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Nursing > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Intracellular Fluid

A

maintaining cell size
70% of total body fluid
about 40% of adult body weight is from ICF

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2
Q

Extracellular

A

30% of total body fluid and ~20% of body
weight

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3
Q

Intravascular fluid

A

Type of ECF
plasma of the blood
blood volume, impacts HR/BP

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4
Q

Interstitial Fluid

A

Type of ECF
surrounds cells

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5
Q

Trans Cellular

A

Cerebrospinal, Pleural,
Peritoneal, Synovial, Digestive secretions,
Sweat

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6
Q

OSMOLARITY

A

Concentration of particles in a solution

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7
Q

Isotonic

A

When the osmolarity is equivalent to plasma

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8
Q

Hypertonic

A

When the osmolarity is greater than plasma. Hypertonic fluids pull water from the cells and into the intravascular spaces.

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9
Q

Hypotonic

A

When the osmolarity is less than plasma. Hypotonic fluids move from the intravascular space to the ICF

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10
Q

Normal Saline

A

Isotonic Solution. Treat hypovolemia, hyponatremia, hypercalcemia, metabolic alkalosis.

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11
Q

Lactated Ringers (LR)

A

Isotonic Solution. Contains multiple electrolytes. Lacks magnesium. Treats hypovolemia, burns, and GI losses

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12
Q

5% Dextrose in Lactated Ringers (D5LR)

A

Hypertonic Solution. Replaces electrolytes, provides calories, shifts fluids from cells to vascular space expanding vascular volume

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13
Q

Half strength normal saline (0.45%NaCl)

A

Hypotonic Solution. Often used as a maintenance fluid. Provides Na Cl and free water

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14
Q

Fluid Intake methods

A

ingested water, ingested food, metabolic oxidation

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15
Q

Fluid Output methods

A

kidneys, skin, lungs, gastrointestinal

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16
Q

Kidneys

A

Filter 180 L of plasma/day while excreting ~1.5 L/day. Manage ECF volume and osmolality. Regulates electrolyte levels by retaining or eliminating.

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17
Q

Heart & Vascular

A

Circulate fluid, adequate perfusion pressure in kidneys for filtration. Stretch receptors respond to changes in volume and stimulate fluid retention when hypovolemia is present

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18
Q

Heart & Vascular

A

Circulate fluid, adequate perfusion pressure in kidneys for filtration. Stretch receptors respond to changes in volume and stimulate fluid retention when hypovolemia is present

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19
Q

Lungs

A

Water vapor excreted/lost per day: 300mL/day

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20
Q

Nervous System

A

Osmoreceptors (type of neuron) sense changes in ECF concentration and stimulate the pituitary gland to release or inhibit release of ADH. Thirst center in the hypothalamus is activated by cellular dehydration

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21
Q

Gastrointestinal Track

A

Absorbs water and nutrients

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22
Q

Adrenal Glands

A
  • Aldosterone secretion causes sodium (and
    water) retention and potassium loss
  • Excess cortisol secretion can cause the same
    effect as aldosterone
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23
Q

Pituitary Gland

A

Manages antidiuretic hormone (ADH)
* ADH allows the body to retain water
* ADH in increased when osmotic pressure of
ECF is greater than that of the cells, when
blood volume is decreased
* ADH is suppressed when osmotic pressure
of the ECF is less than that of the cells, or
when blood volume is increased

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24
Q

Thyroid Gland

A
  • Thyroxine secretion least to increased blood
    flow, including to the kidneys , whey increases
    filtration rate and urinary output
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25
Q

Thyroid Gland

A
  • Thyroxine secretion least to increased blood
    flow, including to the kidneys , whey increases
    filtration rate and urinary output
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26
Q

Parathyroid Gland

A
  • Regulates calcium and phosphate balance
    through parathyroid hormone (PTH)
  • PTH influences bone reabsorption, calcium
    absorption from the intestines and calcium
    reabsorption from the kidneys
  • Increased PTH cases increased blood
    (serum) calcium and deceased phosphate;
    and decreased PTH cases decreased
    calcium and increased phosphate
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27
Q

