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Med Surg > Exam 5 > Flashcards

Exam 5 Flashcards

0
Q

What is a lab test useful in determining a persons fluid volume status

A

BUN and its relation to serum creatine concentration.

A volume depleted person has a BUN elevated out of proportion to serum creatine. Ratio 20:1

The HCT level is also greater than normal because there is a decreased plasma volume.
Urine specific gravity is increased in relation to the kidneys attempt to conserve water

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1
Q

What is HYPOVOLEMIA

A

FVD or HYPOVOLEMIA occurs when loss of ECF volume exceeds the intake of fluid.

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2
Q

Why can a BUN be elevated

A

It can be elevated because of dehydration or decreased renal perfusion and function

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3
Q

When does hypokalemia occur

A

HYPOKALEMIA occurs with GI & renal losses

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4
Q

Hyperkalemia results from what

A

Adrenal insufficiency

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5
Q

When does hyponatremia occur

A

It occurs with increased thirst and ADH release.

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6
Q

What does hypernatremia result from

A

Hypernatremia results from increased insensible losses and diabetes insipidus

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7
Q

When is urine specific gravity decreased

A

With diabetes insipidus

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8
Q

What is secreted when fluid volume is low

A

Aldosterone is secreted when fluid volume is low causing reabsorption of sodium and chloride.
Urine osmolality can be greater than 450 because the kidneys try to compensate by conserving water.

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9
Q

For a person with fluid volume deficit,what type of fluids will be administered

A

Isotonic electrolyte solutions ( lactate ringers, 0.9% sodium chloride)
Are 1st line of choice to treat the hypotensive person with FVD because they expand plasma volume.
As soon as the person becomes normotensive, a hypotonic solution ( 0.45% sodium chloride) is often used to provide both electrolytes and water for renal excretion of metabolic wastes.

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10
Q

What assessments should be done to determine when therapy should be slowed to avoid fluid volume overload.

A

Accurate and frequent assessments of I&O, weight, vital signs, central venous pressure,LOC,breath sounds and skin color

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11
Q

What are contributing factors to fluid volume deficit

A

Loss of water and electrolytes from vomiting, diarrhea, fistulas, excessive sweating,burns, blood loss, GI suction, 3rd space fluid shifts, decreased intake

Uncontrolled Diabetes and diabetes insipidus both contribute to depletion of extra cellular fluid volume.

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12
Q

What are signs symptoms and of a person with FVD

A

Acute weight loss, decreased skin turgor, oliguria, concentrated urine, capillary filling prolonged, low CVP, low BP, flattened neck veins, dizziness, weakness, thirst and confusion. Increased pulse, muscle cramps,sunken eyes, nausea, increased temp,cool clammy pale skin.

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13
Q

What lab values are indicative of FVD

A

Increased HGB, HCT
increased serum and osmolality and specific gravity
Increased BUN and creatine

Decreased urine sodium

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14
Q

What are contributing factors of fluid volume excess

A

Compromised regulatory mechanisms such as renal failure heart failure and cirrhosis
Overzealous administration of sodium containing fluids
Fluid shifts in other words treatment of burns
Prolonged corticosteroid therapy severe stress and hyper aldosteronism augment fluid volume excess

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15
Q

What are signs and symptoms of hypervolemia

A

Acute weight gain peripheral Edema and ascites
Distended jugular vein crackles elevated CVP shortness of breath and increased blood pressure bounding pulses and cough increased respiratory rate increase urine output

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16
Q

What lab values are in the indicative of hypervolemia

A

Decreased hemoglobin and hematocrit
Decreased serum and urine osmolality
Decreased urine sodium and specific gravity

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17
Q

What are contributing factors of sodium deficit

Hyponatremia levels less than 135

A

Loss of sodium as the use of the Diuretics,loss of G I fluids renal disease adrenal insufficiency gain of water as an excess of the ministration of D5W and water supplements for patients receiving hypotonic tube feedings
Disease states associated with SIADH such as head trauma and oat cell lung tumor.
Meds associated with water retention such as oxytocin and certain tranquilizers and psychogenic polydipsia
Hyperglycemia and heart failure can cause a loss of sodium

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18
Q

What are signs and symptoms of hyponatremia

A

Anorexia,nausea,and vomiting,headache lethargy,dizziness,confusion muscle cramps,weakness,muscular twitching,seizures,papilledema Dry skin, increased pulse,decreased blood pressure, weight gain,edema

