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218 Cards in this Set
- Front
- Back
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What % of the adult body is fluid
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60% (40% Intracellular, 20% Extracellular) Extracellular further broken into 15% interstitial, 5% intravascular
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Interstitial Spaces means in the
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tissue
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First spacing is also called
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homeostasis
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Second spacing in abnormal
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accumulation of interstitial fluid-edema
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Example of second spacing
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Periorbital edema- or anasarca
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What is anasarca
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Whole body fills with fluid
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What is 3rd spacing
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fluid that accumulates from a shift in intravascular to insterstital spaces. The fluid is not easily exchanged with the rest of the ECF
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Name a 2 causes of 3rd spacing
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edema from burns, ascites
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Diffusion
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is the movement of molecules from a region of high concentration to a region of low concentration
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Osmosis
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Movement of water molecules from regions of higher water potential to regions of lower water potential across a semi-permeable or selectively permeable membrane.
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Active Transport:
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Against energy gradient
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Filtration
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transfer of water and a dissolved substance from high pressure to a region of low pressure
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Normal intake for 24 hours
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2500ml
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Insensible loss comes from ________ & ___________ it is ___________ and normal amt is
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sweat and respirations,
unmeasurable 500-1000ml/24 hrs |
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Sensible losses are ____ they take place through
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Measurable, urine and feces
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How much Sensible loss do we have in 24 hrs
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1500mls
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One liter of fluid = how many lbs or kg?
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2.2 lbs or 1 kg
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If you have a weight gain if _____ lbs in 24 hours it is suspected that you are retaining h20
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2-3
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Water intake is controlled by
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thirst
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Which group of people are at risk of decreased h20 intake? why?
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Elderly, lose sense of thirst and means to drink
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Water is saved by the kidneys through the pituitarys secreation of
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ADH
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This hormone increases sodium and water reabsorption in the body and decreases sodium and water excretion in the urine
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aldosterone( produced in adrenal cortex)
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S/S Fluid Volume Deficit
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Tachycardia, low bp, cool dry skin, weakness, confusion, decreased CO, falsely decreased electrolyte values,
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The best indicator of fluid and electrolytes is
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A clear Sensorium
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Hemoconcentration of RBC's causes
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falsely increased hgb/hct see in fluid volume deficit
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A patient with water intoxication may present with
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hyponatrimia, cerebral edema, seizure, coma and death
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Normal Sodium Level
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135-145
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Major Function of Sodium
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Regulates fluid since Water follows sodium
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Sodium also does what to neuromuscular responses
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helps transmit nerve and muscle impulses
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Combines with chloride and bicarb to alter pH
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Sodium
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Hyponatremia is a Na level below
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135
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Combines with chloride and bicarb to alter pH
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Sodium
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Hyponatremia is a Na level below
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135
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N/V/D/Abd Cramps, Tachycardia, Hypotension, HA, Lethargy, confusion, weakness, dry pale skin, dry mucous membranes are s/s of which electrolyte imbalance
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hyponatremia
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fatigue, decreased bowel motility, constipation, n/v postural hypotension, U wave after T wave, hypoventilation, drowsiness, decreased deep tendon reflexes, polyuria, nocturia are s/s of which electrolyte imbalance
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hypokalemia
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When doing a specific gravity they are comparing the urine to ________ what is normal
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water, 1.010-1.020
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With hyponatremia you will also have a _____ specific gravity and a _________ Serum Osmolality
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Low (<1.008)
Low (<280) |
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Excessive sweating or excessive ADH can cause
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hyponatremia
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When treating severe hyponatremia what type of IV solution will you use?
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3% or 5% Nacl
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What assessment is important when giving fluids for hyponatremia?
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Lung Sounds- Monitor the fluid balance carefully especially in the elderly and cardiac pts to prevent CHF
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What 3 things can you do for a pt in mild hyponatremia
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-give salt orally
-Ng tube feeds high in NA -0.9% NS or LR |
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Milk, oysters, egg yolks, sardines, dark green leaft veggies, and yogurt are high in
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Calcium
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What is the normal potassium level
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3.5-5.5 mEq/L
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In hypo natremia cells __________ in hypernatremia cells __________
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cells swell, cells shrink
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For hypovolemic hyponatremia you may give ____________ or __________ with fluid restrictions
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Diuretics (osmotic diuretics such as loop diuretics) or ACE inhibitors
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hypernatremia is a value over
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145
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This is the 1st electrolyte usually added to IVF since it is excreted almost completely
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potassium
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Oranges, bananas, apricots, dates, avacados, sweet potatoes, mangos and lentils are good sources of
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potassium
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hypertonic tube feedings without adequate water supplements can cause
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hypernatremia
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What is the max rate you can run KCL
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10meq/hr
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What ekg changes do you see in hyperkalemia
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peaked T waves
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Why do you have tachycardia and hypertension in hypernatremia?
