Exam 1 Flashcards

Question

Hypernatremia Nursing Interventions

Answer 1

> Restrict Na+ Intake from diet > Patient safety -- they're confused and agitated > MD may order an isotonic or hypotonic IV sol'n like 0.45% NS given slowly to rehydrate the cell. the patient is at risk for cerebral edema if given too quickly (confusion is an initial sign). > Educate about diet and signs/symptoms of increased salt level

Answer 2

Hypo/Hyper affects the cardiac system! Vital for skeletal, cardiac, and smooth muscle regulation. It's concentrated mostly inside the cell (ICF). Maintains acid/base balance. Helps transmit nerve and other electrical impulses.

Answer 3

Renal excretion and conservation. Aldosterone increases K+ excretion. Insulin helps move K+ into the cells. Tissue damage and acidosis shift K+ out of the cells and into the ECF.

Answer 4

< 3.5 mEq/L; <=2.5 is DANGEROUS!! Caused by: "DITCH" D: drugs, such as laxatives, diuretics, or corticosteroids I: inadequate intake, due to NPO, anorexia, or really sick and not eating. T: too much water intake dilutes K+ C: Cushing Syndrome = too much aldosterone H: heavy fluid loss due to NG suction, vomiting, diarrhea, wounds also hyper-insulinism

Answer 5

Everything is slow & low K+ plays an important role in muscle and nerve conduction. So, low K+ becomes slow and low (exhausted body): weak, thready pulse orthostatic HTN Decreased bowl sounds decreased deep tendon reflexes flaccid paralysis (late with very low paralysis) confusion Shallow respirations/ diminished breath sounds (no K+ means low ability of accessory muscles) 7Ls: Lethargic Low/shallow breathing Lethal cardiac changes Loss of urine (diuretics) Leg cramps limp muscles low BP & HR EKG --> depressed ST segment, flat or inverted T wave, prominent U wave

Answer 6

Monitor: > Heart rhythms > respiratory status > GI & Renal status > I/O > Magnesium (Mg+ and K+ are linked) > Glucose, Ca2+, Na+ because of the roles in cell transport > K+ supplement for 2.5 - 3.5; give with food to avoid GI upset > K+ infusion for <2.5; this is NEVER given as an IV Push, or IM or SubQ. Give slowly via IV. no more than 20 mEq/L per hour. Watch for phlebitis and infiltration > Hold diuretics that waste K+ and cause urination. Notify the MD. May switch to K+ sparing such as spironolactone/aldactone, dyazide, maxide, triamterene. > Check apical pulse and AM labs before giving digoxin.

Answer 7

"Potassium" P = Potatoes, pork O = oranges T = tomatoes A = avocados S = strawberries S = Spinach I = fish U = mushrooms M = melons / cantaloupe Also carrots, raisins, bananas

Answer 8

<5.0; if >=7.0 DANGEROUS Causes: body "CARED" too much for K+" C = cellular mov't of K+ from ICF to ECF due to trauma like burns/tissue damage/ acidosis A = Adrenal insufficiency (Addison's disease) R = renal failure E = excessive K+ intake D = drugs (K+ sparing diuretics, NSAIDs, Ace Inhibitors)

Answer 9

"MURDER" M = muscle weakness U = low Urine production R = respiratory failure due to muscle weakness or seizures D = decreased cardiac contractility (weak pulse, low BP) E = early signs of muscle twitching / cramping. Late sign is profound muscle weakness R = rhythm changes: tall, peaked T wave; flat P wave; wide QRS; prolonged PR interval

Answer 10

Monitor cardiac, respiratory, neuromuscular, and GI status Stop IV K+ infusions and hold supplements Initiate K+ restricted diet Prepare patient for dialysis Kayexalate sometimes order PO or enema; it causes GI N+ absorption which promotes K+ excretion MD may switch to K+ wasting diuretics (thiazides or lasiz/furosemide) MD may order hypertonic sol'n or glucose and insulin to pull K+ back into the cell.

Answer 11

PTH (ParaThyroid Hormone) and Calcitriol increase serum Ca2+ levels Calcitonin decreases Ca2+ levels

Answer 12

Vital in regulating muscle contraction, neuromuscular function, and cardiac function. Sedative effect on neuromuscular transmission! Forms bones and teeth Transmits nerve impulses Maintains cardiac pacemaker (automaticity) Blood clotting Actives enzymes such as pancreatic lipase and phospholipase Ca2+ and Mg+ are aligned Ca2+ and Phosphate are opposite

Answer 13

<9.0 Manifestations: Trousseau's Chvostek's 3 Bs: Bones, Blood, heart Beats Causes: "LOW CALI" L: low PTH due to a thyroidectomy, pancreatitis O: oral meds, such as corticosteroids, anti-seizure meds such as dilantin and phenobarbital; Phosphate enemas, Citrate (anticoagulant used in blood products) W: wound drain (GI wounds) C: chronic diseases like celiac and crohn's/ chronic kidney issues, diuretics A: antibiotics L: low Vit D or Mg2+ levels I: Increased Phosphate in the blood

Answer 14

Weak bones / fractures Weak clotting Weak heart beats / dysrhythmias Heart: excitability = ventricular tachycardia EKG: prolonged QT and ST Slow clotting factors Lungs = narrowing of the windpipe, stridor Dyspnea and crackles GI = massive diarrhea, intestinal cramping Neurological == seizures, confusion, personality changes, dementia, psychosis Musculoskeletal: Trousseau's and Chvostek's

Answer 15

"FAST" F = foods high in calcium: Leafy greens, sardines/tofu, dairy A = Administer meds like calcium acetate, IV Calcium, Oral Calcium with vit D, aluminum hydroxide S = safety, risk for falls/fracture/ bleeding. Fracture precautions / fall precautions low clotting factors / risk for bleeding. Don't bear down when pooping! cardiac dysrhythmias T = Teach take Ca2+ boosters and avoid Ca2+ depletors like laxatives and loop diuretics.

