Exam 1 NR 324 Adult Health 1 (2024/2025)/ NR 324 Adult Health 1 Exam 1/ NR 324/ NR 324 Adult Health 1.

Exam 1 NR 324 Adult Health 1 (2024/2025)/ NR 324 Adult Health 1 Exam 1/ NR 324/ NR 324 Adult Health 1. What age group has the highest percentage of water content? Preterm / Neonates Two fluid compartments in the body Intracellular space (inside cells) located in the ICF Extracellular space (outside cells) located in the ECF ICF makes up what percent of total body weight? 40% What are the two main compartments containing ECF? What other compartments are there? Interstitial fluid (fluid in the spaces between cells) Intravascular fluid (plasma) Other compartments include lymph and transcellular fluids Transcellular fluid includes Cerebrospinal fluid, fluid in the gastrointestinal tract, and joint spaces as well as pleural, peritoneal, intraocular, and pericardial fluid. 1L of water = _____ lb. 2.2 lb (1kg) The concentrations of electrolytes in body fluids is expressed in _________ milliequivalents (mEq) per Liter What are the main Ions found in the ECF and ICF ECF cation- sodium, with small amounts of potassium, calcium, and magnesium ECF anion- chloride, with small amounts of bicarbonate, sulfate, and phosphate anions. ICF cation- potassium, with small amounts of magnesium and sodium ICF anion- phosphate, with some protein and a small amount of bicarbonate. Hypovolemia (ECF volume deficit) abnormal loss of normal body fluids, (D/V, hemorrhage, polyuria) inadequate intake, or plasma-to-interstitial fluid shift Fluid volume deficit Assessment- Causes-Treatment-Client education Assessment- Restlessness, drowsiness, lethargy, confusion • Thirst, dry mucous membranes • Cold clammy skin • Decreased skin turgor, ↓ capillary refill • Postural hypotension, ↑ pulse, ↓ CVP • ↓ Urine output, concentrated urine • ↑ Respiratory rate • Weakness, dizziness • Weight loss • Seizures, coma Causes- • ↑ Insensible water loss or perspiration (high fever, heatstroke) • Diabetes insipidus • Osmotic diuresis • Hemorrhage • GI losses: vomiting, NG suction, diarrhea, fistula drainage • Overuse of diuretics • Inadequate fluid intake • Third-space fluid shifts: burns, pancreatitis Treatment- replace water and electrolytes with balanced IV solutions Client education- Good skin care, if orthostatic hypotension is present, teach to change positions slowly, remind patient to drink Hypervolemia (ECF volume excess) Excessive intake of fluids, abnormal retention of fluids (HF or renal failure), or interstitial-to-plasma fluid shift Fluid volume excess Assessment- Causes-Treatment-Client education Assessment- • Headache, confusion, lethargy • Peripheral edema • Jugular venous distention • S3 heart sound • Bounding pulse, ↑ BP, ↑ CVP • Polyuria (with normal renal function) • Dyspnea, crackles, pulmonary edema • Muscle spasms • Weight gain • Seizures, coma Causes- • Excessive isotonic or hypotonic IV fluids • Heart failure • Renal failure • Primary polydipsia • SIADH • Cushing syndrome • Long-term use of corticosteroids Treatment-Remove fluid without changing electrolyte composition or osmolality of ECF Client education- elevate edematous extremities Nutrition related to potassium Diet is the source -Fruit, dried fruits and vegetables -Many salt substitutes contain substantial K+ Nutrition related to sodium -Daily intake far exceeds bodys daily requirments -Glucose promotes sodium and water absorption Hypertonic solutions initially raises the osmolality of ECF and expands it -higher osmotic pressure draws water out of the cells into the ECF -Useful in treatment of hyponatremia and trauma patients with head injuries Isotonic solutions has a similar concentration of water and electrolytes to plasma, with an osmolality of 250 to 375 mOsm/L -administering an isotonic solution expands only ECF and the fluid does not move into cells -the ideal fluid replacement for patients with ECF volume deficits Hypotonic solutions solution has more water than electrolytes, with an osmolality of less than 250 mOsm/kg. -Infusing a hypotonic solution dilutes ECf -good for treating patients with hypernatremia As a nurse it is important to remember what administration guidelines when administering IV KCL? • IV KCl must always be diluted and never given in concentrated amounts. • Never give KCl via IV push or as a bolus. • Invert IV bags containing KCl several times to ensure even distribution in the bag. • Do not add KCl to a hanging IV bag to prevent giving a bolus dose. Hypernatremia Occurs when either too much water is lost or not enough water intake, or too much salt is taken in What S/S should the nurse look for when a patient is experiencing hypernatremia with decreased, normal and increased ECF volume? Hypernatremia with