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NSG 312 OB > Exam 2 med surg > Flashcards

Exam 2 med surg Flashcards

1
Q

clinical manifestations of urinary tract calculi

A
  • sudden severe pain
  • common sites include: ureteropelvic junction (dull pain in costovertebral flank and renal colic)
  • mild shock with cool, moist skin
  • pain moves to lower quadrant
  • UTI symptoms
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2
Q

how do you treat an acute attack of urinary tract calculi?

A

treat pain with opioids, look for infection

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3
Q

lithotripsy

A

sends extracorporeal shock-wave lithotripsy (ESWL) throughout the kidneys to break up stones

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4
Q

functional unit of the kidney

A

nephron

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5
Q

functions of the kidney

A
  • RBC production (erythropoietin)
  • BP regulation
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6
Q

capacity of the bladder

A

600-1000 mL

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7
Q

between what ages do the size and weight of kidneys decrease and by how much?

A

between 30-90 and by 20-30%

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8
Q

how much glomerular function is lost by the seventh decade of life?

A

30-50%

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9
Q

what does atherosclerosis do in terms of kidneys?

A

accelerates the decrease of renal size with age

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10
Q

what does decreased renal BF result in?

A

decreased GFR

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11
Q

what is an important consideration in the gerontologic group concerning meds and renal function?

A

make sure their kidneys can handle some meds

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12
Q

CVA tenderness

A
  • kidney punch
  • where vertebrae meets ribs
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13
Q

what would you not want to hear at CVA with the bell of your stethoscope?

A

any bruits

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14
Q

is it normal for the urinary tract to have bacteria?

A

no, the bladder and its contents are free of bacteria in majority of healthy persons

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15
Q

most common pathogen in a UTI

A

escherichia coli

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16
Q

where does E. coli come from?

A

the GI tract

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17
Q

patients at risk for UTIs

A
  • immunosuppressed
  • diabetic
  • having undergone multiple antibiotic courses
  • have traveled to developing countries
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18
Q

what parts are involved in an upper UTI?

A

kidneys, pelvis, and ureters

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19
Q

signs of upper UTI

A

fever, chills, flank pain/CVA, pyelonephritis

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20
Q

signs of lower UTI

A

usually there are no systemic manifestations, cystitis

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21
Q

uncomplicated UTI

A

occurs in otherwise normal urinary tract and usually involves only the bladder

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22
Q

complicated UTI

A

coexists with presence of obstruction/stones, catheters, diabetes/neurologic disease, pregnancy-induced changes, recurrent infection

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23
Q

how are organisms introduced in a UTI?

A

via the ascending route from urethra and originate in the perineum

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24
Q

what percentage do HAUTIs account for nosocomial infections?

A

31%

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25
Q

manifestations of UTI

A
  • urinary frequency (more than every 2 hours)
  • urgency (sudden strong desire to void immediately)
  • incontinence
  • nocturia
  • nocturnal enuresis
  • weak stream
  • hesitancy
  • intermittency
  • postvoid dribbling
  • urinary retention
  • dysuria
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26
Q

manifestation of UTI in older adults

A
  • symptoms are often absent
  • nonlocalized abdominal discomfort rather than dysuria
  • cognitive impairment possible
  • fever less likely
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27
Q

what’s important to determine from a urine culture?

A

need to determine susceptibility to antibiotics - sensitive or resistance

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28
Q

when should you start antibiotics in someone with a UTI?

A

AFTER obtaining a culture

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29
Q

what is important to teach a patient that is put on phenazopyridine (pyridium) for a UTI?

A

it stains the urine a reddish-orange that can be mistaken for blood and may stain clothing

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30
Q

objective findings in someone with a UTI

A
  • fever
  • hematuria, foul-smelling urine, tender, enlarged kidney
  • leukocytosis, + bacteria, WBCs, RBCs, pyuria, US, CT scan IVP
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31
Q

acute pyelonephritis

A

inflammation of renal parenchyma and collecting duct caused by bacteria ~ infection/bacteria goes up into the kidneys

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32
Q

if left untreated, what can acute pyelonephritis lead to?

