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NU 340 > Ch. 13 > Flashcards

Ch. 13 Flashcards

1
Q

dehydration means that there is a lack of ___ in the body

A
  • fluid intake is less than what is needed to meet the body’s fluid needs
  • no water or no salt or both
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2
Q

causes of dehydration

A
  • inadequate fluid intake
  • loss of sodium in diet (ie maybe they completely cut out sodium from diet)
  • loss of fluid and electrolytes (ie. vomiting and diarrhea, or diabetes insipidus, excessive sweating)
  • excessive caffeine intake, alcohol intake
  • fever of 102/103- diaphoretic
  • medication: diuretics
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3
Q

adverse effects of dehydration: 0% body weight loss

A

thirst

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4
Q

adverse effects of dehydration: 2% body weight loss

A
  • stronger thirst
  • vague discomfort
  • loss of appetite
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5
Q

adverse effects of dehydration: 3% body weight loss

A
  • decreasing blood volume
  • impaired physical performance
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6
Q

adverse effects of dehydration: 4% body weight loss

A
  • increased effort for physical work
  • nausea
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7
Q

adverse effects of dehydration: 5% body weight loss

A
  • difficulty concentrating
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8
Q

adverse effects of dehydration: 6% body weight loss

A
  • failure to regulate excess temperature
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9
Q

adverse effects of dehydration: 8% body weight loss

A
  • dizziness
  • labored breathing with exercise
  • increased weakness
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10
Q

adverse effects of dehydration dehydration: 10% body weight loss

A
  • muscle spasms
  • delirium
  • wakefulness
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11
Q

adverse effects of dehydration: 11% body weight loss

A
  • inability of decreased blood volume to circulate normally
  • failing renal function
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12
Q

clinical manifestations of dehydration

A
  • cardiovascular changes: decreased plasma volume, increased HR, low BP
  • respiratory changes: increased RR
  • skin changes: dry, moist (fever)
  • neurologic changes: confusion, lethargic
  • renal changes: decreased urinary output, dark/concentrated urine
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13
Q

laboratory assessments of dehydration

A

elevated:
- hemoglobin
- hematocrit
- serum osmolarity
- glucose
- BUN
- electrolytes

hemoconcentration causes the blood to be very concentrated and elevate these levels

*assess in correlation with physical findings, labs on their own don’t conclude dehydration

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14
Q

analysis/patient problems of dehydration

A
  • poor perfusion due to excess fluid loss or inadequate fluid intake
  • potential for injury due to blood pressure changes and muscle weakness
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15
Q

dehydration: nurse management

A
  • safety
  • strict I&O**
  • monitor labs
  • monitor cardiovascular/ respiratory status
  • daily weights**
  • skin care, oral care (very dry- make sure that they are moist/clean)
  • monitor for complications
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16
Q

1L of water is ____ lb of water, which is __ kg

A

2.2 lbs, 1 kg

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17
Q

weight change of 1 lb = fluid volume change of ___ mL

A

500 mL

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18
Q

fluid overload

A
  • excess of body fluid
  • hypervolemia
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19
Q

dilution of sodium and potassium can lead to ___

A
  • seizures
  • coma
  • death
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20
Q

severe fluid overload can lead to ___

A
  • heart failure
  • pulmonary edema (RRT needed)
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21
Q

hyponatremia

A
  • sodium level below 136mEq/L
    (more common than hyper)
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22
Q

causes of hyponatremia

A
  • increased sodium loss
  • excess water- dilutional (kidneys are not working well)
  • dehydration* most likely cause
  • liver disease
  • adrenal insufficiency
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23
Q

clinical manifestations of hyponatremia

A
  • sodium loss vs fluid gain
  • *neurologic: lethargic, seizures, confusion
  • CV: low BP, high HR
  • skin: dry, decreased skin turgor
  • GI: nausea, diarrhea

*affects neuro the most

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24
Q

hyponatremia interventions

A
  • treat underlying cause
  • sodium replacement
  • monitor
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25
Q

hyponatreamia interventions: sodium replacement

A
  • IV (hypertonic) (0.9% NS)
  • diet (foods with sodium)
  • medications (mannitol if dilutional)
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26
Q

hyponatremia interventions: monitor for

A
  • I/O
  • urine specific gravity
  • BP, CV, respiratory status
  • neurologic status
  • daily weights
  • edema (effect from the treatment- fluid volume overload)
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27
Q

hypernatremia

A
  • serum sodium level over 145 mEq/L
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28
Q

causes of hypernatremia

A
  • dehydration
  • excessive sodium intake (high sodium diet)* most likely cause
  • regulatory abnormalities
  • hypercortisolism
  • kidney disease
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29
Q

clinical manifesations of hypernatremia

A
  • neurologic
  • renal: underlying kidney disease
  • cardiovascular: elevated BP
  • respiratory (if caused by dehydration)
  • integumentary (if caused by dehydration)
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30
Q

hypernatremia interventions

A
  • safety (seizure monitoring)
  • medication: diuretic (lasix)
  • IV therapy: sodium free fluids initially
  • diet: low sodium diet, fluids if dehydrated
  • monitor: VS, I&O, daily weights, edema

