FLUID, ELECROLYTES AND ACID BASE IMBALANCE

1. When the amount of water you gain each day is equal to the amount you lose to the environment, you are in - fluid balance
2. When the production of hydrogen ions in your body is precisely offset by their loss, you are in acid-base balance
3. Electrolyte balance primarily involves balancing the rates of absorption across the digestive tract with rates of loss at the kidneys and sweat
glands
4. Nearly two-thirds of the total body water content is intracellular fluid (ICF)
5. Extracellular fluids in the body consist of interstitial fluid, blood plasma, lymph, cerebrospinal fluid, synovial fluid, serous fluids, aqueous humor,
perilymph, endolymph
6. The principal ions in the ECF are sodium, chloride, bicarbonate
7. If the ECF is hypertonic with respect to the ICF, water will move from the cells into the ECF until osmotic equilibrium is restored
8. When water is lost but electrolytes are retained, the osmolarity of the ECF rises and osmosis then mvoes waterout of the ICF and into the ECF
until isotonicity is reached
9. When pure water is consumed, the ECF becomes hypotonic with respect to the ICF
10. Physiological adjustments affecting fluid and electrolyte balance are mediated primarily by ADH, aldosterone, ANP & BNP
11. The two important effects of increased release of ADH are reduction of urinary water losses and stimulation of the thirst center
12. Secretion of aldosterone occurs in response to a drop in plasma volume at the juxtaglomerular apparatus, a decline in filtrate osmotic
concentration at the DCT, high potassium ion concentrations
13. Atrial natriuretic peptide hormone reduces thirst, blocks the release of ADH, blocks the release of aldosterone
14. The force that tends to push water out of the plasma and into the interstitial fluid is the net hydrostatic pressure
15. The exchange between plasma and interstitial fluid is determined by the relationship between the net hydrostatic and net colloid osmotic
pressures
16. The concentration of potassium in the ECF is controlled by adjustments in the rate of active secretion along the distal convoluted tubular and
collecting system of the nephron
17. The activity that occurs in the body to maintain calcium homeostasis occurs primarily in the bone, digestive tract, kidneys
18. The hemoglobin buffer system helps prevent drastic alterations in pH when the plasma PCO2 is rising or falling
19. The primary role of the carbonic acid-bicarbonate buffer system is in preventing pH changes caused by the rising and falling of the plasma PCO2
20. Pulmonary and renal mechanisms support the buffer systems by secreting or generating hydrogen ions, controlling the excretion of acids and
bases, generating additional buffers when necessary
21. The lungs contribute to pH regulation by their effects on the carbonic acid-bicarbonate buffer system
22. Increasing or decreasing the rate of respiration can have a profound effect on the buffering capacity of body fluids by lowering or raising the
PCO2
23. The renal response to acidosis is limited to secretion of H+ and generation or reabsorption of HCO3
24. When carbon dioxide concentrations rise, additional hydrogen ions are produced and the pH goes down
25. Disorders that have the potential for disrupting pH balance in the body include emphysema, renal failure, neural damage, CNS disease, heart
failure, hypotension
26. Respiratory alkalosis develops when respiratory activity lowers plasma PCO2 to below-normal levels
27. The most frequent cause of metabolic acidosis is production of a large number of fixed or organic acids
28. mismatch between carbon dioxide generation in peripheral tissues and carbon dioxide excretion at the lungs is a respiratory acid-base disorder
29. The major causes of metabolic acidosis are production of a large number of fixed or organic acids, impaired ability to excrete H+ at the kidneys,
a severe bicarbonate loss
30. The most important factor affecting the pH in body tissues is the PCO2
31. As a result of the aging process, the ability to regulate pH through renal comensation declines due to a reduction in the number of functional
nephrons
32. The risk of respiratory acidosis in the elderly is increased due to a reduction in vital capacity
33. All of the homeostatic mechanisms that monitor and adjust the composition of body fluids respond to changes in the extracellular fluid
34. Important homeostatic adjustments occur in response to changes in plasma volume or osmolarity
35. All water transport across cell membranes and epithelia occur passively, in response to osmotic gradients and hydrostatic pressure
36. Whenever the rate of sodium intake or output changes, there is a corresponding gain or loss of water that tends to keep the sodium
concentration constant
37. Angiotensin II produces a coordinated elevation in the ECF volume by stimulating thirst, causing the release of ADH, triggering the secretion of
aldosterone
38. The rate of tubular secretion of potassium ions changes in response to alterations in the potassium ion concentration in the ECF, changes in pH,
aldosterone levels
39. the most important factor affecting the pH in body tissues is carbon dioxide concentration
40. The body content of water or electrolytes will rise if intake exceeds outflow
41. When an individual loses body water plasma volume decreases and electrolyte concentrations rise
42. The most common problems with electrolyte balance are caused by an imbalance between sodium gains and losses
43. Sodium ions enter the ECF by crossing the digestive epithelium via facilitated diffusion and active transport
44. Deviations outside of the normal pH range due to changes in hydrogen ion concentrations disrupt the stability of cells membranes, alter protein
structure, change the activities of important enzymes
45. When the PCO2 increases and additional hydrogen ions and bicarbonate ions are released into the plasma, the pH goes down, acidity rises
46. Important examples of organic acids found in the body are lactic acid and ketone bodies
47. In a protein buffer system, if the pH increases a carboxyl group (COOH) of an amino acid dissociates and releases a hydrogen ion
48. Normal pH values are limited to the range between 7.35-7.45
49. The condition that results when the respiratory system cannot eliminate all the carbon dioxide generated by peripheral tissues is respiratory
acidosis
50. When a pulmonary response cannot reverse respiratory acidosis, the kidneys respond by increasing the rate of hydrogen ion secretion into the
filtrate
51. Chronic diarrhea causes a severe loss of bicarbonate ions resulting in metabolic acidosis
52. Compensation for metabolic alkalosis involves decreased pulmonary ventilation, increased loss of bicarbonates in the urine

