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186 Cards in this Set
- Front
- Back
movement of fluid to maintain homeostasis , space between the cells in the tissues is called
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interstitual space
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fluid in cells (made of pottasium) is called
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intracellular fluid
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fluid outside of cells (plasma, i.f.) , these are NOT in cells
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extracellular fluid
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what gets rid of pottassium, secreted by adrenal cortex, stimulates renal (K) reabsorption.
Holds on to H20 and Sodium |
aldosterone
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what is secreted by the posterior pituatary gland, reabsorbs H20 in kidney and rids body of Pottasium
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ADH antidiuretic hormone
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the body wants to maintain what kind of state
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Isotonic/Homeostatic
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when you hold on to H20 and Sodium, what do you rid the body of
ex) ADH |
Pottasium
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a decrease in tissue perfusion and a decrease of fluid to the tissues is an example of
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HYPOvolemia (ECF volume deficit)
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EFC volume deficit is also known as
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HYPOVOLEMIA
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same concentration as normal body fluids is known as (saline)
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isotonic
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measurement of number of solutes per concentration is called
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osmolarity
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higher concentration (MORE solutes to number of fluids) is known as
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hypertonic
(shrinks) |
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less concentration (LESS solutes to number of fluid) is known as
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HYPO tonic
(bursts) |
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loss of H20 alone describes
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dehydration
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circulating volume increases and circulatory overload, including dehydration, this occurs with electrolyte imbalances
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ECF volume excess , HYPERVOLEMIA
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Major loss of all insensible fluids is through
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PERSPIRATION
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what is caused by insensible loss of fluids(H20) , draining wounds, diuretics, thirs space loss, decreased fluid intake
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HYPOVOLEMIA
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Supplemental O2 adds to
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fluid loss, fever, heat stroke
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a loss of blood sugar is what kind of loss?
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Isotonic
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thirst
dry mucous membranes decreased turgor are later signs of |
ECF decrease , hypovolemia
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hypovolemia comes with a _______ in urine output and weight loss
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decrease
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signs and symtoms of HYPOVOLEMIA are
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deceraed urine output
weight loss postural orthostatic hypotension increase pulse and RR decreae cap refill neckvein distention |
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you must treat the ___________ w/ hypovolemia
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underlying cause
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with hypovolemia, explain what you do to loss of h20 and electrolytes and blood
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- use an ISOTONIC IV solution
to replace h20 and electrolytes repalce blood if blood loss |
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excessive IV fluids can cause heart failure or renal failure, this is known as
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hypervolemia (Excess fluid volume)
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drinking too much is known as
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polydipsia
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excessive steroids, corticosteroids is known as
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cushings syndrome
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inappropriate ADH secretion at wrong time is known as
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SIADH
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clinical manifestations of hypervolemia include distended abdomin, liverenlargement, seizure coma, increase BP, NVD, and what ....
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fluid in lungs backup causing dyspnea and oprhopnea cough
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name one way to treat underlying cause of hypervolemia
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remove f/e with diuretics, fluid restriction, NA restriction or finally with needle (paracentesis)
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if intake and output is INCREASED, urine is
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more concentrated, you want urine to be concentrated
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if intake and output is DECREASED urine is
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more dilute
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pulse rate, heart sound, bp changes , your heart is working too hard, flatteened neck veins, these are examples of
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cardiovascultar changes
(reflects sympathetic nervous system compensation) |
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pulmonary congestion (fluid in alveoli) or decreased tissue perfusion, change in respiratory rate, SOB, dyspnea, cough, are exammples of what type of changes
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respiratory
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THE EASIEST AND MOST ACCURATE WAY TO JUDGE FLUID LOSS IS WITH
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DAILY WEIGHTS
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asess skin turgor and mobility, temp, mositure, edema, mucuous membrane and do what for implementation to patient?
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change position
elevate edemous extremties use lotions and oils |
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1 kg = 2.2 lb =
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1 LITER FLUID!
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PRIMARY determinant of ECF osmolarity
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SODIUM NA+
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SODIUM NORMAL LEVEL IS
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135-145
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sodium is important for the body for
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GENERATION AND TRANSMISSION OF NERVE IMPULSES AND
REGUALTE ACID=BASE BALANCE |
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WHAT IS MOST SENSITIVE TO CHANGES IN NA+ LEVELS!?
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THE BRAIN
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sodium moves with what?
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water
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a change in K pottasium level affects what?
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the HEART
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the body gets most of it's NA+ from what?
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FOOD (GI absortption)
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how does the body lose NA+
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feces, urine, sweat
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what regulates the NA+ Balance?
