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Nursing 201D > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

Calcium function

A

-Regulated by calcitriol, parathyroid hormone, and calcitonin
-99% is in bone
-Combines with MG and Phosphorus for rigidity and structure
-involved in forming fibrin and in clotting
- involved in nerve transmission, muscle contraction and relaxation
Total serum Calcium = free ionized + albumin bound

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2
Q

Hypocalcemia

A

<8.5 mg/dL
-causes osteoporosis
-can cause muscle spasm and tetanus
-Chvostek’s (facial construction) and Trosseau’s (carpal spasm)

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3
Q

Causes of Hypocalcemia

A

“The hyper hippo has alcoholism so his albumin and magnesium levels are low, and has renal insufficiency”

-Hypoparathyroidism: can’t secrete PTH to increase calcium. (Neck injury)
-Hyperphosphatemia: calcium and phosphate are bound and when there are more Phosphorus ions, less free Ca+ in blood
- Renal insufficiency: can’t convert Vitamin D into Calcitriol
-Low Magnesium: Magnesium plays a role in PTH secretion
-Chronic Alcohol: promotes Ca+ excretion and prevents reabsorption by the kidneys
-Loop Diuretics: most potent/dumps everything
-Low Albumin: Calcium binds to albumin

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4
Q

Hypocalcemia Sx

A

-Hyperreflexia: Exaggerated contractions; happens bc there are more depolarizations
- Tetany (Chvostek/Trousseau)
-Numbness/tingling in extremities and around the mouth
-Cardiac dysrhythmias

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5
Q

Hypocalcemia Nursing Implications

A

-Increase Ca+ dietary sources and Vitamin D supplements
-Assess diuretic intake
-Assess post-opp thyroid or neck surgery
-Assess motion, sensation reflexes
-Assess changes in cardiac rhythm.
-Assess labs

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6
Q

Serum Calcium levels

A

8.5-10.5 mg/dL

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7
Q

Explain Calcium Regulation (High Levels)

A

When serum Calcium is too high, thyroid secretes calcitonin, which stimulates osteoblasts to remove ca from blood and deposit into bone; tells intestines to stop reabsorbing Calcium, and kidneys to stop reabsorbing calcium–> ca levels go down.

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8
Q

Explain Calcium Regulation (Low levels)

A

If serum Calcium levels are low, parathyroid secretes PTH which stimulates osteoclasts to break down bone and put into blood, and tells intestines and kidneys to reabsorb Calcium–> ca levels go up

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9
Q

Explain what happens to phosphorus when PTH is secreted

A

PTH tells the kidneys to increase calcium reabsoption and dump phosphorus, and increases the conversion of alpha hydroxylase into Vitamine D

PTH will increase phosphorus absorption in bone

The small intestine responds to increased Vitamin D levels produced by the kidney and is stimulated to reabsorb both calcium and phosphorus into blood

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10
Q

Hypercalcemia serum levels

A

> 10.5 mg/dL

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11
Q

Causes of hypercalcemia

A

-hyperparathyroidism: too much PTH being secreted
-bone cancer : all types of cancer actually. Tumor factors are secreted and stimulate osteoclastic activity
-excess intake of calcium

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12
Q

Hypercalcemia Symptoms

A

-muscle weakness
-lethargy, confusion
-cardiac dysrhythmias
-bone pain, fractures - too much osteoclatic activity
-kidney stones
“The quad-fecta + bone fractures and stones”

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13
Q

Hypercalcemia Nursing Implications

A

-low calcium diet
-fluid intake
-assess neurological functioning
-assess cardiac rhythm
-filter urine if needed
-assess labs
-bedrest

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14
Q

Phosphorus Levels

A

2.5-4.5 mg/dL

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15
Q

Functions of Phosphorus

A

-energy production from CHO, fat, and protein (ATP)
-acid-base buffering system

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16
Q

Hypophosphatemia

A

<2.5 mg/dL

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17
Q

Causes of hypophosphatemia

A

-inadequate intake/absorption issues
-chronic alcoholism
-vitamin D difficiency: can’t convert into calcitriol–> no reabsorption from GI
-overuse of phosphate binding antacids (Tums)
-hyperparathyroidism:P is Regulated by kidney: too much PTH = excessive dumping of P

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18
Q

Symptoms of Hypophosphatemia

A

-muscle weakness
-lethargy, confusion
-respiratory weakness
-cardiac dysrhythmia
similar to hypercalcemia

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19
Q

Hypophosphatemia Nursing Implications

A

-Assess neurological and respiratory function
-Assess cardiac rhythm
-Assess alcohol consumption
-Assess antacid use
-Assess for malabsorption issues
-Assess for hypercalcemia

