195 exam 2 Flashcards
What diet should a person w/ burns be on?
High calorie & high protein
Increased fluids
Increased vit. & minerals
What diet should a person Dx w/ hyperlipemia be on?
Low cholesterol & saturated trans fats
High fibers
What diet should a person w/ wounds be on?
High protien
Increased carbohydrates & fat
Increased fluid intake
Increase Vit (C) & minerals (Zinc/Iron)
What is the healing process of a wound based on?
Pattern
Type of wound
Severity of wound
Overall condition
Time it takes to heal
Begins as soon as wound / injury occurs
Blood platelets adhere to the walls of the injured vessel, a clot begins to form
Fibrin in the clot begins to hold wounds together & bleeding subsides
hemostasis (Termination of bleeding)
Initial increase in the flow of blood elements (antibodies, electrolytes, plasma protein) & water out of the blood vessel into the vascular space
Repair cells to move toward the wound site & causes cardinal
S/s of inflammation
* erythema (redness)
* Heat
* Edema (swelling)
* Pain
* Tissue dysfunction
Cells in injured tissue migrate, divide, & form new cells w/in 24-48 hours
As this ends, new cells & capillaries refill in the wound from the underlying tissue to the skin surface
Inflammitory Phase of wounds
Myofibroblasts produce collagen (glue like protein strengthening wound tissue)
Collagen formation increases rapidly between postoperative days 5-25
Wound fills w/ granulation tissue & takes on the appearance of an irregular, raised, purplish, immature scar
* wound dehiscence most frequent in this pase
Reconstruction / proliferation phase of wounds
Wounds in which skin edges are closed together and little tissue is lost
* minimal scarring
Begins during inflammatory phase of healing in surgery
* usually in closure of wound
Primary Intention of wounds
When a wound must gradulate during healing
Occurs when skin edges are not close together (approximated), or when pus is formed
Some wounds develope purluent exudate (fluid, cells, or other that have been excreted from cells or blood through small pores/breaks in skin)
Slowly necrotized tissue decomposes & escapes , & the cavity begins to fill w/ granulation tissue, or soft, pink, fleshy projections that consist of capillaries surrounding by fibrous collagen
Secondary intention
Practitioner leaves contaminated wounds open & closes it later, after infection is controlled, by suturing two layers of granulation tissue together in the wound
* occurs when a wond becomes infected , opened, allowed to granulate, & and then sutured
Tertiary intention
What nutritional needs should be monitored in a pt w/ wounds?
Protein
Carbs
Fats
Vitamins
What can you do for a client who is unable to tolerate large meals or solid foods?
Eat small frequent meals
What food class helps promote wound repair?
Protein
* Meats
* Peanut butter
* Legumes
Vit A
* Dark leafy veg.
* Yellow/orange fruits & veg.
Vit C
* Strawberries
* Tomatoes
* Spinach
* Broccoli, califlower, cabbage
Zinc
* Fortified cereals
* Red meat
* sea food
What are some interventions for a pt w/ a wound?