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19
Q

What labs are indicative of hyponatremia

A

Decreased serum and urine sodium,

decreased urine specific gravity and osmolality

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20
Q

What are contributing factors to hypernatremia

A

Water deprivation inpatients unable to drink
Hypertonic two feedings without adequate water supplements
diabetes insipidus,heatstroke,hyperventilation,watery diarrhea,burns and diaphoresis
Excess corticosteroids sodium by carbonate and sodium chloride administration saltwater in near drowning victims

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21
Q

What are signs and symptoms of hypernatremia

Levels greater than 145

A

Thirst elevated body temperature swollen dry tongue sticky mucous membranes hallucinations lethargy restlessness irritability simple partial or tonic clonic seizures pulmonary edema hyperreflexia twitching nausea vomiting and anorexia increased pulse and blood pressure

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22
Q

What are contributing factors of hypokalemia

Levels less than 3.5

A

Diarrhea,vomiting,gastric suctioning,corticosteroid administration hyperaldosteronism,carbenicillin,amphotericin B, bulimia,osmotic diuresis,alkalosis,starvation,diuretics and digoxin and toxicity

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23
Q

What are contributing factors of hyperkalemia

A

Pseudo hyperkalemia,oliguric renal failure,use of potassium sparing diuretics,metabolic acidosis,Addison’s disease,crush injury, burns,stored bank blood transfusions,rapid the administration of potassium,medications such as ACE INHIBITORS, NSAIDS, CYCLOSPORINE

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24
Q

What are signs and symptoms of hyperkalemia

A

Muscle weakness, tachycardia, bradycardia, dysrhythmias, flaccid paralysis, paresthesia, intestinal colic, cramps, abdominal distention,irritability, anxiety prolonged PR interval and QRS duration absent P waves, ST depression

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25
Q

What are calcium levels

A

8.5-10.5

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26
Q

What are contributing factors of hypocalcemia levels less than 8.5

A

Hi both parathyroidism (May follow thyroid surgery or radical neck dissection) malabsorption, pancreatitis, alkalosis, vitamin D deficiency, massivesubcutaneous infection, generalized Peritonitis, massive transfusion of citrated blood, chronic diarrhea, diuretic phase of renal failure, fistula, Burns and alcoholism

27
Q

What are contributing factors of hypercalcemia

A

Hyper parathyroidism, malignant neoplastic disease, prolonged immobilization, overuse of calcium supplements, vitamin D excess,oliguric phase of renal failure, acidosis, corticosteroid therapy, fire is not diuretic use, digoxin toxicity

28
Q

What are signs and symptoms of hypercalcemia

A

Muscular weakness,constipation, anorexia, nausea and vomiting, polyuria and polydipsia, dehydration, hypoactive deep tendon reflexes,Lethargy, deep bone pain, pathologic fractures, flank pain, calcium stones, hypertension

29
Q

What are signs and symptoms of hypocalcemia

A

Numbness,tingling in the fingers and toes, positive Trousseau’s sign and chvostek’s signs,seizures, carpopedal spasms, hyper active deep tendon reflexes irritability, bronchospasm, anxiety,impair clotting time, decreased prothrombin, diarrhea, decreased BP

30
Q

What will a ECG show for a person with hypocalcemia

A

Prolonged QT interval are in length and ST

31
Q

What labs indicate hypocalcemia

A

Decrease magnesium

32
Q

What are safe ranges of magnesium

A

1.8- 2.7

33
Q

What are contributing factors to magnesium deficit

A

Chronic alcoholism, hyperparathyroidism, hyperaldosteronism, diuretic phase of renal failure, malabsorption since disorders, diabetic ketoacidosis, Refeeding after starvation, parenteral nutrition, chronic laxative use, diarrhea, acute myocardial infarction, heart failure, decreased potassium and calcium

34
Q

What are signs and symptoms of a magnesium deficit

A

Neuromuscular irritability,positive Trousseau’s sign, and chvostek’s sign,insomnia, mood changes, anorexia, vomiting, increased tendon reflexes, and increased blood pressure

35
Q

What will a ECG show of a person with a magnesium deficit

A

PCVs, flat or innervated T waves, depressed QT SEGMENT, PROLONGED PR IMTERVAL, AMD WIDENED QRS

36
Q

What are contributing factors of hypermagnesemia

A

Oliguric phase of renal failure particularly when magnesium containing meds are Administered
Adrenal insufficiency
Excess magnesium administration, diabetic ketoacidosis, and hypo thyroidism.

