MDC II Final Exam Study Guide updated 2022

MDC II Final Exam Study Guide updated 2022 Chapter 11: Care of Patients with Fluid and Electrolyte Balance Hypervolemia S/S: pitting edema, increased HR/BP/HR, distended neck and hand veins, weight gain, SOB, lung crackles, pale/cool skin, decreased lab values, alter LOC Treatment: patient safety (assess every 2 hours for PE), assess for skin breakdown (skin care), provide supplemental O2 and position patient in semi-fowler’s to improve SOB, furosemide, fluid restriction, monitor daily weight and output, restrict Na/low sodium diet (water follows) Hypovolemia S/S: increased HR, orthostatic hypotension (increased risk for falls), weak/thready pulse, flattened neck/hand veins, increased RR, decreased turgor, warm/dry skin, dry mucous membranes, fever, decreased urine and increased concentration, increased lab values Treatment: fluid replacement (monitor pulse rate/quality and urine output of 30 ml/hr. during rehydration), antidiarrheals, antiemetics, antipyretics Calcium: Hypercalcemia Causes: hyperparathyroidism/hyperthyroidism, dehydration, use of thiazide diuretics, use of glucocorticoids, kidney failure, malignancy, excessive intake of calcium or vitamin D S/S: (EKG CHANGES FROM CLOT): cyanosis, pallor, EKG changes, increased risk for blood clots, profound muscle weakness, decreased DTR, decreased peristalsis/bowel sounds, constipation, kidney stone formation Calcium: Hypocalcemia Causes: lactose intolerance, Crohn’s disease, celiac disease, acute pancreatitis, ESKD, diarrhea, wound drainage, alkalosis (hyperventilation), hyperproteinemia S/S: (HYPERACTIVE CRAMPS): muscle spasms (“charley horses”), tetany, hyperactive reflexes, + Trousseau’s and Chvostek’s signs, arrythmias, weak/thready pulse, painful abdominal cramping, diarrhea, loss of bone density (osteoporosis), brittle/fragile bones (may break with slight trauma), confusion Normal Calcium (Ca+): 9.0-10.5mg/dL Potassium: Hypokalemia Causes: diuretics, alkalosis (hyperventilation), TPN, NPO, Cushing’s syndrome, vomiting, wound drainage, prolonged NG suctioning, heat-induced/excessive diaphoresis, corticosteroids, increased aldosterone S/S: (SLOW, LOW, + LETHAL): low/shallow respirations, muscle weakness, reduced DTR, leg cramps, limp muscles, lethal cardiac changes, low BP and HR, increased urine output, decreased bowel sounds (constipation) Normal Potassium (K+): 3.5-5.0 mEq/L Magnesium: Hypomagnesemia S/S: (HYPERACTIVE TWITCHING/SEIZING): HTN, dysrhythmias, constipation, hyperactive DTRs, involuntary movements, + Trousseau’s and Chvostek’s signs, Torsade’s de Pointes, weak respirations Normal Magnesium (Mg+): 1.8-2.6 mEq/L Sodium: Hyponatremia S/S: (SALT LOSS): confusion, trouble concentrating, seizures, stupor, muscle weakness/spasms, diminished DTRs, abdominal cramping, increased urine output, loss of appetite, shallow respirations, orthostatic hypotension, diarrhea Normal Sodium (Na+): 136-145 mEq/L Chapter 12: Care of Patients with Problems of Acid-Base Balance ABG Interpretation 1. Is the pH out of range? (in range and opposite direction-fully compensated; out of range and opposite direction-partially compensated; same direction-uncompensated) 2. Is the PaCO2 normal/out of range? (respiratory) 3. Is the HCO3 normal/out of range? (metabolic) 4. Match the one (PaCO2 or HCO3) that is the same as the pH. (acidosis or alkalosis) 5. Does the one that does not match/remains go in the opposite direction of pH? (compensation) 6. Is PaO2 and O2 sat out of range? (hypoxemia) Respiratory Acidosis/Metabolic Acidosis Interpretation: Kussmaul breathing, hyperkalemia, warm/dry/pink skin Causes: hypoventilation, asthma, COPD, pneumonia, in table below Respiratory Alkalosis/Metabolic Alkalosis Interpretation: hypocalcemia and hypokalemia, dizziness, twitching, tingling, increased HR and RR Causes: in table below Common Causes of Alkalosis etabolic Alkalosis ncrease of base components Oral ingestion of bases: Antacids Parenteral base administration: Blood transfusion Sodium bicarbonate Total parenteral nutrition ecrease of acid components Prolonged vomiting Nasogastric suctioning Hypercortisolism Hyperaldosteronism Thiazide diuretics