A

urosepsis which can lead to septic shock which can result in death

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33
Q

what preexisting factors might be present in a pt. with pyelonephritis?

A
  • vesicoureteral reflux: backward movement of urine from lower to upper urinary tract
  • dysfunction of lower urinary tract from obstruction from BPH, stricture, urinary stone
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34
Q

manifestations of pyelonephritis

A
  • mild fatigue
  • chills
  • fever
  • vomiting
  • malaise
  • flank pain
  • lower urinary tract symptoms characteristic of cystitis
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35
Q

parts of upper respiratory tract

A
  • nose
  • mouth
  • pharynx
  • epiglottis
  • larynx
  • trachea
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36
Q

parts of lower respiratory tract

A
  • bronchi
  • bronchioles
  • alveolar ducts
  • alveoli
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37
Q

where would a chest tube go if there is pneumothorax?

A

chest tube is up because air goes up

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38
Q

where would a chest tube go if there is a hemothorax?

A

chest tube goes down because blood sits down

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39
Q

what does a ventilation-perfusion (V/Q) scan look for?

A

a pulmonary embolism (PE)

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40
Q

why might a person need a trach?

A
  • throat cancer
  • impaired airway
  • trauma
  • anaphylaxis
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41
Q

what are trachs used for?

A

to bypass obstruction, facilitate secretion removal, permit long-term mechanical ventilation

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42
Q

advantages of trach vs. endotracheal tube

A
  • more secure airway
  • increased mobility
  • less risk of long-term damage to airway
  • easier breathing
  • increased comfort
  • patient can eat and speak
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43
Q

how should trach tie strings be put changed?

A

one side at a time

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44
Q

what does an obturator of a trach do?

A

used to put it back in if it falls out

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45
Q

what is a trach tube with an inflated cuff used for?

A

risk of aspiration or in mechanical ventilation (inflate cuff with min. volume required to create an airway seal ~ should not exceed 20mm Hg in order to prevent necrosis)

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46
Q

what is important to know before deflating a trach cuff?

A

deflate only if patient is not at risk for aspiration

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47
Q

what does deflating a trach cuff allow?

A

talking and makes swallowing easier

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48
Q

when is dislodgement the most dangerous?

A

during the first 5-7 days

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49
Q

retention sutures

A

free ends taped to skin and left accessible in case tube is dislodged you can just rip them opened if lost airway

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50
Q

precautions to prevent with dislodgement

A
  • have replacement tube at bedside
  • do not change ties for 24 hours
  • physician performs first tube change
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51
Q

how might minor dyspnea be alleviated

A

put patient in semi-fowler’s

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52
Q

if a trach cannot be replaced what should you do with the stoma?

A

cover with a sterile dressing and ventilate with bag mask until help arrives

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53
Q

how often should a trach tube be changed?

A

monthly

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54
Q

how should a person with a trach receive oxygen?

A

should be humidified

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55
Q

can patients change their trach tubes at home?

A

yes, using a clean technique

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56
Q

what is important to know with decannulation of a trach?

A
  • take out when patient can adequately exchange air and expectorate
  • close stoma with tape and occlusive dressing
  • splint the incision when coughing, swallowing, speaking
  • should close in 4-5 days
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57
Q

most common facial fracture

A

nasal fracture

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58
Q

what does a nasal fracture occur as a result of?

A

blunt trauma

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59
Q

complications of nasal fracture

A

airway obstruction, epistaxis, CSF leak (clear or pink tinged nasal drainage), hematomas, deformity

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60
Q

treatment of nasal fracture

A

maintain airway, reduce pain and edema, prevent complications, upright position, ice, analgesic, nasal decongestants or nasal sprays, no smoking

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61
Q

what could occur from a rhinoplasty

A

swelling, so elevate the head

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62
Q

treatment of epistaxis

A

keep patient quiet, sitting, and pinch entire lower portion of the nose for 10-15 minutes

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63
Q

what can treatment of epistaxis cause?

