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Nursing Semester 3 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Fluid balance varies by:

A

age, gender, & size

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2
Q

Intracellular space is found

A

inside the cells

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3
Q

Extracellular space is found

A

outside of the cells

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4
Q

Extracellular space is composed of

A

intravascular space, interstitial space, & transcellular space

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5
Q

Intravascular space is composed of

A

vessels; where we draw labs from

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6
Q

Interstitial space is made of

A

the fluid between the cells; third spacing

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7
Q

Causes of hypovolemia include:

A

hemorrhage, vomiting, diarrhea, sweating, fever, wound drainage, burns, NPO status, NGT suctioning, diabetes,

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8
Q

Symptoms of hypovolemia include:

A

tachycardia, weak pulses, hypotension, tachypnea, poor skin turgor, dry & scaly skin, altered mental status, low fever, oliguria, dry mucosa, edema, & polydipsia

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9
Q

Labs that you may see with hypovolemia include:

A

increased H&H, osmolarity, glucose, protein, BUN, electrolytes, urine specific gravity, creatinine; decreased GFR

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10
Q

Interventions of hypovolemia include:

A

oral fluids, IV solutions, antiemetics, antipyuretic, ice chips, assess skin integrity, monitor labs, & daily weights

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11
Q

Causes of hypervolemia include:

A

excessive fluid replacement, kidney failure, heart failure, long-term corticosteroid therapy, & SIADH

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12
Q

Isotonic fluids

A

fluid floods into the extracellular space; D5W, 0.9%NS, & LR

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13
Q

Hypotonic fluids

A

fluid moves from the extracellular space to the intracellular space; 0.45%NS, water

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14
Q

Hypertonic fluids

A

fluid moves from the intracellular space to the extracellular space; TPN, D5 0.45%NS, D5 0.9%NS, & 3%NS

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15
Q

What size gauge is blood administered through?

A

22 gauge

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16
Q

Infiltration of IV site

A

IV site will be swollen & cool to touch; remove the IV, elevate the limb, & place a cool compress on it

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17
Q

Phlebitis of IV site

A

IV site will be red, warm, & painful; monitor for further signs of infection

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18
Q

Symptoms of hypervolemia include:

A

tachycardia, bounding pulse, HTN, tachypnea, SOB, crackles, raspy voice, edema, altered mental status, JDV, low H&H, cool skin, ascites

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19
Q

Interventions of hypervolemia include:

A

fluid restriction, Na restriction, diuretics, monitor lung sounds, u/o, daily weight, skin integrity, elevate the extremities, semi or high fowler’s, safely use restroom, & obtain chest xray

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20
Q

Infection of IV site

A

discharge & fever; remove IV & give abx

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21
Q

Extravagation of IV site

A

when caustic drugs eat away tissue, causing necrosis; like chemo, vasopressors, & dopamine

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22
Q

6 Rights & 3 Cs of IV Meds

A

Right patient, time, dose, med, route, & documentation. Correct dilution, correct access, & compatibility.

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23
Q

What is shock?

A

inadequate tissue perfusion & gas exchange that results in impaired cellular metabolism

