Exam 1 SG Flashcards
1
Q
Fluid Volume Deficit Causes
A
-Fluid loss (diarrhea, vomiting, polyuria, hemorrhage)
-Inadequate intake (unconscious, not thirsty)
-Fluid shift (burns)
HYPOVOLEMIA
2
Q
Fluid Volume Deficit Labs
A
Electrolytes are lost (elderly at risk)
3
Q
Fluid Volume Deficit S/S-
A
-Confusion, restlessness/drowsy
-Thirst, dry mucous membranes*, decreased skin turgor & capillary refill
-Postural hypotension, increased HR, RR, low BP, low concentrated urine
-Weakness and weight loss
4
Q
Fluid Volume Deficit Treatment
A
-Correct underlying causes and replace water and electrolytes (orally, blood products, balanced (isotonic) IV solutions
-Seizure precautions
5
Q
Fluid Volume Excess Causes
A
-Excess fluid intake
-Renal failure
-Heart failure
-Burns (interstitial to plasma fluid shift)
-HYPERVOLEMIA
6
Q
Fluid Volume Excess Labs
A
-Electrolytes aren’t necessarily unbalanced
-Monitor daily weights and I&O’s
1kg = 1L of fluid
7
Q
Fluid Volume Excess S/S
A
-Weight Gain
-HA, confusion
-Peripheral edema, JVD, increased CVP
-S3 heart sounds, bounding pulse, increased BP
-Polyuria
-Dyspnea, crackles, pulmonary edema
-Muscle spasms, seizures, coma
8
Q
Fluid Volume Excess Treatment
A
-Diuretics
-Na+ restriction
-Para/thoracentesis
-Monitor I&O’s
-Seizure Precautions
9
Q
Hypertonic IV
A
-Too much can dehydrate cells, causing them to shrivel
-pulls fluid from cell
10
Q
Hypotonic IV
A
-Too much can burst cells, cerebral edema
-Fluid moves into cells, plumps up the cells
- Risk for cells to explode!!
11
Q
Isotonic IV
A
-Too much can cause fluid overload
-Hydrates the cells, expands vascular volume
-ISO = same
12
Q
Hypernatremia Lab Value
A
> 145
13
Q
Hyponatremia Lab Value
A
<136
14
Q
Hyperkalemia Lab Value
A
> 5.0
15
Q
Hypokalemia Lab Value
A
<3.5
16
Q
Hypercalcemia Lab Value
A
> 10.5
17
Q
Hypocalcemia Lab Value
A
<9.0
18
Q
Hypermagnesemia Lab Value
A
> 2.1
19
Q
Hypomagnesemia Lab Value
A
<3.1
20
Q
Hyperphosphatemia Lab Value
A
> 4.5
21
Q
Hypophosphatemia Lab Value
A
<3
22
Q
Hypernatremia causes
A
“MODEL”
M-medications, meals (too much sodium intake)
O-osmotic diuretics
D-diabetes insipidus
E-excessive water loss
L-low water intake
> 145
23
Q
Hypernatremia S/S
A
“FRIED & SALTED”
F-fever (low grade)
R-restlessness and agitation
I-increased fluid retention
E-edema: peripheral & pitting
D-dry mouth
S-skin flushed
A-altered LOC, confusion
L-low urinary output
T-thirst
E-elevated BP
D-decreased energy, weakness
24
Q
Hypernatremia Treatment
A
Decreased ECF
-PO or IV isotonic fluid replacement
Normal/increased ICF
-Hypotonic IV (plumps up cells)
-Diuretics for Na+
-Na+ restriction
-Seizure precautions
-Fluid restriction
25
Hyponatremia Causes
"MOBS Fail"
M-medications (diuretics)
O-oral gastric tube suctioning
B-burns
S-SIADH
F-failure: heart, kidney, liver.