Interstitial excess

A

edema

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28
Q

Intravascular excess

A

hypervolemia

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29
Q

Acidis/Third Spacing

A

Fluid moves into transcellular compartments (pleural,
peritoneal, pericardial, joints, bowel,) or interstitial spaces. Causes hypovolemia (fluid is unavailable for use)

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30
Q

hyponatremia

A

Not enough Sodium. Nausea, vomiting, muscle cramps, hypotension, edema, weakness, confusion, lethargy, twitching, seizures, coma

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31
Q

Hypernatremia

A

Too much sodium. Thirst, dry mucous membranes, hallucinations, lethargy, seizures, coma

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32
Q

Hypokalemia

A

Not enough potassium. Fatigue, anorexia, nausea, committing, muscle weakness, decreased bowel motility, cardia arrhythmias, paresthesia, postural hypotension, EKG changes

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33
Q

Hyperkalemia

A

Too much potassium. Vague muscle weakness, cardia arrhythmia, decreased excitability of the heart. Paresthesias of face, tongue, feet, and hands

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34
Q

Hypomagnesemia

A

Not enough magnesium. Neuromuscular irritability, increased reflexes, coarse tremors, seizures, cardiac manifestations=tachyarrhythmias, increased susceptibility to digitalis toxicity, disorientation, mood changes

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35
Q

Hypermadnesemia

A

Too much magnesium. Hypotension, flushing, drowsiness, decreased reflexes

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36
Q

Hypocalcemia

A

not enough calcium. Increased excitability of muscles and nerves (cardiac arrhythmias) trousseau and Chvostek signs, numbness and tingling of fingers and toes, mental changes, cramps in musles

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37
Q

Hypercalcemia

A

too much calcium. Muscle weakness, tiredness, lethargy, constipation, decreased memory, kidney stones, cardiac arrest

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38
Q

Chvostek’s sign

A

tapping on facial nerve just anterior to the ear produces tetany (inoluntary twitching on the
ipsilateral (same) side of the patients face/upper lip). Tests for hypocalcemia

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39
Q

Trousseau Sign

A

Inflate a BP cuff above NSBP range. Positive response in a patient with hypocalcemia is a wrist, metacarpal and phalangeal/thumb flexion. Tests for hypocalcemia

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40
Q

Hypophosphatemia

A

not enough phosphate. Respiratory failure, seizures, decreased tissue oxygenation, joint stiffness, increased risk for infection

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41
Q

Hyperphosphatemia

A

Tetany (tingling of fingers, mouth, numbness, spasms) long term can lead to calcification of soft tissues

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42
Q

Hypovolemia

A

loss of both fluids and solutes from the extracellular spaces. Leaves interstitial space to be hypertonic resulting in cells without adequate fluid to function
5% weight change is considered a deficit
15% weight change is considered life threatening

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43
Q

Onset, Peak, and Duration of Rapid-Acting insulin

A

O=15-30m
P=30m-2.5h
D=3-6h

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44
Q

Onset, Peak, and Duration of short-Acting insulin

A

O=30-60m
P=1-5h
D=6-10h

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45
Q

Onset, Peak, and Duration of intermediate-Acting insulin

A

O=1-2h
P=4-12
D=16h

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46
Q

Onset, Peak, and Duration of long-Acting insulin

A

O=3-4h
P=continuous
D=24h

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47
Q

Digoxin

A

Anti-Arrhythmic. Toxicity: monitor digoxin level (nausea, vomiting. Visual disturbances, bradycardia. Assess apical pulse for 1 minute. Hold if rate is under 60bppm

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48
Q

Aspirin

A

Antipyretic, non-opioid analgesic

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49
Q

Aspirin Side Effects

A

Prolongs bleeding time
Toxicity: tinnitus, agitation, confusion, GI bleed
Do not crush. Enteric coded
Take with a full glass of water and sit up for 15-30m
Avoid Alcohol

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50
Q

Furosemide

A

Loop Diuretic

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51
Q

Furosemide Considerations

A

Consider hypovolemia. Won’t hold K+.
Toxicity=tinnitus
Give am. Last dose no later than 17:00
Ototoxic (hearing loss) if given rapidly through IV.

