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Fluids, Musculoskeletal, pharm, assistive devices, healthcare delivery systems > exam 1 (IM 4) > Flashcards

exam 1 (IM 4) Flashcards

1
Q

what factors influence the body fluid?

A

age
gender
body fat
skeletal

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2
Q

fluid inside the cell

A

intracellular space

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3
Q

fluid outside the cell

A

extracellular space

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4
Q

what is in the extracellular space

A

intravascular, interstitial , transcellular

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5
Q

contains plasma

A

intravascular

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6
Q

surround the cells

A

interstitial

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7
Q

working apart from the circulating system
(cerebral, spinal, pericardial, pleura)

A

transcellular

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8
Q
A
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9
Q

abnormal shifting of fluid

A

third spacing

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10
Q

what are some manifestations of third spacing?

A

-decrease urine output
-increase heart rate
- decrease bp, decrease cvp,
-edema
-increase body weight

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11
Q

what are the causes of third spacing?

A

-liver problems
-burns
-bowel obstruction
-trauma

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12
Q

what does homeostasis do in the body?

A

-promote neuromuscular activity
-maintain body fluid osmolality
-regulate acid base balance
- regulate distribution of body fluid compartments

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13
Q

what is the most important to assess with electrolyte balance?

A

-monitor daily weight
-i&o

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14
Q

what do you also assess with electrolytes?

A

-assess overall fluid balance
-assess neuro status (loc)
-evaluate sensory and motor function
-monitor vs, and electrolytes (trends)
-EKG changes
-nutritional status
-hx
-medical hx

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15
Q

what are your (+charge)

A

sodium
potassium
calcium
magnesium

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16
Q

what are your (- charge)

A

bicarbonate
chloride
phosphate

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17
Q

what are your regulations of fluid?

A

osmosis and osmolality
diffusion
filtration
sodium potassium pump

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18
Q

what are the routes of losses of electrolytes?

A

-kidneys
-skin
-lungs
-GI

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19
Q

what helps fluid balance? (regulators)

A

-kidneys
-hypothalamus
-pituitary gland
-adrenal cortex

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20
Q

what do kidneys need to have to work properly?

A

they have to have enough pressure

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21
Q

how to kidneys help with fluid balance?

A

they help filter

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22
Q

how does the hypothalamus help with fluid balance?

A

thirst

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23
Q

how does the pituitary gland help with fluid balance?

A

release and inhibits ADH which is an antidiuretic hormone

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24
Q

how does the adrenal cortex help with fluid balance?

A

regulates Na+ by releasing aldosterone

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25
Q

what can increase the hydrostatic pressure in the body?

A

venous obstruction
sodium and water retention

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26
Q

what occurs in the body when their is an increase in hydrostatic pressure?

A

edema

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27
Q

what causes a decrease in oncotic pressure?

A

loss or decrease in plasma albumin

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28
Q

what occurs in the body when their is a decrease in oncotic pressure?

A

edema

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29
Q

what causes an increase in capillary permeability?

A

-inflammation
-immune response

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30
Q

what occurs in the body if there is an increase in capillary permeability?

A

edema

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31
Q

what causes a obstruction the lymph channales?

A

tumors
inflammation
surgical removal

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32
Q

what can occur if their is a obstruction in the lymph channels?

A

edema

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33
Q

what does the lymphatic system absorb?

A

interstitial fluid and small amounts of protein

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34
Q

edema in the lungs is called?

A

pleural effusion

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35
Q

edema in cardiac

A

pericardial effusion

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36
Q

edema in the belly

A

ascietes

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37
Q

edema in the feet

A

peripheral edema

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38
Q

edema everywhere in the body?

A

anasarca

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39
Q

what are some complications of edema?

A

-pressure injuries
-infections
-life threatening (brain, lungs, larynx)

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40
Q

if sodium is low, what happens to the osmolality?

A

it is low

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41
Q

the osmolality of blood primary reflects what?

A

sodium
blood/urea (bun)
glucose

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42
Q

what is the normal osmolality?

A

280-300

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43
Q

if osmolality if less than 280 then the patient is?

A

fluid overload

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44
Q

if the patients osmolality is higher than 300 then the patient is?

A

dehydrated

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45
Q

what are other factors of increasing osmolality?

A

dehydration
free water loss
DI
hypernatremia
hyperglycemia
stroke of head injury
renal tubular necrosis

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46
Q

what are other factors decreasing osmolality?

A

fluid volume excess
SIADH
renal failure
hyponatremia
overhydration

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47
Q

what is an isotonic solution?

A

similar to osmolarity to the ECF
given to replace fluid loss
does not shrink or swell the RBCs
osmolality is 280-300 m0sm/kg

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48
Q

what are the isotonic solutions?

A

5% dextrose (D5W)
Normal saline (NS, NACL, 0.9%)
Lactated ringers (LR, RL)

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49
Q

what does D5W supply?

A

water and glucose

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50
Q

what happens to D5W when administered inside the body?

A

becomes hypotonic

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51
Q

which patients should you be cautious about when administering D5W?

A

diabetics
hypernatremia pt
head trauma patients

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52
Q

what can D5W cause in a patient with diabetes?

A

hyperglycemia

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53
Q

what does 0.9% sodium chloride do?

A

corrects extracellular deficit

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54
Q

what kind of patients can reicieve 0.9% sodium chloride?

A

hypovolemic states
resusicative efforts
shock
metabolic alkalosis
hypercalcemia
Na+ deficit

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55
Q

what does 0.9% sodium chloride help replace?

A

large sodium losses

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56
Q

who should not receive 0.9% sodium chloride solution?

A

CHF
pulmonary edema
renal impairment

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57
Q

does 0.9% sodium chloride provide callories?

A

no

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58
Q

what does lactated ringers contain?

A

potassium
calcium
sodium chloride

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59
Q

what does lactated ringer help with?

A

corrects dehydration
Na+ depletion
GI lossess

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60
Q

who should be cautious when recieving lactated ringers?

A

CHF
renal insuffiency
edema
Na+ retention
hyperkalemia

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61
Q

what is a hypotonic solution?

