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Exam 2 Flashcards

1
Q

Hypertonic solution & examples

A

Solute outside, water inside (water moves out)
Cell shrinks
5% saline, 3% saline, D5, D6

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2
Q

Isotonic solution & examples

A

Equal solute/water
0.9% saline, LR

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3
Q

Hypotonic solution & examples

A

Solute inside, water outside
Cell swells
0.45% saline, 0.225% NS

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4
Q

S/S of dehydration

A

Tachycardia
Hypotension
Weak pulses
Hypernatremia
Poor skin turgor
Dry mucous membranes
Low urine output
Concentrated urine/serum

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5
Q

Interventions for dehydration

A

Offer minimum 2-4oz/hr
Sit on side of bed for 1 min before getting up

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6
Q

S/S of fluid overload

A

HTN
Bounding pulses
Low sodium
Polyuria
Dilute urine/serum
Crackles
JVD

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7
Q

S/S of CHF

A

Dyspnea at rest
JVD
AMS hypoxia
Rapid/shallow respirations
Pitting edema
Weight gain

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8
Q

S/S of hyponatremia

A

Seizure-coma-death
Anorexia/ N/V
Tendon reflex decreased
Limp muscle (weakness)
Orthostatic hypotension
Stomach cramping

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9
Q

Causes of hyponatremia

A

Diuretics, SIADH, low aldosterone, GI wound drainage, FVO, decreased intake of Na

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10
Q

S/S of hypernatremia

A

Flushed skin
Restlessness
Increased fluid retention & BP
Edema
Decreased urine output
Dry mouth

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11
Q

S/S of hyperkalemia

A

Muscle weakness
Urine output little or none
Respiratory failure
Decreased cardiac contractility (weak pulse)
Early muscle twitches/cramps
Rhythm changes

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12
Q

S/S if hypokalemia

A

Lethargic
Low, shallow respirations
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Hyporeflexia

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13
Q

Causes of hypokalemia

A

Drugs
Inadequate consumption of K
Too much water intake
Cushings syndrome
Heavy fluid loss

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14
Q

Causes of hyperkalemia

A

Adrenal insufficiency
Addisons disease
Renal failure
Excessive potassium intake
Drugs (NSAIDS, ACE inhibitors)

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15
Q

S/S if high Mg

A

Weakness, drowsiness
Respiratory depression
Bradycardia

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16
Q

Causes of high magnesium

A

Loss tendon reflex syndrome

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17
Q

Treatment of high Mg

A

Calcium gluconate

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18
Q

S/S of low Mg

A

Torsades de pointe
Respiratory arrest
Nystagmus

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19
Q

Causes of low Mg

A

Diuretics
Alcohol
Burns

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20
Q

S/S of low calcium

A

Positive chvostecks sign
Hyperactive reflexes
Carpal/pedal spasms
Tetany
Seizures
Laryngospasms
Dysrhythmias
Trousseaus sign

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21
Q

Causes of low calcium

A

Low intake of calcium
Hypoparathyroidism

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22
Q

Causes of high calcium

A

Hyperparathyroidism
Low Ca output from use of thiazide diuretics

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23
Q

S/S of high calcium

A

Confusion
Cardiac arrest if seizure
Painful bones
Renal stones
Abd groans
Sitting on throne

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24
Q

Normal blood ph

A

7.35-7.45

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25
Q

Normal paCO2

A

35-45

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26
Q

Normal HCO3

A

22-26

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27
Q

Causes of respiratory acidosis

A

Hypoventilation
Inadequate chest expansion
Airway obstruction

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28
Q

S/S of respiratory acidosis

A

Respiratory depression
Weak decreased pulses

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29
Q

Tx of respiratory acidosis

A

Ambu bag, prepare for intubation

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30
Q

Causes of Respiratory alkalosis

A

Hyperventilation
Pulmonary embolism
Pneumonia
ARDS (mech ventilation)

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31
Q

Tx of respiratory alkalosis

A

Breathe in paper bag if from anxiety

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32
Q

Signs of metabolic acidosis

A

Kussmaul respirations (deep and rapid)

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33
Q

Causes of metabolic acidosis

A

Diarrhea
Alcohol intoxication
Dehydration
Renal failure
DKA
Sepsis
Burns

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34
Q

Tx of metabolic acidosis

A

Administer IV bicarbonate

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35
Q

Causes of metabolic alkalosis

A

Vomitting
Blood transfusions
Overhydration
Antacid abuse

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36
Q

S/S of metabolic alkalosis

A

Muscle weakness
Twitching
Cramps

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37
Q

Tx of metabolic alkalosis

A

Stop antacids
Stop suctioning
Stop vomitting

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38
Q

3 main symptoms of diabetes

A

Polyuria
Polydipsia (thirsty)
Polyphagia (eating a lot)