Encourage fluid intake of 2000-2400mL in 24hrs
Monitor I/Os
* until stable (48-72hrs)
Balance rest & activity
Encourage to move one body part at a time
* To sit up, pt should roll to the side, use elbow as lever, & push into sitting position
If coughing occurs, apply pillow, rolled blanket, or palms of hands to incision area and apply pressure (Splinting)
Monitor for malnutrition, & chronic disease (HTN, DM, arthritis)
* these add stress to body & need ongoing monitoring
Watery plasma that is mostly clear, but may have some pink/yellow tinge to it
Thin, composed of serum portion of blood
Serous drainage
Thick
Yellow/green/tan/brown drainage
Indicates infection
Purulent drainage
Pale
Red, watery
Mixture of serous & sanguineous drainage
Thin
Can occur on the day of surgery
Serosanguineous
Bright red
Indicates active bleeding
Can occurs on day of surgery
Sanguineous
Closed drainage system that uses a bulb to provide the needed vacuum
Have wide, flat areas that must be brought through stab wound w/ great foce
Jackson-Pratt drainage device
Used after removal of gallbladder (via open cholecystectomy), the bile duct often is inflamed & edematous
* Drainage tube goes into duct to maintain free flow of bile until edema subsides
Long end of tube inserted through abdominal incision or through seperate surgical wound
Tube drains by gravity into closed drainage system
Collection bag emptied & measure Q shift
T-Tube drainage system
Used to treat acute wounds (traumatic wounds, flaps, & grafts) & chronic wounds
* Functions by applying negative pressure to wounds
Healing of wounds if facilitated by increased blood flow, improved/ increased fluid drainage, & enhance wound closure as pressure draws wounds together
Accelerated wound healing by promoting granulation tissue, collagen, fibroblasts, & inflammatory cells to close completely/ improve confition for skin graft
Negative pressure removes fluid from surrounding areas, thus reducing local edema & improving circulation
* After 3-4 days bacteria count drops
Wound-Vacuum-Assisted Closure (Wound vac)
Heart is not as effiecient as it should be
Ventricle is loaded with blood to the point where the heart muscle contraction becomes less efficient
Labs:
* CBC, MP
* Cardiac enzymes
* T3/T4, TSH
* C-reactive protein (If infection is suspected)
* B-type natrietic peptide (BNP)
* N-terminal pro b-type natiuretic peptide (NT-proBNP
Heart Failure
Often the choice for management of a wound w/ little exudate or drainage, such as abrasions and nondraining postoperative incisions
Keeps initial bleeding to a minimum & protects wounds from injury
Prevents introduction of bacteria, reduces discomfort, & speed healing
Prevents deeper tissues fromm drying out by keeping the wound surface moist
If dressing adheres to a wound, moisten dressing w/ sterile normal saline solution or sterile water before removing the gauze
Dry Dressing
Most appropriate for wounds that do not have significant amounts of ischemic or necrotic tissue or large amounts of drainage or exudate
Purpose is to keep wound bed moist or provide mechanical debridement
* Used NS & LR (Isotonic solutions)
Wet-to-dry dressing
Gentle washing of an area with a stream of solution delivered through an irrigating syringe
Benefits include cleansing & medication
Soulutions include topical cleansers, antibiodics, antifungals, antiseptics, & anesthetics
* Most common is NS solution
Promotes wound healing by removing debris from the wound surface, decreasing bacterial counts,
& loosening/removing eschar
Irrigation
What does the principles of basic wound irrigation include?
Cleansing in direction from least contaminated area to most contaminated
What are some complications of wound healing?
Abscess: contains pus & surrounds inflammed tissue
Adhesion: Scar tissue that binds 2 anatomic surfaces
* Most commonly found in the abdomen
Cellulitis: Infection of skin characterized by heat, pain, erythema, & edema
Dehiscence: Seperation/rupture of surgical incision or wound
* Sometimes preceded by serosanguineous drainage
Evisceration: Protrusion of internal organ through a surgical incision or wound
Extravasation Passage/escape into tissues
* Usually blood, serum, or lymph
Hematoma: Collection of extravasated blood trapped in the tissues or organ that results from incomplete hemostasis after surgery/injury
What are nursing interventions for Evisceration (Medical emergency)?
Remain w/ pt & notify HCP
Place pt in low fowlers position w/ knees slightly flexed
* Relieves pressure wounds, prevents dehiscence of the wound edges, & reduces the risk of further evisceration
Cover protruding organ w/. saline dressing moistened w/ sterile NS
Monitor closely & assess vitals
* Pulse ox readings determine if the pt is showing signs of shock
Keep NPO for surgery
Reassure the pt & family because occurance if frightening
Interventions for dehiscence
Bed rest
NPO
Encourage pt not to cough
Place warm, moist, sterile dressing over area until seen by surgeon
Provide reassurance
What are some cardiovascular changes w/ aging & their results?
Decreased cardiac o/p:
* Increased risk of HF
* Decreased peripheral circulation
Decreased elasticity of heart muscle & blood vessles:
* Decreased venous return
* Increased dependent edema
* Increased risk of orthostatic hypotension
* Increased risk of varicosities & hemorrhoids
Increased atherosclerosis:
* Increased BP
* Increased MI
What other Dx does HTN contribute too?
CAD
Stroke
HF
PVD
Renal failure
What are nursing interventions for a pt having dysrhythmias?