Answer 16

Kidneys conserve and excrete Mg2+ Intestinal absorption is increased by Vit D and PTH (which means the serum levels are reduced by Vit D and PTH)

Answer 17

Relaxes muscle contractions! Important for DNA synthesis, regulates cardiac & neuromuscular function Intracellular Metabolism (transfer & store energy) Operates the Na+ / K+ pump Transmits nerve impulses Regulates cardiac function Regulates PTH, which regulates Ca2+ Metabolizes carbs, lipids, proteins Regulates BP Absorbed in the small intestine and excreted via the kidneys

Answer 18

<1.6 mg/dL Causes: "LOW MAG" L = Limited intake of Mg+ due to starvation O = other electrolyte issues, such as hypOcalcemia and hypOkalemia W= wasting Mg+ in the kidneys --> loop/furosemide or thiazide diuretics, cyclosporines M = malabsorption issues due to Crohn's, Celiac, vomiting. Also proton-pump inhibitors like protonix, prilosec, any that end in 'zole' like Prazole A = Alcoholism due to poor dietary habits, and alcohol stimulates the kidney to waste Mg+, and causes acute pancreatitis G = Glycemic Issues, for example patients in DKA or who need insulin

Answer 19

"TWITCHING" Neuromuscular excitability T = Trousseau's W = weak respirations I = irritability T = torsades de pointes: goes along with alcoholism. It's a lethal, abnormal heart rhythm. Tetany = abnormal twitching C = Cardiac changes: moderately low = tall T waves and depressed ST segments Severely low = prolonged PR and QT intervals with wide QRS complexes. Wide QT --> Torsades indicator also Chvostek's H = HTN and Hyper-reflexia I = involuntary movement N = nousea G = GI issues - decreased bowel sounds and mobility

Answer 20

Monitor cardiac, GI, respiratory, neuro status Put them on a cardiac monitor for EKG changes MD might order K+ supplements, Ca2+ supplements w/ Vit D *Administer Mg Sulfate IV infusion. Have to monitor the Mg levels very closely to avoid hypermagnasemia. Check deep tendon reflexes. Hypomagnasemia = lots of reflexes; if you get to hypermagnasemia they're absent. Seizure precautions Oral Mg may cause diarrhea

Answer 21

Avocado Green leafy veggies Peanut butter and pork Fish (canned tuna, mackeral) Dark chocolate Cauliflower Legumes nuts Oranges Milk

Answer 22

>2.6 mg/dL Causes: "MAG" This is less common than hypomagnasemia. Can happen if you're trying to correct hypomag. M = Mg+ containing antacids and laxatives like magnesium sulfate - mylanta or malox A = Addison's disease (adrenal insufficiency) G = Glomerular filtration insufficiency or renal failure. Filtration <30mL/min. Kidneys are conserving too much Mg+.

Answer 23

Mild cases are without symptoms. Symptoms only present with very high Mg+ levels. "LETHARGIC" L = profound lethargy E = EKG changes: PR and QT interval prolonged and wide QRS complex T = tendon reflexes are absent / dimished H = hypOtension A = Arrhythmias, such as bradycardia or heart blocks R = respiratory arrest G = GI issues like nausea and vomiting I = impaired breathing due to the weakness of the skeletal muscles C = Cardiac Arrest

Answer 24

Monitor cardiac, respiratory, neuro, GI, renal system. Place the patient on a cardiac monitor for EKG changes. Ensure patient safety due to lethargy / drowsiness Prevention: avoid giving the patient renal failure due to excessive Mg+ containing antacids / laxatives, checking for high Mg+ during infusions, not giving foods high in Mg+ MD order of K+ wasting diuretics like furosemide/lasix (loop diuretics) If in renal failure, prep for dialysis IV Ca2+ can be ordered to reverse side effects of Mg+, although have to watch for infiltration. A central line is preferred for this.

Answer 25

Excreted and reabsorbed along with Na+ in the kidneys Aldosterone increases chloride reabsorption with Sodium

Answer 26

Linked with Na+ --> same impacts HCl production - aids in digestion Helps Na+ maintain ECF balance and vascular volume Regulates acid/base balance Buggers O2 / CO2 exchange in RBCs

Answer 27

<97 Causes: "CHAMP" C: Chloride loss from fluid loss, like vomiting, diarrhea, NGT suctioning, sweating, fever, or burns H: HypOnatremia A: Addison's disease and renal crisis M: Medications such as diuretics P: pH imbalances from metabolic alkalosis (fluid loss from GI from vomiting)

Answer 28

Same as hypOnatremia! Generally depressed and deflated. Hypotension (low BP) EKG: dysrhythmias Respiratory: depressed and deflated -- dyspnea from a deflated diaphragm muscle SOB Neugological depressed -- agitation, irritability, seizures, coma, confusion GI: diarrhea, nausea, vomiting Musculoskeletal: tremors and muscle cramps