BURNS
1. A patient is brought to the Emergency Department from the site of a chemical fire. The paramedics report that the patient has a burn that
involves the epidermis, dermis, and the muscle and bone of the right arm. When you assess the patient he verbalizes no pain in the right arm and
the skin appears charred. Based upon these assessment findings, what is the depth of the burn on the patient's right arm? FULL THICKNESS
2. The nursing instructor is going over burn injuries. The instructor tells the students that the nursing care priorities for a patient with a burn injury
include wound care, nutritional support, and prevention of complications such as infection. Based upon these care priorities, the instructor is most
likely discussing a patient in what phase of burn care? ACUTE
3. A patient in the emergent/resuscitative phase of a burn injury has had her lab work drawn. Upon analysis of the patient's laboratory studies, the
nurse will expect the results to indicate what? HYPERKALEMIA, HYPONATREMIA, ELEVATED HEMATOCRIT AND METABOLIC ACIDOSIS
4. The patient you are caring for has an electrical burn and has developed thick eschar over the burn wound. Which of the following topical
antibacterial agents will the nurse expect the physician to order for the wound? MAFENIDE ACETATE 10% (SULFAMYLON) HYDROPHILIC-BASED
CREAM
5. The occupational health nurse is called t the floor of the factory where a patient has sustained a flash burn to the right arm. The nurse arrives and
the flames have been extinguished. The next step is to "cool the burn." How will the nurse cool the burn? WRAP COOL TOWELS AROUND AFFECTED
EXTREMITY INTERMITTANTLY
6. The emergency department nurse has just admitted a patient with a burn. The nurse recognizes that the patient is likely to experience a local and
systemic response to the burn when the burn exceeds a total body surface area (TBSA) of what? 25%
7. The nurse on a burn unit is caring for a patient in the acute phase of burn care. While performing an assessment during this phase of burn care,
the nurse recognizes that airway obstruction related to upper airway edema may occur up to how long after the burn injury? 2 DAYS
8. A patient has sustained a severe burn injury and is thought to have an impaired intestinal mucosal barrier. Since this patient is considered at an
increased risk for infection, what intervention will assist in avoiding increased intestinal permeability and prevent early endotoxin translocation?
EARLY AND ENTERAL FEEDING
9. A patient has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. What would be the nurse's
priority concern about this patient? FLUID STATUS
10. The nurse is preparing the patient for mechanical debridement and informs the patient that this will involve: USE OF SURGICAL SCISSORS,
SCALPELS OR FORCEPS TO REMOVE THE ESCHAR UNTIL THE POINT OF PAIN AND BLEEDING OCCURS
11. A patient with a partial-thickness burn injury had Biobrane applied 2 weeks ago. The nurse notices that the Biobrane is separating from the
burn wound. What is the appropriate nursing intervention when this separation occurs? TRIM AWAY THE SEPARATED BIOBRANE
12. An emergency department nurse learns from the paramedics that they are transporting a patient who has suffered injury from a scald from a
hot kettle. What factors does the nurse know are considered when determining the depth of burn? CAUSATIVE AGENT
13. The triage nurse in the emergency department (ED) receives a phone call from a frantic father who saw his 4-year-old child tip a pot of boiling
water onto her chest. The father has called an ambulance. What would the nurse in the ED receiving the call instruct the father to do? IMMERSE
THE CHILD IN A COOL BATH
14. The nurse is teaching a patient with a partial-thickness wound how to wear his elastic pressure garment. How would the nurse instruct the
patient to wear this garment? CONTINUOUSLY
15. The nursing instructor is teaching about the emergent/resuscitative phase of burn injury. During this phase, what would the nursing instructor
tell the students they should closely monitor in the laboratory values? SODIUM DEFICIT
16. A nurse taking care of a burn patient is asked why the patient is losing so much weight. What would be the nurse's most appropriate answer?
YOUR BODY HAS USED YOUR FAT DEPOSITS FOR FUEL BECAUSE YOU HAVEN'T BEEN EATING VERY MUCH
17. A 45-year-old man is brought in by Life-Flight after a motor vehicle accident is which he was trapped in a burning vehicle. The burn team is
estimating the patient's likelihood of survival based on the severity of the burn injury. The emergency department nurse knows that the severity of
the injury is based on what factors? AGE, DEPTH OF THE BURN, PRESENCE OF INHALATION INJURY
18. You have just reported to the burn unit to start your shift. Four new patients have been admitted in the past 12 hours. Which patient is most
likely to have life-threatening complications? A 4 YEAR OLD SCALD VICTIM BURNED OVER 24% FO THE BOdy
19. A burn patient is brought to the emergency department. The nurse knows that the first systemic event after a major burn injury is what?
HEMODYNAMIC INSTABILITY
20. A burn victim is admitted to the Intensive Care Unit to stabilize and begin fluid resuscitation before transport to the burn center. If inadequate
fluid resuscitation occurs what happens to the patient? DISTRIBUTIVE SHOCK
21. An emergency department nurse has just received a burn victim brought in by ambulance. The paramedics have started a large-bore IV and
covered the burn in cool towels. The burn is estimated as covering 24% of the patient's body. The nurse knows that pathophysiologic changes
resulting from major burns during the initial burn-shock period include what? DECREASED CARDIAC OUTPUT
22. A male patient, 16 years old, comes to the emergency department (ED) after burning his right hand and arm while working on a friend's car. The
injury is determined to be a superficial burn and it is treated. What would the nurse teach the patient before discharging him home to return on a
daily basis for dressing changes? The burned area will start to swell in about 4 hours and blisters will form. If you think the dressing is too tight
come back to the ED."
23. A patient is admitted to the burn unit after being transported from a facility 1000 miles away. The patient has burns to the groin area and both
legs. The burns to the lower legs are circumferential. The nurse knows to monitor closely for what as the edema in this patient increasesA ) Ischemia
24. A nurse on the burn unit is caring for a patient who has gone into the acute phase of her burn. What would be important for the nurse to
monitor the patient for? HYPONATREMIA
25. The acute phase of the burn begins 48 to 72 hours after the burn. What begins at this time? DIURESIS
26. As the patient begins the acute phase of a burn, cautious administration of fluids and electrolytes continues. The nurse knows that this caution
is because of what? Patient's physiologic responses to the burn injury, Losses of fluid from large burn wound Shifts in fluid from the interstitial to
the intravascular compartment
27. What is the nursing goal during the acute phase of a burn? To ultimately prevent or control infection in the burn population

