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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
Q

Albumin 5% (309 mOsm/L) treats

A

Hypovolemic shock (surgery or trauma)

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26
Q

What solutions have these characteristics?
Interstitial edema (draws fluid into the intravascular space)

Replacement for low albumin levels

A

Albumin 5% (309 mOsm/L)

Albumin 25% (312 mOsm/L)

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27
Q

Albumin 5% (309 mOsm/L)

Albumin 25% (312 mOsm/L)
considerations

A

must be transfused within four hours of opening

Monitor for circulatory overload (especially with 25% albumin) and pulmonary edema

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28
Q

Albumin 5% (309 mOsm/L)

Albumin 25% (312 mOsm/L)
contraindications and adverse reactions

A

Adverse reactions: Urticaria, flushing, chills, fever, headache

Contraindications: Severe anemia, heart failure

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29
Q

What to colloidal solutions are used for dShock (burns, hemorrhage, surgery, trauma)

A

Dextran 40 (low-molecular-weight: 280 to 324 mOsm/L)

Dextran 70 (high-molecular-weight: 280 to 324 mOsm/L)

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30
Q

Dextran 40 (low-molecular-weight: 280 to 324 mOsm/L)

Dextran 70 (high-molecular-weight: 280 to 324 mOsm/L)
monitor for

A

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.

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31
Q

Dextran 40 (low-molecular-weight: 280 to 324 mOsm/L)

Dextran 70 (high-molecular-weight: 280 to 324 mOsm/L)

A

Increased risk for bleeding.

Adverse reactions: Anaphylaxis

Contraindications: Low platelet level, hemorrhagic shock

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32
Q

What is Hetastarch (308 mOsm/L) used for?

A

hypovolemia

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33
Q

Hetastarch (308 mOsm/L)
monitoring

A

Monitor for circulatory overload.

Monitor hematocrit/hemoglobin levels.

Monitor for bleeding.

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34
Q

Hetastarch (308 mOsm/L)

adverse rxn
contraindications

A

Adverse reactions: Metabolic acidosis, anaphylaxis

Contraindications: Liver, cardiac, or renal disorders

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35
Q

IV flow rate depends on what?

A

based on the client’s clinical presentation and need for replacement fluids

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36
Q

How often should continuous infusion IV tubing be changed according to INS?

A

every 96 hours or according to facility policy

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37
Q

How often should intermittent infusion tubing sets be changed according to the INS?

A

24 hours or per facility policy

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38
Q

What types of IV must be changed more frequently? why?

A

blood or blood products and lipid IV’s because higher risk of bacterial growth

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39
Q

how often should blood administration sets be changed?

A

after every unit or every 4 hours

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40
Q

Where is erythropoietin created?

A

in the kidneys

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41
Q

What does a transfusion of PRBC’s do to the blood

A

typically raises the hemoglobin level by 1 g/dL and the hematocrit by 3%

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42
Q

Why might some people need platelets?

A

cancer grown and destruction of bone marrow from cancer therapy

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43
Q

how many donors are needed to create one unit of platelets?

A

about 10 people

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44
Q

What part of the blood helps maintain BP and volume?

A

plasma

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45
Q

What is in plasma?

A

proteins, antibodies, albumin, nutrients
glucose
electrolytes

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46
Q

Who frequently receives plasma transfusions?

A

cancer
disseminated intravascular coagulation (DIC)
burn

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47
Q

Cryoprecipitate (Cryo) contains what factors

A

clotting factors

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48
Q

Cryoprecipitate (Cryo) can be given to who?

A

hereditary conditions that lead to inadequate clotting

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49
Q

What is the most common blood type?

A

O+

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50
Q

Universal donor blood

A

type: O

51
Q

Universal recipient blood

A

type: AB+

52
Q

Universal recipient blood

A

type: AB+

53
Q

How often should blood transfusions be monitored?

