Geriatrics

1. HESI HINT: Confusion: not enough or too much stimulation

2. HESI HINT: decrease efficiency of heart and lungsdecrease oxygen
utilizationdecrease activity tolerance.
Recommend rehab programs, exercise, and nutrition
Cardiovascular Disease: HESI HINTS
1. decreased cardiac output & dysrhythmias: syncope, falls, and TIAs
2. Respiratory
A. Lungs are less elastic, which makes it more difficult to breathe
B. Cough is not as efficient
C. They are more likely to develop chronic bronchitis, emphysema, and
pneumonia due to less efficient cough
3. GI
A. Decreased enzymes-decreased efficiency of digestive process
B. Decreased intestinal motility
C. Laxative abuse
D. Decrease in fluid intake and mobility
4. Urinary
A. Urinary output is the first sign of loss of renal integrity
B. lower specific gravity <1.001
C. Proteinuria
D. BUN >30
E. DM: fatigue, infection, sensation
F. Decreased GFRdecreased drug clearance
A. Penicillin
B. Tetracylcine
C. Digoxin
G. Decreased capacity of bladderfrequency and nocturia
H. Weakeningdecreased urge and sensation to voidUTI
I. Kegel exercises: tightening and relaxing the vaginal and urinary
meatus to prevent incontinence
5. Neurologic
A. Delay in reflex responses
6. LOC, sensory, & mental
7. Endocrine
A. Decreased metabolism, aldosterone secretion, urinary output, and
glucose intolerance
B. Hypothyroidism can lead to depression
C. Thyroid dysfunction and diabetes are most common
8. Musculoskeletal
A. Decreased lean body mass and increased muscle fat
9. Hearing
A. hearing of high-pitches diminishes first
B. Presbycusis-decreased hearing acuity
I. Decreased socialization
II. Avoidance of friends and family
Iii. Decreased sensory stimulation
IV. hazardous conditions while driving
10. Pseudodementia
A. Barbituates, lithium, atropine, bromides
B. Nutrition deficiency
C. Depression
D. Metabolic disorders, hypothyroidism, anemia, and hypoglycemia
E. Speak in calm voice and avoid excitement

Respiratory
1. Pneumonia
A. Increased respiratory rate
B. Irritability and restlessness
C. Fever, shaking, crackles (lungs are filled with fluid)
D. Chills, productive cough (alveoli is filled with fluid)
E. Confusion and lethargy in elderly
F. Assess ABGs
G. Deep breath, cough, suction
H. Hint: irritability and restlessness are the first signs of cerebral
hypoxia
I. provide hydration
J. Difficulty breathingstiff lungshypoxia
K. Decreased breath soundscongested lungs
2. Always give steroids last
A. Follow with oral hygiene due to risk of super-infection
3. Singulair (a leukotriene)
A. chronic asthma
4. oral suctioning is not sterile
5. Mask, gloves, and goggles for suctioning
6. Acute Respiratory Failure
A. Ph less than 7.35
B. Oxygen less than 50
C. C02 greater than 50
1.

2.
3.
4.
5.
6.
7.

8.

Neurosensory

Encephalitis
A. Vitals
I. Widened pulse pressure
II. Bradycardia
III. Irregular respirations
IV. Eyes do not PERRLA
V. Elevate head of the bed to 30 or 45 degrees
Parkinsons
A. Dopamine
Hydrocephalus
A. IICP
B. 6th nerve defect
Meningitis
A. 3, 4, 6, 7, 8
Lumber puncture
A. Measure pressure in CSF
B. Indicate neuro disorders, infections, brain, or spinal cord damage
EEG
A. Avoid caffeine and hair products before the test
IICP
A. Compresses brain structures
B. Reduces blood flow
C. Widened pulse pressure
D. Bradycardia
E. Increased temp.
F. Cheyne-stokes
G. Administer oxygen and monitor intake and output
H. Elevate head of bed 30-45 degrees
Seizures
A. Prodromal

