
Neuromuscular Changes
• Altered level of consciousness
• Headache
• Visual disturbances
• Skeletal muscle weakness
• Paresthesias
Gastrointestinal Changes
• Increased motility
• Enlarged liver
Chvostek’s sign what is it and why is it important - Assessing for hypocalcemia (positive Chvostek’s sign
usually occurs with alkalosis)
, 2
Dehydration – what would you expect lab values to look like
The Patient With Dehydration
• When possible, provide oral fluids that meet the patient's dietary restrictions (e.g., sugar-free, low-sodium, thickened).
• Collaborate with other members of the interprofessional team to determine the amount of fluids needed during a 24-hour period.
• Ensure that fluids are offered and ingested on an even schedule at least every 2 hours throughout 24 hours.
• Teach unlicensed assistive personnel to actively participate in the hydration therapy and not to withhold fluids to prevent
incontinence.
• Infuse prescribed IV fluids at a rate consistent with hydration needs and any known cardiac, pulmonary, or kidney problems.
• Monitor the patient's response to fluid therapy at least every 2 hours for indicators of adequate rehydration or the need for
continuing therapy, especially:
• Pulse quality
• Urine output
• Pulse pressure
• Weight (every 8 hours)
• Monitor for and report indicators of fluid overload, including:
• Bounding pulse
• Difficulty breathing
• Neck vein distention in the upright position
• Presence of dependent edema
• Assess the IV line and the infusion site at least hourly for indications of infiltration, extravasation, or phlebitis (e.g., swelling around
the site, pain, cordlike veins, reduced drip rate).
• Administer drugs prescribed to correct the underlying cause of the dehydration (e.g., antiemetics, antidiarrheals, antibiotics,
antipyretics).
**specific gravity increase with dehydration
What medication is given for high potassium?
sodium polystyrene sulfonate (Kayexalate)
Diuretic furosemide
s/s of circulatory overload aka PULMONARY EDEMA
**Monitor Respiratory efforts**
The patient will present with acute pulmonary edema when cardiac output cannot be maintained. Other symptoms
include, cyanosis, orthopnea, hypertension, headache, tachycardia, chest tightness, and cough. Symptoms set in near the end of the transfusion
or within six hours of completion.
What if you run out of TPN, what should you have at bedside ready to hang until TPN arrives**
**use 10% percent dextrose until pharmacy sends up TPN, also you need to take out of fridge for an hour
know ABGs
, 3
what would a patient look like if they had metabolic acidosis or metabolic alkalosis
treatment for pulmonary edema
• monitor for sx of fluid overload
• low sodium diet
• diuretics to increase urine production for excess salt and water (Furosemide or Bumetanide/Bumex)
o Furosemide may be administered PO, IV, or SQ. IV push is effective within minutes and is preferred for HF and
pulmonary edema
• Nitroglycerin to decrease preload and afterload
• sometimes nifedipine (Procardia) will be prescribed – CCB and antihypertensive to treat high BP and chest pain
• Morphine decreases sympathetic nervous system response and anxiety and promotes mild vasodilation
• Inotropic agents like Digoxin and dobutamine improve cardiac output
• Antihypertensives – ACE inhibitors and beta-blockers
NUR2571: Professional Nursing II / PN2 Final Exam Review
s/s of fluid overload - Hypervolemia or Over Hydration
Cardiovascular Changes
• Increased pulse rate
• Bounding pulse quality
• Elevated blood pressure
• Decreased pulse pressure
• Elevated central venous pressure
• Distended neck and hand veins
• Engorged varicose veins
• Weight gain
Respiratory Changes
• Increased respiratory rate
• Shallow respirations
• Shortness of breath
• Moist crackles present on auscultation
Skin and Mucous Membrane Changes
• Pitting edema in dependent areas
• Skin pale and cool to touch
Neuromuscular Changes
• Altered level of consciousness
• Headache
• Visual disturbances
• Skeletal muscle weakness
• Paresthesias
Gastrointestinal Changes
• Increased motility
• Enlarged liver
Chvostek’s sign what is it and why is it important - Assessing for hypocalcemia (positive Chvostek’s sign
usually occurs with alkalosis)
, 2
Dehydration – what would you expect lab values to look like
The Patient With Dehydration
• When possible, provide oral fluids that meet the patient's dietary restrictions (e.g., sugar-free, low-sodium, thickened).
• Collaborate with other members of the interprofessional team to determine the amount of fluids needed during a 24-hour period.
• Ensure that fluids are offered and ingested on an even schedule at least every 2 hours throughout 24 hours.
• Teach unlicensed assistive personnel to actively participate in the hydration therapy and not to withhold fluids to prevent
incontinence.
• Infuse prescribed IV fluids at a rate consistent with hydration needs and any known cardiac, pulmonary, or kidney problems.
• Monitor the patient's response to fluid therapy at least every 2 hours for indicators of adequate rehydration or the need for
continuing therapy, especially:
• Pulse quality
• Urine output
• Pulse pressure
• Weight (every 8 hours)
• Monitor for and report indicators of fluid overload, including:
• Bounding pulse
• Difficulty breathing
• Neck vein distention in the upright position
• Presence of dependent edema
• Assess the IV line and the infusion site at least hourly for indications of infiltration, extravasation, or phlebitis (e.g., swelling around
the site, pain, cordlike veins, reduced drip rate).
• Administer drugs prescribed to correct the underlying cause of the dehydration (e.g., antiemetics, antidiarrheals, antibiotics,
antipyretics).
**specific gravity increase with dehydration
What medication is given for high potassium?
sodium polystyrene sulfonate (Kayexalate)
Diuretic furosemide
s/s of circulatory overload aka PULMONARY EDEMA
**Monitor Respiratory efforts**
The patient will present with acute pulmonary edema when cardiac output cannot be maintained. Other symptoms
include, cyanosis, orthopnea, hypertension, headache, tachycardia, chest tightness, and cough. Symptoms set in near the end of the transfusion
or within six hours of completion.
What if you run out of TPN, what should you have at bedside ready to hang until TPN arrives**
**use 10% percent dextrose until pharmacy sends up TPN, also you need to take out of fridge for an hour
know ABGs
, 3
what would a patient look like if they had metabolic acidosis or metabolic alkalosis
treatment for pulmonary edema
• monitor for sx of fluid overload
• low sodium diet
• diuretics to increase urine production for excess salt and water (Furosemide or Bumetanide/Bumex)
o Furosemide may be administered PO, IV, or SQ. IV push is effective within minutes and is preferred for HF and
pulmonary edema
• Nitroglycerin to decrease preload and afterload
• sometimes nifedipine (Procardia) will be prescribed – CCB and antihypertensive to treat high BP and chest pain
• Morphine decreases sympathetic nervous system response and anxiety and promotes mild vasodilation
• Inotropic agents like Digoxin and dobutamine improve cardiac output
• Antihypertensives – ACE inhibitors and beta-blockers
