CHAPTER 6

Fluid imbalances-elderly are at the highest risk.

Dehydration s/s (need 30ml/kg)
Thirst (1st sign)
Rapid weak pulse
Low BP
Dry skin, mucous membranes, decreased tears
temp, poor skin turgor
Urine output less than 30ml qh
Weight loss
Elevated BUN20, hematocrit 40-54w 36-48m, specific gravity 1.002-
1.003

Isotonic fluid replacement

Fluid excess s/s

Opposite of dehydration
Edema, crackles in lungs, distended jugular veins, *CHF*

Get rid of the fluid, O2 therapy, bed, restrict sodium (remember dont
use fake salt)
*daily weights* best indicator

Electrolytes- Patients should be checked for electrolyte imbalance

when there is a
change in mental status or muscle function.

Sodium-hyponatremia; less than 135 disorientation, confusion,

personality changes,
weakness, nausea, vomiting and diarrhea.

Hypernatremia greater than 145. Thirst, agitation, confusion,

personality changes,
seizures, muscle twitches and weakness may become comatose.

Potassium
Hypokalemia less than 35; muscle cramping and fatigue, VS change,
weak irregular
pulse, cardiac arrest, orthostatic hypotension, lethargic, nausea,
vomiting, abdominal
distention and constipation.
Hyperkalemia greater than 5; muscle twitching and cramps, profound
muscular weak-
 ness, diarrhea, slow heart rate, BP.

Calcium
Hypocalcemia less than 9 or 4.5: trousseaus sign, inflate a BP cuff for
1-4 minutes if the
hand spazzes Chvosteks sign, tap on the cheek for facial twitching.
Hypercalcemia greater than 11mg; increased heart rate and BP
skeletal muscle weak-
ness and decreased GI motility.

Magnesium
Hypomagnesium less than 1.5: Mag and calcium go hand in hand.
Patient with Crohns disease are unable to absorb Mag. Alcoholism is a
major cause. Mag affects the heart so cardiac monitoring.
Hypermagnesium greater than 2.5: renal failure. Decreased heart rate,
hypotension and
Bradycardia.

ACID-BASE IMBALANCES

7.35-7.45 32-45 20-26

PH CO2 HCO3
RESPIRTORY ACIDOSIS -------
RESPIRTORY ALKETOSIS -------
METABOLIC ALKALOSIS -------
METABOLIC ACITOSICIS -------

ABGs

CHAPTER 7

TPN- nutrition, monitor site for infection. Monitor glucose levels goal is
to get patient
eating again, start slow, wean off slow.

IV therapy
Isotonic: NS, Lactated Ringers
Hypertonic: D5 in NS
Hypotonic: D.45 NSD 2.5
Complications: hematoma, thrombosis, phlebitis,
infiltration/extravastation, local infection, venous spasm
*** MONITOR FOR FLUID OVERLOAD***

CHAPTER 20
 Pt education: Medication adherence, must not miss doses, dont double
doses, viral loads could increase and resistance could happen.

Food and safety: disinfect prep areas 1:10 bleach. Thaw foods in
fridge. Cook food thoroughly. Use oldest food first. Body fluid spills
with soap and water.

Report: Fever, SOB, pain, change in sputum production, upper

respiratory tract infection diarrhea 5x/day 5day or more, 10 pounds or
more weight loss in the past month
******IMMEDIATELY*******
Prevention of HIV/AIDS: abstinence, PREP, Condoms
HIV antibody-done 2 times if positive, done yearly
CBC
CD 4 TCells- 200 or less AIDs dx
Viral load-desire undetectable

A&P of the Heart

Find pictures to upload
Medulla contains the cardiac center
Aging: conduction cells less effective
Artherosclerosis: BP increases, decreased heart rate, vein valves
incompetent

CHAPTER 23

Mitral regurgitation: exertional dyspnea. Fatigue, syncope, cough, and

edema. Palpitations and irregular pulse due to afib. Weakness related
to decreased cardiac output if L ventricle fails. ACE inhibitors and
anticoagulants. May need surgery
(no symptoms, no treatment).

Aortic stenosis: angina is primary symptom (in younger adult blockage

is sever) murmer, syncope and HF signs and symptom. Congenital
defects *rheumatic heart disease*.
Most commonly acquired valvular heart disease in adults. Treatment is
valve replacement, lifelong anticoagulation therapy.

Thrombophlebitis: DVT immobility (Chart Pg 23.9)

CHAPTER 29
Respiration and Acid-Base balance: decrease in the rate or efficiency of
respiration permits excess carbon dioxide to accumulate causing
acidosis
to fast alkalosis
 Also compensation occurs during metabolic acidosis as we try to blow
off carbon dioxide to raise PH or slow breathing in metabolic alkalosis.

Abnormal breath sounds: table 29. Pg 603

CHAPTER 31
Nursing interventions:
Nursing care plan- pg 649-652
Respiratory procedures- I dont even know what she is talking about so
guess will x-ray, CT scan, sputum culture test to find underlying
causes. Antibiotics, mucolytics, expectorants, bronchodilators, chest
physiotherapy, oxygen, surgical resection.
Symtoms:take a good guess. Difficulty breathing, coughing, cyanosis,
bad o2 stats, VS,
breath sounds.

CHAPTER 33

Peptic Ulcer Disease- table 33.2

Complication of gastric surgery.

Hemorrhage-decrease risk
Acute gastric distention-NG tube clogged
Dumping syndrome-food goes straight to jejunum, dizzy, tachycardia,
fainting, sweating, nausea, diarrhea, feeling of fulness and abd
cramping, then hypoglycemia.
Lay down dont drink with food. May last upto 6 months over time.
Steatorrhea: fat in the stool.
Pernicious anemia: Vitamin B12 deficiency.

CHAPTER 34

Celiac disease: sensitivity to gluten-causes malabsorption of protein.

*classically diagnosed in infants after introduced in diet*
Adult can have disease for decades bfore dx. previousdx of IBS is
common.
Genetic predisposition
Ingestion of gluten
Autoimmune response inflammation of small intestine
Stay away from wheat, barley and rye. Oats are gluten free, but can
become
contaminated. Pt education requires strict adherence to diet and
careful selection in
prepared food.
 S&S: Weight loss, weakness, general malaise, lactose intolerance, abd
cramping,
excessive gas and loose stools. Can have many or no symptoms.
Stool may be
frequent, gray with and increased fat content.

Appendicitis: increased WBC, fever, RLQ pain, nausea, vomiting,

guarding and rebound
tenderness. Keep patient NPO, semifowlers, surgery unless peritonitis.
Peritonitis, perforation or abscess are major complications. May
need NG tube if
appendix ruptures. Pain control, cough and deep breathing, and
moving. Post op to
prevent respiratory complications.

Bowel obstruction Pg 763 table 34.8

Assessment findings for pt with GI disorders: ***** GOOD LUCK *****

CHAPTER 37

Renal calculi:
Pg 841 37.3
Pg 842 37.4
Pg 843. 37.5

Whites have highest incidence. Hydrate, analgesics, and Flomax.

Sudden acute onset because it begins in attempt to be passed. Obstruction
is an emergency.
Monitor I&Os
Urine should be strained
*At risk for infection*

Chronic kidney disease- table 27.8 pg 855

Nursing care plan pg 864-867

CHAPTER 38

Thyroid gland: in the throat-dont palpate it if a goiter. It could cause thyroid

storm, parathyroid is embedded on it T3 T4 and calcitonin. T3 and T4 affect
metabolic rate.
Calcitone inhibites resorption of calcium. Type 2 diabetes: fat people, loose
weight and
excersize.