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20
Q

Hyperphosphatemia levels

A

> 4.5 mg/dL

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21
Q

Causes of Hyperphosphatemia

A

-renal failure
-chronic use of phosphate enemas
-hypoparathyroidism

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22
Q

Symptoms of hyperphosphatemia

A

-hyperflexia
-tetany (Chvostek/Trousseau)
-numbness/tingling to extremities and around mouth
-cardiac dysrhythmia
similar to hypocalcemia

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23
Q

Hyperphosphatemia Nursing Implications

A

-Assess ROM, sensation reflexes
-Assess cardiac rhythm
-Assess kidney function
-Assess for hypocalcemia

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24
Q

Magnesium levels

A

1.8-2.2 mg/dL

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25
Q

Function of Magnesium

A

-second most abundant ICF cation
-50-60% stored in muscle and bone and 30% in cells
-Regulated by kidneys and GI
-cofactor in CHO metabolism, DNA and protein synthesis, blood glucose control, and BP regulation
-regulation of insulin secretion by pancreatic beta cells
-muscle contration/relaxation
-neurotransmitter release and neurological function

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26
Q

Hypomagnesemia

A

<1.8 mg/dL

27
Q

Causes of hypomagnesemia

A

“C triple D”
-chronic alcoholism
-dietary intake
-diarrhea
-diuretics

28
Q

Hypomagnesemia symptoms

A

-low MG interferes with PTH release–> same as hypocalcemia
-cardiac dysrhythmia
-Hyperglycemia
-elevated BP

29
Q

Hypomagnesemia Nursing Implications

A

-Assess CA, K, and glucose levels
-Assess CMS
-cardiac rhythm & BP
-alcohol consumption
-GI/medical history
-review meds

30
Q

Hypermagnesemia

A

> 2.2 mg/dL

31
Q

Causes of hypermagnesemia

A

-renal failure
-ingestion of Mg containing medications

32
Q

Hypermagnesemia symptoms (severe)

A

-lethargy
-muscle weakness
-diminished deep tendon reflexes
-low BP

33
Q

Hypermagnesemia Nursing Implications

A

-ASSESS:
-intake of mg containing meds
-kidney function
-neuromuscular function
-bp

34
Q

Elements in a crystallography solution

A

-water
-Glucose
-Electrolytes
-Vitamins

35
Q

Glucose

A

70-110 mg/dL
-primary source of fuel
-levels fluctuate with intake and excess stored as glycogen
-insulin secreted by beta cells of islets of langerhans

36
Q

Causes of Hypoglycemia

A

<70mg/dL
-insufficient food intake
-excessive physical exertion
-hypoglycemic agents (insulin or oral)
-alcohol: liver gets distracted from glucose regulation bc it has to detoxify body

37
Q

Hypoglycemia Symptoms

A

-hungry
-shaky or diaphoretic
-Dizzy
-Headache
-Confusion/difficulty speaking
-weak/tired
-nervous or upset

38
Q

Hypoglycemia Nursing Implications

A

-Assess Neurological status
-monitor glucose
-consider modifications to diet
-consider modifications to meds ( Mayne insulin dose too high or too frequent)

39
Q

Hyperglycemia causes

A

> 110 mg/dL
-excessive CHO intake
-insulin deficiency
-empotional/physical stressors: post opp pts can develop hyperglycemia
- corticosteroids reduce effect of insulin
-parenteral therapy: some crystalloids contain dextrose

40
Q

Hyperglycemia Symptoms

A

-sleepy
-slow wound healing
* 3 P’s:
-Polydipsia (excessive thirst)
-Polyurea (frequent urination)
-Polyphagia (hunger)

41
Q

Hyperglycemia Nursing Implications

A

-Assessment diet
-Asses glucose levels (especially in pt with 3Ps)
-Assess output
-Assess corticosteroid use (concerned for wound healing)
-Assess parenteral therapy
-Assess wound healing (BG needs to be under 180 to facilitate wound healing)

42
Q

Hemoglobin

A

12-18 g/dL
-is a protein combo of heme and globin
-heme carries iron; the perforin give it the red pigment
-carries 02 and CO2 back to lungs and tissues
-important for perfusion and transport of nutrients

43
Q

Causes of Low levels of hemoglobin

A
  1. Anemia due to blood loss : loss of RBC and reduced ability to carry O2; possible after surgery
  2. Hemodilution: most common with IV fluid use “pseudo-anemia” –> RBC ratio gets diluted but no loss of RBC
44
Q

Symptoms of Anemia

A

-fatigue/weakness
-pale
-SOB/dizzy/weakness.
-headache
-irregular HR/chestpain

45
Q

Anemia Nursing Implications

A

-Assess for improvement of symptoms
-monitor vitals and trends
-monitor RR and O2 sat
-Assess surgical sites and drains

