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157 Cards in this Set
- Front
- Back
Immobility, bone Ca, excess intake, incr. parathyroid hormone & thiazide diuretics are all causes of ___________.
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causes of hypercalcemia
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Actual excess: overuse of salt substitutes, rapid IV LR, multiple blood transfusions can cause _________.
relative excess: CRF, overuse of K-sparing diuretics, tissue damage, acidosis |
hyperkalemia
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Renal failure & excess use of magnesium-containing antacids can cause _____________.
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hypermagnesemia (rare)
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Excess IV saline, hypertonic tube feeds w/o enough water can cause __________.
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hypernatremia (Na+)
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A pancreatic or small intestine disease, acute renal failure, vit D deficiency, hypoparathyroidism, & hyperphosphatemia can lead to ____________.
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hypocalcemia
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A loss of intestinal fluids, malnutrition, renal probs, loop diuretics, parathyroid hormone deficiency can cause __________.
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hypomagnesemia
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In regards to fluid movement between extracellular & intracellular; A water __________ (increased ECF) is associated w/symptoms that result from cell shrinkage as water is pulled ____ the vascular system.
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deficit
into |
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Macro-vascular disease is most common with which type of diabetes?
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type II
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Phosphate imbalance is assoc. with _____ and parathyroid probs
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Ca++
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s/s of hypercalcemia
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constiptaion, N/V, polyurea, renal stones
decreased muscle tone deep bone pain decreased reflexes lethargy coma |
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s/s of hyperkalemia
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diarrhea
abd cramps muscle twitch cardiac irregularities resp. failure |
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s/s of hypermagnesemia
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hypotension
cardiac arrest resp. depression decreased reflexes |
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s/s of hypernatremia
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thirst & elevated temp
restlessness seizures muscle twitch rubbery skin dry MMs tachycardia fast thready pulse decr. urine output |
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s/s of hypocalcemia
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tetany
tingling/numbness in xtrmitys facial muscle spasm (Chovstek's sign) carpopedal spasm (Trousseau's sign) laryngospasm dyspnea hyperactive reflexes seizures, arrhythmias |
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s/s of hypokalemia
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muscle weakness & leg cramps
constipation irritability & confusion irregular pulse, heart block orthostatic BP shallow resp |
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s/s of hypomagnesemia
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confusion
hallucinations seizures increased reflexes parasthesias tremors, spasms arrhythmias |
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s/s of hyponatremia
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anorexia, N/V, cramps, muscle weakness, lethargy, confusion, seizures, Na+ <135 mEq/L
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Those with type II diabetes are often...
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overweight
dyslipidemic (high cholstrol) hypertensive |
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Type I is characterized by a lack of _______ and a relative excess of _______
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lack of insulin and excess of glucose
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What accompanies macro-vascular disease?
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coronary arterty disease
stroke peripheral vascular disease |
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What accompanies micro-vascular disease?
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retinopathy- retna ascempia
diabetic nephropathy- destruction of kidneys due to damage of glumaria |
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What are the symptoms associated with type I?
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hyperglycemia
loss of glucose in urine polyuria polydipsia |
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What does insulin do in type I?
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reduces the blood glucose level
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What does sulfonylureas do?
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stimulates insulin release from pancreatic beta cells
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what is ketoacidosis?
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increased glucose and ketones and makes breath smell fruity and sweet
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what is macro-vascular disease?
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athrosclerosis, thickening of arteries
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What is the classic symptom of type I?
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weight loss
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What is the diagnosis for Diabetes Mellitus?
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-More than one fasting glucose level greater or equal to 126.
-Plasma glucose level in the 2nd hr of the standard oral glucose tolerance test (OGTT) is greater or equal to 200, confirmed on subsequent day -random plasma glucose level greater than 200, confirmed with classic symptoms of polyuria, polydipsia, and polyphagia |
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Alcoholism can cause what?
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hypophosphatemia, hypomagnesemia, hypokalemia, and hypocalcemia
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What are the 3 functions of phosphate
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1-acid base balance
2-muscle contractions 3-nerve conduction |
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Phosphate has a relationship with what other electrolyte?
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Calcium, also vit D
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Phosphate is found more abundant in which fluid?
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ICF
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Why is it important to monitor I & O of a patient with hypermagnesemia?
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may indicate renal failure, also may be hypokalemic
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What would ask a hypermagnesemic patient to avoid?
