Exam 1 Flashcards

Question

What is the calculation for anion gap?

Answer 1

Na - (Cl + HCO3)

Answer 2

8 - 12 mEq/L

Answer 3

higher than 30 mEq/L

Answer 4

ketoacidosis, aspirin poisoning, uremia, methanol or ethylene glycol (antifreeze) toxicity

Answer 5

Hypoproteinemia

Answer 6

diarrhea, use of diuretics, early renal insufficiency

Answer 7

Short-acting beta 2 adrenergic agonists

Answer 8

Albuterol (proair, proventil, ventolin) | Xopenex

Answer 9

Anticholinergics

Answer 10

Ipratropium bromide (Atrovent)

Answer 11

Long-acting beta 2 adrenergic agonists

Answer 12

Theophylline | Serevent

Answer 13

Corticosteroids

Answer 14

``` Budesonide (Pulmicort) Flovent Asmanex Prednisone QVAR ```

Answer 15

Leukotriene modifiers

Answer 16

Singulair | Accolate

Answer 17

Exposure to allergens or irritants that initiate the inflammatory cascade. The inflammatory process results in vascular congestion, edema formation, production of thick, tenacious mucus, bronchial muscle spasm, thickening of airway walls, and increased bronchial hyperresponsiveness. Environmental Factors - pollen, animal dander, household dust, cockroaches, exhaust fumes, fireplaces, molds, perfumes or other products with aerosol sprays, smoke including cigarette or cigar smoke, and sudden weather changes. Thus, in order to prevent exacerbations, it is important to avoid exposure to these allergens or irritants.

Answer 18

Restlessness, wheezing or crackles, absent or diminished lung sounds, hyperresonance, use of accessory muscles for breathing, tachypnea with, diaphoresis, cyanosis, decreased SaO2, and PFT tests results that demonstrate decreased air flow rates. Upright positioning – tripod, using accessory muscles and exhibiting anxiety.Hypoxemia, restlessness, inappropriate behavior, increased pulse and blood pressure – may have pulsus paradoxus. Speech may become difficult, tachypnea, percussion of lung fields reveals hyperresonance and auscultation indicates inspiratory/expiratory wheezing

Answer 19

Stand up or sit up straight. 1. Slide the indicator to the base of the meter. 2. Take in a deep breath. 3. Place the mouthpiece in your mouth and seal your lips around it. 4. Blow out as hard and fast as you can (one quick blow). 5. Repeat that process 2 more times. 6. Select the highest number of the 3 efforts. 7. Record this number on your peak flow diary or on a graph.

Answer 20

Green so continue taking your maintenance meds

Answer 21

Yellow, so take your rescue medication, then wait 20 to 30 min and check your peak flow again.

Answer 22

Report this to your doctor

Answer 23

Recheck your peak flow about every 4 hours for a day or so. Call your doctor if you continue to need rescue medicine.

Answer 24

Consider this an emergency; take your rescue medicine and call your doctor or go to the ER right away

Answer 25

high risk are women who have a hx of STI, HIV, smokers, poor nutritional status, under age 20, multiple partners, multiple pregnancies, use BC, family hx, been exposed to DES in utero

Answer 26

Women need to be educated post surgery for frequent follow up bc is 35 % chance of recurrence of cancer within 2 years often occuring in upper quarter of vagina. Sign is urethra obstruction so reduced urine flow or no urine flow, weight loss, edema, pelvic pain.

Answer 27

Main manifestation is post menopausal uterine bleeding. Other sx: pelvic cramping, bleeding after intercourse or with abd pressure, enlarged lymph nodes, ascites, abd masses.

Answer 28

Goal of care is to provide the woman with treatment that eradicates cancer or minimizes complications. Activity restriction for 4-6 weeks postop, but don’t want to just sit bc blood can pull in abd area and increase risk of clots. So need to change position frequently and avoiding sitting for prolonged periods. Stage 1: might do a total abd hysterectomy Stage 2 or higher: do radical hysterectomy which is removal of uterus, ovaries, fall tubes, proximal vagina, and bilateral lymph nodes done through abd incision. Lymph node biopsy if think it metastized.

Answer 29

General abdominal discomfort, Sense of pelvic heaviness, Loss of appetite, Feeling of fullness, Change in bowel habits, Abnormal vaginal bleeding

