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NURSING 110 JUST US!!!!! > Exam 3 part b FLUID &ELECTROLYTES IN HERE FOR EXAM 4 > Flashcards

Exam 3 part b FLUID &ELECTROLYTES IN HERE FOR EXAM 4 Flashcards

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1
Q

peripheral vascular disease affects what part of the body more

A

legs

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2
Q

peripheral vascular disease is a ____disease

A

progressive

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3
Q

is sudden arterial occlusion reversible?

A

no; irreversable

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4
Q

with gradual occlusion, tissue adapts gradually to what

A

decrease blood flow

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5
Q

what has less risk of sudden tissue death sudden or gradual occlusion

A

gradual occlusion

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6
Q

what can cause damage of veins

A

a thrombus, incompetent valves, decreased pumping action of surrounding muscles

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7
Q

what is edematous tissue

A

tissue that cannot get adequate nutrition

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8
Q

3 common venous diseases

A

DVT, varicose veins, & venous stasis ulcers

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9
Q

what arteries are more often affected by peripheral arterial disease

A

aortoiliac, femoral, popliteal, tibial & peroneal

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10
Q

3 risk factors for peripheral arterial disease and atherosclerosis

A

diabetes, hyperlipidemia, and hypertension

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11
Q

when assessing the vascular system what should you ask the patient about

A

pain, function, change in function

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12
Q

in vascular assessment what do you look at

A

skins temp, color, appearance, integrity, edema

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13
Q

classic symptom of peripheral arterial disease

A

intermittent claudication

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14
Q

hallmark symptom of chronic arterial occlusion

A

intermittent claudication

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15
Q

complications of PAD can lead to?

A

nonhealing ulcers or amputation

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16
Q

complications of PAD

A

atrophy of skin &underlying muscles, delayed healing, wound infection, tissue necrosis, and arterial ulcers

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17
Q

4 nursing diagnoses for PAD

A

ineffective tissue perfusion, impaired skin integrity, activity intolerance, and ineffective therapeutic regimen management

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18
Q

overall goals for patient with PAD

A

adequate tissue perfusion, relief of pain, increased exercise tolerance, and intact healthy skin on extremeties

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19
Q

collaborative care for PAD includes

A

exercise therapy, nutritional therapy and alternative therapy

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20
Q

What are some CV/perfusion changes with age?

A

decreased vessel elasticity, increased calcification of vessels, impaired valve function, decreased muscle tone, decreased baroreceptor response to blood pressure changes, decreased conduction ability of the heart

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21
Q

foot care for patients with PAD are similar to

A

care for patients with diabetes (use neutral soaps, pat skin dry, do not rub, prevent blisters)

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22
Q

interventions for patients with PAD

A

promote vasodilation and prevent compression (educate)

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23
Q

6 Ps of Peripheral vascular disease

A

positioning, pain, percutaneous (skin), pulse, puffy (edema), & pleseion lesion

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24
Q

STUDY PERIPHERAL CHART

A

STUDY PERIPHERAL CHART

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25
Q

What are the 5 sites used to auscultate heart sounds?

A

aortic base, angel of louis, pulmonic area, Erb’s point, tricuspid area, Mitral apex (PMI)

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26
Q

What are factors affecting perfusion?

A

cardiac output (SV x HR); preload, afterload, contractility; peripheral vascular resistance; blood volume; blood viscosity; artery elasticity; O2 saturation

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27
Q

What information is needed in cardiovascular assessment?

A

Cardiovascular health history, current lifestyle and psychosocial status (smoking, exercise, alcohol, meds, family history), assessment of chest pain (PQRST), physical exam (auscultation and inspecting neck vessels, circulatory system, cyanosis, edema, bp, and all pulse points)

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28
Q

What is PQRST?

A

P- provocative or palliative: what makes things better or worse?;
Q- quality: describes the symptoms;
R- region or radiation: where are the symptoms?;
S- severity: use scale 0-10;
T- timing: is pain associated with activity?

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29
Q

potential nursing diagnoses?

