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Med Surg > Exam 1, Deck 2 > Flashcards

Exam 1, Deck 2 Flashcards

1
Q

Potassium levels:

  • Intracellularly
  • Intravascularly
A
  • Intracellular: As high as 150 m#q

- Intravascular: 3.5-5.2

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2
Q

Four causes of hypokalemia

A
  • Loss from GI tract
  • Diet
  • Diuretics (except aldactone)
  • Enema or laxative abuse
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3
Q

Some sxs of hypokalemia (4)

A
  • Constipation
  • ECG changes
  • Lower leg weakness
  • Paresthesia
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4
Q

A hypokalemic patient as at higher risk of…

why?

A

Dig toxicity

Because digoxin is positive cardiac inotropic drug

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5
Q

Three types of K+ to administer to a hypoakalemic patient:

A
  • Klor, KDor (PO)

- KCl (IV, if severe)

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6
Q

Notes about administration of K+ (3)

A
  • Never IV push or bolus
  • Must be diluted
  • No more than 40mEq/L (in 1000mL of fluid)
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7
Q

Three requirements patient must meet in order to recieve K+

A
  • BUN WNL
  • Creatinine WNL
  • Normal urine output
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8
Q

ECG changes with hypokalemia

A

Lower T wave

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9
Q

ECG changes with hyperkalemia

A

Peaked T (almost as high as QRS)

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10
Q

Most common cause of Hyperkalemia

A

Kidney failure

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11
Q

Three other causes of Hyperkalemia

A
  • Intake of excess K+
  • Crush injuries / burns
  • Addison’s disease
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12
Q

Electrolyte imbalances of Addison’s (2)

A
  • Hyponatremia

- Hyperkalemia

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13
Q

Physical assessment of Hyperkalemic patient (4)

A
  • HR is slow/weak/absent
  • ECG changes
  • Irregular heartbeat
  • Acidosis
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14
Q

Symptoms of Hyperkalemia (3)

A

Nausea
Paresthesias
Muscle cramps

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15
Q

How does hyperkalemia lead to acidosis?

A

As potassium rises, kidneys try to excrete it. In the process, kidneys hold onto H+ levels

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16
Q

Hyperkalemia: Interventions (6)

A
  • Calcium Gluconate
  • IV fluids
  • IV Na Bicarbonate
  • Hemodialysis
  • Kayexalate
  • Insulin and Glucose IV
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17
Q

Why would you give Calcium Gluconate to a Hyperkalemic patient

A

It doesn’t change K+ levels, but protects the myocardium and buys time.

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18
Q

Why would you give IV fluids to a hyperkalemic patient

A

To help the kidneys flush it out

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19
Q

Why would you give Sodium bicarbonate to a hyperkalemic patient

A

Helps when acidosis is at play: Bicarb makes body alkalotic, convinces body to get rid of potassium

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20
Q

Why would you give Kayexalate to a hyperkalemic patient

A

Binds to potassium in bowel and brings it out with fecal material (*administered PO or as retention enema)

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21
Q

Why would you give Insulin and glucose IV to a hyperkalemic patient?

A

SHOVE EVERYTHING INTO THE CLOSET BEFORE THE GUESTS COME

Only administered in the most severe cases (6.8 or above)

Drives potassium into cells

Short term solution

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22
Q

Absorption rate of calcium

A

30-50% of calcium ingested is absorbed

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23
Q

Functions of calcium (3)

A
  • Needed for muscle contraction
  • Essential for blood clotting
  • Necessary for electrical conduction of the heart
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24
Q

Three causes of hypocalcemia

A
  • Inadequate intake of calcium / anorexia
  • Renal failure
  • Lasix
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25
Q

Signs of Hypocalcemia (4)

A
  • Muscle cramping
  • Twitching
  • Tetany / convulsions
  • Cardiac arhytmias
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26
Q

Assessment of hypocalcemia

A
  • Trousseau’s Sign (claw w BP)

- Chvostek’s Sign (cheek flick twitch)

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27
Q

Hypercalcemia - causes (3)

A
  • Increased bone reabsorption
  • Cancers (bone and others)
  • Immobility
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28
Q

Symptoms of Hypercalcemia (3)

A
  • Lethargy / weakness
  • Decreased reflexes
  • Constapation
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29
Q

Hypercalcemia interventions (4)

A
  • Decrease intake
  • Lasix
  • Calcitonin
  • Ambulation
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30
Q

“Acidity” is a measure of…

A

H+ concentration

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31
Q

In acid-base balance, Kidneys control the _______ component.

A

Metabolic

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32
Q

In acid-base balance, Lungs control the _______ component.

A

Respiratory

33
Q

Kidneys: Mechanism for controlling Acid-Bae

A

Controlling sodium bicarbonate (HCO3)

**Secondary mechanism: Controlling H+

34
Q

Lungs: Mechanism for controlling acid-base

A

Controlling carbon dioxide (CO2)

35
Q

What does CO2 do to acid-base balance?

  • High CO2 = ________
  • Low CO2 = _________
A

High CO2 = low ph (acidic)

Low CO2 = high pH (basic)

36
Q

Mechanism with which CO2 affects pH balance:

A

CO2 + H20 –> H2CO3 (carbonic acid)

37
Q

Mechanism with which HCO3 affects pH balance:

A

H2CO3 (carbonic acid) breaks down into HCO3 and H+

38
Q

SaO2 def:

A

Saturation of hemoglobin with O2

39
Q

PaO2: def

A

Partial pressure of oxygen dissolved in arterial plasma

40
Q

What blood gas level would make you start thinking about intubation?