I. Mood changes, irritability, insomnia

9. Menieres Disease
A. Salt-free diet
B. Vasodilators
C. Neuroleptics
D. Diuretics
E. Anti-histamines
F. Anti-cholingergics
G. Sedatives
H. Encourage slow movement
10. Acute closed angle glaucoma
A. Severe eye pain
B. halos
C. Pupils dilate
D. nausea and vomiting
E. Administer stool softeners, constrictive clothing, and colds
11. Detached retina
A. Sclera buckling

Cardiovascular

1. Peripheral Vascular Disease

A. Arterial
I. Arteriosclerosis & Atherosclerosis
II. Raynaud, Buerger, and Diabetes diseases
III. Smooth, shiny skin with loss of hair
IV. Thickened nails
V. pale when elevated, rubor when dependent
VI. Decreased or absent pulses (impaired perfusion)
VII. Sharp pain; intermittent claudicateion
VIII. necrotic ulcers on lateral lower legs, toes, and heels
IX. cool temperature (reduced blood supply)
X. pain is relieved when dependent
XI. numbness and tingling (impaired perfusion)
Ai
I. Anti-platelets to thin blood)
ii. anti-hypertensives
iii. anti-coagulants
iv. exercise
B. Venous
I. DVT and valvular disorders
II. Varicose veins
III. venous stasis ulcers
iv. brown pigment around ankles
v. cyanotic when dependent
vi. normal pulses
vii. ulcers on medial legs and ankles
viii. marked edema
ix. elevate extremities for relief
x. warm temperature
C. Avoid crossing legs and wearing constrictive clothing
D. Keep legs dependent if arterial, and elevated if venous
E. Compression dressing for venous
2. AAA
A. abdominal and back pain (pressure on lumbar nerves)
B. Bruit

C. Asses peripheral pulses (tachycardia and hypotension indicates

hemorrhage or shock)
D. Neuro (brain is not being perfused)
E. Vitals
I. Impending shock and graft occlusion
F. Renal
i. artery clampedkidney damage
ii. BUN and creatnine
G. graft occlusion
I. change in pulses
ii. pain
iii. coolness below graft
iv. white or blue extremities
H. pulsatile mass
I.
3. DVT
A. calf pain
B. edema
C. warmth and redness
D. tender areas
E. Notify doctor of abnormal bleeding during drug therapy
F. avoid aspirin
G. wear anti-embolism stockings
H. anti-coagulants
I. elevate leg
4. Valvular disorders
A. Decreased cardiac output
B. impaired gas exchange
C. stenosis or regurgitation
D. mitral valve most commonly effected
*E. prophylactic treatment before dental work to prevent infection of
the heart, and lifelong anticoagulant therapy
F.
5. Endocarditis
A. vegetation adhere to the valve surface of endocardium
B. Fever, chills, malaise, fatigue, splenomegaly,
C. Murmur
*D. Symptoms of heart failure
E. *treat with antibiotics
6. Pericarditis
A. friction rub
B. substernal pain radiating to back and arm, worst on inspiration,
better when leaning forward
C. Fever
D. Dysphagia (fluid around heart places pressure on esophagus)
E. Tachypnea
7. Cardiac tamponade
A. JVD (heart is squeezed, so blood backs into circulation)
B. hypotension (decreased cardiac output)
C. muffled heart sounds (due to fluid accumulation)
D. pulsus paradoxius (pulse drops during inspiration)
E. decreased LOC
F. Increased HR
G. edema
H. *treat with 02
8. Atherosclerosis

A. life-style modification
B. nitrates
C. antihypertensive
d. anti-coagulants
e. calcium-channel blockers
f. ACE inhibitors
g. anti-platlets
9. Arteriolosclerosis
A. arteries harden and thicken
B. vitals organs are not adequately perfused
C. kidneys are most affected
10. Buergers disease
A. inflammation and blockage of small and medium sized arteries of the
extremities
B. Caused by smoking (causes inflammation and constriction of blood
vessels)
C. claudication
D. numbness and tingling
E. skin ulcerations and gangrene
11. How to calculate mean arterial pressure
A. (SBP+2DP)/3
i. less than 60 indicates inadequate perfusion
12. PTT
a. 16-40 normally
13. Central venous pressure
A. 5-10 cm water
14. Stenosis-blood flow is impeded
15. regurgitation-backward leakage of blood
16. Mitral valve disorders (both sided heart failure)
17. Aortic disorders-left side heart failure
18. Avoid green leafy vegetables while taking warfarin
19. APPT with heparin: 60-80 seconds