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39
Q

Type 1 diabetes

A

Often younger/Caucasian populations
Produces no insulin at all

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40
Q

Type 2 diabetes often in who

A

Older adults and minorities

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41
Q

Other name for Hgb A1c

A

Glycosylated hemoglobin

42
Q

Postprandial BS

A

Blood sugar taken after meals
Should be less that 180

43
Q

Diet for diabetics

A

No missed meals
Don’t decrease intake during exercise or consume alcohol
Take metformin with meals

44
Q

How exercise affects diabetics

A

Lowers sugar by increasing carbohydrate metabolism

45
Q

Teaching for diabetics and exercise

A

Check BS while exercising- can lead to hypoglycemia
Don’t exercise around time insulin peaks (regular- 2-4hrs; NPH- 4-10hrs)
Take snack before exercising
Don’t exercise if BS <100

46
Q

Sick day rules for diabetics

A

Continue taking insulin and diabetic pills as usual (never stop taking)
Drink extra calorie free liquids
Weigh everyday (losing wt sign of high BS)
Self monitor BS q2-3hrs
Check temp morning and night

47
Q

Foot care for diabetics

A

Inspect feet daily
Never wash with hot water
Neuropathy- low sensation, high risk for injury
Moisturize but NOT in between toes
Socks to bed, no heating pad or hot water bottles
Hard sole shoes- no open toed or flip flops

48
Q

Insulin administration

A

Abdomen- 2 in from umbilicus
Pens good in fridge for 3 weeks
Roll NPH in hand before injection
Store pens upright to prevent clogging

49
Q

Steps of drawing up insulin

A

Check expiration date
Roll NPH between hands
Inject air in NPH, inject air in regular, draw up regular and then draw up NPH

50
Q

Somogyi effect

A

Early morning HYPERglycemia due to rebound from late night HYPOglycemia
Early AM levels less than 50-60
7AM levels greater than 180

51
Q

How to prevent somogyi effect

A

HS snack or adjusting insulin dosage

52
Q

Dawn phenomenon

A

Everyone has it- growth hormone released at night
Lantas (ultra lente) instead of NPH eliminates this phenomenon

53
Q

Cystitis

A

Infection and inflammation of bladder
Usually caused by UTI

54
Q

S/S of cystitis

A

Traces of blood, dark, cloudy or strong smelling urine
Pain just above pubic bone, lower back or abdomen
Burning, frequency and urgency of urination

55
Q

Interventions for cystitis

A

Empty bladder completely
Wipe from front to back
2-3 L daily
No long baths

56
Q

Urinary incontinence

A

Decrease in muscle tone= irritation and urgency

57
Q

Stress incontinence

A

Urine leaks when laughing, coughing, lifting heavy objects, etc

58
Q

Overactive bladder

A

Urge incontinence
Caused by urinary muscle spasms
Usually from multiple pregnancies, overweight, genetic weaknesses

59
Q

Teaching for urinary incontinence

A

Avoid caffeine
Bladder training- void q2hrs
Kegel exercises 10x/day

60
Q

Renal calculi (Nephrolithiasis)

A

Kidney stones
Higher risk in diabetics, fluid volume deficit or family hx
Severe flank pain

61
Q

Urolithiasis

A

Stones in urinary tract

62
Q

Tx for nephrolithiasis

A

Pass with fluids (4L/day)
Pain managed with NSAIDS (ketorolac, morphine IV, antispasmodic agent oxybutynin/ditropan)
Strain all urine
Monitor I&Os

63
Q

Nephrolithiasis diet

A

Don’t eat diet high in oxalates

If stone contains Uric acid- low purine diet

64
Q

Diet high in oxalates

A

Beer
Chocolate
Nuts
Berries
Spinach
Grains

65
Q

Bladder cancer risk factor

A

Smoking MAJOR risk

66
Q

S/S of bladder cancer

A

Blood in urine
Pain with urination

67
Q

Dx of bladder cancer

A

UA
Cytology
Cystoscopy
Biopsy

68
Q

Pyelonephritis

A

Kidney infection caused by bacteria (usually e. Coli)
Caused by females with poor hygiene or Foley catheters
Reduce nylon underwear or stockings

69
Q

S/s of pyelonephritis

A

Headache
Abd + flank pain
CVA tenderness and pain radiating down ureter due to inflammation
Nocturia
Fever/chills
N/V
Tachycardia
Tachypnea
Malaise/fatigue

