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105 Cards in this Set
- Front
- Back
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Hypocalcemis S/S C.A.T.S. |
C - Convulsions A - Arrythmias T - Tetany (involuntary contraction of muscles) S - Spasms and Stridor |
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Hypernatremia S/S You are Feeling "F.R.I.E.D." or "S.A.L.T" |
F - fever (lowgrade) or flushed R - restless (irritable) I - increased fluid retention and increased BP E- Edema (peripheral and pitting) D - DRY (decreased urine output, dry mouth) S - skin flushed A - agitation L - low grade fever T - thirst |
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Hyperkalemia M.U.R.D.E.R |
M - Muscle Weakness U - Urine (oliguria, anuria) R - Respiratory Distress D - Decreased Cardiac Contractility E - ECG changes R - Reflexes (hyperreflexia or areflexia (flaccid)) |
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HyperKalemia Causes "M.A.C.H.I.N.E." |
M - MEDS (NSAIDs and ACE inhibitors) A - Acidosis (metobolic and respiratory) C - Cellular Death (trauma, burns) H - Hyperaldosteronism, hemolysis I - Intake - Excessive N - Nephrons, renal failure E - Excretion, impaired |
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Treatment for CHF "U.N.L.O.A.D. F.A.S.T." |
U - Upright (sit)
N - Nitro L - Lasix O - Oxygen A - Aminophylline D - Digoxen F - Fluids (decrease) A - Afterload (decrease) S - Sodium (decrease) T - Test (Dig level, ABG, K+) |
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Diabetes Mneumonic |
Hot and dry; Sugars HIGH old and Clammy, Need some CANDY! |
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Causes of ST Elevation "E.L.E.V.A.T.I.O.N" |
E - Electrolytes L - LBBB (left bundle branch block) E - Early repolarization V - Vetricular Hypertrophy A- Aneurism T - Treatment (Pericardiocentesis) I - Injury (AMI, contusion) O - Osborne Waves (hypothermia) N - Non-occlusive vasospasms |
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HyperCalcemia "S.H.A.M.P.O.O. D.I.R.T" |
S - Sarcoidosis H - hyperparathyroidism/hyperthyroidism A - Alkali/milk syndrome M - Metastisis; myeloma P - Pagett Disease O - Osteogenesis Imperfecta O - Osteoporosis D - D Vitamin Intoxication I - Immobility R - RTA T - Thiazides |
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Main Causes of Metabolic Acodosis "D.H.L." |
D - Diabetic Ketoacidosis H - Hyperchloremic Acidosis L - Lactic Acidosis |
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Hypokalemia Causes "B.A.D. L.O.A.D" |
B - Barters/Cons Synd. (hyperaldosteronism) A - Alkalosis D - Diuretics L - Limp Muscles O - Orthostatic Hypotensions A - Acute Glucose Load D - Diarrhea |
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HypoNatremia Clinical Manifestations "S.A.L.T. L.O.S.S." |
S - Stupor/Coma A - Anorexia, Nausea, Vomiting L - Lethargy T - Tendon Reflexes Decreased L - Limp Muscles O - Orthostatic Hypotension S - Seizures/Headache S - Stomach Cramps |
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What are elctrolytes?
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Active chemicals that carry positive (cations) and negative (anions) electrical charges
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List the major cations Hint: There are 5 |
Sodium Potassium Calcium Magnesium Hydrogen gen, ium, ium, ium, ium |
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List the major anions Hint: There are 5 |
Chloride Bicarbonate Phosphate Sulfate Proteinate ide, ate, ate, ate, ate |
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How are electrolytes expressed in amounts?
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mEq (milliequivalents)
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What four mechanisms are needed to regulate fluid?
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osmosis diffusion filtration active transport |
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What is Osmosis?
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Area of low solute concentration shifts to area of high solute concentration until the solutes are equal |
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What is Diffusion?
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Solutes move from area of higher concentration to one of lower concentration so that the solutes are equal
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What is Filtration?
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Movement of water and solutes out of intravascular compartment into interstitial compartment i.e. the kidneys |
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What is active transport?
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Physiologic pump that moves fluid from area of lower concentration to one of higher concentration *this mechanism requires ENERGY |
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What does the Sodium-Potassium Pump do?
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It moves Sodium back into ECF from ICF ICF is where it wants to be |
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What are two examples of Isotonic Fluids?
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0.9% NaCl - (normal Saline) LR - Lactated Ringers |
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Name some characteristics of Isotonic Fluids
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Stays where I put it Close to ECF Cells don't shrink or swell Crystalloid |
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D5W is an isotonic fluid. What makes it different from NS and LR when infused?