A

activity intolerance, acute pain, anxiety, ADLs, constipation, decreased cardiac output, deficient knowledge, excess fluid volume, fatigue, imbalanced nutrition, impaired mobility, impaired skin integrity, impaired verbal communication, ineffective peripheral tissue perfusion, risk for activity intolerance, risk for decreased cardiac output, risk for decreased cardiac tissue perfusion, risk for frail elderly syndrome, risk for unstable bp

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30
Q

What are factors affecting cardiopulmonary functioning and oxygenation?

A

level of health, developmental considerations, medication considerations, lifestyle considerations, environmental considerations, psychological health considerations

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31
Q

What are some nursing interventions related to cardiovascular and perfusion?

A

patient education, activity level, exercise tolerance, smoking cessation, balanced nutrition, balanced activity level including mobility without symptoms

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32
Q

What are you looking for in evaluation for cardiovascular/perfusion?

A

levels of symptoms with activity, level of adherence to diet, vital signs

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33
Q

What are some CV/perfusion changes with age?

A

decreased vessel elasticity, increased calcification of vessels, impaired valve function, decreased muscle tone, decreased baroreceptor response to blood pressure changes, decreased conduction ability of the heart

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34
Q

functions of fluid (water) in the body

A

transport nutrients, hormones, enzymes, rbc, wbc, maintain body temp, facilitate digestion

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35
Q

what 2 components of fluid in the body and what percent

A 
intracellular fluid (70%)
extracellular fluid(30%)
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36
Q

total body fluid represents what percent of adult body weight

A

50-60%

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37
Q

define sodium chief function

A

controls &regulates volume of body fluids

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38
Q

define potassium chief function

A

main regulator of cellular enzyme activity & water content

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39
Q

calcium main function

A

nerve impulse, blood clotting, muscle contraction, b12 absorption

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40
Q

magnesium main function

A

metabolism of carbs & proteins, vital actions involving enzymes

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41
Q

chloride main function

A

maintains osmotic pressure in blood, produces hydrochloric acid

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42
Q

phosphate function

A

involved in important chemical reactions, cell division, & hereditary traits

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43
Q

What are the two main categories of nursing diagnoses?

A

alterations in oxygenation as the problem and alterations in oxygenation as the etiology

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44
Q

define hyper/hyponatremia

A

high or low sodium levels

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45
Q

signs/symptoms of hyponatremia

A

confusion, hypotension, edema, muscle cramps, dry skin

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46
Q

what do you do for hyponatremia

A

increase sodium

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47
Q

signs/symptoms of hypernatremia

A

signs of neurological impairment( restlessness, weakness, delusion)

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48
Q

what do you do for hypernatremia

A

correct sodium levels (no faster than 1mEq/L every 2 hours)

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49
Q

causes of hypomagnesemia

A

poor dietary intake, poor GI absorption, excessive GI/urinary losses

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50
Q

who is at high risk for hypomagnesemia

A

people with:
chronic alcoholism, malabsorption issues,
GI/urinary system disorders, sepsis, burns,
wounds needing debridement

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51
Q

what do you see with hypomagnesemia

A

CNS; altered loc, confusion, hallucinations
Neuromuscular: muscle weakness,foot/leg cramps, hyper deep tendon reflexes, tetany, Chvostek’s & Trousseau’s signs
Cardiovascular: tachycardia, hypertension, ECG changes
GI: dysphagia, anorexia, n/v

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52
Q

what do you do for hypomagnesemia

A

Mild: dietary replacement
Severe: Iv or IM magnesium sulfate
Monitor: neuro, cardiac status and overall safety

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53
Q

causes of hypokalemia

A

by GI losses, diarrhea, insufficient intake, non-K+ sparing diuretics

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54
Q

causes of hyperkalemia

A

by altered kidney function, increased salt intake, blood transfusions, medications and cell death

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55
Q

What are you looking for in evaluation with oxygenation?