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Na retains H20- fluid overload
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In hypernatremia you have a _______ specific gravity and, Osmolality
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high
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What electrolyte controls hydrogen ions in the acid base balance
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Potassium- they have a recipricol relationship if 1 moves in the other moves out which changes the pH. If it pulls in hydrogen it releases potassium
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Steriods affect 2 electrolytes, what are they
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Na (hypernatremia), K+
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n/v/ anorexia, rough dry tongue, tachycardia, increased bp restlessness, agitation, stupor, muscle twitch, flushed dry skin, dry sticky mucous membranes are s/s of which electrolyte imbalance
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hypernatremia
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You should gradually lower the sodium level to decrease the risk of
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cerebral edema
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Regulates fluid volume in cell, promotes nerve impulse transmassion, contraction of muscles, energy production--- are the roles of this electrolyte
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Potassium
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Pt has a pH of 7.34, pCO2 33.9, HCO3 18.2, Base excess of -6.2, pO2 85.2
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Metabolic Acidosis
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If albumin is low you expect what other electrolyte to be low
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Calcium- it is bound to albumin
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Calcium cannot be absorbed if there is not ___________ in the GI tract
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active form vitamin d
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In order for your diaphram to work which electrolyte do you need
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Mag
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Normal HCO3
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22-29
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Normal PaO2
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80-100
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Normal base excess
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-2 to +2
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Normal pH and PaCO2
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7.35-7.45 and 35-45
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If bicarb increases _______ ventilation occurs
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hypoventillation- (its an attemp to retain CO2 allowing more acid to be formed)
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The ______compensates for metabolic system
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lungs -
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If bicarb decreases _______ ventillation occurs
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hyperventilation- blow off co2 decrease acid
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The ______ compensate for the lungs
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kidneys
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The lungs compensate ________ the kidneys compensate in up to _____ hours
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immediately, 48
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If CO2 increases the kidneys do what
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conserve bicarb
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If CO2 decreases kidneys
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excrete bicarb
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If you are hypoventillating and retaining CO2 you will most likely have this acid base imbalance
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resp acidosis
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This acid base balance is the #1 reason people are intubated
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resp acidosis
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If you are hyperventilating and blowing off too much co2 you will most likely have this acid base imbalance
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resp alkalosis
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The primary factor causing metabolic acidosis is
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addition of amounts of fixed acids to body fluids (circulatory problem)
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Examples of causes of metabolic acidosis
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lactic acidosis, ketoacidosis, renal disease
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What is the minimum water requirement a day
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1000ml/d
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Increased RR, fever, diaphoresis, low humidity and elderly need additional ______
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water
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_______ calories/day are needed for bedrest in adult (not including fever or other causes of increased metabolism)
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1600
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Dextrose is _____kcal/g
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3.4
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What are your fat soluble vitamins
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a d e k (cannot give IV except the synthetic vit k)
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Water soluble vitamins are
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B and C (usually yellow in iv bag)
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Isotonic solutions are used for
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hypotension r/t hypovolemia, volume loss from diarrhea or vomitting
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When giving isotonic fluids you should check for _________ by _________
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fluid volume overload, check bp, pulse, lung sounds
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Hypotonic solutions are used to
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hydrate cells and dec sodium levels, With diuretic therapy when cells are dehydrated and in DKA HHS
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0.20%NS, 2.5% dextrose in water and 1/2NS are types of
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hypotonic fluids
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Hypertonic fluids have a ______ osmolarity
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high (375 or higher) hyperosmolar
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Hypertonic fluids cause fluid to
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be pulled from interstitial and intracellular compartments into blood vessels
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Hypertonic fluids are often given
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post op or to pts with edema
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This type of fluid may irritate vein walls if used for more than 24 hours
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hypertonic
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Crystalloid solutions have solutes that mix with and __________
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dissolve into solution
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Crystalloid solutions are diffuse through membranes so they will difuse out of
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vascular space
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Would you use a Crystalloid solution to expand volume?
