Exam 4 Study Guide Flashcards
1
Q
pH
A
7.35-7.45
acidic - alkalosis
2
Q
PaO2
A
80-100 mmHg (respiratory)
3
Q
PaCO2 (carbon dioxide)
A
35-45 mmHg (respiratory)
4
Q
HCO3 (bicarbonate)
A
22-26 mEq/L (metabolic)
5
Q
SaO2
A
95-100%
6
Q
sodium
A
135-145
7
Q
potassium
A
3.5-5.0
8
Q
chloride
A
95-105
9
Q
phosphate
A
2.5-5.0 (3-5)
10
Q
calcium
A
8.5-10.5
11
Q
magnesium
A
1.6-2.6
12
Q
glucose
A
70-105
13
Q
BUN
A
8-21
14
Q
creatinine
A
0.5-1.2
15
Q
RBC
A
4.6-6.1
16
Q
WBC
A
4,000-10,000
17
Q
Hgb
A
12-18
18
Q
platelets
A
150k - 450k
19
Q
Prostate Specific Antigen (PSA)
A
< or = to 4.0 or 4-10
20
Q
Urine Specific Gravity (USG)
A
0.005-1.030
21
Q
Patient with acid-base imbalance. (Metabolic Acidosis)
What additional lab values should you check if a patient has (Metabolic-Acidosis)
A
- Arterial blood gas results for metabolic acidosis are pH less than 7.35 and
HCO3– less than 22 mEq/L. If compensated, then the PaCO2 is less than 35 mm Hg. - Metabolic acidosis is an acid-base imbalance caused by an increased accumulation of metabolic acids that rise in proportion to bicarbonate and result in decreased arterial pH.
- treatment depends on the underlying cause.
- Potassium levels
22
Q
Client admitted with acid-base imbalance and the diagnosis of patient is AKI (Acute Kidney Injury). Patient has been taking a potassium wasting diuretic.
What acid-base balance would we be looking for in this patient?
A
hypokalemia
23
Q
A patient has a fluid volume excess.
What discharge instructions should we give this patient regarding monitoring for fluid volume excess when they go home?
A
- Limit fluid intake
- Sodium restriction
- Weight themselves every day same time
- Pt education - clinical manifestations of hypervolemia such as edema
24
Q
Why is it so important to weigh a patient first thing in the morning?
A
- To check for weight gain or weight loss that happens abruptly
- Best noninvasive indicator of fluid status
- IV fluid rates or solutions may change for the same reason
- Providers may base treatment decisions on weight because it reflects fluid balance
25
What are the risks for dehydration?
Is an elderly patient who is cognitively impaired at risk for dehydration?
Cognitively impaired
o Cannot obtain fluids independently or cannot make his or her need for fluids known
o Causes poor cerebral perfusion and cerebral hypoxia, causing confusion
o Increasing IVF rate would increase perfusion but rehydrating too rapidly with IVF can lead to cerebral edema
o Watch for SOB when rehydrating rapidly, you may need to slow down the infusion and notify the physician
Older adults
o Less total body water than younger adults
26
What patient teaching/discharge instructions should you provide to a patient going home with a diagnosis of Fluid Volume Excess.
* Risk for developing pulmonary edema/ congestive heart failure; for adults at greater risk due to reduced kidney function
* Diet low in sodium
* Restrict fluid intake
27
pH is abnormal
either PaCO2 or HCO3 is also abnormal
uncompensated
28
pH is abnormal
both PaCO2 and HCO3 are also abnormal
partially compensated
29
pH is normal
both the PaCO2 and HCO3 are abnormal
fully compensated
30
What is the highest amount of Oxygen would we want to administer to a COPD patient.
If a COPD patient’s Oxygen Saturation is low how much Oxygen would we administer?
patient with COPD, will use the lower amount of oxygen (1–2 L/min) so that the patient does not lose the hypoxic drive to breathe.