decreased ECF volume: • Restlessness, agitation, lethargy, seizures, coma • Intense thirst, dry swollen tongue, sticky mucous membranes • Postural hypotension, ↓ CVP, weight loss, ↑ pulse • Weakness, muscle cramps Hypernatremia with normal or increased ECF volume: • Restlessness, agitation, twitching, seizures, coma • Intense thirst, flushed skin • Weight gain, peripheral and pulmonary edema, ↑ BP, ↑ CVP Sodium plays a key role in the body by... Transmitting nerve impulses Hyponatremia Occurs when the body loses more sodium than water and there is a low level of sodium in the blood or when too much water is taken in or retained or when there is organ failure Hyperkalemia Occurs when potassium levels in your blood are higher than normal -Excess K+ intake -Shift of K+ out of cells -Failure to eliminate K+ Potassium is crucial for __________ and ____________ function within the body? Neuromuscular and cardiac function What S/S should the nurse look for when a patient is experiencing hyperkalemia? • Fatigue, irritability • Muscle weakness, cramps • Loss of muscle tone • Paresthesias, decreased reflexes • Abdominal cramping, diarrhea, vomiting • Confusion • Irregular pulse • Tetany What S/S should the nurse look for when a patient is experiencing hyponatremia with decreased, normal and increased ECF volume? Hyponatremia with decreased ECF volume: • Irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma • Dry mucous membranes • Postural hypotension, ↓ CVP, ↓ jugular venous filling, ↑ pulse, thready pulse • Cold and clammy skin Hyponatremia with normal or increased ECF volume: • Headache, apathy, confusion, muscle spasms, seizures, coma • Nausea, vomiting, diarrhea, abdominal cramps • Weight gain, ↑ BP, ↑ CVP Hypokalemia Occurs when potassium levels in your blood are lower than normal -K+ loss -Shift of K+ into cells -Lack of K+ intake What S/S should the nurse look for when a patient is experiencing hypokalemia? • Fatigue • Muscle weakness, leg cramps • Soft, flabby muscles • Paresthesias, decreased reflexes • Constipation, nausea, paralytic ileus • Shallow respirations • Weak, irregular pulse • Hyperglycemia Hypermagnesmia Occurs when magnesium levels in your blood are higher than normal Magnesium is responsible for what reactions in the body? Reactions that involve muscle function, energy production, and carbohydrate and protein metabolism What S/S should the nurse look for when a patient is experiencing hypermagnesemia? • Lethargy, drowsiness • Muscle weakness • Urinary retention • Nausea, vomiting • Diminished deep tendon reflexes • Flushed, warm skin, especially facial • ↓ Pulse, ↓ BP What S/S should the nurse look for when a patient is experiencing hypomagnesemia? • Confusion • Muscle cramps • Tremors, seizures • Vertigo • Hyperactive deep tendon reflexes • Chvostek's and Trousseau's signs • ↑ Pulse, ↑ BP, dysrhythmias Hypomagnesemia Occurs when magnesium levels in your body are lower than normal -associated with high mortality rates Calcium plays what role in the body? Plays a role in blood clotting, transmission or nerve impulses, myocardial contractions, and muscle contractions -Major cation in bones and teeth Hypercalcemia Excess calcium leading to reduced excitability of muscles and nerves -causes by hyperparathyroidism in about 2/3 of persons -the other 1/3 come from hematologic, breast, and lung cancers Patients with hypocalcemia could have what conditions or problems leading to low calcium? Surgical removal of parathyroid gland Multiple blood transfusions Sudden alkalosis Malnutrition Acute pancreatitis Renal insufficiency Primary hypoparathyroidism Chronic alcoholism What S/S should the nurse look for when a patient is experiencing hypercalcemia? Manifestations • Lethargy, weakness, fatigue • Decreased memory • Depressed reflexes • ↑ BP • Confusion, psychosis • Anorexia, nausea, vomiting • Bone pain, fractures • Polyuria, dehydration • Nephrolithiasis • Seizures, coma -ventricular dysrhythmias Hypocalcemia Low calcium levels from decreased total calcium or decreased ionized calcium -low ionized calcium levels decrease the threshold for activating the sodium channels resulting in increased nerve excitability and sustained muscle contraction Low ionized calcium levels can lead to tetany, as a nurse you know that clinical signs of tetany include Chvostek's sign (contraction of facial muscles and Trousseau's sign (carpal spasms induced by BP cuff on arm) What S/S should the nurse look for when a patient is experiencing hypocalcemia? • Weakness, fatigue • Depression, irritability, confusion • Hyperreflexia, muscle cramps • ↓ BP • Numbness and tingling in extremities and region around mouth • Chvostek's sign • Trousseau's sign • Laryngeal and bronchial spasms