Nur 214 2026

Osmosis

movement of water across a semipermeable membrane from an area of low solute concentration (more water) to an area of high solute concentration (less water) until equilibrium is reached.

Diffusion

The tendency of solutes to move freely throughout a solvent. The solute moves from an area of higher concentration to an area of lower concentration until equilibrium is established.

Active Transport

A process that requires energy for the movement of substances throughout a cell membrane against the concentration gradient.

Filtration

movement of fluid and solutes through a permeable membrane. From an area of higher pressure to a lower pressure.

what is Fluid Voulme deficit

Fluid volume deficit (hypovolemia) is the loss of both water and electrolytes from the extracellular fluid in equal proportions. It may result from inadequate fluid intake or excessive fluid losses. Signs include tachycardia, hypotension, dry mucous membranes, poor skin turgor, decreased urine output, concentrated urine, weight loss, and confusion. Nursing care includes monitoring vital signs, strict I&O, daily weights, assessing mental status and skin turgor, monitoring labs (Hct, BUN, urine specific gravity), providing oral fluids if tolerated, and administering isotonic IV fluids as ordered

Nursing care for patients for those who have a fluid volume deficit

oral fluid intake, if possible (Broths, Pedialyte). First choice IV fluids: LR or NS

Reassess hydration status.

what are the causes of FVE

HF, Kidney failure, liver cirrhosis

s/s of FVE

crackles, sob, dyspena , Plumonary edema. JVD distention bouding pluse, and restlessness agigtation

Nursing interventions for FVE

daily weights, strict 1&0 mointior for sob and elevate HOB.

Monitior labs: Na, hct, bun often is low dued to dilution

Medications: Lasix, Bumex

Identify the effects of aging on fluid and electrolyte regulation.

The thirst mechanism decreases for older adults, and their ability to handle fluid overload. The use of diuretics ex: lasix

Hyponatremia

refers to a sodium deficit in ECF (serum sodium <135 mEq/L) caused by a loss of sodium or a gain of water. Sodium may be lost through vomiting, diarrhea, fistulas, sweating, or as a result of the use of diuretics. The decrease in sodium causes fluid to move by osmosis from the less concentrated ECF compartment to the ICF space. This shift of fluid leads to swelling of the cells, with resulting confusion, hypotension, edema, muscle cramps and weakness, and dry skin. Severe hyponatremia (serum sodium <120 mEq/L) is manifested by signs of increasing intracranial pressure, which may include lethargy, muscle twitching, hyperreflexia, coma, and seizures; death may occur

Nurse intervention ( hyponatremia)

Treatment- IV fluids- isotonic fluids and in extreme cases hypertonic fluids (3% NS) or sodium supplement

Hypernatremia

refers to a surplus of sodium in ECF (serum sodium >145 mEq/L) caused by excess water loss or an overall excess of sodium. Fluid deprivation, lack of fluid consumption (such as in patients who cannot perceive, respond to, or communicate thirst)

RF for Hypernatremia

Diarrhea and excess insensible water loss (hyperventilation, burns) lead to excess sodium. Rapid or excessive administration of sodium-containing intravenous solutions can also lead to an excess of sodium Diabetes insipidus

s/s of hypernatremia

Fluids move from the cells because of the increased extracellular osmotic pressure, causing them to shrink and leaving them without sufficient fluid. The cells of the central nervous system are especially affected, resulting in signs of neurologic impairment, including restlessness, agitation, weakness, disorientation, delusions, hallucinations, and seizures. Permanent brain damage, especially in infants and children, can occur.

Nurse interventions for hypernatremia

Treatment- restrictions or hypotonic fluids

for example, NS.hypotonic saline

Diuretics, restrict intake, encourage PO water consumption

Hypokalemia

refers to a potassium deficit in ECF (serum potassium <3.5 mEq/L) and is a common electrolyte abnormality. Potassium may be lost through vomiting, gastric suction, alkalosis, or diarrhea, or as the result of the use of diuretics.

S/S of hypokalemia

muscle weakness and leg cramps, fatigue, paresthesias, and dysrhythmias

Nursing interventions for Hypokalemia

KCl supplements orally or IV

IV slow administration (around 10 mEq/hr)

To prevent hyperkalemia and cardiac arrest

NEVER IVP

hyperkalemia

refers to an excess of potassium in ECF (serum potassium >5 mEq/L). Excess potassium may result from renal failure, hypoaldosteronism, or the use of certain medications such as potassium chloride, heparin, angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal antiinflammatory drugs (NSAIDs), and potassium-sparing diuretics.

s/s of hyperkalemia

Eliminate oral and parenteral K intake.

Increase elimination of K (diuretics, dialysis, Kayexalate).