*depends on cause (water loss or sodium gain)

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31
Q

hypernatremia interventions: diet

A
  • fluids if dehydrated
  • low sodium diet
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32
Q

hypernatremia interventions: monitor for

A
  • VS
  • I/O
  • daily weights
  • edema
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33
Q

hypokalemia

A

serum potassium level below 3.5mEq/L
*can be life threatening because every body system is affected

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34
Q

causes of hypokalemia

A
  • abnormal losses: diuretics, GI losses (vomiting, NG tube, diarrhea)
  • other conditions: metabolic and respiratory alkalosis
  • fluid overload
  • insulin administration
  • hyperaldoseteronism
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35
Q

clinical manifestations of hypokalemia

A
  • cardiovascular: irregular beat and rhythm- should be on heart monitor
  • metabolic: muscle weakness, falls
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36
Q

hypokalemia interventions

A
  • safety
  • potassium replacement (PO or IV)
  • educations: diet (citrus, banana), diuretic use (electrolyte checks)
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37
Q

potassium replacement IV should not be faster than _____

A

10 mEq/hr **NO FASTER

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38
Q

can potassium replacement be given as IV push?

A

no- never
- can cause cardiac arrest –> heart stops –> kill patient

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39
Q

hyperkalemia

A

serum potassium greater than 5.0 mEq/L

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40
Q

what is the most severe problem that results from hyperkalemia?

A

cardiovascular changes
- also the most common cause of death in patients with hyperkalemia

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41
Q

causes of hyperkalemia

A
  • dehydration
  • kidney disease
  • acidosis
  • adrenal insufficiency
  • crush injuries
  • medication (potassium-sparing diuretic: spironolactone, ACE-Inhibitors)
  • blood transfusion
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42
Q

clinical manifestations of hyperkalemia

A
  • cardiovascular
  • neurologic: muscle weakness
  • GI: diarrhea
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43
Q

hyperkalemia interventions

A
  • safety
  • drug therapy
  • monitoring
  • health teaching
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44
Q

drug therapy for hyperkalemia

A
  • sodium polystyrene (drink- causes patient to have a BM, gets rid of potassium through BM)
  • IV insulin (pulls potassium from blood stream back into cell) and glucose (balancing out the blood sugar)
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45
Q

hyperkalemia interventions: monitoring

A
  • cardiac - life threatening
  • neurologic
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46
Q

hyperkalemia interventions: health teaching

A
  • diet (no citrus, low sodium diet)
  • avoid salt substitutes
  • increase fluid intake (helps dilute potassium)
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47
Q

hypocalcemia

A

total serum calcium level below 9.0 mg/dL

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48
Q

causes of hypocalcemia

A
  • dietary intake
  • inadequate absorption
  • increased phosphorus
  • decreased PTH
  • vit D deficiency
  • hypothyroidism
  • hypoparathyroidism
  • kidney disease
  • excessive intake of phosphorus-containing foods and drinks
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49
Q

clinical manifestations of hypocalcemia

A
  • neurologic (tingling/numbness)
  • cardiovascular changes (bradycardia, EKG changes)
  • intestinal changes (cramping)
  • skeletal changes (charlie horse, tingling in muscle)
    chvostek’s sign: decrease calcium in the blood results in facial twitching when the facial nerve is tapped
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50
Q

hypocalcemia inteventions

A
  • drug therapy (Vit D)
  • nutritional therapy (encourage foods high in calcium: yogurt, milk)
  • environmental management (potentially, seizure precautions)
  • injury prevention strategies (taking vitamins to prevent bone fractures
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51
Q

hypercalcemia

A

total serum calcium level above 10.5 mEq/L

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52
Q

causes of hypercalcemia

A
  • hyperparathyroidism
  • increased CA or Vit D
  • malignancy
  • prolonged immobilization
  • hyperthyroidism
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53
Q

clinical manifestations of hypercalcemia

A
  • effects of hypercalcemia occur first in excitable tissues
  • cardiovascular (most important)
  • GI
  • renal
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54
Q

hypercalcemia interventions

A
  • drug therapy
  • dialysis
  • cardiac monitoring
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55
Q

hypercalcemia interventions: drug therapy

A
  • IV 0.9% sodium chloride
  • furosemide
  • calcium chelators
56
Q

agents that prevent hypercalcemia

A
  • phosphorus
  • calcitonin
  • biphosphonates
  • prostaglandin synthesis inhibitors
57
Q

hypophosphatemia

A

serum phosphorous level below 3 mEq/L

58
Q

hyperphosphatemia

A

serum phosphorous level above 4.5 mEq/L

59
Q

what two ions exist in the blood in a balanced reciprocal relationship?