A

can impair respiratory status

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64
Q

treatment of allergic rhinitis

A

identify and avoid allergens

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65
Q

treatment of acute viral rhinitis (common cold)

A

relieve symptoms, gargles, saline nasal sprays, antihistamines and decongestants, cough suppressants

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66
Q

complications of the common cold

A

pharyngitis, sinusitis, otitis media, tonsillitis and lung infections - need to mobilize secretions

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67
Q

manifestations of secondary bacterial infection

A

higher temperature, tender swollen glands, sinus pain, ear pain, green drainage

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68
Q

can acute viral rhinitis be treated with antibiotics?

A

yes they may be treated with them

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69
Q

treatment of influenza

A

antivirals (zanamivir-relenza and oseltamivir-tamiflu), prevention, vaccination (inactivated and live, attenuated)

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70
Q

what would you caution someone with sinusitis using topical decongestant?

A

don’t use for longer than 3 days to prevent rebound congestion caused by vasodilation ~ dry mucosa

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71
Q

nasal polyps

A

benign growths in sinus or nasal mucosa

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72
Q

manifestations of acute pharyngitis

A

fever, anterior cervical node enlargement and tonsillar exudate (yellow-green), absence of cough-bacterial, irregular white patches-candida albicans

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73
Q

how is TB spread?

A

airborne droplet: transmission requires close, frequent, or prolonged exposure, not spread by touching, kissing, or other physical contact

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74
Q

what does ghon focus develop into?

A

a granuloma - infection is walled off and further spread is stopped

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75
Q

classification of TB

A

0 = no TB exposure
1 = exposure, no infection
2 = latent TB, no disease
3 = TB, clinically active
4 = TB, not clinically active
5 = TB suspected

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76
Q

discuss pulmonary TB

A
  • takes 2-3 weeks to develop symptoms
  • initial dry cough that becomes productive
  • symptoms of fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats
  • dyspnea and hemoptysis late symptoms
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77
Q

how does LTBI present?

A

it is asymptomatic

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78
Q

positive response in TST

A
  • > = 15mm induration in low-risk individuals
  • > = in immune-compromised patients (a waning immune response can cause false negative results
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79
Q

what kind of study is required for TB diagnosis

A

bacteriologic

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80
Q

bacteriologic studies

A
  • sputum samples obtained usually on 2-3 consecutive days
  • culture can take up to 8 weeks
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81
Q

how long is TB infectious for after starting treatment?

A

first 2 weeks

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82
Q

how to treat active disease TB

A
  • treatment is aggressive
  • in two phases: initial (8 weeks) and continuation (18 weeks)
  • four-drugs: INH, rifampin, pyrazinamide, ethambutol
  • liver function should be monitored
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83
Q

how is latent TB infection treated?

A
  • usually treated with INH for 6-9 months
  • HIV should take INH for 9 months
  • alternative 3 month regimen of INH and rifapentine OR 4 months rifampin
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84
Q

physical symptoms of TB

A
  • productive cough - color of sputum
  • night sweats
  • afternoon temperature elevation
  • weight loss
  • pleuritic chest pain
  • crackles over apices of lungs
85
Q

how can a patient prevent spread of TB?

A
  • wear mask if outside negative-pressure room
  • identify and screen close contacts
  • hand hygiene
86
Q

when can airborne isolation for a patient with TB be discontinued?

A

after three consecutive acid-fast bacillus smears are negative

87
Q

three ways organisms can reach lungs

A
  1. aspiration
  2. inhalation of microbes present in the air
  3. hematogenous spread from primary infection elsewhere in body
88
Q

community-acquired pneumonia (CAP)

A
  • occurs in patient who have not been hospitalized or resided in LTC facility within 14 days of the onset of symptoms
89
Q

medical-care associate pneumonia (MCAP)

A
  • HAP: occurring 48 hours or longer after admission and not incubating at time of hospitalization
  • VAP: occurring more than 48 hours after endotracheal intubation
  • HCAP: new onset pneumonia in pt. who was hospitalized for 2 days or longer within 90 days of infection OR resided in LTC facility OR received recent IV antibiotic therapy, chemo, or wound care within past 30 days OR attended a hospital or hemodialysis clinic
90
Q

how to we determine the probable organism in pneumonia?