A

PaO2 of <60

41
Q

SaO2 of < _____ &

PaO2 of < _____ are considered to be hypotonic

A

SaO2 < 90%

PaO2 < 60

42
Q

How would you measure the PaO2? What is the normal value?

A

Arterial stick

Normal = 80-100

43
Q

Abnormal ABG profile of respiratory acidosis:

A

pH: Low
PaCO3: High

44
Q

Abnormal ABG profile of metabolic acidosis:

A

pH: Low
HCO3: Low

45
Q

Abnormal ABG profile of respiratory alkalosis:

A

pH: High
PaCO2: Low

46
Q

Abnormal ABG profile of metabolic alkalosis:

A

pH: High
H2CO3: High

47
Q

Interpreting ABG’s:

4 steps

A

1) Look at the number
2) Look at the pH
3) Is the problem respiratory or metabolic?
4) Determine compensation (absent / partial complete)

48
Q

Function of Allen test

A

Test that must be positive to proceed with testing ABGs

49
Q

Allen test: Steps (4)

A

1) Patient forms tight fist
2) Apply pressure at wrist (ulnar and radial)
3) Patient opens wrist. Palm should be pale.
4) Release ulnar

50
Q

What does a positive Allen test look like? Why is this important?

A

Palm turns pink within 15 seconds of releasing Ulnar (then you know that it is safe to use radial)

51
Q

What precautions do you take with the blood drawn from ABGs? (2) Why?

A

Precautions:

  • Heparinize the container so it doesn’t clot
  • Put it on ice to decrease BMR

IT IS LIVING TISSUE

52
Q

After taking an ABG, what do you do and why?

A

Pressure for 10-15 minutes

To prevent bleeding / hematoma

53
Q

How do you know if the problem with the ABG is respiratory or metabolic?

A

If the PaCO2 has the same acid/base status as the pH, it’s respiratory.

If the HCO3 has the same acid/base status as the pH, it’s metabolic,

54
Q

Common causes of respiratory acidosis (2)

A
  • Depression of the respiratory center

- Decreasing aerating surface of hte lung

55
Q

Four things that could depress the respiratory center

A
  • Opioids
  • Barbituates / Benzos
  • Anesthesia
  • Head trauma
56
Q

Four problems that would decrease the aerating surface of hte lung

A
  • COPD
  • Pneumonia
  • Airway obstruction
  • Chest wall trauma
57
Q

Nursing assessment of a patient with respiratory acidosis (4)

A
  • Ashen color
  • Change in mental status due to hypoxia
  • pH <7.35
  • Change in respiratory rate
58
Q

How does respiratory rate change with acidosis? Why? (2)

A
  • If due to a CNS problem: Slow and shallow

- If due to decreased lung surface area: Quicker RR

59
Q

Respiration assistance for pt in respiratory acidosis

  • If severe
  • If mild
  • Other note
A
  • Intubation if severe, cannula if mild

- COPD: LOW FLOW O2

60
Q

Why do you give low flow CO2 to a COPD patient

A

Because of the Haldene effect

61
Q

What is the Haldene effect

A

Increased levels of O2 will actually bump up PaCO2 levels, and COPD patients can’t compensate.

62
Q

Respiratory acidosis: Nursing interventions for…

  • Opioids (2)
  • Benzos
A
  • Assess RR before administering opioids
  • Opioid antidote = narcan
  • Benzo antidote = Romazicon
63
Q

Common causes of respiratory alkalosis (3)

A

Hyperventilation
Pain
Head trauma (medulla)

64
Q

Respiratory Alkalosis: Nursing assessment (3)

A

Lightheadedness / dizziness

Tetany

65
Q

Why does respiratory alkalosis cause tetany?

A

Because alkalosis can interfere with calcium utilization, so tetany can develop. Claw-like hands.

66
Q

Nursing intervention for respiratory alkalosis

A

Rebreather mask (paper bag) – allows patient to rebreathe CO2

67
Q

How does DKA occur?

A
  • Glucose is not being metabolized because of lack of insulin
  • so body breaks down fatty acids, which yield ketones (acidic)

hence KETOACIDOSIS

68
Q

Common causes of metabolic acidosis (6)

A
  • Diabetes mellitus (DKA)
  • Starvation
  • ASA overdose
  • Renal failure
  • Severe diarrhea
  • Tissue anoxia
69
Q

Why does tissue anoxia occur and what does it do to acid/base balance?

A

Tissue anoxia occurs if the patient is not breathing – body switches to anaerobic metabolism, which produces acid.

70
Q

Nursing assessment of metabolic acidosis (3)

A
  • Lethargy –> coma
  • High serum K+
  • Kussmaul breathing to compensate
71
Q

What is Kussmaul breathing?

A

Deep, rapid respirations to compensate for acidosis

72
Q

Nursing interventions for metabolic acidosis (3)

A
  • Amp of sodium bicarb
  • Check potassium (may be high)
  • Treat the cause (insulin, food, lavage)
73
Q

Common causes of metabolic alkalosis (3)

A
  • Loss of HCl (due to gastric loss)
  • Excessive intake of sodium bicarb
  • Fluid and electrolyte loss
74
Q

Explain how fluid loss can lead to alkalosis

A

Body compensates by saving sodium and water, subsequently wastes H+ (result: alkalosis)

75
Q

Two sources of HCl loss

A
  • Vomiting

- Gastric suction

76
Q

Nursing assessment of metabolic alkalosis (2)

A
  • Low serum potassium

- Shallow slow respirations

77
Q

Why would you see low serum potassium in metabolic acidosis?

A

Because cells take in potassium to compensate for alkalinity (release H+)

78
Q

Nursing interventions for metabolic alkalosis (2)

A
  • KCl

- Fluid (NS, LR)

Med Surg (13 decks)

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