Exam #3 Flashcards
Hypokalemia
diarrhea, repeated vomiting, use of potassium-wasting diuretics
Hyperkalemia
decreased urine output
Hypocalcemia
acute pancreatitis and neuromuscular excitability
Hypercalcemia
cancer patients
Hypomagnesmia
increases neuromuscular excitability
hypermagnesmia
ESRD, neuromuscular excitability, lethargy, and decreased DTR
Normal value of Potassium
3.5-5
Normal value of Calcium
8.5-10
Normal value of Sodium
135-145
Normal value of Magnesium
1.8-4.8
Normal value for Phosphate
2.8-4.5
Metabolic Acidosis
arises from increase in metabolic acid or a decrease in base (bicarb).
Kidneys are unable to excrete enough metabolic acids, which accumulate in the blood
Results in a decreased LOC
Metabolic Alkalosis
arises from direct increase in base (bicarb) or decrease in metabolic acid
results in increased blood bicarbonate
Respiratory acidosis
-arises from alveolar hypoventilation
-lungs are unable to excrete enough CO2
-excess carbonic acid in the blood decreases pH
Respiratory alkalosis
-arises from alveolar hyperventilation
-lungs excrete too much CO2
-deficit of carbonic acid in the blood increases pH
Who are the most susceptible to fluid imbalances?
the very young and very old
What is the #1 indicator of fluid status?
daily weights
What are the possible IV complications?
fluid overload, infiltration, extravasation, phlebitis, local infection, bleeding at insertion site, and bruising.
Infiltration or Extravasation
when IVF is infusing into tissues outside of the vein
What is the treatment for infiltration and extravasation?
stop IVF, remove IVF catheter, elevate extremity, encourage active ROM, apply warm or cold compress depending on the type of solution, restart IV and IVF proximal to infusion.
How can you prevent infiltration and extravasation?
monitor IV often for light swelling or pain, secure IV well, carefully select site
What is phlebitis?
inflammation of the walls of the vein
What is Thrombophlebitis?
blood clot formation at the site of the inflammation
What is the treatment for phlebitis?
Stop IVF, remove IV catheter, elevate extremity, apply a warm compress 3-4 times daily, restart IV and IVF proximal to infusion or in another extremity, obtain culture of site and culture of IV cath tip if drainage at site.
How can you prevent phlebitis?
monitor IV often for redness and pain, rotate sites every 72 hours or more frequently if policy, avoid lower extremities, use hand hygiene, use surgical aseptic technique.
What is cellulitis?
a bacterial infection that has signs and symptoms similar to that of phlebitis and treatment but cellulitis is more severe
What is the treatment for cellulitis?
similar to that of phlebitis but includes antibiotics, antipyretics, analgesics if needed
What is the nursing assessment related to fluid and electrolyte embalances?
Age, environment (excessively hot?), dietary intake, lifestyle (ETOH intake history), medication, and recent medical history
What is the nursing care while administering a blood transfusion?
-check vitals every 5 minutes
-watch for transfusion reactions
-check and verify blood with at least 2 nurses before a transfusion
-if a reaction occurs stop the transfusion immediately
What are the endocrine functions of the kidney?
BP CONTROL
-Renin causes vasoconstriction when released from the juxtaglomerular cells
-prostaglandin E2 and prostacyclin secretion causes vasodilation
ERYTHROPOIETIN STIMULATES RBC PRODUCTION AND MATURATION in the bone marrow
SYNTHESIS OF VITAMIN D
What problems does poor kidney function cause?
anemia, hypertension, and electrolyte imbalances
What is stress incontinence ?
coughing, sneezing, laughing, or physical activity causing urine leakage
What is urge incontinence ?
a strong need or urge to urinate causing leakage
What is reflex incontinence?
urine leakage due to nerve damage
What is overflow incontinence?
incomplete bladder emptying- overfills when full, leads to leakage
What is functional incontinence?
physical inability to reach the toilet in time
What is a possible treatment for stress or urge incontinence?
strengthening your pelvic floor with Kegel Exercises
What is a possible treatment for functional incontinence?
Habit training to improve voluntary control
What is a possible treatment for reflex incontinence?
Self- catheterization - aseptic technique for chronic disorders such as a spinal cord injury
What is a possible treatment for overflow incontinence?
Crede method- manual compression of bladder to help with emptying
In order for healthy kidney perfusion what should your systolic BP be?
80 or greater
What is the average urine output per day?
1-2 liters
What should the minimum urine output per hour be?
30 mL
What should a nurse do if a pts urine output is less than 30 mL for more than 2 hours?
assess for blood loss and call the HCP
What is a normal urinary frequency?