A

osmolarity is lower than the serum <280
dilutes the ECF, lowering the osmolality
causes water to move into the interstitial spaces

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62
Q

hypotonic solution is good for hypernatremia, true or false?

A

true

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63
Q

what are the hypotonic solutions?

A

0.45% sodium chloride (1/2 NS)
0.33% sodium chloride (1/3 NS)
0.225% sodium chloride (1/4 NS)
2.5% dextrose in water (D2.5W)

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64
Q

who cannot receive hypotonic solutions?

A

ICP
CVA
head trauma
burns
trauma
malnutrion
liver disease

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65
Q

what is hypertonic solutions?

A

osmolarity is higher than >300
causes water to move out of the cells
decrease in edema, stabilizes BP, regulate urine output

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66
Q

what are hypertonic solutions used for?

A

-used to repair electrolytes and acid/base imbalances, TPN
-used cautiously in patient with diabetes, and impaired heart or kidney function
-monitor closely for circulatory overload

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67
Q

what are they hypertonic solutions?

A

5% dextrose in 0.9% sodium chloride (D5NS)
5% dextrose in 0.45% sodium chloride (D51/2NS)
5% Dextrose in 0.225% sodium chloride (D51/4NS)
5% Dextrose in Lactated Ringers (D5LR)
10% Dextrose in water (D10W)

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68
Q

what can hypertonics cause in the veins?

A

phlebitis

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69
Q

what are colloids?

A

large molecules that do not dissolve and can not pass through a membrane
-used clinically for volume expansion
-pull fluid into the bloodstream

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70
Q

what are colloids primarily used for?

A

volume expansion

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71
Q

what are the different colloid solutions?

A

albumin
dextran
hetastarch
mannitol

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72
Q

osmotically=to plasma

A

albumin

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73
Q

plasma volume expander

A

dextran

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74
Q

synthetic volume expanxer

A

hetastarch

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75
Q

alcohol-sugar

A

mannitol

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75
Q

what should you monitor if a patient is on colloids?

A

increase in bp
dyspnea
bounding pulse
fluid overload
anaphylaxis

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76
Q

what electrolytes should you watch when giving colloids?

A

potassium
sodium

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77
Q

what is fluid volume deficit?

A

decrease in circulating blood volume

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78
Q

what are the causes of fluid volume deficit?

A

vomiting
severe dehydration
trauma
burns
medication

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79
Q

what are the moderate symptoms of fluid volume deficit?

A

dry mucous membranes
excessive thirst
postural hypotension
thready pulse, rapid hr
dark urine
decrease LOC

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80
Q

what the symptoms of severe fluid volume deficit?

A

body will to compensate and vessels will try to vasoconstrict
HR increases

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81
Q

what are the nursing interventions for fluid volume deficit?

A

oral rehydration
increasing fluid intake
IV hydration

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82
Q

what is fluid volume overload? (hypervolemia)

A

overloading circulatory system with excessive IV fluid

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83
Q

what are the causes of hypervolemia?

A

rapid infusion rate
hepatic, cardiac or renal disease
can be more common in elderly patients

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84
Q

what are the signs and symptoms of hypervolemia?

A

edema
wt gain
palpable veins
crackles in the lungs
pulmonary edema
increase in BP and CVP
JVD
moist crackles, dypnea
shallow respirations
periorbital edema
decreased lab values

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85
Q

how to prevents fluid volume overload?

A

infuse ivf via pump
monitor pt closely

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86
Q

what are interventions for fluid volume overload?

A

decrease IV rate
monitor VS, assess respiratory status
high-fowlers positions
notify MD

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87
Q

what happens if albumin is low?

A

edema

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88
Q

what is the normal range of sodium

A

135-145

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89
Q

what is the major electrolyte in the ECF?

A

sodium

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90
Q

what follows sodium?

A

chloride

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91
Q

what is the normal range of chloride?

A

98-106

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92
Q

what are the functions of sodium?

A

blood pressure
blood volume
ph balance

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93
Q

what does sodium do to the body?

A

maintains proper water and minerals
water distribution

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94
Q

what are the regulators of sodium?

A

ADH
aldosterone
sodium potassium pump

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95
Q

what is ADH?

A

controls water retention

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96
Q

what is aldosterone?

A

water regulator, kidneys retain sodium and water
helps keep bp up

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97
Q

what does the sodium potassium pump do?

A

process of moving Na+ and K+ across the cell membrane by using atp

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98
Q

what are the causes of hyponatremia?

A

“N”a+ excretion increases w/renal problems, ng suction, vomiting, diuretics, sweating, diarrhea, decrease secretion of aldosteron (DI)
“O”verload of fluid (CHF, hypotonic fluid infusion
“N”a+ intake is low
“A”ntidiuretic hormone oversecretion (SIADH)

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99
Q

what are the symptoms of hyponatremia?

A

“S”eizures and stupor
“A”bdominla cramping, attitude change (confusion)
“L”ethargic
“T”endon reflex diminished, trouble concentrating
“L”oss of urine & appetite
“O”rthostatic hypotension
“S”hallow respirations
“S”pasms of muscles

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100
Q

what is the serum Na+ of hyponatremia?

A

<135

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101
Q

what is the serum osmolality in hyponatremia?

A

<280 mOsm/kg

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102
Q

what is the urinary Na+ of hyponatremia?

A

<20 mEq/L

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103
Q

what is the urine specific gravity of hyponatremia?

A

<1.010

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104
Q

what is the medical treatment of hyponatremia?

A

-Na+ replacement by mouth, IV, or NGT
-replacement depends on the rate lost
can use LR, NS

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105
Q

replacement depends on the rate lost, if so you can use?

A

lactated ringers
normal saline

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106
Q

what is the rule of thumb when it comes to hyponatremia?

A

serum Na+ must not be increased >12 mEq/L in 24 hours

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107
Q

what are the treatments for hyponatremia with water gain?

A

restrict h20 safer than giving Na+ (800ml/24hrs
hypertonic solution 3%-5% NaCL
edema only- restrict Na
edema and Na-restrict both
loop diuretics

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108
Q

what are the nursing interventions for hyponatremia?