Answer 29

Give salt, because Cl- will follow salt! IV NS or 0.45% NS Avoid free water

Answer 30

>107 Same as hypERnatremia Causes: Trauma (head injury) Dehydration Hyperparathyroidism Respiratory alkalosis (hyperventilating)

Answer 31

Same as hypERnatremia (big and bloated!) Hypertension EKG: dysrthythmias Lung: tachypnea, respiratory alkalosis Neurological: ICP, cognitive changes, altered level of consciousness GI: diarrhea, diuresis, dehydration MSK: muscle weakness

Answer 32

Treat the causes! Restore fluid imbalance via IV LR (lactated ringers) or Sodium Bicarbonate

Answer 33

2.5 - 4.5 mg/dL Excretion and reabsorption by the kidneys PTH decreases phosphate levels by increasing renal excretion Opposite relationship with Ca2+ --> increasing Ca2+ will decrease phosphate levels and vice versa Vit D plays a role in phosphate absorption

Answer 34

forming bones and teeth (stored mainly in the bone) Metabolizes carbs, proteins, and fats Cellular metabolism: producing ATP and DNA Muscle, nerve, and RBC function Regulate acid/base Regulate Ca2+ levels

Answer 35

<2.7 mg/dL low "PHOSPHATE" P = Pharmacy: aluminum hydroxide and aluminum based antacids cause malabsorption which reduces phosphate absorption. Also, lack of Vit D. H = Hyperparathyroidism: PTH is too high in the serum, which inhibits the reabsorption of phosphate in the kidneys and it is excreted. O = oncogenic osteomalacia --> kidneys waste phosphate due to bones softening. S = syndrome of refeeding. Watch for this on patients TPN; occurs in malnutrition or starvation pathologies. The body was in starvation mode and when it gets nutrients, it releases way too much insulin. It then releases phosphate and magnesium to help digest (but they were already too low to begin with) P: pulmonary issues due to respiratory alkalosis b/c phosphate moves out of the blood and into the cell. H: Hyperglycemia leads to glycosuria, polyuria, and ketoacidosis. Causes the kidney to waste phosphate. A: Alcoholism impacts the body's ability to absorb phosphate. plus, alcoholism is associated with malnutrition. T: thermal burns -- extreme burns causes a shift of phosphate out of the blood and into the cells. E: electrolyte imbalances cause low phosphate levels like hypERcalcemia, hypOmagnasemia, and hypOkalemia.

Answer 36

"BROKEN" (the patient is at risk for bone fractures and every system of the body is breaking down!) B = breathing problems due to muscle weakness R = Rhabdomyolysis, an electrolyte disturbance due to low levels of Phosphate, K+. Affects the muscles and causes rapid necrosis of the muscles. This releases myoglobulin into the blood, which is toxic to the kidneys causing tea-colored urine, muscle-weakness, and pain. also deep tendon reflexes will decrease O = osteomalacia: bone fractures, deformities Also, Cardiac outpute is decreased K= kills immune system through decreased platelet aggregation (increased bleeding) E = extreme weakness and ecchymoses ( due to decreased platelets) N = neuro changes such as irritability, confusion, seizures

Answer 37

MD orders oral phosphorous w/ vit D to help with absorbption Monitor patients on TPN for muscle pain and weakness (rhabdomyolosis), also re-feeding syndrome Ensure patient safety (bed down, call light in reach) due to risk for fractures and confusion Encourage foods rich in phosphate If <1.7 the MD may order IV phosphate. Be careful with patients who are in renal failure, because they can't clear the phosphate. Monitor Ca2+ level, as this can decrease if the phosphate gets higher. Monitor phosphate levels to avoid hyperphosphatemia Monitor EKG changes

Answer 38

Fish Organ meats Nuts Pork Beef Whole grains (essentially meat)

Answer 39

>4.5 mg/dL "PHOSHI" --> note that Phoslo is a phosphate binding drug that patients in renal failure take to keep phosphate low (because the kidneys can't get rid of phosphate anymore) P: Phospho-soda overuse. Laxatives and enema overuse H: HypOparathyroidism causes high phos levels due to PTH being too low. PTH causes the kidneys to keep too much phosphate. O: overuse of Vit D, which supports absorption of phosphate S: syndrome of tumor lysis, which occurs with chemo. Chemo kills off good and bad cells. This lets out the phosphate which is normally inside the cell into the ECF. H: rHabdomyolysis --> rapid necrosis of muscles. Dead muscles release myoglobulin into the blood, which is toxic to the kidneys, which sends the patient into renal failure and phosphate excretion is decreased. I: insuffiency of the kidneys (ESRF) which means phosphate won't be excreted.

Answer 40

Same as the symptoms of hypOcalcemia Confusion Hyperactive reflexes Anorexia Muscle spasms in calves/feet, seizures, tetany Positive Trousseau's sign and Chvostek's sign

Answer 41

Administer phosphate-binding drugs (Phoslo) which works on the GI system. Give with food or right after a meal. Don't give phosphate laxatives or enemas. Restrict foods that are high in phosphorous. Prepare patient for dialysis due to renal failure.