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No, you would have to give 3-4 times the volume equal to colloid solution
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Colloid solutions have protein or starch molecules that stay _____________
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in the blood stream they increase osmotic pressure- can stay in vascular space for several days if capillary permeablitly is normal
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Dextrose, NS, D51/2NS, Ringers, LR are all types of ______________ solutions
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crystalloids
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Acute hemolytic reactons occur with
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incompatible RBC's
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Order for 125ml/hr the infusion set is a microdrip tubing with a drop factor of 60gtt/ml, how many gtt/min do you give
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125
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Hematoma from IV looks like ____________ poss reason for hematoma
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discolored skin, swelling, painful, can happen if not taped down properly
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Treatment for Hematoma is to
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Put direct pressure over site after d/c IV, elevate extremity so blood reabsorbs, can use warm moist dressing and document
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IV thrombosis is a _________ the s/s include
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Clot in Vein at iv site- s/s slow gtt rate, meet resistance,
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Prevention of thrombosis includes
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good taping and using a pump
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Treatment of Thrombosis includes
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d/c IV, cold compress (do not elevate), assess site and document
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Phlebitis is a ______- it looks like a ___________
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inflammed vein-red line up vein
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Causes of phlebitis include
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sensitivity to cath, chemical causes are sugar or drugs through line, bacterial cause not clean or post infusion occurs after d/c
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s/s of Phlebitis include
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redness at site, warm to touch, local swelling, palpate cord along vein (feels like iv tubing under skin) slow infusion rate, increased temp (small increase)
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Preventing Phlebitis
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rotate iv site every 72 hrs, use large veins for hypertonic solutions, use central lines for long term solutions, appropriate needles for solutions
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Treatment of phlebitis includes
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D/c Iv, warm or cold compress, follow policy to notify MD and or infection control
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Thrombophlebitis is a ___________ s/s include
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clot and inflammation s/s- sluggish flow rate, edema in limb, tender cordlike vein, warm to touch, red line above site, diminshed pulses, color changes (mottling or cyanosis severe after long term)
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IV sites should be checked how often
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hourly
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Preventing thrombophlebitis includes
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good technique, using gloves
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Treatment for Thrombophlebitis includes
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remove IV and restart in opposite extremity, notify MD (next rounds) warm moist compress, comfort measures and documentation
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Infiltration is __________ s/s include
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seepage of solution into surrounding tissue, s/s coolness of skin, taut skin, dependent edema, no blood return, slowed infusion rate
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Prevention for infiltration includes
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tape well, gentle IV starts, avoid trauma to site
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Treatment for Infiltration includes
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Stop infusion, elevate extremity, warm or cold compress, document and start new IV
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Intermittent infusions are
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saline locks, giving abx
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When giving lidocaine as a local anesthestic be careful not to
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knick the vein
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A transdermal analgesia used before IV start is ______ it takes how long to work
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EMLA, 30min
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Topical Nitroglycerin can be used with a dr order in pts who's veins
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cannot be seen- RARE
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Should you draw blood from an IV
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try not to, unless it has a butterfly in it
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Extravasation is
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an infiltration from an irritating solution that kills tissue and causes necrosis
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s/s extravasation include
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pain or burning, swelling proximal or distal to IV site, blanching and puffiness at site, slowed or stopped infusion
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How do you prevent extravasation
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dont put caustic meds into peripheral vein
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Treatment of extravasation includes
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Stop IV (leave in place) Give antidote, d/c iv, compresses, elevation
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Regitine is a
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antidote that can also be used prophylactically as SQ injections around site if you have to give a caustic material thru peripheral vein
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Local infections of IV s/s
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redness, swelling, purulent material(pus), increased WBC, elevated temp
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How do you prevent IV infections
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Hold fluids up to light to check clarity, asepsis during preparing, mixing IV's, clean for 30 sec if indicated, transparent dressing to observe site,
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A Verous Spasm is caused from
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It should never happen but does, occurs from cold fluid, thick fluid, running IV too fast
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After pulling IV fluids out of the fridge you should
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warm to room temp
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If a patient complains of pain during IV therapy you should 1st
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slow the rate
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s/s of venous spasm
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sharp pain at IV site-can travel up arm, slowed infusion,
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Prevention of venous spasm includes
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dilute meds correctly, warm to room temp medications
