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NSG 250 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Isotonic solutions

A

Same concentration as body fluid/plasma
250-375 mOsm
NO FLUID SHIFT OUT OF CELL OR INTO VASCULAR SPACE

Sample Solutions:
.9NS – Normal Saline
LR – Lactated Ringers

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2
Q

Hypotonic solution

A 
Less concentrated than plasma
Below 250 mOsm
FLUID MOVES INTO THE CELLS AND OUT OF THE VASCULAR SPACE, cells swell
Sample Solutions:
.225, .33,  and .45 NS
D5W
D5.225NS, D5.45NS, 
D2.5W
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3
Q

Hypertonic solution

A 
More concentrated than plasma
Above 375 mOsm
FLUID MOVES OUT OF CELLS INTO INTRAVASCULAR SPACE, Cells shrink
Sample Solutions: 
D10W and higher conc
D5NS
D5RL
TPN
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4
Q

Crystalloids

A 
Capable of crystallization	
Dextrose
NaCL
Electrolyte solutions
Alkalizing and Acidifying Agents
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5
Q

Colloids

A 
Expand plasma volume – pull fluid into the bloodstream
Albumin
Dextran
Hydroxyethyl starches
Gelatins
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6
Q

Nursing care for crystalloid solutions

A 
Monitor for signs of fluid overload
Assess urine output and specific gravity
Monitor lab values
Maintain rate per orders
Intake and Output
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7
Q

Nursing care for colloid solutions

A 
Assess for history of allergic response
Monitor urinary output
Monitor lab values
Evaluate CVP or jugular vein distention
Maintain infusion rate
Monitor for fluid overload – B/P, dyspnea, bounding pulse, 
Monitor for bleeding
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8
Q

What IV solution is the most commonly prescribed

A

LR

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9
Q

Sodium chloride solution

A

Percentages: .25, .45, .9 (Normal saline), 3 and 5
Treats sodium depletion
ECF replacement when chloride loss greater or equal to Na loss
Metabolic alkalosis
Used for blood administration
Precautions – can cause hypernatremia, low potassium, acidosis when continuous infusion of .9NS
WATCH FOR CIRCULATORY OVERLOAD

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10
Q

Balanced electrolyte solution

A

Ringers Solution and Lactated Ringers (Hartmann’s)
LR most commonly prescribed
Used for trauma, alimentary fluid loss, dehydration, sodium depletion, acidosis, and burns
Ringers - also to restore fluid balance before and after surgery
Can be used for patients with liver disease unable to metabolize lactate
DISADVANTAGES – Don’t use in renal failure, can worsen sodium retention, CHF, renal insufficiency

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11
Q

Albumin

A

Natural plasma protein
Expands proportionate to amount of circulating blood
No danger of serum hepatitis
Improves cardiac output, reduces edema, and raises serum protein levels, maintains electrolyte balance (low sodium), promotes diuresis
CAUTIONS – Allergic reaction, circulatory overload, pulmonary edema, can alter lab findings

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12
Q

Dextran

A

Comes in low (40) and high molecular weight (70)
Treating SHOCK
EXPANDS BY ONCE OR TWICE ITS OWN VOLUME
Improves microcirculation
CAUTIONS – HYPERSENSITIVITY REACTIONS, INCREASED RISK OF BLEEDING, CIRCULATORY OVERLOAD
IV use only

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13
Q

HYDROXYETHYL STARCHES(Hetastarch, Pentastarch)

A

Synthetic, made from starch
Hespan 6 or 10%
Less toxic, less expensive
HEMODYNAMICALLY SIGNIFICANT PLASMA VOLUME EXPANSION
Permits retention of intravascular fluid
CAUTIONS – ALLERGIC REACTION, RISK OF INTRACRANIAL BLEEDING, ANEMIA OR BLEEDING DUE TO HEMODILUTION

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14
Q

Gelatins

A

Replacing blood volume due to acute blood loss
Large molecular weight protein
Priming heart – lung machines
Three types –
succinylated or modified fluid gelatins, urea- crosslinked, and oxypolygelatins
CAUTIONS – ANAPHYLACTOID REACTIONS, high calcium and potassium with urea linked,

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15
Q

Passive diffusion

A

Passive movement of water, ions, and lipid-soluble molecules randomly in all directions from a region of high concentration to an area of low concentration