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antacids w/ magnesium
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Clinical manifestations of hypermagnesemia would include:
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weakness
lethargy weak/absent deep reflex hypotension flushing slow arrythmia(Cardiac arrest) respiratory depression |
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hypokalemia, hypocalcemia, poor GI absorption, alcoholism, can cause what?
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hypomagnesemia
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What are the 4 main functions of Magnesium?
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1-neuromuscular activity
2-heart contractions 3-transport Na + K across membrane 4-activates many enzymes for metabolism of carbs, proteins, vit b |
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Magnesium is the 2nd most abundant electrolyte in what fluid?
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ICF
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If you correct the potassium levels this usually corrects what other electrolytes?
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calcium and magnesium
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Which type of diuretics can cause hyperkalemia?
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Potassium sparing/Aldactone
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Which diuretics can cause hypokalemia?
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loop diuretics(lasix)
Thiazide diuretics |
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What two meds are given with severe hyperkalemia in order to rid the body of K+ and replentish k+ absorption in cells?
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Kayexlate and insulin/dextrose
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When the hormone aldosterone is secreted the kidneys reabsorb _______ and excrete ______?
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kidneys reabsorb Na+
and excrete K+ |
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If a patient has a K+ of 2.5 what will happen to the patients heart?
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Arrythmias
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What hormone controls glucose levels and also causes K+ to move into the cells?
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Insulin
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Name some food high in potassium
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Bananas/fruit
Nuts Meat |
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If the kidneys are damaged or there is a markedly decrease in urine output what happens to potassium?
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k+ concentration increases in the ECF
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What are the functions of Potassium?
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1-contraction of skeletal/smooth muscle
2-transmission/conduction of nerve muscles 3-strengthens heart muscle contraction/conduction |
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Potassium is predominantly in what fluid?
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ICF
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Sodium is found predominantly in what fluid?
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ECF
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What are the clinical manifestations of Hypervolemia ??
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Edema
Full bounding pulses Moist breath sounds (crackles, rhonchi) Distended neck veins Moist skin |
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What happens in Hypervolemia?
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retain water & Na+ so serum lab values remain normal
Manifests as edema & increase in fluid volume. Condition usually secondary to elevated Na+ content in the body from excessive intake of Na+ Cl-Na+ containing IV fluids renal failure, cirrhosis, heart failure & Cushings |
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What are the clinical findings of Hyperphosphatemia?
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Hyperphosphatemia can be caused by damage to cells which forces PO- into ECF,
overuse of laxatives PO4 infants fed cow’s milk causes numbness & tingling in fingers & around mouth muscle spasms & tetany |
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Phosphate Imbalances in the body are usually related to??
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Imbalances are usually related to treatment for other disorders such as glucose or insulin administration which forces phosphate into the cells from the ECF
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What are the clinical signs of Hypochloremia??
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Hypochloremia-related to loss from GI tract
causes muscle twitching, tetany and tremors |
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Imbalances are usually related to
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Imbalances are usually related to changes in the sodium(Na+) level.
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What is Sodiums job in the body?
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and major contributor to serum osmolality
Controls and regulates water balance “Where Na+goes; H2O follows”-maintains ECF volume |
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Caution about clients and Magnesium...
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Any one who cannot take in Magnesium orally or parenterally is at risk for Magnesium deficiency.
Clients with altered renal function are at risk for hypermagnesemia |
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What is Magnesium used for in the body?
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Needed for DNA and protein synthesis, ATP production, neuromuscular and cardiac function
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Where is Magnesium found in the body?
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Found mostly in the skeleton and intracellular fluid
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What are the Magnesium-norm values in a adult?:
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1.5-2.5
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What is the Physical Assessment of the Client with Fluid Volume Imbalance findings?
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HEENT/Integument
Cardiovascular System Respiratory System Gastrointestinal System Genitourinary Musculoskeletal |
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What is the minimum expected amount of hourly urinary output for a healthy adult?
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30cc/hr
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What supports and maintains bones and teeth in conjunction with Ca++?
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Phosporus
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you have a pt who is experiencing parasthesia and muscle weakness. What are they suffering from?
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Hyperkalemia
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you have a pt who is taking loop diuretics and they are experiencing leg cramps and muscle weakness. What are they suffering from?
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Hypokalemia
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What is the purpose of stimulating the release of aldosterone with low BP, in general or low pressure through the kidney, specifically?
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To conserve water in order to increase plasma volume.
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What electrolye imbalance usually results from kidney dysfunction, and also results in cardiac dysfunction from hypoaldosterone secretion?
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hyperkalemia
(high plasma postassium) |
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Does aldosterone directly regulate plasma postassium concentration?
