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UT MEDSurge
Study guide for Exam III
| Question | Answer |
|---|---|
| Describe the composition of the major body fluid compartments. | Intracellular - all fluid within a cell and Extracellular - All fluid outside of a cell and transcellular. |
| What is extracellular fluid? | Intravascular (inside the blood vessels), Interstitial (in spaes between cells |
| What are the percentages of the fluid compartments? | Plasma - 5%, interstitial, 15% and Intracellular - 40% |
| what is intracellular fluid? | located within cells and accounts for 40% of body weight. |
| What is transcellular? | Part of ECF. fluid in cerebrospianl, GI Tract, pleural spaces, synovial spaces, peritoneal spaces. |
| What are Electrolytes? | Substances that dissociate into ions when placed in water? |
| What is the prevalant cation in the ICF | Potassium |
| What is the prevalent anion in the ICF? | phosphate |
| what is the prevalent cation in the ECF? | Sodium |
| What is the prevalent anion in the ECF? | Chloride |
| What are the mechanisms that control fluid and electrolyte movement? | Diffusion, facilitated diffusion, Active transport, osmosis, hydrostatic pressure, oncotic pressure |
| What is diffusion? | The movement of solutes from high concentration to low concentration through a semipermeable membrane. |
| What is facilitated diffusion? | Diffusion that utilizes a specific carrier molecule to accelerate diffusion. No energy is required. |
| What is active transport? | Process where molecules move from low concentration to high concentration - Sodium potassium pump keeps sodium out and potassium in, against the concentration force. Energy is required. |
| What energy is used in active transport? | ATP |
| What is osmosis? | The movement of water from lower solute concentrations to high solute concentrations. It requires no energy. |
| What is Osmotic pressure? | The amount of pressure required to stop the osmotic flow of water (determined by solute concentration) |
| what is hydrostatic pressure? | The force within a fluid compartment. (this is the force that will push fluid out of the vascular bed at the capillary level. |
| What is oncotic pressure? | It is the osmotic pressure exerted by colloids in solution. (Protein is the major colloid) |
| What are the primary causes of hypovolemia? | diarrhea, fistula drainage, hemorrhage, inadequate fluid intake, fluid shifts |
| What are some manifestations of hypovolemia? | increased solutes - hgb, HCT, serum osmolarity, specific gravity, sodium, BUN, creatinine. Hyperthermia, tachycardia, hypotension, dizziness, syncope, weakness, confusion, dry mucosa, weight loss, oliguria, cool clammy skin, flat neck veins, sunken eyeba |
| Nursing diagnoses for hypovolemia. | decreased cardiac output (no fluid to allow circlulation), ineffective tissue perfusion, deficient fluid volume, risk for injury, potential complication: hypovolemic shock |
| What are nursing interventions for hypovolemia? | I&O, shock position, vital signs, respiratory status, daily weights, skin assessment, fluid replacement, treatment of underlying causes, monitor level of concsiousness, maintain safety. |
| sodium? | Monitor osmolarity ( sodium is the primary determinant of ECF osmolarity) ECF volume excess Seizure precautions and management Life support interventions |
| What are the nursing implications for the administration of potassium | Monitor for hypoxemia and hypercapnia Intubation and mechanical ventilation by be required Perform continuous cardiac monitoring Treat life-threatening dysrhythmias |
| What are the nursing implications for the administration of calcium | Seizure precautions Emergency equipment on stand by Monitor respiratory |
| What are the nursing implications for the administration of phsophate | Frequent monitoring of phosphate levels is necessary for IV therapy Sudden symptomatic hypocalcemia, secondary to increased calcium phosphorus binding, is a potential complication of IV phosphorus administration |
| What are the nursing implications for the administration of magnessium | Too rapid aministration of magnesium can lead to cardiac or respiratory arrest |
| What diagnostic tests are used to identify fluid and electrolyte imbalances? | o Skin Turgor Cold, clammy skin Pitting edema Flushed dry skino Pulse Changes in pulseo Blood pressure Hypertension, or hypotensiono Respirationso Skeletal muscles Cramping Positive chvostek’s signo Behavoiral or mental state Picking at bedclothe |
| What is isotonic fluid? | o O.9%o Osmo- 308o Used to expand intravascular volume and replace extracellular fluid losseso Only solution that may be administered with blood productso Contains sodium and chloride in excess of plasma levelso Doesn’t provide free water, calories, other |
| What is hypotonic fluid? | o 0.45%o Osmo- 154o Provides free water in addition to sodium and chlorideo Used to replace hypotonic fluid losseso Used as maintenance solution, although it does not replace daily losses of other electrolyteso Provides no calorieso Have the potential to |