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KIDNEYS
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Name examples of kidney regulation of NA+ balance
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ADH
aldosterone |
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adh and aldosterone help lose sodium and where does sodium get excreted
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kidneys
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what reflects the ratio of NA+ to H20?
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serum NA+ level
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if isotonic imbalance NA + Level remains what?
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NORMAL, an isotonic loss
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where does NA+ come from primarily
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food such as processed food, canned goods
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what causes nerve impulses to move?
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sodium switching
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HYPERNATREMIA affects what?
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THE BRAIN
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a GAIN of na+ or a loss of H20 is called
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HYPERNATERMIA
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shifts from cells to ECF cuasing
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cell shrinkage (hyper)
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the body picks up increasing NA+ to maintain
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homeostasis
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H20 to ECF helps maintain what kind of state
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isontonic
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causes of hypernatermia are impaired thirst, dysphagia, watery diareah, polyuria
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excessive hypertonic solutions IV, edxcessive PO intake of NA+m, disease
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what kind of symptoms (restlessness, agitation, seizures, coma) would you see with HYPERNATREMIA?
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CNS symptoms, the BRAIN is affected
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you must treat underlying cause of hypernatremia, and use hypotomnic IV solutions slow or fast?
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slow, NA levels must be reduced SLOWLY
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A DECREASED ADH will
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RETAIN NA+ AND RID H20 (hypernatremia)
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gained too much H20 or too little NA+ is known as
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HYPONATERMIA
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IN hyponatermia , H20 shifts into cells causing
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cell swelling and bursts
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a condition commonly found in the hospital population, especially in patients being hospitalized for central nervous system (CNS) injury. This is a syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload. It should be noted that vasopressin has other important functions, addressed in the appropriate articles.
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SIADH
syndrome of inappropriate ADH secretion |
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SIADH result is
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hyponatermia
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hyponatremia occurs when there is a _______ of na+ containing fluids, example is a wound.
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LOSS
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h20 Excess / hypotonic IV fluids causes
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hyponatremia
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too little NA+ or too muc hH20 in ECF causes
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hyponatremia
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a Sodium level above 145(157) is
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hypernatremia
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a soidunm level below 134 (129) is known as
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hyponatremia
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hyponatermia retains H20 causing
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weight gain
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how do you care for a patient with HYPONATREMIA?
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treat underlying cause
HYPERTONIC IV - SLOWLYYYY replace PO fluids with NA+ correct slow to prevent NEURO DAMAGE |
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To fix HYPERNATREMIA you give what kind of IV SLOWLY
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HYPOTONIC IV
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to fix HYPONATERMIA you give what kind of IV slowly
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HYPERTONIC IV
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Primary determiant of ICF osmolarity is known as
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K POTASSIUM (IN THE CELLS)
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Pottassium is located
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IN THE CELLS
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Cardiac Cells are very sensitive to changes in
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K+ LEVELS
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K levels affect the
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HEART
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The body gets most it's K+ from
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Food such as fruits and vegetables
BANANAS ORANGES GREEN LEAFY VEGS |
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Potassium is important to the body for
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cell funciton
generation of nerve impulses cell growth |
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The body loses K in
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urine, stool, sweat, medication such as diuretics
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What excrete extra K -
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kidneys
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what kind of relationship occurs between K and NA
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INVERSE relationship
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Serfum K+ levels refelect the movement of K+ .........
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OUT OF CELLS INTO ECF
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Trauma to cells (medications) is known as
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acidosis
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cell building, stress, insulin is known as
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ALKALOSIS
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Kidneys hold NA+ and excrete
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POTASSIUM K
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what are some things that increase potassium levels
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surgery, accidents, tissue cell damage
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Potassium normal level is
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3.5-5
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a gain of K+ movement of fluid from ICF into ECF.
amn EXCESS K intake |
hyperkalemia
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you must look at what level to asess KIDNEY problem
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BUN/CREATINE level
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hydrogen moves INTO cell and potassium moves out causing hyperkalemia is known as
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ACIDOSIS
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a K + level greater than 5 = HYPERKALEMIA and sings are
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EKG CHANGE, Irregular pulse, cardiac arrest, LOWER EXTREMEITY WEAKNESS
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A sure sign of HYPERKALEMIA or excess K+ is
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LOWER EXTREMITY WEAKNESS
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RN interevention for hyperkalemia is to
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decrease K intake, increase elimiation of K+ with diuretics such as KAYEXALATE, dialysis
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What causes HYPERKALEMIA?