A

culture of sputum

91
Q

what is opportunistic pneumonia caused by?

A

microorganisms that do not normally cause disease ~ sneak in when someone is down and they find an opportunity

92
Q

manifestations of pneumonia

A
  • cough
  • fever, shaking chills
  • dyspnea, tachypnea
  • pleuritic chest pain
  • green, yellow, or rust-colored sputum
  • change in mentation for older or debilitated patients
93
Q

physical findings of pneumonia

A
  • rhonchi and crackles
  • bronchial breath sounds
  • egophony
  • fremitus
  • dullness to percussion if pleural effusion present
94
Q

c-reactive protein (CRP)

A

a protein made by liver and released into the blood within a few hours after tissue injury, the start of infection, or other cause of inflammation

95
Q

when is pneumococcal vaccine suggested?

A

for those at risk! age 65 or older, age 2-64 with LT health problem or immunosuppression, age 19-64 who smoke or have asthma, live in nursing homes or LTC facility

96
Q

how does drug therapy work with pneumonia?

A
  • shart with IV and switch to PO as soon as patient is stable
  • min. of 5 days of therapy (should see improvement in 3-5 days)
97
Q

what would you want to know in someone with pneumonia?

A
  • past health history of lung cancer, COPD, diabetes, malnutrition, chronic debilitating disease
  • use of antibiotics, corticosteroids, chemo, or immunosuppressants
  • recent abdominal or thoracic surgery (not willing to cough)
  • recent intubation
  • tube feedings
98
Q

what does COPD include?

A

chronic bronchitis and emphysema

99
Q

what percentage of smokers develop airway obstruction?

A

15%

100
Q

what percentage of COPD deaths are related to tobacco smoking?

A

80-90%

101
Q

what does nicotine do?

A
  • simulates sympathetic NS: inc. HR, causes peripheral vasoconstriction, inc. BP and cardiac workload
  • dec. amount of functional Hgb: will be high when drawn b/c body is working a lot
  • inc. platelet aggregation
  • compounds problems in CAD
102
Q

how does cigarette smoking affect the respiratory tract?

A
  • inc. production of mucus
  • lost of dec. ciliary activity
  • chronic, enhanced inflammation
  • carbon monoxide
  • dec. O2 carrying capacity: inc. HR, impaired psychomotor performance and judgment
103
Q

what can COPD result in?

A

pulmonary hypertension

104
Q

manifestation of COPD

A
  • develops slowly
  • cough
  • sputum production
  • exposure to risk factors
  • dyspnea on exertion - at rest with advanced
  • chest breathing
  • chest tightness
  • underweight with adequate caloric intake
  • chronic fatigue
  • prolonged expiratory phase
  • wheezes
  • dec. breath sounds
  • barrel chest
  • tripod position
  • pursed lip breathing
  • bluish-red color of skin
105
Q

complications of COPD

A
  • cor pulmonale
  • exacerbations of COPD
  • acute respiratory failure
  • peptic ulcer disease
  • depression/anxiety
106
Q

cor pulmonale manifestations

A
  • dyspnea
  • JVD
  • hepatomegaly with RUQ tenderness
  • peripheral edema
  • weight gain
107
Q

typical ABG findings in COPD later stages

A
  • low PaO2
  • inc. PaCO2
  • dec. pH
  • inc. bicarbonate level
108
Q

CO2 narcosis

A

over time some COPD pts. develop tolerance for high CO2 levels

109
Q

diet for COPD patients

A

high protein, high calorie, 3L of fluid per day

110
Q

activity recommendations for COPD pts.

A

walk 15-20 minutes a day at least 3 times a week with gradual increase

111
Q

is asthma reversible?

