Chronic Regulatory test #4 Flashcards
isotonic
a happy cell that is equal parts plasma and solutes
Hypotonic IV fluids definition and kinds
contains fewer solutes than plasma.
types:1/2 NS, 1/4 NS and 1/3 NS
Hypertonic IV fluids definition and kinds
contains greater concertation of solutes than plasma
types: 3% saline 5% saline D10W D5NS and DSLR
hypovolemia
fluid volume deficit
preferred method of fluid replacement when someone is hypovolemic?
oral fluid intake!
it is less invasive than IV
Signs of hypovolemia
- rapid but weak pulse
- low BP
- Decrease in body temp, unless it is becuse of an infection
medical treatment of hypervolemia
- reducing sodium
- diuretics
- potassium supplements
T/F
any loop diuretic or thiazide should also be given with a potassium supplement
True
Treating hyponatremia (<135 MEQ/ L)
monitor I&O, weight, GI and CNS symptoms and serum sodium
Increase sodium in the diet, if not possible supplement by giving sodium chloride
hypernatremia (>145 MEQ/L)
Monitor I&O, weight, thirst, change in behavior, and checking serum sodium levels.
-Giving diuretics or hypotonic elecreolyte solution
What would we do to manage hyperkalemia?
-ECG to monitor for arrhythmias
-restrict potassium
constipation is common
-IV calcium gluconate
- IV insulin
- IV sodium bicarb
-polystrene sulfonate (kayalte)
What levels are considered hypercalcemia and hypocalcemia?
Hypocalcemia: (<8.6)
Hypercalcemia ( >10.2)
How to treat hypocalcemia?
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)
What IV fluids can be given if someone is hypercalcemic
Furosemide
Phosphate
Calcitonin
Bisphosphonate
what should we have on hand to treat hypermagnesmia or hypocalcemic tetny
Calcium gluconate
what should we monitor in sever hypomagnesemia situation
- monitor for dysphagia
- use seizure precautions
What kinds of fluids can we use to treat Hypermagnesemia?
IV Calcium gluconate
- hemodialysis
- Ventilatory support
IV calcium gluconate
used to protect the heart
What should be a monitor for someone with hypermagnesimia?
LOC and decrease in deep tendon reflexes
Chronic Kidney Disease manifestations
HIGH serum creatinine levels metabolic acidosis electrolyte abnormalities fluid retention ( risk for CHF) anemia LOW GFR
Common kidney electrolyte abnormalities
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
What are the diagnostic test we look at for an individual with renal disease?
- creatine clearance (down)
- serum creatine
- ABGs
- Electrolytes
- serum BUN
- GFR (down)
What is the common ABG in people who suffer from renal failure?
Metabolic acidosis
Replace bicarb
Nursing care for someone with renal disease
- asses and manage fluids
- educate on reducing risk factors and lifestyle changes
- provide emotional support
- manage complications
- educate of the disease process
- monitor weight
calcium and phosphourus binders
Treat hyperphosphatemia and hypocalcemia by binding dietary phosphorus in the GI tract
Decreasing phosphorus will increase calcium
What are antiepileptic agents used in individuals with renal failure?
- maybe prescribed for someone with neuropathy “because they neuropathy goes hand in hand with renal failure”
- may suffer from seizures.
What are Erythrocyte stimulating used in individuals with renal failure?
erythropoietin used to maintain hematocrit levels
takes 2-6 weeks for max effects
Adverse effects: HTN, Seizures, depletion of iron
what in the diet needs to be restricted in someone who has the renal disease?
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)
What electrolytes typically need to be restricted in someone who has a renal disease?
reduced-sodium and potassium
what are some indicators that someone is in need of dialysis?
Uremic (nausea/ vomiting/ mental confusion, lethargy/ annorxia)
Hyperkalemia
fluid overload and not responsive to fluid restriction or diuretics
lack of well being
what are the types of dialysis?
Peritoneal dialysis and hemodialysis (most common)
continuous renal replacement (rare) (CRRT)
Hemodialysis
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)
What are complications of hemodialysis?
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
vascular access when giving hemodialysis ? what are the types and what is the prefered
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
What kind of medications should not be given to someone going in for dialysis?
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
peritoneal dialysis :
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
what is hepatic cirrhosis?
Chronic progressive disease liver. a normal issue with diffuse fibrosis.
blood vessels damages, deprives the liver of nutrients,
Manifestations of Hepatic cirrohisis?
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
what are angiomas and palmar erythema and why do they occor.
seen with dysfunctional liver and it not being able to process estrogen
what are angiomas (spider) and palmar erythema (red palms)
If an individual has complications what kind of cirros would they have
Uncompensated cirrhosis
What are the complications of hepatic cirrhosis?
- 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
What kind of diagnostic test would be likely seen in a person who is suffering from hepatic cirrhosis?
- Decreased serum albumin
- Abnormal LFT’s
- Increased bilirubin levels
- Prolonged PT
- Ammonia levels
the liver plays a role in blood clotting, true or false
true , make sure they are on bleeding precautions
How should the nurse promote care with someone with cirrhosis
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
How can someone improve the nutritional status of someone with cirrhosis?
- High Protein diet
- Supplemental B complex, A, C and K
- small frequent meals better tolerated
- sodium restriction when ascites is present (distended abdomen)
Hepatic cirrhosis usually means the person is deficient in vitamin K.
True or false
True
What should a person with Hepatic cirrhosis avoid?
- Acetaminophen
- NASIDS
- ASA
- Alcohol
What might you see a person with Hepatic cirrhosis be on for medications?
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
Esophageal varices
vessels burst in the esophageal and need to take vasoconstrictor
- vendodilators
- esophageal band litigation
Hepatorenal syndrome
liver transplant then the kidneys will be fine
How would we as nurses asses Ascites.
Ascites is the abnormal abdominal distetnion with fluid.
it would be assessed by Weight and ABDOMINAL girth I & O respiratory status and labs
Ascites treatment
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
what is hepatic encephalopathy?
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
What are the goals of treatment for Hepatic encephalopathy? (there are 4 stags)
-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