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Treatment for venous spasm includes
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warm compress, slow down rate, may need to change IV site if pain continues, document
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As a general rule IVPB's should infuse over
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50mlbag over 30 min
100ml bag over 1 hour |
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KVO rate
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differs at each facility
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Hypersensitivity reactions r/t iv therapy are prevented by
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assess allergies, patient ID
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Hypersensitivity reactions are treated by
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d/c solution, switch to kvo saline, DO not remove IV till another one started (if reaction severe may be your only iv access in emergency), monitor vitals, document
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If the reaction is a true allergic reaction you should do this
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call md
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S/S of Septicemia
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fluctuating fever, diaphoresis(cold sweat) N/V/D, abd pain, tachycardia (may be 1st sign), AMS, Hypotension, Tachypnea,
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How do you prevent septicemia
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wash hands, follow policy ie chloroprep
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Treatment of septicemia
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Call MD, restart IV in opposite extremity, culture IV site and BCx2, IV antimicrobials, monitor pt, document
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What is fluid overload caused from
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Rapid IV infusion, hepatic, cardiac or renal disease, common in elderly and infants
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S/S of fluid overload includes
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edema, lungs, bp
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Preventing Fluid Overload includes
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monitor pt, don't run fluid wide open, watch to see if fluid is doing what it should be
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Treatment for fluid overload includes
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slow iv rate, diuretics, aminophylline (bronchodilator with small diuretic effect-works great for wet lung sounds) document and watch pt
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Pulmonary edema s/s and treatment
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crackles in lungs- aminophylline
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Reasons Air embolism happens
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allowing solution to run dry, staring a new IV bag in a line without clearing the line of air, loose connection , poor technique in drussing and tubing changes on central line (clamp line before change), air in tubing cassettes or pump
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s/s of air embolism
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palpitations, resp distress, cp (not angina more pulmonary) increased HR, decreased BP, restless, AMS
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Treatment for Air emboli
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Call for help, clamp, place head down on left side (air rises want to trap it in R atrium) O2, monitor VS, call MD, document
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Why wouldnt you put a pt in trendelenberg when they have a Air emboli
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it will increase the ICP
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s/s of catheter emboli
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sharp or sudden pain at IV site, minimal blood return, cyanosis, cp, increased HR, Hypotension, PE, cardiac dysrhythmia, death,
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When removing the catheter of suspected catheter emboli you will see
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rough or uneven edges
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Prevention for catheter emboli
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NEVER reinsert needle into cath, use radiopaque catheters (all are this way, can be seen on XRAY
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Treatment for Catheter emboli
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Apply pressure above the insertion site or tourniquet, document
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Speed shock happens when
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occurs when a foreign substance is introduced rapidly into circulation-almost toxic r/t IV running to fast
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S/S speed shock
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Dizzy, light headed, cp, flushing, HA, decreased BP, dysrhythmias, irr. pulse, shock, cardiac arrest
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You should be careful because these 2 age groups have fragile veins
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peds, elderly
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When giving IV meds you should always question
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why does it need to be IV
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Physical Incompatibility of drugs examples
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cannot be exposed to light
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Chemical incompatibility of drug example
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combination of dilantin and dextrose causes crystals to form
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Therapeutic incompatibility with meds includes
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medication interactions
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2 types of malnutrition
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under and over
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Anthropometric means
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types of measurements BMI, ht, wt, body fat
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Serum Albumin and transferrin levels are the best at telling
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visceral stores of protein
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Speed shock happens when
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occurs when a foreign substance is introduced rapidly into circulation-almost toxic r/t IV running to fast
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S/S speed shock
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Dizzy, light headed, cp, flushing, HA, decreased BP, dysrhythmias, irr. pulse, shock, cardiac arrest
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You should be careful because these 2 age groups have fragile veins
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peds, elderly
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When giving IV meds you should always question
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why does it need to be IV
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Physical Incompatibility of drugs examples
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cannot be exposed to light
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Chemical incompatibility of drug example
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combination of dilantin and dextrose causes crystals to form
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Therapeutic incompatibility with meds includes
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medication interactions
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2 types of malnutrition
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under and over
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Anthropometric means
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types of measurements BMI, ht, wt, body fat
