Exam 1 Flashcards
What is an example of hypertonic IV solution?
Fluorescent 💚
D5% & 0.45% Saline
What is an example of an isotonic solution
Pale 💛
Lacerated Ringers
What is an example of a hypotonic solution?
Fluorescent 💚
0.45% Saline
What is an example of a colloid solution?
Pale 💛
Albumin
Leaving the patient “high & dry” =
Heloconcentration/fluid dehydration
Hypovolemic shock😱=
Excess loss of 🩸or fluids resulting in organ failure 📉
Hypotonic solution causes?
Fluid to move into 👉cell causing it to swell ⭕
Hypertonic solution causes?
Fluid 💦to move out 📤of the cell causing it to shrink 🤏🏽
What is inversely related with Calcium?
Phosphate
What is important in 💪contraction?
Magnesium
What can cause 🫀arrhythmias?
Potassium imbalance
Can use calcium, Albuterol😮💨, bicarbonate, insulin & dextrose 💊to fix 🔧 this acute imbalance?
⬆️ Hyperkalemia
You should push & encourage 💦fluids w/this electrolyte imbalance?
Hypercalcemia ⬆️
You can 👀 see
➕Trousseau’s and
➕Chvostek’s
In these 2 imbalances?
Hypocalcemia ⬇️
Hypomagnesemia ⬇️
Hyponatremia🧂can be caused by?
Ingesting too much 💦 too quickly ⌛
3% 💦saline can be used for this acute imbalance?
Hyponatremia ⬇️🧂
Hypernatremia ⬆️🧂can be caused by?
Excess 💦⬇️loss or inadequate water intake
20mEq KCI is to be infused ↪️
Via central line
💦🥤restrictions🚫can be used in this imbalance?
⬇️ Hyponatremia 🧂
Daily📆 weights is an easy way to?
Monitor 📝 fluid💦 status
PaCO2 level of 62 can be considered?
⬆️Hypercapnia or
⬆️Hypercarbia
Sodium 🧂 main function
Helps maintain 🩸volume & BP
Imbalances can lead to:
🧠changes
Potassium main function
Helps 💪🏻to contract, including♥️
Imbalances can lead to:
🫀Dysrhythmias
Calciums main function
Helps w/🫀 function, 🩸clotting, & 🦴formation
Imbalances can lead to:
⬆️Risk for 🦴fractures
Magnesium’s main function
Helps 💪🏽& nerve stay healthy regulates energy 🏃🏽♀️
Imbalances can lead to:
Sedation 🧠💤
Phosphorus’s main function
Maintained 🦷&🦴. Repairs🔧 cells & body tissue 🌀
Chloride’s main function
Maintains acid-base balance
Controls 💦levels in cells ⭕
DKA happens most often with?
Type 1 Diabetic
DKA has?
Keytones
(Breaks down protein & fat, making it Acidotic)
DK(A)= Acidotic
Who is at risk for DKA?
Type 1 Diabetic
Illness 🤧 (steroid use)
Stress 😖
Economic (No💰for 💊💉)
Labs to check for Endocrine?
Calcitonin- secreted by thyroid, regulates calcium
Cortisol- stress hormone
ADH- amount of H2O in body
Aldosterone- helps balance fluids
DKA is?
A profound deficiency of insulin
DKA is characterized by?
Hyperglycemia
ketosis
Acidosis
Dehydration
Clinical manifestations of DKA?
Early- lethargic & weak
Dehydration
Tachycardia
Orthostatic Hypotension
Kussmaul respirations (Deep/fast)
Abdominal pain
Fruit breath
Labs:
Glucose- 250+
pH less than 7.30
Bicarb less than 16
+ketones in urine or serum
DKA Nursing Management
✅for: fever, N/V, Diarrhea, AMS, cause of DKA
Fluid balance: 0.45% or 0.9% to⬆️BP & restore urine output
✅potassium
Telemetry for potassium imbalance
Assess 🧠status
Goal: don’t correct too quick
correct electrolytes
Monitor for fluid overload
Reduce glucose by 36-54mg/dl/hr (cerebral edema)
HHS often occurs in people
60+ years w/ Type 2 DM
HHS can be caused by?
UTIs
PNA
Sepsis
Acute illness
Newly Dx DM2
Inadequate fluid intake
Impaired cognition
Polyuria
What’s different about HHS?
Ketosis does not accur
With HHS, glucose can be
Greater than 600 w/ absent keytones
With correction of HHS, what is often given?
IV dextrose to prevent Hypoglycemia
Hypokalemia is not as significant in?
Not as significant in HHS as DKA
What is DI?
Diabetes Insipidus
Caused by ⬇️ADH or ⬇️renal response to ADH
(Dry inside! Dumps urine💛)
Causes of DI
Brain injury & 🧠Tumor
Clinical manifestations of DI
Dehydration
⬆️Uribe output
Hypernatremic
Thirsty
Confused
Hypotension
DI Nursing management
✅SG, I/Os, vitals, LOC🧠
Hypotonic solution
Electrolyte replacement
Desmopressin💊- retains 💦
Thiazide💊 or Indomethacin
Nutrition- ⬇️🧂
What is SIADH?
