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1、外科脱水题（Surgical dehydration）Item 1 basic skills of surgical nursingTask 1, fluid imbalance, patient careFirst, the noun explanation1. hypertonic dehydration2. hypotonic dehydration3. isotonic dehydration4. paradoxical urine5. liquid therapy6. total parenteral nutrition (TPN)Two. Fill in the blanks1.
2、normal adults need sodium chloride () daily, equivalent to isotonic saline (water); daily need of potassium salt (), equivalent to 10% potassium chloride ().2. adult male body weight (total), which (as) () for intracellular fluid, extracellular fluid; extracellular fluid in plasma (body weight), the
3、 rest () for interstitial fluid; * extracellular fluid can be divided into (a) and (third), which is located in the gap for fluid ().3. normal adults discharge approximately a total of liquid daily, of which urine volume is approximately (), and respiration evaporates approximately (), the skin evap
4、orates about (), and the faeces are about (). Such as tracheotomy, adults increase daily loss of water (), sweat soaked, underwear, water loss about ().4. hypertonic dehydration caused by increased osmolality of the body fluid, resulting in urinary volume () and specific gravity of urine.5. low perm
5、eability dehydration early, due to lower body fluid pressure, antidiuretic hormone secretion (), so the urine volume (or), but the urine gravity ().6. the safest way to supplement potassium is (). If you need an intravenous supplement of potassium, the concentration should not exceed (), the drop sp
6、eed is not more than () per person; and the potassium chloride solution is definitely prohibited.7. acidosis increases H+, stimulates telangiectasia, and occurs in the face of the patient (but), but when the shock patient is accompanied by acidosis, the facial expression is ().8., the body through t
7、he (,), (and) 3 ways to maintain the acid-base balance of the body fluid, the role is fast (), the role of lasting and powerful is ().Three, Jane answerHow many questions should be paid attention to in 1. intravenous potassium supplementation?2. what are the main indicators of the response to infusi
8、on therapy?Four case discussion1. Mr. Wang, 38 years old, weight 70kg. Paroxysmal abdominal pain 2 days, accompanied by frequent vomiting, no bowel movement, thirst, oliguria, fatigue, the diagnosis of acute intestinal obstruction admitted to hospital. Check: a temperature of 38 DEG C, the pulse of
9、100 / 86 / 60mmHg, blood pressure, apathy, rapid breathing, orbital subsidence, dry lips, facial flushing slightly, abdominal intestines, umbilical week extensive tenderness, hyperactive bowel sounds, knee reflex. Serum sodium, 145mmol/L, serum potassium, 3.5 mmol/L, carbon dioxide binding power (CO
10、2CP) 13.84 mmol/L (30 volume%). Vomiting 1 times after admission, about 500ml. Ask:(1) what are the main manifestations of fluid imbalance in this patient?(2) what are the main current nursing diagnoses?(3) develop a fluid replacement program.2. Mr. Lee, 50 years old, weighing 60 kg. Diagnosis of es
11、ophageal cancer, the difficulty of the diet for 1 months, V. fatigue, extreme thirst, oliguria and deep color. Check the blood pressure and body temperature in the normal range, obvious orbital depression, poor skin elasticity dry lips and tongue. No other specific serum sodium has been reported. As
12、k:(1) the type and extent of fluid imbalance in the patient?(2) what is the amount of liquid supplement on that day? (note the calculation process)3. weeks, madam, 50. Emergency admission for acute pancreatitis has been 5 days, after admission to give fasting and gastrointestinal decompression, dail
13、y infusion of 10% glucose solution, 2000ml, 5% glucose, saline, 1000ml, the patient complained of fatigue, lethargy, nausea, abdominal distension. Check the body temperature, blood pressure is normal, apathy, heart rate of 110 beats per minute, abdominal lung, abdominal tenderness, no shifting dulln
14、ess, decreased bowel sounds, tendon reflex. Ask:(1) what has happened to the patient? Why?(2) what drugs should be added?Five, multiple-choice questionsType A1 problem1. which of the following is not a direct cause of hypertonic dehydration?A. B. application of a large number of high fever sweating
15、osmotic diuresisC. with advanced esophageal cancer with frequent vomiting of D.E. coma, fasting2., the main pathophysiological changes of isotonic dehydration areA.Extracellular fluid concentration, B. cell, extracellular fluid, hypotonicC. extracellular fluid volume dropped sharply, D. cell interna
16、l fluid was low, and E. cell internal fluid was hypertonic3. which of the following pathological changes is wrong in patients with hypertonic dehydration?A. thirst, B., antidiuretic hormone secretion decreasedC. cells move outward, D. aldosterone secretion increases, E. urine concentration4. the cli