Gastrointestinal System
1. Hiatal Hernia
A. Portion of the stomach protrudes through esophageal hiatus
B. Feeling of fullness
C. Feeling of suffocation and smoothing after meals (eating distends the
stomach, leading to decreased ability of the lungs to expand
D. Breathing difficulty
E. Anemia
F. *sit up after eating
2. GERD
A. Pain, burning, and dysphagia (scarring from irritation)
B. Eat low fat, high protein foods
C. Limit chocolate and mints
D. Avoid carbonated beverages
E. Proton pump inhibitors (zole)
F. H2 receptor blockes (dine)
G. Antacids
H. mucosal barrier fortifiers (sucralfate-Carafate)
I. Can lead to stricture and barrets esophagus
3. Peptic ulcer disease

A. Erosion of the lining of the stomach, pylorus, duodenum, or esophagus

due to exposure of hydrocholoric acid, pepsin, and H. pylori infection
B. Caused by NSAIDS, alcohol, smoking, anti-coagulants, and trauma
C. Belching, bloating, epigastric pain, indigestion, pain after eating,
nausea, and vomiting
D. Gastric: eating causes pain; Duodenal: eating helps pain
Treatments:
A. avoid spicy foods
B. Give cytotec and other anti-ulcer meds
C. Antacids neutralize gastric acid
D. Monitor for
i. dark, tarry stools (melena)
ii. coffee-ground vomit
iii. bright red rectal bleeding
iv. fatigue
v. pallor
vi. abdominal pain
vii. abdominal mass or bruit
viii. decreased BP, rapid pulse, cool extremities
Treatments
A. saline lavage
B. NPO and IV fluids
4. Perforation
A. ulcers penetrating the wall of the GI tract
B. sudden, excruciating pain in shoulders
C. becomes more intense with position change and deep breathing
D. Rebound tenderness
E. fever
Treatments
A. administer fluids
B. NG suction
C. emergency surgery
5. Stomatitis
A. ask about nutrition, oral hygiene, antibiotic use, use of mouthwash
and toothpaste
B. Use soft bristle tooth brushes
C. Avoid spicy foods
D. Viscous lidocane-can numb throat and impair swallowing
E. *risk for impaired nutrition and fluid volume deficit
6. Gastritis (inflammation of stomach lining)
A. Pain, heartburn, belching, bloating, loss of appetite, and weight
loss, bleeding
B. Antacids and anti-biotics due to H. Pylori infection
7. Gastroenteritis
A. inflammation of GI tract
B. *Diarrhea (large intestine cannot retain fluids): hallmark sign
C. abdominal cramps due to inflammation
D. loss of appetite
E. dehydration due to diarrhea
F. weakness and fatigue due to nausea and vomiting
G. obtain history of travel and recent foods eaten
Treatments
A. replacing fluids and electrolytes
B. avoid dairy products, vegetables, and fruits
C. avoid caffeine