46
Q

Hematocrit

A

36-50%
Volume percentage of blood that contains RBC
Hemoglobin and hematocrit have a 1:3 ratio

47
Q

Low hematocrit causes

A
  1. Anemia due to blood loss
  2. Hemodilution
    nursing Implications and SX are same as hemoglobin
48
Q

Isotonic Crystalloids

A

-between 250 and 375 mOsm/L
-will stay in intravascular space
Examples:
- 0.9% NS
-Lactated Ringer’s
-Dextrose 5% in water “D5W”

49
Q

Indications for Isotonic Crystalloids

A

-maintain fluid balance
-replace losses
-increase BP
-to support other IV therapies such as antibiotics
-NS can be used to treat mild hyponatremia and hypercalcemia (flushes kidneys)

50
Q

Why is Lactated Ringers unique?

A
  • it contains electrolytes and lactate
    -it’s the closest to blood composition
    -lactate is a base that metabolized by the liver
    Do not administer to pts with Hyperkalemia, alkalosis, or pt with liver disease (lactate metabolized by liver)
51
Q

Nursing Implications for isotonic crystalloids

A

-Assess for hypervolemia
-pulmonary edema
-hemodilution
-peripheral edema
-electrolyte labs : anytime someone is receiving IV fluids labs are drawn every morning

52
Q

Hypotonic Crystalloids

A

<250 mOsm
Fluid will move from the intravascular space into body cells (swelling) ; left running can deplete circulatory system
Examples:
-0.45% NS
-0.2% NS
-5% dextrose (note this is also in hypotonic)

53
Q

Why is D5W unique ?

A

-the solution itself is isotonic but after 20 mins, glucose is metabolized and it becomes hypo
-can be used for mild hypernatremia bc there isn’t Na, but monitor for normalizing values otherwise hyponatremia

54
Q

Hypotonic solution Indications

A

-mild hypernatremia,
-hyperosmolar hyperglycemia: this is when so much glucose is in the blood cells are crenating (BG 700) need hypotonic to help rehydrate cells and dilute glucose

55
Q

Hypotonic Crystalloid Nursing Implications

A

-monitor for changes in cognitive: cerebral edema is a concern; especially for pts with brain injury (hydrocephalus) you don’t want to administer hypo
-only administer for short periods of time
-may reduce BV intravascular space bc of fluid shifting into cells
-can worsen hypovolemia and hypotension

56
Q

Hypertonic Crystalloids

A

> 375 mOsm
Fluid will shift from intravascular space into body cells (crenation)
-good blood volume expander
Example:
-3% NS : this one used for severe hyponatremia in ICU–>usually seizures (118-120 na level)
-10% Dextrose in water
-5% Dextrose, 0.9% NS
-5% Dextrose, Lactated Ringers

57
Q

Hypertonic crystalloid indications

A

-severe hyponatremia (NS only)
-to expand intravascular volume
-maintain or replace electrolytes
* you would chose this over an iso if someone needed electrolytes

58
Q

Hypertonic Nursing Implications

A

-risk of fluid volume overload
Use cautiously in cardiac and renal pt : heart and kidney help get rid of excess fluid
-administer for a short period

59
Q

Colloid: Albumin

A

-protein that stays in intravascular space bc it can’t cross capillary membranes
- has a high affinity for water and Na and exerts “colloidal oncotic pressure” that pulls water into intravascular space
-it’s a strong (100x crystalloid) intravascular expander used for fluid volume deficit or low albumin levels

60
Q

Albumin Nursing Implications

A

-monitor for fluid overload
-Assess urine output, protein, albumin levels
-contraindicated in heartfailure

61
Q

Albumin Nursing Implications

A

-monitor for fluid overload
-Assess urine output, protein, albumin levels
-contraindicated in heartfailure

62
Q

How are the Vitamin D cycle and calcium regulation connected?

A

When serum Calcium is low, parathyroid hormone is secreted. This tells the kidney that ut needs to:
1. Reabsorb calcium into blood
2. Slow reabsorption of phosphorus (P bind to Ca–>less in blood)
3. Convert calcidiol into calcitriol (Vitamin D) this is how the kidney communicates to the intestines that calcium needs to be reabsorbed; phosphorus is also reabsorbed here.

63
Q

Significance of Mg

A

It is needed (in addition to potassium) to secrete insulin from pancreas

It also is responsible for triggering the release of parathyroid hormone

64
Q

Functions of phosphorus

A

-85% is bound in bones and teeth
-it requires renal function
-it’s acquired from food
-primary ICF anion

Nursing 201D (7 decks)

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