A

usually

112
Q

risk factors in asthma

A
  • genetic factors
  • environment
  • male gender in children
  • obesity
  • genetics
  • immune response
113
Q

exercise-induced asthma (EIA)

A

induced or exacerbated during physical exertion; pronounced with exposure to cold air

114
Q

occupational lung disease

A

exposure to diverse agents, may take months or years of exposure, pt. will arrive at work well and then experience gradual decline

115
Q

air pollutants

A

cigarette or wood smoke, vehicle exhaust, concentrated pollution

116
Q

asthma triggers

A
  • respiratory infections: inc. inflammation and hyperresponsiveness of the tracheobronchial system
  • asthma triad: nasal polyps, asthma, and sensitivity to aspirin and NSAIDs
  • GERD: reflux may trigger bronchoconstriction as well as cause aspiration and asthma medications may worsen GERD
  • psychological factors: panic and anxiety
117
Q

where are salicylates found?

A

foods, beverages, flavorings

118
Q

primary response of asthma

A

chronic inflammation

119
Q

what do inflammatory mediators cause in asthma?

A
  • vascular congestion
  • edema formation
  • production of thick, tenacious mucus
  • bronchial muscle spasm
  • thickening of airway walls
120
Q

what could occur in asthma if airway inflammation is not treated or does not resolve?

A

may leave to irreversible lung damage

121
Q

structural changes in the bronchial wall is know as?

A

remodeling

122
Q

do severe attacks have audible wheezing?

A

they may not

123
Q

characteristics of severe and life-threatening exacerbations

A
  • RR >30
  • pulse >120
  • PEFR is 40% at best
  • seen in ED or hospital
124
Q

life-threatening asthma characteristics

A
  • too dyspneic to speak
  • perspiring profusely, drowsy/confused
  • require hospital care and often admitted to ICU
125
Q

what does IV magnesium sulfate do in asthma?

A

given as a bronchodilator ~ relaxes smooth muscle

126
Q

corticosteroids

A
  • taken on a fixed schedule
  • systemic form to control exacerbations and manage persistent asthma
127
Q

what should you be careful for in those taking corticosteroids?

A

oropharyngeal candidiasis; teach pt. to gargle after each use

128
Q

example of bronchodilator

A

albuterol ~ rescue not maintenance

129
Q

what is ephedrine used for?

A

simulated CNS and CV system, used in emergency airway attacks

130
Q

how much water should asthma patients drink?

A

2-3 L of fluid each day

131
Q

what should asthma pts. avoid?

A
  • cold air
  • aspirin, NSAIDs, nonselective B-blockers
132
Q

green, yellow, and red zone of PEFR

A
  • green = 80-100% of best
  • yellow = 50-80%
  • red = 50% or less
133
Q

how much does 1L of water weigh?

A

2.2 lbs (1 kg)

134
Q

cations

A

+ charge: sodium, potassium, calcium, and magnesium

135
Q

anions

A
  • charge: bicarbonate, chloride, and phosphate, most proteins
136
Q

most prevalent cation and anion in ICF

A

cation: K+
anion: PO43-

137
Q

most prevalent cation and anion in ECF

A

cation: Na+
anion: Cl-

138
Q

diffusion

A

movement of molecules across a permeable membrane from high to low concentration

139
Q

facilitated diffusion

A

uses carrier to move molecules

140
Q

active transport

A

molecules move against concentration gradient - energy is required

141
Q

osmosis

A

movement of water down concentration gradient from low solute concentration to high across a semipermeable membrane

142
Q

osmotic pressure

A

amount of pressure required to stop osmotic flow of water

143
Q

osmolarity

A

measures total milliosmoles/L of solution

144
Q

osmolality

A
  • measures number of milliosmoles/kg of water
  • preferred measure to evaluate concentration of plasma, urine, and body fluids
145
Q

isotonic

A
  • equal
  • NS or LR
146
Q

hypotonic

A
  • less solutes than fluid, “fat gummy bear”
  • D5 1/2 NS
147
Q

hypertonic

A
  • more solutes than fluid
  • D10W or 3% NS
148
Q

plasma-to-interstitial fluid shift results in…

A

edema

149
Q

interstitial fluid drawn into plasma…

A

decreases edema

150
Q

first spacing

A

normal distribution

151
Q

second spacing

A

abnormal (edema)