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METABOLIC ACIDOSIS
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THE MOST COMMON ELECTROLYTE IMBALANCE IN THE HOSPITAL IS KNOWN AS
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HYPOKALEMIA
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caused by a lack of intake, lack of potassium, shifts into cells
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hypokalemia
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K must be replentished in the body, a decrease in cellular exciteability causes changes in the
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HEART
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weakness, fatigue, cramps, decreased pulse ox, vital changes, orthostatic hypotension, are clinical manifestiations of
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Hypokalemia
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to care for hypkalemia , you must replace what
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K+ PO or IV and SLOWLY
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A PH level greater that 7.45 is
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ALKALOSIS
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A PH level less than 7.35 is
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ACIDOSIS
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kidnesy excrete what and retain what
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kidneys EXCRETE HYDROGEN IONS
and RETAIN BICARBONATE. |
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Lungs exhale what?
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CO2
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An increase of HCO3 (Bicarbonate) =
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HIGH ALKALOSIS
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an increase of Hydrogen Ions =
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LOW ACIDOSIS
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ARTERIAL BLOOD GAS PROBLEMS
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LOOK AT PH TO FIND ACID./ALK
LOOK AT PACO2 AND HC03 to figure out respiratory or metabolic |
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PH normal
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7.35-7.45 ACID/ALK
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PAC02 normal
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35-45 RESPIRATORY
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PAC03 Normal
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22-26 METABOLIC
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Respiratory is the lungs and metabolic is the
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kidneys
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excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload.
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SIADH
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failure of respiratory system to remove CO2 from body fluids as fast as it is produced causing excess CARBONIC ACID (pac03) leads to
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RESPIRATORY ACIDOSIS
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RESPIRATORY ACIDOSIS =
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PACO2 > 45
PH < 7.35 |
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RESPIRATORY acidosis is caused by
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HYPOVENTILATION
EX) copd/ meds that depress resp. |
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too much o2 decreases respiratory drive because it decreases
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stimuls to breathe and let off CO2
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a patient with cyanosis and rapid shallow respirations, disorientation and blurred vision and weakness is experiencing
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RESPIRATORY ACIDOSIS
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What compensates for respiratory acidosis?
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KIDNEYS reabsorb HC03 AND EXCRETE HYDROGEN IONS into the urine
this takes HOURS TO DAYS |
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Another way to compensate for respiratory acidosis is to
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hyperventialtion to blow off CO2
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a loss of CO2 from lungs faster than produced by cells aka CARBONIC ACID DEFICIT is known as
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RESPIRATORY ALKALOSIS
(excessive CO2 exhalation) |
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REspiratory Alkolosis is caused by
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HYPERVENTILATION
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respiratory alkolosis can also be triggered byt
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high altitude, anxiety, fever, excercise, stimulation of respiratory center, brain injury, septicemia
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a pt complains of ligheadednes, parasthesias, altered consciousness, cramps, spasms, these are signs of
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RESPIRATORY ALKOLOSIS
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RESPIRATORY ALKALOSIS =
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PACO2 < 35
PH > 7.45 |
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to compensate for RESP ALKALOSIS
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kidneys reabsorb H+ and excrete HC03 (Bicarbonate)
takes hours to days |
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respiratory alkalosis patients can counteract it with
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CO2 rebreather
antianxiety agents |
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Abnormal accumulation of acids or loss of bases from the body known as base bicarbonate deficit is called
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METABOLIC ACIDOSIS
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abnormal accumulation of acids or loss of bases from the body (base bicarbonate deficit)
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METABOLIC ACIDOSIS
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METABOLIC ACIDOSIS =
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PH < 7.35
HCO3 > 22 |
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metabolic acidosis is caused by
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DM acidosis, lactic acidosis, starvation, renal failure, breakdown of muscle
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a pt with deep rapid respirations (kussmaul resp) is a clinical manifestation of
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metabolic acidosis
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to compensate for metabolic acidosis ,patient is given
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IV bicarbonate, lungs try to blow off excess CO2, renal buffering
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loss of hydrogen ions or too much bicarobate is called
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METABOLIC ALKALOSIS
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METABOLIC ALKALOSIS =
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ph > 7.45
hc03 bicarb > 26 |
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DURING metabolic alkalosis, H and K compete in the
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kidneys
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Kidneys choose H + and remove K + , this is called
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hypokalemia
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meds that increase excretion of H and K , fluid loss from stomach, cushings disease, excessive adminstartion of alkali lead to
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metabolic alkalosis
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pt ocmplains of apathy, mental confusion, dizziness, weakness, shallow respirations, spastic muslces and cramping shows signs of
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metabolic alkalosis
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RESPIRATIONS SLOW AND SHALLOW WITH PERIODS OF APNEAAAAAAAAAA occur with
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METABOLIC ALKALOSIS
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To compenssate for metabolic alkalosis, the lungs
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retain CO2 by decreasing respirations (slow hypoventilation)
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what can you use to incrase HC03 (bicarb) excretion?