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24
Q

Stages of shock

A

initial, nonprogressive or compensatory, progressive, & refractory

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25
What changes are seen during the Initial Stage of AKI?
tachycardia, tachypnea, MAP decreased by 10mmHg
26
Nonprogressive or Compensatory Stage
kidneys activate flight or fight response; tachycardia, tachypnea, MAP decreased by 10-15mmHg, hypotension, cool & clammy skin, decreased CR, weak & thready pulse, change in LOC, & decreased u/o
27
Progressive Stage
decreased blood volume to vital organs; hypoxia & electrolyte imbalance; change in LOC, SOB, low RR, bradycardia, hypotension, decreased GI motility, GI bleeds or ischemia, decreased u/o, cool & dry skin, changes in BUN & creatinine
28
Refractory Stage
organ damage; unresponsive, labored or irregular breathing, bradypnea, bradycardia, hypotension, GI bleed, anuria, cool & moist skin, cyanosis; end of life discussion
29
What to do if a patient is in shock:
VS hourly, maintain HR BP & airway, obtain chest xray, place on oxygen, monitor ECG, feed the gut early (enteral feedings), give lots of isotonic fluids, abx, & vasoactives, skin integrity, turn & reposition, skin care, OOB, communicate with family
30
Labs to monitor with shock
BUN, creatinine, GFR, CBC, WBC, H&H, ABG, electrolytes, lactic acid, blood cultures
31
Causes of Hypovolemic Shock
external loss of blood (surgery or OB), external loss of fluid (V/D), or internal loss of fluid (3rd spacing, ascites)
32
Symptoms of Hypovolemic Shock
dehydration, change in LOC, tachypnea, tachycardia, thready pulse, decreased u/o, decreased bowel sounds, N/V, cool skin, & decreased CR
33
Interventions of Hypovolemic Shock
fluids, monitor VS, ECG, I&Os, daily weights, H&H, electrolytes, BUN, & creatinine, obtain CT or US, & control the bleeding
34
Causes of Cardiogenic Shock
MI or any damage to the heart
35
Symptoms of Cardiogenic Shock
change in LOC, SOB, chest pain, dysrhythmias, thready pulse, change in HR, diaphoresis, oliguria, cool & pale skin, N/V, and decreased bowel sounds
36
Interventions of Cardiogenic Shock
treat dysrhythmias, ECG, cardiac cath, CABG, MONA protocol (morphine, oxygen, nitro, & aspirin)
37
Symptoms of Neurogenic Shock
hypotension, bradycardia, dry & warm skin
38
Interventions of Neurogenic Shock
treat the symptoms, HOB 30 degrees, immobilize patient, monitor for DVT & PE, turn & reposition, apply SCDs
39
Symptoms of Anaphylactic Shock
SOB, expiratory wheezing, inspiratory stridor, hypotension, tachycardia, V/D, hives, swelling of tongue, angioedema, loss of airway
40
Interventions of Anaphylactic Shock
get rid of allergen, give epi or diphenhydramine or antihistamines, H2 blockers, & steroid
41
Order of septic shock
SIRS, sepsis, septic shock, MODS
42
Symptoms of SIRS
hypotension, decreased u/o, tachypnea, temperature changes, increased WBCs, tachycardia,
43
Symptoms of Sepsis
fever, increased WBCs, tachycardia
44
Symptoms of Septic Shock
changes in LOC, tachypnea, hypoxemia, hypotension, edema, decreased u/o, necrotic fingers & toes, motteling, & petechiae
45
Interventions of Sepsis
sepsis bundle, CBC, BMP, lactic acid, culture everything, chest xray, abx, give fluids, vasopressors, VS, monitor u/o, ECG, skin integrity
46
Symptoms of MODS
impaired perfusion, oliguria/anuria, changes in LOC, unresponsive, cold skin, bradypnea, bradycardia, weak pulses, mottled & dry skin,
47
Type 1 Diabetes
little or no insulin is produced
48
Type 2 Diabetes
slow & progressive glucose intolerance
49
Rapid Acting Insulin
onset = 5-15min peak = 30min-3hrs duration = 3-5hrs; | humalog, novolog, & apidra
50
Short Acting Insulin
onset = 30-90min peak = 2-4hrs duration = 5-12hrs; | regular insulin, Novolin R, & Humulin R
51
Intermediate Acting Insulin
onset = 30min-4hrs peak = 1-12hrs duration = 10-24hrs; | NPH & Humulin N