4-6 times a day
Nocturia
voiding at night
urgency
sudden or strong desire
dysuria
painful or difficulty voiding
urinary hesitancy
delay in initiating voiding
neurogenic bladder
nerve pathway not intact, does not sense fullness, or control sphincters
dribbling
leaking small amounts
hematuria
blood in the urine
polyuria
production of abnormally large amounts of urine
polydipsia
extreme thirst associated with polyuria
anuria
absence of urine production
oliguria
decreased urine output, may signal impending urine failure, and is less than 30 mL/h for more than 2 hours
What are the 5 subcutaneous sites for injections?
-outer posterior aspect of the upper arms
-the abdomen from below the costal margins to the iliac crests
-the anterior aspects of the upper thigh
-the upper back
-upper ventral gluteal
Chemical drug names
come from the various chemical compounds
Generic drug names
manufacturer who develops, help to recognize class
Trade drug names
first manufacturer of the drug
Drug classification name
based on its desired effect on body system
What is the biological half-life?
the time it takes for excretion to lower the blood concentration of a drug to decrease by 50 percent. determines how often a med is given
What is a med’s trough and when would bloodwork be drawn to measure them?
A trough is the lowest level of the drug in a pt’s body. It can be measured by a lab draw approximately 30 minutes before the next dose.
What are the 6 rights of medication administration ?
right patient
right medication
right dose
right time
right route
right documentation
What are the 4 additional medication rights discussed in class?
right assessment
right evaluation
right refusal
right education
What is the purpose of medication reconciliation?
Develop, update, coordinate and communicate accurate client medication information during transitions of care. It is done to avoid medication errors.
What are some healthy actions that prevent bowel elimination probelms?
Good diet, 3.7 L of water for men and 2.7 L of water for women, physical activity
What is a closed drainage system?
free drainage by gravity. Urine flow should be unobstructed.
What are the special considerations for male catheter insertion?
insert catheter at a 90 degree angle to straighten, ease insertion, insert until bifurcation to ensure balloon not inflating in prostatic urethra, secure to upper thigh or lower abdomen.
What is an anticholinergic medication?
Increases bladder retention
Benign hyperplastic hyperplasia
enlarged prostate and can cause urinary retention and incontinence
what is impaction?
unrelieved constipation and unable to expel the hardened feces in the rectum
What are signs of impaction?
debilitated, confused, unconscious- dehydrated, weak or unaware of need, stool dry and difficult to pass. pt has the inability to pass stool for several days spite the urge to defecate.
What are hemorroids?
veins in rectum dilated from straining pressure- internal or external. Painful. Thrombosed.
What are the treatments for hemorroids?
ice pack, warm sitz bath, topical medications, surgery
How many mL of gas are we supposed to expel on average?
10 mL
What are the age related changes of the bowel and digestive system when we are younger?
small stomach, rapid peristalsis
What are the age related changes effecting the bowel and digestive system when you get older?
-decreased chewing ability
-arteriosclerosis decreases GI blood flow
-innervation decreases esophogeal emptying and peristalsis
-decreased perineal and sphincter muscle tone
-taste bud atrophy
-decreased gastric acid
What is being tested in a Urinalysis?
pH, protein, glucose, ketones, blood, specific gravity, WBC, and bacteria
What should the specific gravity be in a urinalysis?
1.005-1.030 (lower= diluted and higher= dehydrated)
Digital rectal exam
assessing for tone and abnormalities
Endoscopy
lightening FiberopticTube to visualize esophagus, stomach, and small intestine (upper GI tract). Can remove polyps for biopsy. Anesthetic to throat, some clear liquids are ok, NPO before and until gag reflex returns.
Colonoscopy
NPO, bowel prep- tube in to visualize LI/colon, remove polyps for biopsy or find source of bleeding
Upper GI series (barium swallow) X-Ray
NPO, drinks barium-opaque contrast solution, clear liquids and laxative day before; shows pharynx, esophagus, stomach
Lower GI series Xray- barium enema
NPO, barium into anal opening, shows large intestine
Amylase and lipase test
serum blood tests for hepatitis, pancreatitis (most accurate results after fasting NPO)
Abdominal xray
obstruction or abnormality, no prep
colorectal transit study
how food moves through colon, swallows capsule with radiopaque markers, X-Ray on 5th day
Computerized tomography of the bowel
ct scan of the cross-section views, oral and/or IV sedation- contrast dye- assess for any/all allergies for IV. NPO 4-6 hours before- depends on if oral contrast is used
MRI
magnet and radio waves to see inside of the body, NPO 4-6 hours before, no metal objects on/in patients