Answer 30

Must provide efficient nursing care d/t nurses are limited to 30 min/day because of the exposure to radiation

Answer 31

Platinum and taxane agents: combo of taxol and paraplatin is most often used bc of clinical benefits with minimal toxicity. Usually do surgery in addition to chemo. Intraperitoneal chemo is used when minimum residual disease exists after surgery

Answer 32

Progressive, nonreversible process of airway narrowing and loss of supporting. Can be caused by emphysema and/or chronic bronchitis

Answer 33

Cough, exertional dyspnea, weight, barrel chest d/t emphysema, use of accessory muscles for breathing, prolonged expiration, orthopnea, cardiac dysrhythmias, congestion and hyperinflation on chest x-ray, ABG levels indicate respiratory acidosis and hypoxemia, pulmonary function test that demonstrates decreased vital capacity

Answer 34

Administer oxygen, hydration, effective cough, percussion, postural drainage, reduce intake of dairy products and salt, provide small frequent meals, assess respiratory status every 1-2 hours or as indicated - rate and pattern; cough and secretions, and breath sounds; monitor ABGS, weigh daily, monitor A&Os, assess mucous membranes and skin turgor; encourage fluid intake of at least 2,000 - 3,000 mL/day, place in Fowler's, high-Fowlers, or orthopneic position, encourage movement and activity as tolerated; assist with coughing and deep-breathing every 2 hours while awake; provide tissues and a paper bag to dispose of expectorated sputum (infection control); refer to resp therapist as needed; provide rest periods between treatments procedures; administer medications as ordered (includes oxygen)

Answer 35

Make sure to teach patient how to pursed-lip and diaphragmatically breath – minimizes air trapping and fatigue (maintains positive pressure longer during exhalation. Inhale through the nose with mouth closed Exhale slowly through pursed lips, as though whistling or blowing out a candle, making exhalation twice as long as inhalation. Pursed lip breathing helps to slow expiration, prevents collapse of small airways and helps the pt control the rate and depth of respiration. It also promotes relaxation, enabling the pt to gain control of dyspnea and reduce feelings of panic. Abd or diaphragmatic Place one hand on the abd et the oth on the chest Inhale, concentrating on pushing the abd hand outward while the chest hand remains still Exhale slowly, while the abd hand moves inward and the chest hand remains still.

Answer 36

Goal of supplementary oxygen is keep the PaO2 above 60mm Hg; LT oxygen therapy is usually introduced when PaO2 is below 55 mm Hg or there are s/s of tissue hypoxia or organ damage – think Cor Pulmonale, secondary polycythemia, R sided HF with edema, and/or impaired mental status.

Answer 37

When O2 delivered by NC during exac it is necessary to closely monitor pt – may actually increase CO2 level and/or decrease the drive to breath – leading to respiratory failure. Must monitor LOC and ABGs.

Answer 38

SE – tachycardia, muscle tremor, hypokalemia, increased lactic acid, HA et hyperglycemia. Patient needs ed. about how to use MDI, periodic cleaning of device, possible SE

Answer 39

SE – Dryness of mouth and respiratory secretions, may cause increased wheezing. Pt. need ed. About correct use of inhaled agents, ensure adequate fluid intake, assess patient for hypersensitivity to atropine, soybeans, peanuts, glaucoma, et prostatic hypertrophy.

Answer 40

SE – Cough, dysphonia, oral thrush (candidiasis), HA; high does systemic effects may occur – adrenal suppression, osteoporosis, skin thinning, and easy bruising. Pt. needs ed. on correct use of MDI et use of spacer/holding chamber devices, rinse mouth p inhalation to reduce local side effects.

Answer 41

HA, dizziness, GI upset. Patient needs education on intake of at least 2L of fluid daily, care in sitting up, standing up and engaging in high-risk activities until response to medication is known, teach how to effectively cough (Huff).

Answer 42

