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133 Cards in this Set
- Front
- Back
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What is an insensible loss of fluid?
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sweat and respirations. 500-1000mL/24hrs
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What is a sensible loss of fluid?
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urine and feces. 1500mL/24hrs
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What are s/s of fluid volume deficit?
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tachycardia, low bp, cool, dry skin, weakness, confusion, decrease cardiac output, false decrease in electrolytes, false increase in H/H, weak thready pulses
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Fluid volume deficit can cause a _______ BUN/creat and ________ glucose
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increase, increase
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What is the movement of H2O from a lower concentration to a higher concentration across semipermable membrane?
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Osmosis
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What is the normal value for sodium?
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135-145 mEq/L
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What is the role of sodium?
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regulates fluid- H2O follows Na, transmission of nerve/muscle impulse,combines w/chloride and bicarb to alter pH
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Signs and symptoms of hyponatremia?
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n,v,d, abd cramps, tachycardia, hypotension, mental status changes, muscle weakness, dry skin, pale dry mucous
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The following labs indicate what, sodium less than 135, specific gravity less than 1.008, serum osmolality less than 280?
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hyponatremia
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What solution would you give for hyponatremia?
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hypertonic. 3% or 5%NaCl
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Mild hyponatremia can be treated with what?
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NS or LR
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N,V, anorexia,dry tongue, tachycardia, increase BP, restlessness, stupor, elevated temp, muscle twitching, hyperreflexia, flushed dry skin, dry sticky mucous are S/S of what?
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hypernatremia
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>145 sodium, >1.025 specific gravity, >295 Osmo indicates what?
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hypernatremia
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What is the treatment for hypernatremia?
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hypotonic solution-0.45%NS or D5W
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What is the normal value for potassium?
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3.5-5.5
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What is the role of potassium?
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contraction of skeletal smooth and cardiac muscle, promote nerve impulse
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The kidneys excrete 80% of ______ a day and 40-80mEq is excreted in urine a day.
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potassium
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What is the most common cause of hypokalemia?
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lack of daily intake
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Signs and symptoms of hypokalemia?
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weakness, heaviness in legs, decreased bowel motility(ileus), EKG changes, hypoventilation, confusion, decrease deep tendon reflexes, polyuria, nocturia
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What happens when hyokalemia is not treated?
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muscles will cease to contract,cardiac/resp arrest
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What foods are high in potassium?
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bananas, sweet potatoes, dates, apricots, mangos, avacodos
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What is the highest rate for KCL?
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No more than 10mEq/hr
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You see a peaked T wave, prolonged PR interval, muscle weakness, flacid paralysis, cramping and diarrhea what do you expect?
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Hyperkalemia
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How do you treat hyperkalemia?
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restrict K, kayexalate, administer insulin, calcium/sodium bicarb, or dialysis
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What is the normal calcium level?
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8.5-10.5
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calcium is measured on how it is bound to _______
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albumin
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What is the role of calcium?
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maintain bones and teeth, nerve impulse in heart, converts PT to thrombin(clot formation)
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Calcium has a reciprocal relationship with _______
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phosphorus
Ca high, PO4 low PO4 high, Ca low |
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What are the main sources of calcium?
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milk, yougurt, cheese, sardines, salmon, egg yolks, cauliflower, oysters, dark green leafy veggies, FORTIFIED orange juice
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what are s/s of hypocalcemia?
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laryngospam w/stridor, convulsions, parethesia of lips and extremities,increased peristalsis
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What is chvostek's sign?
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tap side of face and facial nerves twitch
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What is trousseau's sign?
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carpal tunnel spasm with BP cuff
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What may you see in a calcium level of 7, or calcium level of 6?
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tetany and stridor, value of 6 can cause death
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what are s/s of hypercalcemia?
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constipation, confusion, weakness, bone pain,
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what is the noraml value of magnesium?
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1.5-2.5mEq/L
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what is the role of magnesium?
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neuromuscular activity(need mag 4 diaphram to work), peripherally acting to produce vasodilation
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what are some causes of hypomagnesemia?
