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89 Cards in this Set

  • Front
  • Back
Hyponatremia
below 135 mEq/L
Hypernatremia
above 145 mEq/L
Hypokalemia
below 3.5 mEq/L
Hyperkalemia
above 5 mEq/L
Hypocalcemia
below 8.9 mg/dl
Hypercalcemia
above 10.1 mg/dl
Hypomagnesemia
below 1.5 mEq/L
Hypermagnesemia
above 2.5 mEq/L
Signs and Symptoms: Dehydration
DRY MUCOUS MEMBRANES
poor skin tugor, weight los, fever, increased RR, BP low
Dehydration
Hypotonic Solutions- D5W- SLOWLY--> Cerebral edema if given too fast
Hypovolemia
loss of fluid AND solutes ( hemorrhage)
Tachycardic- compensate for lack of circulating volume
BP drops, less than 30 ml/hr of urine
restless, shock
SHOCK
Bp down, Urine Down, HR INCREASE
Hypovolemia Treatment
ISOTONIC= same level of each lost
NS or LR
Dopamine ( raise BP) = vasopressors
LOWER HOB
Hypervolemia
excess water and Na in extracellular space
rapid pulse, increased BP, distended veins, edema ( dependent areas), weight gain, crackles in the lungs--> Pulmonary Edema
Hypervolemia Tx
restrict Na and fluid
STOP IV
diuretics
MOrphine ( air hunger is present-lowers RR)
RAISE HOB
Hyponatremia
excess h20, increased Na loss or deficient Na intake
headache
nausea
lethargy
Hyponatremia Tx
Hypovolemic- IV NS and high sodium foods
Hypervolemic- restrict fluids, replace NA
Tx of Hyponatremia
GIVE IV SLOWWWLY!!! Can cause fluid overload--> irreversible brain damage
Hypernatremia ( rare)
>145--thirst prevents this from happening
Causes of Hypernatremia?
MODEL ( Medications, osmotic diuretics, diabestes inspipidus, excessive fluid loss, low water intake)
Signs and Hymptoms of Hypernatremia
SALT
skin flushed
agitation
low grade fever
thirst
Na
big time responsibility for fluid balance and nerve impulse control
Potassium
3.5-5 mEq/L
within the cell
neuromuscular transmission
skeletal and cardiac muscle contraction and conductivity
Hypokalemia Causes
< 3.5
diuresis
vomiting, diarrhea
poor intake
low Mg levels--renin--aldosterone = K secretion
S&S Hypokalemia
muscle paralysis ( repiratory/cardiac)
decreased DTR
decreased pulse
polyuria- dumping K
Tx of Hypokalemia
IV potassium replacement if severe:
GIVE THROUGH CENTRAL LINE--SLOWLY--CARDIAC ARREST IF TOO FAST!!!!!
NEVER GIVE POTASSIUM IV PUSH!!!
Hyperkalemia
>5mEq
-use of salt substitutes
-Beta-blockers, chemotherpay, K-sparring ( destroy cells--leak)
Hyperkalemia S&S
muscle weakness
crampls
decreaed pulse and BP ( iregular and slow)
decreased CO ( cardiac arrest)
TX of Hyperkalemia
hemodyalysis
Kayexelate/Sorbitol
EMERGENCY= 1-% ca gluconate ( treats cardiac changes)
Insuilin with hypertonic dextrose
Infilltration
leak into extravacular tissue
edema, tight skin , coolness, tender
STOP infusion, remove, cold compress, elevate
Phlebitits
red, painful, vein is hard/cordlike
inflammation of the vein
remove catheter, warm compress, start new cath in opp extremity
Echymosis/Hematoma
bruise
small intestine
absorption( carbs protein)
Large intestine
primary organ of elimination
strongest peristalsis
defacation begins with desending colon
straining bad for
cardiac problems
glaucome
increased intercranial pressure and increased BP)
Constipation
symptom, not a disease
<3 bm/week
hard feces= more water absorbed
Diarrhea
loose, unformed stool
causes: antibiotics, NG tube feedings, foodborne pathogens, C-dipth
Flatulence
inability to control feces and gas to the anus
abdominal surgery, opiates, general anesthesia
Ileostomy
bypasses the large intestine- waterry/frequent stool
ascending- watery
transverse- little more formed
desending- normal looking
Clay or white bowel
no bile
Tarry black bowel
BLOOD- Upper Gi bleed
Red bowel
lower gi bleed OR hemorroids
Mucosy bowel
infection or collitis
Strong odor in bowel
blood or infection
Acute Pain
trauma, inflammation, ischemia, surgery
localized
subsides without treatment
acts as a warning signal
Chronic Pain
LONG term > 3 months
healed injury but healed poorly
emotional response/behavioral
Non-Opiod Tx
first line for mild-moderate pain
aspirine, tylenol, NSAIDS
NSAID ( ibuprofen)
GI Upset, bleeding, nephrotoxicity, CHF, drug interactions with antihypertensives
Opiods
block release of neurotransmitters

Codeine, Hydrocodone, Morphoine, Hydromorhopne, fentanyl, methadone, tramdol, meperidine
Codeine
short acting weak
can cause constipation in older adults
need enzyme to break down...
