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NSG 452 Synthesis > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

K ranges

A

3.5 - 5.0

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2
Q

Na ranges

A

135-145

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3
Q

the nursing process

A

ADPIE ~ Assessment, Diagnosis, Planning, Implementation, Evaluation

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4
Q

BUN ranges

A

5-20

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5
Q

creatinine ranges

A

0.6-1.2

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6
Q

glucose ranges

A

70-100

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7
Q

Ca ranges

A

8.5-10.5

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8
Q

what measures can we give to decrease K?

A
  • kayexelate PO, assess bowel sounds first!
  • insulin, watch glucose
  • albuterol, bronchodilator
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9
Q

if Na is < 135, what is that a sign of and what should we give?

A

fluid overload, give 0.9% NS and fluid restrict.

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10
Q

If Na is > 145, what is that a sign of and what should we give?

A

dehydration, give 0.9% NS or LR

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11
Q

isotonic solutions

A
  • 0.9% NS
  • D5W
  • D5W 1/4 NS
  • LR
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12
Q

hypotonic solutions

A
  • 0.45% NS (1/2NS)
  • 0.225% NS (1/4 NS)
  • 0.33% NS (1/3 NS)
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13
Q

hypertonic solutions

A
  • 3% NS
  • 5% NS
  • D10W
  • 5% D in 0.9% NS
  • 5% D in 0.45% NS
  • 5% D in LR
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14
Q

what would the BUN look like if in renal failure?

A

> 20

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15
Q

good UO

A

1-2 mL/kg/hr or 30 mL/hr

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16
Q

prerenal AKI

A
  • before kidneys
  • decreased perfusion issue
  • indication: decreased MAP (CHF, hypovolemia, dehydration), decreased UO, obstruction (tumor, emboli, clot)
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17
Q

intrarenal AKI

A
  • inside kidneys
  • from CT dye or meds like NSAIDs, -mycins (ibuprofen, naproxen, ketorolac), contract, infection, immune system issues
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18
Q

postrenal AKI

A
  • after kidneys
  • prostate, stone, tumor
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19
Q

phases of AKI

A

onset, oliguric, diuretic, recovery

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20
Q

oliguric phase of AKI

A
  • sudden decrease in UO
  • dark urine
  • signs of excess fluid volume
  • restrict fluid!
  • give vasopressin
  • edema, swollen, fluid overload
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21
Q

diet for AKI

A
  • low to moderate protein
  • high carbs
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22
Q

what meds are good at providing “kidney protection” along with other benefits?

A
  • ACE inhibitors (-prils)
  • ARBs (sartans)
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23
Q

AEIOU indications for dialysis

A
  • Acidotic (pH < 7.1)
  • Electrolytes ~ refractory hyperkalemia
  • Intoxication
  • Overload ~ CHF
  • Uremia ~ uremic pericarditis, uremic encephalopathy
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24
Q

who can authorize a medical proxy to represent the patient if there is no MDPOA?

A

provider

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25
Q

when is a declaration of medical proxy directive used?

A

when no MDPOA on file, patient is declining and someone needs to make a decision

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26
Q

which AD is used when there are multiple dates ones available?

A

the newest one

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27
Q

in what circumstances is a MOST form used?

A

alert, oriented, in their right mind ~ MDPOA can also fill out

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28
Q

who is automatically the patient’s agent and can make decisions when they become incapable of doing so?

A

MDPOA

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29
Q

where are ADs kept in a hard copy chart?

A

in the front in green

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30
Q

function of endocrine glands

A

maintenance and regulation of vital functions

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31
Q

diabetes insipidus

A
  • excretion of large amounts of dilute urine dried out
  • increased Na
  • polydipsia
  • monitor neuro, CV, electrolyte
  • administer vasopressin or desmopressin (ADH)
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32
Q

SIADH

A
  • 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.
33
Q

what is solumedrol for?

A

addison’s; push slow, can give adrenaline rush

34
Q

pheochromocytoma

A
  • tumor
  • catecholamine-producing tumor usually found in adrenal medulla
35
Q

myxedema coma

A
  • 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
36
Q

thyroid storm interventions

A
  • extreme hyperthyroid
  • assess for fever, tachycardia, systolic HTN, confusion, seizures, delirium, coma
  • administer antithyroid medications, iodides, propranolol, and glucocorticoids as prescribed
  • maintain patent airway
37
Q

what thyroid issue do we give calcium gluconate for? why?