D. perform skin care due to diarrhea

E. avoid raw meat, fruit, and vegetables during travel
F. Do not use tap water or ice
G. monitor for s/sx of dehydration: decreased urination, dry skin and
mucous membranes, dark urine, decreased BP, low potassium and sodium levels,
and elevated BUN
8. Malabsorption
A. nutrients are digested or absorbed properly
B. Weight loss
C. steatorrhea due to decreased fat absorption
D. diarrhea
E. increased bruising
F. edema due to decrease protein absorption
G. anemia due to vitamin B12, and iron deficiency
9. Polyps
A. Bleeding due to polyp irritation
B. Abdominal pain and cramping due to obstruction of GI contents
C. Diarrhea due to polyp excretion of water and salts
Treatments
A. polypectomy
B. increase calcium intake
C. exercise
D. low fat, high fiber diet
10. Hemorrhoids
A. bleeding due to irritation
B. itching due to inadequate cleaning of rectum
C. pain
Treatments
A. sitz bath
B. creams and ointments
C. compress pads and wiping with moist wipes
D. high fiber diet and increase fluids
E. stool softener
F. avoid long periods of sitting
11. Dumping syndrome
A. sweating
B. fatigue and desire to lie down
C. palpitations
D. light-headedness and syncope
E. flushing
F. abdominal pain and cramping
G. hunger
Treatments
A. restrict fluid during eating
B. eat small frequent meals
C. lie flat on left side after eating
D. decrease carbs and increase fat and proteins
E. dietary fiber supplements
F. anti-cholinergics
12. Hernia
A. Inguninal, femoral, umbilical, and incisional
B. caused by increased abdominal pressure and abdominal surgery
C. new onset pain and tenderness indicate strangulation
D. Decrease abdominal pressure
E. provide stool softeners
F. Avoid coughing post op and increase fluids

13. Intestinal obstruction

A. abdominal cramping and pain due to obstruction
B. distention because foods or gas cannot pass the obstruction
C. bowel changes
D. decreased bowel sounds distal to obstruction
E. vomiting due to accumulation of fluids
F. fluid and electrolyte imbalances due to inability to absorb nutrients
G. Fever due to infection
Treatments
A. NPO
B. NG tube low to suction to remove contents
C. Fluid and electrolyte replacement
D. withhold pain meds
14. Appendicitis
A. pain around umbilical area
B. fetal position helps relieve pain
C. abdominal guarding
D. pain increases with cough and movement and relieved by flexion of
knees (rupture)
E. nausea and vomiting
F. AVOID USING HEAT!
G. DO NOT GIVE LAXATIVES OR ENEMAS
H. NPO
I. IV fluids
J. antibiotics
15. Peritonitis (risk for shock)
A. inflammation of peritoneum
B. pain
C. rebound tenderness
D. abdominal rigidity
E. board like abdomen (widespread inflammation)
F. decreased bowel sounds
G. increased pulse (hypovolemia)
H. decreased urinary output (decreased fluid in circulation)
I. nausea and vomiting
J. fluid and electrolyte imbalances
Treatments
A. NPO
B. IV fluids and electrolytes
C. antibiotics
D. NG insertion
E. peritoneal lavage to indicate GI bleeding
F. oxygen and semi-fowlers position
*can lead to septicemia, shock, and respiratory distress
16. Crohns disease
A. portion of small intestine thickens and narrow the lumen
B. Pain, vomiting and diarrhea
C. weight loss and malabsorption
D. elevate temperature
E. fluid and electrolyte imbalances due to malabsorption
F. NPO for bowel rest
G. low residue diet: low fiber, low fat diet high in calories, carbs,
proteins, and vitamins
H. corticosteroids
I. anti-diarrheals

J. antibiotics
K. Increase calories and fluids to heal fistulas
17. Ulcerative colitis
A. inflammation of large intestine and rectum
B. 10-20 liquid stools per day
C. rectal bleeding
D. increased bowel sounds
E. weight loss
F. *bloody diarrhea mixed with mucous
G. anemia
H. NPO
I. TPN
J. low-residue foods, low-fat, high protein, high calories food
K. Avoid milk and encourage bed rest
L. anti-diarrheals
M. sulasalazine
18. Irritable bowel syndrome
A. altered intestinal motility
B. diarrhea, constipation, or both
C. bloating and gas
D. Increase fiber and give laxatives for constipation
E. anti-diarrheals and increase fluids for diarrhea
F. avoid caffeine, dairy foods, and fructose
G. bulk-forming laxatives for constipation
H. anti-depressants
I. Imodium for diarrhea
19. Diverticulitis
A. inflammation or infection of blind pouches
B. pain
C. fever
D. weakness
E. diarrhea
F. anemia caused by rectal bleeding
G. do not do barium enema or colonoscopy during diverticulitis
H. liquid diet initially
I. low fiber diet
J. avoid laxatives
K. *signs of intestinal obstruction
L. acute phase: NPO or liquids
M. recovery: no fiber or foods
N. maintenance: high fiber with bulk forming laxatives. Avoid popcorn,
nuts, or seeds
20. Ileostomy drains liquid, increasing risk of skin breakdown
21. Pouch system is changed every 3-7 days
22. Cirrhosis
A. fatal scarring and fibrosis of liver tissue
B. Jaundice due to bilirubin build up
C. Pruritis & clay colored stools
D. ascites due to decreased albumin (albumin keeps fluid in vascular
space)
E. hepatomegaly
F. nausea due to toxin buildup
G. spider angiomas (decreased vitamin K)
H. increased medication sensitivity

