NUR 242 - Med surg Exam 2 Study Guide
S S S S S S S S
MedSsurgSexamS2SstudySguide
ChapS11
FluidScompartments
IntracellularS60%
ContainedSwithinStheScellSbodyS
AboutS25L
Veins,Sarteries,Scapillaries,Sheart,SetcS
ExtracellularS33%
MostSimportantSareaSofShomeostasis,SareaSoutsideSofScellsSDiv
idedSintoSintravascularSspaceSandSinterstitialSspaceSExtracellu
larSfluidSvolumeSisSaboutS15L
In-betweenStheScells
FluidSBalance
CloselySlinkedSto/affectedSbySelectrolyteSconcentrationsSFlu
idSintake
2.3-
3LSaSdaySFluidSloss
MinimumSurineSamountSneededStoSexcreteStoxicSwasteSproducts=S400-600
mL/day
InsensibleSwaterSloss-
throughSskin,Slungs,Sstool.SUsuallyS500StoS1LSaSdaySThisSincreasesSduringSaSfev
er,StachypneaSandSextremeSstress
FactsStoSremember
AnySfluidSimbalancesSthatSoccur=continuousSassessmentSofSUOPSUrin
eSoutput
DehydratedSpts,SCHF,SRF,SFluidSvolumeSdeficient,SandSfluidSvolumeSoverloadSIV
Sfluids,Sdiuretics
DailySweights
1LSofSwaterSweighsS2.2lb,SequalStoS1kg
WeightSchangeSofS1lb=SfluidSvolumeSchangeSofSaboutS500SmLSFl
uidSvolumeSdeficit:SDehydration
FluidSintake/retentionSdoesSnotSmeetSbodysSfluidSneeds;SresultsSinSfluidSvolumeSdeficitSAsses
sment
ThreadSandSincreasedSpulseSrate;SdecreasedSBP;Slethargy;SdecreasedSUOP;SdrySmuc
ousSmembranes;Sconstipation;Sthirst
IncreasedSH&HS(hemoconcentration),SBUN,Ssodium,SandSurineSspecificSgravityS
Causes-vomiting,Sdiarrhea,Sileostomy,Slaxatives,Sburns,Sfever,Sdiuretics,SGI
suctioning,SandSNPO
Interview/riskSfactors
InquireSaboutSrecentSdietaryShabitsS
UseSofSOTCSdiuretics
OutdoorSactivities
WeightSgainSandSweightSloss
WhoSatSrisk:Shemorrhage,Svomiting,Sdiaherra,SexcessiveSsweating,SNPO,SsustainedSburnSwou
nds,SGISsuction,SDiuretics,SuncontrolledSdiabetes,SPoorSintake
, NUR 242 - Med surg Exam 2 Study Guide
S S S S S S S S
FlatSneckSandShandSveins,SincreasedSRR,SskinStenting,StongueSwrinkles,Sdehydration,Sfever,SU
OPSconcentrated,
UrineSspecificSgravitySconcentratedS(theShigherStheSdryer)SB
UNSandSCreatinine
BUNSandSCreatinineSareSkidneySmarkersSandSareSsensitiveStoSdecreasedSbloodSflowSB
UNS(10-20)SandSCreatinineS(06-1.2)SriseSwhenSnitrogenousSwastesSareSfoundSinSthe
bloodSindicatingSkidneySimpairment
GFRS(>65)StypicallyShasSanSinverseSrelationshipS(increasedSBUNSandSCreatinineSwithSaSdecrea
sedSGFR)-SchronicSrenalSfailure
ElevationsScanSbeScausedSbySdehydrationSFlui
dSvolumeSoverload
Assessment
BoundingSandSincreaseSpulse;SelevatedSBP;Sdyspnea,ScracklesSonSlungSauscultation
;Sedema;SdecreasedSHematocritS(hemodilution),SdecreasedSserumSsodiumSandSurineSspecificSgravi
tyS(diluteSurine).SWeightSgainSisStheSbestSindicator
Causes-
SESRD,SCHF,SwaterSintoxication,SSIADH,ScorticosteroidStherapy,SandSrapidSfluidSreplacement
DrugStherapy
DiureticsS(loopSdiuretics)S
NutritionStherapy
FluidSrestrictionS(S1200Sml/day)S
SaltSrestriction
MonitoringSofSintakeSandSoutputS
DailySWeight!!!!