Occurs when water and electrolytes are lost in the same proportion as they exist in normal body fluids, so that the ratio of serum electrolytes to water remains the same. (do not confuse with dehydration, which is when only water is lost and thus sodium levels of the body are increased).

Answer 43

vomiting, diarrhea, sweating, decreased fluid intake, third-space fluid shifts, edema formation in burns, ascites, hemorrhage, and coma.

Answer 44

acute weight loss, decreased skin turgor, oliguria, concentrated urine, orthostatic hypotension, weak, rapid heart rate, flattened neck veins, increased temperature, thirst, decreased capillary refill, cool, clammy, pale skin.

Answer 45

Elevated BUN out of proportion to the serum creatinine (ration greater than 20:1), increased hematocrit level due to decreased plasma volume.

Answer 46

assessment of skin turgor is not as valid in the elderly because the skin has lost some of its elasticity. Therefore it is best to use other assessments such as slowness in filling of veins in the hands and feet. Skin turgor is best tested over the forehead or the sternum in elderly patients.

Answer 47

Isotonic electrolyte solutions (lactated Ringer’s solution and 0.9% NS) are used because they expand plasma volume.

Answer 48

monitor I/Os, encourage fluids, monitor for weak, rapid pulse and orthostatic hypotension, administer antidiarrheal and antiemetics as needed.

Answer 49

Occurs when there is an abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF. It is always secondary to an increase in the total body sodium content, which in turn leads to an increase in totaly body water.

Answer 50

heart failure, renal failure, cirrhosis, and consumption of excessive amounts of table salt.

Answer 51

edema, distended neck veins, crackles, tachycardia, increased blood pressure, increased weight, increased urine output, shortness of breath, and wheezing.

Answer 52

BUN and hematocrit levels are decreased because of plasma dilution.

Answer 53

Restrict fluids and sodium and administer diuretics. Thiazide diuretics (hydrochlorothiazide, metolazone) are prescribed for mild to moderate hypervolemia, and loop diuretics (lasix, bumex) for severe hypervolemia. Pt will be on a dietary restriction of sodium. Lemon juice, onions, and garlic are good substitute flavorings. Some patient’s prefer salt substitutes, but they generally contain potassium and must therefore be used cautiously by patients taking potassium-sparing diuretics (spironolactone, triamterene).

Answer 54

I/O, daily weight, monitor degree of edema, promote rest, restrict sodium intake, monitor parenteral fluid therapy, administer diuretics. If dyspnea occurs, place pt in semi-Fowler’s position to promote lunch expansion. Reposition at regular intervals bc edematous tissue is more prone to skin breakdown than normal tissue.

Answer 55

• Sodium concentration is less than the body so they dilute the ECF and thus cause water to go into the ICF (cells), causing the cells to swell.

Answer 56

Hypernatremia and other hyperosmolar conditions

Answer 57

half strength saline (0.45%)

Answer 58

Sodium concentration is higher than the body, so they put lots of salt into the ECF and thus draw water out of the ICF (cells) and into the ECF (bc water follows salt), causing cells to shrink.

Answer 59

Used to treat hyponatremia but must be used with extreme caution

Answer 60

3% sodium saline | 50% dextrose in water

Answer 61

Fluids that are classified as isotonic have a total osmolality (sodium concentration) close to that of the ECF and do not cause red blood cells to shrink or swell. However, they do still expand the ECF volume. Thus, patient’s with hypertension and heart failure should be carefully monitored for signs of fluid overload.

Answer 62

D5W Normal saline (0.9%) Lactated Ringer's

Answer 63

given to burn victims and hemorrhaging pts

Answer 64

Contractility

Answer 65

