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Nursing Semester 3 > Exam 1 > Flashcards

Exam 1 Flashcards

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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
Q

What changes are seen during the Initial Stage of AKI?

A

tachycardia, tachypnea, MAP decreased by 10mmHg

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26
Q

Nonprogressive or Compensatory Stage

A

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

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27
Q

Progressive Stage

A

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

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28
Q

Refractory Stage

A

organ damage; unresponsive, labored or irregular breathing, bradypnea, bradycardia, hypotension, GI bleed, anuria, cool & moist skin, cyanosis; end of life discussion

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29
Q

What to do if a patient is in shock:

A

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

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30
Q

Labs to monitor with shock

A

BUN, creatinine, GFR, CBC, WBC, H&H, ABG, electrolytes, lactic acid, blood cultures

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31
Q

Causes of Hypovolemic Shock

A

external loss of blood (surgery or OB), external loss of fluid (V/D), or internal loss of fluid (3rd spacing, ascites)

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32
Q

Symptoms of Hypovolemic Shock

A

dehydration, change in LOC, tachypnea, tachycardia, thready pulse, decreased u/o, decreased bowel sounds, N/V, cool skin, & decreased CR

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33
Q

Interventions of Hypovolemic Shock

A

fluids, monitor VS, ECG, I&Os, daily weights, H&H, electrolytes, BUN, & creatinine, obtain CT or US, & control the bleeding

34
Q

Causes of Cardiogenic Shock

A

MI or any damage to the heart

35
Q

Symptoms of Cardiogenic Shock

A

change in LOC, SOB, chest pain, dysrhythmias, thready pulse, change in HR, diaphoresis, oliguria, cool & pale skin, N/V, and decreased bowel sounds

36
Q

Interventions of Cardiogenic Shock

A

treat dysrhythmias, ECG, cardiac cath, CABG, MONA protocol (morphine, oxygen, nitro, & aspirin)

37
Q

Symptoms of Neurogenic Shock

A

hypotension, bradycardia, dry & warm skin

38
Q

Interventions of Neurogenic Shock

A

treat the symptoms, HOB 30 degrees, immobilize patient, monitor for DVT & PE, turn & reposition, apply SCDs

39
Q

Symptoms of Anaphylactic Shock

A

SOB, expiratory wheezing, inspiratory stridor, hypotension, tachycardia, V/D, hives, swelling of tongue, angioedema, loss of airway

40
Q

Interventions of Anaphylactic Shock

A

get rid of allergen, give epi or diphenhydramine or antihistamines, H2 blockers, & steroid

41
Q

Order of septic shock

A

SIRS, sepsis, septic shock, MODS

42
Q

Symptoms of SIRS

A

hypotension, decreased u/o, tachypnea, temperature changes, increased WBCs, tachycardia,

43
Q

Symptoms of Sepsis

A

fever, increased WBCs, tachycardia

44
Q

Symptoms of Septic Shock

A

changes in LOC, tachypnea, hypoxemia, hypotension, edema, decreased u/o, necrotic fingers & toes, motteling, & petechiae

45
Q

Interventions of Sepsis

A

sepsis bundle, CBC, BMP, lactic acid, culture everything, chest xray, abx, give fluids, vasopressors, VS, monitor u/o, ECG, skin integrity

46
Q

Symptoms of MODS

A

impaired perfusion, oliguria/anuria, changes in LOC, unresponsive, cold skin, bradypnea, bradycardia, weak pulses, mottled & dry skin,

47
Q

Type 1 Diabetes

A

little or no insulin is produced

48
Q

Type 2 Diabetes

A

slow & progressive glucose intolerance

49
Q

Rapid Acting Insulin

A

onset = 5-15min peak = 30min-3hrs duration = 3-5hrs;

humalog, novolog, & apidra

50
Q

Short Acting Insulin

A

onset = 30-90min peak = 2-4hrs duration = 5-12hrs;

regular insulin, Novolin R, & Humulin R

51
Q

Intermediate Acting Insulin

A

onset = 30min-4hrs peak = 1-12hrs duration = 10-24hrs;

NPH & Humulin N

52
Q

Long Acting Insulin

A

onset = 1-4hrs no peak duration = 6-24hrs; Lantus & Levemir

53
Q

Symptoms of Hypoglycemia

A

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
Q

Symptoms of DKA

A

BGM>300, polyuria, hypovolemia, fruity breath, ketones in the urine, dry mucosa, hypotension, tachycardia, ECG changes, & kussmaul’s respirations

55
Q

What to do for a patient in DKA

A

IV fluids, continuous IV infusions of regular insulin, & monitor for hypokalemia

56
Q

Symptoms of HHNKS

A

same symptoms as DKA except ketosis

57
Q

Interventions for HHNKS

A

rehydration, insulin, at risk for hypokalemia

58
Q

What are the functions of the kidneys?

A

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
Q

What labs would indicate an AKI?

A

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
Q

What is prerenal etiology?

A

decrease in blood flow & volume

61
Q

Causes of prerenal etiology

A

hypovolemia, diuretics, V/D, decreased cardiac output, shock, constricted blood vessels, & nephrotoxic drugs

62
Q

Symptoms of prerenal & intrarenal

A

decreased u/o, increased BUN/Cr, tachycardia, hypotension, & infection

63
Q

Interventions of prerenal

A

abd xray or us, give fluids, give vasoactive for BP, be cautious with nephrotoxic drugs & fluid overload in patients with comorbidities

64
Q

What is intrarenal etiology?

A

kidney is directly damaged; prolonged renal phase (MAP <60-70mmHg for more than 30 min; may have hypoxia)

65
Q

Causes of intrarenal

A

tumors, ingestion of toxins or heavy metals, some drugs, anything that can lead to necrotic kidney tissue

66
Q

Examples of nephrotoxic agents

A

NSAIDs, antibiotics, IVP dye, ACE inhibitors, pesticides, metals, plants, mushrooms, venom, & antifreeze

67
Q

Interventions of intrarenal

A

give fluids then diuretics, regulate abx, & give low doses of dopamine to improve renal perfusion

68
Q

What is postrenal etiology?

A

obstructed flow of the kidneys; reversible when obstruction is removed (may need stent)

69
Q

What can cause postrenal etiology?

A

BPH, blood clots, renal stones, tumors, postop edema, foley catheter obstruction

70
Q

Symptoms of postrenal

A

same, but may include tender or painful abdomen with some swelling

71
Q

Phases of AKI

A

onset, oliguric, diuretic, & recovery

72
Q

Describe the onset phase of AKI

A

time from initial cause until a decrease in u/o is seen; min to hrs to days

73
Q

What is the common cause of AKI in children?

A

hypovolemia

74
Q

Describe the oliguric phase

A

u/o is at the lowest amount, BUN/Cr increased, GFR is decreased; 8-14 days to 1-11mos

75
Q

Normal GFR v Dialysis

A

120 is normal. 15 indicates a need for dialysis

76
Q

Describe the diuretic phase

A

kidney function returns, u/o increases, GFR recovers, & labs stabilize watch for FVD

77
Q

Describe the recovery phase

A

renal tissue repairs, BUN/Cr normalize, & GFR recovers, but may remain decreased by 1-3%

78
Q

Symptoms of AKI

A

change in LOC, crackles, pulmonary edema, tachycardia, changes in BP, dysrhythmias, dry skin or edema, pallor, or echymosis

79
Q

Diagnostics for AKI

A

KUB, Renal Ultrasound, IVP, CT (w/out contrast for stones), Nuclear Scans, & Renal Biopsy

80
Q

Interventions for AKI

A

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
Q

What are the requirements for a renal diet?

A

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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