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156 Cards in this Set
- Front
- Back
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What are errors in Testing usually caused by?
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Multiple sample technique, Dilution with excess anticoagulant, Inadequate flushing of a sample line, Incorrect technique using a pulmonary artery catheter
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What are the 3 responsibilities of the Nurse when interpreting lab values?
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Assessment, Intervention, Evaluation
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Which of the following is not a responsibility of the nurse when it comes to lab reports?
A. Assisting during the course of the test B. Monitoring the results of the test C. Ordering treatments as a result of the test. D. Preparing the patient for the test |
C. Ordering treatments as a result of the test.
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What is the chloride level useful for?
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Useful in diagnosing acid-base and water balance
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What is a normal Magnesium level?
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1.5-2.5 mEq/liter
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What are some reasons for decreased Magnesium?
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Chronic diarrhea
Diuretic use Malabsorption syndrome Prolonged gastric drainage |
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What are some reasons for increased Magnesium?
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Renal failure or insufficiency
DKA before treatment (after treatment there may be a low MG level) Dehydration |
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Magnesium is what type of electrolyte?
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An intercellular cation (moves with potassium)
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What is a normal Potassium level?
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3.5-5.5 mEq/liter
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What is Hypokalemia
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Low potassium
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What type of electrolyte is Potassium?
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intracellular remember Potassium is within the cell
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Why is potassium important?
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Important for the rate and force of cardiac contractions and cardiac outpout
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What are symptoms of Hypokalemia?
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muscle weakenss, decreased LOC, irregular heart rate
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What are causes of hypokalemia?
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Diarrhea, pyloric obstruction, starvation, malabsorption, severe vomiting, severe burns, diuretic administration, NPO status with no Potassium replacements
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What is the most common hypokalemia cause?
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Diuretic administration
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What is hyperkalemia?
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High Potassium greater than 5.5
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What are the common causes of hyperkalemia?
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Anything that damages a cell causing the potassium to be released, Renal failure, DKA, Internal hemorrhage, over correction of hypokalemia
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What is the most common cause of hyperkalemia?
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Renal failure. A person who has high potassium over an extended period of time is not as concerning as a person who suddenly spikes a high level
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How should potassium be administrated?
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By IV, must be diluted only give 10mEq per hour or by PO should be only given on a full stomach
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Why is potassium never administrated via IV push?
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Will cause cardiac arrest
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Why is potassium never given IM?
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very irritating to the tissues.
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What type of electrolyte is sodium?
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Extracellular
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What is a normal Sodium level?
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135-145 mEg/liter
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Variations in Sodium levels is usually a what?
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Water issue more so than an increase/decrease in the electrolyte. if low sodium do not give sodium get rid of the excess water
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What is Hyponatremia?
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low sodium
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What are some reasons for Hyponatremia?
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Severe burns, Severe diarrhea, vomiting, excessive IV Fluids of non electrolytes, Pyloric obstruction, DKA, Edema, Stomach suction accompanied by water or ice chips
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What is the most common reason for Hyponatremia?
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Edema-too much fluid
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What is Hypernatremia?
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High sodium levels
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What are some reasons for Hyprenatremia?
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Hypovolemia, Dehydration, Fever, Diabetes insipidus, increased salt intake, hyperventilation, Cushing syndrome
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With sodium imbalances you should watch for what?
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CNS Changes
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What is Hypovolemia?
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Low blood volume
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Patients who retain large amounts of fluid are likely to have?
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Hyponatremia
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What causes Hypercalcemia?
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Acidosis, Hyperparathyroidism, Bone cancer, Immobility
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What causes Hypocalcemia?
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Alkalosis, hypoparathyroidism, inadequate intake of calcium and/or vitamin D
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Immobility which causes demineralization of bones may result in which electrolyte imbalance?
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Hypercalcemia
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Which electrolyte is regulated by the parathyroid gland?
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Calcium
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What is a normal Glucose value?
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80-120 mg/dl
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What patients should have their blood glucose checked?