* Systemic manifestations because the heart can’t pump blood out of the right ventricle and into the lungs so the blood backs up into the body. * Dependent edema * increased BP (if fluid overload is causing problem) * decreased BP (if decreasing CO is causing problem) * hepatomegaly * Weight gain * JVD - measured by laying bed flat and then bringing the bed up to 30-40 degree angle. If have JVD, the veins will pop out at this angle. * Swelling of the fingers and hands * Splenomegaly * Abdominal distention * Nocturnal diuresis - urinate more than 1 time at night because excess fluid is reabsorbed by kidneys when lying supine. * Orthopnea - SOB when supine * A weight gain of 2 lb in 24 hours or 5lb in one week is considered a sign of worsening failure. * Cor pulmonale - compression of heart by the excess fluid, very severe

Answer 66

* Heart can’t pump blood out of left ventricle to the body, so blood gets backed up in the lungs. This causes decreased cardiac output and decreased blood flow to the body. * Pulmonary edema - crackles, pink frothy sputum, feel like suffocating * Dyspnea, tachypnea * Cough * Paroxysmal nocturnal dyspnea - awakened at night with SOB * Ventricular gallop - S3 sound present * Increased blood pressure * cyanosis in fingers and toes * anxious

Answer 67

diuretic and fluid restriction (to get rid of excess fluid and thus make blood thinner and easier to pump)

Answer 68

ACE inhibitor, ARBs, calcium channel blocker, digoxin (to make the heart pump more effectively and get the blood pumped to the body better)

Answer 69

angiotensin converting enzyme inhibitors; inhibit production of angiotension II, reducing afterload, improving CO et renal function. Also, ACE inhibitors reduce pulmonary congestion and et peripheral edema, suppress myocyte growth et reduce ventricular remodeling in HF (hypertrophy). Can cause hyperkalemia. May also cause a chronic cough.

Answer 70

angiotensin receptor blockers – work in much the same manner as ACE inhibitors, but block the action of angiotensin II at the receptor rather than interfering with its production. Reduces afterload

Answer 71

Neutropenia (low WBC)

Answer 72

reduce the adverse effects from the constant stimulation of the sympathetic nervous system (such as increased heart rate that happens since body is trying to compensate for decreased CO). This medication slows the heart down, and reduces anxiety so that the heart doesn’t get too tired. SE: hypotension, bradycardia

Answer 73

remove excess extracellular fluid by increasing the rate of urine produced in pt with s/s of FVE.

Answer 74

can be ototoxic do not adm concurrently with aminoglycoside antibiotics (gentamicin) which are also ototoxic. Never IVP Lasix faster than 20mg/min Bumex also popular loop diuretic.

Answer 75

Spironolactone, triamterene, et Midamor are K+ sparing. Spironolactone (Aldactone) blocks aldosterone receptor et reduces symptom of HF and slows progression of HF. Need to monitor for hyperkalemia (bananas, raisins, spinach, potassium supplements, salt substitues bc they usually have potassium in them).

Answer 76

Positive inotropic - helps heart contract more effectively

Answer 77

anorexia, nausea et vomiting, HA, altered vision (yellowish green halos), et confusion. Rhythms assoc with dig toxicity include Sinus arrest, supraventricular and ventricular tachycardias, and high levels of AV block. Low potassium (hypokalemia) assoc. with increased risk for dig toxicity (as well as hypomagnesemia and hypercalcemia).

Answer 78

above 60 bpm

Answer 79

0.5 - 2.0 mg/mL

Answer 80

Cardizem and amlodipine used with diastolic HF – not with systolic HF. They cause vasodilation and decrease systemic vascular resistance SVR.

Answer 81

sympathomimetic; increase the force of cardiac contraction. Dobutamine is preferred for HF because it does not increase heart rate as much as Dopamine. Route is IV et must be titrated

Answer 82

vasodilator that relaxes smooth muscle in blood vessels, causing dilation. Arterial dilation reduces peripheral vascular resistance (PVR) and afterload thus reducing myocardial work. Venous dilation reduces venous return and preload. Pulmonary vascular relaxation reduces pulmonary capillary pressure and allows for reabsorption of fluid from interstitial tissues et the alveoli. Nitrites dilate both venous and arterial vessels.

Answer 83