A

note O2 saturation percentages, note expectorations (thick, loose secretions), note level of comfort, note activity level, note lung sounds

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56
Q

What are non-modifiable risk factors for oxygenation?

A

age, pollution, allergies

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57
Q

What are modifiable risk factors for oxygenation?

A

tobacco use, aspiration factors

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58
Q

What are essential factors to normal functioning of the respiratory system?

A

integrity of the airway system to transport air to and from the lungs, properly functioning alveolar system, properly functioning CV and hematologic systems

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59
Q

What is upper airways function and what does it consist of?

A

to warm, filter, humidify inspired air;

nose, pharynx, larynx, epiglottis

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60
Q

What is lower airway’s function and what does it consist of?

A

conduction of air, mucociliary clearance, production of pulmonary surfactant;
trachea, R and L mainstem bronchi, segmental bronchi, terminal bronchioles

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61
Q

What is hypoxia?

A

inadequate amount of oxygen available to the cells

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62
Q

What is dyspnea?

A

difficulty breathing

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63
Q

What is hypoventilation?

A

decreased rate or depth of air movement into the lungs

64
Q

What are factors affecting cardiopulmonary functioning and oxygenation?

A

level of health, developmental considerations, medication considerations, lifestyle considerations, environmental considerations, psychological health considerations

65
Q

signs and symptoms of hyperkalemia

A 
Irritability
Paresthesia
Muscle weakness (especially legs)
ECG changes ( tented T wave)
Irregular pulse
Hypotension
Nausea, abdominal cramps, diarrhea
66
Q

what do you do for hyperkalemia

A

Mild: Change diuretic and restrict K in diet

Moderate: administer Kayexalate

Emergency: treat cardiac effect & reverse acidosis

67
Q

normal magnesium levels

A

1.5-2.5mEq/L

68
Q

causes of hypomagnesium

A

poor dietary intake, poor GI absorption, excessive GI/urinary losses

69
Q

who is at high risk for hypomagnesium

A

people with:
chronic alcoholism, malabsorption issues,
GI/urinary system disorders, sepsis, burns,
wounds needing debridement

70
Q

what do you see with hypomagnesium

A

CNS; altered loc, confusion, hallucinations
Neuromuscular: muscle weakness,foot/leg cramps, hyper deep tendon reflexes, tetany, Chvostek’s & Trousseau’s signs
Cardiovascular: tachycardia, hypertension, ECG changes
GI: dysphagia, anorexia, n/v

71
Q

what do you do for hypomagneisum

A

Mild: dietary replacement
Severe: Iv or IM magnesium sulfate
Monitor: neuro, cardiac status and overall safety

72
Q

common cause of hypermagnesemia

A

renal dysfunction

73
Q

what do you see with hypermagnesemia

A

Decreased neuromuscular activity

Hypoactive deep tendon reflexes

Generalized weakness

Occasionally nausea/vomiting

74
Q

hypermagnesemia what do you do

A

Increase fluid if renal function is normal

Loop diuretic if no response to fluids

Calcium gluconate for toxicity

Mechanical ventilation for respiratory depression

Hemodialysis

75
Q

normal calcium levels

A

serum-8.9mg/dl -10.1mg/dl

ionized- 4.5mg/dl -5.1mg/dl

76
Q

hypocalcemia caused by

A

inadequate intake, malabsorption, pancreatitis, thyroid or parathyroid surgery, loop diuretics, low magnesium levels

77
Q

hypocalcemia sings/symptoms

A

Neuromuscular: anxiety, confusion, irritability, muscle twitching, paresthesias (mouth, fingers, toes), tetany