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52
Q

Warfarin

A

Anti-Coagulant

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53
Q

Warfarin Considerations

A

Antidote=SQ Vit K
Monitor labs=PT/INR=2-3=how quickly is blood clotting?
Monitor for s/s of bleeding=use electric razor
avid food high in K+
consult PCP before starting new medications or OTC medications due to interaction lists

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54
Q

Prednisone

A

Corticosteroid (antiasthmatic)

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55
Q

Prednisone Considerations

A

monitor electrolytes (hypokalemia) and glucose (hyperglycemia)
cannot stop suddenly
administer in am with meals.

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56
Q

Nitrogylcerin transdermal

A

Anti-angina-vasodilator

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57
Q

Nitrogylcerin transdermal Considerations

A

monitor HR and BP=hypotension. Watch orthostatic hypotension
Remove patch before reapplying new patch. rotate patch application site
Headache common side effect
contraindication: verify if patient is taking erectile dysfunction medications
remove before MRI, cardio version or defibrillation

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58
Q

Sertraline

A

SSRI (selective serotonin reuptake inhibitor)

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59
Q

Sertraline Considerations

A

careful suicide assessment
avoid alcohol and other CNS antidepressants.
Photosensitivity

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60
Q

metoprolol

A

Beta-blocker, antihypertensive

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61
Q

metoprolol consideration

A

monitor BP and HR. Monitor EKG periodically and during adjustments
assess apical pulse for 1 minute: hold if HR is less than 60HR or Systole of less than 90

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62
Q

Metformin

A

Antidiabetic

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63
Q

Metformin Considerations

A

Do not crush=extended release
monitor serum glucose and glycosylated hemoglobin levels
Contraindications: IV contrast procedures=stop taking at time of test and alert for 48hrs

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64
Q

Enoxaparin

A

Anticoagulant, antithrombotic

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65
Q

Enoxaparin Considerations

A

prefilled syringe: do not expel the air
can be given for 7-14 days
Antidote: protamine sulfate
Avoid ASA, NSAIDS
Monitor stool for occult blood

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66
Q

Morphine Sulfate and Hydromorphone

A

opiod

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67
Q

Morphine Sulfate and Hydromorphone Considerations

A

Given IVPB
More potent that morphone sulfate
Antidote=narcan
monitor HR or BP
two nurses verification for discarding

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68
Q

Heparin Infusion

A

Anticoagulant

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69
Q

Heparin Infusion Considerations

A

Monitor labs during IV infusion
PTT or aPTT: blood viscosity test for heparin
antidote: protamine sulfate
Can be given sub cue

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70
Q

Routine

A

carried out until canceled by a physician

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71
Q

Standing

A

Carried out if/when the circumstances exist

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72
Q

PRN

A

given when Pt. requires it

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73
Q

Single doses

A

given only one time

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74
Q

STAT:

A

given immediately

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75
Q

Telephone or verbal order

A

only acceptable in emergency situations–write down and perform a read back

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76
Q

Medication reconciliation

A

review of all medications that the patient took before they reached you. Then medications are reconciled each time the patient changes care areas.

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77
Q

Triple Check

A

Visually confirm the medication three times:
At reach
In hand (med/dose)
One last time before administration

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78
Q

Three Checks:

A

Check the medication order
Check pt. Allergies
Check expiration date

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79
Q

Six Rights

A

Right drug, right dose, right route, right time, right patient, right documentation

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80
Q

Patient’s Rights

A

Right to information
Right to refuse
Right to a careful assessment
Right to informed consent
Right to safe administration
Right to supportive therapy
Right to have no unnecessary medications

81
Q

Topical Medications

A

Emollients, steroids, antihistamines, hormone replacement, nitroglycerin

82
Q

Transdermal

A

Adhesive stickers/patches. Absorbed in the bloodstream through the skin. Nicotine, fentanyl, lidocaine, dramamine, hormone replacement, birth control, scopolamine.