I. splenomegaly (decreased platelets and WBCs)

J. Esophageal varices (portal hypertension)
K. Neuro deficits (increased ammonia buildup): encephalopathy
L. shortness of breath
M. increased bilirubin, albumin, ALT & AST, PT, serum ammonia
Treatments
A. take vitaminas
B. sodium and fluid restriction
C. frequent rest periods
D. diuretics
E. albumin administration
F. elevate head 30 degrees
G. monitor meds
H. monitor esophageal bleeding
23. Cholecystitis
A. inflammation of gallbladder
B. pain righting to right shoulder and scapula
C. nausea and vomiting due to pain
D. fever, elevated liver enzymes, and bilirbun
E. steatorrhea & jaunide
f. NPO initially
G. low fat diet
H. anti-spasmodics and anticholinergics
I. morphine can cause spasms
J. IV hydration and pain control
K. decompress stomach with NG tube
24. Pancratitis
A. enzymes are activated while still in pancreas
B. autodigestion
C. Pain radiating to back or epigastrium radiating to left should or
back
D. decreased bowel sounds
E. respiratory distress caused by enzymes entering pleura cavity
F. cullens sign (blue color around umbilicus)
G. decreased LOC
h. turners sign (gray color of flank)
I. ascites
J. steatorrhea
Treatments
A. IV fluids and electrolytes
B. NPO
C. prophylactic antibiotic
D. oxygen administration
E. NG low to suction
F. pain management
G. replacement of pancreatic enzymes
H. insulin
I. measure abdominal girth

OTHER GI NOTES
1. The barium swallow study detect anatomic and functional changes of the
esophagus, stomach, and small intestine.
A. laxatives and fluids are given after the test
2. The barium enema study detects changes of the large intestine.
3. Clear liquid diet indicated for endoscopic studies.
4. Monitor cardiac and respiratory functions after EGD procedure

5. Antacids and H2 receptor antagonists should not be given before gastric

analysis.
A. Pernicous anemia
B. Zollinger-Ellisons syndrome
6. Place on right side after liver biopsy
7. TPN for GI motility disorders and dysfunction
A. check weight and glucose levels
B. monitor for infection and air embolism
8. GERD: avoid citrus fruits, caffeine, garlic, fried foods, onions, and
tomato-based products
9. Gastric resection (Bilroth I & II): NPO until suture line heals
10. Dumping syndrome: avoid high-carb meals; eat high-protein, high-fat, low
carb meals
11. IBS: pain relieved by sleeping and having a bowel movement
12.

13. Hepatitis: focus on prevention

14. Cirrhosis: normal liver cells are replaced with scar tissue
15. Regular functions of the liver:
A. synthesis of clotting factors
B. metabolism of hormones (aldosterone, ADH, estrogen and testerone)
C. synthesize albumin (maintains normal colloid pressure)
D. carb, protein, and fat metabolism
E. filtration of drugs
F. storage of vitamins and minerals
16. Early stages of cirrhosis: enlarged liver, jaundice, GI disturbances,
abdominal discomfort
16.late stages: enlarged spleen, ascites, bleeding tendencies, esophageal
varices, dyspnea, pruritis, clay-colored stools
17. end-stage: heptatis encephalopathy
18. Encourage rest, decreased fluid intake, high-calorie, low-protein, lowsodium, low-fat diet, assess abdominal girth, diuretics, lactulose, IV fat
soluble vitamins and albumin