Monitor vitals
Note rate, regurality, & strength of pulse
Monitor I/O
Observe & report reaction to meds
Keep stress to a minimum
* Balance rest & activity
What interventions would you provide a pt w/ CAD?
Assess knowledge & understanding of disease process
* Discuss Dx, s/s, & potential complications
Explain purpose, dosage, side effects, & special effects of meds
Assess modifiable cardiac risk factors
Assess diet:
* Intake, intake of processed/canned foods
* Salt intake
Exercise:
* 150 min/week
Obesity:
* Manage caloric intake
Smoking:
* Avoid tobacco
* Avoid second hand smoke
Identify source of stress & sleeping habits
DM
What interventions would you provide a pt w/ COPD?
Ask if smoker
* if so, how many packs a day
Assess lung sounds
* Diminished
* Crackles, wheezes
* Barrek chest d/t increased anteroposterior diameter
Pulmonary hygiene, breath retraining
Meds, exercise
chest physiotherapy (CPT)
Smoking cessation
Encourage fluids, deep breathing exercises, & pured -lip breathing
Education on lifestyle changes
What lab should you draw if an Infection is suspected in a post-op pt?
Culture of any drainage taken before antibiodics
What interventions would you perform for a pt w/ inadequate oxygenation?
Prevent pneumonia & atelectasis by frequent position changes & deep breathing
Instruct pt to breath through the nose & gradually blow out of the mouth
Use incentive spirometer 10x/hr
* Ball rises w/ inhale
Splint when coughing
What are some S/s of diverticulitis?
Often asymptomatic
Changes in bowel habits
* Constipation
* Diarrhea
* Periodic bouts of each
Rectal bleeding
Pain in left lower abdomen
N/V
Urinary problems
Elevated BP
* Confirmed by repeat BP findings averaging 140/90mm Hg or higher
Most serious complications include MI, HF, stroke, kidney disease & blindness
* Assess more frequently
S/s:
* Occipital headaches (more severe when arising)
* Lightheadedness, blurred vision
* Epistaxis (nosebleeds), “Silent killer”
emergency crisis: 180/100
Tx:
* Monitor vital (esp. BP)
* EKG
* Blood studies: Glucose, Hct, K, Ca, Cr, Liped profile
(Elevated Cr = kidney damage, abnorm serum lipids & lipoprotein may indicate artheroscleosis)
* CXR (May show enlargment of heart/pulmonary blood vessels)
* Education on weight reduction, smoking cessation, Na & alcohol reduction, exercise, & relaxation techs.
* Education on Dietary Approaches to Stop HTN (DASH diet - Fruit/veg, whole grains, low fat dairy)
* Medications (Beta-blocker, ACE inhibit., Thiazide/Diuretics, ect)
HTN
protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues
Rotate injection site to prevent lipohypertrophy & lipoatrophy
- DO NOT massage
- Heat & exercise increase absorption rate
lowers blood glucose
AKA “beta cells”
- acts as key that allows sugar into the cell
Insulin
Elevated BS (>100)
- occurs in type 2 DM
Can result from:
- Insufficient insulin production / secretions
- Deficient hormone signaling
- Excessive counterregulatory hormone secretion
S/s: (Think “FLUSHED”)
- F: Flushed skin/ fruit like breath (acetone)
- L: Listless/ lethargic
- U: Unusual thirst, hunger,urine o/p (3 p’s)
- S: Skin warm/ dry, poor wound healing
- H: hyperventilation (kussmaul RR - deep/rapid breathing)
- E: Emesis, increased N/V ( late findings)
- D: Drowsiness, decreased appetite (N/V)
Hyperglycemia
BS less than normal (<70)
- occurs in type 1 & 2
S/s:
- Tremors, tachycardia
- Clammy skin, cold
- Alt consciousness, irritability
- Hunger
- seizure/ stroke like s/s
- diaphoresis
- Apathy (severe lethargy)
Can result from:
- Insufficient intake
- Adverse reaction to meds
- Excessive exercise
Hypoglycemia
What are some diagnostic testing for diabetes?