83
Q

Ophthalmic Medications

A

Medications administered to the eye
Glaucoma agents, antihistamines
Ointments or drops

84
Q

Ear Drops

A

Lubricants or antibiotics
We should have warmed solutions by rolling medication in hands until it is warm

85
Q

Nasal Medications:

A

Antihistamines, steroids, decongestants, moisture

86
Q

Vaginal

A

Patients should urinate before this
Antifungals, antibiotic, hormone replacement
Instill with applicator
Have them remain in the supine position for 5-10 minutes

87
Q

Rectal

A

Laxatives, antiemetic, analgesic, antipyretic
Suppositories
Placed in Sims position
Drape the patient well
Suppositories are designed to melt at body temperature
Insert 3-4 inches
REmain in sims position for 5 minutes

88
Q

Parenteral

A

Not using the GI tract.

89
Q

Insulin Syringe Size

A

1-3 mL and Gauge 25-30. Length 3/8” to 1”

90
Q

Subcutaneous Administration Locations

A

Abdomen, Outer aspects of upper arms, Outer thigh, Upper buttock, Scapular area

91
Q

Intramuscular Injection Amount/Size

A

3-5 mL syringe,
Gauge 18-25
Length 5/8”-1.5”
Usually 21-23 G, 1-1.5”

92
Q

Intramuscular Sites

A

Deltoid: no more than 1 mL
Ventrogluteal: no more than 3 mL
Vastus Lateralis: Up to 2mL

93
Q

IV Infiltration

A

IV fluids enter the surrounding space around the venipuncture site.
s/sx: sweeling, pallor, coolness around the site, pain

94
Q

Phlebitis

A

Inflammation of the vein
s/sx: pain, edema, erythema, increase skin temperature, redness traveling the path of the vein

95
Q

Sub Cue Angle of Needle

A

Can be 45 or 90 degree angle. Adjust your angle because we cannot change needle size

96
Q

IM Angle:

A

always 90 degrees but you can change the length of size of the needle

97
Q

1 CC/mL

A

100 units

98
Q

1 CC/mL

A

100 units

99
Q

Cold and clammy, give candy.

A

Low blood sugar

100
Q

Hot and dry is very high

A

High blood sugar/Ketoacidosis

101
Q

Lovenox

A

weight based and comes in a prefilled syringe with an air bubble. We want to RETAIN the airbubble

102
Q

Ventilation

A

movement of air into and out of the lungs

103
Q

Respiration

A

gas exchange between atmospheric air in the alveoli and the capillaries

104
Q

Perfusion

A

oxygenated capillary blood passes through body tissues for use

105
Q

Inspiration

A

Part of Ventilation: diaphragm and intercostal muscles contract, enlarging the thorax and decreasing intrathoracic pressure, which allows air to rush in.

106
Q

Expiration

A

Part of ventilation: diaphragm & intercostal muscles relax, causing the thorax to get smaller and increases pressure, which forces air out of the lungs

107
Q

Proprioceptors

A

send signal to increase ventilation with increased physical activity

108
Q

Hyperventilation

A

Ventilation in excess of what is required to remove CO2. Possible causes include: anxiety, infection/fever, hypoxia, diabetic ketoacidosis, aspirin overdose

109
Q

Hypoventilation

A

Ventilation is inadequate to meet the body’s oxygen demand OR is inadequate to remove sufficient CO2. Possible causes include: COPD, obesity hypoventilation syndrome, atelectasis

110
Q

Hypoxia

A

Inadequate oxygen available for the cells. Possible causes include: decreased hemoglobin, hypoventilation, aspiration, poor tissue perfusion

111
Q

Plumbing

A

Pump (heart), Pipes (vessels)

112
Q

Electrical

A

Pacemaker (SA node), Electrical signal needs to move in an orderly fashion for the cardiac tissue to adequately function

113
Q

Arrhythmia

A

electrical conduction problem causing irregular or ineffective beats

114
Q

Ischemia

A

impaired oxygen delivery

115
Q

Myocardial Ischemia

A

can lead to myocardial infarction (MI)

116
Q

Cardiac valve stenosis

A

causes inefficient pumping

117
Q

Heart failure

A

inefficient pumping of blood supply

118
Q

Hypovolemia

A

inadequate blood supply

119
Q

Diaphragmatic breathing

A

To create a more functional respiratory pattern,
especially for people with COPD.
Decreases RR, increases gas exchange in
more alveoli

