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chronic > Chronic Regulatory test #4 > Flashcards

Chronic Regulatory test #4 Flashcards

1
Q

isotonic

A

a happy cell that is equal parts plasma and solutes

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2
Q

Hypotonic IV fluids definition and kinds

A

contains fewer solutes than plasma.

types:1/2 NS, 1/4 NS and 1/3 NS

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3
Q

Hypertonic IV fluids definition and kinds

A

contains greater concertation of solutes than plasma

types: 3% saline 5% saline D10W D5NS and DSLR

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4
Q

hypovolemia

A

fluid volume deficit

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5
Q

preferred method of fluid replacement when someone is hypovolemic?

A

oral fluid intake!

it is less invasive than IV

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6
Q

Signs of hypovolemia

A
  • rapid but weak pulse
  • low BP
  • Decrease in body temp, unless it is becuse of an infection
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7
Q

medical treatment of hypervolemia

A
  • reducing sodium
  • diuretics
  • potassium supplements
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8
Q

T/F

any loop diuretic or thiazide should also be given with a potassium supplement

A

True

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9
Q

Treating hyponatremia (<135 MEQ/ L)

A

monitor I&O, weight, GI and CNS symptoms and serum sodium

Increase sodium in the diet, if not possible supplement by giving sodium chloride

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10
Q

hypernatremia (>145 MEQ/L)

A

Monitor I&O, weight, thirst, change in behavior, and checking serum sodium levels.
-Giving diuretics or hypotonic elecreolyte solution

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11
Q

What would we do to manage hyperkalemia?

A

-ECG to monitor for arrhythmias
-restrict potassium
constipation is common
-IV calcium gluconate
- IV insulin
- IV sodium bicarb
-polystrene sulfonate (kayalte)

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12
Q

What levels are considered hypercalcemia and hypocalcemia?

A

Hypocalcemia: (<8.6)

Hypercalcemia ( >10.2)

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13
Q

How to treat hypocalcemia?

A

recommend to take 1000 to 1500 mg a day of Ca+

low calcium at risk for seizures so “you should have them on seizure precautions”

take with vitamin D to boost absorption

acute: administer IV calcium salt (calcium gluconate or calcium chloride)

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14
Q

What IV fluids can be given if someone is hypercalcemic

A

Furosemide
Phosphate
Calcitonin
Bisphosphonate

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15
Q

what should we have on hand to treat hypermagnesmia or hypocalcemic tetny

A

Calcium gluconate

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16
Q

what should we monitor in sever hypomagnesemia situation

A
  • monitor for dysphagia

- use seizure precautions

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17
Q

What kinds of fluids can we use to treat Hypermagnesemia?

A

IV Calcium gluconate

  • hemodialysis
  • Ventilatory support
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18
Q

IV calcium gluconate

A

used to protect the heart

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19
Q

What should be a monitor for someone with hypermagnesimia?

A

LOC and decrease in deep tendon reflexes

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20
Q

Chronic Kidney Disease manifestations

A 
HIGH serum creatinine levels 
metabolic acidosis 
electrolyte abnormalities 
fluid retention ( risk for CHF)
anemia
LOW GFR
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21
Q

Common kidney electrolyte abnormalities

A

You are going to see low calcium and high phosphate

calcium is the only one that will be low all of the other electrolytes will be high

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22
Q

What are the diagnostic test we look at for an individual with renal disease?

A
  • creatine clearance (down)
  • serum creatine
  • ABGs
  • Electrolytes
  • serum BUN
  • GFR (down)
23
Q

What is the common ABG in people who suffer from renal failure?

A

Metabolic acidosis

Replace bicarb

24
Q

Nursing care for someone with renal disease

A
  • asses and manage fluids
  • educate on reducing risk factors and lifestyle changes
  • provide emotional support
  • manage complications
  • educate of the disease process
  • monitor weight
25
Q

calcium and phosphourus binders

A

Treat hyperphosphatemia and hypocalcemia by binding dietary phosphorus in the GI tract

Decreasing phosphorus will increase calcium

26
Q

What are antiepileptic agents used in individuals with renal failure?

A
  • maybe prescribed for someone with neuropathy “because they neuropathy goes hand in hand with renal failure”
  • may suffer from seizures.
27
Q

What are Erythrocyte stimulating used in individuals with renal failure?

A

erythropoietin used to maintain hematocrit levels

takes 2-6 weeks for max effects
Adverse effects: HTN, Seizures, depletion of iron

28
Q

what in the diet needs to be restricted in someone who has the renal disease?

A

Protein because of how the body breaks it down. so with a little protein they are able to eat they should be of high biologic value, complete proteins (ex. dairy eggs and meat)

29
Q

What electrolytes typically need to be restricted in someone who has a renal disease?

A

reduced-sodium and potassium

30
Q

what are some indicators that someone is in need of dialysis?

A

Uremic (nausea/ vomiting/ mental confusion, lethargy/ annorxia)
Hyperkalemia
fluid overload and not responsive to fluid restriction or diuretics
lack of well being

31
Q

what are the types of dialysis?

A 
Peritoneal dialysis 
and hemodialysis (most common)

continuous renal replacement (rare) (CRRT)

32
Q

Hemodialysis

A

the process that filters the blood for individuals that are receiving dialysis. This process filters out toxins and though the solution of dialysate return back electrolytes, bicarbonate, and heaprin(prevent blood clots)

33
Q

What are complications of hemodialysis?