A
  • calcium and phosphorous
60
Q

assessment of hypophosphatemia

A
  • low phosphorus , high calcium
61
Q

assessment of hyperphosphatemia

A
  • high phosphorus, low calcium
62
Q

management of hypophosphatemia

A

think high calcium (hypercalcemia interventions)
- drug therapy (IV 0.9% NS, furosemide, calcium chelators
- dialysis
- cardiac monitoring

63
Q

management of hyperphosphatemia

A
  • drug therapy (Vit D)
  • nutritional therapy (encourage foods high in calcium: yogurt, milk)
  • environmental management (potentially, seizure precautions)
  • injury prevention strategies (taking vitamins to prevent bone fractures
64
Q

hypomagnesemia

A

serum magnesium level below 1.3 mEq/L

65
Q

effects of hypomagnesemia are caused by

A
  • increased membrane excitability
  • accompanying serum calcium and potassium imbalances
  • malnutrition
  • alcoholism
  • ketoacidosis
66
Q

clinical manifestations of hypomagnesemia

A
  • neuromuscular changes
  • CNS changes
67
Q

interventions for hypomagnesemia

A
  • drugs: IV mag sulfate
68
Q

hypermagnesemia

A

serum magnesium level above 2.6 mEq/L

69
Q

when magnesium excess occurs, excitable membranes are ___

A

less excitable
- need a stronger than normal stimulus to respond

70
Q

clinical manifestations of hypermagnesemia

A
  • cardiac changes
  • CNS changes
  • neuromuscular changes
  • respiratory changes
71
Q

hypermagnesemia interventions

A
  • magnesium-free IV fluids
  • furosemide
  • calcium
72
Q

percentage of the body composed of fluid

A

> 50%

73
Q

body fluids deliver _____ to all tissues and cells in the body

A

nutrients and electrolytes

74
Q

two main compartments of body fluids

A
  1. ECF
  2. ICF
75
Q

three processes that control fluid and electrolyte balance

A
  1. filtration
  2. diffusion
  3. osmosis
76
Q

filtration

A

movement of fluid through cell or blood vessel membrane because of differences in water pressure (hydrostatic pressure)
- water volume pressing against confining walls

77
Q

diffusion

A

free movement of particles (solute) across permeable membrane from area of HIGHER to LOWER concentration

78
Q

osmosis

A

movement of water only through a semipermeable membrane to achieve an equilibrium of osmolarity from area of LOWER concentration to HIGHER concentration

79
Q

clinical example of filtration

A

blood pressure

80
Q

hydrostatic pressure is

A

“water pushing pressure”
- force that pushes water outward from a confined space through a membrane

81
Q

what determines the amount of pressure? (re: hydrostatic pressure)

A

the amount of water in any body fluid space

82
Q

example of hydrostatic pressure

A

blood pressure
- moving whole blood from the heart to capillaries where filtration occurs to exchange water, nutrients, and waste products between the blood and tissues

83
Q

this process is important in the transport of most electrolytes

A

diffusion

84
Q

other particles diffuse through ____

A

cell membranes

85
Q

clinical example of diffusion

A
  • transport of most electrolytes and other particles through cell membrane
  • sodium pumps
86
Q

glucose cannot enter most cell membranes without help of ___

A

insulin

87
Q

osmolarity

A

number of milliosmoles in a liter of solution

88
Q

osmolality

A

number of milliosmoles in a kilogram of solution

89
Q

1L of H2O = __ kg

A

1 kg

90
Q

normal osmolarity for bodily fluids:

A

270-300 mOsm/L

91
Q

osmosis and filtration work together to ___

A

act at capillary membrane to maintain normal ECF and ICF volumes

92
Q

example of how osmosis helps maintain homeostasis:

A

thirst mechanism

93
Q

the feeling of thirst is caused by ___

A

activation of brain cells responding to changes in the ECF osmolarity

94
Q

fluid types

A
  • isosmotic or isotonic (normotonic)
  • hyperosmotic or hypertonic-osmolarity
  • hypo-osmotic or hypotonic-osmolarity
95
Q

isosmotic or isotonic (normotonic): osmolarity

A

270-300

96
Q

hyperosmotic or hypertonic-osmolarity: osmolarity

A

> 300

97
Q

hypo-osmotic or hypotonic-osmolarity: osmolarity

A

< 270

98
Q

fluids are regulated through the

A

thirst drive

99
Q

fluids enter the body mostly as

A

liquids

100
Q

adults need ___ (amount) of water per 1000kcal

A

1000mL per 1000kcal

101
Q

fluids loss occurs through

A

several routes
- sweating
- urine

102
Q

minimum amount of urine needed to excrete toxic waste products is ___

A

400-600mL

103
Q

insensible water loss is (amount)

A

500-1000mL

104
Q

what 3 hormones control fluid and electrolyte balance

A
  1. aldosterone
  2. antidiuretic hormone (ADH)
  3. Natriuretic peptides
105
Q

what are the most important fluids to keep in balance?

A
  • blood (plasma) volume
  • intracellular fluid
106
Q

what organ is the major regulator of water and sodium?

A

the kidneys

107
Q

the kidneys maintain ____ and ___ to all tissues/organs

A
  • blood pressure and perfusion to all tissues/organs
108
Q

what do the kidneys secrete when they sense a low parameter?

A

renin

109
Q

RAAS (renin-angiotensin-aldosterone system) is greatly stimulated when ____

A
  • when in shock
  • when stress response is stimulated
110
Q

electrolyte imbalance can occur in healthy people as a result of

A

changes in fluid intake and output

111
Q

electrolyte imbalance includes:

A
  • sodium
  • potassium
  • calcium
  • magnesium
112
Q

causes of hypermagnesemia

A
  • kidney disease
  • hypoparathyroidism
  • adrenal insufficiency
113
Q

causes of hypochloremia

A
  • fluid overload
  • excessive vomiting or diarrhea
  • adrenal insufficiency
  • diuretic therapy
114
Q

causes of hyperchloremia

A
  • metablic acidosis
  • respiratory alkalosis
  • hypercortisolism
115
Q

causes of hypo-osmolarity

A
  • fluid overload
  • hyponatremia
  • hypoproteinemia
  • malnutrition
116
Q

causes of hyperosmolarity

A
  • dehydration
  • hypernatremia
  • hyperglycemia
117
Q

normal sodium range

A

136-145 mEq/L

118
Q

normal potassium range

A

3.5-5.0 mEq/L

119
Q

normal calcium range

A

9.0-10.5 mg/dL
(2.25-2.62 mmol/L)

120
Q

normal chloride range

A

98-106 mEq/L

121
Q

normal magnesium range

A

1.3-2.1 mEq/L
(0.65-1.05 mmol/L)

122
Q

sodium often enters the body through

A

foods and fluids
- smoked or pickled foods, snack foods, condiments

123
Q

where sodium goes, ___ follows

A

water

124
Q

major cation of ICF:

A

potassium

125
Q

potassium is highest in what? (food)

A
  • meat
  • fish
  • many vegetables
  • fruits
126
Q

calcium enters the body through

A

intake of dairy products
- milk
- cheese
- yogurt

127
Q

absorption of calcium requires what vitamin?

A

the active form of Vit D

128
Q

calcium stored in what part of the body?

A

bones

129
Q

what hormone is released when more calcium is needed?

A

PTH (parathyroid hormone)

130
Q

what hormone is present when there is excess calcium?

A

the thyroid gland secretes TCT (thyrocalcitonin)

131
Q

magnesium is stored in what body parts?

A
  • bone
  • cartilage
132
Q

magnesium assists with:

A
  • skeletal muscle contration
  • carbohydrate metabolism
  • generation of energy stores
  • vitamin activation
  • blood coagulation
  • cell growth
133
Q

dehydration: nursing priorites

A
  1. fluid replacement-IV fluids
  2. drug therapy
  3. patient safety
134
Q

difference in treatment of mild vs severe dehydration

A

mild: regular fluids
severe: IV fluids

135
Q

assessments for fluid overload

A
  • shortness of breath
  • edema
  • crackles in lungs
  • high BP
  • distention of jugular vein
136
Q

fluid overload: nursing priorities

A
  1. patient safety (falls)
  2. restore normal fluid balance
  3. prevent future fluid overload
    - drug therapy: diuretic (ie. furosemide- monitor electrolytes with diuretics)
    - nutrition therapy (low-sodium diet)
    - strict monitoring of I/O’s, daily weights
137
Q

IV potassium causes what sensation to patients?

A

burning

NU 340 (26 decks)

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