NSG122 Exam 5 Blueprint

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Herzing University *

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Chemistry

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Jan 9, 2024

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Page 1 of 13 NSG 122 Fundamentals EXAM V Exam Blueprint Unit 13: Nursing Support of Fluid, Electrolyte, & Acid-Base Balance Topic: Location Fluid Loss: definitions and Types A. Sensible B. Insensible - Fluid is lost from both sensible and insensible A. Sensible losses can be measured and include fluid lost during urination, defecation, and wounds. B. Cannot be measured or seen and includes: - fluid lost from evaporation through the skin and - as water vapor from the lungs during respiration. NSG122.13.01.01. Fluid Intake: Regulation A. Hypothalamus- controls? B. Kidneys-controls? C. Metabolic Oxidation? A. Fluid intake is regulated by the thirst mechanism and the thirst control center is located w/in the hypothalamus. The thirst control center is stimulated by intracellular dehydration (the loss of deprivation of water from the body or tissues) and decreased blood volume. B. Fluid output/ approximately 1500 mL as urine from the kidneys C. Fluid intake approximately 300 mL from metabolic oxidation - Water is an end product of the oxidation that occurs during the metabolism of food substances, specifically carbs, fats, and protein NSG122.13.01.01 Fluid and Electrolyte: Regulation A. Adrenal Glands B. Pituitary Glands C. Thyroid glands A. Regulate blood volume and sodium and potassium balance by secreting aldosterone, a mineral corticoid secreted by the adrenal cortex, causing sodium retention (water retention) and potassium loss. - It helps the body CONSERVE sodium, save chloride and water, and EXCRETES potassium. B. Stores and releases ADH C. ↑ blood flow in the body and ↑ renal circulation NSG122.13.01.02. Body Fluid Compartments: Types A. Intracellular fluid (ICF) within cells B. Extracellular fluid (ECF) outside of cells - The body produces balance by shifting fluids and solutes between the ECF and the ICF. A. Shift of fluids and transporting materials to and from intracellular compartments include: - Organs and body systems: kidneys, Gi tract, nervous system, CV system, lungs, adrenal glands, pituitary glands, thyroid glands, parathyroid glands - Osmosis: water moving from an area of lesser concentration to an area of greater concentration. Osmosis stops when concentration is equalized on both sides of the membrane. - Diffusion: Solutes move from an area of higher concentration to an area of lower concentration until the concentration is equal on both sides. NSG122.13.01.03

Page 2 of 13 - Active transport: Solutes are moved/pumped from an area of lower concentration to an area of higher concentration. - Capillary filtration: Results from the force of blood pushing against the walls of the capillaries. Depends on both arterial and venous blood pressure. B. Includes: - Intravascular fluids- plasma - Interstitial fluids- surrounds tissue cells including lymph - Transcellular fluids-cerebrospinal, synovial, intraocular, pleural fluid, sweat, and digestive secretions - Infants have more ECF and are at ↑ risk for fluid volume deficits bc ECF is more easily lost from the body Fluid Volume: Signs and Symptoms: Deficit A. Intercellular B. Intracellular A. Hyponatremia/ hypernatremia B. Hypokalemia/hyperkalemia C. Hypocalcemia, hypercalcemia D. Hypomagnesia/ hypermagnesia E. Hypophosphatemia/ hyperphosphatemia F. Hypochloremia/ hyperchloremia NSG122.13.02.01 Fluid Volume: Excess A. Most Accurate Assessment of Fluid Volume? A. Fluid I/O- alert family and caregivers the need to measure all fluids entering and leaving the body B. daily weight – more accurately depicts fluid balance status. C. lab studies (CBC) D. physical assessment: skin and tongue turgor, edema, moisture, tearing, salivation, facial appearance, temp, VS ) - NSG122.13.02.01 Fluid Volume Deficit: Third Space fluid shift: Definition A. Definition B. Deficit in ECF occurs C. Becomes trapped in the body D. Causes: Burns, Sepsis, ect A. refers to a distributional shift of body fluids into the transcellular compartment such as the pleural peritoneal or pericardial areas, joint cavities, the bowel, or an excess accumulation of fluid in the interstitial space. B. W/ 3 rd space fluid shift a deficit in ECF volume occurs C. The fluid moves out of the intravascular spaces (plasma) to any of the transcellular compartment spaces where once they’re trapped, the fluid is not easily exchanged w/ ECF. - Fluid isn't lost but it is trapped in another body space for a period of time and is essentially unavailable for use. D. 3 rd Space Shift may occur as a result of a severe burn, bowel obstruction, surgical procedures, pancreatitis, ascites, or sepsis. NSG122.13.01.03 Diuretics A. Potassium sparing, loop, and thiazide NSG122.13.01.03

