Exam 4 Study Guide: Q Flashcards
causes of respiratory alkalosis
o anxiety induced hyperventilation
o poor oxygenation can induce hyperventilation
nursing interventions for a patient with respiratory alkalosis
o identify causes of anxiety
o rebreathing techniques (breathe into a paper bag or cupped hands) to retain CO2 and slow down breathing
o teach patient stress reduction
**non-rebreather mask is not a good option because the client should rebreathe some CO2
ABG values correlated with respiratory alkalosis
o PaCO2 < 35 mmHg
o pH > 7.45
S/S of respiratory acidosis
o high respiratory rate
o patient is acidic
o respiratory system is attempting to compensate by “blowing off” excess acid in the form of CO2
nursing priority of respiratory acidosis
o maintain patient’s airway
primary cause of respiratory acidosis
o primarily hypoventilation - which occurs with opioid overdose
which acid base disorder correlated with change in HCO3?
Metabolic acid base disorder correlate with changes in HCO3 (respiratory do not)
what ABG values are associated with metabolic acidosis?
o HCO3 < 22 mEq/L
o pH < 7.35
o normal PaCO2
causes of metabolic alkalosis??
o excessive oral ingestion of bicarbonate-based antacids
o vomiting and NGT suctioning
o Potassium wasting diuretics
ABG values indicate metabolic alkalosis
o pH . 7.45
o HCO3 > 26 mEq/L
o CO2 is normal
S/S of acute kidney injury (AKI)
o volume overload due to decreased urine output such as edema, JVD, SOB, hypertension, pulmonary edema and increased potassium
important interventions for a patient with CKD
o Monitor I&Os
o SPO2 > 93% and low protein diet
o monito lung sounds
what is the purpose of daily weights?
o weight is the best non-invasive indicator of fluid status
what is a good way to measure fluid retention?
1 L of H2O = 1kg
o a change in BWT is a good measure of excess fluid loss or retention
o patient education: clinical manifestations of hypervolemia such as edema
what diet should patients with fluid retention follow?
limit sodium and fluid intake
who is at risk for dehydration?
older adults
o less total body water than younger adults
what are important points with older patients at risk for dehydration
cognitively impaired
o and 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
what should the nurse do when a patient has an elevated BUN with dehydration?
prepare to administer IV fluids
S/S of hypovolemia
o tachycardia
o hypotension
o concentrated urine
o flattened neck veins - could quickly lead to hypovolemic shock
o preventing injury - older adult with moderate dehydration may experience orthostatic hypotension, dangle on the bedside before ambulating
how is hypovolemia corrected
Isotonic Solutions (0.9% NS, LR)
o used for fluid volume deficit
hypervolemia interventions
o daily weights each morning before anything to eat or drink
o fluid restrictions
o monitor for edema
o edema in the lower extremities - elevate legs on a pillow or two
S/S of HYPERVOLEMIA
o tachycardia
o JVD
o edema
o crackles
o absence of adventitious sounds upon auscultation of the lungs indicates a lack of fluid overload and fluid balance in the patient’s body
S/S of HYPOCALCEMIA
o anxiety
o confusion
o irritability
o paresthesia
o positive chvostek/trousseau sign
o tetany
o twitching
o tremors
o focal numbness
o muscle spasms
o biliary colic
o dysphagia
o wheezing
o tingling around the mouth
o bronchospasms
o laryngospasms
causes of HYPOCALCEMIA
o chronic alcohol abuse is an etiology of hypocalcemia and hypomagnesemia
o parathyroid regulates calcium in the body and a thyroidectomy can affect the parathyroid increasing risk of hypocalcemia
who is at risk for HYPERMAGNESEMIA?
o patients taking excessive amounts of milk of magnesia
who is at risk for HYPOMAGNESEMIA?