Opiod Side Effects
NV- antiemetic
COnstipation
Sedation
respiratory depression
Normal Flora
competes with microorganisms to prevent infections
do NOT cause disease- prevent them!
Droplet transmission
Flu
droplets don't stay susended in air
Airborne transmission
TB
leaves host and enters host BUT these are suspended in air for longer periods of time
standard precautions
gloves, masks, gown, goggles
( splash)
Airborne
negative pressure rooms
(air from hallway in)
high filtration masks
Droplet
private or co-hort room
weak mask if close contact
COntact
private or co-hort
gloves, gown, specific equipment
Infection : Physical infection
pain, swelling, heat, redness, puss, lymphadenopathy, GI upset, sore throat, photophobia, fever > 100.5
Hyperthermia interventions
FEVER
antimicrobial, antipyretic therapy
External cooling, fluid administration and NO FANS!
sponge with tepid water, hyperthermia blanket
Fever
fluid loss ( sweating)-- increased thirst, decreased skin tugor, dry mucous membrane---disorientation
Shivering
cooled too quickly using energy to create heat--fever will spike again
Calcium
bone strength, bone density, cardiac muscle contraction, transmit nerve impulses, clotting
8.9-10.1 mg
Ca and PTH
serum Ca is low--pth released--draw CA into plasma from bones increasing serum level
CAlcitonin
increases and lowers by inhibiting Vtamin D activation
Hypocalcemia S&S
anxiety/confusion/irritability
muscle twitching ( initial painful muscle spasms)
trousseau and chvostek sign
Trousseu
inflate bp cuff for 1-4 minutes...will have a palmar flexion
Chvosteks
tap below and front of ear...will cause facial twitching for patient...side of mouth by nose
Hypocalcemia Tx
Acute: calcium gluconate or chloride IV
Chronic: oral replacement with vitamin D
Ca Seizures
risk of seizures...
take precaution
Hypercalcemia causes
>10.1
loss of calcium INTO bone plasma
prolonged immobility
osteoporosis
excess intake ( antacids)
bone tumors
Hyperparathyroidism
pulls more Ca from bone ( excess in ECF) kidneys holding onto it
Hypercalcemia SS
personality change
fractures ( serum level is high)
excessive clotting
Hypercalcemia Management
weight bearing exercise
IV NS
loop diuretics
ambulate
Magnesium
1.5-2.5
tied in function to Ca
low mg= low pth= decreased Ca
MEagnesium Functions
carb metabolism
produce ATP
moves Na and K across cell membrane
influences vasodilation
cardiac and muscle contractility
cofator in clotting cascade
Hypomagenesemia CAuses
<1.5
alcoholism
uncontrolled diabetes mellitis
malabsorption, starvation
renal disease ( dumping)
Hypomagenesia Symptoms
tetany, irritability
Chvostek's sign
dysrhtymias, HTN
NVAC
Hypomag Management
slow infusion of MgSo4 NO IM
dietary intake
reduce environmental stimuli
avoiding laxatives
Hypermag Causes
>2.5
Chronic renal failure ( not dumping)
excessive intake-- ABUSE ANTACIDS--takes lots of laxatives
Hypermag Symptoms
>2.5
BP drops
bradycardia, weak pulse
respiratory weakness
CARDIAC DYSRHTYMIA AND MUSCLE TETANY
Hypermagnesium Management
dialysis if renal failure
IV fluids
loop diuretics
Ca ( reverse cardiac affects)
Diet therapy: limit nuts, beans, fish, whole grains
SYmptoms if DIstress at End of LIfe
pain, dyspnea, cheyne-stokes, lethary, restlessness
Kubler-Ros Theory of DEath and Dying
Depression
Anger
Bargaining
Denial
Acceptance
Blood transfusion needle gage
18,19 or 20
Autologous Transfusion
collects their own blood for 5 weeks before surgery
1-5 units
Starting transfusion
remain with client for 15 minutes
slowly
finished infusing within 4 hours
tell client to tell you if they feel ANYTHING
Transfusion Reaction
flush with saline
notify MD
remain with patient
save the blood product, tubing
Documentation of Restraints
1 hour- Doc to give order
24 hours- order is good for
2 hour- assessment results
15 minutes- eyes on them
30- circulation and neurovascular