31
What type of patient is at risk for Hypocalcemia?
o Vitamin D deficiency,
o hypoparathyroidism
o diarrhea
o malnutrition
o lactation
o pregnancy
o chronic renal failure
o bone disease
o chronic alcohol abuse
32
If a patient is Hypovolemic, are they at risk for a fall? If they are at risk for a fall, what nursing intervention would we implement?
Orthostatic hypotension
o Dangle on the bedside before ambulating
33
S/S of Respiratory Alkalosis
o seizures
o deep, rapid breathing
o hyperventilation
o tachycardia
o low or normal BP
o hypokalemia
o lethargy & confusion
o light headedness
o nausea/vomiting
numbness & tingling of extremities
34
causes of respiratory alkalosis
o hyperventilation (anxiety, PE, fear)
o mechanical ventilation
35
If a patient is hyperventilating (in respiratory alkalosis) what nursing actions/interventions can we do to help the patient.
* If pt is hyperventilating try to assist pt with breathing techniques, decrease stimuli and provide therapeutic environment
36
If a patient has an acid-base balance problem our bodies naturally try to normalize our pH. What is this called when our body attempts to normalize our pH?
Compensation (there is full compensation and partial compensation)
o Full compensation happens when pH returns to normal
o Partial compensation is when pH is unable to normalize
37
What is the treatment for Hyperkalemia?
Treatment
o Sodium polystyrene sulfonate
o 50% dextrose
o IV regular insulin IVP bonus & bull
o Sodium bicarbonate 50mEq IVP & bull
o Albuterol nebulization
o Loop diuretics
38
How does the Calcium level affect the Thyroid?
Hypocalcemia
o Parathyroid regulates calcium in the body
o A thyroidectomy can affect the parathyroid increasing the risk hypocalcemia
39
What type of lung sounds would you expect to auscultate on a Chronic Kidney Disease patient if their fluid balance level is stable.
Absence of adventitious
o On auscultation indicates a lack of fluid overload and fluid balance in a pts body
40
causes of respiratory acidosis
o central nervous system depression (head trauma, oversedation, anesthesia, high spinal cord injury)
o pneumothorax
o hypoventilation
o bronchial obstruction and atelectasis
o severe pulmonary infections
o heart failure with pulmonary edema
o massive pulmonary embolus
o myasthenia gravis
o multiple sclerosis
41
A patient comes into the ER and is experiencing a Fluid Volume Deficit.
What Physical S&S would you expect to find with this patient?
* Weight loss
* Loss of skin tugor
* Oliguria
* Thirst
* Flatten neck veins
42
If a patient is having shortness of breath is the patient experiencing a fluid volume overload/excess or a fluid volume deficit?
fluid excess
43
What Physical S&S would be present in an older adult who is experiencing a fluid volume excess?
* Weight gain
* Ascites (too much fluid build up in abdomen)
* Edema
* Urinary output
* Hypertension
* Tachycardia
* Elevated central venous pressure
* Development of S3 heart sounds
* JVD
44
What Physical S&S would you see in a patient experiencing a fluid volume deficit?
* Dry skin,mouth,or cracked lips
* Sunken eyes
* Frequent urine infections
* Easily tired or confused
* Dark urine, small quantity
45
If a patient’s pH is 7.24 why would they be breathing rapidly?
Person is breathing faster to get rid of carbon dioxide and get the pH back to normal
46
If a patient is receiving diuretics for Hypertension. What acid-base imbalance can this cause?
Hypokalemia (low potassium)
47
T or F:
if a patient has an NG tube and it is connected to suction, it puts the patient at risk for metabolic alkalosis
True
48
elevated BUN/creatinine can be linked to what?
dehydration
49
If BP is low, are you going to give 0.45 Normal Saline?
* No we would give pt NS (0.9% NS)
50
Know the different IV fluids and what they are used for when treating a patient.