A

identify pt at risk
monitor labs, i&o, daily weight
review medications
gi manifestations
monitor s/s of hyponatremia
monitor for neuro changes
oral hygiene
seizure precaution(suction at the bedside)
fall risk

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109
Q

what are the causes of hypernatremia?

A

“H”ypercorisolism (cushings syndrome, hyperventilation)
“I”ncreased intake of sodium
“G”I feeding w/o adequate water supplements
“H”ypertonic solution
“S”odium excretion decreases and corticosteroids
“A”ldosteronism (hyper)
“L”oss of fluids (infection, sweating, diarrhea, DI)
“T”hirst impairment

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110
Q

what are the signs and symptoms of hypernatremia?

A

“F”ever “flushed skin
“R”estless, really agitated
“I”ncreased fluid retention
“E”dema, extremely confused
“D”ecreased urine output, dry mouth/skin

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111
Q

what happens to patients with hyponatremia and taking lithium?

A

can cause lithium toxicity, due to urinary sodium loss

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112
Q

what is the serum Na+ for hypernatremia?

A

> 145mEq/L

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113
Q

what is the serum osmolality for hyernatremia?

A

> 300mOsm/L

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114
Q

what is the urine specific gravity of hypernatremia?

A

> 1.015

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115
Q

what is the medical treatment for hypernatremia?

A

-decrease Na+ level gradually
-decrease 0.5mEq/L/hr over 48 hours
-monitor for neuro changes and cerebral edema
-D5W or 0.45NS
-desmopressin (DDAVP)

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116
Q

how much should be decreased in hypernatremia?

A

0.5mEq/L/hr over 48 hours

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117
Q

what treatments are used for hypernatremia?

A

loop diuretics
desmopressin
D5W

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118
Q

what are nursing interventions for hypernatremia?

A

-identify pt at risk
-monitor fluid loss/gain
-labs and oral Na intake
-neuro precautions and behavior changes
-offer fluids
-note medicaton with increase Na+ content
-daily wts

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119
Q

what are foods with high sodium?

A

chips
cheese
fast food
tv dinner
canned foods
crackers
popcorn
fish
poultry
bacon

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120
Q

what should be restricted with hyponatremia?

A

fluid intake

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121
Q

what is the normal range for potassium?

A

3.5-5.0

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122
Q

what are the regulators for potassium?

A

kidneys and aldosterone

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123
Q

what is the function of potassium?

A

influences both skeletal and cardiac muscle activity

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124
Q

what is the major electrolyte in the intracellular fluid?

A

potassium

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125
Q

where do you obtain most of the potassium?

A

diet

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126
Q

where is potassium absorbed?

A

intestines

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127
Q

what are some foods that help with potassium intake?

A

bananas
watermelon
spinach
avocadoes
sweet potatoes
white beans
dried fruit

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128
Q

what causes hypokalemia?

A

“D”rugs (diuretics, laxatives, insulin, IV fluids
“I”nadequate consumption of K+
“T”oo much water intake
“C”ushings syndrome
“H”eavy fluid loss
NPO, anorexia, TPN, high aldosterone secretions

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129
Q

what are the signs and symptoms of hypokalemia?

A

“SLOW”
-weak irregular pulses
-orthostatic hypotension
-shallow respirations
-confusion,weak
-deep tendon reflex decreased
-decreased bowel sounds
“Low”
-lethargy
-low, shallow respirations
-lethal cardiac dysrhythmias***
-lots of urine
-leg cramps
-low bp and heart

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130
Q

what are some causes for renal loss of potassium?

A

diuretics
hyperaldosteronsim
high dose of sodium PNCs
large dose corticosteroids

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131
Q

what are the cardiac changes caused from hypokalemia?

A

-decrease strength of contractions
-myocardium irritablility
-<2.7 may result in cardiac arrest
-<3.5 alkalosis, high ph and high HCO3
-digoxin toxicity

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132
Q

what are signs and symptoms of digoxin toxicity?

A

irregular pulse
fast heartbeat
confusion
vision change
n/v

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133
Q

what are risk factors of digoxin toxicity?

A

low potassium and magnesium
high potassium and calcium

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134
Q

what are the is the lab result for lethal dysrhythmias?

A

<2.7

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135
Q

what lab increases with hypokalemia?

A

ph and HCO3

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136
Q

what are the medical treatments for hypokalemia?

A

k+ replacement (po or IV)
increase on a daily basis (40-80mEq/day)
at risk patients 50-100mEq/day
k+ rich foods
treat underlying cause

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137
Q

how much should you increase on a daily basis for someone with hypokalemia?

A

40-80 mEq/day

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138
Q

how much should you increase on a patient high risk with hypokalemia?

A

50-100mEq/day

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139
Q

how to minimize oral supplementation of potassium?

A

dilute liquid and effervescent supplement
give tabs and capsules with 8 oz of water
give medication with food

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140
Q

what are adverse reactions to oral k+ supplements?

A

N/V/D
GI blood

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141
Q

what are nursing interventions for intravenous potassium supplements?

A

-must be diluted
-NO IVP
-max dose is 60mEq at a time
-must use IV pump
monitor renal output
CHS policy-heart monitor
monitor iv site

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142
Q

what is the max dose of intravenous potassium supplement?

A

60 mEq at a time

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143
Q

what are nursing interventions for hypokalemia?

A

-identify pt at risk-esp if on digoxin
-monitro ECG and BP
-monitor serum K+
-pt education -diuretics and laxatives
-administer K+ supplements PO or IV
- increase dietary K+
-monitor urine output

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144
Q

what are the causes for hyperkalemia?

A

“C”ellular movement (intracellular to extracellular)
“A”drenal insufficency w/Addison’s diease
“R”enal failure
“E”xcessive K+ intake
“D”rugs (ace inhibitors, NSAIDS, beta blockers

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145
Q

what are the signs and symptoms of hyperkalemia?

A

“M”uscle weakness
“U”urine production little/none
“R”espiratory failure
“D”ecrease cardiac contractility
“E”arly signs of muscle twitches/cramps
“R”hythm changes

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146
Q

what are hyperkalemia cardiac changes?

A

slow heart rate
ECG changes
risk for heart block, a-fib, v-fib
-severe increase K+
decreased heart contraction strength
dilated and flaccid heart

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147
Q

what is the serum potassium for hyperkalemia?

