NRS 312 Study Guide - Spring 2018, Comprehensive Midterm Notes - Urine, Edema, Constipation
NRS 312
MIDTERM EXAM
STUDY GUIDE
Fall 2018
Fluid and Electrolyte Balance- Lecture Part 1
• 1st space:
o Intracellular: where fluid in our cells should be (70%)
• 2nd space
o Interstitial (22%) + intravascular (6%): where we see edema. Commonly see this in the
lower extremities, arms, face. We are concerned about fluid in the lungs.
o We want to first assess the lungs. This is our primary concern.
• 3rd space
o Fluid trapped in an abnormal space
o Common in the peritoneal cavity that results in the ascities
• Important electrolytes
o Sodium (Na+): (ECF) primarily an extracellular cation, plays a role in cell action
potentials and water balance. 135-145 mEq/L
o Potassium (K+): (ICF) primarily intracellular cation. Important role in cell actions
potentials for transmission of nerve impulses, cardiac myocyte contractility, and skeletal
muscle function. 3.5-5.0 mEq/L
o Calcium (Ca++): 90% in bones, 10% ECF. Healthy bones and teeth, promotes
coagulation factors, plays a role in cell action potentials for nerve conduction,
cardiomyoctye contractility, and skeletal muscle. Total calcium 8.4 – 10.5 mg/dL
o Magnesium (Mg2+): Provides the energy source for the sodium – potassium pump
(necessary for nerve impulse conduction) 1.5-2.5 mEq/L
o Bicarbonate (HCO3-): Both ECF and ICF. Major base buffer, essential for acid-base
balance to maintain pH 7.35 to 7.45.
o Chloride (Cl-): Major ECF anion. Nerve conduction role again, also important in
digestion. 95-105 mEq/L
• First spacing
o Patho repeat
• Different organs involved and hormones for volume regulation
o Pituitary
▪ Body knows when to secrete ADH when you have a low MAP but more
specifically a high concentration (high HCT and high Specific gravity). Reabsorb
more water and do not secrete urine. Blood serum concentration tell kidneys to
hold on to water
o Thyroid hormone
▪ Helps to regulate cardiac output (fluid being sent throughout the body)
▪ If we have a problem: hypothyroid= low cardiac output.
o Adrenal glands
▪ Regulation of electrolytes. Enhance sodium retention and K+ excretion.
o Kidneys
▪ Responds to low MAP. Secrete Renin and start the RAAS system.
o Atrial natriuretic peptides
▪ Found in heart in response to increased aerial pressure. Overstretched atrium
wants less volume.
find more resources at oneclass.com
find more resources at oneclass.com
▪ Senses excess preload
▪ Suppresses Aldosterone secretion. Suppresses ADH
▪ Promotes water loss and sodium excretion.
Assessing fluid balance
• FVE: fluid volume excess
• FVD: fluid volume deficit.
• Subjective assessment:
o Intake: too much or too little
o Urinary output
o Bowel output: do they have loose stool, diarrhea
o Nausea/vomiting
o Energy level
o Weakness/dizziness
o Recent activities ( illness, endurance rate, heat exposure)
▪ Concerned about dehydration. Severely affect anybody.
• Objective data assessment
o LOC-mental status changes?
o Vital signs: tell us if they have excess fluid or not
o Repertory status: rapid breathing with fluid deficiency
▪ Crackles in the lungs with excess
o Cardiac/peripheral deficiency: warmth color cap refill as well as heart rate and listening
to hear sounds
o Skin
o Weight: fluid volume excess. Should be weighed at the same time, same scale, same
clothes. FVE R/T heart failure
o I/O: objective part
• Sensible and insensible I/O
o Sensible: that can be measured. Most common in health care setting. Look at IV bag and
amount given per hour. Also measure how much is in a cup or how much is in a boost
that a person is taking. Jello is considered an intake.
▪ Clear and full liquid would be considered. Maybe soups?
▪ Suctioning tools.
▪ Weighing diapers or linens that are soiled
o Insensible: a’t e easured y oral eas. Perpetratio reathig
• Fluid balance- Sensible/ insensible examples
o It’s difficult to measure how much liquids are in solid foods so we do not measure
this=insensible.
o We so measure oral fluids. Measure oxidative metabolism and intake=insensible
o We can measure fluid output from the kidneys
o Sweat or perspiration: insensible unless it is weighing sheets of the patients
o Fluid loss from the lungs: moisture we breath out is insensible fluid loss.
o GI/ stool: yes if possible.
• Calculating %weight loss or gain
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Fluid and electrolyte balance- lecture part 1: 1st space: Intracellular: where fluid in our cells should be (70%: 2nd space. Interstitial (22%) + intravascular (6%): where we see edema. This is our primary concern: 3rd space, fluid trapped in an abnormal space, common in the peritoneal cavity that results in the ascities. Important electrolytes: sodium (na+): (ecf) primarily an extracellular cation, plays a role in cell action potentials and water balance. Assessing fluid balance: fve: fluid volume excess, fvd: fluid volume deficit, subjective assessment: Intake: too much or too little: urinary output, bowel output: do they have loose stool, diarrhea, nausea/vomiting, energy level, weakness/dizziness, recent activities ( illness, endurance rate, heat exposure, concerned about dehydration. I/o: objective part: sensible and insensible i/o, sensible: that can be measured. Maybe soups: suctioning tools, weighing diapers or linens that are soiled. Insensible: (cid:272)a(cid:374)"t (cid:271)e (cid:373)easured (cid:271)y (cid:374)or(cid:373)al (cid:373)ea(cid:374)s. perpetratio(cid:374) (cid:271)reathi(cid:374)g: fluid balance- sensible/ insensible examples.