RENAL DISORDERS

1. You're preparing for urinary catheterization of a trauma patient and you observe bleeding at the urethral meatus. Which action has priority? D.
Delay catheterization and notify the doctor.
2. Which of the following causes the majority of UTI's in hospitalized patients? C. Invasive procedures.
3. A patient with diabetes has had many renal calculi over the past 20 years and now has chronic renal failure. Which substance must be reduced in
this patient's diet? C. Protein
4. You're developing a care plan with the nursing diagnosis risk for infection for your patient that received a kidney transplant. A goal for this
patient is to: A. Remain afebrile and have negative cultures
5. Which criterion is required before a patient can be considered for continuous peritoneal dialysis?A. The patient must be hemodynamically stable
6. You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?A. Check for kinks
in the outflow tubing
7. You suspect kidney transplant rejection when the patient shows which symptoms? C. Fever, weight gain, and diminished urine output
8. Which cause of HTN is the most common in acute renal failure? B. Hypervolemia
9. The most common early sign of kidney disease is: . Elevated BUN level
10. Frequent PVCs are noted on the cardiac monitor of a patient with end-stage renal disease. The priority intervention is: . Check the patient's
latest potassium leveL
11. Your patient has complaints of severe right-sided flank pain, N/V, and restlessness. He appears slightly pale and is diaphoretic. VS are BP 140/90
mmHg, P 118 bp, RR 33 breaths/min, and T 98.0F. Which subjective data supports a diagnosis of renal calculi? . Dark, scanty urine output
12. Which sign indicates the second phase of acute renal failure? A. Daily doubling of urine output (4 to 5 L/day)
13. Which drug is indicated for pain r/t acute renal calculi? A. Narcotic analgesics
14. A patient returns from surgery with an indwelling urinary catheter in place and empty. Six hours later, the volume is 120 mL. The drainage
system has no obstructions. Which intervention has priority? Evaluate the patient's circulation and VS
15. Your patient is complaining of muscle cramps while undergoing hemodialysis. Which intervention is effective in relieving muscle cramps? .
Infuse normal saline solution
16. What is the priority nursing diagnosis with your patient diagnosed with ESRD? Fluid volume excess
17. Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?
Taking a BP reading on the affected arm can cause clotting of the fistula.
18. Your patient returns from the operating room after abdominal aortic aneurysm repair. Which symptom is a sign of acute renal failure? Oliguria
19. Which finding leads you to suspect acute glomerulonephritis in your 32 y/o patient? HTN, oliguria, and fatigue
20. What is the best way to check for patency of the arteriovenous fistula for hemodialysis? PAlpate the fistula throughout its length to assess for a
thrill
21. Which action is most important during bladder training in a patient with a neurogenic bladder? Set up specific times to empty the bladder
22. Clinical manifestations of acute glomerulonephritis include which of the following? Hematuria and proteinuria
23. Your patient becomes restless and tells you she has a headache and feels nauseous during hemodialysis. Which complication do you suspect?
Disequilibrium syndrome
24. You have a paraplegic patient with renal calculi. Which factor contributes to the development of calculi?Increased calcium loss from the bones
25. Polystyrene sulfonate (Kayexalate) is used in renal failure to: . Exchange potassium for sodium
26. patient with DM and renal failure begins hemodialysis. Which diet is best on days between dialysis treatments? Low-protein diet with a