Answer 42

Excretion and reabsorption by the kidneys Regeneration by the kidneys

Answer 43

Major body buffer involved in acid/base regulation

Answer 44

Isotonic IV Solutions: 0.9 NS, LR, D5W

Answer 45

Hypertonic IV Solutions: D5 LR, D10W, D20W, D50W, D5 0.45%, D5 NS, 3% NaCl, 5 % NaCl

Answer 46

Hypotonic solutions have less salt (lower osmolality) than the cells, so water goes into the cell. 1/2 NS or 0.45% 1/3 NS or 0.33% 1/4 or 0.25% NS NEVER use with ICP patients NEVER use with diabetics who are at risk for HYPERglycemia Used to help with cellular dehydration, which is when the cells are thirsty -- hypERnatremia and HHNS (type 2 diabetic disorder with uncontrolled high blood sugar, which causes cellular dehydration). Also used with DKA (type 1 diabetics; involves burning ketones instead of sugar for energy --> causes dehydrated cells)

Answer 47

isotonic in the bag Hypotonic in the body due to sugar! NEVER use with diabetics who are at risk for HYPERglycemia

Answer 48

NEVER given for ICP patients Give SLOWLY to prevent cellular edema Watch out for hypovolemia signs and symptoms such as tachycardia, decreased BP, cellular edema, and cell damage. Be cautious with liver disease, trauma, burn patients.

Answer 49

The fluid is escaping from inside the cell to outside the cell. Hypertonic solutions have higher concentrations than the ICF. Thick, concentrated solution - higher osmolality. Will pull fluids out of the cells and making the cell more skinny. 3% NS 5% NS D10W D5.5 NS D5LR D50W Used for hypOvolemia, heat related (heat exhaustion)

Answer 50

Infuse slowly, no boluses! too quick could cause a massive fluid shift that can domino into cellular dehydration and fluid volume overload. S&S --> bounding pulses, high BP, jugular vein distention, crackles, edema.

Answer 51

"iso-perfect" Causes no fluid shifts, so fluid remains in the vesicle. Used primarily to treat fluid volume deficit. Same osmolality as body fluids 0.9% NS LR (which contain potassium, so no liver impaired patients! like cirrhosis) D5W is isotonic in the bag and hypotonic in the body due to sugar Monitor for S&S of hypovolemia: tachycardia, weak pulse, hypotension. Monitor for S&S of hypervolemia: HTN, bounding pulse, crackles, dyspnea, jugular vein distention, extra heart sounds such as S3.

Answer 52

Fluid output> Fluid intake, which causes hypOvolemia / dehydration Causes: Loss of fluids from thoracentesis, paracentesis, hemorrhage, NG tube, trauma, GI losses - vomiting and diarrhea, polyuria (caused by diabetes or diuretics) Third spacing, such as caused by burns and ascites (volume from the vessels goes to the cells due to truama)

Answer 53

Decreased weight overall Increased HR (weak and thready) Decreased BP Decreased CVP (Central Venous Pressure) Increased RR Decreased Urinary Output due to not enough fluid to urinate or because they're holding on to it. Decreased skin turgor (tenting), dry mucous membranes, thirst Flat neck veins Labs - INCREASED serum osmolality, urine specific gravity, hematocrit, Na+, BUN

Answer 54

Replace the fluid loss! either PO or IV Monitor for fluid volume overload when using IV Safety precautions -- orthostatic HTN is a risk (rise slowly) Daily I/O Daily Weight --> same time, same scale, same clothes

Answer 55

=Hypervolemia Caused by: Heart Failure Kidney dysfunction (can't excrete excess volume) Cirrhosis Increased Na+ intake

Answer 56

Increased weight due to water weight increased HR because the heart wants to push volume forward. Bounding HR! Increased BP due to increased volume Increased CVP Wet lung sounds (crackles) due to the backflow of fluids from the heart. Polyuria, large amounts of dilute urine from the kidney Edema in the skin Distended neck veins (JVD = jugular vein distention) Labs: diluted, DECREASED: serum osmolality, urine specific gravity, hematocrit, Na+, BUN

Answer 57

Low Na+ diet Daily I/O and weight Diuretics high /semi fowler's position

Answer 58

Hypoventilation --> causes CO2 to increase in the blood (hypercapnia), causing a drop in blood pH. Hypercapnia then causes papilledema (swelling of the optic nerve) and peripheral vasodilation. Narcotic overdose Chest Trauma Airway Obstruction HypERkalemia Hypoventilation, air trapping, bronchoconstriction Secondary to neuro-muscular disorder, COPD, asthma, sleep apnea, pneumonia, sedation.

Answer 59

pH<7.35 CO2> 45 Kidneys may compensate by retaining HCO3 (HCO3 will be >28) Respiratory center is stimulated as well to increase the RR so that you exhale CO2 and raise the pH

Answer 60

HypERkalemia Tachycardia Headache, feeling of fullness Mental cloudiness, decreased LOC dizziness, muscle twitching, seizures dysrhythmias due to hypERkalemia Hypotension, which can lead to CNS depression

Answer 61

>After the primary assessment is the focused respiratory assessment - look at mental status and lung sounds. >Monitor ABG >Monitor K+ >Vital Signs --> tachycardia, LOC, safety protocols >Correct the underlying cause > Restore effective gas exchange in the lungs: symptoms are activity intolerance and SOB. >Chest Physiotherapy >O2 >Fluids >Fowlers position >Meds: bronchodilators to open up airways and decrease bronchospasms; antibiotics to treat infections > Deep breathing and coughing > Oral suction