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Diuretics (diamox)
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who get dehyrdrated quicker and are at greater risk for kidney problems due to excess medication
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elderly
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major cause of elderly problem are
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diuretics
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most accuarte measurement of fluid loss is
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weight
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what value shows blood concentration level of red blood cells
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hematocrit HCT
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what value if increased shows a definite kidney problem
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CREATINine
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if hematocrit is off there is a decrease of
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fluid
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patient should learn to
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report signs and symptomsof imbalances such as weight gain or loss, edema, urine production changes, hygiene oral
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primary - for mild to moderate dehydration is
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oral replacement
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if patient has mild or chronic FVE Fluid volume excess or hypervolemia, you need to
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restrict fluids and sodium
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if given a diuretic, you must monitor
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Electrolytes
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if you have a kidney problem you cannot give a
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diuretic
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potassium given orally, tasetes bad , ggive with food because of GI upset , this is for
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electroltye replacement
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increase excretion of potassium, given rectally
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kayexalate
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MOST COMMON OCCURING ELECROTYEPROBLEM IN HOSPITAL
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HYPOKALEMIA
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NEVER GIVE POTASSIUM IV PUSH
OR IM OR SUBQ T/F |
TRUE
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IF potasium mixed in IV you must give with a
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infusion pump
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patients shoudl learn to report
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weight gain or loss, edema, urine proudction changes.
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primary cure for dehydration is
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OREAL REPLACEMENT
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if fluid volume excess, you must
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restrict fluids and sodium, no caffeine or salt.
|
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must monitor what if you are taking diuretics, cant use with kidney problems
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ELECTROLYTE MONITORING
|
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most useful if renal failure is not cause of problem, potential to cause dehyrdation and elec imbaalnce
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diuretics
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A nurse understands isotonic solutions when the nurse states:
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It is helpful in the treatment of hypotension from the loss of fluid.
|
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Why is old blood and injuries like burns important to K monitoring?
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K is released from damaged blood cells.
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Nurse Lala is assessing her pt's IV site. She notices that is red and warm to the touch. What can Lala take away from this?
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phlebitis
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Which condition needs extra assessment when considering hypertonic solutions?
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heart
|
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Nick has had surgery and is having post op edema. Which solution would you expect, as the nurse, to see being used for Nick?
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hypertonic
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Oral K is not usually a problem unless a pt has this problem?
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kidney/renal failure
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Concentrations of electrolytes are similar in ICF and ECF.
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false
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A nurse understand hypokalermia when the nurse states:
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hypokalemia can decrease BP
|
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In pt teaching about hypokalemia, what is the most important education to be done?
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Bowel management care
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Hypernatremia can be caused by:
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high fever, sweating
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A nurse understand hypertonic solutions when the nurse states:
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It has a higher osmolality than plasma , pushes fluid into the cells
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k is important for
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muscle function
|
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A nurse understand K and IV infusion when the nurse states:
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K never be infused into a patient
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Why is insulin good for K regulation?
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keeps K from being pulled out of cells
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Mary Anne is a 86 year old woman. She has olguria and a swollen tongue. She does ask for water. She is confused and has muscle weakness. Her Na serum came back at 165. What could the problem be?
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she has hypernatremia
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A nurse understand the use of hypertonic solutions to be used in surgery when the nurse states:
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It is used when there is substantial loss of blood and BP needs to be raised.
|
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It replaces or maintains vascular fluid volume. (correct answer)
C. It is helpful in the treatment of hypotension from the loss of fluid. (correct answer) |
isotonic solutions
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Nancy is having a low output of urine. The doctor orders an hypotonic solution. Should you question the order?
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yes
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patienst with memory loss and concentration have
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hyperkalemia
|
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regulated by BP and kidney perfusion (correct answer)
B. regulated by hormones such as aldosterone and ADH (your answer) C. reflects the blood osmolality (your answer) |
serum NA
|
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How often does a nurse want to assess a pt on IV fluids?
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q 2 hours
|
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A patient is hyperkalemic, which foods are best for this patient?
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beans and chicken
|
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Which condition needs extra assessment when considering hypertonic solutions?
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heart
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