A

> 5.0

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148
Q

what are the arterial gases for hyperkalemia?

A

low ph indicating acidosis

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149
Q

what are medical treatments for hyperkalemia?

A

K+ restricted diet
stop K+ containing medication
monitor for digoxin toxicity
cation exchange resins -kayexelate (polystyrene sulfonate)
dialysis

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150
Q

what are emergency treatment for hyperkalcemia?

A

Ca Gluconate-IV
Hypertonic glucose & insulin
Sodium Bicarbonate

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151
Q

how long should calcium gluconate be given

A

over 3 minutes

152
Q

what does calcium gluconate do?

A

protects the heart

153
Q

what does hypertonic glucose & insulin, and sodium bicorbonate do with hyperkalemia?

A

K+ shifts into cells

154
Q

what are the nursing interventions for hyperkalemia?

A

be aware of pt at risk
monitor for:
generalized weakness and dysrhythmias
irritability & GI symptoms
nausea and intestinal colic
ECG or lab abnormalities

155
Q

what are some preventions of hyperkalemia?

A

educate pt on medication and diet
do NOT draw blood about K+ infusion site

156
Q

what is the normal range for magnesium?

A

1.5-2.5

157
Q

what is critical labs for magnesium?

A

<1.2 or >4.9

158
Q

what is the function of magnesium?

A

regulating muscle and nerve function
blood sugar levels
immune system
important for normal cardiac function
stimulates PTH (regulates calcium)

159
Q

what is hypomagnesemia associated with?

A

hypokalemia

160
Q

low mg makes low K resistant to treatment, true or false

A

true

161
Q

what are signs and symptoms of hypomagnesemia?

A

tight airway: stridor, laryngospasm, difficulty swallowing
Neuromuscular: muscle twitiching
GI: N/V/D
Heart: increase BP, increase HR

162
Q

what are the causes of hypomagnesemia?

A

Mg absorbed in the intestines
renal loss
chronic alcoholism (most common)
antibiotics
GI (N/V/D)
malabsorption (crohns, celiac disease)

163
Q

what are some nursing interventions with hypomagnesemia?

A

Safety with swallowing
IV Mg+Sulfate (Give slowly)
Monitor respiratory status and reflexes

164
Q

what are food rich in magnesium?

A

dark chocolate
avocados
milk
peas
peanut butter
oranges
nuts
bananas

165
Q

what are the causes for hypermagnesemia?

A

antacids
renal failure
potassium excess

166
Q

what are signs and symptoms of hypermagnesemia?

A

heart: calm and quiet
low and shallow respirations, bradycardia, hypotension
Lung: low and shallow respirations
GI: hypoactive bowel sounds
Neuro: drowsiness, lethary
MS: weakness

167
Q

what is the normal lab value for calcium?

A

9-11

168
Q

where is calcium mostly stored?

A

bones and teeth

169
Q

what are the functions of calcium?

A

bones
blood
beats

170
Q

how does calcium help with the blood?

A

clotting

171
Q

how to calcium help with beats?

A

helps to regulate the heart
relaxing and contracting muscles

172
Q

to proteins (less than 50%)
calcium

A

bound

173
Q

found in serum (50% of calcium and is most important)

A

ionized

174
Q

combined with nonprotein anions: phosphate, citrate, and carbonate
calcium

A

complexed

175
Q

how does ionized calcium help the body?

A

-activate body chemical
-muscle contractions and relaxation
-promote transmission of nerve impulses
-cardiac contractility and automaticity
-formation of prothrombin

176
Q

what are the calcium regulators?

A

PTH
vitamin D
calcitonin
phosphate

177
Q

how does the parathyroid hormone (PTH) help regulate calcium?

A

“pulls”
-release Ca from the bone
-increase Ca absorption from GI
-increases Ca absorption from renal tubles

178
Q

how does calcitonin regulate calcium?

A

“keeps”
-antagonist of PTH
-secretion stimulated by high serum Ca++
-inhibit Ca reabsorption from bone

179
Q

where is calcitonin secreted?

A

thyroid

180
Q

calcium has a reciprocal relationship with?

A

phosphate

181
Q

why is vitamin D needed for calcium?

A

necessary for absorption and utilization of Ca

182
Q

what are sources of vitamin D?

A

mushrooms
egg yolk
fatty fish
safe sun exposure
spinach
tuna
dairy

183
Q

what are causes of hypocalcemia?

A

“L”ow parathyroid hormone
“O”ral intake inadequate
“W”ound drainage
“C”eliac, crohn’s, & corticosterids
“A”cute pancreatitis
“L”ow vitamin D levels
after thyroid surger
alcohol drinkers
malabsorption

184
Q

what are signs and symptoms of hypocalcemia?

A

“C”onfusion
“R”eflexes hyperactive
“A”rrythmias
“M”uscle spasms, tetany*** seizures
“P”ositive trousseau’s
“S”igns of chvosteks (facial nerves hyperexcitalbe

185
Q

what is trousseau’s sign?

A

carpopedal spasms of hand when
blood supply decrease
pressure on nerve

186
Q

what is chvisteks sign?

A

spasms of muscles innervated by facial nerves
tap facial nerve anterior to ear lobe below zygomatic process

187
Q

what is a goiter? and what causes it?

A

-develops as a result of iodine deficiency or inflammation of the thyroid gland
-seen in hypocalcemia and hypercalcemia

188
Q

what are the cardiac effects of hypocalcemia?

A

-prolonged QT interval
-prolonged ST segment
-decrease cardiac contractility
-decrease sensitivity to digoxin

189
Q

what is an important cardiac event caused by hypocalcemia?

A

torsades de pointis
ventricular tachycardia

190
Q

what is the lab for hypocalcemia?

A

<9

191
Q

what can give incorrect levels of calcium?

A

albumin and protein

192
Q

what labs should be obtained for accurate results of calcium

A

ionized serum

193
Q

what can effect levels of calcium

A

PTH

194
Q

what should also be obtained with calcium labs?

A

magnesium and phosphate

195
Q

what is considered an emergency for hypocalcemia?

A

symptomatic symptoms

196
Q

what is required for acute symptomatic hypocalcemia?