Answer 62

Prevention Pursed Lip Breathing Suctioning airways (even in infants)

Answer 63

ABG PFT ECG X-ray Sputum studies

Answer 64

Due to an increase of HCO3 ABGs: pH >7.45; CO2 <35 Compensation: kidneys conserve H and get rid of HCO3 HypOkalemia HypOcalcemia Respiratory center compensates by becoming depressed, decreasing the rate and depth to retain CO2

Answer 65

HyPERventilation causes a CO2 deficit, which leads to respiratory alkalosis due to a decreased concentration of carbonic acid (H2CO3) in the blood. HypERventilation is rapid breathing, causing the person to feel dizzy, cramping of the hands and feet, and the feeling that you'll black out. HypOkalemia, HypOcalcemia - tetany Cardiac arrythmias Blurred vision Headache Warm/flushed skin high pulse rate muscle weakness Dyspnea, chest tightness, dizziness, anxiety, panic, blurred vision Hyperthermia can cause the hyperventilation Hypokalemia --> K+ moves out from the cells in exchange for H+ ions HypOcalcemia --> alkalosis causes binding of Ca2+ to albumin, causing symptoms of hypocalcemia: numbness and tingling of the mouth and fingers. Trousseaou, Chvostek Decreased/normal BP Tachycardia Deep, rapid breathing

Answer 66

Provide calm and reduce the respiratory rate. If on a ventilator, decrease the tidal volume to increase the CO2 level. Monitor labs, ECG,neurologic changes Assess lungs and respiratory style Assess cardiac rhythms Give O2 as needed A paper bag on someone's head can increase the CO2 level, but be careful not to induce hypoxia. Consider referral to counseling for anxiety Give anti-anxiety meds (diazepam/valium)

Answer 67

Relaxation techniques Stress management Keep aspirin out of the reach of children Maintain safety protocols Seek help for anxiety

Answer 68

ABG ECG WBC, Sputum testing to rule out infection

Answer 69

HypOkalemia related to dysrhythmias can lead to ventricular fibrillation Increased RR, decreased BP --> patient tires out and can no longer continue breathing Assess the potential of respiratory arrest and if the patient is deteriorating.

Answer 70

Metabolic acidosis is due to DKA, Shock, Sepsis pH<7.35; HCO3<24 Also likely a low O2 level<75

Answer 71

Eating Disorders Laxative Abuse Renal failure Aspirin turns into acid when it breaks down, which causes metabolic acidosis. GI: starvation, malnutrition Diarrhea (mostly in children)

Answer 72

Decreased pH; HCO3<24 HypOmagnasemia Compensation from the kidneys - conservation of HCO3 HypOtensive Decreased BP HypERkalemia Abdominal pain, nausea, vomiting Kaussmal respirations (rapid, deep breathing) Mental status changes Alcoholic keto-acidosis due to abrupt alcohol cessation; treated with 5% dextrose in NS, Mg+/K+ replacements, and optional thiamine and folate treatment

Answer 73

ABG ECG Electrolyte Panel

Answer 74

I/O, Daily Weight K+ and ECG Vital Signs LOC GI Function Protect from injury Hydration - (0.9% NS) Replace electrolytes Insulin HCO3 Sodium Lactate Meds to prevent diarrhea Meds for DKA/ dialysis

Answer 75

Hypotension, dysrthythmias, decreased LOC, hyperkalemia can lead to lethal cardiac rhythms such as ventrical fibrillation

Answer 76

Adequate nutrition Take meds as prescribed Educate about signs and symptoms of metabolic acidosis if the patient is on meds such as diuretics, ACE inhibitors, and anticonvulsants

Answer 77

High pH High HCO3 >28 High respirations as compensation

Answer 78

Loss of H due to vomiting, NG tube suctioning, increase of bicarbonate (Alka seltzer) Purging / on purpose vomiting, diarrhea, abuse of laxatives or diuretics. Anything that makes the stomach contents leave the body. Hypochloremia --> Cl- is replaced by HCO3- leading to increased alkalinity Post-cardiac surgery in young children.

Answer 79

severe vomiting NG suctioning Diuretic therapy Lots of black licorice Excessive use of sodium bicarbonate (alka seltzer)

Answer 80

ABG ECG Electrolyte panel HypOkalemia HypOcalcemia HypOnatremia

Answer 81

confusion Nausea, vomiting, diarrhea Tremors, muscle cramps, tingling of fingers and toes HypOkalemia HypOcalcemia HypOnatremia Excitatory effect on the CNS Restlessness followed by lethargy Dysrhythmias Bradypnea HypOtension

Answer 82

Restore hydration and electrolytes Monitor I/O, ABG ECG, vital signs Protect patient from injury Meds such as 0.90% NS, histamine 2 receptor antagonist to help reduce the loss of H from GI damage Identify altered temperature regulation, irregular breathing pattern, fall risks Hypokalemia, Hypocalcemia, Hyponatremia

Answer 83

Hypotension, dysrhythmias, drops in the respiratory rate to maintain O2 (compensation)

Answer 84

Teach about proper positioning in infants to avoid aspiration Take antacids appropriately Signs / Symptoms of hypOkalemia