Glucose screening:
- Fasting (> 100 and < 126 = prediabetes)
- GTT (Detects early Diabetes)
- Glycosylated hemoglobin (HgbA1c; below 7%)
Antibody testing:
- Glutamic acid decarboxylase (GAD ; most common)
- C-peptide
lipid analysis:
- Triglycerides, HDL, LDL
Renal function tests:
- BUN/Cr, albumin in urine,
C-reactive peptide
What is the lab value for cholesterol?
< 200 mg/dL
What is the lab value for HDL?
Males: > 45mg/dl
Females: > 55mg/dl
(want high)
T/F: When glucose levels are high, triglyceride levels will also be high
True
- Triglycerides are general reflection of glycemic control
What is the lab value for LDL?
< 70 mg/dL
What is the lab value for triglycerides?
<150 mg/dL
What is the lab value for C-reactive protein?
< 1.0 mg/L
Lispro (Humalog)
Aspart (Novolog) - Given AC
Clear insulin; most common
Given before pt eats
Onset: 10-30 minutes
Peak: 2hrs
Duration 3-5hrs
Rapid insulin
Humulin R
Novolin R
Clear
Only insulin able to be administered by IV
- Takes longer to kick in
Onset: 30min-1hr
Peak: 2-3hrs
Duration: 5-8hrs
Short/ Regular insulin
Humilin N
Novolin N
Cloudy; roll to mix
Onset: 2-4hrs
Peak: 4-12hrs
Duration: 12-16hrs
Intermediate Insulin/ NPH
Glargine (lantus) - give seperatly
Detemir (levemir)
Clear; given in AM/PM
Onset: 1hr
Peak: N/A
Duration: up to 24hrs
Long acting insulin
T/F - You should not mix short and rapid insulin together
True
Anticoagulant (blood thinner)
- PO
- vitamin K antidote
action:
- interferes with blood clotting
side effects:
- nausea, rash, anemia, ect
adverse effects:
- hematuria and hemorrhage
Lab: INR 2-3 (Give if below 2, hold if above 3)
BBW: monitor for bleeding
Warfarin (Coumadin)
The nurse educates a client with diabetes on proper use of insulin glargine. The nurse determines further education is needed after which client statement?
A.) “I will rotate injection sites on my abdomen.”
B.) “I will use a sliding scale to determine my dose.”
C.) “I will throw out an opened vial after 28 days.”
D.) “I will keep my opened pen at room temperature.”
B.) “I will use a sliding scale to determine my dose.”
Explanation: Sliding scale doses of insulin are for short- or rapid-acting insulins only. Long-acting insulins like glargine are not dosed using a sliding scale
The nurse triages a client with a history of type 1 diabetes who reports abdominal pain, nausea, weakness, and thirst. Fruity odor on the client’s breath is noted. A bedside glucose check shows the client’s blood sugar is 323 mg/dL (17.9 mmol/L). The nurse prepares for which drug therapy?
A.) Insulin detemir
B.) Insulin degludec
C.) Regular insulin
C.) Regular insulin
A patient has impaired glucose tolerance, high serum insulin hypertension elevated triglycerides low high density cholesterol and altered size and density of low density lipoproteins (LDL) cholesterol’s. Which disorder is associated with these characters?
A.) Retinopathy
B.) Neuropathy
C.) metabolic syndrome
D.) macrovascular syndrome
C.) metabolic syndrome
a medical condition associated with a group of metabolic risk factors
- obesity, diabetes (T2) , high cholesterol, hypertension, heart disease, and stroke
Precursor to Diabetes
Pts often have:
- Impaired glucose tolerance
- insulin resistance, hyperglycemia
- HTN
- Low HDLs, elevated triglycerides
- Altered size (large waist) & density of LDL
Treatment :
-weight loss, dietary & lifestyle changes
-reduce sugar & refined grains
metabolic syndrome
What is the lab value BUN an indicater for?
Kidneys ability to excrete urea (end product of protein metabilism)
* Nephrotoxic drugs, high protein diet, GI bleed, dehydration, MI, shock, burns, & sepsis
Lab value: 10-20
Waste product of skeletal muscle breakdown
* Renal function test
Not influenced by diet, hydration, nutritional status, or liver function
Lab value: 0.6-1.2
Cr
How will electrolytes be effected for a pt Dx w/ renal failure?