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Patients with diabetes, on TPN/HAL or having any symptoms of hypo or hyperglycemia
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What causes Hyperglycemia?
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Diabetes mellitus, shock or trauma, obesity, stress
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What causes Hypoglycemia?
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Starvation, Increased insulin dosage Malabsorption problems
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What group of medications may cause hyperglycemia?
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Steroids
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This is the end product of protein metabolism
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Ammonia
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How is ammonia normally removed from the body?
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The liver normally removes ammonia and changes it to urea. With liver damage, the ammonia level increases
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How can you lower ammonia levels?
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Decrease protein intake and use antibiotics to decrease intestinal bacteria
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What laxative which causes ammonia to be eliminated from the body is often given to patients with high ammonia levels?
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Lactulose
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What does BUN stand for?
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Blood Urea Nitrogen
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What is BUN used for
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It is a gross indicator of kidney function
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What causes an increased BUN?
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usually due to inadequate excretion due to kidney disease or urinary obstruction/renal failure
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What is a normal BUN?
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10-15 mg/100cc
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What other elevation would you see when you see an elevated BUN?
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Elevated Creatinine
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If a patient is suspected of having impaired kidney function you would see what?
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Elevated BUN/Creatinine
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What is a normal WBC white blood count
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4,100-10,900 cell/uL
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What is WBC used for?
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Used to determine infection/inflammation, Used to determine if differential or bone marrow biopsy needed Used to monitor chemotherapy or radiation therapy
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What is Leukocytosis
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An elevated WBC indicates infection
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What is Leukopenia
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A low WBC indicates bone marrow depression
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The volumne of RBC (red blood cells) in 100 cc of blood is known as?
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Hematocrit (HCT)
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The normal HCT percentage for males is?
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40-54%
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The normal HCT percentage for females is?
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37-47%
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The oxygen carrying pigment and main component of the red blood cells is
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Hemoglobin
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What is a normal hemoglobin for males?
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13-18 gm/dl
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What is a normal hemoglobin for females?
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12-16 gm/dl
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at hemoglobin levels <8 gm/dl what is the treatment
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blood transfusion
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What is a normal platelet count?
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150,000-400,000
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What is thrombocytopenia
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Low platelets
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Thrombocytopenia puts patients at risk for?
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bleeding
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What is the PT (prothrombin time) test for?
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Used to measure the anticoagulation effects of coumadin
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What is the INR-international normalized ratio test for?
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More consistent than PT used to monitor the effects Coumadin should be between 1.5-2 when patient is on Coumadin
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PTT (partial thromboplastin time) and APTT (Activated partial thromboplastin time) are used for?
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To monitor the anticoagulation effects of heparin
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Anemia or dehydration would cause what to happen to a patient's hematocrit?
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It would go up
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What electrolyte is increased with pancreatic disease
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Amylase
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What is urinalysis used for?
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Usually just a screening tool
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What are cardiac enzymes used for?
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To diagnosis MI (heart attack)
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What other cardiac test is given that is more sensitive than CK?
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Troponin
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What are CK?
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Creatine Kinase is released when there is muscle damage in the body
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What are the levels of Troponin
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Normal is negative, it is increased 1-3 hours after onset of chest pain and remains elevated for 14-15 days
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What two labs would a physician most likely order if he wants to rule out a myocardial infarction?
