Exam 1 Flashcards
Fluid balance varies by:
age, gender, & size
Intracellular space is found
inside the cells
Extracellular space is found
outside of the cells
Extracellular space is composed of
intravascular space, interstitial space, & transcellular space
Intravascular space is composed of
vessels; where we draw labs from
Interstitial space is made of
the fluid between the cells; third spacing
Causes of hypovolemia include:
hemorrhage, vomiting, diarrhea, sweating, fever, wound drainage, burns, NPO status, NGT suctioning, diabetes,
Symptoms of hypovolemia include:
tachycardia, weak pulses, hypotension, tachypnea, poor skin turgor, dry & scaly skin, altered mental status, low fever, oliguria, dry mucosa, edema, & polydipsia
Labs that you may see with hypovolemia include:
increased H&H, osmolarity, glucose, protein, BUN, electrolytes, urine specific gravity, creatinine; decreased GFR
Interventions of hypovolemia include:
oral fluids, IV solutions, antiemetics, antipyuretic, ice chips, assess skin integrity, monitor labs, & daily weights
Causes of hypervolemia include:
excessive fluid replacement, kidney failure, heart failure, long-term corticosteroid therapy, & SIADH
Isotonic fluids
fluid floods into the extracellular space; D5W, 0.9%NS, & LR
Hypotonic fluids
fluid moves from the extracellular space to the intracellular space; 0.45%NS, water
Hypertonic fluids
fluid moves from the intracellular space to the extracellular space; TPN, D5 0.45%NS, D5 0.9%NS, & 3%NS
What size gauge is blood administered through?
22 gauge
Infiltration of IV site
IV site will be swollen & cool to touch; remove the IV, elevate the limb, & place a cool compress on it
Phlebitis of IV site
IV site will be red, warm, & painful; monitor for further signs of infection
Symptoms of hypervolemia include:
tachycardia, bounding pulse, HTN, tachypnea, SOB, crackles, raspy voice, edema, altered mental status, JDV, low H&H, cool skin, ascites
Interventions of hypervolemia include:
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
Infection of IV site
discharge & fever; remove IV & give abx
Extravagation of IV site
when caustic drugs eat away tissue, causing necrosis; like chemo, vasopressors, & dopamine
6 Rights & 3 Cs of IV Meds
Right patient, time, dose, med, route, & documentation. Correct dilution, correct access, & compatibility.
What is shock?
inadequate tissue perfusion & gas exchange that results in impaired cellular metabolism
Stages of shock
initial, nonprogressive or compensatory, progressive, & refractory
What changes are seen during the Initial Stage of AKI?
tachycardia, tachypnea, MAP decreased by 10mmHg
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
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
Refractory Stage
organ damage; unresponsive, labored or irregular breathing, bradypnea, bradycardia, hypotension, GI bleed, anuria, cool & moist skin, cyanosis; end of life discussion
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
Labs to monitor with shock
BUN, creatinine, GFR, CBC, WBC, H&H, ABG, electrolytes, lactic acid, blood cultures
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)
Symptoms of Hypovolemic Shock
dehydration, change in LOC, tachypnea, tachycardia, thready pulse, decreased u/o, decreased bowel sounds, N/V, cool skin, & decreased CR
Interventions of Hypovolemic Shock
fluids, monitor VS, ECG, I&Os, daily weights, H&H, electrolytes, BUN, & creatinine, obtain CT or US, & control the bleeding
Causes of Cardiogenic Shock
MI or any damage to the heart
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
Interventions of Cardiogenic Shock
treat dysrhythmias, ECG, cardiac cath, CABG, MONA protocol (morphine, oxygen, nitro, & aspirin)
Symptoms of Neurogenic Shock
hypotension, bradycardia, dry & warm skin
Interventions of Neurogenic Shock
treat the symptoms, HOB 30 degrees, immobilize patient, monitor for DVT & PE, turn & reposition, apply SCDs
Symptoms of Anaphylactic Shock
SOB, expiratory wheezing, inspiratory stridor, hypotension, tachycardia, V/D, hives, swelling of tongue, angioedema, loss of airway
Interventions of Anaphylactic Shock