Answer 85

Cilia protect the airway from unwanted, small particles. Epiglotis helps protect foods from passing into the airway system Trachea bifurcates, gives access to right and left lungs Right lung has 3 lobes and is small/shorter than the left lung, which has 2 lobes Pleural lining helps protect, aids in respiration, has two layers: visceral pleura (lung side) and parietal (rib side)

Answer 86

Restlessness Confusion Anxiety Increased BP Increased HR Increased RR Dyspnea

Answer 87

Decreased LOC Decreased activity level Hypotension Bradycardia Metabolic Acidosis Cyanosis

Answer 88

Clubbing of the fingers and toes Peripheral edema Right-sided heart failure Respiratory Acidosis O2 saturation <87%

Answer 89

Adults: 12-20 Newborn: 30-80

Answer 90

breathing too fast (RR>20 for adults and >80 for infants)

Answer 91

Breathing too slow (RR<10 for adults and <30 for infants) Leads to inadequate O2 and possibly too high CO2

Answer 92

No breathing, can lead to cardiac arrest. Obesity can cause apnea.

Answer 93

labored breathing - subjective assessment by the patient that they're having trouble breathing

Answer 94

Can't breathe in certain physical positions, like on their back. Asthma and pneumonia can cause orthopnea.

Answer 95

mild impairment in oxygenation, can lead to hypoxia

Answer 96

lung collapse; asymmetrical respiration. While pneumothorax may occur spontaneously, most occur as the result of trauma.

Answer 97

Physical: Patency Bilateral symmetry View anterior & posterior chest Auscultate lungs Gag reflex & need for suctioning to prevent aspiration Ability to cough up sputum and need for percusion/vibration/positioning History: Smoking history Corticosteroid use: if stopped abruptly can cause hypOtension, tachycardia, cardiovascular collapse

Answer 98

Sputum (use coughing technique or suction sample) ABG Pulse Ox (expect 95+) PFTs- changes in lung function Peak Expiratory Flow Rate (PEFR): for asthma, gives an indication of improvement Chest X-ray for pneumothorax, hemothorax, pneumonia Pulmonary Angiogram Pulmonary V/Q scans for oxygenation and perfusion Bronchoscopy - to view the pulmonary structures Thoracentesis - to get fluid from between the pleural lining for testing

Answer 99

O2 as indicated (be careful with COPD) Incentive Spirometry -- air flow of lung volumes (how much/how quickly exhale) Lung reduction surgery - diffuse emphysema Frequent turning b/c tissue hypoxia increases skin breakdown Deep breathing exercises Positioning - fowlers and possibly (prone) Encourage smoking cessation Pulmonary hygeine, suctioning Chest physiotherapy Bronchoscopy to remove mucus Thoracentesis to remove fluid from interpleural space

Answer 100

Deep, rapid exhalations. Increases CO2 exhalation Indicates respiratory alkalosis

Answer 101

rapid breathing, then shallow and apnea Indicative of HF, increased ICP, drug overdose

Answer 102

shallow type breathing with apnea Indicative of neurological issues

Answer 103

Normal tracheal sounds are harsh and high pitched. These should diminish over the bronchi and become almost nonexistent over the alveoli. The strongest vibration should be felt over the trachea.

Answer 104

Medium in loudness and pitch. They are heard between the scapulae, posteriorly and next to the sternum.

Answer 105

soft and low pitched. They are longer on inhalation and exhalation

Answer 106

loud, high pitched sounds next to the trachea

Answer 107

wheezing when breathing in, usually in the trachea area. High pitched sound; most often can be heard when people are taken off the ventilator. Caused by narrow airway passages.

Answer 108

narrowing of the bronchi, heard on expiration

Answer 109

popping / bubbly type sound like pouring milk over rice krispies. Caused by fluid in the lung and atelectasis. Coughing can clear it up.

Answer 110

low pitched sound that is continuous throughout inspiration. It's a blockage of the airway, a loud and rumbling sound, usually caused by sputum that could be cleared by coughing.

Answer 111

low pitched, dry grating, rubbing sound caused by inflamed pleura. Present during inspiration and expiration.

Answer 112

collapsed lungs or surgically removed lobes.

Answer 113

Used for patients who are noncritical, with minor breathing problems. Or for those who can't/won't wear a mask. O2 concentrations of 24-44% Flow rates 1-6L Always use humidification for >4L/min Provide nose care every 4 hours

Answer 114

Used for clients who require a moderate flow rate for a short period of time. 40-50% O2 Flow rates 5-8L/min Because CO2 can build up, don't use a flow rate lower than 6L/min; use a humidifier above 4L/min Replace sterile water at least every 24 hrs or per facility policy

Answer 115

used when CO2 is too high and the patient needs more O2. Always used with higher than 6L/min The reservoir fills with pure O2, allowing the patient to breath pure O2. (keep this at least 2/3 inflated as this is the O2 source!!) 95-100% O2 Flow rates 10-15 L/min

Answer 116

used for patients who are getting claustrophobic with the face mask, but it's hard to keep in place. 24-100% O2 Flow rates of at least 10L/min

Answer 117

used for clients with COPD when an accurate FiO2 is essential and CO2 buildup has to be kept to a minimum. 24-50%; 4-12L No humidifiers. Color-coded adaptors based on flow rate. Interferes with eating and talking, so might be paired with nasal canula during meals.

Answer 118

Small mask that fits over the tracheostomy site. Flow rate is usually 10L/min

Answer 119

Commonly used for sleep apnea because the continuous pressure keeps the airway open. Pressure is usually between 5-20 cm of water.