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Troponin/CK-MB
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What is BNP
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Brain natriuretic peptide
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What does BNP measure
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Measurement for CHF should be zero, elevated levels means patient has CHF
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Substances that carry an electrical charge when dissolved in water
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Electrolyte
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Within a vessel or vessels
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Intravascular
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A molecule (electrolyte) that carries an overall negative charge when dissolved in water
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Anion
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A molecule (electrolyte) that carries an overall positive charge when dissolved in water
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Cation
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Present outside of the cell
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Extracellular
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Situated between the cells
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Interstitial
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Diffusion of water (no other substance) through a selectively permeable membrane from an area of low osmotic pressure to an area of greater osmotic pressure
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Osmosis
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Unimpeded movement of a substance through a permeable membrane between two fluid compartments; occurs down a concentration gradient; does not require the expenditure of chemical energy
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Diffusion
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Any solution with a solute concentration less than that of normal body fluids (<270mOsm/L)
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Hypotonic
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Any solution with a solute concentration greater than that of normal body fluids (>310 mOsm/L)
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Hypertonic
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The movement of fluid through a biologic membrane as a result of hydrostatic pressure differences on the two sides of the membrane
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Filtration
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Any solution with a solute concentration equal to the osmolarity of normal body fluids or normal saline
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Iostonic
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Found inside a cell
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Intracellular
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Water loss from the skin, lungs, and stool, can not be controlled
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Insensible loss
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Assisted movement of a substance through a permeable membrane between two fluids compartments; occurs against a concentration, electrical, or pressure gradient; requires the expenditure of chemical energy
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Active transport.
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the adults body is what percentage water?
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60%
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The infants body is what percent water?
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77%
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Fluid that is separated by thin layer of epithelial cells from ECF includes digestive juices, intraocular fluid, CSF. Only accounts for about 1-3% of all body fluid
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Transcellular
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Factors that affect osmosis?
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Concentration, Temperature, Electrical Charge, and Differences between osmotic pressure
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The movement of materials across the cell membrane by means of chemical activity which allows the cell to admit larger molecules than otherwise would be allowed
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Active Transport
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What is the primary regulator of fluid intake
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Thirst
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Expected minimum output of urine is?
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30CC per hour
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How is fluid lost from the body?
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Kidneys, Skin, Lungs, GI tract
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What too Hormones regulate body fluids
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ADH-Antidiuretic hormone and Aldosterone Hormone
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What is the hormone released by the posterior pituitary gland in response to an increase in blood osmolarity.
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ADH Antidiuretic hormone
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This hormone is produced by the adreanl cortex that regulates sodium and potassium balance. `
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Aldosterone Hormone
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This causes the renal tubules to increase their reabsorption of sodium and excrete potassium
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Aldosterone Hormone
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This results in a decrease production of urine by increasing the reabsorption of water by the kidneys
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ADH Antdiuretic hormone
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The release of this hormone results in arterial vasodilation and increased glomerular filtration rate and diuresis
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ANP Atrial Natriuetic Peptide
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This hormone is produced from specialized cells in the atrial muscle during periods of circulatory overload
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ANP Atrial Natriuetic Peptide
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Patients at risk of fluid overload
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Cardiovascular disease, Receiving IV therapy, Receiving TPN receiving steriods
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Patients at risk of being under fluid
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Severe burns, Trauma, Prolonged GI upset Receiving diurectics
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Patients at risk of being both under and over in fluid balance
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Renal disease, Endocrine disturbances, Very Old Very Young,
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Patients who are receiving steroids retain?
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Sodium
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1 kg of weight gained or loss is equal to ?
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one liter of fluid gained or loss.
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Signs and Symptoms of dehydration
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Flushed, dry skin, Dry mucous membranes, Oliguiria, thirst, Weight loss, Fever Hemoconcentration of lab values, Low blood pressure, Tachcardia Rapid R.R.
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When a patient has too much fluid in their interstitial space and not enough in their intravascular space?
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Third Spacing
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Signs and Symptoms of Fluid volume overload
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Mental changes, weight gain, edema, neck vein distention, bounding pulse, congested breath sounds
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What is the most common indicator of overhydration
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congested breathing
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When an IV needle has come out of the blood vessel and needs to be moved
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infiltration
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Inflammation of IV Blood vessel, needs to be restarted someplace else
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Phlebitis
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Introduction of nutrients into the body by a route other than the GI tract
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Total Parental Nutrition TPN
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What are complications of TPN?
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Infection, Air embolism, Venous Complications, Hyperglycemia, F and E imbalance
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How does a bactericidal work?
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Kills the bacteria directly
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How does a bacteriostatic work?
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Stops the reproduction of the bacteria but does not kill it, the patients own immune system must also help to stop the continued growth of the bacteria
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What are the two types of resistance to antibiotics?