A. low-protein due to the bodys inability to secrete ammonia, lowsodium to prevent ascites, low-fat diet due to the livers inability to break
down fats
19. Varices in the esophagus bleed due to coughing, trauma, and vomiting
20. Murphy sign
A. extreme pain on deep inspiration: cholecystitis
21. Greatest risks for pancreatitis are those suffering from alcohol abuse,
liver, and gallbladder disease
22. Do not give ice chips and hard candies to prevent stimulation of pancreas
23. Major complication of liver biopsy is hemorrhage, so assess PT prior to
procedure
24. GGT assesses possibility of alcohol abuse
25. Fatty foods have no direct effect on diverticulitis
26. Ginger root has antiemetic, analgesic, and sedative properties
27. Bariatric surgery results in the construction of a small pouch in the
upper part of the GI. Overfilling of the pouch leads to nausea
28. *Zenkers diverticulum is an outpouching of the esophagus near the
hypopharyngeal spincter. Risk for aspiration
29. Weight can cause a non-alcoholic fatty liver
30. Beta-blockers are given in cirrhosis to prevent esophageal varrices
bleeding
31. Positioning the client on the right side after a liver biopsy splints the
puncture site to prevent and decrease bleeding.
32. Grey-Turner sign in pancreatitis-blood-stained exudates from the pancreas
indicates a severe disease process
33. Patients with IBS have mucous in stools
34. Bowel strictures in Crohns disease can lead to obstruction
35. Patients are placed in side-lying position after anorectal surgery
36. Asprin decreases risk of colon cancer
37. Peristalsis do not return for 3-5 days after abdominal surgery

DIABETES
1. Type I
A. Glucose usually 350 and above
B. Ketonuria
C. Bicarbonate less than 15
D. Clients are usually thin and under 30
2. Type II.
A. *nonketotic hyperosmolar hyperglycemia
B. Plasma hyperosmolality
C. Dehydration
D. change in mental status
3. Assessment:
A. Breaks in skin
B. Dental caries and fungal infection
C. Cataracts and diabetic retinopathy
D. Chest pain and shortness of breath
E. Hair loss on extremities with non-palpable pulse, pallor, and
ulcerations
F. Edema of face, hands, feet, and urinary retention
G. Neuropathies
H. night time diarrhea
I. vaginal dryness and frequent yeast infections
4. Take meds according to insulin peak times
5. Eat bedtime snacks
6. Wash feet daily but DO NOT soak! Dry them well
7. Do not moisturize feet between toes
8. Sandles should be avoided
9. Do not wear garters or elastic topped socks
10. Stress and illness can cause hyperglycemia
11. Hypovolemia (polyuria)

Oral meds
1. Sulfonylureas (Glyburide & glipizide)
A. stimulates the release of insulin from pancreas and tissues take up
glucose more easily
B. hypoglycemia is adverse reaction
C. Give with meal once daily
2. Biguinides (metformin)
A. inhibit hepatic glucose production and increase sensitivity of tissue
to insulin
B. GI disturbances
3. Thiazolidinediones (actos & avandia)
A. decrease insulin resistance to the tissues
B. weight gain and edema
4. Alpha-glucosidase inhibitors
A. decrease blood glucose absorption
B. take with first bite of each meal
5. Meglitindes
A. same as sulfonylureas

*Insulins
1. Rapid acting
A. Humalog & Novolog
B. 5-15 minutes onset
C. 45-1.5 hours peak
D. Give within 5-15 minutes of meal
2. Short acting
A. Regular insulin
B. 30-60 minutes onset
C. 2-3 hours peak
3. Intermediate
A. NPH & Humulin L
B. 1-2 hours onset
C. 6-12 hours peak
4. Long acting
A. Lantus
B. 4-8 hours onset
C. 14-20 hours peak
D. Give at bedtime
E. Bottle is shaped differently than regular insulin, but is clear
F. Do not shake or mix with other insulins
1.
2.
3.
4.
5.
6.