120
Q

Oral hydration

A

2-3 liters of oral fluid intake/day to help
thin secretions

121
Q

Lung Compliance

A

elasticity. Ability of a lung to recoil and expand

122
Q

Pleural space

A

Surrounds the lungs to allow the lungs to expand and contract without much friction. There is fluid inside the pleural space that allows less friction

123
Q

Atelectasis

A

collapsed alveoli which lead to impared gas exchange

124
Q

Acute Hypoxia

A

Emergency that can lead to death and needs to be dealt with quickly

125
Q

Chronic Hypoxia

A

The pts body can adjust to the lower level of oxygen

126
Q

EKG

A

maps out the electrical activity of the heart

127
Q

Holter Monitor

A

24-48 hour EKG that will record the heart for a longer period of time

128
Q

Echocardiogram

A

Ultrasound that shows the heart

129
Q

Transesophageal Echocardiogram

A

visualizing the heart from the heart down from inside the esophagus

130
Q

Cardiac Stress Test

A

running on a treadmill to see what is happening to their heart in stress

131
Q

Pharmacologic Stress Test

A

medication is injected to cause a stressful response

132
Q

Cardiac Angiography

A

pt is NPO and they go to the cath lab. Physician threads a cath through the radial artery/vein and into the heart. This allows him to identify blockage or build up in the heart or arteries

133
Q

Capnography

A

evaluate CO2 from breath

134
Q

VQ scan

A

evaluates the presence of a blood clot in the pulmonary system

135
Q

Pulmonary Function Testing

A

tests that seek to discover the capacity of ones lungs

136
Q

Thoracentesis

A

fluid is removed from the thorax. Draining fluid in the pleural space and into collection containers

137
Q

Bronchoscopy

A

tube placed into respiratory tract and into the bronchioles to examine/diagnose or collect tissue samples for bx

138
Q

Productive Coughing

A

moves secretions

139
Q

Non-Productive Coughing

A

irritation in respiratory tract

140
Q

Expectorant Medications

A

Helpful for a productive cough

141
Q

Suppressants

A

Helpful for a non-productive cough

142
Q

Lozenges

A

Provide a local anesthetic

143
Q

Incentive Spirometer

A

Used for lung expansion
Semi-Fowlers or Fowlers
Exhale normally place mouth on mouthpiece and inhale through the mouth. At full inhalation, instruct to hold breath for 3 seconds, if possible

144
Q

Chest Physiotherapy

A

Helps to mobilize secretions for large amounts of secretions or ineffective coughs
Selective usefulness in some populations
Usually performed by RT, PT, specifically trained nurses
Use of percussion, vibration, and postural drainage

145
Q

Suctioning

A

Required when pts is unable to clear secretions. Avoid excessive suctioning
Oropharynx or nasopharynx suctioning removes secretions from the patient’s mouth or upper throat
Tracheal Suctioning: requires sterile technique

146
Q

Pneumothorax

A

trapped air in the pleural space

147
Q

Hemothorax

A

trapped blood in the pleural space

148
Q

Pleural Effusion

A

trapped fluid in the pleural space

149
Q

Room air

A

21% oxygen

150
Q

Flow Meter

A

attaches to the O2 outlet to adjust the O2 being delivered

151
Q

High Flow Oxygen Administration

A

oxygen delivery does not vary with breathing pattern or depth

152
Q

Low Flow of Oxygen Administration

A

provides only part of the total inspired air because oxygen delivery varies with breathing pattern/depth

153
Q

Chemical make-up of blood

A

pH, O2 & CO2

154
Q

Upper airway Structure

A

nose, pharynx, larynx, & trachea

155
Q

Lower Airway Structure

A

right lung (3 lobes)
Left lung (2 lobes)

156
Q

Thoracic cavity

A

rib cage, muscles, & diaphragm

157
Q

Barrel chest

A

Anteroposterior diameter vs. transverse
diameter=1/1

158
Q

tactile fremitus

A

External vibration while a patient talks

159
Q

Bronchial, Bronchovesicular, and Vesicular lung sounds

A

All normal and vary depending on location:
1. Bronchial: throat area
2. Vesicular, Lung Area
3. Bronchovesicular: mid chest sxphoyd processes

160
Q

Crackles

A

Bubbly sounds during inspiration
Typically not cleared with coughing
Usually due to fluid in the lungs
Commonly noted in lower lung lobes