get rid of allergen, give epi or diphenhydramine or antihistamines, H2 blockers, & steroid
Order of septic shock
SIRS, sepsis, septic shock, MODS
Symptoms of SIRS
hypotension, decreased u/o, tachypnea, temperature changes, increased WBCs, tachycardia,
Symptoms of Sepsis
fever, increased WBCs, tachycardia
Symptoms of Septic Shock
changes in LOC, tachypnea, hypoxemia, hypotension, edema, decreased u/o, necrotic fingers & toes, motteling, & petechiae
Interventions of Sepsis
sepsis bundle, CBC, BMP, lactic acid, culture everything, chest xray, abx, give fluids, vasopressors, VS, monitor u/o, ECG, skin integrity
Symptoms of MODS
impaired perfusion, oliguria/anuria, changes in LOC, unresponsive, cold skin, bradypnea, bradycardia, weak pulses, mottled & dry skin,
Type 1 Diabetes
little or no insulin is produced
Type 2 Diabetes
slow & progressive glucose intolerance
Rapid Acting Insulin
onset = 5-15min peak = 30min-3hrs duration = 3-5hrs;
humalog, novolog, & apidra
Short Acting Insulin
onset = 30-90min peak = 2-4hrs duration = 5-12hrs;
regular insulin, Novolin R, & Humulin R
Intermediate Acting Insulin
onset = 30min-4hrs peak = 1-12hrs duration = 10-24hrs;
NPH & Humulin N
Long Acting Insulin
onset = 1-4hrs no peak duration = 6-24hrs; Lantus & Levemir
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
Symptoms of DKA
BGM>300, polyuria, hypovolemia, fruity breath, ketones in the urine, dry mucosa, hypotension, tachycardia, ECG changes, & kussmaul’s respirations
What to do for a patient in DKA
IV fluids, continuous IV infusions of regular insulin, & monitor for hypokalemia
Symptoms of HHNKS
same symptoms as DKA except ketosis
Interventions for HHNKS
rehydration, insulin, at risk for hypokalemia
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
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)
What is prerenal etiology?
decrease in blood flow & volume
Causes of prerenal etiology
hypovolemia, diuretics, V/D, decreased cardiac output, shock, constricted blood vessels, & nephrotoxic drugs
Symptoms of prerenal & intrarenal
decreased u/o, increased BUN/Cr, tachycardia, hypotension, & infection
Interventions of prerenal
abd xray or us, give fluids, give vasoactive for BP, be cautious with nephrotoxic drugs & fluid overload in patients with comorbidities
What is intrarenal etiology?
kidney is directly damaged; prolonged renal phase (MAP <60-70mmHg for more than 30 min; may have hypoxia)
Causes of intrarenal
tumors, ingestion of toxins or heavy metals, some drugs, anything that can lead to necrotic kidney tissue
Examples of nephrotoxic agents
NSAIDs, antibiotics, IVP dye, ACE inhibitors, pesticides, metals, plants, mushrooms, venom, & antifreeze
Interventions of intrarenal
give fluids then diuretics, regulate abx, & give low doses of dopamine to improve renal perfusion
What is postrenal etiology?
obstructed flow of the kidneys; reversible when obstruction is removed (may need stent)
What can cause postrenal etiology?
BPH, blood clots, renal stones, tumors, postop edema, foley catheter obstruction
Symptoms of postrenal
same, but may include tender or painful abdomen with some swelling
Phases of AKI
onset, oliguric, diuretic, & recovery
Describe the onset phase of AKI
time from initial cause until a decrease in u/o is seen; min to hrs to days
What is the common cause of AKI in children?
hypovolemia
Describe the oliguric phase
u/o is at the lowest amount, BUN/Cr increased, GFR is decreased; 8-14 days to 1-11mos
Normal GFR v Dialysis
120 is normal. 15 indicates a need for dialysis
Describe the diuretic phase
kidney function returns, u/o increases, GFR recovers, & labs stabilize watch for FVD
Describe the recovery phase
renal tissue repairs, BUN/Cr normalize, & GFR recovers, but may remain decreased by 1-3%
Symptoms of AKI
change in LOC, crackles, pulmonary edema, tachycardia, changes in BP, dysrhythmias, dry skin or edema, pallor, or echymosis
Diagnostics for AKI
KUB, Renal Ultrasound, IVP, CT (w/out contrast for stones), Nuclear Scans, & Renal Biopsy
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
What are the requirements for a renal diet?
low protein, sodium, K, Mg, & P
high caloric intake 25-35kcal/kg of ideal body weight