ESRD=SEndSstageSrenalSdisease
SIADH=SsyndromeSofSinappropriateSADH
Edema-
SwhileSstandingSankles,Sfeet,SwhileSlayingSdownSsacrum,SbackSExtreme
ScasesSitSwillSbeSeverywhere
ElectrolyteSimbalances:SetiologyS
Hyponatremia
DueStoSsodiumSloss,SwaterSgain,SorSinadequateSintake
SodiumSloss:Sdrugs;Sdiuretics,Santiconvulsants,SSSRIs,Santipsychotics,ScancerSmedsSHy
pernatremia
Dehydration,SexcessiveSNaSintakeS(sodiumSpolystyrene,SsodiumSbicarb,Srenal
issue)
Hypokalemia
NotSenoughSinStooSmuchSout,SdepletingSdrugs,SmedicalSconditionsSNotS
enoughSin:SinadequateSKSintake
TooSmuchSout:SGISfluidSlosses
DepletingSdrugs:Sdiuretics,Scorticosteroids,Sinsulin,SexcessiveSlaxativeSuse,
albuterol
BlackSlicorice-actsSlikeSaldosterone
Hyperkalemia
TooSmuchSintake,SbloodSproducts,Sdrugs,SnotSenoughSexcreted,ScrushSinjury
, NUR 242 - Med surg Exam 2 Study Guide
S S S S S S S S
TooSmuchSintake:SincreasedSdietarySintake,,SsaltSsubstitutes,Spotassium
supplements
DonatedSblood
Drugs:SKSsparingSdiuretics,SACESinhibitors,SARBs,SNSAIDsSNot
SenoughSexcreted:SrenalSfailureS(SlowSNa,SK,SproteinSdiet)SCrus
hSinjury:SintracellularSKSreleased
Hypocalcemia
InadequateSintake,Smalabsorption,ScalciumSloss,SothersSInade
quateSintake:ScalciumSandSvitaminSDS(sunlight)
Malabsorption:SpostSmenopausalSwomen,SdiseasesSthatSaffectStheSsmallSbowel,Sdrug
sS(anticonvulsants)
CalciumSloss:SloopSdiuretics
Others:SrenalSfailure,Shypoparathyroidism,SlowSmagnesium,SmultipleSbloodStransfusi
ons,Salkalosis,SlowSalbuminSlevels
Hypercalcemia
IncreasedSresorptionSfromStheSboneS
Hyperparathyroidism
Cancer
ThiazideSdiureticsS
Hypomagnesemia
PoorSintake,SpoorSGITSabsorption,SexcessiveSGITSloss,SexcessiveSurinarySlossesSP
oorSintake;Salcoholics,SpatientsSonSTPNSorSenteralSfeeding
PoorSabsorption:SIBD,SceliacSdisease
GITSloss:Sdiarrhea,SlaxativeSuse,SNGTSdrainageSUrina
rySloss:SdiureticsS(loopSandSthiazide)
Hypermagnesemia
ExcessiveSintake,SimpairedSexcretion
ExcessiveSintake:SmagnesiumScontainingSantacids/laxativesSIm
pairedSexcretion:SrenalSdysfunction
Rare
SodiumSimbalances:SaffectSCNSS
Hyponatremia
Common:Sheadache,Sirritability,Sdisorientation/confusion,Stired,SabdominalScrampin
g,SmuscleStwitching/weakness,ScraveSsalt
WorstScaseSscenarioS(criticalSlow):Spsychosis,Sseizures,Sataxia,SairwaySissuesSTreatme
nt
Mild:SfluidSrestrictionS(safest),SoralSsodiumSsupplementsS
Critical:ShypertonicS3%Ssaline ---- SLOWLY!!!
NursingSimplications:
MonitorSneurologicSstatus,Sseizure/fallSprecautions,SstrictSI/Os,SimplementSfl
uidSrestriction,SmonitorSlabs
Hypernatremia
Common:
, NUR 242 - Med surg Exam 2 Study Guide
S S S S S S S S
restlessnessSorSagitation,Sanorexia,SN/V,Sweakness,Slethargy,Sconfusion,
craveSwater
WorstScaseSscenario:
decreasedSLOC<Sseizures,ScomaS
Treatment:
fluidsSPO/IV,SwhatStypeS(initiallySisotonicSfluid,SincreaseSBP,SswitchSthenSto
hypotonicSfluidS(D5W)S(lessSsaltSmoreSwater!!!)