70
Q

Glomerulonephritis

A

Inflammation of glomeruli (capillaries in kidneys)
Unable to handle waste products (protein, Na, K, Phosphorus)
Usually triggered by other infection

71
Q

S/S of glomerulonephritis

A

Hematuria
Proteinuria
N/V
Anorexia

72
Q

Tx of glomerulonephritis

A

Abts
Small freq meals
Avoid foods high in protein, Na and K
Monitor kidney function
Monitor for HTN and FVO

73
Q

Polycystic kidney disease

A

Genetic disorder- gets progressively worse until transplant
Growths can be up to 30 lbs
Leads to end-stage kidney disease

74
Q

S/S of Polycystic kidney disease

A

Flank pain
Bloody/cloudy urine
Enlarged abdomen

75
Q

Adverse effects of polycystic kidney disease

A

Severe headache = sign of HTN crisis

76
Q

Polycystic kidney disease interventions/teaching

A

Control HTN - low Na diet
Daily weights
Ace inhibitors can cause hyperkalemia
Avoid NSAIDS
treat pain and avoid constipation
Drink fluids, high fiber diet and walk

77
Q

Acute kidney injury

A

Sudden episode of kidney failure, occurs within hours or few days
Causes buildup of fluid, electrolytes, and waste products (K, Mg, Na, Ca)

78
Q

Most at risk for acute kidney injury

A

Diabetics
NSAID abuse
CT contrast dye
Metformin

79
Q

S/S of acute kidney disease

A

Oliguria/anuria (little or no urine)
Swelling in legs, ankles and around eyes
Fatigue/tiredness
SOB
Confusion-seizure-coma
Chest pain/pressure

80
Q

Nephrosclerosis

A

Progressive renal impairment caused by poorly controlled HTN

81
Q

S/S of nephrosclerosis

A

Anorexia
N/V
Pruritis
Somnolence/confusion
Wt loss
Unpleasant taste in mouth

82
Q

Atherosclerotic renal artery stenosis

A

Narrowing of arteries

83
Q

Arteriosclerosis

A

Hardening of arteries

84
Q

At risk for renal vascular disease

A

Diabetics
CAD
Aortoiliac occlusive disease

85
Q

Risk factors for renal vascular disease

A

Older age
HTN
High cholesterol
Diabetics
Smoking
Heavy alcohol/drug abuse

86
Q

BPH

A

Non-malignant
Common in older men and African Americans

87
Q

S/S of BPH

A

Groin/Abd pain
testicular/scrotal issues
Infections
Nocturia
Frequency/urgency
Post-void dribbling
Straining

88
Q

Medication Tx for BPH

A

5-alpha reductase inhibitors (finasteride, dutasteride) -shrinks prostate
Alpha-blocking agents (tamsulosin, alfuzosin) - decreases pressure in urethra

Watch for orthostatic hypotension

89
Q

TURP after teaching

A

Continuous bladder irrigation (urine goal- pink-tinged, REPORT burgundy)
REPORT confusion or bradycardia
Teach catheter care
Avoid baths
Post op dribbling or spasms expected

90
Q

Nephrostomy tube

A

Inserted surgically into kidneys when they’re backed up with urine

91
Q

Teaching for nephrostomy tube

A

Fluids 2L/day MINIMUM
Inspect often for kinks in tube
Measure for drainage, position and dressing intact
Report decreased urine output (clog/dehydration)- assess abd for distention or pain
Dressing changed weekly-STERILE
Place on side with tube up for dressing change

92
Q

Testicular cancer

A

Common in ages 15-34
High recovery and curable even at end stage
Typical sign- lump or swelling in testicle

93
Q

Tx of testicular cancer

A

Surgery (orchiectomy)
Radiation
Chemo

Use sperm bank before treatment

94
Q

Causes of erectile function

A

Medications
Poor blood flow
Drink too much alcohol
Too tired

95
Q

Tx of erectile dysfunction

A

PDE5 inhibitors - sildenafil (viagra, -afil) causes blood vessels to dilate, improving blood flow

96
Q

Teaching for -afil drugs

A

Don’t take it on nitrate drug for CP or heart problems
Can cause sudden vision loss
Take 30-60 min before intercourse
Allow 24 hrs between each tablet
minimize alcohol
Facial flushing possible
Report erection that lasts longer than 4 hrs (priapism) or painful

97
Q

Calcium level

98
Q

Magnesium level

99
Q

Potassium level

100
Q

Sodium level

MedSurg (5 decks)

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