A

prompt admin of IV calcium

197
Q

what is given for severe symptoms of hypocalcemia?

A

10% ca-gluconate

198
Q

what can happen if given calcium to fast?

A

cardiac arrest

199
Q

what should you watch when given calcium supplements through IV?

A

IV site for necrosis and infiltration

200
Q

what are nursing interventions for hypocalcemia?

A

identify pt at risk
seizure precautions if severe decrease
monitor airway
monitor ECG
educate patient Ca loss and risks and Ca rich foods

201
Q

what are causes for hypercalcemia?

A

“H”yperparathyroidism
“I”ncreased intake of calcium
“G”lucocorticoids usage
“H”yperthyrodism
“C”alcium excretion w/thiazide diuretic and renal failure, bone CA
“A”drenal insufficiency (Addison’s)
“L”ithium usage

202
Q

what does lithium affect with calcium

A

parathyroid

203
Q

what are the signs and symptoms of hypercalcemia?

A

“W”eakness of muscles
“E”KG changes (arrhythmias)
“A”bsent reflexes (absent minded, abdominal distention from constipation
“K”idney stone formation
excessive urination

204
Q

what are cardiac changes in hypercalcemia?

A

calcium:inotropic effects oh heart and reduces heart rate
-shortens ST segment and QT interval
-prolonged PR interval
-potentiate digoxin toxicity

205
Q

what are the labs for hypercalcemia?

A

serum calcium: >11
ECG: dysrhthmias
PTH:increased
Xray:osetoporosis
urine-dense

206
Q

what are the medical treatments for hypercalcemia?

A

-treat underlying cause
-dilute serum Ca with NS
-lasix/furosemide
-IV phosphate
-calcitonin
-glucocorticoids
-hemodialysis or CAPD

207
Q

what are the nursing interventions for hypercalcemia?

A

-monitor for pt risks
-increase activity and fluid if possible
-decrease Ca intake
-safety measures for confusion
-monitor ECG, I&O, breath sound
-monitor for digoxin toxicity
-prevent Ca renal stones

208
Q

what is normal phosphorus?

A

2.5-4.5

209
Q

what is the inverse relationship with calcium?

A

phosphorus

210
Q

where is phosphorus found?

A

teeth
bones

211
Q

what are the functions of phosphorus?

A

-bone and teeth formation
-repair cell tissue/energy production through ATP
-nervous system
-muscle function

212
Q

what are the regulators of phosphorus?

A

parathyroid and calcitrol

213
Q

what are good sources of phosphorus?

A

dairy
meats
beans
nuts

214
Q

what are the causes of hypophosphatemia?

A

-malnutrition/starvation
-increase phosphorus excretion
-hyperparathyroidism (calcium increases)
-malignancy
-diuretics/diarrhea
-use of magnesium/aluminum antacids (increase Ca, deplets phos)

215
Q

what are the signs and symptoms of hypophosphatemia?

A

cardio: decreased BP/HR
gi: hypoactive bowel sounds
gu: kidney stones
neuro: altered loc
musc: severe muscle weakness
bone pain/fractues

216
Q

what are interventions for hypophosphatemia?

A

replace phosphorus IV/PO
give slowly
administer oral phosphorus with vitamin D
fracture precautions

217
Q

what are the causes for hyperphosphatemia?

A

increase phosphorus intake
overuse of laxative
renal insufficiency
decreased excretion
hypoparathyrodism
hypocalcemia

218
Q

what are the signs and symptoms of hyperphosphatemia?

A

GI: diarrhea, hyperactive bowel sounds
Neuromuscular: positive trousseau’s/chvostek’s
painful muscle spasms
hyperactive deep tendon reflex
irritable skeletal muscles-twitches, tetany, seizures
osteoporosis-body trying to get more calcium

219
Q

what are the composition of musculoskeletal system?

A

bone
connective tissue
voluntary muscle

220
Q

bone-forming cells

A

osteoblasts

221
Q

breakdown bone tissue

A

osteoclasts

222
Q

what are the risk factors associated with musculoskeletal disorders?

A

-autoimmune disorders
-calcium deficiency
-falls
-hyperuricemia
-metabolic disorders
-neoplastic disorders
-obesity
-post-menopausal states
-trauma and injury

223
Q

what are the diagnostic for Musculoskeletal Disorders

A

Radiography (x-ray) and MRI
Arthrocentesis
Arthroscopy
Bone scan
Bone or muscle biopsy
Electromyography (EMG)

224
Q

what are the interventions for musculoskeletal?

A

-handle injured areas carefully
-stabilize/support above and below injured joint
-administer analgesics as prescribed
-remove any radiopaque and metallic objects (jewelry)

225
Q

-needle aspiration to joint
-used to diagnose joint inflammation and infection
-aspirating synovial fluid, blood, or pus via needle in joint cavity
-corticosteroid may be injected to decrease inflammation

A

arthrocentesis

226
Q

what are the interventions for arthrocentesis?

A

consent
administer analgesia are prescribed
rest 8-24 hours post-procedure
notify HCP if fever/swelling of joint

227
Q

what is arthroscopy?

A

used to diagnose and treat acute and chronic disorders of joint
-biopsy can performed during arthroscopy

228
Q

what are the interventions for arthroscopy?

A

-NPO 8-12 hours prior to procedure
-consent
-administer analgesics
-neurovascular assessment per policy
-elastic compression 2-4 days post-op
-wt bearing activity encouraged but should be limited 1-4days
-elevate and ice prn for swelling 12-24 hours post-op
-notify physician of fever, swelling, or increased pain >3days post-op

229
Q

what are the subjective data in nursing assessment?

A

past health hx
medications
surgery or other treatments
health perception
nutritional-metabolic pattern
activity-exercise pattern
sleep-rest pattern
coping-stress tolerance pattern

230
Q

what are the nursing assessments for objective data?

A

-general overview with focused exam
-physical examination
-inspection
-palpation
-motion
-measurement
other
-use of assistive devices
-posture and gait
-straight-leg raising

231
Q

what are the soft tissue injuries?

A

sprains
strains
dislocations
subluxations

232
Q

an injury to ligaments around a joint

A

sprain

233
Q

what is grade 1 sprain?