NursingSimplications
FrequentSv/s,SmonitorSneurologicSstatus,Sseizure/fallSprecautions,SstrictSi/os,
SassessSskin/mm,SoralScare,SmonitorSlabs
GiveSfluidsSifSdehydrationSpresentS
PotassiumSimbalances:SaffectSheart/muscles/GIStract
Hypokalemia
Common
CardiacSarrhythmias,SlegScrampsS(hallmark),SmuscleSweakness,SdecreasedSG
ISmotilityS(decreasedSBS,Sconstipation,Sn/v),SdecreasedSDTRs,SmuscleSweakness,Salkalosis
WorstScaseSscenario
LifeSthreateningScardiacSarrhythmias/cardiacSarrestS
HypokalemiaSmaySpotentiateSdigStoxicity***
Treatment
IncreaseSdietarySintakeSofSpotassium,SkSsupplementation,SGiveSIVSpota
ssiumSslowly!!!!S20mEq/hr
NursingSimplications
FrequentSV/s,ScardiacSmonitoring,SpatentSIV,SmonitorSlabsS(recheckSafterSsupp
lementation),SNEVERSGIVESPOTASSIUMSIVPSORSBOLUS!!!!!
VerySdangerousSRe
memberSsuction
S=SskeletalSmuscleSweakness,SU=SUSWAVE,SC=Sconstipation,ST=StoxicSeffectSofSdig,SI=S
irregularSpulse,So=SorthostaticShypotension,SN=numbness
Hyperkalemia
Common
CardiacSarrhythmias,SmuscleSweaknessS(whichSmaySleadStoSflaccidSpar
alysis),SincreasedSGISmotility,SdecreasedSDTR’s,Sacidosis
WorstScaseSscenario
LifeSthreateningScardiacSarrhythmias/ScardiacSarrestS
Treatment
PotassiumSrestrictedSdiet,SifScritical/symptomaticSwillSrequireSdrugStherapyS(
CBIGKD)SwhichSstandSfor:
C=Scalcium,SB=Sbicarb,SI=SInsulinS(regular,SIVSpush),SG=Sglucose,SK=Skus
ulateS(sodiumSpoly),SD=Sdialysis
NursingSimplications
CardiacSmonitoring,SfrequentSlabs,SVS,SmonitorSforShypoglycemiaSifSinsulin
IVPSgiven
CalciumSimbalances:SaffectSneurological/neuromuscularSsystemS(9-10.5)
S S S S S S S S
MedSsurgSexamS2SstudySguide
ChapS11
FluidScompartments
IntracellularS60%
ContainedSwithinStheScellSbodyS
AboutS25L
Veins,Sarteries,Scapillaries,Sheart,SetcS
ExtracellularS33%
MostSimportantSareaSofShomeostasis,SareaSoutsideSofScellsSDiv
idedSintoSintravascularSspaceSandSinterstitialSspaceSExtracellu
larSfluidSvolumeSisSaboutS15L
In-betweenStheScells
FluidSBalance
CloselySlinkedSto/affectedSbySelectrolyteSconcentrationsSFlu
idSintake
2.3-
3LSaSdaySFluidSloss
MinimumSurineSamountSneededStoSexcreteStoxicSwasteSproducts=S400-600
mL/day
InsensibleSwaterSloss-
throughSskin,Slungs,Sstool.SUsuallyS500StoS1LSaSdaySThisSincreasesSduringSaSfev
er,StachypneaSandSextremeSstress
FactsStoSremember
AnySfluidSimbalancesSthatSoccur=continuousSassessmentSofSUOPSUrin
eSoutput
DehydratedSpts,SCHF,SRF,SFluidSvolumeSdeficient,SandSfluidSvolumeSoverloadSIV
Sfluids,Sdiuretics
DailySweights
1LSofSwaterSweighsS2.2lb,SequalStoS1kg
WeightSchangeSofS1lb=SfluidSvolumeSchangeSofSaboutS500SmLSFl
uidSvolumeSdeficit:SDehydration
FluidSintake/retentionSdoesSnotSmeetSbodysSfluidSneeds;SresultsSinSfluidSvolumeSdeficitSAsses
sment
ThreadSandSincreasedSpulseSrate;SdecreasedSBP;Slethargy;SdecreasedSUOP;SdrySmuc
ousSmembranes;Sconstipation;Sthirst
IncreasedSH&HS(hemoconcentration),SBUN,Ssodium,SandSurineSspecificSgravityS
Causes-vomiting,Sdiarrhea,Sileostomy,Slaxatives,Sburns,Sfever,Sdiuretics,SGI
suctioning,SandSNPO
Interview/riskSfactors
InquireSaboutSrecentSdietaryShabitsS
UseSofSOTCSdiuretics
OutdoorSactivities
WeightSgainSandSweightSloss
WhoSatSrisk:Shemorrhage,Svomiting,Sdiaherra,SexcessiveSsweating,SNPO,SsustainedSburnSwou
nds,SGISsuction,SDiuretics,SuncontrolledSdiabetes,SPoorSintake
, NUR 242 - Med surg Exam 2 Study Guide
S S S S S S S S
FlatSneckSandShandSveins,SincreasedSRR,SskinStenting,StongueSwrinkles,Sdehydration,Sfever,SU
