Exam 1 Flashcards
K ranges
3.5 - 5.0
Na ranges
135-145
the nursing process
ADPIE ~ Assessment, Diagnosis, Planning, Implementation, Evaluation
BUN ranges
5-20
creatinine ranges
0.6-1.2
glucose ranges
70-100
Ca ranges
8.5-10.5
what measures can we give to decrease K?
- kayexelate PO, assess bowel sounds first!
- insulin, watch glucose
- albuterol, bronchodilator
if Na is < 135, what is that a sign of and what should we give?
fluid overload, give 0.9% NS and fluid restrict.
If Na is > 145, what is that a sign of and what should we give?
dehydration, give 0.9% NS or LR
isotonic solutions
- 0.9% NS
- D5W
- D5W 1/4 NS
- LR
hypotonic solutions
- 0.45% NS (1/2NS)
- 0.225% NS (1/4 NS)
- 0.33% NS (1/3 NS)
hypertonic solutions
- 3% NS
- 5% NS
- D10W
- 5% D in 0.9% NS
- 5% D in 0.45% NS
- 5% D in LR
what would the BUN look like if in renal failure?
> 20
good UO
1-2 mL/kg/hr or 30 mL/hr
prerenal AKI
- before kidneys
- decreased perfusion issue
- indication: decreased MAP (CHF, hypovolemia, dehydration), decreased UO, obstruction (tumor, emboli, clot)
intrarenal AKI
- inside kidneys
- from CT dye or meds like NSAIDs, -mycins (ibuprofen, naproxen, ketorolac), contract, infection, immune system issues
postrenal AKI
- after kidneys
- prostate, stone, tumor
phases of AKI
onset, oliguric, diuretic, recovery
oliguric phase of AKI
- sudden decrease in UO
- dark urine
- signs of excess fluid volume
- restrict fluid!
- give vasopressin
- edema, swollen, fluid overload
diet for AKI
- low to moderate protein
- high carbs
what meds are good at providing “kidney protection” along with other benefits?
- ACE inhibitors (-prils)
- ARBs (sartans)
AEIOU indications for dialysis
- Acidotic (pH < 7.1)
- Electrolytes ~ refractory hyperkalemia
- Intoxication
- Overload ~ CHF
- Uremia ~ uremic pericarditis, uremic encephalopathy
who can authorize a medical proxy to represent the patient if there is no MDPOA?
provider
when is a declaration of medical proxy directive used?
when no MDPOA on file, patient is declining and someone needs to make a decision
which AD is used when there are multiple dates ones available?
the newest one
in what circumstances is a MOST form used?
alert, oriented, in their right mind ~ MDPOA can also fill out
who is automatically the patient’s agent and can make decisions when they become incapable of doing so?
MDPOA
where are ADs kept in a hard copy chart?
in the front in green
function of endocrine glands
maintenance and regulation of vital functions
diabetes insipidus
- excretion of large amounts of dilute urine dried out
- increased Na
- polydipsia
- monitor neuro, CV, electrolyte
- administer vasopressin or desmopressin (ADH)
SIADH
- SOAKED = decreased Na
- hyperfunctioning of posterior pituitary
- monitor neuro, CV, electrolyte
- monitor weight, strict I&O
- administer diuretics (watch for K)
- administer vasopressin ANTAGONISTS
- dilutional hyponatremia, crackles, pulmonary edema
- give furosemide
- fluid restrict pt.
what is solumedrol for?
addison’s; push slow, can give adrenaline rush
pheochromocytoma
- tumor
- catecholamine-producing tumor usually found in adrenal medulla
myxedema coma
- severe hypothyroid
- persistently low thyroid production brought on by illness, rapid withdrawal of thyroid medication, surgery
- assess for hypotension, bradycardia, hypoglycemia
- maintain patent airway
- administer levothyroxine, glucose, corticosteroids as prescribed
thyroid storm interventions
- extreme hyperthyroid
- assess for fever, tachycardia, systolic HTN, confusion, seizures, delirium, coma
- administer antithyroid medications, iodides, propranolol, and glucocorticoids as prescribed
- maintain patent airway
what thyroid issue do we give calcium gluconate for? why?
thyroidectomy, can cause hypocalcemia and monitor for tetany
what parathyroid issue do we give calcium gluconate for? why?
