Med Surg 324 - Exam 1 Exam Questions And Answers (Verified And Updated)

Med Surg 324 - Exam 1 Exam Questions And Answers (Verified And Updated) Insensible Water Loss - answerFluid loss that can not easily be measured. Including sweat, tears, weepy wounds, exhalation and water excretion in the stool. Osmolarity and Osmolality - answerBoth are 270-300 mOsm/L Isotonic IV solutions - answerConcentration of solutes in IV is equal to solute concentration in the blood. Between 270-300 mOsm/L, 0.9% saline. Hypertonic IV solutions - answerConcentration of solutes in the IV are greater than the solutes in the blood. 300 mOsm/L, 3% or 5% saline. Parenteral nutrition solutions as well. Hypotonic IV solutions - answerConcentration of solutes in the IV are less than the solutes in the blood. 270 mosm/L, 0.45% saline. Sodium Na+ - answerNormal Range: 135-145 mEq/L Think Brain - cannot handle rapid changes in Na levels. Hyponatremia - answerSerum Na 135mEq/L. Critical value is 120mEq/L. Caused by diuretics (furosemide), NPO, Low-salt diet, excessive ingestion of hypotonic fluids (like water), decreased water excretion through the kidneys. Hyponatremia cues and intervention - answerCerebral changes - sudden onset confusion, altered LOC Neuromuscular changes - muscle weakness, check for respiratory changes Q2h. GI - Increased motility Cardiovascular - rapid, weak, thready pulse. Decreased BP, severe orthostatic hypotension Drug therapy: reduce drugs that decrease Na , IV saline solution, Tolvaptan. Nutrition: Increased oral sodium take, restrict fluids. Tolvaptan - answerMay cause hypernatremia. It is used in people with heart failure and individuals with low sodium levels. Correction of hyponatremia should never exceed ______mEq/L within in 24hrs. - answer8 mEq/L Hypernatremia - answerSerum Na level 145mEq/L. Caused by excessive oral intake, excessive admin of sodium containing IV fluids, NPO, fever, dehydration. Hypernatremia cues and intervention - answerCNS changes - Altered LOC, short attention span, confusion Skeletal muscle changes - twitching, irregular muscle contraction, weakness, reduced DTR's. Cardiovascular - Increased pulse rate, hypotension or sever orthostatic hypotension. Drug therapy: 0.9% saline or dextrose 5% in 0.45% NaCl. Nutrition: Ensure adequate water intake, sodium restriction and avoid processed foods. Potassium K+ - answerNormal Range: 3.5-5.0 mEq/L Think Heart - regulates protein synthesis, glucose use, and storage. Some control intracellular osmolarity and volume. Hypokalemia - answerSerum 3.5 mEq/L. Most potassium is inside cells. Caused by diuretics (K+ comes out in poop), diarrhea, vomiting, prolonged nasogastric suctioning, water intoxication, NPO, heat-induced excessive diaphoresis. Hypokalemia cues and intervention - answerAge - poor ability to concentrate urine. Drugs - potassium wasting diuretics, are they using potassium supplements? Assess Diet and disease (Recent illness or surgery) Respiratory: Shallow respirations, effort, rate and depth Musculoskeletal: muscle weakness Cardiovascular: thread, weak and rapid pulse. irregular heartbeat, ECG changes. Orthostatic hypotension. Neurologic changes: Altered mental status, LOC. Intervention: Increase serum potassium levels, PO and IV potassium chloride, Nutrition therapy (meat, fish, fruit and veggies), maintain O2 above 95%. IV potassium chloride is a severe tissue irritant, so if it infiltrates you need to stop the IV immediately and notify the ______ and _______. - answerRapid response team and health care provider. Hyperkalemia - answerSerum K+ 5.0 mEq/L. Caused by salt substitutes, potassium (oral or IV), blood transfusion, tissue damage, potassium-sparring diuretics, uncontrolled diabetes. Hyperkalemia cues and intervention - answerAge - decreased kidney function Comorbidities - diabetes, kidney disease, recent medical or surgical treatment