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Fundamentals > Electrolytes 2 > Flashcards

Electrolytes 2 Flashcards

1
Q

for pediatric dehydration, how much should you give them and when?

A

first step for dehydrated and 5-10 mL every 5-10 minutes

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2
Q

Why are older adult clients are at higher risk for dehydration

A

Diminished thirst response
Decline in total body fluid
Decreased kidney function
Underlying health conditions
Medications

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3
Q

Contraindications for tourniquet use

A

High risk for bleeding
Compromised circulation
Fragile skin

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4
Q

What types of areas should be avoided when inserting IV?

A

tortuous veins
areas of flexion
painful upon palpation
axillary node dissection
AV fistula
radiation therapy
stroke side

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5
Q

What are some considerations for managing an IV?

A

monitoring of the IV site
tubing, solution
rate of administration
effects of the therapy on the client
including monitoring laboratory results
skin integrity
intake and output

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6
Q

What are types of solutions used to treat fluid imbalances?

A

crystalloid solutions and colloidal solutions

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7
Q

What do Crystalloids contain?

A

fluids that contain solutes such as electrolytes or dextrose

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8
Q

how easily do crystalloids dissolve?

A

readily dissolve in a solvent such as water and can diffuse through cell membranes

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9
Q

how are crystalloid solutions classified?

A

osmolality- hypotonic, isotonic, or hypertonic.

tonicity- ability to make water move in or out of the cells via osmosis

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10
Q

Hypotonic (less than 250 mOsm/L) treats

A

hypernatremia and diabetic ketoacidosis.

Monitor for hypotension.

Contraindicated in clients with burns, liver disease, increased intracranial pressure, and trauma.

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11
Q

Hypertonic (greater than 375 mOsm/L)
3% Sodium chloride treats

A

Used as volume expander for emergent replacement of solutes, cerebral edema, and symptomatic hyponatremia.

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12
Q

Hypertonic (greater than 375 mOsm/L) Dextrose 5% in 0.45% sodium chloride solution (D51/2NS) treats

A

Used as a maintenance IV fluid and to treat hypovolemia.
Monitor for fluid overload.

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13
Q

Hypertonic (greater than 375 mOsm/L) Dextrose 5% in 0.9% sodium chloride solution (D5NS)
treaats

A

Used to provide electrolytes (sodium, chloride), water, and calories. Monitor for fluid overload.

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14
Q

Hypertonic (greater than 375 mOsm/L) Dextrose 5% in lactated Ringer’s solution (D5LR) treats

A

provide calories, electrolytes, and water; treatment of metabolic acidosis.

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15
Q

Hypertonic (greater than 375 mOsm/L) Dextrose 10% in water (D10W) treats

A

hypoglycemia.
Provides calories and water.
Use a central line if possible; may cause phlebitis or thrombosis. Infuse slowly to avoid hyperglycemia, fluid overload, or pulmonary edema.
Monitor for new onset of confusion or loss of consciousness.

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16
Q

Hypertonic solutions may be contraindicated in what diseases?

A

cardiac or renal disease.

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17
Q

Isotonic (250 to 375 mOsm/L)0.9% Sodium chloride solution (NaCl) treats

A

One of the most commonly used IV fluids.

Promote hydration in the following conditions: vomiting, diarrhea, hemorrhage, and shock.

Only solution used with blood product administration.

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18
Q

Isotonic (250 to 375 mOsm/L) Lactated Ringer’s (LR) treat

A

Commonly used for burn and trauma clients.

Used for hypovolemia, acute blood loss, electrolyte imbalances, and metabolic acidosis. Use with caution in clients who have renal failure.

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19
Q

Isotonic (250 to 375 mOsm/L)Dextrose 5% in water (D5W)

A

hypernatremia
Dilutes osmolarity of extracellular fluid
After the cells absorb the dextrose, the remaining water and electrolytes become an isotonic solution.
Provides limited nutrition due to dextrose being a form of glucose.
Contraindicated in resuscitation, early postoperative period, renal and cardiac issues, and increased intracranial pressure.

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21
Q

one of the most commonly used IV fluids

A

Isotonic (250 to 375 mOsm/L)0.9% Sodium chloride solution (NaCl) treats

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21
Q

What are colloidal solutions?

A

Intravenous solutions that contain large molecules unable to pass through capillary membranes.

often referred to as plasma or volume expanders

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22
Q

What solutions are used to increase osmotic pressure within the plasma?

A

colloidal solutions

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23
Q

What are adverse effects associated with the administration of colloidal solutions? (3)

A

allergic reactions
renal failure
blood clotting disorders

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24
Q

During transfusion of colloids, the nurse should carefully monitor for manifestations of hypervolemia such as hypertension, jugular venous distention, edema, dyspnea, and adventitious breath sounds.

