Complete-Nclex-Notes-Review

FLUID

1




NCLEX REVIEW

TABLE OF CONTENTS

Fluids and Electrolytes……………………………………………………………

Acid-Base Balance………………………………………………………………..

Burns………………………………………………………………….…………..

Oncology………………………………………………………………..…………

Endocrine…………………………………………………………………..……..

Cardiac…………………………………………………………………..………..

Psychiatric Nursing……………………………………………………………..

Gastrointestinal…………………………………………………………………..

Neuro……………………………………………………………………………...

Maternity Nursing……………………………………………………………….

Respiratory………………………………………………………………..………

Orthopedics……………………………………………………………………….

Renal………………………………………………………………………………

Questions………………………………………………………………………….

Pediatric……………………………………………………………………………..




FLUID VOLUME EXCESS: HYPERVOLEMIA

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Define: too much volume in the __________________ _________________
l. Causes:
a. CHF: heart is__________, CO__________, decreased__________ perfusion,
UO__________
*the volume stays in the _________________ _______________
b. RF: Kidneys aren't____________________
c. Alkaseltzer
Fleets enemas All 3 have a lot of_______________IVF with Na
d. Aldosterone (steroid, mineralocorticoid)
Where does aldosterone live?

-Normal action: when blood volume gets low (vomiting, blood loss, etc.)
→aldosterone secretion increases→ retain Na/water→ blood volume ______
** Diseases with too much aldosterone:
-also seen with liver disease and heart disease
1._________________________
2._________________________
**Disease with too little aldosterone:
1._________________________

e. ADH (anti-diuretic hormone)
Normally makes you retain
Retain? ____water_____________________
2 ADH problems
Too Much Not enough
Retain Lose (diuese)
Fluid Volume _________ Fluid Volume __________
SIADH DI
Syndrome of Inappropriate ADH Secretion Diabetes Insipidus
Urine Urine
Blood Blood
*Concentrated makes #’s go up specific gravity, Na
*Dilute makes #’s go down
ADH lives in pituitary; key words to make you think potential ADH problem:
craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy
*Another name for anti-diuretic hormone (ADH) is Vasopressin.
The drug Vasopressin (Pitressinor DDAVP (Desmopressin acetate) may be
utilized as an ADH replacement in Diabetes Insipidus.

f. S/Sx of FVE:
Distended neck veins/peripheral veins: vessels are_______________

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Peripheral edema, third spacing: vessels can't hold anymore so they start to
_______________
CVP: measured where? ____________________; number goes_________
More____________________....More____________________
Lung sounds:
Polyuria: kidneys trying to help you_________________________
Pulse: _______________; your heart only wants fluid to go__________________
If the fluid doesn't go forward it's going to go______________into
the_____________
BP: _______________ move volume.....more_______________
Weight: _______________ any acute gain or loss isn't fat-it’s fluid

g. Treatment:
Low Na diet
Diuretics
Loop *Bumex® may be given when Lasix® doesn’t work.
Thiazide (HCTZ) * Watch lab work with all diuretics
*Dehydration and electrolyte problems
K-sparing
Bed rest induces____________________
*when you are supine you perfuse your kidneys more
h. Interventions:
Physical Assessment
Give IVF’s slowly to elderly

FLUID VOLUME DEFICIT: HYPOVOLEMIA
Big Time Deficit=Shock
l. Causes: Loss of fluids from anywhere
Thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage
Third spacing (when fluid is in a place that does you no good)
*burns
*ascites


Polyuria-
Diseases with polyuria Oliguric-
Anuric-
2. Weight
Decreased Skin Turgor
Dry mucous membranes
Decreased Urine Output

, 4


kidneys either aren't being__________________ or they are trying to
________________
BP? ___________ (less_____________________, less______________________)
Pulse? __________, heart is trying to pump what little is left around
CVP? __________, less volume, less __________
Peripheral Veins/Neck veins
Cool Extremities (peripheral ______________in an effort to shunt blood to
_______________
__________________)
Urine Specific Gravity ______________, if putting out any urine at all it will be
____________
3. Tx and Nursing Interventions:
Mild Deficit:
Severe Deficit:

Quickie IV Fluid Lecture
Isotonic: Go in the vascular space and stays there!
Examples of Isotonic Solutions: ____________________, ________________,
________________
Hypotonic: Go in the vascular space, hang out a little while and rehydrate, but they
do not stay in
the vascular space.....If they stayed in the vascular space they wouldn't be
hypotonic.....they would
be ___________________. These solutions go in and hang out and rehydrate, then
they move into
the cell and the cell burns the remainder up in cellular metabolism. They are
hydrating solutions,
but they won't drive your pressure up because they do not stay in the vascular
space.
Hypertonic Solution:
- Volume expander and solution that draws fluids into the vascular space.
- Examples: D10W, 3% NaCl, 5% NaCl, D5 LR, D5 ½ NaCl, D5 NaCl, TPN
Hypotonic Solution:
- Causes a fluid shift from the vascular space into the cells.
- Examples: D2.5 W, ½ NaCl, 0.33% NaCl


MAGNESIUM AND CALCIUM
Fact: Magnesium is excreted by kidneys and it can be lost other ways, too (GI
tract)
Hypermagnesemia Hypercalcemia