Nursing 1 Exam 1


Intracellular fluid

2/3 of body fluid
Most in skeletal muscle mass

Extracellular fluid

1/3 of the body fluid

Third spacing

-Fluid that is not useable for body composition
-Swelling all over body
-Peripheral edema
-They will appear to be gaining weight but hte fluid Is going to areas where there is lots of edema

Third spacing signs

-Decreased urine output with adequate fluid intake
-Burns, sepsis, bleeding
-Pitting and non pitting edema

Osmosis and osmolaity

Movement of water, sleeping on textbook and drools and sucks up the information from the textbook


Higher to lower concentration, kool aid into water


Lower to higher, kidneys

What is the best way to measure fluid intake and output

Daily weight

Urine Specific Gravity

Up when depleted
Down when overloaded


10-20mg, unreliable factor of kidney function, elevate in dehydration, increased protein, only time to decrease is protein malnutrition


0.6-1.4, not indicated by fluid status, best indication of renal function


Should take patients hemoglobin x3 and that is the hematocrit, hemoglobin (12)- hematocrit (32)

Volume depleted

Hemoglobin 12 - hematocrit 48%

Volume overload

Hemoglobin 12 -
Hematocrit 24%

ANP (atrial natriuretic peptide)

Secreted in response to excess blood volume in the heart, promotes salt and thus water excretion, normal level 20-77, determines CHF, anything greater than 200


secreted in volume depletion, holds onto fluid (synthetic= vasopressin)


Holds onto sodium and water and gets rid of potassium, fluid volume deprived


Stress response, holds onto sodium and water

Central venous pressure

2.6 mm

Hypovolemia Causes

Diarrhea, vomiting, fever, exercise, diuretics, blood loss, burns, third spacing

Hypovolemia Clinical Manifestations

Hypotension, tachycardia, decreased urine output, decreased CVP, weight loss unless third spacing

Hypotension medical management

IV fluids, oral intake, vasopressin, ADH, antibiotics and diarrheals

Hypervolemia causes

CHF, kidney disease, neuro causes, schizophrenia

Hypervolemia manifestations

JVD, weight gain, peripheral edema, decrease in hematocrit, hypertension, tachycardia, increase in CVP, pulmonary edema (Crackles/rales)

Hypervolemia medical management

Diuretics, nutritional therapy

Crystalloid solutions

-Cheap, readily available, contain water, electrolytes and sugar
-Isotonic, hypotonic, and hypertonic (relation of concentration to things in the solution)

Isotonic solutions

-Same concentration as plasma
-Same electrolytes as plasma
-Replaces intravascular
-Once vascular space is filled then it starts replacing intracellular
-Normal saline 0.9%

Normal Saline 0.9%

Trauma, losing lots of blood, can mix with blood, cold effects (have to warm this)

Lactated ringers

-Has calcium and potassium in it
-Never use because of its potassium content (renal failure)(hyperkalemia), cold can trigger coagulation, can develop DIC


-5% dextrose in water
-When hanging on the IV pole it is isotonic, and when it is transfused it is hypotonic
-Insulin pushes dextrose into cells
-Brain issues = no D5W (causes cerebral edema, increased ICP)


-Given when the cell is dehydrated (DKA)
Replace cellular fluid
-Provide free water to excrete body wastes
-0.45% sodium chloride
-Makes cells swell up
-Goes into cells
-Worsen intravascular depletion
-Leave vascular places and go to cells


-Dextrose 50%
-3 and 5% sodium chloride
-Critical care unit
-Frequent electrolyte checks
-Relieve cerebral edema
-Intravascular volume overload (brings everything to the intravascular space and out of cells)
-Pulmonary edema is biggest concer


-More expensive
-Plasma expander, replace plasma loss
-Effect clotting ability
-Increase cardiac output
-Stay in vascular system longer
-Blood and albumin

Blood administration

-Cross match
-Prime with normal saline
-Infused less than 4 hours
-Two licensed professionals approval
-Older the blood = higher potassium count

Blood reactions

-Allergic reaction
-Hemolytic reactions
-Be with patient for 30 mins

PICC lines and midline cath

-Longer IV access
-Own protocol
-long term antibiotics
-Need consent
-TPN, antibiotics

Air embolism

-Central lines are the biggest risk
-Turn then on their side, right side up, head down (Trendelenburg's)
-Keep air at the top of the heart
-Prevent from getting into pulmonary circulation

IV complecations

-Fluid overload
-Air embolism
-Febrile reaction

IV infiltration

-Pale, swollen, and cold
-Get the IV out and get another one started
-Elevate extremity
-Fluid is leaking out into interstitials space

IV infiltration (types of issues)

-Vesicants- necrose the tissue and cause blisters
-Chemo drugs, D-50, 3% and 5% NS, vasopressors, potassium, hypertonic solutions
-Reverse agent: hyaluronic acid


-Red, warm and swollen, infection in the vein, elevate extremity and get the IV out


-PICC line
-Central line
-Implanted infusion port

How do we measure CVP? (central venous pressure?

Fluid status in the right atrium


Puncture lung, air in the lung

Bleeding symptoms

-Tachycardic, hypotensive
-treat like fluid defecit

No lactated ringers in..?