152
Q

third spacing

A

fluid is trapped where it is difficult or impossible for it to move back into cells or blood vessels (peritoneal or pleural spaces)

153
Q

primary organ for regulating fluid and electrolyte balance

A

renal system

154
Q

manifestation of hypovolemia

A

restlessness, drowsiness, lethargy, confusion, postural hypotension, tachycardia, tachypnea, weakness, dizziness, weight loss, seizures, and come

155
Q

what could cause hypovolemia?

A

diarrhea, vomiting, hemorrhage, polyuria

156
Q

what would cause hypervolemia?

A

heart failure, renal failure, colloids

157
Q

manifestation of hypervolemia

A

headache, confusion, lethargy, peripheral edema, JVD, bounding pulse, hypertension, dyspnea, crackles, pulmonary edema, muscle spasms, seizures, coma

158
Q

most accurate measure of volume status

A

daily weights - an increase of 1 kg (2.2 lbs) is equal to 1000 mL (1L) of fluid retention

159
Q

concentrated urine specific gravity

A

1.025

160
Q

dilute urine specific gravity

A

1.010

161
Q

normal ranges of sodium

A

135-145

162
Q

manifestations of hypernatremia

A

thirst, postural hypotension, tachycardia, weakness, alterations in mental status

163
Q

what would be considered too much sodium loss/gain?

A

more than 8-15 mEq/L in an 8 hour period

164
Q

manifestations of hyponatremia

A
  • mild: headache, irritability, difficulty concentration
  • severe: confusion vomiting, seizures, coma
  • clinical manifestations are result of cellular swelling and are first manifested in the CNS
165
Q

main cause of hyponatremia

A

water excess - SIADH ~ fluid restriction needed and loop diuretics

166
Q

in hyponatremia, what can you do with severe symptoms (seizures) in the ICU only?

A

give small amount of IV hypertonic saline solution (3% NaCl)

167
Q

potassium normal ranges

A

3.5-5.0

168
Q

sources of potassium

A
  • fruits and vegetables (bananas and oranges)
  • salt substitute
  • potassium medications
  • stored blood
169
Q

where is potassium regulated?

A

in the kidneys and this is the only mechanism to clear excess

170
Q

most common cause of hyperkalemia

A

renal failure

171
Q

hyperkalemia causes

A
  • impaired renal excretion
  • shift from ICF to ECF (acidosis)
  • massive intake
172
Q

manifestations of hyperkalemia

A
  • cardiac dysrhythmias
  • cramping leg pain
  • weak or paralyzed skeletal muscles
  • abdominal cramping or diarrhea
173
Q

urgent Rx to give someone with hyperkalemia

A

insulin and D50 IV, calcium, bicarbonate

174
Q

hypokalemia causes

A
  • loss of potassium via kidneys or GI tract (most common)
  • increased shift of potassium from ECF to ICF (with DKA)
  • dietary deficiency (rare)
  • alkalosis causes shift if severe
175
Q

manifestations of hypokalemia

A
  • cardiac most serious
  • skeletal muscle weakness (legs)
  • weakness of respiratory muscles
  • dec. GI motility
  • hyperglycemia
176
Q

what is important for anyone with a potassium problem to have?

A

cardiac monitor

177
Q

what is important when administering potassium?

A
  • PO or IV
  • always dilute IV KCl
  • NEVER give KCl via IV push or as a bolus
  • should not exceed 10 mEq/hr via pump
  • except in severe deficiencies, KCl is not given unless there is urine output of at least 0.5 mL/kg of body weight per hour
178
Q

normal calcium levels

A

8.5-10.2

179
Q

what is calcium balance controlled by?