Answer 120

Provides assistance during inspiration and keeps the airway open during exhalation. It increases the amount of air in the lungs at the end of expiration, reduces airway closure, and improves O2.

Answer 121

In Asthma, the airway becomes constricted and histamine is released. Most common in kids. Usually caused by exposure to an allergy or trigger, such as dander, foods, nuts, drugs, exercise induced, weather induced (usually cold), irritants, genetics, exposure to smoke, allergies, or a respiratory infection. The loss of heat or moisture from the bronchial surface is a characteristic of exercise-induced asthma, which is triggered by exercising in cold, dry air.

Answer 122

coughing, wheezing, tachycardia, tachypnea Most common symptom in older adults is cough, which might also indicate COPD, CHF, or pulmonary fibrosis. Dyspnea, tachypnea, and rhinitis typically occur in children and younger adults.

Answer 123

Race (African Americans), exposure to irritants, genetics, allergies, and respiratory infection.

Answer 124

Apparent level of distress and LOC Respiratory rate and excursion Breath sounds Skin color / Vital signs Inspect/palpate chest for symmetry Assess for use of accessory muscles --> this indicates respiratory distress and rapid intervention is needed! Assess for presence and nature of pulmonary secretions.

Answer 125

Allergy/skin testing --> scratch or patch testing and IgE testing can be used to determine the severity of the patient's allergies. SpO2 chest x-ray ABGs PFT WBC count Serum IgE and eosinophils

Answer 126

Acute episodes are managed by 'rescue medications' such as bronchodilators (Albuterol), Anticholinergics (Atrovent) - to prevent further bronchoconstriction, and steroids such as methylprednisone to reduce inflammation. LT mgmt use of Long-Acting Beta Agonists Assess respiratory and O2 status Identify triggers/precipitating factors Create an Asthma Action Plan

Answer 127

Teach to avoid asthma triggers! Rescue vs. maintenance Proper use of meds

Answer 128

Blocks the cholinergic receptors of the Parasympathetic Nervous System, which allows the Sympathetic Nervous System to dominate. Releases Epinephrine, relaxes smooth muscles around the airways, and promotes bronchodilation. Tiotropium is administered through inhalation.

Answer 129

Assess for allergies to soybean/peanuts Use cautiously during lactation, pts with glaucoma, prostatic hypertrophy Assess for improved gas exchanged, decreased chest tightness, and decreased dyspnea After use, offer mouth rinses to relieve dry mouth and bitter taste.

Answer 130

Activates the Sympathetic Nervous System beta-2 receptors to relax bronchial smooth muscles causing bronchodilation. Relieves bronchospasms for improved gas exchange in patients experiencing an acute asthma attack. "Rescue inhaler" -- works within minutes

Answer 131

Use cautiously in pts with high BP, CAD, cardiac arrhythmias, and diabetes. Inhalation is the desired route to minimize adverse systemic effects. Should be administered with a MDI, DPI, or nebulizer. Desired effects are a reduction in tachypnea, work of breathing, wheezing, and anxiety Observe for signs of tremors, as beta2 agonists may activate the beta2 receptors in skeletal muscles.

Answer 132

MDI is the most common method of delivery Instruct the patient to depress the canister while taking slow, deep breaths for the most precise dose. When 2 puffs are needed, wait for 1 minute between puffs. Take Rescue inhaler 5 minutes before any other inhaled drugs, since the bronchodilator effects will impact those. Monitor HR for tachycardia (SABAs have systemic effects)

Answer 133

Not recommended for acute attacks due to a 30 minute onset. Some LABAs (salmeterol) have an increased risk of asthma-related deaths b/c patients try to use them as a Rescue Inhaler. Combination products include a LABA with a corticosteroid.

Answer 134

Not beneficial for acute attack! Suppress inflammation in the airways and decrease mucus production. Reduces the impact of exacerbations, improves speed of recovery, and decreases rate of relapse. Combination salmeterol/fluticasone lasts as long as 12 hours, but takes 30 minutes to work so can't be used for acute attacks.

Answer 135

Administer each dose of the corticosteroid about 5-10 minutes after the inhaled dose of bronchodilators to enhance the distribution of medication into the lungs. Assess for throat irritation, nasal dryness, and oral/laryngeal candidias. Administer antifungals or gargles as directed by HCP.

Answer 136

Rinse mouth after each use to decrease throat irritation and reduce the risk of fungal infections. NOT for acute attacks! Could take a couple of weeks to experience the beneficial effects. Take the medication continuously and refrain from stopping during symptom-free periods to ensure that therapeutic levels are maintained.

Answer 137

NOT FOR ACUTE ATTACKS. These are a 2nd line therapy if an ICS cannot be used or adjunctive if ICS is insufficient. Suppress inflammation and the release of leukotrienes/other inflammatory mediators. This results in less edema, mucus production, and airway obstruction. May have adverse effects of depression and suicidal thinking.

Answer 138

With Exercise-Induced Bronchoconstriction (EIB), take meds at least 2hours before exercising. NOT for an acute attack! Monitor liver function tests May increase levels of warfarin, resulting in bleeding.

Answer 139

Stabilize mast cell membranes and prevent the release of inflammatory mediators, such as leukotrienes, histamines. This reduces edema, mucus production, and airway obstruction. Also used to prevent asthma attacks triggered by inflammation/allergens. Administered by MDI or nebulizer and are relatively safe with few side effects.

