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73 Cards in this Set
- Front
- Back
TO HELP REMIND, NA=
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NEURO EFFECTS (AFFECTS BRAIN)
=NOT ALERT |
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AS NURSE:WHAT IS TO BE DONE FOR FVE
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REDUCE NA
GIVE DIURETICS |
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WHAT IS THE CAUSE OF HYPOMAGNESIA ?
AS NURSE:WHAT IS TO BE DONE? |
ALCOHOL,MALABSORPTION MEDS
-CAN POTENTIATE DYSRYTHMIAS -GIVE IT IV VERY SLOWLY -CAN BE GIVEN DURING PRE-TERM LABOR |
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WHAT CAUSES METABOLIC ALKALOSIS?
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-TOO MUCH BASE OR TOO LITTLE ACID
-TOO MUCH USE OF ANTACIDS -**VOMITING MOST COMMON CAUSE**(CAUSES LOSS OF ACID) |
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WHAT CAUSES METABOLIC ACIDOSIS?
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LOSS OF BASE W/DIARRHEA
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S/S OF FLUID VOLUME DEFICIT:
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POOR SKIN TURGOR,DRY MUCOUS MEMBRANE,PT C/O THIRST,LOW U/O,LOW WT.,POSTURAL HYPOTENSION (ORTHOSTATIC)-SYS BELOW 15 & DIASTOLIC BELOW 10 (DUE TO CHANGE IN POSITION)
-PT C/O DIZZINESS, HIGH URINE SPEC GRAV,HIGH HCT,HIGH BUN,HIGH ALBUMIN |
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IF DIABETIC ACIDOSIS,__ IS TO BE GIVEN
IF RENAL FAILER,GIVE__ |
1.INSULIN
2.DIALYSIS |
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ADH
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VASOPRESSIN-POSTERIOR PITUITARY
-HIGH OSMOLALITY LEADS TO HIGH ADH RELEASE -KIDNEYS -URINE MORE CONCENTRATED, BLOOD LESS CONCENTRATED |
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CAPILLARY HYDROSTATIC PRESSURE=
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PRESSURE OF FLUID ON CAPILLARY WALLS
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WHAT CAN DEPRESS RESPIRATIONS DURING RESPIRATORY ACIDOSIS?
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INEFFECTIVE AIRWAY CLEARANCE,RESPIRATORY ILLNESS,MEDS
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WHAT IS THE CAUSE OF RESPIRATORY ACIDOSIS ?
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TOO MUCH CO2 RETAINED
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CONTROL MECHANISMS OF FLUID & ELECTROLYTES ARE:
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1.ADH
2.ALDOSTERONE 3.THIRST |
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INTERVENTIONS FOR FLUID VOLUME EXCESS:
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**I & O **
**DAILY WTS** -CHECK LUNG SOUNDS-FVE CAN LEAD TO PULMONARY EDEMA -INCREASE HOB,ASSESS EDEMA,TEACHING |
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MOVEMENT OF ECF BETWEEN INTRAVASCULAR & INTERSTITIAL COMPARTMENTS IS DETERMINED BY AN INTERACTION OF:
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1.PLASMA ALBUMIN CONCENTRATION
2.CAPILLARY HYDROSTATIC PRESSURE 3.CAPILLARY PERMEABILITY |
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WHAT CAUSES FLUID VOLUME EXCESS?
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KIDNEY FAILURE, CONGESTIVE HEART FAILURE,PT OVERLOAD W/ IV FLUIDS,CORTICOSTEROIDS
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S/S OF FLUID VOLUME EXCESS:
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BOUNDING PULSE,HIGH BP,LOW BUN,NECK VEINS DISTENDED
-1L OF WATER= 1KG (2.2 LBS) -500 CC= 1 LB |
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WHATS THE CAUSE OF RESPIRATORY ALKALOSIS?
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LOSS OF CO2-HYPERVENTILATION
DUE TO EARLY SHOCK,HEAD INJURY |
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WHOS AT RISK FOR FLUID VOLUME EXCESS ?
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ELDERLY AND INFANTS
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S/S OF METABOLIC ALKALOSIS:
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-HYPOVENTILATION-RESP SHALLOW & SLOW
-PH ABOVE 7.45 -PCO2 NORMAL OR HIGH (RETAIN CO2 TO COMPENSATE0 -HCO3 HIGH (TOO MUCH BASE) -**ALL VALUES ARE HIGH** |
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ALDOSTERONE
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ADRENAL CORTEX
-ACTH-ANTERIOR PITUITARY -REABSORPTION OF NA >>> WATER LEASES TO LOSS OF K+ |
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CAUSE OF FLUID VOLUME DEFICIT (FVD):
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N/V/D, 3RD SPACE SHIFTING
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AS NURSE:ASSESSMENT FOR RESPIRATORY ALKALOSIS
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LIGHT HEADED
-TINGLING IN FINGERS & FEET -PH HIGH,LOW PCO2 (BLOWING OFF HCO3 NORMAL OR LOW TO COMPENSATE) |
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MAGNESIUM NORMAL VALUES:
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1.5-2.5
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HYPERCALCEMIA CAN CAUSE:
AS NURSE:WHAT IS TO BE DONE? |
***CANCER MOST COMMON**
-MALIGNANCY AFFECTING BONES -GIVE LASIX TO FLUSH OUT HIGH CA -CANCER PT TO HAVE LOW CA DUE TO ALBUMIN GIVEN |
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LUNGS-CO2 AS MECHANISM TO REGULATE PH
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HYPERVENTILATE-BLOW OFF ACID
HYPOVENTILATE-RETAIN ACID |
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WHAT TRIGGERS 3RD SPACE SHIFTING?