Lifestyle changes include restriction of dietary sodium, avoidance of excessive fluid intake, alcohol, and smoking; weight reduction when indicated, and perform regular exercise. Weigh self daily and if more than 2 lb per 24 hours or 5 lb per week is gained, contact physician.

Answer 84

collection of excess fluid in the pleural space as a result of systemic (heart failure, liver or renal disease, and connective tissue disorders) or local disease (pneumonia, atelectasis, TB, lung CA, and trauma).

Answer 85

Transudate

Answer 86

Hemothorax

Answer 87

Hemorrhagic pleural effusion

Answer 88

Chylothorax

Answer 89

Objectives of tx are to discover the underlying cause of the pleural effusion, to prevent reaccumulation of fluid, and to relieve discomfort, dyspnea, and respiratory compromise. Thoracentesis is performed to remove fluid. If the underlying cause is a malignancy, the effusion tends to recur within a few days or weeks. Pleurectomy may be performed for recurring pleural effusions. It is surgically stripping the pareital pleura away from the visceral pleura, resulting in intense inflammatory reaction that promotes adhesion formation between the two layers during healing.

Answer 90

Frequent turning and movement are important to facilitate adequate spreading of the talc over the pleural surface. Monitor chest tube function and drainage, pain management.

Answer 91

Taking a deep breath, coughing, or sneezing worsens the pain. Pain usually occurs only on one side. Pain may become minimal or absent when the breath is held. Later as pleural fluid develops, the pain decreases.

Answer 92

The objectives of tx are to discover the underlying condition causing the pleurisy and to relieve the pain. Prescribed analgesic agents and topical applications of heat or cold provide symptomatic relief. Indocin is a NSAID often given. If the pain is severe, an intercostal nerve block may be required.

Answer 93

Keep pt comfortable, turn frequently onto the affected side to splint the chest wall and reduce the stretching of the pleurae. Teach pt to use hands or a pillow to splint the rib cage while coughing.

Answer 94

Crackles, SOB, dyspnea

Answer 95

Administer oxygen to correct hypoxemia, intubation or mechanical vent may be necessary. If problem is fluid overload, administer diuretics and restrict fluids.

Answer 96

heparin, warfarin (takes 4-5 days to take effect, monitor labs q 2-3 weeks), lovenox (low-molecular-weight heparin, check morning platelet labs), and heparinoids (fondaparinux, dalteparin, inzaparin, lepirudin, and argatroban). Lepirudin et argatroban are contraindicated in pts with overt major bleeding et pt who are hypersensitive to these meds or high risk for bleeding, anomaly of vessels/organs, recent major surgery, recent puncture of large vessels/organ biopsy All pts continue anticoagulation therapy for at least 3-6 months p the event.

Answer 97

urokinase, streptokinase, alteplase) for pts who are severely compromised (hypotensive with significant hypoxemia). Dissolves emboli et restores normal hemodynamic fx of the pulmonary circulation et reduces pulmonary hypertension et improves perfusion, oxygenation et cardiac output. Contraindication for thrombolytic therapy include CVA in past 2 mths, oth active intracranial processes, active bleeding, surgery within 10 day of the event, recent labor/delivery, trauma or severe hypertension.

Answer 98

Reduce risk of PE – , preventing thrombus formation, assessing potential for pulmonary embolism , monitor thrombolytic therapy (only essential arterial punctures or venipuncture performed with manual pressure applied to site for at least 30 minutes, managing pain, managing oxygen therapy, relieving anxiety, monitoring for complications, postoperative care – pulm arterial pressure, UO, insertion site of catheter, elevation of feet with isometric exercises, anti-embolism stockings, walking when permitted, sitting discouraged because hip flexion compresses the lg veins in the legs.

Answer 99

Notify rapid response team, reassure client and elevate HOB, prepare to administer oxygen, obtain vital signs and check lung sounds, prepare to obtain an ABG, prepare for the administration of heparin therapy or other therapies. Document the event, interventions taken, and the pts responses to the interventions