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Hyponatremia S/S
"LOW SODIUM"
L-LOC altered (confusion*)
O-orthostatic hypotension
W-weak muscles
S-seizures*
O-osmolality low (serum)
D-diarrhea
I-increased ICP (difficulty concentrating*)
U-urine osmolality high
M-more bowel sounds
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Hyponatremia Treatment
Fluid and Na+ loss
-Administer isotonic IV solutions
-Encourage oral fluid intake
-Stop diuretics
Dilutional hyponatremia
-Fluid restriction
-Diuretics
-Demeclocycline
*Correct sodium level slowly (to prevent brain damage*
28
Hyperkalemia Causes
"SIMM"
S- shift from ICF to ECF (acidosis)
I-impaired renal excretion (MOST COMMON)
M-massive intake of K+ (salt substitutes)
M-medications: digoxin, beta blockers, ACE inhibitors, potassium sparing diuretics
29
Hyperkalemia S/S
"MURDER"
M-muscle cramps
U-urine abnormalities
R-respiratory distress
D-decreased cardiac contractility
E-EKG changes (Peaked T waves and QRS waves, widened P wave)
R-reflexes (depressed/absent DTRs)
30
Hyperkalemia Treatment
-Stop oral or parenteral K+ intake
-Increase excretion
-Force into ICF with dextrose, insulin, bicarb, or albuterol (temporary)
Stabilize cardiac membranes using IV calcium
31
Hypokalemia Causes
"GRIM"
G- GI losses (diarrhea & vomiting)
R-renal losses (magnesium deficiency, diuretics)
I-inadequate K+ intake
M- metabolic alkalosis or insulin administration (shifts K+ into ICF)
32
Hypokalemia S/S
"7 L's"
L-lethargic (N/V)
L-low shallow respirations (failure)
L-Lethal cardiac dysrhythmias (prominent U wave, ST depression, shallow T)
L-Leg cramps
L-Limp muscles
L-Low BP
L-Low GI motility
Hyperglycemia
33
Hypokalemia Treatment
1) Oral K+ first
2) Then IV
more K+ in diet
34
Hypercalcemia Causes
"CHIVE"
C-cancer
H-hyperparathyroidism
I-immobilization
V-vitamin D overdose
E-elevated vitamin D
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Hypercalcemia S/S
"BACK ME"
B-bone pain
A-arrhythmias, HTN
C-cardiac arrest
K-kidney stones
M-muscle weakness
E-excessive urination (dehydration)
36
Hypercalcemia Treatment
Mild
-Stop meds
-low calcium diet
-exercise
-hydration
Severe
-Isotonic IV
-Calcitonin (inhibits Ca movement)
-Biphosphates (inhibit osteoclast activity, prevents Ca release)
-Dialysis (if life threatening)
37
Hypocalcemia Causes
"MAID"
M-multiple blood transfusions (6-10 per day)
A-alkalosis
I-increased calcium loss
D-decreased production of PTH
38
Hypocalcemia S/S
"CATS go Numb"
C-convulsions
A-arrhythmias
T-tetany
S-spasms and stridor
NUMB-numbness in the fingers and around mouth
*Trousseau's (BP cuff, hand spasms)
*Chvostek's (eye/lip twitch)
39
Hypocalcemia Treatment
-Treat underlying cause
-increase dietary calcium intake
-Vit D supplements
-IV calcium gluconate
-Change loop to thiazide
40
Hypermagnesemia Cause
-Increased intake of Maalox/milk of mag with renal insufficiency/failure
-Excess IV Mg administration
41
Hypermagnesemia S/S
-Hypotension, facial flushing
-Lethargy
-N/V
-Impaired DTR's
-Muscle paralysis
-Resp and cardiac arrest
42
Hypermagnesemia Treatment
-Avoid Mg food/drugs
-Fluid administration to promote excretion
-Calcium gluconate IV to counteract the effects of the elevated Mg
43
Hypomagnesemia Causes
-Chronic alcoholism
-Prolonged fasting/starvation
-Fluid loss from GI tract
-Prolonged parenteral nutrition w/o supplementation
-Diuretics, PPI's
-Hyperglycemic osmotic diuresis
44
Hypomagnesemia S/S
Resembles hypocalcemia
-Muscle cramps, tremors, hyperactive DTRs, Chvostek's and Trousseau's sign
-Confusion, vertigo and seizures
-Dysrhythmias
45
Hypomagnesemia Treatment
-Treat underlying cause
-Increase oral Mg intake
-Administer Mg IV if needed (monitor for hypotension and arrhythmias)
46
Hyperphosphatemia Causes
-Acute kidney injury
-Chronic kidney disease
-Excessive intake
-Excessive vitamin D
-Hypoparathyroidism
47
Hyperphosphatemia S/S
-Tetany, muscle cramps, paresthesia
-Hypotension, dysrhythmias
-Seizures
-Calcium deposition -> organ dysfunction
48
Hyperphosphatemia Treatment
-Treat underlying cause
-Restrict dietary intake of phosphate
-Calcium carbonate to bind
-Volume expansion & forced diuresis with loop diuretics
-Dialysis
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Hypophosphatemia Causes
-Malnourishment/malabsorption
-Alcohol withdrawal
-Diarrhea
-Phosphate binding antacids
-Inadequate replacement from parenteral feeding
50
Hypophosphatemia S/S
-CNS depression
-Muscle weakness (including resp.) and pain
-Resp. and heart failure
-Rickets
-Osteomalacia (soft bones)
-Rhabdomyolysis (skeletal muscle breaks down rapidly)
51
Hypophosphatemia Treatment
-Increase oral intake (dairy)
-Supplements (can irritate GI tract)