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16
Q

Filtration

A

Transfer of water and dissolved substances from a region of high pressure to a region of low pressure; the force behind it is hydrostatic pressure

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17
Q

Osmosis

A

Movement of water from a lower concentration toward a higher concentration across a semipermeable membrane

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18
Q

Sensible fluid loss

A

urine output, GI tract

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19
Q

Insensible fluid loss

A

500 – 1000 mL per day

Lungs and skin

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20
Q

Assessments for fluid deficit/excess

Cardiovascular

A
  • Deficit: increased pulse rate, decreased blood pressure, narrow pulse pressure, slow hand filling, decreased pulse volume
  • Excess: bounding pulse, increased pulse rate, jugular vein distention, overdistended hand veins
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21
Q

Assessments for fluid deficit/excess

Respiratory

A
  • Deficit: lungs clear

- Excess: moist crackles, respiratory rate >20, dyspnea, pulmonary edema

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22
Q

Assessments for fluid deficit/excess

Integumentary system

A

Deficit: decreased turgor, decreased skin temperature
Excess: warm, moist skin; fingerprinting over sternum

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23
Q

Assessments for fluid deficit/excess

Special senses

A
  • Deficit: dry conjunctiva, sunken eyes, decreasing tearing, sticky mucous membranes, dry cracked lips, extra longitudinal furrows
  • Excess: periorbital edema
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24
Q