Answer 100

changes in the pulmonary artery leading to abnormal growth and modeling of pulmonary vessels. That leads to abnormal vasoconstriction and fibrosis of pulmonary vessels.

Answer 101

Unknown etiology, can be related to a BMPR2 gene. PPH occurs most often in women 20-40 years of age. After diagnosis, survival is about 3 years.

Answer 102

Develops most often from chronic hypoxemia – chronic lung diseases, sleep apnea, and hypoventilation d/t obesity or neuromuscular disease. Also can result from HIV, Lupus, and Scleroderma.

Answer 103

progressive dyspnea, fatigue, angina, and syncope with exertion

Answer 104

Cor Pulmonale

Answer 105

CBC, ABGs, CXR, ECG, Doppler ultrasound

Answer 106

phlebotomy, oxygen prevent thrombus formation, calcium channel blockers to reduce pulmonary vascular resistance and improve cardiac output, coumadin, bilateral lung transplant, cor pulmonale – salt/water restriction and diuretics.

Answer 107

Serum sodium level less than 135 mEq/L

Answer 108

Adrenal insufficiency, water intoxication, SIADH, vomiting, diarrhea, sweating, diuretics

Answer 109

poor skin turgor, dry mucosa, headache, decreased salivation, fall in blood pressure, nausea, vomiting, and abdominal cramping. Neurologic changes: altered mental status, status epilepticus, lethargy, confusion, muscle twitching, coma, death.

Answer 110

Decreased serum and urine sodium, decreased urine specific gravity and osmolarity

Answer 111

Most common treatment is careful administration of sodium by mouth, NG tube, or parenteral route. In a patient with normal or excess fluid volume, hyponatremia can be treated by restricting fluid rather than administering sodium and it is far safer.

Answer 112

I/O, daily weight, monitor for GI manifestations and central nervous system changes. Encourage foods and fluids with high sodium content or encourage fluid restriction if the primary problem is fluid retention

Answer 113

Serum sodium greater than 145 mEq/L

Answer 114

excess water loss, fluid deprivation, excess sodium intake, diabetes, heat stroke, and near drowning in sea water.

Answer 115

Thirst, increased temperature, dry swollen tongue, sticky mucosa, weight gain, restlessness, weakness, disorientation, delusions, hallucinations

Answer 116

increased hematocrit and BUN, increased specific gravity

Answer 117

Infusion of hypotonic solution (0,3% sodium chloride) or an isotonic nonsaline solution (D5W). Diuretics may also be prescribed to treat the sodium gain.

Answer 118

I/O, daily weight, monitor ingestion of OTC meds that may have a high sodium content (Alka-Seltzer), monitor for changes in behavior, provide fluids at regular intervals.

Answer 119

Potassium less than 3.5 mEq/L

Answer 120

Poor diet, potassium-losing diuretics (loop and thiazide diuretics), vomiting and gastric suctioning, diarrhea, acid/base imbalances.

Answer 121

Fatigue, anorexia, nausea, vomiting, muscle weakness, leg cramps, decreased bowel motility ,paresthesias, dysrythmias (flat T waves and elevated U wave).

Answer 122

Increased intake in the daily diet or oral potassium supplements. For severe give IV replacement potassium (40-30 mEq/day is adequate). Foods high in potassium include most fruits and vegetables, lgumes, whole grains, milk, and meat.

Answer 123

Encourage foods rich in potassium, I/O, daily weight, monitor ECG for changes and arterial blood gas. Potassium is NEVER administered IV push or IM to avoid replacing potassium too quickly and can cause cardiac arrest!!

Answer 124

Potassium level greater than 5.0 mEq/L

Answer 125

Decreased renal excretion of potassium rapid administration of potassium, untreated renal failure, Addison’s disease, and potassium sparing diuretics (aldactone, triamterene).

Answer 126

Peaked T waves, widening of the QRS complex, ventricular dysrhythmias, cardiac arrest, skeletal muscle weakness, and paralysis.

Answer 127

ECG to detect peaked T wave, restriction of dietary potassium and potassium-containing medication, administration of loop diuretics. If severe administration of Kayexalate either orally or by retention enema, or IV calcium gluconate.