| What is hypertonic fluid? | o 3.0%o Osmo- 1026o Used to treat symptomatic hyponatremiao Must be administered slowly with extreme caution because it may cause dangerous intravascular volume overload and pulmonary edemao Initially raises the osmolality of ECF and expands ito Require f |
| What is the action of a diuretic? | Causes body to decrease fluid volume through urination. The goal is to lower BP. |
| What is a loop diuretic? | Inhibit NaCl reabsorption in the thick ascending limb of the loop of henle. Increase excretion of sodium and chloride More potent diuretic effect than thiazides, but shorter duration of action Less effective for hypertension |
| What is a Thiazide diuretic? | Inhibit NaCl reabsorption in the distal convoluted tubule Increase ecretion of sodium and chloride Intial decrease in ECF; sustained decrease in SVR Lower BP moderately in 2-4 weeks |
| What is a potassium sparing diuretic? | Reduce Potassium and sodium exchange in the distal and collecting tubules Reduce excretion of potassium, hydrogen, Calcium, and Magnesium |
| What are some primary causes of hypervolemia? | i. excessive isotonic or hypotonic IV fluidsii. heart failureiii. renal failureiv. primary polydipsiav. SIADHvi. Cushing syndromevii. Long-term use of corticosteroids |
| What are some manifestations of hypervolemia? | i. Headaches, confusion, lethargyii. Peripheral edemaiii. Distended neck veinsiv. Bounding pulse, ↑ BP, ↑ CVPv. Polyuria (w/ normal renal function)vi. Dyspnea, crackles (rales), pulmonary edemavii. Muscle spasmsviii. Weight gainix. Seizures, coma |
| Nursing diagnoses for hypervolemia. | 1. Excess fluid volume r/t ↑ water and/or sodium retention2. Impaired gas exchange r/t water retention leading to pulmonary edema3. Risk for impaired skin integrity r/t edema4. Disturbed body image r/t altered body appearance secondary to edema5. Potentia |
| What implications are there for treatment of hypervolemia? | I&O, monitor cardiovascular changes, vital signs, assess breath sounds and monitor changes, daily weights, skin assessment, neurologic assessment, Semi-Fowler’s position, administer oxygen, reduce IV flow rates, administer diuretics, limit fluid and sodiu |
| Describe the prevalence and incidence of diabetes mellitus (DM). | DM: A chronic multisystem disease related to either abnormal insulin production (type 1) or impaired insulin utilization (type 2)-or both Leading cause of: end-stage renal disease, adult blindness, non-traumatic lower limb amputationsMajor contributing |
| What are the major organs affected by the lack of tight glucose control and how are they affected negatively? | Continued elevated glucose levels cause damage to the small blood vessels & large arteriesAngiopathy-Macrovascular complications: coronary heart disease, peripheral vascular disease, and stroke **tight glucose control may delay atherosclerotic process** P |
| Nephropathy: | • single leading cause of end stage renal disease• microvascular complication: the glomeruli’s (filtering units of kidney) function to filter blood becomes compromised.• Microalbuminuria: earliest indicator of diabetic nephropathy |
| Neuropathy: | • microvascular complication • 60% to 70% of patients with diabetes have some degree of neuropathy• Nerve damage due to metabolic derangements of diabetes• Sensory versus autonomic neuropathy |
| Sensory neuropathy | • Distal symmetric Most common form Affects hands and/or feet bilaterally Characteristics include: loss of sensation, abnormal sensations, pain, and paresthesias • Foot injury and ulcerations can occur without the patient having pain• Can cause atrop |
| Autonomic neuropathy | • Can affect nearly all body systems• Complications Gastroparesis: delayed gastric emptying Cardiovascular abnormalities Sexual function Neurogenic bladder |
| Retinopathy: | • found in both type 1 & 2 DM• common cause of blindness among adults 20-74• nourishment of the blood vessels of the retina is severely compromised triggering growth of new extremely fragile blood vessels – microvascular complication = growth, swelling an |
| Compare the pathophysiology, risk factors, manifestations & complications of type 1 & type 2 diabetes. TYPE 1 Diabetes Mellitus | Type I accounts for 10% of all diabetes (used to be called juvenile diabetes)• Pancreatic atrophy & specific loss of beta cells• Autoimmune à cell-mediated destruction of the beta cells• Lack of insulin production or production of defective insulin **Affe |
| 80-90% of function of the insulin secreting beta cells must be lost before you start seeing the hyperglycemia. | • Other clinical manifestations include the glycosuria in which glucose appears in the urine as the renal threshold for glucose is exceeded à gives an osmotic diuresis à polydipsia & polyuria • Because of lack of insulin àprotein & fat occur resulting in |
| TYPE 2 Diabetes Mellitus | Type 2 à much more common than type 1 • Formerly known as “juvenile onset” or “insulin dependent” diabetes• Most often occurs in people under 30 years of age• Peak onset between ages 11 and 13 • onset occurs at least 7 yrs before its diagnosis (50% of cas |
Created by:
mpabner
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