37
Q

What are signs and symptoms of excess magnesium

A

Flushing, hypotension, muscle weakness, drowsiness, hypo active reflexes, depressed respirations, cardiac arrest and coma, diaphoresis
Prolonged PR IMTERVAL and QRS, peaked T WAVES

38
Q

What are phosphorus levels

A

2.5-4.5

39
Q

What are contributing factors of hypophosphatemia

A

Re feeding after starvation
Alcohol withdrawal, diabetic ketoacidosis, respiratory and metabolic alkalosis, Decreased magnesium and potassium, hyper parathyroidism, vomiting,diarrhea, hyperventilation,vitamin D deficiency assoc with malabsorption disorders,mourns, acid base disorders,parenteral nutrition,and diuretic and antacid use.

40
Q

What are signs and symptoms of hyperphophatemia

A

Tetany, tachycardia, anorexia, nausea and vomiting,muscle weakness, signs of symptoms of hypocalcemia, hyperactive reflexes,soft tissue calcifications In lungs,heart, kidneys and cornea.

41
Q

What are signs and symptoms of hypophosphatemia

A

Paresthesias, muscle weakness, bone pain, tenderness, chest pain, confusion, cardiomyopathy, respiratory failure,seizures, tissue hypoxia, increased susceptibility to infection, nystagmus.

42
Q

What are contributing factors of phosphorus excess

A

Acute and chronic renal failure
Excess intake of phosphorus, vitamin D Excess
Respiratory and metabolic acidosis
Loop, osmotic or thiazide diuretic use.
Overuse of bicarbonate
Rapid removal of ascetic fluid with a high sodium content
IV fluids that lack chloride ( dextrose and water)
Draining fistulas and ostomies,HF, cystic fibrosis

43
Q

What are chloride levels

A

96-108

44
Q

What are contributing factors of excess chloride

A

Excessive chloride infusions with water loss, head injury ( sodium retention), hypernatremia, renal failure, corticosteroid use, dehydration, sever diarrhea ( loss of bicarbonate) respiratory alkalosis,diuretics, overuse of salicylates, kayexalate, acetazolamide,phenylbutazone, and ammonium chloride use, hyper parathyroidism, and metabolic acidosis.

45
Q

What are signs and symptoms of excess chloride

A

Tachypnea, lethargy, weakness, deep rapid respirations, decline in cognitive status, decreased cardiac output, dyspnea, tachycardia,pitting edema, dysrhythmias, coma

46
Q

What lab values are indicative of excess chloride

A

Increased serum chloride,potassium and sodium
Decreased pH
Decreased serum bicarbonate, normal anion gap, increased urinary chloride level.

47
Q

What is treatment of HYPOVOLEMIA

A

Isotonic fluids such as normal saline.

Give salt if they do not have HF, in which salt would be contraindicated.

48
Q

For fluid depletion what fluids will you give

A

Isotonic

49
Q

For cellular dehydration what will u give

A

Hypotonic solutions
Lactated ringers, normal saline
There is no change in osmolality, it increases circulating volume

50
Q

Aldosterone

A

Increases thirst sensation and retains fluids

51
Q

ADH hormone

A

As they name states ( ANTIDIURETIC) it retains fluid, urine output will be low and concentrated.

52
Q

For cellular dehydration which occurs secondary to dehydration, what type,of fluids will be ordered

A

Hypotonic solutions it draws fluids back into the cells.

53
Q

What do hypertonic solutions do

A

Draws fluids back out of the cell.

54
Q

What is a hypertonic solution

A

Mannitol

55
Q

For a person experiencing fluid loss what fluids will they be given

A

Start with NS or Lactated ringers

Do not use d5 1/2 which will push fluid into the cells.

56
Q

What does D5 1/2 do

A

Push fluid in the cell.

57
Q

What vital signs indicate FVD

A

Decreased BP, increased HR

The Herat is pumping more to circulate blood thru the body.

58
Q

What happens in Addison’s disease

A

Looses salt, the person must seek salt replenishment

59
Q

What organ can contribute to fluid volume excess

A

The kidney

Renal impairment can contribute to fluid volume excess due inability to excrete fluids

60
Q

Dialysis

A

Removes fluids when diuretics are no longer working ( CHF)

61
Q

What normal potassium levels

A

3.5-5
Above 7 can cause dysrhythmias
Above 8 can cause cardiac arrest

62
Q

When would you not replace a persons potassium

A

If the person is in end stage renal disease, it will accumulate leading to hyperkalemia

63
Q

What 2 electrolytes go together

A

Phosphorus bonds with calcium

64
Q

What is therapy for HYPERCALCEMIA

A 
Calcitonin spray ( test for allergies because it is derived from a fish
Alternate nostril each day.
65
Q

For hypocalcemia, what would be a supplement

A

Vit D Supplementation

66
Q

Increased phosphate levels coincides with what other electrolyte

A

Calcium
Increased phosphate means decreased calcium
Increased calcium means decreased phosphate

Med Surg (19 decks)

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