A

few fiber tears, mild tenderness and swelling

234
Q

what is a grade 2 sprian?

A

partial disruption of tissue; increased swelling and tenderness

235
Q

what is grade 3 sprain?

A

complete tear with moderate to severe swelling

236
Q

excessive stretching of muscle and fascia; may involve tendon

A

strain

237
Q

what is grade 1 strain?

A

mild or slightly pulled

238
Q

what is grade 2 strain?

A

moderately torn muscle

239
Q

what is grade 3 strain?

A

severely torn or ruptured muscles

240
Q

what are the manifestations of sprains and strains?

A

pain
edema
decreased function
bruising

241
Q

what are the complications of sprains and strains?

A

avulsion fracture
subluxation
dislocation
hemarthrosis

242
Q

whats the acute care/interventions for sprains and strains?

A

RICE

243
Q

what does RICE stand for?

A

r-rest, stop activity and limit movement
i-ice 24 to 48 hours ;20-30 minutes at a time
c-compression, elastic bandage, apply distal to proximal
e-elevate above the heart
analgesia

244
Q

what are the treatments for sprains and strains?

A

self-limiting
rice
surgical repair

245
Q

what are the interventions for compression?

A

-decrease edema and pain
-50-70% tightness
distal to proximal
cap refill

246
Q

what are fractures?

A

disruption or break in continuity of structure of bone
-some fractures secondary to disease process

247
Q

what is open fracture?

A

skin broken; bone exposed

248
Q

what is closed fracture?

A

skin intact

249
Q

what is displaced?

A

two ends separated from one another
-often comminuted or oblique

250
Q

what is nondisplaced?

A

periosteum is intact, and bone is aligned
-transverse, spiral, or greenstick

251
Q

what are the manifestations of a fracture?

A

-damage to surrounding tissue
-peri-osteum
-blood vessels in the cortex/marrow
-hematoma
-bone tissue triggers inflammatory response
-thick callus
-remodeling-aka bone turnover

252
Q

what are signs and symptoms of fracture?

A

-edema/swelling
-pain and tenderness
-muscle spasm
-deformity
-contusion
-loss of function
-crepitation
-guarding

253
Q

what is crepitation?

A

cracking, crunching, rattling as bones move together

254
Q

what are the nursing objective data for fractures?

A

-apprehension
-guarding
-skin laceration, color changes
-hematoma, edema
-decrease or absent pulse, decrease skin temp
-delayed capillary refill
-paresthesia
-absent or decrease or decrease sensation
-restricted or loss of function
-deformaties

255
Q

bleeding at fractured ends of the bone

A

hematoma

256
Q

hematoma organized into fibrous network-hematoma converts into

A

granulation tissue

257
Q

new bone is built up as osteoclasts destroy dead bone

A

callus formation

258
Q

of the callus occurs (3 weeks to 6 months)

A

ossification

259
Q

callus continues to develop, closing the distance between bone fragments (up to 1 year after injury)

A

consolidation

260
Q

is accomplished as excess callus is reabsorbed and trabecular is laid down

A

remodeling

261
Q

what is traction?

A

prevent or decrease pain and muscle spasm
-pulling force to attain realignment -countercontraction pulls opposite direction
-immobilized joint or part of body
-reduce fracture or dislocation
-treat a pathologic joint condition

262
Q

what are the different tractions?

A

skin traction
skeletal traction

263
Q

what is bucks traction?

A

skin traction used for hip, knee, or femur fracture
can be used for 24 to 48 hours to relieve painful muscle spasms

264
Q

what is skeletal traction?

A

-long term pull to maintain alignment
-pin or wire inserted into bone
-weight 5 to 45 pounds
-risk for infection
-complications of immobility

265
Q

what should be done with skeletal traction?

A

-maintain counter traction
-elevate end of bed
-maintain continuous traction
-keep wts off the floor

266
Q

what should be done with lower extremity immobilization?

A

-elevate extremity above heart
-do not place in dependent position
-observe for signs of compartment syndrome and increased pressure

267
Q

Do’s for cast care?

A

-frequent neurovascular assessment
-apply ice for first 24 hours
-elevate above heart for first 48 hours
-exercise joints above and below
-use hair dryer on cool setting for itching
-check with health care provider before getting wet
- dry thoroughly after getting wet
-report increase in pain despite elecation, ice, and analgesia
-report swelling assoc. with pain and discoloration or movement
-report burning or tingling under cast
-report sores or foul oder
-keep app to have fx and cast checked/removed

268
Q

DONT’S of case care

A

-do not get plaster cast wet
-discourage pulling out cast padding
-do not place foreign objects inside cast
-do not bear wt on new cast for 48 hr
-do no cover cast with plastic for prolonged periods of time

269
Q

what is external fixation?

A

-metal pins and rods on the outside
-applies traction
-compress fracture fragments
-immobilize and holds fracture fragments in place
-mostly used for long bones

270
Q

what should be assessed for external fixation?

A

-assess for pin loosening and infection
-pin site care per MD order
-pt teaching

271
Q

what is internal fixation?

A

-pins, plates, rods, and metal surgically repaired in the inside
- continuous xrays to see that pins etc.. are in proper place

272
Q

why is nutritional therapy important bone surgeries?

A

-optimal for soft tissue and bone healing
-promotes muscle strength and tone
-builds endurance
-provides energy

273
Q

what are the peripheral vascular assessments?

A

-color and temp
-capillary refill
-pulses
-edema

274
Q

what is the peripheral neurologic assessment

A

sensation and motor function
pain

275
Q

what are the 6p’s

A

pain
pallor
pulse
paresthesia
paralysis
poikilothermia

276
Q

when assessing peripheral assessment, what should you do?

A

compare to both extremities to obtain accurate assessment

277
Q

what are nursing implementation to bone safety?

A

-teach safety precautions
-advocate to decrease injuries
-encourage moderate exercise
-safe environment to reduce falls
-calcium and vit d intake

278
Q

what are clinical manifestations for hip fractures?

A

-external rotation
-muscle spasms
-shortening of the affected extremity
-severe pain and tenderness

279
Q

what are the preoperative care considerations?