o chronic alcohol abuse
o caused by malnutrition, alcohol abuse, vomiting, diarrhea, laxative abuse, and dehydration
may cause dysrhythmias
potassium > 5.0
S/S of HYPERKALEMIA
o generalized weakness
o muscle cramps
o paresthesia to weakness
o ECG changes (abnormal rhythms, widened QRS complex)
o bradycardia
o sinus arrest
o heart blocks
o ventricular dysrhythmias
treatment of HYPERKALEMIA
o must be treated immediately to reduce the extracellular potassium level
o insulin: enhances potassium movement into the cells to decrease both serum potassium and glucose levels and therefore should be administered with DEXTROSE to prevent hypoglycemia
o dialysis may also be needed (not the first prescription the nurse should implement
causes of HYPOKALEMIA
o many diuretics
- especially loop and thiazide diuretics, increase the excretion of hydrogen ions, leading to excess acid loss through the renal system. this situation is an acid deficit of metabolic origin. monitor for metabolic alkalosis
S/S of HYPERNATREMIA
o disorientation
o hallucinations
o agitation
o restlessness
o neuromuscular irritability
o confusion
o seizures
o lethargy
o tachycardia
o dry mucous membranes
o skin flushed
o agitation
o thirst
causes of HYPERNATREMIA
o cushing’s syndrome
o hyperaldosteronism
o patient’s taking corticosteroids are at risk for hypernatremia
o dehydration can increase risk of hypernatremia
what should you education patients with hypernatremia
o drink at least 8 glasses of water/day
o administration of sodium bicarbonate for metabolic acidosis
what is one cause of HYPONATREMIA?
o hyperglycemia with glucosuria can cause sodium loss causing hyponatremia
hypnotic fluids important points
o hypnotic fluids (0.45% NS)
o may cause hypotension to worsen if given to patients with low BP
o hypotonic IV fluid, such as 0.45% NS shifts fluid out of the vessels and into the cells - because of fluid shift, hypotension may be worsened
what should you do if a provider orders 0.45% NS for a serum osmolality > 300 mOsm/kg
o causes fluid to move from the intravascular space into both the intracellular and interstitial spaces
o physicians tend to miss this so if you see this, question the order and remind the physician this ight not be the best choice for rehydration
a procedure to closely examine your cervix, vagina, and vulva for signs of disease.
allows direct visualization of the bladder wall and urethra
o dr may recommend this if your pap test result is abnormal
cystoscopy
what is cystoscopy used for
o to diagnose, monitor and treat conditions affecting the bladder and urethra
reveals the size and anatomy of the kidney, ureters, and bladder (KUB), as well as any tumors, cysts, calculi, and obstructions within the urinary tract
IV Urography
what is the first symptoms of polycystic kidney disease
o hypertension
infection and inflammation of the kidney, pelvis, calyces, and medulla
pyelonephritis
what is the drug phenazopyridine used for
o an antispasmodic agent that is used to treat bladder spasms caused by UTIs
o this is taken as needed and is not used to TREAT UTIs
S/S of bladder cancer
o painless hematuria
o dysuria
risk of bladder cancer
smoking
what controls the menstrual cycle
o hormonal secretions of FSH and LH from the anterior pituitary
o and the release of estrogen and progesterone from the ovaries
which testicle hangs lower?