Answer 128

Observe for signs of muscle weakness and dysrhythmias, avoid potassium rich foods such as fruits and vegetables, legumes, whole grain breads, meat, milk, eggs, coffee tea, and cocoa. Never give potassium supplements or salt substitutes to patients with renal dysfunction.

Answer 129

Serum calcium level below 8.5 mg/dL

Answer 130

Hypoparathyroidism, thyroid and parathyroid surgery (because the parathyroid regulates serum calcium levels), pancreatitis, renal failure, inadequate vitamin D consumption, magnesium deficiency, loop diuretics.

Answer 131

Tetany, sensations of tingling around the mouth, spasms of the muscles, hyperactive DTR’s, trousseau’s sign, Chvostek’s sign, dypsnea and laryngospasm, seizures, hyperactive bowel sounds, dry and brittle hair and nails.

Answer 132

IV treatment with calcium salt such as calcium gluconate diluted in D5W and administered slow IV bolus or slow IV infusion. Vitamin D therapy to increase calcium absorption from the GI tract. Foods rich in calcium such as: green leafy vegetables, canned salmon, milk, sardines, fresh oysters.

Answer 133

seizure precautions, monitor airway, teach pt’s which foods are rich in calcium, observe IV site often for evidence of infiltration, administer calcium supplements with food, avoid overuse of laxatives and antacids.

Answer 134

Serum calcium greater than 10.5 mg/dL

Answer 135

malignancies and hyperparathyroidism, immobility, tiazide diuretics, vitamin A and D intox, chronic lithium use. (*calcium levels are inversely related to phosphorus levels*)

Answer 136

Hypercalcemia reduces neuromuscular excitability so muscle weakness, incoordination, and constipation occur. Abdominal and bone pain, severe thirst, confusion, impaired memory, slurred speech, lethargy, bradycardia, coma.

Answer 137

administer fluids, mobilize patient, restrict dietary calcium intake, loop diuretics, calcitonin. For patient’s with cancer: surgery, chemo, radiation.

Answer 138

increase pt mobility and encourage fluids (3-4 quarts daily), adequate fiber in diet to reduce constipation.

Answer 139

Serum magnesium lower than 1.8 mg/dL

Answer 140

alcoholism, GI loss, DKA, sepsis, burns, hypothermia

Answer 141

muscle weakness, tremors, cardiac dysrhythmias, nystagmus, tetany, chvostek’s and trousseau’s signs, marked alterations in mood.

Answer 142

magnesium diet: green vegetables, seafood, milk, bananas, citrus, chocolate, magnesium supplements,

Answer 143

observe for signs and symptoms, give foods rich in magnesium, adm mag supplements

Answer 144

Serum magnesium greater than 2.7 mg/dL

Answer 145

Renal failure, DKA

Answer 146

Depresses the CNS and peripheral neuromuscular junction. Facial flushing, lethary, difficulty speaking, diminished DTR’s, muscle weakness and paralysis, depressed respiratory center, cardiac arrest, coma.

Answer 147

Avoid administration of magnesium to pts with renal failure. IV calcium gluconate, loop diuretics, IV NS, hemodialysis

Answer 148

Monitor VS, observe for decreased DTR's and changes in LOC

Answer 149

Serum phosphorus level below 2.5 mg/dL

Answer 150

Overzealous refeeding of malnourished pt’s receiving parenteral nutrition, alcoholism, vit D deficiency.

Answer 151

wide range of neurologic manifestations such as irritability, fatigue, weakness, numbness, diplopia, confusion, seizures, coma.

Answer 152

Neutra-phos PO, IV for severe

Answer 153

gradually introduce refeeding, prevent infection, encourage foods such as: milk, organ meats, nuts, fish, poultry, and whole grains.

Answer 154

Serum phosphorus greater than 4.5 mg/dL

Answer 155

Renal failure, excessive vitamin D, chemo

Answer 156

Few symptoms, soft-tissue calcification, tetany (because of the reciprocal relationship between phosphorus and calcium, a high serum phosphorus level tends to cause a low serum calcium level, so may have tingling around mouth, tetany etc).

Answer 157

Calcium-binding antacids, restriction of dietary phosphate, loop diuretic, phosphate binding gels.

Answer 158

Encourage pts to avoid foods rich in phosphorus, avoid phosphate-containing substances such as laxatives and enemas