OPSconcentrated,
UrineSspecificSgravitySconcentratedS(theShigherStheSdryer)SB
UNSandSCreatinine
BUNSandSCreatinineSareSkidneySmarkersSandSareSsensitiveStoSdecreasedSbloodSflowSB
UNS(10-20)SandSCreatinineS(06-1.2)SriseSwhenSnitrogenousSwastesSareSfoundSinSthe
bloodSindicatingSkidneySimpairment
GFRS(>65)StypicallyShasSanSinverseSrelationshipS(increasedSBUNSandSCreatinineSwithSaSdecrea
sedSGFR)-SchronicSrenalSfailure
ElevationsScanSbeScausedSbySdehydrationSFlui
dSvolumeSoverload
Assessment
BoundingSandSincreaseSpulse;SelevatedSBP;Sdyspnea,ScracklesSonSlungSauscultation
;Sedema;SdecreasedSHematocritS(hemodilution),SdecreasedSserumSsodiumSandSurineSspecificSgravi
tyS(diluteSurine).SWeightSgainSisStheSbestSindicator
Causes-
SESRD,SCHF,SwaterSintoxication,SSIADH,ScorticosteroidStherapy,SandSrapidSfluidSreplacement
DrugStherapy
DiureticsS(loopSdiuretics)S
NutritionStherapy
FluidSrestrictionS(S1200Sml/day)S
SaltSrestriction
MonitoringSofSintakeSandSoutputS
DailySWeight!!!!
ESRD=SEndSstageSrenalSdisease
SIADH=SsyndromeSofSinappropriateSADH
Edema-
SwhileSstandingSankles,Sfeet,SwhileSlayingSdownSsacrum,SbackSExtreme
ScasesSitSwillSbeSeverywhere
ElectrolyteSimbalances:SetiologyS
Hyponatremia
DueStoSsodiumSloss,SwaterSgain,SorSinadequateSintake
SodiumSloss:Sdrugs;Sdiuretics,Santiconvulsants,SSSRIs,Santipsychotics,ScancerSmedsSHy
pernatremia
Dehydration,SexcessiveSNaSintakeS(sodiumSpolystyrene,SsodiumSbicarb,Srenal
issue)
Hypokalemia
NotSenoughSinStooSmuchSout,SdepletingSdrugs,SmedicalSconditionsSNotS
enoughSin:SinadequateSKSintake
TooSmuchSout:SGISfluidSlosses
DepletingSdrugs:Sdiuretics,Scorticosteroids,Sinsulin,SexcessiveSlaxativeSuse,
albuterol
BlackSlicorice-actsSlikeSaldosterone
Hyperkalemia
TooSmuchSintake,SbloodSproducts,Sdrugs,SnotSenoughSexcreted,ScrushSinjury
, NUR 242 - Med surg Exam 2 Study Guide
S S S S S S S S
TooSmuchSintake:SincreasedSdietarySintake,,SsaltSsubstitutes,Spotassium
supplements
DonatedSblood
Drugs:SKSsparingSdiuretics,SACESinhibitors,SARBs,SNSAIDsSNot
SenoughSexcreted:SrenalSfailureS(SlowSNa,SK,SproteinSdiet)SCrus
hSinjury:SintracellularSKSreleased
Hypocalcemia
InadequateSintake,Smalabsorption,ScalciumSloss,SothersSInade
quateSintake:ScalciumSandSvitaminSDS(sunlight)
Malabsorption:SpostSmenopausalSwomen,SdiseasesSthatSaffectStheSsmallSbowel,Sdrug
sS(anticonvulsants)
CalciumSloss:SloopSdiuretics
Others:SrenalSfailure,Shypoparathyroidism,SlowSmagnesium,SmultipleSbloodStransfusi
ons,Salkalosis,SlowSalbuminSlevels
Hypercalcemia
IncreasedSresorptionSfromStheSboneS
Hyperparathyroidism
Cancer
ThiazideSdiureticsS
Hypomagnesemia
PoorSintake,SpoorSGITSabsorption,SexcessiveSGITSloss,SexcessiveSurinarySlossesSP
oorSintake;Salcoholics,SpatientsSonSTPNSorSenteralSfeeding
PoorSabsorption:SIBD,SceliacSdisease
GITSloss:Sdiarrhea,SlaxativeSuse,SNGTSdrainageSUrina
rySloss:SdiureticsS(loopSandSthiazide)
Hypermagnesemia
ExcessiveSintake,SimpairedSexcretion
ExcessiveSintake:SmagnesiumScontainingSantacids/laxativesSIm
pairedSexcretion:SrenalSdysfunction
Rare
SodiumSimbalances:SaffectSCNSS
Hyponatremia
Common:Sheadache,Sirritability,Sdisorientation/confusion,Stired,SabdominalScrampin
g,SmuscleStwitching/weakness,ScraveSsalt
WorstScaseSscenarioS(criticalSlow):Spsychosis,Sseizures,Sataxia,SairwaySissuesSTreatme
nt
Mild:SfluidSrestrictionS(safest),SoralSsodiumSsupplementsS
Critical:ShypertonicS3%Ssaline ---- SLOWLY!!!