Isotonic Fluids are go-to IV fluids for rehydration and maintenance fluids
o Dehydration
o nausea/vomiting/diarrhea
o Bolus or maintenance
o AKI
o Hyponatremia
o Hypotension
o Sepsis
o burns
Hypotonic fluids have lower concentration of solutes than blood plasm, causing intracellular shift of fluids, leading to cellular swelling
o ½ NS (0.45% NS) (Maintenance fluids, DKA)
o D5W (Mixed with meds, hypernatremia, overly corrected hyponatremia)
Hypertonic Fluids (0.3%) have higher concentration of solutes than blood plasma, causing extracellular shift of fluid leaking to cellular dehydration and “shrinking”
o Severe hyponatremia
o Increased ICP
51
What are the characteristics of Metabolic Alkalosis?
* May be caused by losing too much acid from the body, or by having to much bi carbonate
* Muscle twitching and cramps
* Tetany
* Dizziness
* Lethargy
* Weakness
* Disoriented
* Coma
* Nausea / vomiting
* Depressed respirations
52
What is the function of Aldosterone? If a patient is taking a medication that inhibits Aldosterone secretion and release, what potential complication can it cause? Hint: (What Electrolyte will it affect)
* Aldosterone promotes the retention of sodium and water in the distal nephrons of the kidney, restoring blood volume.
* Aldosterone is a naturally occurring hormone of the mineralocorticoid type that increases the reabsorption of water and sodium in the kidney at the same time that it promotes excretion of potassium.
* Any drug or condition that disrupts aldosterone secretion or release increases the clients risk for excessive water loss and increased potassium reabsorption. The client would not be at risk for over hydration or sodium in balance
* Complication is hyperkalemia / affects potassium
o Affects potassium as in to much potassium since it is blocking sodium
53
The Potassium level is high what abnormalities will show up on the EKG?
* In potassium levels of greater than 7.5 mEq/L, there is a disappearance of the P wave with the development of junctional rhythms. As the potassium level exceeds 9.0 mEq/L, the QRS complex continues to widen
54
Your patient has Hypocalcemia. What clinical manifestations will be present with Hypocalcemia?
* May have no symptoms, focal numbness, muscle spasm, paresthesias, twitching, tremors and tetany, dysphagia
55
difficulty/pain/discomfort with urination that may indicate obstruction, infection, UTI, or cystitis
dysuria
56
presence of blood in the urine
hematuria
57
What does Urinary Retention mean?
* occur due to complications from anesthesia, opioids, and immobility.
o Anesthesia depresses the nervous system, which can affect the nervous system’s control of micturition.
* can result in a decreased sensation of a full bladder and urinary retention.
o Opioids -may interfere with the patient’s ability to fully empty the bladder.
o Immobility and bedrest impact the ability to fully relax the perineal structures to allow voiding and complete emptying of the bladder.
58
Why do percuss the Costovertebral angle?
* Percuss to assess for pain or tenderness-if pain/ tenderness is reported, suggestive of kidney inflammation or infection.
* location of the kidneys can be estimated by the costovertebral angle
59
How do you collect a Clean Catch Urine Specimen?(
* Wash hands.
* Remove cap from sterile specimen container, ensuring not to touch the inside of the lid or container.
* Males: Use enclosed towelette(s) to wipe the head of the penis.
* Females: Spread the labia with one hand and use the other hand to wipe from front to back with the enclosed towelette(s).
* Begin urinating a small amount into the toilet. Without stopping the flow of urine, place the cup into the stream of urine and collect enough urine to fill the cup. Finish urinating into the toilet.
* Securely attach the cap onto the sterile container, ensuring not to touch the inside of the lid or container.
60
Your Patient has just come back to the floor recently after a Cystoscopy. What would be an abnormal finding after this procedure?
* pink tinged urine
Gross bleeding and/or clots in the urine are not normal and should be reported to the healthcare provider
61
What are some age related changes in the Renal System? SATA
* In females, the bladder, vagina, and pelvic floor muscles lose tone and elasticity, which contributes to an increased occurrence of urinary incontinence. This can be further intensified in women who previously lost muscle tone and elasticity during pregnancy and childbirth.
* a higher incidence of UTIs.
62
anatomical picture of a woman
bladder <--
--> (top) uterus
--> (middle) Pessary
--> (bottom) Vagina
63
What foods or drinks should be avoided with a Diagnosis of Urolithiasis?