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Serum Albumin and transferrin levels are the best at telling
|
visceral stores of protein
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When evaluating nutritional status what physical things should you look at
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hair, eyes, mucosa, muscle mass, bowel movements, gloss of skin
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When giving TPN you should have insulin on hand because
|
D50 is in TPN
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In TPN which vitamins can you give
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water soluble and vit k
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Heparin may be in TPN for what reason
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to keep line clear
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histimine 2 inhibitors would be in TPN to
|
decrease ulcer risk
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Complications of Parenteral Nutrition include
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pneumo, air embolism, vein thrombosis (use filters, arm will swell) catheter malposition, rebound hypoglycemia, hyperglycemia, sepsis,
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DKA happens in type ___ diabetics where as HHS occurs in type ____
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1----2
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decreased insulin in DKA causes the inability to use glucose for energy which causes the body to ___________
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breakdown of fats for fuel
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Ketones are
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by products of fat metabolism
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A pt with DKA presents with which s/s
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polydipsia, polyuria, polyphagia with wt loss, dyspnea, and general malaise (ketones are building up causing met. acidosis)
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DKA pts usually have kussmaul respirations which are
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rapid and deep
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Dka pts usually have breath that smells like
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acetone, sweet and fruity
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To Dx DKA they must have
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BS above 300 with KETONES (big differential of dka)
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What IVF and how much do you expect to give a dka pt
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1/2 NS or NS up to 1L/hr till BP comes up and UO is 50-60ml/hr
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After the DKA pts BS is 250 you change your IVF to ________ why?
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d51/2NS to avoid insulin shock (decrease risk of rebound hypoglycemia)
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What rate do you start an insulin gtt at
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0.1u/kg/hr
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In HHS the body is doing what with insulin
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body is still making some but not enough
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HHS will lead to hypovolemia what will a HHS pt present with
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over 60yrs old, lethargic, coma, the BS will be over 1000(much higher than DKA) and high osmolarity
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What fluid and rate would you run on a pt with HHS
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300ml/hr NS or 1/2 NS
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Nursing care for both HHS and DKA includes
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frequent VS, monitor UO, neuro checks and monitor electrolytes
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As insulin takes glucose into the cell it also takes
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potassium
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The liver and gallbladder are in which abd quadrant
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RUQ
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The spleen is in which quadrant
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LUQ
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What quadrant is the appendix in
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RLQ
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The pancreas is in which quadrant
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LUQ
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Light palpation is how deep? Deep palpation is how deep?
|
1-2cm
3-4cm |
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How long must you listen to each quadrant before saying bowel sounds are absent
|
1 min per quadrant + 1 additional min in middle= total of 5 min
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When performing a test for rebound tenderness how do you palpate? What is it testing for?
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Push deep and let off fast at an area away from pain, it is testing for peritonitis
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Normal Bilirubin level are
|
2-3mg/dl or 34-50 mol/L
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How high would bili levels be to see jaundice
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3x normal
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Hemolytic Jaundice takes place before the ________ it is a increase in _________ that causes
|
liver
breakdown of RBC's Increased unconjugated bile |
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What causes hemolytic jaundice
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transfusion reactions, sickle cell crisis, hemolytic anemia
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Hepatocellular Jaundice is
|
an actual problem with the liver- liver can nt take up bili from the blood or conjugate it or excrete it
|
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Obstructive Jaundice is
|
post hepatic- obstructive flow of bile through liver and biliary system
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2 types of obstructive jaundice are
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Intrahepatic-swelling or fibrosis
Extrahepatic-obstruction of common bile duct |
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What does icteric mean
|
jaundice
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3 phases of hepatitis are
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1. preicteric or prodromal
2. Icteric phase 3. Posticteric Phase |
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The Preicteric phase of hepatitis is before they become _________ are they infectious? ______ and how long does this phase last.
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jaundice
YES- often don't know it 1-21days |
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s/s of preicteric phase hepatitis
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gi symptoms, HA, joint pain, low grade fever, enlarged lymph nodes and liver
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The icteric phase is ______ it lasts _______ often the urine looks __________ the fever _______
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when they are jaundice
1-4 weeks tea colored subsides |
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Questran is a drug used for
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pruritis-bile salts ooze out of skin causing itching during icteric phase
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The postichteric phase of hepatitis lasts _________ you will see what symptoms _____________
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2-16wks
decreased hepaomegaly, decreased jaundice, fatigue and improving appetite |
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Do all patients with viral hepatitis have jaundice
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no
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