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Inherent and Acquired
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When an Organism will always be resistant to that antibiotic
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Inherent
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When an organism changes so that it is now resistant to the antibiotic when it may not have been in the past
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Acquired resistance
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What are some of the common allergic reactions to penicillins/cephalosporins
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Skin rash, uticaria, anaphylaxis
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What are the adverse reactions and contraindications of Cephalosporins?
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may cause GI upset, Superinfections may arise, May cause platelet dysfunctions, Do not give with aspirin, can not take if allergic to Penicillin
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What is one major side effect of Quinolones that keeps them from being given to children?
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Damage to cartilage
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Erythromycin is used for many of the same bacteria that _______ is used for?
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Penicillin
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What is biggest side effect of clindamycin (Cleocin)?
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Colitis
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What are VRE?
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Vancomycin Resistant Enterococci Bacterimia caused by VRE has a high mortality rate
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What is one bacteria Vancomycin is commonly used for
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MRSA
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If Vancomycin is given IV undiluted it causes Nausea, flushing, itching. What indicates the medicine is being given too fast?
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Red Man Syndrome (from the flushing)
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Two indications of Antibiotic toxicity
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Ototoxic and nephertoxicity
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What is the most unusual side effect of tetracycline>
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Stained teeth
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What is the most unusual contraindications for tetracycline
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Sun exposure
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This class of antibiotics have potential toxic side effects so they are limited to those patients that have moderate to severe infections
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Aminoglycosides
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What are the four ways Cyclooxygenase (COX) inhibitors work?
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Suppress inflammation
Relieve pain Reduce Fever Protect against MI's |
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What are the adverse affects of aspirin
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Gastric irritation, Nausea, Heart burn, bleeding, ulcerations in the GI tract
Bleeding Renal impairment |
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What are the clinical manifestations of Salicylism
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Tinnitus, Sweating, headache, dizziness, acid base disturbances
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This causes acid base disturbances which result in respiratory depression, coma, and death
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Aspirin poisoning
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What are the adverse effects of glucocorticoid drugs
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Osteoporosis, Infection, Glucose problems, F and E imbalances, tend to retain sodium, Peptic ulcer disease, Iatrogenic Cushing's syndrome
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What is a dangerous drug interaction for glucocorticoids?
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May cause hypokalemia so take with caution with any meds that cause a loss of potassium or cardiac meds.
Take with caution with meds that cause GI disturbances Take with caution with meds that increase blood sugar Must decreasee these meds slowly so as not to cause withdrawal syndrome with symptoms of hypotension, hypoglycemia, myalgia, arthralgia, fatique |
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Dexamethasone (Decadron), Hydrocortisone (Solu-Cortef) Methylprednisolone (Solu-Medrol) and Prednisone (Deltasone) are all examples of?
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Glucocorticoid Drugs also called corticosteriods
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The process by which pathogens are transmitted from the environment to a host, invade the hose and cause infection is called?
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Chain of infection
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What are the portals of entry for infections?
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skin & mucous membranes, Respiratory Tract, Urinary Tract, Gastrointestinal Tract, Reproductive Tract, Blood
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When there is swelling, redness, heat, pain/tenderness this is a
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Localized infection
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When there is fever, general malaise, fatigue, leukocytosis, anorexia, nausea, vomiting and lymph node enlargement
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Systemic infection
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When Microorganism becomes resident flora that grows and reproduces but does not produce disease
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Colonization
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What are the four stages of course of infection
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Incubation, Prodromal, Acute and Convalescence
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This mare the time from entrance of pathogen to first symptoms
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Incubation
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This is the time from onset of nonspecific symptoms to more specific symptoms
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Prodromal
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When vasodilatation increases vascular permeability and releases chemotoxic agents which summon phagocytes which ingest microorganisms is called ?
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Inflammation Process
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What are some nonspecific defenses?
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Normal Flora, inflammation
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What are specificc immune responses
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Cell mediated immunity and Humoral immunity
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