Monitor patient

Hypocalcemia

serum calcium <8.9 mg/dL, ionized calcium <4.5 mg/dL). Common causes related to a calcium deficit involve inadequate calcium intake, impaired calcium absorption, and excessive calcium loss. Manifestations of hypocalcemia include numbness and tingling of fingers, mouth, or feet; tetany; muscle cramps; and seizures.

RF for Hypocalcemia

Inadequte calcium intake imparied calcium absoprtion. Those with hypothyroidism

Nursing Interventions for Hypocalcemia

Treat cause.

Oral or IV calcium supplements

Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis.

check for s/s Chvostek and Trousseau

Hypercalcemia

refers to an excess of calcium in ECF (serum calcium >10.5 mg/dL, ionized calcium >5.6 mg/dL). Two major causes of hypercalcemia are cancer and hyperparathyroidism. Manifestations of hypercalcemia include nausea, vomiting, constipation, bone pain, excessive urination, thirst, confusion, lethargy, and slurred speech. Severe hypercalcemia (serum calcium ≥15 mg/dL) is an emergency situation

RF for Hypercalcemia

Bone malignancies

Drug toxicity (Vitamins, antacids)

Excessive intake

Prolonged immobilization or trauma

Calcium has left the bones

cancer and hyperparathyroidism

S/S of hypercalcemia

include nausea, vomiting, constipation, bone pain, excessive urination, thirst, confusion, lethargy, and slurred speech. Severe hypercalcemia (serum calcium ≥15 mg/dL) is an emergency situation

Nursing Interventions for Hypercalcemia

Excretion of Ca with loop diuretic

Hydration - PO and isotonic saline infusion

Synthetic Calcitonin

Mobilization

Hypomagnesemia

refers to a magnesium deficit in the ECF (serum magnesium <1.3 mEq/L). Magnesium loss may occur with nasogastric suction, diarrhea, chronic alcohol use, administration of tube feedings or parenteral nutrition, sepsis, or burns. This abnormality may lead to muscle weakness, tremors, tetany, seizures, cardiac arrhythmias, change in mental status, hyperactive deep tendon reflexes (DTRs), and respiratory paralysis.

Nursing interventions for hypomagnesmia

Treatment- hypotonic fluids

for example: 0.45%NS, 0.33%NS and D5W

Hypermagnesemia

refers to a magnesium excess in the ECF (serum magnesium >2.1 mEq/L). It usually occurs with renal failure when the kidneys fail to excrete magnesium or from excessive magnesium intake (use of magnesium-containing antacids or laxatives)

RF of Hypermagnesmia

Renal failure, excessive antiacids/laxative use. Renal failure ( kidneys unable to excrete magnesium)

Excessive magnesium intake ( use of Mg containing antacids or laxatives)

S/S of hypermagnesemia

Clinical manifestations include nausea, vomiting, weakness, flushing, lethargy, hypoactive DTRs, respiratory depression, coma, and cardiac arrest

1. what is hydrogen ion balance, physiology, and homeostatic mechanisms.

Concentration is controlled by buffers, and an imbalance results in either acidosis or alkalosis.

Explain the roles of the lungs, kidneys, and chemical buffers in maintaining acid-base balance

Respiratory System: lungs & brain

Regulate carbonic acid by eliminating or retaining CO2.

Renal System:

Generates bicarb and excretes or retains acid (H+)

.Differentiate acidosis from alkalosis.

Acidosis is the condition characterized by an excess of H ions or loss of base ions (bicarbonate) in ECF in which the pH falls below 7.35 (Alkalosis occurs when there is a loss of H ions or a gain of bases (e.g., bicarbonate) and the pH exceeds 7.45

Respiratory acidosis pathophysiology

Excess of carbonic acid in ECF.

pH below 7.35 and PCO2 above 45 mm Hg "hypercapnia"

Impaired alveolar ventilation = accumulation of PCO2.

clinical manifestations of respiratory acidosis

rapid shallow respirstion lower BP

skin/mucosa pale to cyanotic hyperkalemia, retention co2 by lungs, drowsiness, dizziness, LOC muscle weakness, hyperflexia

causes: resp depression ICP, OD COPD pneumonia, PE , ARDS.

respiratory acidosis nursing management

TX is directed at improving ventilation ABGS, Resp status provding 02 and bronchodilators

Metabolic acidosis pathophysiology

decrease in serum bicarbonate caused by increase acid production loss of bicarbnate or decreased acid excretion

manifestation for metabolic acidosis

diarrhea Intestinal fistulas Parenteral nutrition Excessive intake of acids, such as salicylates Diabetic ketoacidosis Renal failure Starvational ketoacidosis

Related diagnostic tests, and medical and nursing management.( metabolic acidosis)

ABGs

(s/s hyperkalemia )BUN, Creatineine, lactic acid and sometimes is given sodium bicarbnate.