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chronic alcholism,prolonged diarrhea, acute pancreatitis, NG suctioning
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S/S of hypomagnesemia?
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hyperactive reflexes, coarse tremors, muscle cramps, + chvostek and trousseau sign, siezures, painfully cold hands and feet, torsades
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What is the antidote for magnesium sulfate?
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calcium
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What causes a high mag level?
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RF, hyperparathyroidism, hyperthyroidism, antacids or laxatives(magnesium based)
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s/s of hypermagnesemia?
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flushing, sense of skin warmth(vasodilation), sedation, depressed RR, hypotension, bradycardia
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What is the normal value for phosphorus?
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3.0-4.5 mg/dL
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What is the normal value for chloride?
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95-108
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How do you treat hypermagnesemia?
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decrease laxatives, antacids, increase fiber, intubation equipment near
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the movement of molecules from an area of higher concentration to an area of lower concentration is what?
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diffusion
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the movement of molecules m against the concentration gradient is called?
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active transport
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the movement of water between 2 compartments seperated by a semiperable membrane
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osmosis
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describes fluids inside the body
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osmolality
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describes fluids outside the body
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osmolarity
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an elderly pt is at higher risk of fluid/electrolyte imbalance because
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sm losses of fluid are more significant because body fluids account for 50% of body weight in elderly
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a pt with hyponatremia you should restrict what?
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fluid restriction
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a pt with loop diuretic should look for signs of what?
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weak irregular pulse, and poor muscle tone
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Who is at risk for hypermagnesemia?
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pt with lupus and renal failure
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what should you asses with a pt who just had a total thyroidectomy?
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positive chvostek sign
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a pt with hyperphosphatemia secondary to renal failure may require what?
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calcium supplements
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the lungs act as an acid-base buffer by?
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increasing RR and depth when CO2 levels in blood are high, reducing acid load
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the fluid replacement for a pt with an ICF fluid volume deficit is
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hypotonic
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to correct metabolic acidosis the parenteral fluid of choice would be
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NaHCO3
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A nursing diagnosis for a pt with calcium deficit would be
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risk for injury r/t eletrolyte imbalance, tetany, and seizures
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D5 and 0.9%NaCl has the fluid move from ________space to _______space
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intracellular to vascular
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0.45%NaCl will move fluid from _______ to _________
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vascular to intracellular
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LR keeps the fluid where?
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in the vascular space
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what is the normal pH?
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7.35-7.45
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what is the normal paO2?
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80-100
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normal HCO3?
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22-29
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normal paCO2
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35-45
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what can be given to excrete bicarbonate
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diamox
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what color willfluids be in an IV bag if there is vitamins?
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yellow
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what are your fat soulable vitamins
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A, D, E, K- can't be given IV
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what are your water soluable vitamins?
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B, C
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how many calories a day does a burn patient need
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30,000
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What fluid would you give for hypotension, diarrhea, or vomiting?
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Isotonic-NS or LR
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What fluid would you give for cellular dehydration, DKA, or HHNKS?
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hypotonic-20%NS, D2.5%NS, 0.45%NaCl
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How would you not give a hypotonic solution to?
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pt with low BP or cerebral edema
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what fluid would you give for edema?
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hypertonic-D5NS, D51/2NS, D5LR,D10W,3%NS, 5%NS
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what should you watch for when giving a hypertonic solution?
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pulmonary edema-listen to lungs
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what is a crystalloid solution?
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solutes that mix with a DISSOLVE into a solution
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what is a colloid solution?
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protein or starch that do not diffuse or dissolve into a true solution
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what fluid would you give for hyperkalemia?
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dextrose solution
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what is disadvantage of dextrose solutions?
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phlebitis, irritates
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what solution would you give for metabolic alkalosis and hyponatremia?
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NS
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what fluid can temporarily treat shock, and has some nutrients and electrolytes
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Dextrose w/Sodium Chloride
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what fluid is subsititued for blood during hemorhage, well tolerated, no calories, and high in sodium
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ringers solution
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what natural plasma protein, does not carry dieases, allergic reaction rare
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albumin
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what is a sugar/alcohol substance, can decrease ICP in 15 mins, but can cause fluid/electrolyte imbalance
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mannitol
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how long can blood be out of the blood bank before it is no longer good?