A

-consider chronic health problems
-discharge planning
-analgesics or muscle relaxants
-comfortable positioning
-traction placed properly

280
Q

what are postoperative care considerations?

A

-vital signs
-i&o
-monitor respiratory function
-encourage TCDB and IS
-pain management
-observe dressing site and monitor bleeding
-neurovascular checks

281
Q

DO’s for hip replacement

A

-use elevated toilet seat
-place chair inside shower or tube and remain seated while washing
-use pillow between legs for 6 wks after surgery when lying on nonoperative side or when supine
-keep hip in neutral, straight position when sitting, walking or lying
-notify HCP at once if severe pain, deformity, or loss of function occur
-discuss risk factors for prosthetics join infection with HCP and dentist before dental work

282
Q

DON’Ts with hip replacement

A

-flex hip greater than 90º
-adduct hip
-internally rotate hip
-cross legs ant knee or ankles
-put on own shoes or stockings w/o adaptive device for 4-6wks
-sit on chairs without arms

283
Q

what assessments are done with amputations?

A

-physical appearance of soft tissue
-preexisting illness
-skin temperature
-sensory function
-quality of peripheral pulse

284
Q

what are nurse managements with amputations?

A

phantom limb sensation
ambulatory and home care
pt and caregiver teaching

285
Q

what are direct complications with fractures?

A

infection
incorrect union
necrosis

286
Q

what are indirect complications of fractures?

A

-compartment syndrome
-venous thromboembolism
-fat embolism
-rhabdomylosis
-hypovolemic shock

287
Q

what increases risk of infection?

A

open fractures
soft tissue injuries

288
Q

what is compartment syndrome?

A

decrease in compartment size
increase in compartment contents

289
Q

collaborative care with compartment syndrome?

A

-no elevation above the heart
-no ice
-loosen bandage and split
-reduce traction wt
-surgically decompression (fasciotomy)

290
Q

what is fat embolism?

A

originates in bone marrow
-occurs after fracture from crushing injury or to long bone

291
Q

what are signs and symptoms of fat embolism?

A

restlessness
hypoxemia
mental status change
dyspnea/tachypnea
tachycardia
hypotension

292
Q

what is osteoarthritis?

A

-gradual loss of articular cartilage
-cartilage becomes dull, yellow, and grandular
-soft and less elastic
-less able to resist wear with heavy use
formation of osteophytes
-bones rub together increasing pain

293
Q

what are risk factors of osteoarthritis?

A

age
menopause
obesity
anterior cruciate ligament injury
frequent kneeling and stooping
smoking
possible genetic link

294
Q

how does osteoarthritis occur?

A

initial inury
attempts at cartilage repair
stimulates cartilage degradation
outgrowth and hyperplasia

295
Q

what is the clinical manifestation of osteoarthritis?

A

joint pain
deformity
non-systemic

296
Q

what is the nursing assessment with osteoarthritis?

A

bilateral joint assessment and check for
tenderness, swelling
limitation of movement
crepitation

297
Q

drug therapy for osteoarthritis with mild to moderate pain

A

acetaminophen
topical agents
otc creams containing camphor, eucalyptus oils and menthol

298
Q

drug therapy for moderate to severe pain in osteoarthritis?

A

nonsteroidal antiinflammatory drug;start low does and increase if needed
-ibupfron 200mg up to 4 times a day
arthrotec
-celebrex

299
Q

what is osteomyelitis?

A

severe bone infection, bone marrow, and surrounding soft tissue

300
Q

what is the common microorganism in osteomyelitis?

A

staphylococcus aureus

301
Q

etiology and path of osteomyelitis?

A

-indirect entry (hematogenous)
-young boys
-blunt trauma
-vascular insufficiency disorders
-GI and respiratory infection
direct entry-via open wound
foreign body presence

302
Q

what is acute osteomyelitis?

A

infection <1 month in duration
local manifestation
-pain unrelieved by rest; worsens with activity
-swelling, tenderness, warmth
-restricted movement

303
Q

what are systemic manifiestations of acute osteomyelitis?

A

fever
night sweats
chills
restlessness
nausea
malaise
drainage

304
Q

what are the diagnostics for osteomyelitis?

A

bone or soft tissue biopsy

305
Q

what is the interprofessional care of acute osteomyelitis?

A

course of IV antibiotics therapy for 4-6 weeks minimum

306
Q

what is the interprofessional care of chronic osteomyelitis?

A

surgical removal
extended use of antibiotics
-iv and/or oral up to 8 weeks

307
Q

what is the objective data of osteomyelitis?

A

-restlessness, high spiking temp, night sweats
-diaphoresis, warmth, edema
-restricted movement, wound drainage, spontaneous fractures
-increase in WBC

308
Q

what is osteoporosis?

A

chronic, progressive metabolic bone disease
-low bone mass
-deterioration of bone tissue that leads to increased bone fragility

309
Q

where does osteoporosis often affect?

A

hips
pelvis
wrists
vertebrae

310
Q

why does osteoporosis occur?

A

osteoclasts increase and osteoblasts decrease
-reabsorption occurs faster than bone deposition

311
Q

what are causes of osteoporosis?

A

< estrogen in females
< testosteron in males
< exercise/activity
< calcium, vitamin D

312
Q

why is osteoporosis most common in women?

A

lower calcium intake
less bone mass
bone resorption begins earlier and becomes more rapid at menopause
pregnancy and breastfeeing
longevity

313
Q

what are risk factors of osteoporosis?

A

advancing age >65 yr
steroids
female gender
low body wt
white or asian ethnicity
current cigarette smoking
nontraumatic fracture
sedentary lifestyle

314
Q

what are some prevention factors of osteoporosis?

A

regular wt bearing exercises
fluoride
calcium
vitamin d

315
Q

what age is peak bone mass

A

20

316
Q

what age does bone loss begin?

A

35-40

317
Q

what are clinical manifestation for osteoporosis?

A

occurs mainly in spine, hips, and wrists
spontaneous fx
gradual loss of height
dowager’s hump

318
Q

what are the screening guidlines for women with osteoporosis?

A

initial bone density test for women over age of 65

319
Q

what is the adequate calcium intake for premenospausal and postmenopausal taking estrogen?