hypoparathyroidism ~ assess for hypocalcemia, hyperphosphatemia, postive trousseau’s and chvostek’s, signs of over tetany
treatment of DKA
- treat dehydration initially with IV NS
- administer regular insulin IV
- flush insulin solution through infusion set, discarding first 50-100 mL of solution before connecting and administering to client
- always use IV infusion controller
- cerebral edema, increased ICP may occur if glucose level falls too fast
- K level will fall rapidly within first hour of treatment
diabetic nephropathy
- progressive decrease in kidney function
- will show microalbuminuria, thirst, anemia, fatigue
hypothyroid labs
decreased T3 and T4, increased TSH
hyperthyroid labs
increased T3 and T4, decreased TSH
what does the urine look like in HHS?
ketones are absent or minimal in blood and urine
what symptoms are different in HHS compared to DKA?
- more severe neuro manifestations because of increased serum osmolarity/dehydration
- ketones less likely
- BG often >600
what can overhydration lead to?
cerebral edema
what do ketosis and acidosis do to the K?
elevate it (hyperkalemia)
as insulin and fluid replacement is working for hyperglycemia, what can happen to K?
it can drop (hypokalemia)
hypoglycemia treatment with 15-15 rule
if BG < 70, intake 15 g carbs, wait 15 minutes, check BGs. if still < 70, intake 15 g more
examples of 15 g carbs
- 1/2 cup fruit juice
- 1/2 cup of soda
- 1 tbsp of sugar, honey, or corn syrup
- hard candies
- glucose tabs
3 things to watch for in a co worker with substance use
- behavior changes
- physical signs
- diversion of drugs
reversal of acetaminophen
n-actetylcysteine (mucomyst)
reversal of opiates
naloxone (narcan) or nalmefene (revex)
reversal of benzos
flumazenil (romazicon)
what do benzos end in?
-pam
definition of eating disorders
characterized by grossly disturbed eating habits
how can death occur from anorexia nervosa?
from starvation, suicide, cardiomyopathies, electrolyte imbalances
bulimia nervosa
- client indulges in eating binges followed by purging behaviors
- most clients remain within a normal weight range but think that their lives are dominated by the eating-related conflict
interventions for clients with eating disorders
- assess for suicide potential
- assess nutritional status
- established a contract concerning nutritional plan
- implement behavior modification techniques
- monitor for physical complications and attend to physiological alterations
- encourage psychotherapy and support groups
screening tools we can use for substance abuse
MAST
DAST
CAGE (alcohol)
what meds do we give for a high CIWA score?
diazepam or lorazepam
what meds do we give for a high COWS score?
buprenorphine
definition of substance dependence
pattern of use resulting in tolerance, withdrawal symptoms, and compulsive drug-taking behavior
3 signs of substance abuse
- uses substances recurrently (craving)
- impairment
- health problems
- failure to meet responsibilities
complications associated with chronic alcohol abuse
- in doubt, pick airway
- vit. B and thiamine deficiencies
- korsakoff’s syndrome
- severe memory problems
- wernicke’s encephalopathy
- cirrhosis of liver
- esophagitis and gastritis
- esophageal varicies
- pancreatitis
- peripheral neuropathy
- immune system dysfunction
- anemias
- cardiac disorders
- brain damage
withdrawal delirium
the state of delirium usually peaks 48-72 hours after cessation or reduction of intake (although can occur later) and lasts 2-3 days
what medication therapy for alcohol abuse and dependence?
- naltrexone
- acamprosate
- disulfiram (antabuse)
education about antabuse
avoid use of substances that contain alcohol such as mouthwash and cough medicines ~ can make them throw up profusely
withdrawal effects of opioids
yawning, insomnia, irritability, rhinorrhea, diaphoresis, cramps, N/V, muscle aches, chills, fever, lacrimation, diarrhea
with CNS depressant OD, if client is awake, what do we do?
vomiting is induced and activate charcoal is administered
with CNS depressant OD, if client is comatose, what do we do?
gastric lavage with activated charcoal are priorities
CNS stimulants
amphetamines, cocaine, crack
how to treat CNS stimulant withdrawal
treat with antidepressants, a dopamine agonist, or bromocriptine (Parlodel)
what are seizure precautions
- no restraints
- side-lying
- 100% NRB
- suction
if your patient is hyperkalemic, what is a priority?
get them on tele
most concerning kidney labs
BUN and creatinine
best indicator of renal perfusion
urine output
if sodium is off, what should we monitor for?
neuro, lethargy, seizures