* AKA kidney stones
* diet high in sodium and protein,
* Inability to metabolize oxalate from foods (black tea, spinach, beets, swiss chard, chocolate, peanuts)
64
What are some risk factors that can contribute to Urinary incontinence?
* Loss of muscle tone and elasticity
* Decreased bladder capacity
65
What are some non-surgical techniques that can be used for incontinence?
* Kegel exercises - females
* Pessary - a device that fits into the the vagina to support the bladder in an attempt to control incontinence and support bladder emptying
66
How are anticholinergics used to treat incontinence?
* Used to calm an overactive bladder
* They block the nervous stimulation from the parasympathetic nervous system to help relax and control bladder muscle contractions
67
First S/S of Bladder Ca?
* Hematuria
* Dysuria, frequency, urgency (infection or obstruction present)
* Weight loss
* Anorexia
* Abdominal asymmetry or bladder distention
* Pelvic, back, or abdominal pain
68
What is a Pyelolithotomy?
* The removal of a large stone from the kidney that causes infections and blocks the flow of urine form the kidney
69
Bactrim is used to treat UTI’s. If the patient is still Symptomatic and returns to the ER what Nursing Diagnosis might be the problem?
* Complications include antibiotic resistance or pyelonephritis and renal abscess
70
Hemoglobin
females: 36%-48%
males: 42%-52%
71
Hematocrit
females: 11.7-15.5 g/dL
males: 14-17.3 g/dL
72
ESR (erythrocyte sedimentation rate)
females: 0.-29 mm/hr
males: 0-22 mm/hr
73
Be concerned about any patient that does not have any urinary output in an hour when they have a foley catheter in place.
74
After a patient has had a lithotripsy what does the nurse need to do every time after the patient voids?
* Strain the urine ? (was said during recording)
* Check urine to see if pt is passing any parts of the stones
75
What questions do we need to ask any female that has a discharge?
* Do you have any discharge?
* What color is it?
* How long have you had it for?
* Does it have an odor?
76
What position is a woman in when the Doctor is performing a breast exam?
* a sitting position (during inspection)
* Lying on their back (for palpation for mass/tenderness)
77
A patient has had a laparoscopy done and has returned to your unit. The patient is complaining of bloating and shoulder pain. What will you tell the patient? Is this a normal finding?
* Yes these are normal findings due to the gas that is put into the abdomen.
advise the patient that this is normal because the surgeon had to fill up their abdomen with gas to make room to maneuver around
78
what happens to our pubic hair when we get older
thins out
79
Adolescent girl starting her cycle. What do you tell her regarding the cramping pain during her cycle
o typically normal and should decrease as you get older
80
Patient has had a positive Pap Smear. Abnormal Pap. What is the next test to be performed?
* Colposcopy with Cervical BX.
81
what is BPH
o Benign prostatic hyperplasia
Enlarged prostate- NOT A FORM OF CANCER
82
what is "watchful waiting"
“Watchful waiting”
o Active surveillance
o Least invasive treatment
Used for minimal symptoms and minimal enlargement of prostate
o Pt is adviced to avoid tranquilizers and over-the-counter medications that contain decongestants because these medications can worsen obstructive symptoms
o Pts should avoid excess fluids in the evening to decrease the chances of nocturia
83
what is TURP
o Transurethral resection of the prostate
Most common surgery for BPH for many years and is usually used to treat smaller prostates.
84
If your patient is experiencing a fever (Temp 101.4 F) after a TURP what does the nurse need to do?
* May indicate a UTI secondary to urinary stasis
85
Why do we give Anticholinergic meds to patients with BPH?
* If the pt has an overactive bladder, an anticholinergic to relax bladder smooth muscle, such as oxybutynin
86
What are some Risk factors that increase the risk for Prostate cancer?
* High consumption off calcium or the ingestion of greater than seven multivitamins a week
* Family HX
* Diets high in red meat
* High body mass (BMI)
87
What discharge instructions would you give a patient that has experienced a Blunt testicular trauma?