Na & K levels are elevated & Ca levels are decreased
What is the normal Hemoglobin level?
12-18 combined
M : 14-18
F : 12-16
Build up of waste in blood makes it hard for kidneys to keep correct fluid balance
Arteries in renal parenchyma become narrowed d/t artherosclerosis, HTN, nephrosclerosis, or blood components (sickled RBC,Hgb or myoglobin)
S/s:
* fluid retention/ hypovolemia
* SOB, cp or pressure
* Irregular heartbeat
* edema lower extremities
* Change in urine o/p
* systolic bp > 70mm Hg
Labs/ Tests:
* UA, BUN/Cr
* CBC
* Kidney biopsy
* GFR
* Ultrasound, CT/MRI, X-ray
Acute Renal Failure
What nursing interventions/ treatements will you anticipate for renal failure?
Fluid restriction, direct restriction
* IV fluids w/ dopamine, furosmide, or both (loop diuretics)
Restore electrolyte imbalance
* restrict Na, K & phos intake (give kayaxelate)
* Place on cardiac monitor
* Hemodialysis
* Diet individualized by electrolyte imbalance
Avoid nephrotoxic drugs
Prevent FVO
* monitor for crackles, cyanosis, increased RR, ect.
Continuous Renal Replacement Therapy
Daily weight
* Same time, same scale, same clothing types, ect.
Monitor s/s related to immobility (constipation, skin breakdown)
Kidneys damaged & cannot propperly filter blood
* progressive destruction of nephrons of both kidneys that is describes in stages 1-5
* Develops slowly
Excess fluids and waste from blood remain in body causing other problems (heart disease, stroke)
Cr clearance is important
* < 15 = stage 4, severe funtion loss
S/s:
* Elevated BUN/Cr
* Elevated serum K (hyperkalemia, hypocalcemia, high phosphate)
* Decreased GFR
* increased BP
* High LDL
* Polyuria leading to oliguria
* Change ins Sp. Grvty d/t decreased ability to concentrate urine
* hypernatremia
* Hypervolemia
Labs:
* BUN/Cr
* UA
* ultrasound, CT/MRI, X-ray
* CBC
* Metabolic panel
Chronic Kidney disease
What are the most common causes of Chronic Kidney disease?
HTN
DM
Artherosclerosis
loop diuretic - po, IV,IM
potassium wasting
* Give if K is high
* Inhibits reapsorption of Na
used for worsening crackles, new edema in the legs, edema w/ HF, rapid weight gain, pulmonary edema, hepatic disease, renal failure, & cirrhosis of the liver
monitor BUN & Cr
only give if K+ is in range
Adverse reactions:
* hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia
* thrombocytopenia
* orthostatic hypotension
* rash
* ototoxicity and deafness
* dehydration
furosemide (lasix)
opioid analgesic and vasodilator - PO/IV/IM
used to treat severe pain, sedation, & cancer pts
* narcotic drug derived from opium
Monitor for resp. depression
Controlled substance
morphine
anticoagulant - SubQ
used to prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability
* Prevents DVT, PE in hip/knee replacements
monitor for hemorrhage
side effects & adverse effects:
* hemorrhage
* hematuria
* epistaxis
* ecchymosis, bleeding gums
* thrombocytopenia
* hypotension
Enoxaparin (Lovenox)
How can you dx HTN?
CXR
EKG
What are some tests you could run to determine the level of HF?