-IV supplements (slow) (potassium phosphate, sodium phosphate)
52
pH Values
7.35-7.45
53
Carbon Dioxide (PaCO2) Values
35-45
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Bicarb (HCO3) values
22-26
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Partial Pressure of Arterial O2 (PaO2) Values
80-100
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Saturation of Arterial O2 (SaO2) Values
95%-100%
57
Respiratory Acidosis Cause
-HYPOVENTILATION
-Respiratory depression from lungs
-Airway obstructions (COPD, pneumonia, PE)
-Ventilator hypoventilation
-Excess HCO3 (bicarb)
58
Respiratory Acidosis Labs
pH: <7.35
CO2: <45
59
Respiratory Acidosis Treatment
Stimulate them
60
Respiratory Alkalosis Cause
-HYPERVENTILATION
-Anxiety, stress
-Pain
-High ventilator settings
61
Respiratory Alkalosis Labs
pH: >7.45
CO2: <35
62
Respiratory Alkalosis Treatment
Calm them down
63
Metabolic Acidosis Causes
-*Diarrhea*
-Acid gain from hypoxia
-Renal Failure
-Drugs or toxins
-Bicarb loss from bile drainage
-Pancreatic fistulas
64
Metabolic Acidosis Labs
pH: <7.35
HCO3 (bicarb): <22
65
Metabolic Acidosis Treatment
-Encourage breathing
-Give bicarb
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Metabolic Alkalosis Causes
Acid Loss
-Vomiting
-NG suctioning
-Diuretics
-Steroids
-Cushing's
-Hyperaldosteronism
-Hepatic disease
-Hypokalemia
-Hypochloremia
Bicarbonate Gain
-Dosing with bicarb
-Excess infusion of lactated ringers' solution
67
Metabolic Alkalosis Labs
pH: <7.45
HCO3 (bicarb): <26
68
Metabolic Alkalosis Treatment
Slow breathing
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Daily amount of insulin secreted by an adult?
40-50 units
70
Type 1 Diabetes Mellitus Patho
-Autoimmune disease resulting in progressive destruction of pancreatic B cells
-80-90% of B cells are destroyed before S/S manifest
-Accounts for 5-10% of all diabetes cases
-Generally, affect those under 40 years
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Type 1 Diabetes Mellitus Causes
-Genetic predisposition (human leukocyte antigen)
-Exposure to a virus or idiopathic
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Type 1 Diabetes Mellitus Diagnostics
-A1C: >6.5
-Fasting glucose >126
-Random glucose >199
-2-hour OGTT >200
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Type 1 Diabetes Mellitus S/S
-Polyuria, polydipsia, polyphagia
-Fatigue
-Weight loss
-No insulin produced
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Type 1 Diabetes Mellitus Treatment-
-Will require insulin, should exercise
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Type 2 Diabetes Mellitus Patho
-Most prevalent type 90-95%
-Pancreas continues to produce some insulin but not enough insulin is produced and the body does not use insulin effectively
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Type 2 Diabetes Mellitus Cause
-Obese/overweight
-Old age
-Family history
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Type 2 Diabetes Mellitus Diagnostics
-A1C >6.5
-Fasting glucose >126
-Random glucose >200
-2-hour OGTT >200
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Type 2 Diabetes Mellitus S/S
-Recurrent infection (increase insulin needed)
-Fatigue
-Polyuria, polydipsia, polyphagia
-Prolonged wound healing, visual changes
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Type 2 Diabetes Mellitus Treatment
-Emphasis on goals for glucose, lipids and BP
-Calorie reduction and weight loss to improve insulin sensitivity
-Needs exercise
80
Short Acting Insulin Examples
Regular Insulin
-Humulin R
-Novolin R
81
Short Acting Insulin Onset
30-60 minutes
Inject 30-45 minutes before meals
82
Short Acting Insulin Peak and Duration
Peak: 2-5 hours
Duration: 5-8 hours
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Short Acting Insulin Uses/Administration Considerations
-Several hours after meal, may have hypoglycemia
-Insulin still present and glucose is falling post meal
-Abdomen is preferred site for all insulin-most rapid and consistent absorption
-The only insulin that can be given IV when immediate onset of action is desired
84
Rapid Acting Insulin Examples
Lispro (Humalog)
aspart (NovoLog)
Glulisine (Apidra)
85
Rapid Acting Insulin Onset
10-30 minutes
Inject 0-15 minutes before meals
86
Rapid Acting Insulin Peak/Duration
Peak: 30 minutes- 3 hours
Duration: 3-5 hours
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Rapid Acting Insulin Uses/Administration Considerations
-Peak and duration more consistent with digestion and metabolism pattern postprandial.
-Better for meal coverage, but because of short duration of action a basal background insulin must be used in conjunction with it.