Diabetic ketoacidosis
Body breaks down fat-ketones
Metabolic acidosis
decreased LOC
hypovolemia (excess sugar and fluid is excreted)
electrolyte imbalances (hyperkalemia)
Kussmaul respirations to blow off excess acid

*monitor for hyperglycemia hyperosmolar nonketotic syndrome

1. Extremely high glucose
2. elevated BUN
Hypoglycemia
1. soda, orange juice, apple juice, or hard candy
2. complex carbohydrate (half of peanut butter sandwich, milk, and cheese
crackers

Other notes
1. post-pandrial glucose is less than 140
2. A1C: 4-7%
3. Diabetics have increased risk for infection
4. Cool, clammy skin is often seen in hypoglycemia
5. in diabetic ketoacidosis, the skin is flushed due to dehydration and poor
skin turgor
A. Administer IV saline, potassium and insulin
6. A bedtime snack is not needed with long-acting insulin
7. Exercising with glucose levels exceeding 250 and ketonuria increases
secretion of glucagon, growth hormone, and catecholamines, casuing the liver
to release more glucose

Fluids Imbalances

1. Organs involved:
A. kidney (fluid and electrolyte, acid-base balances)
B. lungs (acid-base balance, rid 300 ml of fluid)
C. heart (kidney perfusion)
D. adrenal gland (secrete aldosterone)
E. pituitary gland (secrete ADH)
F. parathyroid gland
2. Fluid volume deficit:
A. loss of water, electrolytes remain normal, but sodium increases)
B. Decreased skin turgor
C. oliguria
D, dry and sticky mucous membranes
E. weak, rapid pulse
F. Elevated BUN (measures excretory function of kidney)
G. elevated Creatnine
H. Increased serum osmolarity (amount of solvent is decreased)
I. Elevated Hgb and Hct
J. Replace isotonic fluids because water is hypotonic
K. Strict I & o
L. Increased urine osmolality (due to concentrated urine)
i. 1.001-1.030
3. Fluid volume excess:
A. Body retains water, sodium level decreases
B. Heart, renal, liver failure
C. Peripheral edema
D. bounding pulse with increased BP
E. distended neck and hand veins
F. dyspnea
G. All lab values decreased (hemodilutional state with diluted urine)
H. Diuretics
I. Fluid and salt restriction
J.Strict I & O
K. Weigh daily

Electrolyte Imbalances
1. Sodium: 135-145
2. Potassium: 3.5-5
3. Calcium: 9-10.5
4. Magnesium: 1.3-2.1
5. Chloride: 95-105
6. Phosphate: 3-4.5
Abnormalities and common
causes
Hyponatremia
-diuretics
-hypotonic solutions
-sweating

Hypernatremia
-water deprivation
-watery diarrhea
-renal failure

Hypokalemia
-diuretics
-vomiting
-NG suctioning

Hyperkalemia
-oliguria
-renal failure
-acidosis

Hypocalcemia
-renal failure
-hypoparathyrodism
-malabsorption

S/Sx

Treatment

- muscle weakness
(decreased excitability
of cell membranes)
-seizures
-muscle cramps
-twitching
-lethargy and confusion
Thirst
-tachycardia (heart is
trying to pump around
what little fluid is
left)
-dry mouth
-irritability
-muscle weakness
(potassium is needed for
muscle contraction)
-decreased GI motility
-dysrhythmias
-paresthesia
-slow, difficult
respirations
(respiratory muscles are
weak)
-bradycardia
-dysrhythmias
-flaccid paralysis
(excessive potassium
interferes with muscle
contraction)
-diarrhea
-numbness and cramps
-tingling of extremities
-convulsions (muscles
contract)
-positive trousseau sign
(hyperexcitability of
hand muscles)
-positive chvosteks
sign (hyperexcitabilty

-restrict fluids
-hypotonic or hypertonic
saline solutions
-increase dietary sodium