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4 hours
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Respiratory acidosis
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retention of CO2, always decreases PaO2
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when would you give FFP?
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DIC, liver diease, coag problemsfactor V, XI, or too much coumadin
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FFP needs to be given within _____ hours of thawing?
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6
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when would you give cyroprecipitate?
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control bleeding-factor VIII, fibrinogen
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When giving blood what 2 electroltyes can be efffected?
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potassium(high-lysis cells increasing K)
calcium(low-persevative depletes it) |
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what are signs of hemolytic reaction(incompatible RBCs)?
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burning along vein, lumbar pain, flank pain, flushing of face, chest pain
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what are signs of reaction after transfusion?
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fever, chills, ha, n/v, hypotension, chest pain, dypnea, non productive cough
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Signs of fluid volume deficit
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tachycardia, low BP, cool/dry skin, weak, confusion,decreased CO,, false decreased electrolytes, false increased H/H
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what are groshong's used for?
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dialysis- do not touch unless advised
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what does a cold compress do if there if a occlusion from a clot?
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prevents further clotting
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Infiltration occurs what do you do?
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stop infusion, elevate extremity, warm/cold compress, document
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what quad is the liver and gallbladder located?
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RUQ
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what quad is the spleen located?
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LUQ
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what quad is the stomach located?
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LUQ
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what quad is the cecum and appendix located?
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RLQ
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what quad is the sigmoid flexure located?
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LLQ
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what quad is the duodenum located?
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RUQ
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what are risk factors for gallbladder diease?
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obese, mult pregnancies, 40+, fasting
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what quad is the liver and gallbladder located?
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RUQ
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what quad is the spleen located?
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LUQ
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what quad is the stomach located?
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LUQ
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what quad is the cecum and appendix located?
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RLQ
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what quad is the sigmoid flexure located?
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LLQ
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what quad is the duodenum located?
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RUQ
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what are risk factors for gallbladder diease?
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obese, mult pregnancies, 40+, fasting
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what quad is the liver and gallbladder located?
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RUQ
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what quad is the spleen located?
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LUQ
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what quad is the stomach located?
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LUQ
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what quad is the cecum and appendix located?
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RLQ
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what quad is the sigmoid flexure located?
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LLQ
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what quad is the duodenum located?
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RUQ
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what are risk factors for gallbladder diease?
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obese, mult pregnancies, 40+, fasting
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what precautions would you use when taking care of a pt with hepatitis B?
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standard
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fulminant liver failure is most often caused by what?
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hepatitis B virus(HBV)
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what pain meds would you give with biliary colic
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demerol(meperidine)
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a pt with a history of pancreatic diease usually has a history of what?
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excessive alcohol consumption
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a pt with history of pancreatic diease describes their pain as what?
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dull, boring, beginning in the mid epigastrium and radiating to back
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what should you teach your pt with portal hypertension?
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avoid straining to have a BM
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What is refeeding syndrome?
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fluid retention, electrolyte imbalance(low NA, low K, low mg+, hyperglycemia.
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what is the hallmark of refeeding syndrome?
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hypophosphatemia, associated w/cardiac dysrhythmias, resp arrest, and neurodisturbamces
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an elevated indirect(unconjugated) bilirubin may indicated what?
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bilirubin is not being conjugated and excreted into the bile by the liver
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the bowel is protected from the acidity of gastric content by ________
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release of bicarb in the pancreas
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a pt is jaundice with clay colored(grey) stools why?
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decreased bile flow into the intestines
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a normal assessment of the abdomen should sound
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tympany on percussion of the abdomen
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obesity is the result of interactions between ______ and ______ factors
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genetic and environmental
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bariatric surgery involving a stoma and gastric pouch that is reversible and no malabsorption occurs is what
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adjustable gastric banding
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what is needed to diagnose metabolic syndrome?
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HTN, elevated glucose
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