BUN
Cr
Electrolytes
* sodium (Na)
* calcium (C)
* magnesium (Mg)
EKG
CXR (Chest X-ray)
Chronic pulmonary disease/ disorder
pressure from fluid buildup and causes backflow of fluids to the right ventricle
fluid backs into venous system/ rest or body
S/s:
* coughing, wheezing
* SOB when lying flat
* dizziness
* fluid retention
* hepatomegaly
* peripheral edema
right sided heart failure
occurs when the heart loses its ability to pump blood
* prevents organs from receiving enough oxygen
* affects pulmonary (edema)
S/s: (pulmonary symptoms)
* Decreased cardiac output
* Dyspnea, orthopnea
* Wheezing
* pink sputum
* Crackles
* SOB when exercising or sleeping
Left sided heart failure
Anemia caused by inadequate iron intake (most common)
* take vitamin C to help absorb iron
S/s:
* brittle nails
* pallor
* dyspnea
* tachycardia
* glossitis (inflammation/ burning tongue)
* Cheilitis (inflammation of lips)
Dx/Tx:
* CBC (decreased Hgb & O2)
* Bone marrow aspiration
* Stool sample, colonoscopy, endoscopy (check for blood)
* *treat cause/ iron supplements *
* increase fluids (use straw to prevent staining)
iron deficiency anemia
Vitamin B12 deficiency
* treatment: B12 injections
causes:
* hypoparathyroidism
* graves disease
* crohn’s disease
* celiac disease
* medications
S/s:
* weight loss
* fatigue, weakness
* loss of balance
pernicious anemia
What happens if you put on a BP cuff that is too big &/or too small?
BP cuff that is too small = false high BP
BP cuff that is too big = false low BP
T/F - If a patient has been in atrial fibrillation for more than 48 hours, anticoagulation is needed prior to a cardioversion due to blood clot risks.
True
Rapidly progressive hypertension that can cause life-threatening damage to small arteries in major organs
Diastolic pressure is usually >140 mm Hg
life-threatening organ damage
- treatment based on severity
S/s usually don’t occur until vascular changes occur in the heart, brain, eyes, or kidneys
malignant hypertension
chaotic, rapid electrical impulses in the atria
* irregular/no P wave - has QRST wave
* 100-150 BPM
* Increases stroke risk
* most common
causes:
* HTN, MI, HF
* CHD, COPD
s/s:
* Palpitations, pulse deficit
* hypotension
* SOB, CP
* fatigue
* tachycardia
* possible stroke
treatment:
* prevent thrombi (warfarin/ anticoagulants - bleeding precaution)
* restore normal rhythm
* synchronized cardioversion/ D-fib
* Count apical pulse for 1 min
arterial fibrillation (AFib)
What labs should you monitor for a patient who has anemia?
Hgb
Your patient has a potassium level of 6, what do you do?
Give spironolactone (Aldactone)
What do you monitor for while taking lovenox?
Bleeding
D-dimer
What type of precautions is C- Diff and what type of PPE do you need?
Contact
gown & gloves
genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape
interventions:
* Hydration
* Oxygen
* Pain management (opioids)
sickle cell anemia
What diet should a patient with pernicious anemia be on?
high protein diet
* meat
* eggs
* dairy
what do you suspect is the problem with your pt complaining of being tired, weak, their skin is itchy and they have a dusky gray color to their skin?
Chronic Renal Failure
which protein choice would align with Dietary Approaches to Stop Hypertension (DASH) eating plan?
A) 12 oz ribeye steak, grilled
B) 3 oz wild salmon, grilled
C) 8 Oz hamburger w/ cheese
D) 12 hot wings w/ skin and hot sause
B) 3 oz wild salmon, grilled
Explaination: DASH diet emphasizes lean sources of protein including poultry, fish, nuts, low-fat dairy, & lean red meats.
What can cause hypercalcemia?
Malignancy
Hyperparathyroidism
Excessive calcium intake
low potassium
* Below 3.5
Causes:
* GI loss, renal loss, diuretics
* Increased perspirations, NG suctioning
* V/D/laxatives
* Excessive use of glucocorticoids, poor dietary intake
S/s:
* Fatigue
* Metabolic alkalosis
* N/V/A, increased sensitivity to digitalis
* ECG changes (ventricular tachycardia and ventricular fibrillation/ can lead to death)
Treatment:
* Salt substitutes
* Dysthymia monitoring
* Increase perspiration (mild loss)
Hypokalemia
high potassium
* Above 5
rare in patients with normal renal function
causes:
* Decreased urinary excretion of potassium (renal failure/disease)
* Movement of potassium from the cells (ICF) to the ECF (burns/ crushing injuries)
S/s:
* cardiac rhythm issues (asystole)
* muscle weakness, flaccid paralysis
* N/D
treatment:
* treat underlying cause
* discontinue potassium supplements
* IV calcium gluconate, IV sodium bicarb
* Albuterol/ salbutamol, kayexalate (NG/ retention enema/ PO)
* regular insulin
* hypertonic dextrose IV
* dialysis
Hyperkalemia
excessive calcium in the blood
* above 10
may be due to malignancy, hyperparathyroidism, or excessive calcium intake
treat pt by handling the pt gently to prevent fractures, avoid high calcium foods, and drink more water
Hypercalcemia
What are some Causes of Metabolic Alkalosis?