A 
disturbances in lipid metabolism
            - high triglycerides
             -  heart failure 
             - CAD, Angina, Stroke, 
                PVD
Gastric ulcers, metallic taste in mouth

hypotension during treatments

SOB between treatments

Air embolism

34
Q

vascular access when giving hemodialysis ? what are the types and what is the prefered

A

Double-Lumen large bore
has high infection rates,
used for acute access

Arteriovenous Fistula (AV Shunt) is preferred 
        created by joining an 
        artery to a vein 
        - requires 2-3 months 
           before use (needs to 
         mature after the joining)
        - Monitor for bruit/ Thrill 
            ( listen for the bruit and 
          feel for the thrill every 
           shift "very important" 
Arteriovenous Graft
        similar to the 
       arteriovenous fistula but 
       uses the material to up the 
       artery to a vein 
      - placed in arm usually, access in 2-3 weeks 
       - high risk of infections, thrombosis
       - monitor for bruit/ thrill
35
Q

What kind of medications should not be given to someone going in for dialysis?

A

Water soluble because they will be then out after the procedure

blood pressure mediations because dialysis will change the blood pressure so should be held

36
Q

peritoneal dialysis :

A

goal is to remove toxic substance and metabolic wastes and reestablish normal fluid and electrolyte

  • Peritonal membrane serves as semipermeable membrane
  • sterile dextrose dialysate fluid is put into the peritoneal cavity through an abnormal catheter at established intervals
37
Q

what is hepatic cirrhosis?

A

Chronic progressive disease liver. a normal issue with diffuse fibrosis.
blood vessels damages, deprives the liver of nutrients,

38
Q

Manifestations of Hepatic cirrohisis?

A

Early: more general
dull, achy upper right quad pain, weight loss, enlarged liver

Late:
jaundice, bleeding, enlarged spleen, skin lesions, peripheral neuropathies, anemia, endocrine issues, cachexia

39
Q

what are angiomas and palmar erythema and why do they occor.

A

seen with dysfunctional liver and it not being able to process estrogen

what are angiomas (spider) and palmar erythema (red palms)

40
Q

If an individual has complications what kind of cirros would they have

A

Uncompensated cirrhosis

41
Q

What are the complications of hepatic cirrhosis?

A
  • portal hypertension
  • Esophageal and gastric varices
  • Peripheral edema
  • Ascites (enlarged abdomen)
  • Hepatic Encephalopathy

-Hepatorenal Syndrome “problems is the liver”’ and it is a functional syndrome

42
Q

What kind of diagnostic test would be likely seen in a person who is suffering from hepatic cirrhosis?

A
  • Decreased serum albumin
  • Abnormal LFT’s
  • Increased bilirubin levels
  • Prolonged PT
  • Ammonia levels
43
Q

the liver plays a role in blood clotting, true or false

A

true , make sure they are on bleeding precautions

44
Q

How should the nurse promote care with someone with cirrhosis

A

Promoting rest is important
- Elevate HOB for max respiratory efficiency
(o2 may be needed)

  • Prevent negative outcomes of immobility
  • Once able, encourage the client to gradually increase activity
45
Q

How can someone improve the nutritional status of someone with cirrhosis?

A
  • High Protein diet
  • Supplemental B complex, A, C and K
  • small frequent meals better tolerated
  • sodium restriction when ascites is present (distended abdomen)
46
Q

Hepatic cirrhosis usually means the person is deficient in vitamin K.

True or false

A

True

47
Q

What should a person with Hepatic cirrhosis avoid?

A
  • Acetaminophen
  • NASIDS
  • ASA
  • Alcohol
48
Q

What might you see a person with Hepatic cirrhosis be on for medications?

A

H2 antagonists or antacids - to decrease GI distress and minimize bleeding risk

POTASSIUM sparing diuretics to decresase that ascetes
(Since there is a low amount of K to begin with need to use sparing diuretics)

milk thistle - helps with jaundice

49
Q

Esophageal varices

A

vessels burst in the esophageal and need to take vasoconstrictor

  • vendodilators
  • esophageal band litigation
50
Q

Hepatorenal syndrome

A

liver transplant then the kidneys will be fine

51
Q

How would we as nurses asses Ascites.

A

Ascites is the abnormal abdominal distetnion with fluid.

it would be assessed by 
Weight and ABDOMINAL girth
I & O
respiratory status 
and labs
52
Q

Ascites treatment

A

Paracentesis: long needle put in to take out fluid and it is temporary

Transjugular intrahepatic porosystemic: (TIPS)
put a stunt between the portal circulation and the hepatic vein.
-effective in removing and keeping off the fluid
-higher risk of encephalopathy and is expensive is why it is the second line

53
Q

what is hepatic encephalopathy?

A

considered uncompensated cirrhosis symptom.
nervous system disorder brought on by severe liver disease. When the liver doesn’t work properly, toxins build up in the blood. These toxins can travel to the brain and affect brain function. People with hepatic encephalopathy may seem confused. Treatments can rid the body of toxins and reverse this temporary condition

look for signs of asterixis -
uncontrolled hand flapping tremors

and signs of
Fector Hepaticus- sweet slightly fecal ordor

54
Q

What are the goals of treatment for Hepatic encephalopathy? (there are 4 stags)

A

-decrease the formation of AMMONIA* ( that is crossing the Blood brain barrier)

  • antibiotics to sterilize the GI tract
  • Lactulose to trap NH3 in the gut
  • Cathartics/enemas

chronic (7 decks)

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