MedSurg II Test 1

• increases insensible water loss or perspiration (fever, heatstroke)
• osmotic diurese
• hemorrhage
• GI losses
• diuretics
• Inadequate intake
• Third spacing - burns, intestinal obstruction

• Restlessness, drowsiness, lethargy, confusion
• Thirst, dry mucous membranes
• Decreased turgor/cap refill
• Postural hypotension, increased pulse
• decreased urine output, concentrated urine
• increased respiratory rate
• Weakness, dizziness
• Weight loss
• Seizures, coma

• Excessive isotonic or hypotonic fluids
• Heart or renal failure
• Primary polydipsia
• SIADH
• Cushing syndrome
• Long-term use of corticosteroids

• H/a, confusion, lethargy
• Peripheral edema
• JVD
• Bounding pulse
• Polyuria (with normal renal function)
• Dyspnea, crackles (rales), pulmonary edema
• Muscle spasms
• Weight gain
• Seizures, coma

More water than electrolytes, dilute ECF causing osmotic movement of water to ICF. Montifor for changes in mentation due to potential for cerebral edema from cellular swelling.

0.45% Saline, D5%

Draws water out of cells and into ECF, used for hypovolemic shock and hypontaremia. Monitor bp, lung sounds, serum sodium. Risk for volume excess.

D10%, 3.0% saline, D5 1/2, D5NS

Expands only ECF, ideal fluid for patient with ECF volume defecit. LR contraindicated in hyperkalmia and lactic acidosis due to inability to convert lactate to bicarbonate.

LR, NS, D5% in 0.225%, Ringer's,.

• Excessive sodium intake
• -hypertonic tube feeding w/o water
• Inadequate water intake
• Excessive water loss
• -heatstroke, fever, prolonged hyperventilation, osmotic -diuretic therapy, diarrhea.
• Disease states:
• diabetes insipidus, primary hyperaldosteronism, cushing syndrome, uncontrolled DM

• restlessness, agitation, twitching, seizures, coma
• intense thirst, dry and swollen tongue, sticky mucous membrane
• postural hypotension, weight loss
• weakness, lethargy

• Restlessness, agitation, twitching, seizurse, coma
• Intense thirst, flushed skin
• Weight gain, peripheral and pulmonary edema, increased BP and CVP

• Exessive sodium loss
• -GI losses - v/d, fistulas, NG suction
• -Renal losses, diuretics, adrenal insufficiency, Na+ wasting renal disease
• -Skin losses,, burns, wound drainage
• Inadequte intake
• Excessive water gain
• Disease states: SIADH, heart failure, primary hypoaldosteronism.

• Irritability, apprehension, confusion, dizziness, personality change, tremors, seizures, coma
• Dry mucous membranes
• Postural hypotension, tachycardia, thready pulse
• Cold and clammy skin

H/a, apathy, confusion, muscle spasms, seizures, coma, n/v/d, abd cramps, with gain, increased BP and CVP

Most common is renal failure

Common with massive cell destruction: burns or crush injuries.

• Excess potassium intake
• Shift of K out of cells by acidosis, tissue catabolism (fever, sepsis, burns)
• Crush injuries
• Tumor lysis syndrome
• ACE inhibitors

• Irritabilyt, anxiety, abd crmaping, diarrhea, weakness in LE, parasthesias, irregular pulse.
• Cardiac arrest if hyperkalemia is sudden or severe.

• Tall, peaked T wave
• Porlonged PR interval
• ST segment depression
• Loss of P wave
• Widening QRS
• V-fib
• Ventricular standstill

• GI losses, renal losses, skin losses, dialysis
• Shift of K into cells thourh increased insulin, alkalosis, tissue repair, increased epinephrine (stress)
• Lack of intake

Fatigue, muscle weakness, leg cramps, n/v, paralyti ileus, soft/flabby muscles, paraesthesias, decreased reflexes, weak/irregular pulse, polyuria, hyperglycemia

ST segment depression, flattened T wave, presence of U wave, ventricular dysrhythmias (PVC's), bradycardia, enhanced digitalis effect.

Multiple myeloma, malignancies with bone metastasis, prolonged immobilization, hyperparathyroidism, Viamin D overdose, thiazide diuretics, milk-alkali sydrome.

Increased ionized calcium from acidosis.

Lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, psychosis, anorexia, n/v, bone pain, fractures, polyuria, dehydration, nephrolithiasis, stupor, coma.

Shortened ST segment, shortened QT interval, ventricular dysrhythmias, increased digitalis effect

Kidney disease, elevated phosphorus, primary hypoparathyroidism, vitamin D deficiency, magnesium deficiency, acute pancreatitis, loop diuretics, chronic alcoholism, diarrhea, low serum albumin (asymptomatic due to normal inoized CA+ level)

Decreased ionized calcium from alkalosis or excess adminstration of citrated blood.

East fatigability, depression, anxiety, confusion, numbness, tingling, hyperreflexia, muscle cramps, Chvostek's sign, Trouseaus's sign, laryngeal spams, tetany, seizures.

Elongation of ST segment, prolonged QT interval, Ventricular tachycardia.

135-145 mEq/L

3-5.5 mEq/L

98-107 mEq/L

8.5-10 mg/dL

70-110 mg/dL

6-20 mg/dL

1.6-2.6 mEq/L

6-8 g/dL

3.4-5 g/dL

1.010-1.035

Systolic dysfunction: heart no pumps

Diastolic dysfunction: heart no fills

Dysrythmias, structural problems (valvular stenosis or regurgitation, ventricular septal rupture, tensions pneumo).