prescribed amount of water
27. Which intervention do you plan to include with a patient who has renal calculi? Strain all urine

CHAIN OF INFECTION AND IMMUNOLOGY

Communicable Disease – is an illness due to a specific infectious agent or its toxic products
that arises through transmission of that agent or its products from an infected person, animal
or inanimate reservoir
Infection – invasion of the body tissue by microorganisms and their proliferation
Carrier – a person who without apparent symptoms of a disease, harbors and spread the
specific with microorganisms
Chain of Infection – is made up of six different links: pathogen (infectious agent), reservoir,
portal of exit, means of transmission, portal of entry, and the new host.
Contamination – invasion of surface (wound) or article (handkerchief) or matter (water and
milk) implies the presence of undesirable substance which may contain pathogenic
microorganisms
Sterilization – describes a process that destroys or eliminates all forms of microbial life and is
carried out in health-care facilities by physical or chemical methods
Disinfection – describes a process that eliminates many or all pathogenic microorganisms,
except bacterial spores, on inanimate objects
Concurrent disinfection – ongoing practices that are observed in the care of the client, his
supplies, environment and control of microorganisms
Terminal disinfection – practices to remove pathogens from the client’s belongings and
environment after his illness is no longer communicable
Disinfectant – substance for inanimate objects that destroys pathogens and the spores
Antiseptic – substance intended for persons that inhibit the growth of pathogens but not
necessarily destroy them
Bactericidal – chemical that kills microorganisms
Bacteriostatic – chemical that prevents the multiplication but does not kill all forms of
microbes
Virulence – the vigor with which the organism can grow and multiply; refers to the degree or
intensity of disease produced
Nosocomial Infection – infections associated with the delivery of health care services in a
health care facility
Opportunistic pathogen – causes disease in a susceptible person
Resident flora – microorganisms that are always present in specific areas of the body;
normally lives on a person’s skin

 Sporadic disease that is intermittent occurrence of few isolated unrelated cases in given locality
 Endemic disease that continuous occur throughout a period of time
 Epidemic disease which the occurrence is of unusually large number of cases in a relatively short period of time and examples are
dengue fever, leptospirosis, mumps, chicken pox, and measles.
 Pandemic disease is an epidemic disease that occur worldwide,

IMMUNOLOGY

(2) types of Immunity: (1) natural

immunity which is innate and non-specific; (2) acquired immunity which adaptive and specific.
EXPANDED PROGRAM ON IMMUNIZATION (EPI) launched in July 1976 by DOH in
cooperation with the World Health Organization (WHO) and UNICEF to ensure that
infants/children and mothers have access to routinely recommended infant/childhood vaccines.
Vaccination among infants and newborns (0-12 months) against seven vaccine-preventable
diseases: tuberculosis, poliomyelitis, diphtheria, tetanus, pertusis, hepatitis and measles.
The Presidential decree No. 996 (September 16, 1976) was passed to provide for compulsory
basic immunization for infants and children below eight years of age. The Republic Act
No. 10152 “Mandatory Infants and Children Health Immunization Act of 2011”
Wednesday is designated immunization day in all parts of the country. Every Monthly is in a Barangay Health Station (BHS) and
quarterly in far flung areas.

