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MedSurg 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Erickson stage for adolescence

A

identity vs. role confusion

tires integrating many roles into a self image under role model and peer pressure

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2
Q

Erickson stage for young adult

A

intimacy vs. isolation

learns to make personal commitment to another as spouse, parent, or partner

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3
Q

Erickson stage for middle age adult

A

generativity vs. stagnation

seeks satisfaction through productivity in career, family, and civic interests

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4
Q

Erickson stage for older adult

A

integrity vs. despair

reviews life accomplishments, deals with loss and preparation for death

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5
Q

Maslow’s hierarchy

A

1) physiological needs
2) safety and security
3) love and belongingness
4) self esteem
5) self actualization

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6
Q

who does patient education before discharge?

A

nurse

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7
Q

who assesses patient?

A

nurse

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8
Q

who holds accountability for delegation?

A

nurse

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9
Q

dehydration - excess or deficit?

A

extracellular fluid volume deficit

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10
Q

who is at risk for dehydration? why?

A

elderly - not enough intake, altered cognition, lack of thirst, diuretics, trouble swallowing, mobility

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11
Q

most common measure of I&O?

A

body weight

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12
Q

average I&O per day?

A

1500-2000ml

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13
Q

expected output for patients with catheters?

A

30ml/hr (or more)

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14
Q

output defined as oliguria for patients with catheters?

A

less than 20ml/hr

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15
Q

changes in vital signs for dehydration

A

low systolic BP, weak pulse, increased HR, increased temp, orthostatic hypotension, flat jugular veins

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16
Q

clinical manifestations of dehydration

A

dry mucous membranes, decreased skin turgor, sunken eyes, muscle weakness, constipation, restlessness, HA, hallucinations, coma

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17
Q

diagnostic findings for dehydration

A

increased sodium, increased BUN, normal creatinine, increased glucose, increased hematocrit

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18
Q

plasma osmolality

A

=2x plasma Na

assesses state of body’s water balance

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19
Q

oral fluid restoration equation

A

100ml/kg for first 10kg
50ml/kg for second 10kg
15ml/kg for remaining kg

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20
Q

which types of patients should you pay special attention to when it comes to fluid overload?

A

renal, cardiac, liver, and pulmonary

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21
Q

which serum level should you pay close attention to with fluid volume excess/deficit?

A

sodium

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22
Q

fluid overload

A

extracellular fluid volume excess (hypervolemia)

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23
Q

top 2 reasons for fluid overload?

A

heart failure and lack of output

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24
Q

clinical manifestations of fluid overload

A

lung involvement (can’t sleep laying down, cough, SOB, crackles)
decreased O2, anxiety, increased CO2, pleural effusion
cardiac involvement (jugular vein distention, bounding pulse, extra S3 heart sound)
dependent edema, weight gain
cerebral involvement (restlessness, confusion, lethargy, seizures, coma)

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25
Q

diagnostic findings for fluid overload

A

decreased Na, decreased hematocrit, plasma osmolality <8

26
Q

tx for fluid overload

A

restrict Na, diuretics, cardiac issues (ACE, ARB, beta blockers)

27
Q

diuretics

A

lasix (stronger, need K supp)
hctz (first choice, weaker)
aldactone (holds K)

28
Q

where do you check for edema r/t fluid overload?

A

sacrum and ankle

29
Q

third spacing

A

accumulation of fluid in the interstitial space
caused by inflammation, protein malnutrition, altered lymph
can cause hypovolemia because fluid isn’t in system

30
Q

clinical manifestations of third spacing

A

starts with restlessness

hypovolemia, pallor, cold limbs, weak rapid pulse, hypotension, oliguria, decreased LOC, no change in body weight

31
Q

tx for third spacing

A

replace fluid, watch for overload, stabilize problem (pull fluid off), measure circumference of limb or abdominal girth, monitor I&O

32
Q

hyponatremia

A

<135mEq/L

most common fluid overload

33
Q

clinical manifestations of hyponatremia

A

HA, apprehension, restlessness, confusion, seizures, brain herniation, decreased BP, weak thready pulse, tachycardia

34
Q

tx for hyponatremia

A

restrict fluids

<115 - 3% NaCl; monitor carefully

35
Q

hypernatremia

A

> 145mEq/L

usually associated with water loss or sodium gain

36
Q

clinical manifestations of hypernatremia

A

polyuria then oliguria, anorexia, weakness and restlessness, cardiac involvement

37
Q

tx for hypernatremia

A

oral fluid replacement, IV hypotonic sol 0.2 or 0.45 NaCl or D5W, watch for cerebral edema

38
Q

hypokalemia

A

<3.5mEq/L
commonly seen in older adult
cause: malnourishment, bulimic, vomiting, diarrhea, NG suction w/o replacement, meds (lasix, hctz, cathartics, digoxin), increased Na levels, renal losses

39
Q

why do you monitor the heart with K problems?

A

potassium imbalances can lead to ventricular dysrhythmias and/or cardiac arrest

40
Q

clinical manifestations of hypokalemia

A

abnormal EKG (prominent U), slow weakened pulse, constipation, anorexia, muscle weakness

41
Q

tx of hypokalemia

A

restore 40-60mEq/day, PO replacement for mild/mod, IV K diluted in IV fluids given slowly for severe
foods - oranges, bananas, tomatoes, potatoes

42
Q

hyperkalemia

A

> 5mEq/L

cause: renal failure, meds, salt substitutes

43
Q

clinical manifestations of hyperkalemia

A

nerve and muscle excitability, cardiac with K >6-7 (tachycardia, vent dysrhythmias, peaked T)

44
Q

tx of hyperkalemia

A

dietary restriction, IV saline, IV lasix, IV calcium gluconate and IV insulin (severe), kayexelate enema
(IV insulin puts K into cells and stops dysrhythmias)

45
Q

hypercalcemia

A

> 10.2mg/dl

cause: hyperparathyroidism, malignancy
tx: isotonic saline, promote excretion, hydrate, lasix

46
Q

hypocalcemia

A 
s sign (tetany)
tx: PO or IV replacement
47
Q

hyperphosphatemia

A

> 4.4mg/dl

cause: renal failure
tx: treat underlying cause, decrease milk products, hydrate

48
Q

hypophosphatemia

A

<2.4mg/dl

cause: malnourishment, alcoholism, fasting
tx: PO or IV supplement

49
Q

hypermagnesium

A

> 2.5mEq/L

cause: renal failure, adrenal insuff
tx: prevention, dialysis, IV calcium chloride or calcium gluconate

50
Q

hypomagnesium

A

<1.5mEq/L

cause: starvation
tx: PO supp, IV mag sulfate

51
Q

allen’s test

A

assesses arterial blood flow of the hand

52
Q

IV blood administration

A 
Y tubing w/ blood and normal saline
14-20 gauge tubing
2 RNs or RN+LPN check blood
stay w/ pt for 15min after infusion
monitor for occlusion (usually r/t positioning), infiltration (white/pale, swelling of fluid), infection (redness, swelling, warmth)
clear dressing to monitor site
53
Q

sodium range

A

135-145

54
Q

potassium range

A

3.5-5

55
Q

calcium range

A

8.6-10.2

56
Q

phosphate range

A

2.4-4.4

57
Q

magnesium range

A

1.5-2.5

58
Q

pH range

A

7.35-7.45

59
Q

CO2 range

A

35-45

60
Q

HCO3 range

A

22-26

MedSurg 2 (1 decks)

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