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NCLEX® - RN & PN TEST PREP COURSE Conductedby:
GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN [email protected]#714-679-9320Fax#909-247-2721
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Knowledge Base
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
NORMAL FLUID INTAKE AND LOSS IN AN ADULT
Intake Output Water in food –1,000 mls Water from oxidation –300 mls Water as liquid – 1,200 mls Total – 2,500 mls.
Skin – 500 mls Lungs –300 mls Feces –150 mls. Kidneys -1,500 mls Total – 2,500 mls.
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Hormonal Regulation • ADH: anti-diuretic hormone- causes
kidneys to retain fluids
• Renin-Angiotensin Aldosterone System
(RAAS) ü Renin released conversion of
angiotensin I to angiotensin II - retain sodium and water ü Stimulate Adrenal Cortex to secrete
Aldosterone (Aldosterone: Na+ reabsorption and K+ excretion)
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Cellular Fluid Compartments • Intracellular Fluid (ICF)
- fluid inside the cell; must be balance with extracellular fluid - Internal aqueous medium for cellular chemical function
• Extracellular Fluid (ECF) - fluid outside the cell; must be balance with intracellular fluid.
-Interstitial fluid (fluid surrounding the cell) and plasma, intravascular fluid and transcellular fluid
- Maintains blood volume
- Transport system to and from the cell
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Electrolytes Ions substance that are sometimes called minerals or salts
breakdown of electrolytes into
tiny particles and has electrical charges.
An electrical charge makes cells function normally.
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Balancing Electrolytes Anions
Cations
are electrolytes that generate a negative charge Example Bicarbonate, Chloride, Phosphorus
are electrolytes that produce positive charge. Example: Calcium, Magnesium, Potassium, Sodium.
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Major Electrolytes found in ECF and in ICF
ECF Major CATION
ICF Major CATION
Na (Sodium)
Ca (Calcium)
K (Potassium)
Major ANION
Major ANION
HCO3 (Bicardbonate) Cl (Chloride)
HPO4(Phosphorus)
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
NORMAL LABORATORY VALUES FOR ELECTROLYTES
Na 135 – 145 mEq./ L
K 3.5 – 5.5 mEq./ L
Ca 4.5 – 5.5 mEq./ L
HPO4 1.7 – 2.6 mEq./ L
Cl 96 – 105 mEq./ L
Mg 1.5 – 2.5 mEq./ L
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Electrolyte Functions Na Serum osmolality; nerve-muscle cells interactions.
Cl Water pulling pressure; production of hydrochloric acid for breakdown of foods
Ca Structure and functions of bones and teeth. Reduce permeability to sodium Contract muscles
HCO3 plays an important role in acid –base balance
K muscle contraction and myocardial membrane responsiveness.
HPO4 energy metabolism; combined with Ca for bone and teeth mineralization
Mg regulates neuromuscular contraction; promotes normal functioning of nervous and cardiovascular systems.
6
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
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Intravenous Fluids Isotonic 0.9% NaCl Ringers Solution Lactated Ringers D5 Water Hypotonic 0.45% NaCl
Hypertonic 5% Na Bicarb 3% NaCl D10-15% Water
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
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7
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
TYPES OF DEHYDRATION A. Isotonic Dehydration ü most common type of fluid
volume deficit loss of isotonic fluids from the ECF space (plasma and interstitial spaces, plasma osmolarity remains normal while fluid volume is reduced.
ü Decreased circulating blood volume (hypovolemia)--- leads to inadequate tissue perfusion.
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
B. Hypertonic Dehydration ü second most common type of fluid
deficit loss of water is greater in the ECF than electrolytes-water loss increases the osmolarity of the remaining plasma. ü with increased osmolarity in the
plasma fluid (hypermosmolar)- increases osmotic pressure resulting in fluid shift from ICF to ECF.
ü leading to cellular dehydration and
shrinkage
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
C. Hypotonic Dehydration ü least common type of fluid
volume deficit. ü Fluid shifts between spaces
causing a decrease in plasma volume.
ü From excessive loss of sodium and potassium from the ECF.
ü Difference in osmotic pressure cause fluid shift from ECF to ICF causing the cells to swell.
ü Brain cells swell- neurological problems.
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
DEHYDRATION • Fluid volume deficit
• Water intake is less than what is needed to meet body fluid requirement.
• Laboratory • BUN • Creatinine • Sodium • Hematocrit • Hemoglobin • WBCs • Protein • Specific Gravity
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Clinical Manifestation • Cardiovascular
• Increased PR, thready pulse, decreased BP Orthostatic hypotension, diminished peripheral pulses, weight loss
• Respiratory • Increased RR, and
depth or respiration • Neuromuscular
• Lethargy to coma, fever
• Renal • Decreased urine
output, increased urine specific gravity
• Integumentary • Skin dry and scaly,
poor turgor, tinting, mouth dry and fissured
• Gastrointestinal • Decrease peristaltic
motility, diminished bowel sounds, constipation, thirst
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Relevant Nursing Diagnoses • Fluid Volume Deficit
• Decreased Cardiac Output
• Altered Bowel Elimination
• Impaired Oral Mucous Membrane
• Potential For Impaired Skin Integrity
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
OVERHYDRATION • Fluid Overload, Excess Fluid
• Isotonic Overhydration • Circulatory Overload • Edema/Renal Failure
• Hypertonic Overhydration • Water intoxication • CHF/SIADH
• Hypotonic Overhydration • Excessive Sodium Intake
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
• Cardiovascular • increased HR, BP,
CVP, weight gain, JVD,, varicosities
• Respiratory • Increased RR,
shallow respirations, dyspnea, crackles
• Integumentary • Pitting edema • Skin cool to touch
• Neuromuscular • Altered level of
consciousness, headache, skeletal muscle weakness, paresthesia
• Gastrointestinal • Increased motility
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Relevant Nursing Diagnoses • Fluid Volume excess
• Decreased cardiac output
• Ineffective breathing
pattern, dyspnea
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Electrolyte Imbalances • Changes in fluid intake and output affect fluid
balance
• People at greater risk for electrolyte imbalances – Older people, chronic renal, or endocrine
disorders – Mentally impaired – People on drugs that alter fluid and
electrolytes.