left testicle
what are the tiny skin folds called
the scrotal wall has tiny skin folds called RUGAE
what is used to treat hot flashes associated with menopause
black cohosh
BPH interventions
o alpha blockers (act on the alpha receptors in the prostate, causing the smooth muscles of the prostate to relax)
o anticholinergic meds (meds prescribed to relax bladder smooth muscle in patients with overactive bladder)
o 5-alpha reductase inhibitors (prevent testosterone from being converted to dihydrotestosterone DHT, which causes enlarged tissues to shrink, thus reducing obstruction of the urethra)
HPV important points
o common STI of the anogenital tract
o evidence revealing its role in cancers of the cervix, vulva, vagina, anus, penis, and some head and neck cancers
genital herpes important points
o tingling or an abnormal sensation before presence of the vesicle
o ulcer is a prodromal sign for genital herpes
o prodromal symptoms may occur before the appearance of the blister, indicating the beginning of an outbreak
S/S of Chlamydia in females
o dysuria
o dyspareunia (painful sexual intercourse)
o lower abdominal pain
o vaginal discharge
o cervical tenderness
o rectal d/c
gonorrhea risk factors
o age (particularly younger than 25 years old)
o low socioeconomic status
o multiple sexual partners
o hx of STIs including pelvic inflammatory disease (PID)
o M sex with M
o unmarried status
syphilis PRIMARY clinical manifestations
genital ulcer and chancre
syphilis SECONDARY clinical manifestations
o skin rash
o mucous patches
o fever
o hepatitis
o arthritis
syphilis TERTIARY clinical manifestations
o cardiovascular and aortic regurgitation
AKI clinical manifestations
o HTN from fluid overload
o edema
o JVD
o crackles
o pulmonary edema
o oliguria
o SOB (think airway/breathing)
how can you reduce the risk of pulmonary edema in AKI
monitor I&O
- balance them
when a patient comes in with potassium of 8, which medication order do you anticipate first
o insulin and dextrose
are you concerned about BG 146?
o slightly, unless they just ate
usually don’t treat till > 150
are you concerned about K of 6.7
yes, can cause arrhythmias
what is a good indicator fluid balance is maintained
o no crackles
o clear lung sounds
o no adventitious sounds
are you concerned about calcium level of 17
yes
which food is high in sodium?
o fresh fruit
o broccoli
o potatoes
o brown rice
o beans
o mac & cheese
mac and cheese
are you going to see patients with creatinine > 2 soon
yes
patient getting 167ml/hr and develops SOB and crackles, what do you do
stop infusion and call the Dr
what do you monitor for in a patient with metabolic acidosis
o decreased HR
o cardiac system
why is a patient with respiratory acidosis tachypneic
o excess CO2 buildup in body, trying to lower level
what is the appearance of syphilis cancres
o Cancre - silver oral ulcers
what STI increases the risk of cervical cancer
HPV
what is the MOA of flomax for BPH
o anticholinergic that relaxes bladder muscles
o alpha adrenergic blocking property relax smooth muscle for prostate
which patient should you see first?
o WBC 9k
o sodium 137
o BG at 146
o potassium 6.8
potassium 6.8
which findings indicates fluid balance in a CK patient?
o decreased calcium levels
o increased phosphorus levels
o edema in legs
o clear lung sounds
clear lung sounds
in a patient with lower extremity edema, what should you do?
o document the pitting edema
o elevate lower limbs
what is a priority to monitor with metabolic acidosis
cardiac rate and rhythm
what can you monitor in a patient with CKD to reduce the risk of pulmonary edema
I&O
what can you assess to see if there has been an improvement in pulmonary edema
o lung sounds (want no adventitious lung sounds and no crackles)
who is at the highest risk for dehydration
o homeless
o elderly
o cognitive impairment (dementia & alzheimers)
what are important discharge education points for a patient with fluid volume excess
o weigh themselves daily
o fluid restrictions
o monitor for peripheral edema (elevate lower limbs if noted)
what causes hypocalcemia and hypomagnesemia
alcohol abuse
S/S of HYPOCALCEMIA
o tremors
o anxiety
o confusion
o irritability
o positive chvostek/trousseau sign
o bronchospasm
o facial tremor/twitching
what condition could put a patient into respiratory alkalosis and what should you instruct the patient to do
o anxiety - hyperventilation
o have clients breath into paper bag or cupped hands
what can put a patient into respiratory acidosis
opioid OD - hypoventilation
what is hyperkalemia?
elevated potassium
what meds are given for critically high potassium levels
insulin and dextrose
what medication is given to treat hypokalemia
potassium (usually 20 - 40 mEq)
what causes hypernatremia
dehydration
what is an important patient education point for hypernatremia
o low salt diet
o drink 8 glasses of water/day
a patient just had a partial thyroidectomy and has facial twitching and irritability, what is wrong?