Metabolic Acidosis: base bicarbonate deficit

A 
Metabolic acidosis (HCO3 deficit) is characterized by a low pH and low plasma HCO3 level
Etiology
Loss of HCO3
Respiratory or circulatory failure
Ingestion of certain drugs or toxins
Septic shock
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25
Tx for metabolic acidosis
Reversing the underlying cause Eliminating the source Administering NaHCO3 IV when pH is equal to or less than 7.2 NOTE: Give NaHCO3 cautiously to avoid patient developing metabolic alkalosis and pulmonary edema secondary to sodium overload
26
Metabolic Alkalosis: base bicarbonate excess
Metabolic alkalosis HCO3 excess is a clinical disturbance characterized by a high pH and high plasma HCO3 concentration Etiology Gain of HCO3 Loss of hydrogen ion (gastric suctioning and vomiting) Renal loss of hydrogen
27
Tx for metabolic alkalosis
Reversing the underlying cause Administering sufficient chloride for the kidney to excrete the HCO3 Replacing potassium if a chloride deficit is also present
28
Respiratory Acidosis: Carbonic Acid Excess
Respiratory acidosis is caused by inadequate excretion of carbon dioxide and inadequate ventilation resulting in increased serum levels or carbon dioxide and H2HC03 Etiology Pulmonary, neurologic, and cardiac causes Aspiration of foreign body Pneumothorax Severe pneumonia Overdose of sedatives
29
Tx of respiratory acidosis
Improve ventilation Administer bronchodilators or antibiotics for respiratory infections Administer oxygen as indicated Administer adequate fluids to keep mucous membranes moist
30
Respiratory Alkalosis: Carbonic Acid Deficit
Respiratory alkalosis is usually caused by hyperventilation which causes “blowing off” of carbon dioxide and decrease in H2HCO3 Etiology Pulmonary disorders that produce hypoxemia Hypoxemia-induced fever, pneumonia, CHF, asthma Stimulation of respiratory centers: anxiety, salicylate overdose
31
Tx of respiratory alkalosis
Treat the source of anxiety Administer a sedative as indicated Treat the underlying cause
32
Normal pH of arterial blood
7.35-7.45
33
Cations
Sodium — Na+ Potassium — K+ Calcium — Ca+ Magnesium — Mg++
34
Normal range for Sodium
135 – 145 mEq
35
Sodium deficit causes | Hyponatremia
GI loss Losses from skin Hormonal factors (SIADH, oxytocin) Pharmacological agents (nicotine, morphine)
36
Signs and symptoms of Hyponatremia
``` Anorexia Muscle cramps Feeling of exhaustion Apprehension Fingerprint edema Neurological symptoms Serum sodium ```
37
Sodium deficit Tx
Replace sodium and fluid losses through diet or parenteral fluids Restore ECF Correct any other electrolyte losses
38
Sodium excess causes | Hypernatremia
Deprivation of water Hypertonic tube feeding with inadequate water supplement Excessive parenteral administration of sodium solutions Increased insensible loss Profuse sweating, heat stroke
39
Signs and symptoms of Hypernatremia
``` Marked thirst Elevated body temperature Swollen tongue Red sticky mucous membranes Disorientation Serum sodium >145 mEq ```
40
Hypernatremia Tx
Infusion of isotonic solution (0.9% NACL) | Use of diuretics
41
Normal range for Potassium
3.5 – 5.5 mEq/L
42
Potassium deficit causes | Hypokalemia
``` GI or renal losses Increased perspiration Shifting of extracellular potassium Protracted vomiting Heat loss Shifting into the cells Poor dietary intake ```
43
Signs and symptoms of Hypokalemia
``` Neuromuscular changes (fatigue, muscle weakness, diminished deep tendon reflexes) Vomiting Irritability Sensitivity to digitalis Serum potassium ```
44
Tx of potassium deficit
Treatment: mild hypokalemia — dietary or oral supplements Administer infusion of 20 – 40 mEq per liter K+ is below 2 mEq/L, monitor patient’s ECG and administer potassium by means of secondary piggyback set in volume of 100 mL Review guidelines for administration of potassium
45
Potassium excess causes | Hyperkalemia
Gain of potassium by intake or by shift from ICF to ECF Excessive administration of potassium parenterally Drugs: potassium, indomethacin, beta blockers Serum potassium >5.5 mEq
46
Signs and symptoms of Hyperkalemia
ECG changes Metabolic acidosis Vague muscle weakness, flaccid paralysis Nausea, cramping diarrhea
47
Tx of potassium excess
Restrict dietary potassium in mild cases Discontinue supplements of potassium Administer IV calcium gluconate for cardiac symptoms Administer sodium bicarbonate (alkalinizes the plasma) Administer regular insulin (10 – 25 U) in 10% dextrose solution Peritoneal dialysis
48
Normal range for calcium
8.5 – 10.5 mg/dL
49
Calcium deficit causes | Hypocalcemia
``` Intestinal malabsorption, altered regulation of calcium Loss through diarrhea, wound exudate Acute pancreatitis Hyperphosphatemia Prolonged NG tube suctioning Surgical hypoparathyroidism ```
50
Signs and symptoms of hypocalcemia
Neuromuscular symptoms: numbness of fingers, cramps in muscles Hyperactive deep tendon reflexes Positive Trousseau’s sign Chvostek’s sign
51
Tx of hypocalcemia
Alleviate underlying cause | Administration of calcium gluconate
52
Calcium excess causes | Hypercalcemia
Excessive release of calcium from the bone, malignancy | Excessive calcium intake
53
Signs and symptoms of hypercalcemia
Neuromuscular symptoms: muscle weakness, lethargy, deep bone pain, pathologic fractures Constipation, anorexia, nausea, vomiting, polyuria Total serum calcium more than 10.5 mg/dL
54
Tx for hypercalcemia
``` Treat underlying disease Administer saline diuresis Give inorganic phosphate salts Hemodialysis or peritoneal dialysis Lasix 20 – 40 mg every 2 hours Calcitonin ```
55