A

hypertension
jugular venous distention
edema
dyspnea
adventitious breath sounds.

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25
Albumin 5% (309 mOsm/L) treats
Hypovolemic shock (surgery or trauma)
26
What solutions have these characteristics? Interstitial edema (draws fluid into the intravascular space) Replacement for low albumin levels
Albumin 5% (309 mOsm/L) Albumin 25% (312 mOsm/L)
27
Albumin 5% (309 mOsm/L) Albumin 25% (312 mOsm/L) considerations
must be transfused within four hours of opening Monitor for circulatory overload (especially with 25% albumin) and pulmonary edema
28
Albumin 5% (309 mOsm/L) Albumin 25% (312 mOsm/L) contraindications and adverse reactions
Adverse reactions: Urticaria, flushing, chills, fever, headache Contraindications: Severe anemia, heart failure
29
What to colloidal solutions are used for dShock (burns, hemorrhage, surgery, trauma)
Dextran 40 (low-molecular-weight: 280 to 324 mOsm/L) Dextran 70 (high-molecular-weight: 280 to 324 mOsm/L)
30
Dextran 40 (low-molecular-weight: 280 to 324 mOsm/L) Dextran 70 (high-molecular-weight: 280 to 324 mOsm/L) monitor for
Monitor pulse, blood pressure and urinary output per facility policy or prescriber’s prescription (every 5 to 15 minutes for the first hour). Monitor for circulatory overload.
31
Dextran 40 (low-molecular-weight: 280 to 324 mOsm/L) Dextran 70 (high-molecular-weight: 280 to 324 mOsm/L)
Increased risk for bleeding. Adverse reactions: Anaphylaxis Contraindications: Low platelet level, hemorrhagic shock
32
What is Hetastarch (308 mOsm/L) used for?
hypovolemia
33
Hetastarch (308 mOsm/L) monitoring
Monitor for circulatory overload. Monitor hematocrit/hemoglobin levels. Monitor for bleeding.
34
Hetastarch (308 mOsm/L) adverse rxn contraindications
Adverse reactions: Metabolic acidosis, anaphylaxis Contraindications: Liver, cardiac, or renal disorders
35
IV flow rate depends on what?
based on the client’s clinical presentation and need for replacement fluids
36
How often should continuous infusion IV tubing be changed according to INS?
every 96 hours or according to facility policy
37
How often should intermittent infusion tubing sets be changed according to the INS?
24 hours or per facility policy
38
What types of IV must be changed more frequently? why?
blood or blood products and lipid IV's because higher risk of bacterial growth
39
how often should blood administration sets be changed?
after every unit or every 4 hours
40
Where is erythropoietin created?
in the kidneys
41
What does a transfusion of PRBC's do to the blood
typically raises the hemoglobin level by 1 g/dL and the hematocrit by 3%
42
Why might some people need platelets?
cancer grown and destruction of bone marrow from cancer therapy
43
how many donors are needed to create one unit of platelets?
about 10 people
44
What part of the blood helps maintain BP and volume?
plasma
45
What is in plasma?
proteins, antibodies, albumin, nutrients glucose electrolytes
46
Who frequently receives plasma transfusions?
cancer disseminated intravascular coagulation (DIC) burn
47
Cryoprecipitate (Cryo) contains what factors
clotting factors
48
Cryoprecipitate (Cryo) can be given to who?
hereditary conditions that lead to inadequate clotting
49
What is the most common blood type?
O+
50
Universal donor blood
type: O
51
Universal recipient blood
type: AB+
52
Universal recipient blood
type: AB+
53
How often should blood transfusions be monitored?
during the first 15 minutes of the transfusion, as most transfusion reactions occur within this time frame. Vital signs 15 minutes after starting the transfusion
54
transfusion reactions
Fever/ Chills Altered blood pressure (elevated or decreased) Respiratory difficulty (wheezing, coughing, dyspnea) Pain in the chest, abdomen, low back, or flank Nausea and/or vomiting Skin manifestations including pruritus, urticaria, flushing, edema (localized), and rash Jaundice Urinary changes including oliguria, anuria, and hematuria
55
transfusion-related acute lung injury (TRALI)
(TRALI), which results in edema of the lung tissues and airways
56
transfusion-associated circulatory overload (TACO)
which is often the result of too-rapid administration of blood products.
57
two examples of delayed transfusion rxns
delayed HTR TA-GVHD (fatal)
58
Transfusion-associated circulatory overload (TACO) cause?
large volume is transfused over a short period of time. clients older than 70
59
Transfusion-associated circulatory overload (TACO) s/s?
Tachycardia, jugular venous distention, increased blood pressure, dyspnea, orthopnea, cyanosis
60
What happens when a client receives blood components that are not compatible with their own
Acute hemolytic reaction
61
Acute hemolytic reaction s/s