A

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
Q

transfusion reactions

A

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
Q

transfusion-related acute lung injury (TRALI)

A

(TRALI), which results in edema of the lung tissues and airways

56
Q

transfusion-associated circulatory overload (TACO)

A

which is often the result of too-rapid administration of blood products.

57
Q

two examples of delayed transfusion rxns

A

delayed HTR
TA-GVHD (fatal)

58
Q

Transfusion-associated circulatory overload (TACO) cause?

A

large volume is transfused over a short period of time.
clients older than 70

59
Q

Transfusion-associated circulatory overload (TACO) s/s?

A

Tachycardia, jugular venous distention, increased blood pressure, dyspnea, orthopnea, cyanosis

60
Q

What happens when a client receives blood components that are not compatible with their own

A

Acute hemolytic reaction

61
Q

Acute hemolytic reaction s/s

A

Fever;
chills
tachycardia
hypotension
dyspnea
pain in the chest, abdomen, back, or flank;
hypotension
red-colored urine
shock

62
Q

Non-hemolytic febrile reaction cause

A

Antibodies attack the client’s leukocytes or platelets

63
Q

Non-hemolytic febrile reaction s/s

A

Fever, chills, headache, nausea and vomiting

64
Q

Transfusion-related acute lung injury (TRALI) is caused by

A

Occurs when the client has antibodies to WBCs in the donor blood

65
Q

Where are peripheral catheters usually placed?

A

hand and forearm
pediatric clients the veins in the scalp and lower extremities

66
Q

Where are CVADS placed?

A

central vein such as the lower superior vena cava or the inferior vena cava

67
Q

When is transillumination a good option

A

identifying veins in children, obese clients, and clients with dark skin tones

68
Q

Peripheral catheters range from

A

14 gauge to 24 gauge

69
Q

When are CVADs used?

A

to administer blood products, medications, fluids, and other therapies

70
Q

Nontunneled CVADs insertions sites

A

jugular, subclavian, or femoral veins.

71
Q

Peripherally inserted central catheters (PICCs) are inserted where?

A

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
Q

how long can you used Subcutaneously tunneled cuffed catheters?

A

several years

73
Q

implanted vascular access port

A

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
Q

ways to prevent occlusion or clot formation in a CVAD

A

flushing these devices with saline or low-concentration heparin

75
Q

causes of phlebitis

A

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
Q

. Manifestations of phlebitis include

A

pain at surrounding, or proximal to the insertion site
swelling
erythema; fever
the presence of a palpable cord along the vein

77
Q

ways to minimize phlebitis risk: (8)

A

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
Q

circulatory overload can include

A

pulmonary edema
heart failure
shock
cardiac arrest

79
Q

Manifestations of circulatory overload include

A

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
Q

risk of circulatory overload can be minimized through what interventions

A

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
Q

Manifestations of infiltration or extravasation include

A

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
Q

how to decrease the risk of infiltration or extravasation (7)

A

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
Q

air embolism can occur through

A

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
Q

air embolism, symptoms

A

abrupt onset
include difficulty breathing
cough/wheezing
low blood pressure
tachycardia
chest or shoulder pain.

85
Q

Interventions to prevent air embolism (5)

A

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
Q

How should you position an person with a suspected air embolism?

A

head down and left side

87
Q

Scalp veins can be utilized for clients younger than

A

18 months of age

88
Q

what output is measured?

A

urine, stool, wound or fistula drainage, and emesis.

89
Q

I&O totals should be recorded how often?

A

at least every 8 hours or according to the facility’s policy

90
Q

At what pH for human blood is normal

A

7.35-7.45

91
Q

At what blood pH does death occur?

A

pH of 6.9 or less or 7.8 or more

92
Q

is carbonic acid acidic or alkaline?

A

acidic

93
Q

is bicarbonate acidic or alkaline?

A

alkaline

94
Q

What is the laboratory evaluation used to interpret acid–base balance in the body.