-restrict sodium
-increase water intake

-never give bolus (do

not exceed 20 meq)
-assess renal status
before administration
-eat bananas, oranges,
cantaloupes, avocados,
spinach, potatoes
-administer potassium
chloride
Administer 50% glucose
with regular insulin
-administer kayexalate
-administer calcium
gluconate
-IV loop diuretics
-administer calcium IV
slowly
-vitamin D

Hypercalcemia
-hyperparathyroidism

of facial muscles)
-laryngeal spasms
-increased DTRs
-constipation
-polyuria
-polydipsia
-dysrhythmmias
-respiratory arrest
(sedative respiratory
muscles)
-decreased bowel sounds
(intestines are sedated)
-muscle weakness
(sedated muscles)

-administer calcitonin
(moves calcium into the
bones)
-IV phosphate

Hypomagnesemia
-alcoholism
-diabetic ketoacidosis
-malabsorption

same signs and symptoms

of hypercalcemia
-BP increases
(vasoconstriction)

-administer magnesium
sulfate

Hypermagnesemia
-renal failure

-flushing
-hypotension
-drowsiness
-depressed respirations
-hypoactive reflexes
-bradycardia
-BP decreases
(vasodilation)
-facial flushing and
warming (vasodilation)
-sedated respiratory
muscles
-parestheias
-muscle weakness
-cardiomyopathy
-respiratory failure
-(SIGNS AND SYMPTOMS OF
HYPERCALCEMIA)
-tentany symptons
(SIGNS AND SYMPTOMS OF
HYPOCALCEMIA)

Avoid magnesium based

antacids and laxatives
-0.45 saline solution
-IV calcium gluconate
-loop diuretics
-respiratory support

Hypophosphaemia
-alcohol withdrawal

Hyperphosphatemia
-renal failure

-IV phosphorus when

serum level drops below
1

Administer aluminum
hydroxide
-administer vitamin D

Other notes
1. hyponatremia caused by hypervolemia: fluid restriction

Acid-base balance
1. 20 bicarbonate to 1 carbonic acid ratio
2. Respiratory acidosis
A. Pulmonary disease
B. Sleep apnea
3. Respiratory alkalosis
A. over-ventilation
B. response to hypoxia
C. fever
4. Metabolic acidosis
A. lactic acidosis
B. ketoacidosis
C. acid ingestion
5. Metabolic alkalosis
A. Gastric drainage
B. vomiting
C. burns

Peri-operative
1. Surgical risks
A. young and old
B. obese and malnourished
C. dehydrated
D. clients with any infection
E. cardiac conditions
F. blood coagulation disorders
G. upper respiratory tract infections and COPD
H. renal disease (renal insufficiency)
I. diabetes due to delayed healing and possibility of wound infection
J. Use of anticoagulants
K. use of antibiotics (may be incompatible to anesthesia)
L. diuretic use (electrolyte imbalances)
M. steroids
N. vitamin E use
2. Client has to be 18 to sign surgical consent form
Pre-operative
1. Client teaching:
A. Coughing and deep breathing
B. Supporting the wound by splinting
C. leg exercises
D. Turning, positioning, ambulation
E. Recovery room procedures
F. Type of dressing, NG tubes, drains, foley catheter

G. Decreases anxiety and promotes client participation

H. Regulations about jewelry
I. NPO status
J. Dietary restrictions
K. informed consent must be signed before the administration of
medications

Intra-operative
1. report changes in pulse, temperature, respirations, and blood pressure to
surgeon
.
1. Signs
A.
B.
C.
D.

Postoperative
of shock and hemorrhage
hypotension
tachycardia
narrowed pulse pressure
cold, moist skin

2. Post-op care
A. Pulmonary
i. Airway (check gag reflex)
ii. Bilateral breath sounds
iii. Deep breathing and coughing
B. Neuro
i. LOC
ii. Reflexes
C. Circulation
i. Vital signs
ii. Peripheral perfusion
D. GI
i. Bowel sounds
ii. Distention
E. GU
i. Urinary output
ii. Intake and output
*malignant hyperthermia
*somogyi/dawn effect
*smoking-pack years