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yes
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What stimulates the release of aldosterone?
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low plasma sodium/
high plasma potassium |
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What does aldosterone act on?
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The renal cortical collecting duct cells to promote the movement of sodium from the filtrate back into the blood
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Why are diabetics always thirsty?
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Because there is an increased plasma osmolarity because of the increased glucose so the regulators are always being stimulated
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What is the principal regulator of water intake?
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Thirst
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How is fluid balance regulated?
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By regulating intake (thirst) and output (kidneys)
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What is water indirectly regulated by and how is it regulated?
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Aldosterone- because it regulates sodium and wherever sodium goes water follows
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What are the two components of extracelluar fluid?
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Plasma and interstitial fluid
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What are the two most important intracellular solutes?
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Potassium and protein
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What are the two most important extracellular solutes?
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Sodium and protein
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Elevated osmolarity is indicative of what?
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Increased solute (sodium) and decreased fluid (water)
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A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for a fluid volume excess?
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Client w/renal failure.
The causes of fluid vol. excess include decr. kidney fxn, CHF, the use of hypotonic fluids to replace isotonic fluid losses, excessive irrigation of wounds & body cavities, excessive ingest of Na+. Client w/an ileostomy, client on diuretics, & client on GI suctioning are at risk for fluid volume deficit. |
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Treatment for Mg+ deficit
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Seizure and safety precautions
monitor airway aspiration precautions increase Mg+ rich foods Mg sulfate IV |
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Characteristics for Mg+ deficit
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mental changes, disorientation, mood changes, intense confusion, hallucinations
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PO4 Helps acidify ______ to decrease stones & has an inverse relationship w/_____
If blood Ca++ is _____, phosphorus level is high Regulated by ___________. |
urine
Ca++ low PTH (parathyroid hormone) |
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Hypophostemia is caused by _____ & ______ administration in addition to _______ alcohol _________, & diuretic use.
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Glucose and insulin
withdrawal |
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Treatment for hypophostemia is to ___________.
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Encourage phosphorus foods
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Causes for hyperphosphotemia are ______therapy, _____ failure, ______ enemas, & a large intake of Vitamin __
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Chemo
Renal Phosphate Too much Vit D |
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Your patient presents w/ cardiac irregularities, hyperreflexia (Chvostek’s & Trousseau’s sign), is eating poorly, exhibits muscle weakness, parethesia, oliguria & numbness. You suspect hyper________.
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Hyperphosphotemia
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Treatment for Hyperphosphotemia is?
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Monitor for signs of hypocalcemia
Adequate hydration |
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Magnesium (Mg) levels are Normal @ 1.8 – 2.7 mEq/L & excreted by _____ , & assists in metabolism of CHO & ______, maintains _______ activity in nerves & ______. Mg is important for __________ function.
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Kidneys
proteins electrical muscles neuromuscular |
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When Mg is out of balance THINK _______ problems & the effect that could occur on the ______ system. Mg & ___ levels tend to increase and decrease together. Mg makes the vascular system _________.
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muscle
nervous K+ vasodilate |
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Causes of hypomagnesaemia are
________, ________, _______, & bulemia. |
Diarrhea
alcoholism anorexia bulimia |
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Treatment for hypomagnesaemia
is to administer ___ Sulfate, keep _______ gluconate & ____ tray at bedside, assess ______ reflex & take _______ precautions |
Mg
Calcium trach swallow seizure |
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Causes of hypermagnesaemia are _______ use, ______ failure, & hyper____________.
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laxative
renal hyperparathyroidism |
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THINK Hypermagnesaemia THINK _____________?
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think Sedative
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S & S of Hypermagnesaemia are reflexes ________, EKG changes, _______ & vomiting, _______ appearance caused by __________ & lethargy. Treatment is ______Calcium gluconate
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decreased
nausea flushed vasoldilation Calcium |
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The parathyroid pulls _______from bones & is found in bones & ______.
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calcium
teeth |
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____________ keeps calcium in the bones.
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Calcitonin
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Ca+ has an inverse relationship w/ ____. You must have vitamin ___ to utilize calcium.
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PO4
D |
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Ca+ functions are ______ impulse transmission (muscle contraction and relaxation), helps w/blood ______, is needed for vitamin ____ absorption, & must have for strong bones & teeth.
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nerve
clotting B12 |
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Causes for hypocalcemia are hypo __________, radical neck, thyroidectomy, _________, & ___________. removal.