Overproduction of ADH
(Soaked Inside- holds onto 💦)
Causes of SIADH
Tumors/CA, head trauma, lung disease/CA, Pancreatic CA, medications
Clinical Manifestations of SIADH
⬆️BP, seizure, HA, puffy, crackles, edema, wt gain, neuro, tachycardia, hypoosmolarity, hyponatremic
Nursing intervention for SIADH?
Fluid restrictions 🚫 800-1000ml/day
Hypertonic solution
Diuretics 💊
Seizure precautions
Cushing syndrome is from
Excess corticosteroids and glucocorticoids
Clinical manifestations of Cushing Syndrome
🌜face, thin skin, prolonged healing,
Buffalo 🦬 hump, thin hair, Weight gain, Acne, Purple striae, Atropic arms , ⬆️glucose, ⬇️potassium
Nursing intervention for Cushing syndrome
Normalize BS & cortisol level
⬇️🧂 in diet
⬆️protein for 💪🏽
⬇️carbs
Exercise
Stress
What is Addisons Disease?
Adrenal insufficiency
(Cortisol & Aldosterone)
Common causes of Addisons disease
Autoimmune disorders such as Celiac Disease
Clinical manifestations of Addisons Disease
Bronze skin🎃
Fatigue
Hyperpigmentation
Orthostatic hypotension
Weight loss irritable
Addisons crisis consists of?
⬇️🧂levels
⬆️potassium levels
⬇️glucose 🍬 levels
ABO compatibility is not needed for?
Platelet transfusions
🩸Administration Procedure
20G IV
Verify patency of IV access
Y-tubing w/filter
Normal saline
🩸product from 🩸bank
Patient identification
2 nurse check
Consents signed ✍🏽
When should vital signs be performed for a 🩸transfusion
Prior to start (stay w/pt for 1st 15min)
15 min after starting 🩸
Completion
1 hour
4 hours
Observe 👀every 30 min
Packed RBC are for?
Anemia- ⬆️oxygen
Acute 🩸⬇️
Start w/in 30 min
Complete w/in 4 hours ⏳
Platelets are for?
Prevent 🩸, serious bleeding
FFP- Fresh frozen plasma is for?
Liver failure
Infections
Burns
Cryoprecipitate is given for?
Lack of fibrinogen
Albumin is given for?
Volume expansion
Hypovolemic shock
Nursing management for transfusion reactions
🛑transfusion
Change tubing
Start NS
Notify Dr & 🩸bank
Re✅tags
Monitor VS
Treat symptoms 💊
Save 🩸bag & tubing
Collect blood samples (distal to site)
✍🏽document reactions in chart
Examples of chest trauma
🔪wounds
Seat belt
GSW
Pneumothorax
Hemothirax
Tension pneumothorax
Flailed chest
Rib fracture symptoms
Pain with inhalation, shallow breathing
Flailed chest symptoms
Rapid shallow breathing
Pneumothorax symptoms
Rapid shallow breathing, poor ventilation
Hemothorax symptoms 🩸
🩸in pleura space, SOB, dyspnea, diminished 🫁sounds
Tension pneumothorax symptoms
Trauma, JVD, deviated trachea and 🫀, cyanosis
With a hemothorax, If 🩸 is more than? You call the physician
200mL in first hour
Pre operative assessment for thoracic surgery 🔪
Cardio-pulmonary assessment
Support system
🚫smoking
Spirometer teaching
Labs
Post op thoracic surgery
Pain management 💊
Respiratory status
Fluid balance
Ambulating
Pneumonia prevention
SDCs
Clot prevention, prevent PE
Watch for stroke
S&S of PE
Hypoxia, Tachycardia, hypotension,
Dyspnea, Hemoptosis, wheezing,
Cough, chest pain, crackles,
Impending doom
Hyperkalemia
Cardiac arrhythmias
Abdominal cramping
Leg cramping
Peak T waves
Paralasis of skeletal muscles
🚨Impairs ammonia excretion and leads to acidosis
Hypokalemia
Cause by 🤮or ⬇️kidney function
PVC, VT, VF 🫀
Parallitic illius
🫁depression from impaired skeletal muscle function
How to fix potassium imbalances
Slowly
No🚫IV pushes or bolus
Potassium monitoring
Telemetry
Respiratory
LOC
Hyperkalemia treatment
See (C)
A
BIG
Potassium (K)
Level (L)
Decrease (D)
Calcium- Chloride/Gluconate
Albuterol
Bicarbonate
Insulin
Glucose/Dextrose
Kayexalate
Loop Diuretics
Dialysis
Hypercalcemia symptoms
Groans- constipation, N/🤮
Moans- fatigue, deoression
Bones- pain
Stones- kidney 🗿
Overtones- psych, depres😭, confus
Muscle weakness & coordination issues
Hypocalcemia symptoms
Tetanus:
Chvostoks sign
Trouddeaus sign
Stridor
Parathesia In ✋, 🦶, and mouth
Hypocslcemia causes
Hypoparathyoid
Renal insufficiency
⬆️Phosohate
⬇️Magnesium
Treating Hypocalcemia
⬆️ calcium in diet
Calcium gluconate
Tums
Hypercalcemia treatment
Fix PTH issues
⬇️calcium in diet
3-4L hydration/day
Exercise
Loop diuretics