The Expanded Program on Immunization Cold Chain and Logistic with a Public Health Nurse
serve as the Cold Chain Manager. Temperature checking is done twice a day early in the morning and in the afternoon before going home. Vaccine
can be stored in Refrigerator: (1) Regional for 6 months; (2) Municipal / City for 3 months, and (3) Main Health Center for 1 month.
The transport box is good for 5 days practicing FEFO (first expiry and first out) vaccine is practiced to ensure that all vaccines are utilized before its
expiry date.

Measles, German measles, Chicken Pox, Influenza, COVID 19

Measles – is a highly contagious disease caused by the rubeola virus.

German Measles – also known as rubella, is a viral infection that causes a red rash on the
body, usually have a fever and swollen lymph nodes.
Chicken Pox – is a highly contagious disease caused by the varicella-zoster virus (VZV). It
can cause an itchy, blister-like rash.
Chicken Pox – is a highly contagious disease caused by the varicella-zoster virus (VZV). It
can cause an itchy, blister-like rash.
Corona virus disease (COVID-19) – is an infectious disease caused by a newly discovered
corona virus.

MEASLES
Francis Home (1757) a Scottish physician, who first discovered measles. Murice Hilleman who
first discovered measles vaccine and first available in 1963
- The causative agent of measles is Morbilli Virus (paramyxovirus).
-The virus is sensitive to heat, light, and extreme acidity and alkalinity. It is transmitted via airborne, and also be transmitted
via direct contact with respiratory secretions coming from infected patients and indirect contact with objects contaminated with secretions. The
incubation period is 10-12 days but it can be ranged from 8 to 20 days after the exposure to the virus.
- The pre-eruptive stage is highly contagious stage with measles signs and symptoms
typically include: high grade fever, coryza, cough, conjunctivitis, photophobia Koplik's spots which is the pathognomoniic sign.
- The complications of measles are bronchopneumonia which is the most common and dreaded
complication.
- The medical management are Pen G – to prevent secondary bacterial Complication; Antiviral of ISOPRENOSINE. Vitamin A for 6 to 12
months of 100,000 IU and more than 1 year old to 5 years old with 200,00 IU.

GERMAN MEASLES
- George de Malon (1814) was first discovered German measles. German measles has 27 strains. German measles, also known as rubella
or 3 days measles, is a contagious viral infection that causes a red rash on the body.
- The virus can be transmitted through droplet. It can spread when an infected person coughs or sneezes. It can also spread by direct contact
with an infected person's respiratory secretions, such as mucus. Indirect contact with objects contaminated with
secretions. Trans-placental transmission - it can also be passed on from pregnant women to
their unborn children via the bloodstream.
- The incubation period is 2 to 3 weeks and the period of communicability is 7 days before and 5 days after the appearance of rashes.
- Forscheimer spot which is the pathognomoniic sign.

CHICKEN POX
Giovanni Filippo (1500) was first discovered chicken pox. Chickenpox is also known as varicella, a highly contagious disease caused by the
varicella-zoster virus (VZV),
- The five (5) stages of rashes: (1) Macule - “flat”; (2) Papule - “elevated”; (3) Vesicle - “fluid-filled”; (4) Pustule - “pus-filled”; and (5) Crust Scab -
dry. The celestial Map is a condition wherein all the stages of chicken pox rash are simultaneously present.

-INFLUENZA
Influenza, one of the most common infectious diseases, is a highly contagious droplet disease that occurs in seasonal epidemics
- Influenza, commonly called "the flu," or “La Grippe” is an illness caused by RNA viruses (Orthomyxoviridae family)

COVID 19
The coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered and a new strain of coronavirus.
- Wuhan, China, in December 2019
- COVID-19 is caused by the SARS-CoV-2 virus.
- Molecular (Swab) Test (PCR) Polymerase Chain Reaction Test - this test uses a long swab to
collect material, including physical pieces of coronavirus, from the back of the nose where it
meets the throat.
- PCR detects for the virus itself that is why PCR is the confirmatory test.