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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
Q

Tx for metabolic acidosis

A

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

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26
Q

Metabolic Alkalosis: base bicarbonate excess

A

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

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27
Q

Tx for metabolic alkalosis

A

Reversing the underlying cause
Administering sufficient chloride for the kidney to excrete the HCO3
Replacing potassium if a chloride deficit is also present

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28
Q

Respiratory Acidosis: Carbonic Acid Excess

A

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

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29
Q

Tx of respiratory acidosis

A

Improve ventilation
Administer bronchodilators or antibiotics for respiratory infections
Administer oxygen as indicated
Administer adequate fluids to keep mucous membranes moist

30
Q

Respiratory Alkalosis: Carbonic Acid Deficit

A

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
Q

Tx of respiratory alkalosis

A

Treat the source of anxiety
Administer a sedative as indicated
Treat the underlying cause

32
Q

Normal pH of arterial blood

A

7.35-7.45

33
Q

Cations

A

Sodium — Na+
Potassium — K+
Calcium — Ca+
Magnesium — Mg++

34
Q

Normal range for Sodium

A

135 – 145 mEq

35
Q

Sodium deficit causes

Hyponatremia

A

GI loss
Losses from skin
Hormonal factors (SIADH, oxytocin)
Pharmacological agents (nicotine, morphine)

36
Q

Signs and symptoms of Hyponatremia

A 
Anorexia
Muscle cramps
Feeling of exhaustion
Apprehension
Fingerprint edema
Neurological symptoms
Serum sodium
37
Q

Sodium deficit Tx

A

Replace sodium and fluid losses through diet or parenteral fluids
Restore ECF
Correct any other electrolyte losses

38
Q

Sodium excess causes

Hypernatremia

A

Deprivation of water
Hypertonic tube feeding with inadequate water supplement
Excessive parenteral administration of sodium solutions
Increased insensible loss
Profuse sweating, heat stroke

39
Q

Signs and symptoms of Hypernatremia

A 
Marked thirst
Elevated body temperature
Swollen tongue
Red sticky mucous membranes
Disorientation
Serum sodium >145 mEq
40
Q

Hypernatremia Tx

A

Infusion of isotonic solution (0.9% NACL)

Use of diuretics

41
Q

Normal range for Potassium

A

3.5 – 5.5 mEq/L

42
Q

Potassium deficit causes

Hypokalemia

A 
GI or renal losses
Increased perspiration
Shifting of extracellular potassium
Protracted vomiting
Heat loss
Shifting into the cells 
Poor dietary intake
43
Q

Signs and symptoms of Hypokalemia

A 
Neuromuscular changes (fatigue, muscle weakness, diminished deep tendon reflexes)
Vomiting
Irritability
Sensitivity to digitalis
Serum potassium
44
Q

Tx of potassium deficit

A

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
Q

Potassium excess causes

Hyperkalemia

A

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
Q

Signs and symptoms of Hyperkalemia

A

ECG changes
Metabolic acidosis
Vague muscle weakness, flaccid paralysis
Nausea, cramping diarrhea

47
Q

Tx of potassium excess

A

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
Q

Normal range for calcium

A

8.5 – 10.5 mg/dL

49
Q

Calcium deficit causes

Hypocalcemia

A 
Intestinal malabsorption, altered regulation of calcium
Loss through diarrhea, wound exudate
Acute pancreatitis
Hyperphosphatemia
Prolonged NG tube suctioning
Surgical hypoparathyroidism
50
Q

Signs and symptoms of hypocalcemia

A

Neuromuscular symptoms: numbness of fingers, cramps in muscles
Hyperactive deep tendon reflexes
Positive Trousseau’s sign
Chvostek’s sign

51
Q

Tx of hypocalcemia

A

Alleviate underlying cause

Administration of calcium gluconate

52
Q

Calcium excess causes

Hypercalcemia

A

Excessive release of calcium from the bone, malignancy

Excessive calcium intake

53
Q

Signs and symptoms of hypercalcemia

A

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
Q

Tx for hypercalcemia

A 
Treat underlying disease
Administer saline diuresis
Give inorganic phosphate salts
Hemodialysis or peritoneal dialysis
Lasix 20 – 40 mg every 2 hours
Calcitonin
55
Q

Normal range for magnesium

A

1.5 – 2.5 mEq

56
Q

Magnesium deficit causes

Hypomagnesemia

A

Chronic alcoholism
Malabsorption syndromes
Critically ill patients
Drugs: aminoglycosides, diuretics, digitalis

57
Q

Signs and symptoms of Hypomagnesemia

A 
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
Q

Tx for Hypomagnesemia

A

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
Q

Magnesium excess causes

Hypermagnesemia

A

Renal failure
Hyperparathyroidism
Excessive magnesium administration
Medications high in magnesium (antacids, laxatives)

60
Q

Signs and symptoms of Hypermagnesemia

A 
Serum magnesium >2.5 mEq
Neuromuscular symptoms: flushing 
Lethargy, depressed respiration
Hypotension
Heart block
Cardiac arrest
61
Q

Tx of Hypermagnesemia

A

Decrease oral magnesium intake
Administer calcium gluconate to antagonize the action of Mg
Support respiratory function
Peritoneal dialysis

62
Q

Care of patients with diarrhea

A
  • 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
Q

Local effects of IV therapy

A
  • Nerve injury
  • local infection
  • venous spasm
  • Hematoma
  • phlebitis
  • Infiltration/extravasation
64
Q

Systemic effects of IV therapy

A
  • Blood stream infection (BSI)
  • Circulatory overload and pulmonary edema
  • Air embolism
  • Speed shock
65
Q

Nerve Injury

A
  • 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
Q

Local Infection

A
  • 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
Q

Venous spasm

A
  • 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
Q

Bloodstream Infection (BSI)

A
  • 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
Q

Circulatory overload and pulmonary edema

A
  • 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
Q

Air embolism

A
  • 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
Q

Speed shock

A
  • 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
Q

Site selection and IV therapy

A
  • 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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