Remediation 1 exam

So what does the body say it needs to do? What do cells do? Sodium  hasn’t changed. Water has! So what would cells do? Cells have water in them. Cells transfer water into the vascular system. Body says “hey u didn’t drink water” body is made up of 60% of water. So the body realizes that the veins need water. You don’t need sodium just water therefore cells will automatically add water. What will the kidneys say? They will say to not to release it so they hold pee. Its bc body is holding on to water. The Kidneys will hold pee for a person. Let’s say the body is transferring water and the kidneys are holding pee but the person still refuses to drink and keeps running. At some point if you don't replace that fluid the body will run out because you have to replace fluids. That's why you drink things throughout the day. So at 26 miles the body is giving up. At that point the person has lost everything and is hypernatremic. 

  • We have a situation where the sodium level is 168 bc I don’t have water. So in this case what can you do as a nurse? Give fluids (IV fluids)

  • Kidneys are holding pee and cells are putting water in. If the level is high and the body is still putting water in and if it stays prolonged then the person is at risk for seizure.

  • How does seizure happen? 

  • All cells in the brain and body are releasing fluid into the vascular and constantly doing this. What will the brain do? It will shrink and cause seizure if a person is hypernatremic and can’t get level down. That is why you can get seizures with high sodium levels.

  • What causes seizure is also the thing that fixes what’s in your cells. It's just overcompensating bc in normal conditions if you have a high NA level our body fixes it, we break it and balance it. 

  • If you have too much water what will u do as a nurse? Give a diuretic, restrict a certain amount of fluids. What are kidneys gonna do here? Pushing out more urine (to get rid of fluid)

  • What are cells gonna do? They're gonna pull fluid out of cells (swell) because they are trying to balance this. So normally that will balance out but if it continues to stay low the process continues to pull water. What will happen to the brain? It will swell causing a seizure. (from cells)

  • With I&O we use this because if a patient has something going on with fluid balance and it is liquids only! Solid has nothing to do with fluids!

  • When we’re looking at I&O you’re looking strictly at the intake of what is fluid, or what is fluid at room temp including ice cream, icechip, jello. NOT PUDDING

  • If it says cup of ice just say the full cup bc all u need is correct intake and output. But if u have more intake than output then what should u do? Let’s say intake is 2000 and output is 1000. What do you do? Restrict certain amount and give a diuretic

  • 300 or less= continue to monitor if for some reason it’s 400 or 450 just continue to monitor, reduce fluids. What if it’s the opposite and output is more than intake? Increase IV fluids

  • If you have a NG tube and u slush NG with 500 mL. Does that count as intake? Yes

  • So what if it’s 200 mL of NG tube irrigation? Would you count it or not? No

  • What if it’s bladder irrigation? Subtract the 800 from totals catheter output bc just like NG tube irrigation u just mark  it out but bladder irrigation u don't count it bc it’s going in and constantly pushing that bladder. So you have to separate it from the total intake.

  • When a person runs a lot they get extreme dehydration, 60% of water in the body doesn't replace the body, fluid runs out. Therefore the body is Hyponatremia (severe dehydration). Have to replace fluids with drinking water. 

  • NA= 168 not enough water. Nurse needs to give fluids. It can cause a seizure bc of cerebral edema. Cells shrink w/ hypernatremia.

  • 300 or less continue to monitor.

  • NG tube irrigation is not included in OUTPUT.

- Body's Needs and Cellular Function:

  - Cells need water for proper functioning.

  - Body is composed of 60% water.

  - Cells transfer water into the vascular system when the body detects dehydration.

  

- Kidneys' Response:

  - Kidneys hold onto urine to conserve water when the body needs hydration.

  - If hydration is not replenished, the body may become hypernatremic.

- Effects of Hypernatremia:

  - Sodium levels rise due to insufficient water intake.

  - Nurse intervention: Administer IV fluids to rehydrate the body.

  - Prolonged hypernatremia can lead to seizures due to cerebral edema caused by shrinking brain cells.

- Seizure Mechanism:

  - Brain cells release fluid into the vascular system.

  - Hypernatremia causes brain cells to shrink, leading to seizures if levels remain high.

- Balancing Fluid Levels:

  - Excess water: Nurse may administer diuretics or restrict fluid intake.

  - Kidneys increase urine output, while cells release water to balance fluid levels.

  - Prolonged low fluid levels can cause brain swelling and seizures.

- Intake and Output (I&O) Monitoring:

  - I&O includes only liquid intake and output.

  - Solid intake does not affect fluid balance.

  - NG tube irrigation counts as intake; bladder irrigation is subtracted from total output.

- Dehydration and Hyponatremia:

  - Severe dehydration can lead to hyponatremia (low sodium levels).

  - Replacing fluids with drinking water is essential to restore hydration.

  - Hyponatremia can cause seizures due to cerebral edema.


Liver, what does it do for you? Produces bile, filters out toxins, The thing with your liver is all the blood that comes from your heart (oxygenated) goes through all your systems, all comes back to the liver to be filtered. It filters everything because it's the last stop before it goes to the heart. Liver produces clotting factors if u dont have enough u can bleed out. 

  • The pt produced too many clotting factors from his liver, so he got really sick. He went to UAB and found so many blood clots in the intestines that he needed to get removed. When he was in the hospital what meds do you think he got? Heparin drip

    • The lab to check for heparin is PTT (45-80)   The pt is on a heparin drip, they check his PTT and it says 110. What do you do as the nurse? Stop it

    • If PTT is too high, the patient is at risk for bleeding out. 

    • What if the PTT came back as 40, what is the pt at risk for? Clotting, so now what do you do? You increase it

    • What labs do you check for warfarin? PT and INR

    • INR range 2-3

    • PT range is 16-22

    • So pt went to the hospital for clotting in the small intestines, therefore he had to get a lot of blood transfusions, what did they not test for in blood prior to 1992? Hepatitis

    • So pt got blood that was infected with hepatitis C. What does Hep C do? Attacks the liver

    • What does Hep C do to the liver? Causes cirrhosis (scarring)

    • How do you test to see the degree of cirrhosis? Liver biopsy

    • Can you do a liver biopsy on a pt who is on a blood thinner? No

    • How long does it take for Hep C to be physically shown? 25 years

  • Ammonia levels (15-45) 

  • Liver damage is not breaking down ammonia so u can get hepatic encephalopathy (makes u goofy)

  • What will you give pt as the nurse to get rid of ammonia? Lactulose enema