Fractures

Diarrhea

Diminished response to digoxin
ECG changes

78
Q

what do you do for hypocalcemia

A

Calcium gluconate for postop thyroid or parathyroid patient

Cardiac monitoring

Oral or IV calcium replacement

79
Q

2 major causes of hypercalcemia

A

cancer & hyperparathyroidism

80
Q

signs/symptoms of hypercalcemia

A

Fatigue, confusion, lethargy, coma
Muscle weakness, hyporeflexia

Bradycardia and may lead to cardiac arrest

Anorexia, n/v, decreased bowel sounds, constipation

Polyuria, renal calculi, renal failure

81
Q

what do you do for hypercalcemia

A

If asymptomatic, treat underlying cause

Hydrate the patient to encourage diuresis

Loop diuretics

Corticosteroids

82
Q

define hyper/hypophosphatemia

A

high or low phosphate levels

83
Q

normal phosphate levels

A

2.5mg/dl- 4.5mg/dl

84
Q

causes of hypophosphatemia

A

respiratory alkalosis (hyperventilation), insulin release, malabsorption, diuretics, DKA, elevated parathyroid hormone levels, extensive burns)

85
Q

hypophosphatemia what do you see

A

Musculoskeletal: muscle weakness, respiratory muscle failure, osteomalacia, pathological fratures

CNS: confusion, anxiety, seizures, coma

Cardiac: hypotension, decreased cardiac output

Hematologic: hemolytic anemia, easy bruising, infection
risk

86
Q

hypophosphatemia what do you do

A

treat underlying cause

oral or IV replacement in a sodium chloride or potassium chloride solution

87
Q

hyperphosphatemia causes

A

impaired kidney function, cell damage, hypoparathyroidism, respiratory acidosis, DKA and increased dietary intake

88
Q

What are some guidelines for obtaining a nursing history?

A

determine why pt needs nursing care, determine what kind of care is needed to maintain a sufficient intake of air, identify current or potential health deviations, identify actions performed by the pt for meeting respiratory needs, make use of aids to improve intake of air and effects on pt’s lifestyle

89
Q

What to look for during inspect on physical assessment for oxygenation?

A

general appearance, LOC, color of skin (pallor, cyanotic), abnormalities in structure of chest, respiratory rate, rhythm and depth

90
Q

What to look for during palpation on assessment for oxygenation?

A

skin temp, thoracic excursion, edema, masses, test cap refill

91
Q

What to percuss during physical assessment?

A

assesses position of lungs, usually done by physicians

92
Q

What to auscultate for during physical assessment?

A

assess airflow through lungs, ask pt to breathe via mouth slowly

93
Q

Normal breath sounds in vesicular?

A

low pithed, soft sounds heard over peripheral lung fields

94
Q

Normal breath sounds in bronchial?

A

loud, high-pitched sounds heard mostly from over trachea and larynx

95
Q

Normal breath sounds in bronchovesicular?

A

medium pitched blowing sounds heard over major bronchi

96
Q

What are adventitious lung sounds?

A

abnormal lung sounds, crackles & wheezes

97
Q

What are crackles?

A

intermittent sounds occurring when air moves through airways that contain fluid, usually heard on inspiration- classified as fine, medium, or coarse

98
Q

What are wheezes?

A

continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors- classified as sibilant or sonorous

99
Q

What are some common diagnostic tests for respiratory?

A

arterial blood gases, spirometry (measures lung volumes and airflow), pulse oximetry

100
Q

What are the two main categories of nursing diagnoses?

A

alterations in oxygenation as the problem and alterations in oxygenation as the etiology

101
Q

signs/symptoms of hyperphosphatemia

A 
Think CHEMO
   C = cardiac irregularities
   H = hyperreflexia
   E = eating poorly
   M = muscle weakness
   O = oliguria
102
Q

what do you do for hyperphosphatemia

A

Low- phosphorus diet
Decrease absorption with antacids that bind phosphorus
Treat underlying cause of respiratory acidosis or DKA
IV saline for severe hyperphosphatemia in patients with good kidney function.