17、nical features of hypotonic dehydration areA. facial expression is faint, B. urine amount decreasesC. had earlier circulatory dysfunction, D. skin elasticity, and E. metabolic acidosis5. isotonic dehydration, if not in time, can be converted into liquidA. hypertonic dehydration, B. hypotonic dehydra
18、tion, C. mixed dehydrationD. cells are swollen and E. are not above6. hypertonic dehydration, first of all, which liquid is most appropriate?A.5% glucose solution, B.5%, glucose isotonic salineSaline E. low molecular dextran C. sodium lactate Ringers solution D.0.45% low permeability7. for patients
19、with severe hypotonic dehydration, the first fluid to be entered isA.50% glucose solution, B.5% glucose saline, C. balanced salt solutionD.5% Sodium Chloride Solution E.10% glucose solution8. which of the following is wrong with regard to water intoxication?A. is also called diluting hyponatremia, a
20、nd the amount of B. is more than the output of waterC. extracellular fluid is transferred into the intracellular fluid. Acute brain edema may occur in D. patientsE. has a high specific gravity9. the most prominent clinical manifestations of water intoxication areA. manifestations of pulmonary edema,
21、 B. edema of brain cells, C. ascitesD. manifestations of generalized edema, E., and cardiac insufficiency10. cases can cause hyperkalemiaA. intravenous infusion of glucose solution, B., severe vomiting and diarrheaC. fasted for 3 days, D. metabolic alkalosis, E. severe crush injury11. about the role
22、 of antidiuretic hormone, the wrong one isA. secretion increases, can cause urine volume decrease, B. secretion is insufficient, can cause diabetes insipidusWhen C. increased blood osmotic pressure, secretion increased and D. secretion increased when blood volume increasedE. vasopressin release from
23、 the pituitary gland12. the same clinical manifestation of hypokalemia and hyperkalemia isA. tachycardia, B. weakness, flaccid paralysis, C. heart, diastolic arrestD. abdominal distention and vomiting E. ECG T wave flat13. an incorrect account of electrolyte in the body isWhen A.cl- increases, HCO3-
24、 decreases and B.Mg2+ and Ca2+ deficiency cause similar clinical symptomsC. Ca2+ can antagonize the inhibitory effect of K+ on myocardium and can be treated with calcium when D.Mg2+ is deficientE.H+ and Na+ are mainly regulated by the kidney14. when the acid-base balance is disturbed, the lips are c
25、herry red, often suggestiveA. metabolic acidosis, B., respiratory acidosis, C., metabolic alkalosisD. respiratory alkalosis is not more than E.15., when the dehydration is corrected, which liquid should be used first, which is harmful to the microcirculation?A.5%, sodium bicarbonate, B.0.9%, sodium
26、chlorideC. balanced salt solution, D. whole blood, E.5% glucose isotonic saline16. which is not the clinical manifestation of hypokalemia?A. excitement, delirium, B. muscle weaknessC. abdominal distension, nausea and vomiting, D. tachycardia, arrhythmiaE. ECG T wave flat, U wave17. the major differe
27、nce between hypertonic and hypotonic dehydration in early stage isA. is there any thirst, B., blood pressure changes?C. urinary volume change, D., consciousness disorder, E. skin elasticity18. patients with hyperkalemia to intravenous injection of calcium gluconate 10% main purpose isA. treatment of
28、 hypocalcemia, B., treatment of flaccid paralysis, numbness, C., potassium excretionD. inhibits K+ against cardiac muscle and E. promotes potassium transfer into the cell19. factors that may cause hypokalemia areA. crush syndrome, B., acute renal failure, C. input, large volume of banked bloodD. lon
29、g-term gastrointestinal decompression E.Extensive burn20. intravenous drip of which of the following liquids does not require strict control of the drip rateA.0.3% potassium chloride solution B. propranolol C. lidocaineD. 5% sodium bicarbonate solution E. procaine amide21. in acute renal failure, on
30、e of the inappropriate measures to treat hyperkalemia isA. timely dialysis treatment, B. intravenous drip, 25% glucose solution and insulinC. intravenous drip of 5% sodium bicarbonate solution, D. intravenous infusion, 10% calcium gluconate solutionE. a large amount of 5% drops of glucose solution22
31、. an ulcer with pyloric obstruction, 15 days after repeated vomiting should be considered possible combinationA. metabolic acidosis, B. metabolic alkalosis, C. respiratory acidosisD. respiratory alkalosis, E. metabolic acidosis, and respiratory acidosis23. when metabolic alkalosis occurs, the major
32、cause of neuromuscular stress hyperactivity isA. serum potassium decreased, B. serum potassium increased, C. serum free calcium decreasedD. serum free calcium increased, E. serum sodium increased24. the reason why metabolic alkalosis is usually treated with supplemental isotonic saline is thatA. nee