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Infuses as isotonic but disperses into a hypotonic solution |
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What is D5W primarily used to treat?
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Hyponatremia
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What does Hypotonic fluid do?
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Hypotonic fluid moves fluid out of the vessel
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What type of fluid is used to replace cellular fluid?
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Hypotonic fluid
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What can overuse of hypotonic fluids cause?
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intravascular depletion hypotension cellular edema cell damage |
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Give an example of hypotonic fluid
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1/2 Normal Saline (0.45% NaCl)
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What effect does hypertonic fluids have on the cell?
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Move fluid into the vessel and causes cells to shrink |
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What can happen if Hypertonic fluids are given in too large of volume or too quickly?
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Circulatory overload and dehydration
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Give an example of a Hypertonic Solution
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3% NS
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Normal Value for Urine Specific Gravity
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1.010-1.025
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What is BUN stand for
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Blood Urea Nitrogen it is a protein from muscle breakdown and diet |
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What may increase a patient's BUN (Blood Urea Nitrogen)?
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Decreased renal function (unable to eliminate) GI Bleed Dehydration Increased PRO intake Fever Sepsis |
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What may decrease a patient's BUN? (Blood Urea Nitrogen)
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ESLD Decrease PRO diet Starvation Increased Fluid Volume (Pregnancy) |
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What is creatinine?
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End Product of Muscle Metabolism
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What is a better indication of renal function?
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Creatinine
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What is Hematocrit? (Hct)
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volume percentage of RBCs in whole blood
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What is the normal Hematocrit level in males?
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42-52%
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What is the normal Hematocrit level in females?
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35-47%
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What two things may increase Hematocrit?
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Dehydration and Polycythemia
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What two things may decrease Hematocrit?
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Overhydration and anemia
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What are the four functions of the kidneys?
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Retention and excretion to regulate volume Regulation of electrolytes Regulation of pH by retaining Hydrogen ions Excretion of metabolic waste |
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What contribute to FVD/hypovolemia?
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Vomiting Diarrhea GI suctioning Sweating Decrease PO intake Fluid shifts |
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What may cause a fluid shift?
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Acites Burns DI (diabetes insipidus) Adrenal Insufficiency Osmotic diuresis Hemorrhage Coma |
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FVD S/S
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Rapid weight loss Decreased skin turgor Oliguria Concentrated urine Postural hypotension Rapid weak pulse |
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FVD Management |
Oral Fluids Isotonic IV fluids I&O Weight VS CVP LOC BS |
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FVD ASSESSMENT
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BS Urine Output - at least 30 ml/hr Skin Turgor Urine concentration Identify who is at risk Nausea/diarrhea/other cause Skin care/reposition |
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What is FVE or Hypervolemia?
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Fluid overload or diminished homeostatic mechanisms
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What types of patients are prone to becoming Hypervolemic?
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Heart failure Renal Failure Cirrhosis of the Liver Also patient receiving large amounts of sodium (either by diet or IV) |
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What diagnostic findings may indicate FVE?
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Decreased BUN and Hct (due to dilution) and pulmonary congestion seen on CXR |
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FVE S/S
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Edema JVD Elevated HR and BP Increased pulse pressure |
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FVE Nursing Management
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I&O Daily Weight Lung Sounds Check for edema Meds - response to diuretics Fluid Restriction Education (Sodium intake and fluid restriction) |
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Hyponatremia is a serum sodium <_________
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135
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What are some causes of hyponatremia?
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Adrenal insufficiency Water intoxication SIADH Losses by vomiting, diarrhea, sweating, diuretics |
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Hypernatremia is serum sodium >_________
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145
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What are some causes of hypernatremia?
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Excess water loss Excess sodium administration Diabetes Insipidus Heat Stroke |
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Hypernatremia S/S
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Thirst Elevated Temp, HR, BP Dry, swollen tongue Sticky mucosa Confusion/restlessness/irritability Seizure activity |
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Hypokalemia is serum potassium <__________
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3.5
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Causes of Hypokalemia
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GI losses Medications Digoxen Toxicity |
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Hypokalemia S/S
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Fatigue Anorexia N&V Dysrrhythmias Muscle weakness and cramps Paresthsias Decreased muscle strength ECG changes |
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Hyperkalemia is serum potassium >__________
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5.0
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What may cause hyperkalemia?
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Impaired renal function Potassium conservative diuretics Metabolic acidosis Addisons Disease Crushing injuries Burns |
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What are some manifestations of hyperkalemia?