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BURNS,CIRRHOSIS,PERITONITIS,
ABDOMINAL SURGER,ALLERGIC RXN,SEPTIC SHOCK |
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WHAT ARE THE 3 MECHANISMS THAT REGULATE PH ?
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1.CHEMICAL (BLOOD) BUFFERS
2. LUNGS-CO2 3.METABOLIC REGULATOR-KIDNEY |
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WHAT TELLS US WHEN INCREASED OSMOLALITY ?
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HYPOTHALAMUS..ALERTS THIRST
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POTASSIUM BELOW 3.5=
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HYPOKALEMIA
CAUSE:LOOP DIURETICS EXP,LASIX VOMITING,DIARRHEA,METABOLIC ALKALOSIS,HEART PROB (ARRYTHMIAS) |
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SODIUM ABOVE 145=
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HYPERNATREMIA
-TOO MUCH ALDOSTERONE -LOSS OF WATER W/ NA -DIABETES INSIPIDUS |
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K+ ABOVE 5 =
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HYPERKALEMIA
CAUSE:**RENAL FAILURE** MOST COMMON CAUSE METABOLIC ACIDOSIS HIGH K+ CAN LEAD TO CARDIAC ARREST |
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WHERE DOES 3RD SPACE SHIFTING TAKE PLACE?
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INTERSTITIAL
-HIDES IN TISSUES -WHERE IT IS NOT USABLE |
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AS NURSE: WHAT MUST BE DONE WHEN GIVING K+ ?
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K+ MUST BE DILUTED
-GIVE NO MORE THAN 20 MEQ/HR (40-80/L) -WE GIVE 10MEQ/100 CC -PT WILL C/O OF BURING/IRRITATION IF GIVEN TOO FAST |
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WHAT OCCURS DURING 3RD SPACE SHIFTING?
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ECF SHIFTS
-INTRAVASCULAR>>>INTERSTITIAL -CAPILLARY BECOMES PERMEABLE & FLUID LEAKS OUT>>>EDEMA |
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NORMAL POTASSIUM VALUE=
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3.5-5
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TXT FOR RESPIRATORY ALKALOSIS:
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-VENTILATION
-LOWER ANXIETY -TREAT SHOCK |
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WHAT ARE THE NORMAL VALUES OF PH,PCO2,PO2,HCO3?
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1.PH= 7.35-7.45
2.PCO2= 35-45 3.PO2= 80-100 4.HCO3= 22-28 |
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CAUSE OF 3RD SPACE SHIFTING:
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INCREASED CAPILLARY PERMEABILTIY
-ALBUMIN LEAKS OUT>>INTERSTITAL SPACE -LEADS TO FLUID VOL DEFICIT |
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SODIUM LESS THAN 135=
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HYPONATREMIA
S/S:N/V,DIARRHEA,LOSS OF ALDOSTERONE |
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WHAT DOES HYPOCALCEMIA CAUSE?
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TETANY & SEIZURES
LOW CA++=CONVULSIONS (TETANY) =CHVOSTEKS (TOUGH CHEEK;CHECK FOR TWITCHING =TROUSSEAUS SIGN (BLD PRESSURE) -CAN LEAD TO COMA |
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NORMAL CALCIUM VALUE=
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8.5-10 MEQ
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50% OF CALCIUM IS BOUND TO __ AND THE OTHER 50% OF CALCIUM IS BOUND TO __ ?
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1.IONS (USABLE FORM)
2.ALUBUMIN |
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WHAT ARE THE 2 PHASES OF 3RD SPACE SHIFTING?
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1ST PHASE-OCCURS BET 1ST 24 HRS AFTER SURGER
2ND PHASE-OCCURS 48 HRS |
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INTERSTITIAL (INTERCELLULAR TISSUE FLUID)
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AROUND THE CELL
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HOW DOES ONE DO A CHECK TO FIND OUT TYPE OF IMBALANCE?