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Potassium Imbalances • Hypokalemia
• K+ level < than 3.5 • Give potassium
supplement ( Kdur) or • Orange juice/
banana • Add K+ to IV fluid
• Hyperkalemia – K+ 3.5- 5.5> – K+ level greater
than 5.5 – Kayexalate – Diuretics – D5-10 Water +
Regular Insulin/IV
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Sodium Imbalances • Hyponatremia: Na < 135 mg/dl
• Movement of water from ECF into the cells • Cells swell • Change in cell excitability • Decrease in levels between ECF and ICF
• Hypernatremia: Na+ > than 145 mg/dl • More excitable tissues are excited more rapidly • Deep tendon reflex are absent • Muscle weakness
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Calcium Imbalances • Stabilizes membrane excitability by regulating
depolarization and generating action potential. • Hypocalcemia: Ca < 8.0 mg/dl.
• Increase sodium movements across excitable membrane allowing inappropriate depolarization
• Hypercalcemia: Ca > 10.0 mg/dl • Causes excitable tissues less sensitive to normal
stimuli • Heart, muscles, nerves and intestinal smooth
muscles
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Management and Treatment • Assessment : Hypercalcemia
• Absent DTR, tripping of the toes, hypoactive bowel sounds, • Decreased deep tendon reflex
• Assessment : Hypocalcemia » Tingling » Trousseaus- BP cuff (1-4 mins.) » + if hand spasm occurs » Chvostek’s Test-facial muscle response » Calcium Supplements w/ Vit D.
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Phosphorus Imbalances • Hyperphosphatemia: > 4.5 mg/dl
• Increased membrane excitability
• Renal insufficiency, cancer treatment, increased phosphorus intake
• Hypophosphatemia: < 3.0 mg/dl • Decrease in serum phosphorus cause increases calcium level • Causes:
– Insufficient phosphorus intake – Increased phosphorus excretion – Intracellular shift – hyperphosphatemia
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Clinical Manifestations Hypophosphatemia Decreased cardiac contractility Cardiomayopathy Shallow respiration Muscle weakness Irritability Decreased platelet aggregation
Management: Diet: fish, beef, cheese, nuts
• Avoid: milk, yogurt, collard green, rhubarb
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Magnesium Imbalances • Hypomagnesemia
• < 1.5mEq/L: increased excitability of membranes
• Decreased stroke volume and cardiac output
• Hypermagnesemia • MgSO4 toxicity • Absent DTR • >2.5mEq/L: less excitable membranes
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Fluid Therapy • Types of Infusion Therapy
• Isotonic
• Hypertonic • Hypotonic
• Total Parenteral Nutrition
• Blood Transfusion
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
19
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Acid-Base Homeostasis • With normal physiologic function hydrogen ions,
bicarbonate, oxygen and carbon dioxide are kept within normal levels.
• Factors that affect homeostasis – Hydrogen ion production – Carbon dioxide loss through breathing – Ratio between carbonic acid and bicarbonate must be
kept at 1:20
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
20
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
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21
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Acid-Base Regulatory Mechanisms • Respiratory Acid-Base Control
Mechanisms • Hyperventilation • Hypoventilation
• Renal Acid-Base Control Mechanisms
• Kidney movement of Bicarbonate
• Formation of Acids • Formation of Ammonia
• Compensation • Respiratory Compensation • Renal Compensation
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
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METABOLIC ACIDOSIS �(Bicarbonate Deficit)
• Assessment – Headache – Mental dullness – Kussmaul’s respiration (attempt to
blow off CO2) – Potassium excess
• Nursing Interventions – Treatment of underlying cause and
restoration of electrolyte balance – Na Bicarbonate IV – Maintain good respiratory function – Fluid replacement, measure I and O – Protect from injury
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NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
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METABOLIC ALKALOSIS (Bicarbonate Excess)
• Assessment – Depressed breathing (to
conserve CO2) – Mental confusion – Dizziness – Numbness and tingling of
fingers or toes – Muscle twitching – Late : tetany, convulsions – Potassium deficit
Nursing Interventions • NaCl or Ammonium
Chloride oral or IV • Carbonic Anhydrase
Inhibitor (Diamox). • To increase excretion
of bicarbonate by the kidneys.
• Maintain good respiratory function
• Protect from injury.
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
23
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
Age-Related Changes in �Acid-Base Balance
• Greater Risk For pH Problems • Kidneys and lungs are less able to respond to body demands
• Reduced Gas Exchange • Impaired gas movement r/t thickened vessel wall
• Decreased Kidney Function • Elderly are less able to excrete hydrogen ions or produce
bicarbonate ions • Drugs
• Diuretics • Digoxin
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected]#714-679-9320Fax#909-247-2721
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