103
Q

normal chloride range

A

97mEq/L- 107mEq/L

104
Q

what do you see with hypochloremia

A 
Effects of fluid loss and dehydration
Weakness or fatigue
Difficulty breathing
Diarrhea or vomiting
Hyponatremia and hypokalemia
105
Q

what do you do for hypochloremia

A

Treat underlying cause or disease

If its mild, may need to add salt to the diet and increase hydration

If its more severe may need IV fluids to correct

106
Q

causes of hyperchloremia

A

kidney disease,diabetes,severe dehydration

May be caused by having too many saline solutions given during hospitalizations,severe diarrhea, ingestion of salt water

107
Q

signs/symptoms of hyperchloremia

A 
Fatigue
Muscle weakness
Excessive thirst
Dry mucous membranes
High blood pressure

May have it and not know it.

108
Q

what do you do for hyperchloremia

A

Treat underlying cause, i.e. dehydration
Stop the ingestion of saline
Stop medication that may be causing the issue
Look at kidney function, treat issues

109
Q

ways to transport body fluids

A

osmosis, diffusion, active transport, and filtration

110
Q

sources of fluids for the body

A

ingested liquids, food, metabolism

111
Q

where is fluid loss

A

kidneys-urine
intestinal tract-feces
skin-perspiration
insensible water loss

112
Q

define hypovolemia

A

deficiency in amount of water &electrolytes in ECF w/ near normal water/electrolyte proportions

113
Q

define dehydration

A

decreased volume of water and electrolyte change

114
Q

define third-space fluid shift

A

distributional shift of body fluids into potential body spaces

115
Q

define hypervolemia

A

excessive retention of water and sodium in ECF

116
Q

define overhydration

A

above-normal amounts of water in extracellular spaces

117
Q

define edema

A

excessive ECF accumulates in tissue spaces

118
Q

define interstitial-to-plasma shift

A

movement of fluid from space surrounding cells to blood

119
Q

What are nursing diagnoses for alterations in oxygenation as the problem?

A

ineffective airway clearance, ineffective breathing pattern, impaired gas exchange

120
Q

What are nursing diagnoses for alterations in oxygenation as the etiology?

A

activity intolerance related to imbalanced between oxygen supply and demand;
anxiety related to feeling of suffocation; fatigue related to impaired oxygen transport system

121
Q

What are outcome identification and planning for oxygenation?

A

general goal is to maintain or restore optimum respiratory function- may include lifestyle change;
promote comfort; promote and control coughing; promote proper nutrition; reducing anxiety

122
Q

What are some nursing interventions promoting adequate respiratory functioning?

A

teaching about pollution-free environment, promoting optimal function, promoting comfort, promoting proper breathing, managing chest tubes, promoting and controlling coughing, suctioning the airway, meeting oxygenation needs with medications, vaccinations

123
Q

How do you promote proper breathing?

A

deep breathing, using incentive spirometry, pursed-lip breathing, diaphragmatic breathing

124
Q

How do you promote and control coughing?

A

voluntary and involuntary coughing, using cough medications (expectorants, cough suppressants, lozenges)

125
Q

How do you promote comfort for oxygenation?

A

positioning, maintaining adequate fluid intake, providing humidified air, performing chest physiotherapy/suctioning, maintaining good nutrition, pacing physical activities

126
Q

What do bronchodilators do?

A

open narrowed airways

127
Q

What do nebulizers do?

A

disperse fine particles of liquid medication into the deeper passages of the respiratory tract

128
Q

What do meter-dose inhalers do?

A

deliver a controlled dose of medication with each compression of the canister

129
Q

What do dry powder inhalers do?

A

breath-activated delivery of medications

130
Q

What are you looking for in evaluation with oxygenation?

A

note O2 saturation percentages, note expectorations (thick, loose secretions), note level of comfort, note activity level, note lung sounds

131
Q

parameters for assessment of electrolyte imbalance

A

Nursing history and physical assessment
Fluid intake and output
Daily weights
Laboratory studies

132
Q

lab studies to assess for imbalances

A

Complete blood count
Serum electrolytes, blood urea nitrogen, and creatinine levels
Urine pH and specific gravity
Arterial blood gases

133
Q

risk factors for imbalances

A

Pathophysiology underlying acute and chronic illnesses
Abnormal losses of body fluids
Burns
Trauma
Surgery
Therapies that disrupt fluid and electrolyte balance

134
Q

nursing diagnoses related to imbalance

A

Excess fluid volume
Deficient fluid volume
Risk for imbalanced fluid volume

135
Q

expected outcomes of imbalance

A

Maintain approximate fluid intake and output balance (2,500-mL intake and output over 3 days).
Maintain urine specific gravity within normal range (1,010–1,025).
Practice self-care behaviors to promote balance.