* Care related to nonsurgical intervention
* Teach patient how to care for a crotal injury by explaining proper dosing of NSAIDS; the use of a scrotal sling or folded towels to elevate the scrotum; the ise of ice packs; including the use of a towel between the skin and the ice pack; the importance of rest to assist in recovery
* Teach patient how care for the surgical, especially keeping it clean and dry to decrease the chance of infection
* Teach the patient and/or significant other how to manage the care of drains, should the patient be discharged with drains in place, to encourage independence
* Teach pt to call the provider when s/s of worsening condition occur, such as fever, redness, a heavy feeling in scrotal area, swelling, bleeding, nausea and vomiting, and increasing pain
88
Can you give an HPV vaccine when a woman is pregnant?
* no , HPV vaccinations can harm baby
89
What are the S/S of Secondary Syphilis?
* It is marked by a rash and/or mucous membrane lessions
* Maculopapular rash may develop on the palms, soles, buttocks, and upper thighs
* Rashes may appear macular, papular, or pustular or a combination of all
o Lessions called condylomata lata
* Other symptoms
o Fever malaise
o Alopecia
o Joint pain
o headaches
90
What antibiotic is usually given to treat Syphilis? What antibiotic is given if the patient is allergic to PCN?
* Penicillin but if the patient is allergic to penicillin may use other approved medications; however may not be as effective
* Medications include
o Ceftriaxone
o Tetracycline
o dozycycline
91
What are the Clinical manifestations of Genital Herpes? SATA
* HSV outbreaks ocur episodically. Between outbreaks, HSV lies dormant in the sacral area in the CNS. Becomes reactivated as a result of stressors or trigger.
* The primary or initial outbreak presents as one or several clear vesicles, or blisters, that erupt in the gential area, the vesicles then ruptures and forms a painful ulcer several days later. The ulcer may last up to 2 to 4 weeks if untreated displays common symptoms observed in males and females.
92
o too much CO2
o HYPOVENTILATION - related to narcotic use (opioids)
respiratory acidosis
93
o not enough CO2
o HYPERVENTILATION
o patients on ventilators often go into this due to the vent providing too many breaths
respiratory alkalosis
94
S/S of respiratory alkalosis
o SOB
o confsion
o irritability
o nubmness
o tingling
o anxiety/panic
o tachycardia
o fatigue
o hypoxemia
95
o poor diet
o related to forcing the body into burning fat (ketoacidosis acid created by not having enough glucose in your blood for energy-ketones)
o can be found in blood and urine
o severe diarrhea
o maintain balanced diet
metabolic acidosis
96
o diuretics (lasix) can lead to this process because it is a potassium depleting medication and acid excretion increases
o muscle twitching and cramping
o prolonged vomiting
metabolic alkalosis
97
Have the same osmolarity as plasma and body fluids, so fluid is not pulled across the cell membrane when these fluids are administered. (Normal Saline 0.9%, Lactated Ringer's 5%, and D5W in Lactated Ringer's)
isotonic fluids
98
Have a lower concentration of solutes than within the cell, causing fluid movement into cells. (0.45% Normal Saline)
hypotonic fluids
99
have higher concentrations of solutes than within cells, causing fluids to shift out of the cell and into the ECF, causing cells to shrink. (3% Normal Saline)
hypertonic fluids
100
inability to empty bladder
urinary retention
101
cystoscopy post-op complication
dark red urine
102
changes the color of urine to orange/reddish orange
pyridium
103
no coffee or tea - as the cause of kidney stones
urolithiasis
104
causes of female urinary incontinence
o obesity
o smoking
o childbirth
o depression
105
surgical procedure for female urinary incontinence.
used for stress incontinence. a procedure to increase bladder capacity; augmentation cystoplasty
suburetheral sling
106
S/S of bladder cancer
hematuria w/out pain
107
kidney stone removal
pyelolithotomy
108
S/S of sepsis from UTI
o low BP
o temp
o HR
o Normal respirations
o SpO2
109
risk for prostate cancer
obesity
red meat
110
4 hormones that control menstrual cycle
o estrogen
o FSH
o LH
o progesterone