A

thyroidectomy, can cause hypocalcemia and monitor for tetany

38
Q

what parathyroid issue do we give calcium gluconate for? why?

A

hypoparathyroidism ~ assess for hypocalcemia, hyperphosphatemia, postive trousseau’s and chvostek’s, signs of over tetany

39
Q

treatment of DKA

A
  • 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
40
Q

diabetic nephropathy

A
  • progressive decrease in kidney function
  • will show microalbuminuria, thirst, anemia, fatigue
41
Q

hypothyroid labs

A

decreased T3 and T4, increased TSH

42
Q

hyperthyroid labs

A

increased T3 and T4, decreased TSH

43
Q

what does the urine look like in HHS?

A

ketones are absent or minimal in blood and urine

44
Q

what symptoms are different in HHS compared to DKA?

A
  • more severe neuro manifestations because of increased serum osmolarity/dehydration
  • ketones less likely
  • BG often >600
45
Q

what can overhydration lead to?

A

cerebral edema

46
Q

what do ketosis and acidosis do to the K?

A

elevate it (hyperkalemia)

47
Q

as insulin and fluid replacement is working for hyperglycemia, what can happen to K?

A

it can drop (hypokalemia)

48
Q

hypoglycemia treatment with 15-15 rule

A

if BG < 70, intake 15 g carbs, wait 15 minutes, check BGs. if still < 70, intake 15 g more

49
Q

examples of 15 g carbs

A
  • 1/2 cup fruit juice
  • 1/2 cup of soda
  • 1 tbsp of sugar, honey, or corn syrup
  • hard candies
  • glucose tabs
50
Q

3 things to watch for in a co worker with substance use

A
  • behavior changes
  • physical signs
  • diversion of drugs
51
Q

reversal of acetaminophen

A

n-actetylcysteine (mucomyst)

52
Q

reversal of opiates

A

naloxone (narcan) or nalmefene (revex)

53
Q

reversal of benzos

A

flumazenil (romazicon)

54
Q

what do benzos end in?

A

-pam

55
Q

definition of eating disorders

A

characterized by grossly disturbed eating habits

56
Q

how can death occur from anorexia nervosa?

A

from starvation, suicide, cardiomyopathies, electrolyte imbalances

57
Q

bulimia nervosa

A
  • 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
58
Q

interventions for clients with eating disorders

A
  • 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
59
Q

screening tools we can use for substance abuse

A

MAST
DAST
CAGE (alcohol)

60
Q

what meds do we give for a high CIWA score?

A

diazepam or lorazepam

61
Q

what meds do we give for a high COWS score?

A

buprenorphine

62
Q

definition of substance dependence

A

pattern of use resulting in tolerance, withdrawal symptoms, and compulsive drug-taking behavior

63
Q

3 signs of substance abuse

A
  • uses substances recurrently (craving)
  • impairment
  • health problems
  • failure to meet responsibilities
64
Q

complications associated with chronic alcohol abuse

A
  • 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
65
Q

withdrawal delirium

A

the state of delirium usually peaks 48-72 hours after cessation or reduction of intake (although can occur later) and lasts 2-3 days

66
Q

what medication therapy for alcohol abuse and dependence?

A
  • naltrexone
  • acamprosate
  • disulfiram (antabuse)
67
Q

education about antabuse

A

avoid use of substances that contain alcohol such as mouthwash and cough medicines ~ can make them throw up profusely

68
Q

withdrawal effects of opioids

A

yawning, insomnia, irritability, rhinorrhea, diaphoresis, cramps, N/V, muscle aches, chills, fever, lacrimation, diarrhea

69
Q

with CNS depressant OD, if client is awake, what do we do?

A

vomiting is induced and activate charcoal is administered

70
Q

with CNS depressant OD, if client is comatose, what do we do?

A

gastric lavage with activated charcoal are priorities

71
Q

CNS stimulants

A

amphetamines, cocaine, crack

72
Q

how to treat CNS stimulant withdrawal

A

treat with antidepressants, a dopamine agonist, or bromocriptine (Parlodel)

73
Q

what are seizure precautions

A
  • no restraints
  • side-lying
  • 100% NRB
  • suction
74
Q

if your patient is hyperkalemic, what is a priority?

A

get them on tele

75
Q

most concerning kidney labs

A

BUN and creatinine

76
Q

best indicator of renal perfusion

A

urine output

77
Q

if sodium is off, what should we monitor for?

A

neuro, lethargy, seizures

78
Q
A

NSG 452 Synthesis (4 decks)

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