Fever; chills tachycardia hypotension dyspnea pain in the chest, abdomen, back, or flank; hypotension red-colored urine shock
62
Non-hemolytic febrile reaction cause
Antibodies attack the client’s leukocytes or platelets
63
Non-hemolytic febrile reaction s/s
Fever, chills, headache, nausea and vomiting
64
Transfusion-related acute lung injury (TRALI) is caused by
Occurs when the client has antibodies to WBCs in the donor blood
65
Where are peripheral catheters usually placed?
hand and forearm pediatric clients the veins in the scalp and lower extremities
66
Where are CVADS placed?
central vein such as the lower superior vena cava or the inferior vena cava
67
When is transillumination a good option
identifying veins in children, obese clients, and clients with dark skin tones
68
Peripheral catheters range from
14 gauge to 24 gauge
69
When are CVADs used?
to administer blood products, medications, fluids, and other therapies
70
Nontunneled CVADs insertions sites
jugular, subclavian, or femoral veins.
71
Peripherally inserted central catheters (PICCs) are inserted where?
into the peripheral veins of the upper extremities, usually the median cubital, cephalic, basilic, or brachial vein, with the tip of the catheter located in the superior or inferior vena cava.
72
how long can you used Subcutaneously tunneled cuffed catheters?
several years
73
implanted vascular access port
surgically placed vascular device, most often in the chest, which contains a port with a septum that is accessed with a special noncoring needle
74
ways to prevent occlusion or clot formation in a CVAD
flushing these devices with saline or low-concentration heparin
75
causes of phlebitis
cannula movement inadequate dressing, speed of fluid infusion type of medication infused, length of therapy failure to follow aseptic technique when initiating or managing an intravenous site, or administration of a contaminated solution vein too small for cannula
76
. Manifestations of phlebitis include
pain at surrounding, or proximal to the insertion site swelling erythema; fever the presence of a palpable cord along the vein
77
ways to minimize phlebitis risk: (8)
aseptic technique consider fluid characteristics, pH, osmolarity, etc discuss CVAD for vesicants avoid sensitive sites for IV use the smallest size possible maintain prescribed infusion rates monitor site every hours and 1-2 hours for vesicants monitor pediatric IV every hour use catheter stabilization device
78
circulatory overload can include
pulmonary edema heart failure shock cardiac arrest
79
Manifestations of circulatory overload include
tachycardia increases in blood pressure client weight and/or central venous pressure jugular venous distention edema cough tachypnea crackles in the lungs decreased oxygen saturation pallor, or cyanosis
80
risk of circulatory overload can be minimized through what interventions
monitor intake and output and daily weight monitor for s/s of circ. overload, especially sodium chloride maintain IVE at prescribed rate repore any changes in client weight or condition and if intake is greater than output
81
Manifestations of infiltration or extravasation include
cool skin around IV site cannulation area is leaking fluid localized edema pallor and delayed capillary refill reports of pain, burning, or discomfort at the site changes in the quality of the infusion rate.
82
how to decrease the risk of infiltration or extravasation (7)
consider characteristics of IV meds and consider CVAD appropriate gage and location select sites proximal to previous sites catheter stabilization device to minimize catheter movement. Assess the patency of the IV catheter prior to administering fluids or medications. Monitor IV site at least every 4 hrs for manifestations of infiltration and every 1-2 hours if infusing vesicant
83
air embolism can occur through
placement of a CVAD disconnection between the IV catheter and the IV tubing infusion of air into the IV tubing caused by failure to prime the tubing allowing an IV bag to run dry loose connections in the tubing that allow air to enter the system
84
air embolism, symptoms
abrupt onset include difficulty breathing cough/wheezing low blood pressure tachycardia chest or shoulder pain.
85
Interventions to prevent air embolism (5)
rime all intravenous tubing sets, syringes, and any add-on sets. Check all set junctions to ensure they are secure, especially when repositioning Monitor the tubing set for the presence of bubbles, the IV bag for the level of fluid remaining, or any leaks or breaks Change IV bags before the previous solution runs dry If the client has a CVAD, ensure the device is clamped when changing tubing.
86
How should you position an person with a suspected air embolism?