161
Q

Rhonchi

A

Loud, Low pitched, Rumbling course sounds
Typically secondary to mucus/fluid in larger airways
May be cleared with coughing

162
Q

Wheezes

A

High pitched, Continuous musical sounds, Squeaking
May be heard throughout breathing cycle
Caused by high velocity airflow through significantly narrowed airways (bronchus)

163
Q

Stridor

A

Harsh honking wheeze with severe bronchospasm
Air passing through a very constricted airway
Secondary to croup or a swallowed object caught in an airway

164
Q

Pleural Friction Rub

A

Dry, grating sound heard best during inspiration and unaffected by coughing.
Secondary to inflamed pleura
Parietal pleura rubbing against visceral pleura

165
Q

Pneumothorax

A

Air or gas in the pleural cavity
– Result of puncture through chest wall or pleura
– Causes collapse of the lung requiring reinflation via chest tube

166
Q

Ateletasis

A

Collapse or incomplete lung expansion
Result of mucus, hypoventilation of the alveoli, or
compression by tumors/enlarged lymph nodes

167
Q

Ateletasis

A

Collapse or incomplete lung expansion
Result of mucus, hypoventilation of the alveoli, or
compression by tumors/enlarged lymph nodes

168
Q

Subcutaneous Emphysema

A

leak of air from lung tissue into subcutaneous tissue
At risk patients: post-op thoracic surgeries & blunt
trauma patients

169
Q

Kussmaul’s respirations

A

A type of hyperventilation. Exaggerated deep, regular, rapid
breathing

170
Q

Cheyne-Stokes respirations

A

Alternating periods of deep, rapid breathing followed by periods of apnea
Associated with end-of-life

171
Q

Biot’s respiration

A

–Irregular pattern characterized by varying shallow respirations followed by periods of apnea
–Associated with intracranial pressure & respiratory compromise

172
Q

Orthopnea

A

unable to breath lying down flat? They have to sleep in a recliner? Then they cannot lay flat

173
Q

Surfactant

A

it is what keeps your alveoli expanded

174
Q

Nasal cannula

A

24-44% O2

175
Q

Mask

A

90% O2

176
Q

Point of maximal impulse

A

Apex

177
Q

Systole

A

Ventricles contract

178
Q

Diastole

A

Ventricles relax

179
Q

P wave

A

Atrial Contraction

180
Q

T Wave

A

Relaxation

181
Q

QRS wave

A

Ventricle Contraction

182
Q

Four Valves

A

Aortic, Pulmonic, Tricuspid, Mitral

183
Q

Aortic Valve Location

A

Right of heart, second intercostal space

184
Q

Pulmonic Valve Location

A

left of heart, second intercostal space

185
Q

Tricuspid Valve

A

left of heart, fifth intercostal space

186
Q

Mitral Valve

A

Apex

187
Q

S1 Sound

A

Mitral valve closing prior to left ventricle contraction.
The Lub

188
Q

S2 Sound

A

Aortic valve closes after the left ventricle empties
The Dub

189
Q

Extra heart sounds

A

S3, S4. murmurs, clicks, rubs

190
Q

JVD

A

Jugular Vein Distension. Influenced by blood volume, capacity of the right atrium to receive and expel blood to the right ventricle, or ability of the right ventricle to move blood into the pulmonary artery

191
Q

Abdominal Aortic Aneurysm

A

No cardiac pulsation, but you will hear a brewy above the umbilicus.
Caused by a weakening in the wall. Then the wall creates a pouch that pops out from the aortic. High pressure

192
Q

Allen test

A

Occlude the radial and ulnar pulse by the wrist at the same time and let the hand turn white then release them one at a time to see if blood flow returns

193
Q

Occlusion

A

too much build up of plaque

194
Q

Stenosis

A

narrowing on its own or from plaque

195
Q

varicosites

A

Superficial dilated veins
Typically in the legs
Common in persons who stand for long periods of time

196
Q

Venistasious

A

blood staying in the veins

197
Q

Dependent edema

A

right sided heart failure if bilateral

198
Q

DVT

A

Calves-Deep Vein Thrombosis

Nursing (17 decks)

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