Answer 140

Assess for decreased frequency of asthma attacks, wheezing, and bronchoconstriction. Use daily, even when asymptomatic. Use the MDI correctly!! (use teach-back when training) NOT FOR ACUTE ATTACKS.

Answer 141

Dual actions: CNS stimulant and bronchodilator. As a CNS stimulant, methylxanthines decrease drowsiness and fatigue, but higherdoses may produce nervousness, insomnia, and tremors. As a bronchodilator, they relax the bronchial smooth muscles. Methylxanthines are infrequently used, as there is a narrow margin of safety and many side effects.

Answer 142

Avoid caffeine, as this increases the level of toxicity. Adverse effects include insomnia, gastric distress, nausea, vomiting, and CNS stimulation. Cardiac dysrhythmias may be observed at higher dosages. Monitor serum levels of the drugs to assure they're at a therapeutic level.

Answer 143

NOT a rescue inhaler Contact HCP about OTC drugs due to possible interactions. Monitor serum theophylline levels to avoid toxicity. Educate on adverse effects and tell patient to report adverse effects.

Answer 144

Inhibits several types of interleukins to decrease an inflammatory response. Administer by subcutaneous injection, except for reslizumab - which is given IV. Instruct the patient or family member how to do a subQ injection.

Answer 145

Incurable, irreversible chronic lung disorder with two main components: 1. chronic bronchitis -- inflammation and excessive mucus. productive cough that has lasted 3+ months in 2 consecutive years. 2. Emphysema-- alveolar membranes break down (usually due to a long history of cigarette smoking) Low pO2 becomes the stimulus for breathing, so it's important to only give the lowest amount of O2 possible to remain stable.

Answer 146

Age related - 50+ Current/past smoker Respiratory infection - frequent trigger for exacerbation of symptoms Occupation - chemicals, dust, air pollution, infections Antitrypsin deficiency - "AAT" inherited, it normally protects the lungs from injury.

Answer 147

Easily fatigued Frequent URIs Use of accessory muscles to breathe Orthopneic Wheezing pursed lip breathing Chronic cough Barrel chest Dyspnea Prolonged expiratory time Bronchitis - increased sputum Digital clubbing Worsening ABGs

Answer 148

Stop smoking!! low flow O2 (goal is 88-92%) CPAP or BiPAP breathing treatments sitting position or tripod position Breathing techniques: > abdominal breathing relieves the work of the accessory muscles > pursed lip breathing slows the respiratory rate and helps maintain open airways. Huff Coughing: inhale deeply while leaning forward, exhale sharply with a 'huff' sound Controlled Coughing: inhale deeply, hold breath briefly, cough twice; inhale by sniffing Small meals that are high in protein; hydration Chest physiotherapy

Answer 149

Pneumonia is acute inflammation of the lung. The inflammatory response causes fluid to accumulate in the alveoli and edema to form as alveolar capillaries dilate and allow fluid to leak into interstitial tissues. This results in impaired gas exchange, causing the patient to become dyspneic.

Answer 150

70% of cases Upper respiratory tract infection Risk factors: air pollution, cigarette smoking, medication, alcohol, COPD, heart failure, kidney failure

Answer 151

patient aspirates gastric contents into the lungs, and this causes pneumonia. Risk is highest during emergency surgery, because the patient hasn't stopped eating. other risks include decreased LOC, dysphagia, nasogastric intubation, 65+ yo, abdominal/chest surgery, tube feeding, vomiting

Answer 152

10% of the adult population. Flu and adenovirus are most common causes, but herpes and measles can also lead to pneumonia. Mostly found in immunosuppressed patients.

Answer 153

Cough Chills Fever Tachypnea Dyspnea Chest pain Sputum Fatigue Decreased LOC

Answer 154

Chest X-Ray Pulse Ox Sputum --> the sputum gram stain can rapidly identify the infecting organisms, which allows the provider to select the correct antibiotic. Blood cultures ABGs WBCs

Answer 155

Prevention incentive Spirometry (prevents alveoli collapse) Chest PT Suction Fowlers position O2 to prevent hypoxemia Small meals, high in calorie/protein, los in carbs Encourage movement! Fluids

Answer 156

Sleeping disorder when a person stops breathing. The average adult needs 7-9 hours of sleep. Considered sleep apnea when there are 5+ apneic periods in an hour. 30+ episodes in an hour is considered severe.

Answer 157

Women who are 60+ Anyone with a mental disorder Large neck / abdominal circumference Smoking Alcohol Could be genetically linked

Answer 158

Snoring Sleeplessness, excessive sleepiness (always tired/irritable) Fatigue Irritability Distractibility Hard time focusing Confusion Morning headaches

Answer 159

Polysomnography Test (PSG) --> records O2 levels, eye movements. ECG ==> used to measure brain waves

Answer 160

Sleep maintaining behaviors Stimulants for daytime CPAP Weight reduction Possibly surgery to remove the obstruction Avoid alcohol

Answer 161

Assess apnea episodes Assess wakefullness Assess O2 status, SpO2, PaO2, CO2 Headaches

Answer 162

Deep breathing exercises Positioning upright promote secretion clearance limit liquid at night encourage smoking & alcohol cessation avoid naps during the day improve diet O2 therapy Exercise regimen