hypocalcemia
why would a dehydrated patient be confused?
lack of cerebral perfusion
what do you need to administer to a patient with lack of cerebral perfusion
IV fluids
a dehydrated patient is getting IVF 150mL/hr and has SOB,
you hear crackles, what do you do?
o stop infusion and call the dr
- fluid overload/pulmonary edema
S/S of dehydration/hypovolemia
o flattened neck veins
o hypotension
o tachycardia
o concentrated dark yellow urine
what fluids will you give patients with hypovolemia (dehydration)
isotonic 0.9% NS or LR
are flattened neck veins high priority? if so, why
yes
o worry about brain perfusion
are you concerned about patient with creatinine of 2?
yes
o kidney function is around 50%
normal Hct
37 - 50%ish
what is the priority in patients with respiratory alkalosis and respiratory acidosis
maintain airway
is skin tenting a S/S of hypervolemia?
no
o hypertension
o JVD
o edema
o tachycardia
o crackles
is skin tenting a S/S of HYPOVOLEMIA
yes
what acid-base imbalance can be caused by potassium wasting diuretic? what are other causes of this condition
metabolic alkalosis
- vomiting
- NG suctioning
what are education points for a patient with mild dehydration
o avoid caffeine
o consume non-caffeinated beverages
what could cause a BUN in the 30s, and what should you give this patient?
fasting and dehydration
- give IV fluids
what is a hypotonic solution
0.45% NS
what happens if hypotonic solution is given to a dehydrated patient
fluid shifts into cells
o will drop BP further
what condition causes hyponatremia
hypoglycemia with glucosuria
hypernatremia is caused by what conditions
Cushing’s & hyperaldosteronism
what are causes of hypomagnesemia
o chronic alcohol abuse
o laxative abuse
o malnutrition
o dehydration
what heart rate would you expect in a hypovolemic patient
o tachycardia
- trying to compensate for hypotension
what should you give to a patient who has a serum osmolality level > 300
hypotonic IVF
0.45% NS
what should you do when a patient receiving a blood transfusion develops abdominal pain, back pain, face flushing, and SOB
o stop transfusion
o take vitals
o call the Dr
what procedure would be performed to remove a kidney stone
cystoscopy
what is the first symptom of polycystic kidney disease
HTN
what are patient education points with Phenazopyridine (pyridium)
o treat bladder spasms with a UTI but does not cure UTI (need abx)
o urine will look orange
what is the number 1 risk factor of bladder cancer?
smoking
what is the early S/S of bladder cancer
painless blood in the urine
pap smears screen for which type of cancer
cervical cancer
a patient comes in with vaginal discharge, itching, and dysuria.
what should you find out
o color of the discharge
what 4 hormones control the menstrual cycle
o FSH
o LH
o Estrogen
o Progesterone
when performing an assess on an adult client’s scrotum,
what are normal and abnormal findings
Normal Findings:
o left testicle lower than right, rugae, skin darker
Abnormal Findings:
o no erythema or swelling
what is the best response by a nurse when a young adolescent client comes in with severe menstrual cramps
- this is normal and they should become less severe as you get older
what is the MOA of an alpha adrenergic blocking medication for BPH
o relaxes the smooth muscle of the prostate
what is the MOA of an ANTICHOLINERGIC medication for BPH
o relaxes the bladder muscle
which STI increases the risk of cervical and penile cancer
HPV
what is a prodromal S/S of genital herpes (before vesicles appear)
tingling and abnormal sensation
what are S/S of a female with chlamydia
o painful urination
o painful intercourse
o lower abdominal pain
o cervical tenderness
what are risks for gonorrhea
o Hx of STIs
o multiple partners
when giving Lasix to patient with AKI,
what electrolyte imbalance are we concerned about
o Hypokalemia
- can put the patient into metabolic alkalosis
the normal range for the bicarbonate HCO3
22 - 26
the metabolic parameter of the arterial blood gas set is
HCO3
the respiratory parameter of the arterial blood gas set is
PaCO2