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Intermediate Insulin Examples
NPH (cloudy)
Humulin N or Novolin N
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Intermediate Insulin Onset
1.5-4 hours
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Intermediate Insulin Peak and Duration
Peak: 4-12 hours
Duration: 12-18 hours
91
Intermediate Insulin Uses/Administration Considerations
-2 injections provide coverage for 24 hours
-Give at breakfast and dinner
-Hypoglycemia attacks most likely with peak of action, if food is not eaten at that time
-Mixed with zinc and protamine to prolong the action, therefore must be mixed (shaken) before administration
92
Long-Acting Insulin Examples
-Glargine (Lantus)
-Detemir (Levemir)
-Degludec (Thesiba)
93
Long-Acting Insulin Onset
0.8-4 hours
Administer at bedtime or in the morning (follow the regimen patients uses at home); important to give at the same time each day
94
Long-Acting Insulin Peak and Duration
Peak: no pronounced peak
Duration: 16-24 hours
95
Long-Acting Insulin Uses/Administration Considerations
-Mimics the basal cell level of insulin produced by the body in 24-hour period, low risk for hypoglycemia.
-DO NOT MIX WITH OTHER INSULINS
-Useful for people with nighttime rises in blood sugar
-Hold metformin for type 2 DM contrast procedures.
96
Hyperglycemia Glucose
>126 mg/dl
97
Hyperglycemia Causes
Poorly controlled diabetes
98
Hyperglycemia Long Term
Can lead to neuropathy, kidney disease, vision loss, stoke, amputation.
99
Hypoglycemia Glucose
<70 mg/dl
100
Hypoglycemia Causes
-Too much insulin
-Exercise
-poor timing (r/t administration of insulin)
101
Hypoglycemia S/S
-Anxious, irritable, sweaty, cool clammy skin, hungry
-Confused, blurred/double vision
102
Hypoglycemia Treatment
-15g of carbs like fruit juice if below 70, recheck in 15 minutes, repeat if needed.
-IV D50 or IM glucagon if unresponsive/unconscious
-A set meal pattern with bedtime snacks is necessary to prevent this
103
Diabetic Ketoacidosis (DKA) Cause
-Profound lack of insulin
-Characterized by hyperglycemia, ketosis, acidosis, and dehydration (needs fluids)
-Occurs more with type 1 DM
104
Diabetic Ketoacidosis (DKA) Labs
Glucose >250
Blood pH <7.30, bicarb <16
High ketones in urine
105
Diabetic Ketoacidosis (DKA) S/S
-Hyperglycemia
-Ketosis (fruity breath), ketonuria
-Deep rapid breathing (Kussmaul)
-Metabolic acidosis, dehydration
-Hyperkalemia, tachycardia
106
Diabetic Ketoacidosis (DKA) Treatment
-Stat isotonic IV, then insulin
-Electrolyte replacement
-Only regular insulin can be used
-Potassium may need to be replaced when insulin is given
-If glucose is below 250 give dextrose in IV
107
Hyperglycemia Hyperosmolar Syndrome (HHS) Glucose
>600
108
Hyperglycemia Hyperosmolar Syndrome (HHS) Causes
-Infections (UTI's pneumonia, sepsis)
-New type 2 diabetes
-Impaired thirst/lack of fluids
109
Hyperglycemia Hyperosmolar Syndrome (HHS) S/S
->600
-Dry parched mouth, extreme thirst, polyuria
-Warm but not sweaty, fever
-Sleepiness, confusion, vision loss, hallucinations
110
Hyperglycemia Hyperosmolar Syndrome (HHS) Treatment
-Boat load of fluids
-IV NaCl and insulin
-More fluids and less insulin is needed compared to DKA
-Add dextrose to IV when glucose <250
-Monitor pt closely, especially K+ levels
111
Diabetic Retinopathy
-Diabetes is the most common cause of new cases of blindness
-Cataracts and glaucoma
-Control diabetes, surgery
112
Diabetic Nephropathy
-Kidney dysfunction
-Labs-elevated BUN and creatinine
-ACE inhibitors and angiotensin receptor 2 blockers with tight glucose control. Dialysis in late stages
113
Diabetic Foot Ulcer
-Staged ulcer resulting from poor lifestyle choices r/t diabetes. Common with sensory neuropathy and peripheral artery disease, smoking increases risk.
-Ulcer, risk for infection
-Wound care and debridement, pt must have meticulous foot care.
-Check water temperature with thermometer, not feet.
114
Diabetic Neuropathy
-Distal symmetric loss of sensation with uncontrolled diabetes (hands and feet), deformities may be present.
-Numbness, burning, tingling, shooting pain and cramps of extremities. Impaired balance, foot deformities, hot and cold sensitivity. Worse at night.
-Delayed gastric emptying CV problems, sexual dysfunction, neurogenic bladder
-Tight glucose control. Drugs- topical creams, tricyclic antidepressants, SSIs and NE reuptake inhibitors, antiseizures.
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