Page 3 of 13 A. Types B. What electrolytes to monitor B. Sodium, potassium, phosphate, and chloride Alcohol (ETOH) Withdrawal A. electrolyte imbalances B. Monitor? A. Hypomagnesia and hypophosphatemia B. Muscle weakness, tremors, tetany, seizures, heart block, change in mental status, hyperactive deep tendon reflexes and respiratory paralysis. NSG122.13.01.03 ABGs: Interpretation Values and Causes: Acidosis: Ph Value A. Normal ph B. Acidosis C. Alkalosis When normal pH is exceeded in either direction, death can occur A. In between 7.35-7.45 -7.4 is the optimal blood pH. B. Condition characterized by an excess of H ions or loss of base/bicarb ions in ECF - pH below 7.35 C. occurs when there’s a lack of H ions or a gain of base/ bicarb ions - pH above 7.45 NSG122.13.01.04 * ABGs: Compensation A. Metabolic buffers B. HCO3: meaning and normal value C. CO2: Meaning and normal value D. Metabolic problem- Respiratory system compensates— E. Respiratory system problem- Renal system compensates A. A substance that prevents body fluids from becoming overly acidic or alkaline. B. Reflects bicarb level of the body and normal value is 22- 26 C. Regulates carbonic acid and normal value is 35-45. D. Metabolic acidosis: the lungs attempt to ↑ CO2 excretion by ↑ the rate and depth of respirations which occurs within a short time. However, respiratory compensation is generally not adequate. Metabolic Alkalosis: The body attempts to compensate by retaining CO2. - Respirations become slow and shallow, and periods of no breathing may occur. E. Metabolic acidosis: Kidneys attempt to compensate by retaining bicarb and by excreting more hydrogen. Metabolic alkalosis. The kidneys attempt to excrete excess water and sodium ions with the excessive bicarb. And retain hydrogen ions. NSG122.13.01.04 ABG A. Which value/result on AG indicates Acidosis or alkalosis? A. ABG findings are obtained through analysis of an arterial blood sample. B. The pH of the plasma blood indicates balance or impending acidosis or alkalosis. C. The blood's O2 and CO2 gas values are also reported, providing info regarding the effectiveness of the respiratory system. NSG122.13.01.04 ABG Interpretation: A. Respiratory Acidosis B. Respiratory Alkalosis A. ↓ pH <7.35, ↑ CO2, Normal HCO3 B. ↑ pH >7.45, ↓ CO2, Normal HCO3 NSG122.13.01.04 Electrolytes: Sodium: Food choices and teaching A. Hypernatremia: B. Hyponatremia A. Avoid foods high in sodium such as processed chees, lunch meats, canned soups/veggies, salted snack foods and eliminate use of table salt. B. - NSG122.13.02.02

