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Nursing In a Flash 
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Question Answer
What are the signs and symptoms of 3rd spacing?
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Increased heart rate with decreased BP, decreased urine output, increased weight, edema, distention, decreased bowel sounds, crackles, decreased LOC.
_______ is usually given with vasopressin to increase CO and improve tissue perfusion. It is a (+) inotrope.
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Dobutamine
Decreased oncotic pressure allows fluids to flow from _______ to _______.
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intravascular to interstitial space
_______ are mediators that trigger arteriole vasoconstriction.
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Thromboxanes
_______ are mediators that increase tissue permeability.
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Leukotrienes
Vasoconstriction r/t 3rd spacing can lead to what adverse effects?
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Hypoxia, ischemia, and SIRS.
How is decreased oncotic pressure treated?
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Hypertonic fluid pulls fluid back into intravascular spaces, increases circulation volume. Isotonic fluid.
A bladder pressure over _______ is indicative of intraabdominal HTN.
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12; I (12-15), II (16-20), III (21-25), IV (over 25). *Indicates bowel edema.
Edema can compress major vessels. Vena Cava leads to _______, Aorta/iliac/femoral leads to _______, Renal leads to _______, Spleen leads to _______.
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Vena Cave: decreased preload, decreased CO, decreased BP; Aorta/iliac/femoral: increased afterload (peripheral circulation pressure) leads to decreased CO and BP; Renal: decreased kidney function; Spleen: impaired blood flow to bowel, liver, and splee
Increased Hgb and Hct = _______ and decreased Hgb and Hct = _______
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Increased = hemoconcentration from fluid shift and decreased = bleeding or dilution
Isotonic, Hypotonic or Hypertonic? 5% albumin, hetastarch, normosol, 5% dextrose.
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Isotonic
Isotonic, Hypotonic or Hypertonic? 0.45% NaCl, 0.33% NaCl, 2.5% dextrose in H2O.
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Hypotonic
What can cause 3rd spacing in the brain?
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Cardiac arrest which leads to hypotension, hypoperfusion, hypoxia, ischemia and cell damage.
What causes the increased HR with 3rd spacing?
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Baroreceptors in the aorta and carotid arches sense decreased volume, triggers SNS release of epinephrine/ norepinephrine, vasoconstriction, increased HR.
Avoid giving _______ solution to a patient at risk for increased ICP because it converts to H2O.
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D5W (isotonic only in container leads to hypotonic in the body).
_______ solutions trigger osmosis and pulls fluid from cells/ interstitium to blood vessels. Post-op it decreases risk of edema, stabilizes BP and urine output.
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Hypertonic
Increased K+ can be caused by...
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intracellular shifting or renal dysfunction
Increased creatinine with a normal BUN =
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intrarenal dysfunction
Hypertonic solutions pulls from _______ spaces to _______ spaces.
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interstitial spaces to intravascular
Istotonic, Hypotonic or Hypertonic? 5% dextrose in 0.45% NaCl, 3% NaCl, 25% albumin.
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Hypertonic
_______ solutions hydrates cells and decreases circulating volume by triggering osmotic fluid movement from vessels to cells.
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Hypotonic
What are signs of decreased oncotic pressure?
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Decreased CO and ascites.
_______ solutions should be administered cautiously because it causes fluid shifts from intravascular to interstitial spaces and can lead to cardiovascular collapse and increase KP.
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Hypotonic
Abdominal girth and bladder pressure should be assessed every _______.
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4-8 hours
Don't give LR to patients with a pH over _______.
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7.5 (liver converts to bicarb)
_______ solutions are ideal for hydration, doesn't trigger osmosis, and stays where it's infused.
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Isotonic
Where can 3rd spacing occur?
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Brain, lungs, abdomen, and extremities.
Intravascular to extravascular fluid movement occurs thru _______; controlled by hydrostatic and oncotic pressure.
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diffusion
_______ = movement from increased concentration to decreased. _______ = movement from decreased to increased concentration thru a membrane. _______ = against concentration from decrease to increase.
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Diffusion = increased to decreased; Osmosis = decreased to increased; Active transport = decreased to increased
Increased lactate levels =
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Bowel ischemia or in patients with liver problems, LR administration.


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