A

PTH and calcitonin

180
Q

hypercalcemia causes

A
  • hyperparathyroidism
  • malignancy
  • thiazide diuretic use, prolong immobilization, and increased calcium intake
181
Q

manifestations of hypercalcemia

A
  • excess calcium acts like a sedative
  • fatigue, lethargy, weakness, confusion
  • hallucinations, seizures, coma
  • cardiac dysrhythmias
  • bone pain, fractures, nephrolithiasis
  • polyuria, dehydration
182
Q

hypocalcemia causes

A
  • dec. PTH
  • multiple blood transfusions - citrate used to anticoagulate the blood binds with calcium *Ca and citrate go together
  • alkalosis
  • inc. calcium loss
  • surgical removal of parathyroid glands
183
Q

manifestations of hypocalcemia

A
  • tetany
    • trousseau’s or chvostek’s sign
  • laryngeal stridor ~ losing airway!
  • dysphagia
  • tingling around mouth or in extremities
  • cardiac dysrhthmias
184
Q

normal phosphate levels

A

2.5-4.5

185
Q

hyperphosphatemia causes

A
  • AKI or chronic disease
  • chemo
  • excess intake of phosphate or vitamin D
  • hypoparathyroidism
186
Q

maintenance of phosphate requires what?

A

adequate renal functioning

187
Q

manifestations of hyperphosphatemia

A
  • NM irritability and tetany (hypocalcemia)
  • calcified deposition in soft tissue such as joints, arteries, skin, kidneys, corneas
188
Q

describe the relationship between calcium and phosphate

A

if Ca is high, phosphate will be low and vise versa

189
Q

what kind of foods contain phosphorus?

A

dairy

190
Q

hypophosphatemia causes

A
  • malnourishment/malabsorption
  • diarrhea
  • use of phosphate-binding antacids
  • inadequate from parenteral nutrition
191
Q

manifestations of hypophosphatemia

A
  • impaired cellular energy and O2 delivery
  • CNS depression
  • muscle weakness and pain
  • respiratory and heart failure
192
Q

normal magnesium levels

A

1.5-2.5

193
Q

what is magnesium important for?

A

normal cardiac function

194
Q

where is magnesium excreted?

A

the kidneys

195
Q

hypermagnesemia causes

A
  • inc. intake or ingestion of products containing Mg when renal insufficiency or failure is present
  • excess IV Mg administration
196
Q

manifestations of hypermagnesemia

A
  • lethargy
  • nausea and vomiting
  • impaired reflexes
  • muscle paralysis
  • respiratory and cardiac arrest
197
Q

what drug reverses out Mg?

A

IV CaCl or calcium gluconate

198
Q

hypomagnesemia causes

A
  • prolonged fasting or starvation
  • chronic alcoholism
  • fluid loss from GI tract
  • prolonged parenteral nutrition without supplementation
  • diuretics
  • hyperglycemic osmotic diuresis
199
Q

manifestations of hypomagnesemia

A
  • hyperactive deep tendon reflexes
  • muscle cramps
  • tremors
  • seizures
  • cardiac dysrhythmias - torsade de pointes and ventricular fibrillation
  • corresponding hypocalcemia and hypokalemia causes symptoms
200
Q

too rapid administration of magnesium can lead to…

A

hypotension and cardiac or respiratory arrest

201
Q

hypotonic fluids

A

0.45% NaCl

202
Q

isotonic fluids

A

0.9 NS
LR
D5W
NS

203
Q

what is the preferred fluid for immediate response?

A

NS

204
Q

what fluid is compatible with most meds and is the only fluid used with blood?

A

NS

205
Q

what do LRs do?

A

expands ECF - treats burns and GI losses

206
Q

why would LRs be contraindicated?

A

those with hyperkalemia and lactic acidosis

207
Q

hypertonic fluids

A

D5 1/2 NS
D10W

208
Q

use of hypertonic fluids

A

to provide calories as part of parenteral nutrition

209
Q

colloids

A
  • contain large molecules that inc. oncotic pressure and pull fluid into the blood vessels
  • also called volume expanders or plasma expanders
  • includes: human plasma products (albumin, fresh frozen plasma, blood) and semisynthetics (dextran and starches, [hespan])

NSG 312 OB (4 decks)

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