Page 4 of 13 Fluid Volume Assessment A. Assessment First B. Daily Volume C. Fluid preferences D. Offer fluids on a schedule A. – B. The care plan specifies the amount of fluid to be ingested in 24 hours C. Patients preference, choose or assist with choosing fluids that must provide the calories and electrolytes needed by the patient. If patients dislike taking fluids or for gelatin, popsicles, ice water or other alternative sources of liquid. D. Always have fluids readily available for the patient. Take care to avoid a situation in which patients are unable to secure their own fluids. Encourage the patient to participate in one's own care by helping to keep a record of intake. NSG122.13.02.02 Fluid Volume Assessment: A. Fluid Volume Deficit: Signs and Symptoms / Findings B. Fluid Volume Excess: Signs and Symptoms / Findings A. Change in mental status, ↑ body temp and HR, ↓ BP, ↓ skin turgor, dry oral mucosa, cracked lips, furrowed tongue, scanty dark urine, sudden weight loss r/t -inability to obtain or swallow fluids (oral pain and debilitation), extremes of age, vomiting, diarrhea, burns, excessive use of laxatives, excessive diaphoresis, fever. B. Pitting edema, shiny skin, up to 10lb weight gain, dyspena w/ exertion, feeling weak and fatigued, adventitious breath sounds, ↑ BP, r/t- renal failure, decreased cardiac output, Excessive IV infusion fluid intake, excessive sodium intake NSG122.13.02.01 Fluid Volume : Treatment A. Fluid Volume Deficit: Treatment B. Fluid Volume Excess: Treatment A. Increase foods w/ high water content, offering a variety of fluids B. Enemas, laxatives, antacids, OTC drugs, or herbal meds to promote urination NSG122.13.02.02 Electrolytes: Diet Modification A. Foods High and low in Sodium B. Foods high and low in Potassium A. High: processed cheese, lunch meats, canned soups and vegetables, salted snack foods B. High: bananas, citrus fruit, apricots, melons, broccoli, potatoes, raisins, lima beans NSG122. 13.02.02 Fluids: Types: when to use: Clinical examples A. Isotonic solution B. Hypertonic solution C. Hypotonic solutions A. Total osmolality close to that of ECF; replaces ECF B. Hypotonic to plasma; replaces ICF C. Hypertonic to plasma NSG122.13.02.03 Fluids: Types: Which type are they? A. Isotonic- 0.9% Normal Saline, Lactated Ringers A. Normal Saline- Not desirable as routine maintenance solution bc it provides only sodium and chloride, which are provided in excessive amounts -May be used to expand temporarily the extracellular compartment if circulatory insufficiency is a problem; NSG122.13.02.03

Page 5 of 13 B. Hypotonic- 0.45% Normal Saline; 0.33% Normal Saline (basic fluid for maintenance) C. Hypertonic- 10% Dextrose in Water; 5% Dextrose in 0.9% Normal Saline Also used to treat hypovolemia, metabolic alkalosis, mild hyponatremia, hypercalcemia. LR- Contains multiple electrolytes and about the same concentrations as found in plasma. Note that this solution is lacking in magnesium. B. 0.33% Sodium Chloride- Provides sodium chloride and free water. -Sodium and chloride allow kidneys to select and retain needed amounts. -Free water desirable as aid to kidneys and elimination of solutes. 0.45% Sodium chloride-a hypotonic solution that provides sodium and chloride and free water. Used as a basic fluid for maintenance needs. C. 5% dextrose in LR solution- Supplies fluid and calories to the body. Replaces electrolytes. Shifts fluid from the intracellular compartment into the intravascular space, expanding vascular volume. 5% dextrose and .9% Sodium chloride- Used to treat SIADH. Can temporarily be used to treat hypovolemia if plasma expander is not available. Selected IV Solutions and Uses: A. Isotonic: 9% Normal Saline • Uses? Lactated Ringers • Uses? B. Hyportonic • Uses? C. Hypertonic 5% dextrose in 0.9% Normal Saline D. • Uses? A. Normal saline- Used with admin of blood transfusions. LR- Using the treatment of hypovolemia, burns and fluid loss from GI sources. B. 0.33% Sodium chloride- Used in treating hypernatremia. 0.45% normal saline- Used as a basic fluid for maintenance needs. Often used to treat hypernatremia because the solution contains a small amount of sodium, it dilutes the plasma sodium while not allowing it to drop too rapidly. C. 5% dextrose in LR solution- Replaces electrolytes. Shifts fluid from the intracellular compartment into the intravascular space, expanding vascular volume. 5% dextrose and 9% sodium chloride- Used to treat SIADH. Can temporarily be used to treat hypovolemia if plasma expander is not available. NSG122.13.02 Fluid Volume Replacement A. Which Solution? Maintenance Fluid A. Which Solution? A. Isotonic, Hypotonic, Hypertonic B. 0.45% NaCl (1/2 strength normal saline) Central Venous Access: Port A. Long term B. Where located? C. X ray needed before use A. A long term CVAD is an implanted port which consists of a subq injection port attached to a catheter. B. The distal catheter tip dwells in the lower segment of the superior vena cava at or near the cavoatrial junction (CAJ), the point at which the superior vena cava meets and melds into the superior wall of the right atrium, and NSG122.13.02.03

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