head down and left side
87
Scalp veins can be utilized for clients younger than
18 months of age
88
what output is measured?
urine, stool, wound or fistula drainage, and emesis.
89
I&O totals should be recorded how often?
at least every 8 hours or according to the facility’s policy
90
At what pH for human blood is normal
7.35-7.45
91
At what blood pH does death occur?
pH of 6.9 or less or 7.8 or more
92
is carbonic acid acidic or alkaline?
acidic
93
is bicarbonate acidic or alkaline?
alkaline
94
What is the laboratory evaluation used to interpret acid–base balance in the body.
arterial blood gas (ABG)
95
PaCO2 range
35 to 45 mm Hg
96
HCO3– range
21 to 28 mEq/L
97
PaO2 range
80 to 100 Hg
98
O2 sat
95% to 100%
99
changes in PaCO2 indicates what kind of problem?
respiratory
100
changes in HCO3– indicates what kind of problem?
indicates a metabolic problem.
101
if H+ is excreted and HCO3– is retained, the pH level will what, and result in what?
increase metabolic alkalosis
102
Metabolic acidosis expected findings
PaCO2 (Carbon Dioxide) normal HCO3– (Bicarbonate) low
103
Metabolic alkalosis
PaCO2 (Carbon Dioxide) normal HCO3– (Bicarbonate) high
104
Respiratory acidosis
PaCO2 (Carbon Dioxide) high HCO3– (Bicarbonate) normal
105
Respiratory alkalosis
PaCO2 (Carbon Dioxide) low HCO3– (Bicarbonate) normal
106
respiratory acidosis can be caused by what CNS depressions? (4)
trauma, opioids sedatives, anesthesia
107
respiratory acidosis can be caused by what pulmonary diseases? (5)
atelectasis pneumonia pulmonary embolism obstructive pulmonary disorders.
108
respiratory acidosis can be caused by what functional disorders limiting respirations? (2)
chest wall injury abdominal distention
109
Manifestations of respiratory acidosis can include
anxiety and confusion fatigue shortness of breath lethargy and sleepiness tremors flushed skin and sweating
110
respiratory alkalosis (high pH, decreased PaCO2) can be caused by
any condition that results in hyperventilation, such as pain, anxiety, severe stress, pregnancy, sepsis, infection, trauma or fever
111
s/s of respiratory alkalosis
lightheadedness dizziness confusion chest discomfort numbness in the hands and feet.
112
Treatment of respiratory alkalosis focuses on
decreasing the rate of breathing in addition to treating the cause
113
Metabolic acidosis (low pH, decreased HCO3–) can be the result of either
too little HCO3- in the bloodstream or too much acid other than CO2.
114
Causes of metabolic acidosis (3)
Lack of HCO3-: Renal or hepatic failure, pancreatitis, dehydration Excessive losses of HCO3: Diarrhea Excessive pH: Starvation, diabetic ketoacidosis, lactic acidosis (cancer, alcohol toxicity, cardiac arrest), salicylate intoxication
115
Manifestations of metabolic acidosis depend on the cause, but can include
long and deep breaths (Kussmaul respirations), confusion, headache, tachycardia, lethargy, loss of appetite, and nausea and vomiting.
116
what is often given to neutralize the acid in the blood
Sodium bicarbonate (a base)
117
Metabolic alkalosis (high pH, elevated HCO3) occurs when
here is an excessive amount of HCO3- in the blood or an increased loss of acid
118
Causes of metabolic alkalosis may include
prolonged vomiting gastric suctioning excessive use of diuretics or antacids renal impairment hypokalemia hypovolemia.
119
Manifestations of metabolic alkalosis (8)
Muscle twitching or spasms Lethargy Nausea and vomiting Tremors or numbness of the hands Tingling of the face or feet Lightheadedness Headache With severe metabolic alkalosis, confusion, seizures, agitation, and coma; arrhythmias can occur
120
Metabolic acidosis → The kidneys are not able to rid the body of ___ → The lungs try to ___ the acid (carbon dioxide) by ___the respiratory ____.
excess acid exhale increasing rate and depth.
121
____→ The body is holding on to too much bicarbonate → The lungs try to ____ acid by slowing the respiratory rate while the kidneys decrease ____through excretion into the urine.
Metabolic alkalosis retain bicarbonate
122
____acidosis → The body is retaining too much ____, often due to respiratory depression → The ____increase the amount of bicarbonate in the body while excreting _____ through the urine.
Respiratory carbon dioxide kidneys hydrogen
123
_________→ Carbon dioxide levels ____due to too much being ____, usually due to hyperventilation → The kidneys ____bicarbonate through the urine while decreasing the amount of new bicarbonate being produced.
Respiratory alkalosis drop exhaled, excrete
124
It takes the lungs ___to ___ to respond to an acid–base imbalance, while it takes the kidneys __to___
minutes to hours hours to days

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