Test 2

Question 1

What is “Third Spacing”?

Answer 1

Loss of extracellular fluid into space that doesn’t contribute to equilibrium. It isn’t increasing blood volume, or carrying nutrients or oxygen, or doing anything useful, just hanging out in the tissues outside of the cells.

Question 2

The difference between osmosis and diffusion is what? How do they both differ from the sodium/potassium pump?

Answer 2

Osmosis is the movement of water across a membrane, diffusion is the movement of stuff across the membrane, and the Na/K pump uses ATP while the other two don’t.

Question 3

How do people lose fluids and electrolytes?

How do they gain them?

Answer 3

LOSS:
Kidneys- pee everything out
Skin- sweat/burns
Lungs - respiration (300ml /day with increased rr)
GI - large losses due to diarrhea
Heart - increases blood flow to kidneys

GAIN:
Drinking and eating

Question 4

What is average healthy urine output?

Answer 4

60ml/hr

Question 5

If Na is high, do we make more or less ADH? If it’s low? Why?

Answer 5

If Na is high we want to dilute it, so we make more ANTIdiuretic Hormone to hold on to the water. If it’s low, we make less so that we don’t further dilute it.

Question 6

What is the importance of the RAAS?

Answer 6

Renin-Angiotensin-Aldosterone System:Primary way we balance our bp. It is a chain of chemicals released to help body increase BP & blood volume (vasoconstriction, sodium/water retention)

Question 7

What are gerontological considerations regarding fluid homeostasis?

Answer 7

Kidney don’t work as well, hold on to the K, don’t release Na

Skin turgor is no longer as reliable an indicator of dehydration.

Fluid deficit actually causes delirium

They don’t want to pee, so they don’t drink

Question 8

What is the difference between fluid volume deficit and dehydration?

Answer 8

FVD you lose everything- all the fluid and the electrolytes therein. Dehydration, you lose the fluid, keep the electrolytes.

Question 9

The Three Major kinds of shock are :
One has subsets, what are they?

Answer 9

Shock is literally your body’s response to cells not getting what they need to function-

That happens 3 ways:

Hypovolemic shock- there is no blood to move to cells

Cardiogenic shock - there is no working pump to move the blood

Distributive Shock - The heart is pumping, and there exists enough blood, but there is a hitch in the get along. Hitches are : Sepsis, Neurogenic, and Anaphylactic

Question 10

What is the only thing that can go in the same line as blood?

Answer 10

Normal Saline

Question 11

What are the symptoms of FVE?

Answer 11

1 Edema/weight gain
2 Distended neck veins /bounding pulses
3 Crackles
4 Increased RR and Urine output as the body tries to pee it out and breathe it off

Question 12

What’s the classic sign of fluid volume deficit?

Answer 12

Orthostatic hypotension

Question 13

What are the symptoms of FVD?

Answer 13

1) Orthostatic Hypotension
2) Weight loss
3) Decreased skin turgor
4) Thirst
5) Oliguria and cool skin as your body vasoconstricts to keep fluid central
6) Fatigue/weakness/cramps

Question 14

What is nursing management of FVD?

Answer 14

I&O at least every 8 hours, sometimes hourly​

Daily weight​

Vital signs closely monitored​

Skin and tongue turgor, mucosa, urine output, mental status​

Measures to minimize fluid loss​

Administration of oral fluids​

Administration of parenteral fluids​

​

Question 15

What is nursing management of FVE?

Answer 15

I&O and daily weights; assess lung sounds (crackles), edema, other symptoms; monitor responses to medications i.e. diuretics​

Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions​

Monitor, avoid sources of excessive sodium, including medications ​

Promote rest ​

Semi-Fowler’s position​ for orthopnea​

Skin care, positioning/turning​

Question 16

How does medical management of FVE differ from FVD?

Answer 16

FVE means diuretics, Na restrictions and possibly diallysis, FVD is basically fluid replacement.