Vomiting
Suctioning
hypokalemia
What are some Causes of Metabolic Acidosis?
diarrhea
renal failure
Diabetic Ketoacidosis
Shock
Sepsis
What are some Causes of Respiratory Acidosis?
sleep apnea
head trauma
opioid overdose
COPD
pneumonia
Antibiotic; fluoroquinolone (bacterial infections)
BBW: Tendon rupture, Increased risdk when used w/ corticosteroids
can cause prolonged Q-T intervals
- danger of prolonged Q-T interval can put heart at an increased risk for cardiac dysrhythmeias (even deadly ones)
Ciprofloxacin (Cipro)
Solution of choice for dehydration
- used frequently in surgery
Check compatibility - has many substances in it:
- dextrose, Na, Cl, K, & Ca
- does not have enough Na or Ca to correct deficiencies in these electrolytes
Do not use if lactate levels are elevated
Lactated Ringers (LR)
Are the following Isotonic, hypotonic or hypertonic solutions?
0.225% NaCl
0.455 NaCl
0.35 NaCl
Dextrose 2.5% in water
Hypotonic solutions
an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
Do not always occur because of an error
- Not all error result
Reported to joint commision
Most frequent sentinel events:
- falls
- wrong patient, site, or procedure
- unintended retention of foreign body
- delay in treatment
- suicide
- operative/ post-op complications
Sentinel events
What are the PN IV therapy Can Do’s?
Initiate/ maintain fluids
Hang initial bag IVPM antibiotics
Hang 2nd bag of vitamins/ electrolyte solutions
Prepare & reconstitute IV antibiotics with normal saline/ heparin
Can maintain/ regulate as IV infusion according to prescribed flow rate
Change tubing used
Place peripheral IV on adults, Can care for adults (18+)
What is the most serious symptom of hypocalcemia?
laryngospasm
- treat with oral/ IV supplements
Ph 7.1 PCO2 49 HCO3 26 PO2 70
Example: Pt has pneumonia
respiratory acidosis
Ph 7.0 PCO2 50 HCO3 28 PO2 67
Pt has an acute exacerbation COPD
respiratory acidosis
A patient is post-op from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Hypokalemia
D. Metabolic acidosis
A. Respiratory acidosis
Ph 7.49 PCO2 46 HCO3 30 PO2 90
Example: Pt has been vomiting for 2 days
metabolic alkalosis
Ph 6.9 PCO2 30 HCO3 19 PO2 98
Example: Pt has a bs of 503, ketones in the urine
metabolic acidosis
Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition?
A. Calcium and sodium levels
B. Potassium and sodium levels
C. Calcium and potassium levels
D. Potassium and phosphate levels
C. Calcium and potassium levels
A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition?
A. Bradypnea
B. Tachypnea
C. Bradycardia
D. None of the options are correct
B. Tachypnea
Which of the following is not a cause of respiratory acidosis?
A. Pulmonary edema
B. Asthma
C. Chronic obstructive pulmonary disease (COPD)
D. Hyperventilation
D. Hyperventilation
low level of calcium in the blood (below 8)
hypoalbuminemia is the most common
S/s:
* Tenany, muscle cramps
* + trousseau and + chvostek signs
* cardiac dysrhythmias, seizures
* laryngospasm (most dangerous symptom)
treat with oral or IV supplements
hypocalcemia
Are the following Isotonic, Hypotonic, or Hypertonic solutions?
Normal sodium chloride(0.9% NaCI)
D5W ( Dextrose 5% & water
LR (Lactated ringers)
Dextrose 5% and 0.225% NaCI
Albumin 5%
Isotonic
Are the following Isotonic, hypotonic or hypertonic solutions?