A

1000mg/day

320
Q

whats the adequate calcium intake for a postmenopausal w/o estrogen?

A

1500mg/day

321
Q

how should calcium be taken?

A

divided doses with food to enhance absorption

322
Q

what are good sources of calcium?

A

milk
yogurt
turnip greens
cottage cheese
ice cream
sardines
spinach

323
Q

what are agents treat osteoporosis?

A

agents that decrease bone resorption
agents that promote bone formation

324
Q

what kind of drug is raloxifene?

A

hormone drug therapy
serm

325
Q

what are the antiresorptive drugs?

A

estrogen
raloxifene
biphosponate
calcitonin
densumab

326
Q

what is raloxifene (evista) similar to?

A

structurally similar to estrogen and binds to estrogen receptors

327
Q

what does raloxifene (evista) do?

A

reduces bone resorption

328
Q

what are the therapeutic uses for raloxifene (evista)

A

helps with osteoporosis and breast ca

329
Q

what are the adverse effects of raloxifene (evista)

A

venous thromboembolism
fetal harm
hot flashes

330
Q

what class is alendronate (fosamax)

A

bisphosphonate

331
Q

what does alendronate (fosamax) do?

A

inhibit bone resorption

332
Q

what are side effects of alendronate (fosamax)

A

anorexia
wt loss
gastritis

333
Q

how to administer oral alendronate(fosamax)

A

take with full glass of water
take 30 min before food or other med
remain upright at least 30 min

334
Q

what does calcitonin do?

A

inhibits bone resorption
inhibits the activity of osteoclast

335
Q

what is denosumab (prolia) used for?

A

used for postmenopausal women and men at risk for fracture

336
Q

how to admin denosumab (prolia)

A

sub q every 6 months

337
Q

what is teriparatide (forteo)

A

form of parathyroid horom
produced by recombinanat DNA
only drug that increases bone formation

338
Q

what are the side effects of teriparatide (forteo)

A

nausea
headache
backpain
leg cramps

339
Q

what is the black box warning for teriparatide (forteo)

A

increased risk for osteosarcoma

340
Q

most widely used antibiotic?

A

cephaosporins

341
Q

first generation cephalosporins

A

cefazolin (ancef)
most widely used

342
Q

fourth generation Cephalosporins

A

cefepime (maxipime)

343
Q

prophylatically used before surgery

A

cefazolin (ancef)

344
Q

what are the adverse reactions of Cephalosporinsi

A

allergic reaction
bleeding
thrombophlebitis

345
Q

what does vancomycin do?

A

inhibits cell wall synthesis
used for severe infections only

346
Q

what are the adverse effects of vancomycin

A

red man syndrome
ototoxicity
thrombophlebitis
thrombocytopenia

347
Q

use of gram negative bacilli

A

aminoglycosides

348
Q

what should walker do to work properly?

A

8-12 inches
lift up and move
utilize arms rest in chairs
wear appropriate footwear
take time ambulating

349
Q

what should you not do with walker?

A

drag
when standing don’t grab handles to pull self up instead push off armrest or bed

350
Q

what should you do with cane to properly function?

A

measure 15-30º elbow flex (measure at the wrist)
hold with unaffected extremity

351
Q

when walking up stairs with cane what leg do you use good or bad? when walking down the stairs what leg do you used good or bad?

A

up-good
down-bad

352
Q

what to do with crutch to work properly?

A

15-30º elbow measure with wrist
2-3 finger width under armpits
about 6 inches each side of feet

353
Q

what should you not do with crutches?

A

lean on crutch
swing through rapidly

354
Q

what to do with arm sling?

A

continually check peripheral neurovascular
promote good blood flow
assess for breakdown

355
Q

what should you not do with arm sling?

A

keep extremity in dependent position
leg fingers fall in dependent position
fasten too tightly

356
Q

what should you do with gait belt?

A

assess skin prior to placement
use with caution in pts with abd surgery/injury, breast cancer/
proper lift tech

357
Q

what to not do with gait belt

A

leave on pt
place too tightly

358
Q

healthcare reform agenda
basic care for all citizens

A

ANA

359
Q

over 65 years old
disabled

A

medicare

360
Q

mother and children
nursing home care

A

medicaid

361
Q

primary and preventive care

A

physicians officers
nurse managed clinics
schools
community health centers
parish and block nursing
-health and nutrition education
immunizations
occupational health programs

362
Q

what is secondary care?

A

medical units
surgical untis
mother/baby care
focus: early dx treatment prevent worsening of conditons

363
Q

what is tertiary care?

A

icu
oncology pt
burn centers
psychiatric facilities
rural hospitals

364
Q

what is quaternary care?

A

transplant centers
level 4 nicu

365
Q

what are the practitioners?

A

physicians
midlevel practioners

366
Q

what are the assistive?

A

cna
pca
unit secretaries

367
Q

what are the nursing team members

A

rns
lvs/lpn

368
Q

what are the supportive team memeber

A

pharmacist
therapist

369
Q

what are the specialty team member?

A

social worker
case manager
registered dieticians
spiritual care

370
Q

what is the ancillary

A

evs
food and nutrition
security

371
Q

they find assistance for medications, housing, transportation, financial needs

A

social worker

372
Q

develops, implements, & reviews healthcare plans for patients– recovering from serious injuries or dealing with chronic illnesses

A

case manager

373
Q

what is direct care?

A

interaction between the nurse and patient
Examples
Administering medications
Providing education for patients and their families
Dressing changes

374
Q

what is indirect care?

A

working on behalf of the patient
creating nursing care plans
serving in the ethics committee
documenting in pts chart

375
Q

model of nursing care

A

tpcn
case method
functional
team
primary
differentiated practice

376
Q

what are causes of phlebitis?

A

Poor aseptic technique
High osmolarity infusions
Improperly diluted medications
Incorrect cannula gauge
Too rapid infusion rate

377
Q

what is thrombophlebitis?

A

Formation of clot and inflammation in the vein
Usually occurs after phlebitis

378
Q
A

Fluids, Musculoskeletal, pharm, assistive devices, healthcare delivery systems (1 decks)

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