Alcoholism, parathyroid removal |
HYPOparathyroidism
alcoholism parathyroid removal |
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S & S of hypocalcemia are muscle tone; ______ & Trousseus sign, Arrhythmias, deep _______ relfexes, mind changes, & _____ difficulties.
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Chvostek’s
tendon swallowing |
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Treatment for Hypocalcemia is Vitamin __, Amphogel, IV ___ gluconate, __________ tray, ____ bag.
|
D
Ca+ Tracheostomy ambu |
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Hypercalcemia is caused by Hyper___________, thiazides, & ___________.
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Hyperparathyroidism
immobilization |
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THINKING Sedative? THINK ___________?
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Hypercalcemia
|
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S & S of Hypercalcemia are kidney ______, deep tendon _______, muscle tone, LOC, change in ______ _______. Treatment is fluids, phospho____, Lasix, & get patient __ & mobile ASAP!
Must have _______ gluconate & _____ tray at ____side. |
stones
reflexes vital signs soda up Calcium trach bed |
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When Na is retained so is ______Chloride.
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Chloride (Cl-)
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__________ is associated with Na.
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Chloride
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Causes of Hypochloremia are ____ salt intake, exclusive D5W, Diuresis, ________ N&V, diarrhea, ____ suctioning & ______ fibrosis
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low
prolonged NG Cystic |
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S & S of Hypochloremia are agitation & ___________, hyperactive deep-tendon reflexes, muscle ______ & ________ tetany, weakness & _______
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irritability
cramps tetany seizures |
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Treatment for Hypochloremia is IV chloride & ___ replacements. Use NS NOT _____ water to irrigate NG
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K+
tap |
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Causes of Hyperchloremia are __________Increased intake, excess _____, metabolic ________, & _______ renal failure
|
Increased
salt acidosis renal |
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S & S of Hyperchloremia are ____ & lethargy, hyper _____, Kussmaul’s _____, tachycardia & _____.
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weakness
natremia breathing edema |
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Treatment for Hyperchloremia is to _______ vital signs, & _______ considerations
|
monitor
safety |
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With hyperchloremia DO NOT not use _______ water.
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tap
|
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When Na+ is ___ , ___ is down.
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up
K+ |
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If Ca+ is up then ___ is down.
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PO4
|
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Mg decreases _______ pressure, causes vaso_____, is found in ____, & causes ___________ in pregnant women.
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blood pressure
vasodilation bone hypertension |
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If a patient presents a positive Chetwicks sign, check _______ & _________ reflex.
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gag & swallow
|
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If Ca+ is down, ___ is up.
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PO4
|
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Treatment for hyperkalemia (excess K+) is ________ which is usually given by enema b/c it binds to K+ in the ____________intestine to decrease K+ level
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Kaexelate
large |
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The number one cause for hypophostemia is _________. What foods should the RN order in the patients diet in response?
|
alcohol
Vitamin D rich foods yogurt milk |
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With fluid volume overload what electrolytes would a patient be low on?
|
Na+
also: Cl- imbalances are affected by Na+ imbalance due to their close relationship |
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A symptom of fluid volume overload would be a ________ because ingesting too much water in a short period of time flushes ___ out of ECF thus causing water to move into ICF. Cells swell within confines of the ______.
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severe headache
Na+ skull |
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Sedimentation reveals the __________ of a disease.
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progression
|
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When a urine specimen is required the RN should consider the patients _______ to participate in the collection.
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ability
|
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If a urine specmen cannot be delivered to the lab within 15-20 minutes it should be ________.
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refrigerated
|
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If a urine specimen has been refrigerated for 25 hours the RN ________.
|
discards it
a new specimen will be necessary |
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What test is used t determine renal fxn & proteinuria in diabetics?
|
Timed Urine Specimen
|
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The RN needs a urine specimen from a non-toilet trained child. What method will she use to collect the specimen?
|
Pedi bag
|
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The proceedure for a Timed urine specimen is to wear _____ & discard the ___ specimen. Documentation would indicate the ___ & ___ the test was started. The RN would have the patient drink an adequate amount of fluid. The RN would place a sign in the ____ & on patients _____.