A

arterial blood gas (ABG)

95
Q

PaCO2 range

A

35 to 45 mm Hg

96
Q

HCO3– range

A

21 to 28 mEq/L

97
Q

PaO2 range

A

80 to 100 Hg

98
Q

O2 sat

A

95% to 100%

99
Q

changes in PaCO2 indicates what kind of problem?

A

respiratory

100
Q

changes in HCO3– indicates what kind of problem?

A

indicates a metabolic problem.

101
Q

if H+ is excreted and HCO3– is retained, the pH level will what, and result in what?

A

increase
metabolic alkalosis

102
Q

Metabolic acidosis expected findings

A

PaCO2 (Carbon Dioxide)
normal
HCO3– (Bicarbonate)
low

103
Q

Metabolic alkalosis

A

PaCO2 (Carbon Dioxide)
normal
HCO3– (Bicarbonate)
high

104
Q

Respiratory acidosis

A

PaCO2 (Carbon Dioxide)
high
HCO3– (Bicarbonate)
normal

105
Q

Respiratory alkalosis

A

PaCO2 (Carbon Dioxide)
low
HCO3– (Bicarbonate)
normal

106
Q

respiratory acidosis can be caused by what CNS depressions? (4)

A

trauma,
opioids
sedatives,
anesthesia

107
Q

respiratory acidosis can be caused by what pulmonary diseases? (5)

A

atelectasis
pneumonia
pulmonary embolism
obstructive pulmonary disorders.

108
Q

respiratory acidosis can be caused by what functional disorders limiting respirations? (2)

A

chest wall injury
abdominal distention

109
Q

Manifestations of respiratory acidosis can include

A

anxiety and confusion
fatigue
shortness of breath
lethargy and sleepiness
tremors flushed skin
and sweating

110
Q

respiratory alkalosis (high pH, decreased PaCO2) can be caused by

A

any condition that results in hyperventilation, such as pain, anxiety, severe stress, pregnancy, sepsis, infection, trauma or fever

111
Q

s/s of respiratory alkalosis

A

lightheadedness
dizziness
confusion
chest discomfort
numbness in the hands and feet.

112
Q

Treatment of respiratory alkalosis focuses on

A

decreasing the rate of breathing in addition to treating the cause

113
Q

Metabolic acidosis (low pH, decreased HCO3–) can be the result of either

A

too little HCO3- in the bloodstream or
too much acid other than CO2.

114
Q

Causes of metabolic acidosis (3)

A

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
Q

Manifestations of metabolic acidosis depend on the cause, but can include

A

long and deep breaths (Kussmaul respirations), confusion, headache, tachycardia, lethargy, loss of appetite, and nausea and vomiting.

116
Q

what is often given to neutralize the acid in the blood

A

Sodium bicarbonate (a base)

117
Q

Metabolic alkalosis (high pH, elevated HCO3) occurs when

A

here is an excessive amount of HCO3- in the blood or an increased loss of acid

118
Q

Causes of metabolic alkalosis may include

A

prolonged vomiting
gastric suctioning
excessive use of diuretics or antacids
renal impairment
hypokalemia
hypovolemia.

119
Q

Manifestations of metabolic alkalosis (8)

A

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
Q

Metabolic acidosis → The kidneys are not able to rid the body of ___ → The lungs try to ___ the acid (carbon dioxide) by ___the respiratory ____.

A

excess acid
exhale
increasing
rate and depth.

121
Q

____→ 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.

A

Metabolic alkalosis
retain
bicarbonate

122
Q

____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.

A

Respiratory
carbon dioxide
kidneys
hydrogen

123
Q

_________→ 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.

A

Respiratory alkalosis
drop
exhaled,
excrete

124
Q

It takes the lungs ___to ___ to respond to an acid–base imbalance, while it takes the kidneys __to___

A

minutes to hours
hours to days

Fundamentals (15 decks)

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