52
Long Acting Insulin
onset = 1-4hrs no peak duration = 6-24hrs; Lantus & Levemir
53
Symptoms of Hypoglycemia
headache, irritability, cool & clammy skin, change in LOC, may cause seizures & loss of consciousness; give fast acting glucose, retest 15-30min, give more if needed & retest, then give snack or meal after
54
Symptoms of DKA
BGM>300, polyuria, hypovolemia, fruity breath, ketones in the urine, dry mucosa, hypotension, tachycardia, ECG changes, & kussmaul's respirations
55
What to do for a patient in DKA
IV fluids, continuous IV infusions of regular insulin, & monitor for hypokalemia
56
Symptoms of HHNKS
same symptoms as DKA except ketosis
57
Interventions for HHNKS
rehydration, insulin, *at risk for hypokalemia*
58
What are the functions of the kidneys?
regulate f/e, receives 25% cardiac ouput, filters electrolytes & GFR, reabsorbs f/e as needed, works with lungs to maintain acid-base balance, & regulates BP
59
What labs would indicate an AKI?
increase in creatinine by 0.3% in 48 hrs increase in creatinine by 50% from baseline in 24hrs-7days decrease in u/o of 400-500ml in 24 hrs nonoliguria (+BUN/Cr & -GFR)
60
What is prerenal etiology?
decrease in blood flow & volume
61
Causes of prerenal etiology
hypovolemia, diuretics, V/D, decreased cardiac output, shock, constricted blood vessels, & nephrotoxic drugs
62
Symptoms of prerenal & intrarenal
decreased u/o, increased BUN/Cr, tachycardia, hypotension, & infection
63
Interventions of prerenal
abd xray or us, give fluids, give vasoactive for BP, *be cautious with nephrotoxic drugs & fluid overload in patients with comorbidities*
64
What is intrarenal etiology?
kidney is directly damaged; prolonged renal phase (MAP <60-70mmHg for more than 30 min; may have hypoxia)
65
Causes of intrarenal
tumors, ingestion of toxins or heavy metals, some drugs, anything that can lead to necrotic kidney tissue
66
Examples of nephrotoxic agents
NSAIDs, antibiotics, IVP dye, ACE inhibitors, pesticides, metals, plants, mushrooms, venom, & antifreeze
67
Interventions of intrarenal
give fluids then diuretics, regulate abx, & give low doses of dopamine to improve renal perfusion
68
What is postrenal etiology?
obstructed flow of the kidneys; reversible when obstruction is removed (may need stent)
69
What can cause postrenal etiology?
BPH, blood clots, renal stones, tumors, postop edema, foley catheter obstruction
70
Symptoms of postrenal
same, but may include tender or painful abdomen with some swelling
71
Phases of AKI
onset, oliguric, diuretic, & recovery
72
Describe the onset phase of AKI
time from initial cause until a decrease in u/o is seen; min to hrs to days
73
What is the common cause of AKI in children?
hypovolemia
74
Describe the oliguric phase
u/o is at the lowest amount, BUN/Cr increased, GFR is decreased; 8-14 days to 1-11mos
75
Normal GFR v Dialysis
120 is normal. 15 indicates a need for dialysis
76
Describe the diuretic phase
kidney function returns, u/o increases, GFR recovers, & labs stabilize *watch for FVD*
77
Describe the recovery phase
renal tissue repairs, BUN/Cr normalize, & GFR recovers, but may remain decreased by 1-3%
78
Symptoms of AKI
change in LOC, crackles, pulmonary edema, tachycardia, changes in BP, dysrhythmias, dry skin or edema, pallor, or echymosis
79
Diagnostics for AKI
KUB, Renal Ultrasound, IVP, CT (w/out contrast for stones), Nuclear Scans, & Renal Biopsy
80
Interventions for AKI
diuretics, IV fluids, renal diet, monitor f/e labs, dialysis, monitor acid-base balance, VS, dysrhythmias, lung sounds, assess skin, daily weights, I&Os, TCDB, IS, oral care, asepsis with lines, & OOB
81
What are the requirements for a renal diet?
low protein, sodium, K, Mg, & P | high caloric intake 25-35kcal/kg of ideal body weight

Nursing Semester 3 (1 decks)

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