33、ds to be filled with water. B. sodium in isotonic saline is lower than serum sodiumC. isotonic saline chloride content is higher than serum chlorine content, D. can increase the excretion of NaHC03 in urineE. can achieve the purpose of first filling the congestion capacity25. respiratory acidosis sh
34、ould be the first to solve the problemA. lung infection, use a large number of antibiotics B. artificial respirationC. uses respiratory center stimulant D. to relieve airway obstruction and improve pulmonary ventilation functionE. gives alkaline liquid26. thirst, oliguria, high specific gravity and
35、poor skin elasticityA. hypertonic dehydration, B. hypotonic dehydration, C. isotonic dehydrationD. E., hypokalemia, hyperkalemia27. patients with dehydration should be admitted to hospital for first days and should be compensated for the amount lostA. one time make up B., first add 2 / 3 C., first a
36、dd 1 / 2D. first add 1 / 3 E., and then add 1 / 428. treatment of severe hypotonic dehydration can be entered firstA.5% dextrose saline, B.10% glucose solution, C.3 5% NaCl solutionD.11.2% sodium lactate solution E. low molecular dextran solution29., the content of monitoring without transfusion isA
37、. mental status, B., cardiopulmonary sign, C., thirst and skin elasticityD. changes in body temperature, E., blood pressure, pulse, urine volume30. the patient who is undergoing infusion has shortness of breath, cough and bloody frothy sputumA. acute renal failure, polyuria stage, B. infusion reacti
38、on, C. infusion insufficiencyD. left heart failure or pulmonary edema, E. severe water shortageThe following 31. common causes of hyperkalemia, what is wrong?A. limb crush injury, B., acute renal failure, oliguria, C., potassium input too much, too fastD. long-term gastrointestinal decompression, E.
39、 input large amount of stored bloodThe following 32. principles of treatment of hyperkalemia, what is wrong?A. immediately stop potassium intake, B. actively prevent arrhythmiaC. rapidly lowers blood potassium concentration, D. restores kidney function, and E. supplements blood volume33. rescue meas
40、ures in patients with hyperkalemia when what is wrong?A. peritoneal dialysis, B. Ringers solution, intravenous dripC.10% calcium gluconate intravenous drip D.5% sodium bicarbonate intravenous dripE.10% glucose solution plus insulin intravenous drip34. the most important organ for regulating acid-bas
41、e balanceA. kidney, B. lung, C. liver, D. heart, E. brain35. normal daily physiological intake of water isA.500 to 1000 ml B.1000 to 1500 ml C.1500 to 2000 ml.D.2000 to 2500 ml E.3000 to 4000 ml.36. which is wrong about hypotonic water shortage?A. thirst obvious, B. may have standing faint, C. urine
42、 weight is lowD. decreased Na and CI in urine, and serum sodium in E. was lower than 135 mmol/L37. treatment of hypotonic dehydrationA supplemented with 5%G.S based B. to supplement 10%G.S basedC. was mainly supplemented with hypertonic saline, and D. was mainly supplemented with isotonic salineE. s
43、upplements 5%G.S and salt water each half38. which of the following conditions do not cause hypertonic dehydration?B. dysphagia in A. patients with esophageal cancer, inadequate water supply for critical patientsC. fasting, D., high fever, sweatingE. large area burn shock stage39. the preferred liqu
44、id for hypertonic dehydration is the infusionA. normal saline B.5%G.SC. compound Sodium Chloride Solution, D.10%G.S, E.1.25%, sodium bicarbonate solution40. which is wrong with moderate hypertonic dehydration?A. B. C. extreme thirst dry tongue reduced skin elasticityD. urine volume decreased signifi
45、cantly, E. water deficit was about 2-4% of body weight41. moderate dehydration is water loss, accounting for about body weightA.1-2%B.2-4%C.4-6%D.6-8%E.8% above42. acute peritonitis with paralytic ileus is caused by water shortageA. hypertonic B. hypotonic C. isotonic D. primary E. secondary43. surg
46、ical fluid replacement, the ideal liquid for replenishing extracellular fluid isA. normal saline, B.5%G.S, C. balanced saline solution, D. dextran, E. Ringers solution44. isotonic dehydration, the best infusion forA.5%NaHCO3 solution, B.0.9%, sodium chloride solutionC. balanced salt solution, D. dex
47、tran solution, E. plasma45. point out the mistakes in the principle of surgical fluid replacementA. what to lack, what to fill, how much to lack, how much to fill, B. first salt, sugarC. first gum, then crystal D. first fast, then slow, urine Chang tonic potassiumE. edge treatment, edge observation, side adjustmentType A2 problem1. Ms. Wang, 49 years old. Due to adhesive ileus, 2 days admission, blood potassium was 3mmol/L. Which is wrong to give an intravenous suppl