136
Q

what medications would be administered to a patient with a electrolyte imbalance

A

Mineral–electrolyte preparations
Diuretics
Intravenous therapy

137
Q

What is COPD?

A

umbrella for emphysema and chronic bronchitis, progressive disease that makes breathing difficult, airflow obstruction from repeated exposure to irritants

138
Q

What is bronchitis?

A

inflammation of the inner lining of the bronchi

139
Q

What is emphysema?

A

long term destruction of lung over time, especially affects the alveoli

140
Q

What is etiology of COPD?

A

smoking, second hand smoke, air pollution, occupational irritants

141
Q

chronic bronchitis symptoms?

A

cough and sputum for at least 3 months in each of 2 consecutive years, pollutants, hypersecretion of mucus and inflammation, decreased ciliary function, thickened bronchial walls, altered function of alveoli macrophages, increased susceptibility to respiratory infection

142
Q

Complications with bronchitis?

A

smoking exacerbates symptoms, heart arrhythmias, pneumonia, osteoporosis

143
Q

Emphysema symptoms?

A

congestion, dependent edema, distended neck veins, cardiac issues which can lead to cardiac failure, marked dyspnea on exertion, weight loss, expiration phase of breathing becomes active

144
Q

Assessment of COPD includes what?

A

PMH- smoker, asthma, allergies, hx of resp. ilnesses, exposure to risk factors, cough?, SOB?, S/S- chronic cough, sputum, barrel chest, accessory muscle use, pursed-lip breathing

145
Q

medical management of COPD?

A

risk reduction including smoking cessation, bronchodilators, corticosteroids, influenza and pneumococcal vaccines, antibiotics, mucolytics, antidepressants, O2 therapy, pulmonary rehab, surgeries

146
Q

Complications of COPD?

A

respiratory insufficiency or failure, atelectasis, pulmonary infection, pneumothorax, pulmonary hypertension

147
Q

Nursing diagnoses for COPD?

A

impaired gas exchange r/t, impaired airway clearance r/t, ineffective breathing pattern r/t, activity intolerance r/t, deficient knowledge r/t, ineffective coping r/t, imbalanced nutrition r/t, compromised family coping r/t

148
Q

Expected outcomes for COPD?

A

activity tolerance, airway clearance, breathing pattern, nutrition, family coping

149
Q

Implementation for impaired gas exchange with COPD?

A

adherence to med regime, avoid pulmonary irritants, attends pulmonary rehab classes, use supplemental O2

150
Q

Implementation for activity intolerance with COPD?

A

pulmonary rehab regime, pacing of activities, exercise training, use of walking aids, use of collaborative approach

151
Q

Implementation for ineffective airway clearance for COPD?

A

ABG results, weigh self daily, postioning (high fowlers), monitor cough, follow med regime, use supplemental O2

152
Q

Implementation for ineffective breathing pattern with COPD?

A

use assistance with ADLs as needed, pace activities, breathing patterns-diaphragmatic + purse-lip, follow med regime

153
Q

Implementation for imbalanced nutrition with COPD?

A

know amount of calories needed to consume, eat frequent small meals and snacks, high fowlers position

154
Q

Implementation for compromised family coping with COPD?

A

identify strengths and challenges of family, provide education about diagnoses, community agencies

155
Q

General evaluation indicators for COPD?

A

pt consistently maintains O2 sat at certain level, pt demonstrates appropriate modifications for ADLs, pt able to maintain open airway, family is able to describe resources available and how to access them

156
Q
  • also know Managing stable COPD handout *
A

.

NURSING 110 JUST US!!!!! (14 decks)

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