Normal range for magnesium
1.5 – 2.5 mEq
56
Magnesium deficit causes | Hypomagnesemia
Chronic alcoholism Malabsorption syndromes Critically ill patients Drugs: aminoglycosides, diuretics, digitalis
57
Signs and symptoms of Hypomagnesemia
``` Serum Mg,1.5 mEq/L ECG: tachydysrhythmias Neuromuscular symptoms Positive Chvostek’s and Trousseau’s signs Paresthesia of feet and legs Painfully cold hands ```
58
Tx for Hypomagnesemia
Administer oral magnesium salts Administer 40 mEq magnesium sulfate IV in dextrose in water Administer 1 – 2 g of 10% solution of magnesium sulfate by direct IV push
59
Magnesium excess causes | Hypermagnesemia
Renal failure Hyperparathyroidism Excessive magnesium administration Medications high in magnesium (antacids, laxatives)
60
Signs and symptoms of Hypermagnesemia
``` Serum magnesium >2.5 mEq Neuromuscular symptoms: flushing Lethargy, depressed respiration Hypotension Heart block Cardiac arrest ```
61
Tx of Hypermagnesemia
Decrease oral magnesium intake Administer calcium gluconate to antagonize the action of Mg Support respiratory function Peritoneal dialysis
62
Care of patients with diarrhea
- Teach hand hygiene - Provide info about foods that can cause diarrhea (highly spiced foods, high-fat foods, greasy foods) - monitor stools, fluid balance, serum electrolytes, skin integrity - BRAT diet - Electrolyte replacement fluids
63
Local effects of IV therapy
- Nerve injury - local infection - venous spasm - Hematoma - phlebitis - Infiltration/extravasation
64
Systemic effects of IV therapy
- Blood stream infection (BSI) - Circulatory overload and pulmonary edema - Air embolism - Speed shock
65
Nerve Injury
- Immediate sharp pain during venipuncture shooting pain up arm or pain or tingling in hand or fingertips - Tx: stop venipuncture, notify LIP, apply pressure - Prevention: Avoid lateral surface of wrist, antecubital area, ventral surface of wrist, avoid probing, reduce risk for infiltration or extravasation as above, make only 2 attempts
66
Local Infection
- Redness and swelling at site possible exudate of purulent material - Tx: Discontinue catheter, culture site and cannula, apply sterile dressing over site, administer antibiotics as ordered - Prevention: practice aseptic technique during venipuncture and site maintenance
67
Venous spasm
- Sharp pain at IV site associated with infusion slowing of infusion resistance to PICC or midline removal - Tx: Apply a warm compress to the site with infusion still running, Restate the infusion if spasm continues, consult with interventional radiology for resistance of line removal Prevention: Dilute medication, keep IV solution at room temperature, administer infusion at prescribed rate
68
Bloodstream Infection (BSI)
- Fever, chills, diaphoresis, tachycardia, tachpnea, change in mental status, hypoxemia, decreased urine output, hypotension, evidence of decreased perfusion or dysfunction - Tx: Notify LIP, restart new IV system, obtain cultures, initiate antimicrobial therapy ordered, monitor pt closely Prevention: Hand hygiene, aseptic tech with all aspects of infusion related care, attention to skin antisepsis prior to placement and with ongoing site care, preference to use chlorhexidine and alcohol solutions, Attention to intact dressings over VAD, Attention to needle-less connector disinfection, Carefully inspect solutions, Follow standards of practice related to rotation of sites and hang time of solutions
69
Circulatory overload and pulmonary edema
- Rapid weight gain increase in BP, HR, bounding pulse, edema, I&O, rise in central venous pressure, SOB, crackles in the lungs, cough, distended neck veins, restlessness and headache - Tx: Call rapid response team, decrease IV flow rate, place pt at high fowler position, keep the pt warm, monitor vitals, administer oxygen as ordered, administer drug therapy - Prevention: Monitor the infusion, maintain flow at the prescribed rate, monitor I&O, daily weights, know the patients cardio hx, do not catch up infusions, instead recalibrate, Use electronic infusion devices (EIDs) that have dose-error reduction systems and anti-free-flow administration sets
70
Air embolism
- Lightheadedness, dyspnea, cyanosis, tachypnea, expiratory wheezes, cough, mill wheel murmur, chest pain, hypotension, change in mental status, confusion, coma, seizures - Tx: Call rapid response team, place pt in Trendelenburg position, administer oxygen, monitor vitals - Prevention: Remove all air from administration sets, Use lure-lock connections, follow protocol for catheter removal
71
Speed shock
- Dizziness, facial flushing, headache, tightness of chest, hypotension, irregular pulse, progression of shock - Tx: stop infusion immediately, call rapid response team Prevention: Use an EID, monitor the infusion rate, administer IV push medications over appropriate time frame
72
Site selection and IV therapy
- Type of solution: irritating fluids, such as certain antibiotics and potassium chloride, select large vein in forearm - Condition of the vein - Duration of therapy: start with most distal veins first - Cannula size: small-gauge catheters take up less space in the vein, allowing for blood flow around the catheter, and cause less trauma when inserted - Patient age - Patient preference - Patient activity - Presence of disease or previous surgery - Presence of shunt or graft: do not use pts arm or hand that has a patent graft or shunt for dialysis - Patients receiving anticoagulation therapy: these pts have a propensity to bleed

NSG 250 (4 decks)

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