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1.1ST CHECK PH
HIGH=ALKALOSIS..LOW=ACIDOSIS 2.2ND CHECK PCO2 HIGH=RESPIRATORY..LOW=METABOLIC 3.3RD CHECK HCO3 4.CHECK PARTIAL PRESSURE OF 02 |
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PLASMA ALBUMIN CONCENTRATION=
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-COLLOID OSMOTIC PRESSURE OR OSMOTIC PRESSURE
-HOW MUCH ALBUMIN IS IN SERUM -IF YOU LOSE ALBUMIN, YOU LOSE FLUID |
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IN A HYPOTONIC SOLUTION, THE CELL WILL __
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SWELL
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CAPILLARY PERMEABILITY TO ALBUMIN=
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NORMALLY ALBUMIN SHOULD ONLY BE IN VESSELS
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ELECTROLYTE DISTURBANCES THAT LEAD TO DIG TOXICITY ARE:
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LOW K+, HIGH CA++, LOW MG
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FLUID=__ ?
2/3 INTRACELLULAR= 1/3 EXTRACELLULAR= |
1.WATER
2.ICF 3.ECF |
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METABOLIC ACIDOSIS COMPENSATION:
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1.HYPERVENTILATE
2.KUSSMAULS RESP-RAPID & DEEP RESP 3.HYPERKALEMIA-CONCERNED ABOUT HEART |
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INTRAVASCULAR
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IN THE VESSELS (ARTERIES,VEINS,CAPILLARIES)
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HOW DOES FLUID MOVE?
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1.ACTIVE TRANSPORT-NEED ENERGY
2.PASSIVE TRANSPORT-NO ENERGY |
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WHICH ABG'S HAVE TO DO WITH GAS EXCHANGE?
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PCO2,PO2,HCO3
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ASSESSMENT AS NURSE:FOR 2ND PHASE OF 3RD SPACE SHIFTING
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48-72 HRS LATER,FLUID STARTS TO REABSORB >>> DIURESIS
U/O >200 CC/HR -S/S FLUID VOL EXCESS |
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AS NURSE:INTERVENTIONS FOR FLUID VOLUME DEFICIT
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** I & O
** DAILY WT -CHECK U/O-SHOULD BE > 30CC/L OF H20= 2.2 LBS -TXT FOR S/S SHOCK -ADVISE PT TO RISE SLOWLY |
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DIFFUSION
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MOVEMENT OF DISSOLVED SUBSTANCES (SOLUTES) FROM AN AREA OF HIGH CONCENTRATION TO AN AREA OF LOW CONCENTRATION
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CHEMICAL BLOOD BUFFERS
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BASE BICARBONATE:CARBONIC ACID
20:1 |
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METABOLIC REGULATOR-KIDNEYS AS A MECHANISM TO REGULATE PH:
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SECRETE OR RETAIN ACID (H+) IONS OR BICARBONATE (BASE)
-TAKES SEVERAL HRS TO DAYS TO COMPENSATE |
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OSMOSIS
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MOVEMENT OF *WATER* FROM LOWER CONCENTRATION TO HIGHER CONCENTRATION OF IONS THROUGH A SEMI PERMEABLE MEMBRANE
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ASSESSMENT AS NURSE:FOR 1ST PHASE OF 3RD SPACE SHIFTING
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S/S FVD
-LOW U/O BUT NO WT LOSS -24 HR INTAKE > OUTPUT -WT GAIN,EDEMA |
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S/S OF METABOLIC ACIDOSIS:
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PH BELOW 7.35
PCO2 NORMAL OR LOW (BLOWING OFF CO2) HYPERVENTILATE KUSSMAULS RESP HCO3 DECREASES (LOSS OF BASE) **ALL VALUES LOW** METABOLIC ACIDOSIS MAY LEAD TO VOMITING |
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IN A HYPERTONIC SOLUTION,THE CELL WILL __
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SHRINK
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WHAT ARE S/S OF RESPIRATORY ACIDOSIS?
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RESTLESSNESS,CONFUSION
LATER-HEART PROB LOW PH,HIGH CO2,HIGH PCO2 ELEVATED OR NORMAL BICARBONATE LEVELS (TO COMPENSATE) |
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EXAMPLES OF HYPOTONIC SOLUTION:
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D5 1/2 NS
-IF GIVEN TOO MUCH, SWELLING IN BRAIN -MAKE SURE GIVE NA WITH D5 IN WATER |
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SODIUM NORMAL LEVEL
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135-145
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AS NURSE: WHAT IS DONE FOR HYPERKALEMIA
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PT GIVEN KAYEXALATE TO LOWER K+
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WHEN IS CALCIUM GIVEN?
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DURING REMOVAL OR SWELLING OF PARATHYROID
EXP: NECK SURGERY |
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WHAT IS THE CAUSE OF HYPERMAGNESIA?
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KIDNEY FAILURE
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FLUID IS ONLY VISIBLE IN __ AND __
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IN CELL OR IN VESSELS
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INTAKE MUST EQUAL __ ?
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OUTPUT
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ISOTONIC MEANS ?
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NO CHANGE IN FLUID
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AS NURSE:WHAT IS TXT FOR RESPIRATORY ACIDOSIS ?
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-IMPROVE VENTILATION
-SUCTION -INCREASE HOB -O2 GIVEN -COUGH & DEEP BREATH |