The RN would measure _____ of ____ void & record. |
gloves
1st date & time bathroom door volume each |
|
Occult blood in stool measures for microscopic __________ in feces.
|
amount of blood
|
|
What could interfere with an occult blood test?
|
red meat
a woman on her period |
|
Red meat can result in a ________ result in an occult blood test.
|
false positive
|
|
A specimen collected to aid in the diagnosis & treatment of bronchitis & lung cancer is a ?
|
sputum specimen
|
|
What are the 3 types of sputum specimens?
|
cystolgy
culture & sensitivity TB (acid fast bacilli) |
|
A TB (acid fast bacilli) test requires 3 consequtive ________ samples & cultures for up to _______ weeks
|
morning
8 |
|
When collecting a sputum sample the patient should be in _______ position & instructed not to _______. Is instructed to take 3-4 ____ breaths, exhale _____, & cough after full _______ & then expectorate sputum into container.
|
semi fowlers
touch the inside of the container deep slowly inhalation |
|
A sputum test should be taken before ________ & the patient should be instructed not to use ________ or _________ before the specimen is collected.
|
breakfast
mouthwash or toothpaste |
|
The best time to collect a specimen from a wound is _______.
|
during a dressing change
|
|
Conditions that can interfere with testing for Occult Blood in Stool are ?
|
• Menstrual period
• Hemorrhoids • Diet • Drugs |
|
An occult blood test is usually comprised of ___ specimens once ______ for 3 days
|
3
every |
|
Guidelines for a diagnostic procedure are to assess patient’s ________, determine patient’s knowledge for _____ findings, for prolonged ____ time, previos history of problems w/_____ & allergies, special instructions.
• Example: Patient must be NPO • Diabetics • Age-related Rest periods • When in doubt always collect a specimen |
base line VS
abnormal clotting anesthesia |
|
Removal of fluid from the peritoneal area is called?
|
Abdominal Paracentesis
|
|
The accumulation of serous fluid in the peritoneal or abd cavity as a result of portal hypertension is called?
|
• Ascites
|
|
For abdominal paracentesis the RN should always Measure the ______ _____ before & after.
|
abdominal girth
|
|
Maximum fluid withdrawn from a abdominal paracentesis is _______.
|
1500mL.
|
|
The RN's responsibility for a abd paracentesis procedure is set up ____ w/supplies, position patient in ___________or in chair w/feet supported, _____ procedure to patient as physician procedes & take VS __ during procedure & ___ for an hr post procedure, monitor for ______ shock, check _____ post procedure & measure abdominal girth.
|
sterile tray
Semi-fowlers or sitting upright on side of bed describe q 15 min q 15 min hypovolemic dressings |
|
A patient who experiences acute abdominal pain during or after a ABD paracentesis may indicate ___________.
|
perforation of the bowl
|
|
A radiographic visualization of the vasculature of the heart and arterial system after injection of radiopaque contrast material is called a __________. In this procedure a small radiopaque ________ is threaded through the artery to the site & a _______ medium is inserted.
|
Angiography
catheter contrast |
|
When an Angiography is ordered the RN assesses patient’s ________ of the procedure, takes ___, locate & mark peripheral _____, arranges NPO for ____hrs, assess for _____ allergy
|
understanding
VS pulses 6-8 hours iodine |
|
Medications administered for a Angiography are:
_____ to decrease salivary secretions _____to decrease allergic response _____to reduce anxiety and promote relaxation |
Atropine
Benadryl-prophylactically Sedative |
|
During a Angiography the patient is in ______ sedation but the RN teaches the patient that during the injection of the dye they may experience _________.
|
IV Conscious sedation
some chest pain and hot flash that twill last a few minutes |
|
After a Angiography the patient presents with decreased peripheral pulses, coolness, mottling, pallor, pain, numbness & tingling in the affected extremity. The RN knows these are signs of signs of __________ tissue perfusion & calls the Dr. _________.
|
decreased
immediately |
|
When a patient experiences decreased tissue perfusion & calls the Dr. immediately, she will also apply a _______ dressing to the vascular access site & keep the patient at bedrest for _____hrs, & ________ the extremity for _____hrs after the catheter is removed & encourage __________.
|
pressure
4-8hrs immobilize 6-8hrs 1-2 liters of fluids post procedure |
|
Examination of the tracheobronchial tree through a lighted tube with mirrors via the mouth is called a ________?
|
Bronchoscopy
|
|
Assessment of a patient for a Bronchoscopy includes patient’s understand of procedure, VS & ____OX, _____ to anesthesia, spraying throat w/_______, ___ for 8 hours, & may use _____
|
pulse
allergy lidocaine NPO IVCS |
|
Procedure for a Bronchoscopy the RN instructs patient not to ______ local anesthetic & provides ____ basin, asseses _____ status thru out procedure, & Post procedure does not allow the patient to ___or___ until ___ is present.
(2 hours, Test w/ tongue depressor) |
swallow
emesis respiratory eat or drink gag reflex |