NursingSimplications:
MonitorSneurologicSstatus,Sseizure/fallSprecautions,SstrictSI/Os,SimplementSfl
uidSrestriction,SmonitorSlabs
Hypernatremia
Common:
, NUR 242 - Med surg Exam 2 Study Guide
S S S S S S S S
restlessnessSorSagitation,Sanorexia,SN/V,Sweakness,Slethargy,Sconfusion,
craveSwater
WorstScaseSscenario:
decreasedSLOC<Sseizures,ScomaS
Treatment:
fluidsSPO/IV,SwhatStypeS(initiallySisotonicSfluid,SincreaseSBP,SswitchSthenSto
hypotonicSfluidS(D5W)S(lessSsaltSmoreSwater!!!)
NursingSimplications
FrequentSv/s,SmonitorSneurologicSstatus,Sseizure/fallSprecautions,SstrictSi/os,
SassessSskin/mm,SoralScare,SmonitorSlabs
GiveSfluidsSifSdehydrationSpresentS
PotassiumSimbalances:SaffectSheart/muscles/GIStract
Hypokalemia
Common
CardiacSarrhythmias,SlegScrampsS(hallmark),SmuscleSweakness,SdecreasedSG
ISmotilityS(decreasedSBS,Sconstipation,Sn/v),SdecreasedSDTRs,SmuscleSweakness,Salkalosis
WorstScaseSscenario
LifeSthreateningScardiacSarrhythmias/cardiacSarrestS
HypokalemiaSmaySpotentiateSdigStoxicity***
Treatment
IncreaseSdietarySintakeSofSpotassium,SkSsupplementation,SGiveSIVSpota
ssiumSslowly!!!!S20mEq/hr
NursingSimplications
FrequentSV/s,ScardiacSmonitoring,SpatentSIV,SmonitorSlabsS(recheckSafterSsupp
lementation),SNEVERSGIVESPOTASSIUMSIVPSORSBOLUS!!!!!
VerySdangerousSRe
memberSsuction
S=SskeletalSmuscleSweakness,SU=SUSWAVE,SC=Sconstipation,ST=StoxicSeffectSofSdig,SI=S
irregularSpulse,So=SorthostaticShypotension,SN=numbness
Hyperkalemia
Common
CardiacSarrhythmias,SmuscleSweaknessS(whichSmaySleadStoSflaccidSpar
alysis),SincreasedSGISmotility,SdecreasedSDTR’s,Sacidosis
WorstScaseSscenario
LifeSthreateningScardiacSarrhythmias/ScardiacSarrestS
Treatment
PotassiumSrestrictedSdiet,SifScritical/symptomaticSwillSrequireSdrugStherapyS(
CBIGKD)SwhichSstandSfor:
C=Scalcium,SB=Sbicarb,SI=SInsulinS(regular,SIVSpush),SG=Sglucose,SK=Skus
ulateS(sodiumSpoly),SD=Sdialysis
NursingSimplications
CardiacSmonitoring,SfrequentSlabs,SVS,SmonitorSforShypoglycemiaSifSinsulin
IVPSgiven
CalciumSimbalances:SaffectSneurological/neuromuscularSsystemS(9-10.5)