Dextrose / sodium chloride (D5/NS)
Dextrose 5% and LR (D5/LR)
Dextrose and 0.45% NaCI (D5 & 1/2 NS)
TPN (Total Paternal Nutrition)
Albumin 25%
Hypertonic
LPN can administer what solutions?
D5W
D5/LR
D5/NS
NS
LR
1/2 NS
1/4 NS
What are some Causes of Respiratory Alkalosis?
panic attack
fast resp rate
When can an LPN change a PICC/CVC dressing?
If the patient is 18 or older
Solution of choice for trauma (except burns)
Compatible with most solutions/ meds
Used to hang blood products & flush CVCs and PICC lines
Can lead to circulatory overload
Normal Saline (NS)
Prolonged _______________ can lead to the development of acute renal failure.
A) hypervolemia
B) hypokalemia
C) hypovolemia
D) hyperkalemia
C) hypovolemia
pH 7.28 , PCO2 54, HCO3 34
A) Respiratory acidosis, partially compensated
B) Metabolic acidosis, fully compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, uncompensated
A) Respiratory acidosis, partially compensated
pH is abnormal and either CO2 or HCO3 is abnormal
Uncompensated
pH, CO2 & HCO3 values will be abnormal
Partially compensated
pH is normal PaCO2 & HCO3 abnormal
Fully compensated
pH 7.22 , PCO2 44 , HCO3 17
A) Respiratory acidosis, compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, fully compensated
B) Metabolic acidosis, uncompensated
pH 7.49 , PCO2 30 , HCO3 17
A) Respiratory acidosis, compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, fully compensated
C) Respiratory alkalosis, partially compensated
pH 7.36 , PCO2 49 , HCO3 28
A) Respiratory acidosis, fully compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, compensated
A) Respiratory acidosis, fully compensated
pH 7.44 , PCO2 50, HCO3 31
A) Respiratory acidosis, compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, fully compensated
D) Metabolic alkalosis, fully compensated
pH 7.46 , PCO2 44, HCO3 29
A) Respiratory acidosis, compensated
B) Metabolic acidosis, fully compensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, uncompensated
D) Metabolic alkalosis, uncompensated
pH 7.25 , PCO2 30, HCO3 15
A) Respiratory acidosis, fully compensated
B) Metabolic acidosis, partially compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, uncompensated
B) Metabolic acidosis, partially compensated
pH 7.3 , PCO2 50, HCO3 24
A) Respiratory acidosis, uncompensated
B) Metabolic acidosis, partially compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, fully compensated
A) Respiratory acidosis, uncompensated
pH 7.48 , PCO2 29, HCO3 23
A) Respiratory alkalosis, uncompensated
B) Metabolic acidosis, partially compensated
C) Respiratory acidosis, compensated
D) Metabolic alkalosis, fully compensated
A) Respiratory alkalosis, uncompensated
pH 7.36 , PCO2 30, HCO3 20
A) Respiratory acidosis, uncompensated
B) Metabolic acidosis, fully compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, partially compensated
B) Metabolic acidosis, fully compensated
NSAID (non-steroidal anti inflammatory)
- IM, IV, nasal spray
Used for mild-moderate pain
- check BUN/Cr (Toxic to liver)
Black box warning: nephrotoxic, hepatotoxic, can cause stroke & MI, GI bleeding, Steven-Johnson’s syndrome
Do not use for pain associated with CABG
- coronary artery bypass graft
Antidote: Narcan, Mucomyst
Toradol (ketorolac)
Organisms include: TB, varicella and measles, Covid
- Think MTV
best practice for precaution:
- isolation room
- negative pressure room
- N-95 or HEPA mask applied before entering room or home
Airborne precautions
Organisms include: VRE, C-Diff, Noroviruses, RSV
PPE: gown, gloves
- DON before entering
- DOFF before exiting
contact precaustions
What are S/s of an overdose?
decreased respirations, resp. depression
decreased SpO2
lethargy
change in LOC
masks and goggles, or a mask with a face shield, to prevent exposure of mucosal surfaces to respiratory secretions
* flu.
* meningococcal disease.
* rubella
Droplet precaution