Renal patients (has potassium in it and they can't excrete

Intracranial pressure


Burn patients

-Present as hypovolemia
-Look hypervolemic but are hypovolemic
-Low BP, urine output
-HR elevated


-Concern = brain
-Foods = cheese, lunchmeat, bologna, taco seasoning
-Brain = LOC, confused, weak, seizures, relative or absolute loss of sodium

Relative loss of sodium

Accompanied by fluid loss or gain

Absolute loss of sodium

Accompanied by a true sodium loss or gain

Hyponatremia Cause

-Less than 135
-Sweating, heat exposure wound drainage, diuretics, hypoaldosteronism

Hyponatremia symptoms

-Musculoskeletal weakness (respiratory system, decreased respiratory effort)
-Seizure, coma
-Headache, confusion, fatigue
-decreased deep tendon reflexes
-hyperactive bowel sounds
-CV changes depend on fluid status

How to fix hyponatremia

-Replace levels slowly
-Correct volume before sodium
-NS then do hypertonic saline
-Increase sodium intake


Sodium greater than 145
-Take in a lot of sodium
-TBI: increase sodium on purpose to suck water out of cells

Hyperatremia symptoms

-Extreme fatigue
-Confusion, and lack of energy
-Muscle twitching or spasms

Hypernatremia correction

-Go slow
-0.5mEq per hour
-Sodium wasting diuretics
-Aldosterone blocking meds
-Increase water intake


-Transmission of electrical impulses in the muscles
-Heart concerned with
-Heart is a muscle, the diaphragm, breathing is an issue
-Associated with renal failure

Hypokalemia interventions

-Cardiac monitor and watch for cardiac arrhythmias
-Caused by vomiting, diarrhea, loop, thiazide diuretics, cushing disease, decreased potassium intake, most related to IV insulin administration

Hypokalemia symtoms

-Everything slows down
-Slow cardiac arrhythmias, muscle weakness and cramps, irritability, confusion, drowsiness,weak pulse, orthostatic hypotension, increased risk for dig toxicity
-Flat T wave, prominent U wave

Never give potassium....


How to fix hypokalemia

-Eat watermelon
-10mEq in peripheral line
-20mEq in central line
-Will hurt when injected


-Renal failure
-Anything destroying the cell walls

Hyperkalemia symptoms

-Slow cardiac transmission
-Skeletal muscle weakness
-Respiratory distress
-QRS complex widens
-No P wave

Hyperkalemia treatments

-Medication (albuterol, bicarb, calcium gluconate, potassium wasting diuretics, dialysis)
-Diet (lots of no sodium stuff have potassium salt)


Normal level = 8-10
-Never not have enough
-When we take it out losing albumin and calcium
-Normally it just isn't where it should be
-Deal with the heart
-Cardiac monitor
-Clotting issues with calcium imbalances
-Parathyroid hormone regulates calcium lev

Hypocalcemia causes

Fix nutrition status with the hypocalcemia
-Albumin and calcium
-renal failure
-Vitamin D deficiency

Hypocalcemia symptoms

-Tetany (muscle twitching)
-Numbness and tingling
-Chvostek signs- tap on cheek and the eye twitches
-Trousseau signs- carpal pedal spasm (hand spasm)
-Decreased cardiac output- decreased HR and BP, weak pulse

Hypocalcemia management

-replaced calcium via IV or PO
-Can give IV push
-Dietary intake
-Decrease stimuli


-Maginancy (common oncology emergency)

Hypercalcemia causes

-Vitamin D toxicity
-Bone metastasis

Hypercalcemia symptoms

-muscle weakness
-decreased LOC
-Decreased HR
-EKG; short QT
-DVT because of coagulation
-GI decreased peristalsis

Hypercalcemia treatment

-Cardiac monitor


-Deal with the brain
-Imbalance = risk for seizures


-Hypokalemia as well (replace magnesium first)
-No absport potassium which is why we give mag 1st
-Give it slow (1g/hour)

Hypomagnesemia symptoms

Hyper-excitability with muscle weakness, tremors, generalized seizures, apathy, confusion, delirium, vertigo, aaxia, and coma, dysrhythmias, chvostek and trousseau signs
-DTR go up


-Pre term OB patients
-Loose deep tendon reflexes
-Loss of muscle contractions and breathing
-Can't grip hands
-rare - kidneys (good kidneys can regulate)
-DTR go down


2.5-4.5, inverse relationship with Ca


Accompanies sodium, direct relationship with sodium and potassium







respiratory acidosis

pH = less than 7.35
CO2 = greater than 45
BiCarb = can be whatever

respiratory acidosis causes

-Opioid overdose

respiratory acidosis interventions

-Pneumonia = bronchodilators
-Pulmonary edema = diuretics
-Opioid overdose = narcan
-COPD = bronchodilator

Metabolic acidosis

pH = less than 7.35
CO2= whatever
BiCarb = less than 22

Metabolic acidosis causes


Metabolic acidosis interventions

-Insulin and fluids
-IV fluids

Respiratory alkalosis

-pH = more than 7.45
-CO2 = less than 35
-BiCarb = whatever

Respiratory alkalosis symptoms


respiratory alkalosis interventions

Brown bag, can help reduce brain edema on a ventilator

Metabolic alkalosis

-pH = greater than 7.45
-CO2 = whatever
-BiCarb = more then 26

metabolic alkalosis causes

-Vomiting, NG drainage

Metabolic alkalosis intervention

-IV fluids

Compensation- complete

Complete is when the pH is back between 7.35-7.45

Compensation- partial

when the pH is not back in the normal range

Potassium and alkalosis

Low potassium

Potassium and acidosis

High potassium