nursing management posistion in high fowlers and monitor for Kussmaul respirations weight daily NG tube sunction

respiratory alkalosis pathophysiology

Decrease in plasma PCO2 "hypocapnia"

pH > 7.45 and PCO2< 35 mm Hg

Often occurs due to decreased ventilation.

metabolic alkalosis pathophysiology

Bicarbonate HCO3 (Base) EXCESS

Excess of HCO3, loss of H+ (acid) or BOTH in ECF.

pH greater than 7.45 and bicarbonate level greater than 26 mEq/L

The body attempts to compensate the loss by retaining CO2.

respiratiory alkalosis clinical manifestion

inability to concerntrate, hyperventilation, dry mouth LOC decrease lightheadness

Related diagnostic tests, and medical and nursing management.(respiratory alkalosis)

If anxiety is the cause, encourage the patient to breathe more slowly (causes accumulation of CO2) or breathe into a closed system (paper bag). Sedative may also be necessary in extreme anxiety.

metabolic alkalosis clinical manifestations

dizziness, Tingling of fingers and toes, hypertonic muscle, depressed respirations

. Describe the role of the kidneys

kidney: regulates ECF volume, electrolyte balance, and osmolality, acid-base balance

how they do it: selective retention/excretion of water for ex: Na, k, CI.

Excrete metabolic waste(urea, creatinine)

produce renin, which helps regulate blood pressure and fluid balance

Describe the role of the lung

Regulate fluid by removing water/day through exhalation (insensible loss). Regulating CO2 levels, which control carbonic acid in the blood.Compensating for metabolic acidosis by increasing respirations

Slowing respirations during metabolic alkalosis to retain CO₂

Why this matters:

CO₂ is an acid → lungs help maintain pH

Faster breathing = more CO₂ removed = less acid

Slower breathing = more CO₂ retained = more acid

Describe the role of the Endocrine Glands

Adrenal glands: regulate blood volume and sodium and potassium balance by secreting aldosterone, a mineralocorticoid that causes sodium retention and potassium loss. pituitary gland: stores/release of ADH manufactured in the hypothalamus which acts to regulate sodium and water intake and excretion

Describe the role of the heart

The release of ANP/BNP when stretched caused the kidneys to excrete sodium and water (blood volume and blood pressure decrease).

Isotonic Solutions

Total osmolality close to that of the ECF; replace the ECFused to treat hypovolemia, metabolic alkalosis, mild hyponatremia, hypercalcemia. (NS, LR)

Hypotonic Solutions

Hypotonic to plasma; replace ICF 0.33% NaCl (1/3-strength normal saline) Used as a basic fluid for maintenance needs Often used to treat hypernatremia (because this solution contains a small amount of Na+, it dilutes the plasma sodium while not allowing it to drop too rapidly)

Hypertonic Solutions

Hypertonic to plasmaSupplies fluid and calories to the body Replaces electrolytes; shifts fluid from the intracellular compartment into the intravascular space, expanding vascular volume (5% dextrose in lactated Ringer's solution)

dextrose in 0.9% Na

5 step ABG interpretation

Check pH: acidotic, alkalotic, or normal

2. Check PaCO₂: respiratory component

3. Check HCO₃⁻: metabolic component

4. Identify the primary disorder: match pH with the abnormal system

5. Assess compensation: uncompensated, partially compensated, or fully compensated

what is the Nursing Process

• Assessment

• Diagnosis

• Planning

• Implementation

• Evaluation

(ADPIE)

What is Clinical Judgment?

Clinical judgment is the process nurses use to:

• Observe patient conditions

• Interpret data

• Make decisions

• Take action

• Evaluate outcomes

Subjective Data

What the client reports to the nurse in their own words

Information perceived only by the affected person

For example, pain experience, feeling dizzy, feeling anxious

"My leg hurts when I walk."

"I'm feeling nauseated."

"I'm scared to have this surgery."

Objective Data

What the nurse finds during the assessment

Observable and measurable data that can be seen, heard, or felt by someone other than the person experiencing them

For example, elevated temperature, skin moisture, vomiting

Blood pressure - 142/98

Patient observed fidgeting with bed covers

Right ankle is warm to touch and red

A 54‑year‑old with fever, chills, and productive cough.

ABG:

pH: 7.30

PaCO₂: 50 mmHg

HCO₃⁻: 24 mEq/L

Respiratory acidosis

A 40‑year‑old with persistent vomiting and dehydration.

ABG:

pH: 7.50

PaCO₂: 40 mmHg

HCO₃⁻: 32 mEq/L

Metabolic alkalosis

A 28‑year‑old hyperventilating after a stressful event.

ABG:

pH: 7.48

PaCO₂: 30 mmHg

HCO₃⁻: 24 mEq/L

Respiratory alkalosis