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Muscle weakness Tachy/bradycardia Disrrhythmias Facial paralysis, parethesias Intestinal colic, cramps, abd. distension Irritability, anxiety ECG changes |
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Hypocalcemia is a serum calcium level < ________
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8.5
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What causes hypocalcemia?
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Hypoparathyroidism Malabsorption Pancreatitis Alkalosis Massive transfusion of citrated blood Renal Failure Medications |
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What physical sign indicates Hypocalcemia
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Trousseau's Sign
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How do we treat hypocalcemia?
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IV Calcium Gluconate or Calcium Chloride Calcium and Vitamin D supplements Diet |
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Nursing management for Hypocalcemia
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Seizure precautions (if severely low) Weight bearing exercises Education (diet and meds) IV calcium administration |
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Hypercalcemia is a calcium level > _________
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10.5
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What may cause Hypercalcemia?
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Mailignancy Hyperparathyroidism Bone loss r/t immobility |
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What are some manifestations of hypercalcemia?
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Anorexia Constipation N&V Dysrrhythmias |
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Hypomagensia is a serum Magnesium Level <______
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1.3
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What causes hypmagnesemia?
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Alcoholism GI losses Feedings deficient in Magnesium Meds Rapid admin of citrated blood Diabetic ketoacidosis Sepsis Burns Hypothermia |
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Hypomagnesemia nursing management
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Assessment Ensure safety Teaching r/t diet, meds and alcohol use |
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What is hypomagnesemia often accompanied by?
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Hypocalcemia Need to monitor for this and possibly treat |
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What is common in magnesium-depleted patients?
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Dysphagia or difficulty swallowing
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Hypermagnesemia is a serum magnesium level > _______
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2.7
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What are some causes of Hypermagnesemia?
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Renal Failure Diabetic Ketoacidosis Excessive admin of Magnesium |
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What are some manifestations of hypermagnesemia?
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Flushing Lower BP N&V Hypoactive reflexes Drowsiness Muscle weakness Depressed respirations ECG changes, dysrrhythmias |
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Hypophosphatemia is a serum phosphate < _______
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2.5
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What are some causes of Hypophosphatemia?
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Alcholism Refeeding of patient after starvation Pain Heat Stroke Respiratory Alkalosis Hyperventilation Diabetic ketoacidosis Hepatic encephalopathy Major burns Hyperparathyroidism Low magnesium Low potassium Diarrhea Vitamin D deficiency Use of diuretics and antacids |
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Hyper Phosphatemia is a serum phosphate level >_______________
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4.5
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What is hyperphosphatemia is caused by?
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Renal Failure Excess phosphorus intake Excess Vitamin D intake Acidosis Hypoparathyroidism Chemotherapy |
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What does a specific gravity measure?
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Fluid Volume Status
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What is "third spacing" and what does it cause?
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Fluid moves out of intravascular space but not into intracellular Can cause hypovolemia |
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Triple lumen central venous access catheters are least invasive. TRUE or FALSE
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False, they may be more invasive
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What is the distal lumen (blue) used for?
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CVP readings Infusing blood products Infusing high volumes of fluids |
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What is the medial lumen (brown) used for?
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TPN Infusing fluid and meds |
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What is the proximal lumen (white) used for?
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Drawing blood Infusing fluids and meds |
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What is an advantage of a triple lumen over a single or even double lumen central venous catheter?
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It allows us to do more than one thing at a time on critically ill patients
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When is a PICC line indicated?
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Long chemotherapy regimens Extended antibiotic therapy TPN |
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What are some benefits of having a PICC?
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Lower infection rates Less risk for injury on insertion May be inserted by trained RN Pt may have PICC for up to a year |
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What is the purpose of tunneling in a Hickman, Boviac catheter?
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to prevent infection
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What prevents the Hickman, Boviac catheter from coming out?
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A small cuff under the skin; the skin grows around and acts as an anchor and a barrier to infection
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What type of needle is required to access a port-a-cath/infusaport?
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Huber needle
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Edema around an IV insertion site is called?
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Infiltration
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What should you assess to gauge Hypermagnesemia?
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Deep tendon reflexes
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What is the most important consideration when choosing a IV site?
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Choosing one that does not interfere with mobility
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How long should the tourniquet remain in place when placing an IV?
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Just until you get "flash" No longer than 2 minutes |
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What is tetany a common clinical manifestation of?
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hypocalcemia and hypomagnesemia
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What are some symptoms of tetany?
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Tingling at tips of the fingers, around the mouth and sometimes in the feet
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What allergies must a nurse look for when inserting an IV?
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Allergies to latex and iodine
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