- CNF Exam 3 Review PDF

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My review sheets for the third exam. Look over the textbook and ATI too...

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Chapter 40: Fluids, Electrolytes, and AB Balance (# Qs). ATI chapters: Chapter 57 (fluid vol def/excess lab tests, expect find, risk fx, IV replace) Chapter 58 (e- imbalance, application exercise (5Q w rationale), learning scenarios (2 precaution of IV K+)

Two compartments of fluid in the body—Intracellular (ICF, 70%) and extracellular (ECF, 30%)  A healthy adult: Total body water is 50-60% of body weight  Infants: 77% is water  Gender and amt of fat cells affect water in body (women/obese have less body water) A hypertonic IV solution has a greater osmolarity, causing water to move out of the cells and to be drawn into the intravascular compartment causing the cell to shrink. Moves from IC to EC → If a pt is given a hypertonic IV solution would increase urinary output

Risk Fxs for Imbalances Acute/Chronic illnesses Burns Surgery Abn loss of. Body fluidTrauma Therapies disrupting fluid/eDeficit Fluid Vol IV fluids, food w high water content, daily weight, monitor urine and serum e-, urine SG, H&H, BUN Hypovolemia: Deficiency in amount of water and electrolytes in ECF with near-normal water/electrolyte proportions (isotonic) Dehydration: Decreased volume of water and electrolyte change (fluid loss due to diarrhea) Third-Space Fluid Shif: Fluid is where the body cannot use it- moves from intravascular – deficit in ECF volume- fluid is “trapped” in body spaces. Example- ascites (fluid in the peritoneal cavity) Note: Urinary output = at least 30 mL/hr

vSim Pt Rashid Ahmed Dehydration & Hypokalemia N&V, diarrhea, weakness, dizziness, weight loss, orthostatic BP readings, irregular HR (tachy) Excess Fluid Vol Fluid restrictions (1-2hrs, divided over all shift), diuretics, distended neck vein Hypervolemia: excessive retention of water and sodium in ECF Overhydration: above-normal amounts of water in extracellular spaces Edema: excessive ECF accumulates in tissue spaces Interstitial-to-plasma shif: movement of fluid from space surrounding cells to blood Parameters of Assessment Fluid intake/output. Daily weight. Lab studies (Serum e-, BUN, creatinine, urine specific gravity) Expected Outcomes Maintain approximate fluid intake/output (2,500 mL in/out over 3 days) Maintain urine specific gravity w/in normal range (1.003—1.035)

COPD (retain CO2), Renal Failure(e- imbalance), DM2 (hyperglycemia affects K+), HF

1kg = 1L

Patients: Excess (Mr. Parks)

Deficit (Jeremiah)

Imbalance (Grace)

1 ounce = 30 mL

Major Electrolytes Table 40-1 Sodium: Controls and regulates volume of body fluids Hyponatremia refers to deficit in ECF caused by a loss of Na+ or gain of water Potassium: Controls intracellular osmolality; electrical impulses Calcium: Nerve impulse, blood clotting, muscle contraction, B12 absorption Magnesium: Metabolism of carbs and proteins, vital actions involving enzymes Chloride: Maintains osmotic pressure in blood, produces hydrochloric acid Bicarbonate: Body’s primary buffer system Phosphate: Involved in important chemical rxs in the body, cell division, and hereditary traits

Fluid Imbalances electrolyte Na+ -natremia Fluid Alert

K+ -kalemia Heart Alert

Ca++ -calcemia Bone and Muscle Alert

Mg+ magnesemi a Full Body Alert

P+

Deficit (hypo-)

2.5 mEq/L Renal failure, excessive intake of antacids or laxatives S&S: weakness, loss of DTRs, resp depr IV of Calcium Gluconate (antidote for Mg OD) >4.5 mEq/L...