Question 17

What is the definition of hyponatremia? What does it look like? Why does that make sense?

Answer 17

Def: Na < 135

It looks like dehydration, which makes sense because where Na goes, H2O goes, and the Na isn’t here.

Symptoms: headache, confusion/neuro probs, poor skin turgor, dry mouth, drop in BP, nausea, abd cramping

Question 18

How does hyponatremia usually occur in the hospital?

Answer 18

Over hydration of surgical patient

Question 19

What organ is most affected by Na imbalance? Different question, What should you think of when you think of Na?

Answer 19

The brain. Too high or low and people start acting real weird.

Think water when you think Na.

Question 20

How is hyponatremia treated?

Answer 20

Treat underlying condition

Water RESTRICTION - it looks like dehydration but isn’t- we don’t want to dilute the blood any more

Same as fluid imbalances- daily wieght, Is&Os, watch labs, CNS changes

Replace Na

Possible ADH receptor antagonists (pee more)

Watch for Li intoxication if patient is on lithium and has low Na, also diuretics can cause hyponatremia, so double check orders

Question 21

What is the definition of hypernatremia? What does it look like?

Answer 21

Na > 145

Also looks like dehydration which also makes sense because there is elevated Na in dehydration

Hypo is cool because vasoconstriction, Hyper is elevated temperature,

SWOLLEN dry tongue, sticky mucus membranes, lethargy, restlessnes SEIZURES, N/V/A -

Looks a lot like low Na - High has seizures, elevated temps, and swollen tongue that Low doesn’t have.

Pts in both cases are confused and generally ADR

Question 21

Neurogenic shock looks like what?

Answer 21

Activation of the parasympathetic nervous system.

LOW hr, low bp, dry warm skin

Question 22

Mnemonic for hyPERcalemia:

Answer 22

Stones, bones, groans, thrones, and moans

The mnemonic painful bones (abnormal bone remodeling), renal stones (kidney stones from hypercalciuria), abdominal groans (hypercalcemia-induced ileus and abdominal pain), thrones (urinary frequency), and psychic moans (depression) can be used to recall the common symptoms of hypercalcemia

Question 23

Mnemonic for hyPERkalemia

Answer 23

MURDER
Muscle weakness
Urine: oliguria, anuria
Respiratory distress
Decreased cardiac contractility
EKG changes: peaked T waves; QRS widening
Reflexes: hyperreflexia or areflexia (flaccid)

Question 24

How do you treat IV infiltration?

Answer 24

*Stop iv

*Replace iv, can use proximal site on same limb

*Warm compress and elevation if happened for a long time or isotonic and neutral pH

*Cold compress if recent, caustic, or hypertonic

Question 25

How is treatment of extravasation different from infiltration?

Answer 25

*Stop infusion
*Call Doctor
*Follow protocol
*New IV in other limb
*Do neurovascular assessments of affected limb

Question 26

What do you do if your IV site gets thrombophlebitis?

Answer 26

*Stop infusion
*Cold compress, then warm compress
*Elevate limb
*New IV in new limb
*If no pus- clean skin with alcohol, then culture catheter

If pus, culture pus, then clean skin

Question 27

What is the difference between endocrine and exocrine glands?

Answer 27

Endocrine release hormones into the blood stream. Exocrine release things onto the skin or into the GI tract

Question 27

What are the glands of the endocrine system?

Answer 27

pituitary, pineal, thryoid, parathyrois, adrenal, pancreatic islets, ovaries and testes

Question 27

What is pheochromocytoma?

Answer 27

A tumor on the adrenal gland that secretes catecholamines, like epi, norepi and dopamine.

Question 28

What is the specific gravity of urine of someone with DI?
What is the diagnostic test for DI? When do you stop the test?

Answer 28

1.001 - 1.005

Withhold fluids and see if the osmoloality of the urine goes up. In regular dehydration it will, in DI, you keep dumping.

The test stops when you lose 3-5% of your body weight, you get tachycardic or hypotensive.