Exam3 Flashcards
What can you anticipate with increased BUN
Found with impaired renal function
Eg , shock, heart failure, salt and water depletion diabetic ketoacidosis and burns
What can you anticipate with increase creatinine
Heart failure , shock and dehydration
What is the squally urine ph
4.6- 8.2
Lower and higher than normal ph can occur in what what conditions?
Metabolic acidosis , diabetic ketosis, and diarist
Higher: respiratory alkalosis , potassium depletion, and chronic renal failure
What test commonly used to determine the adequacy of oxygenation and ventilation?
Arterial blood gases
It also assess with treatment of acid base and balance
Tell me about excess fluid volume
May result from increased fluid intake, or decreased excretion, such as occurs with progressive renal disease is dysfunction of the heart I’m certain cancers
Tell me about fluid volume deficit
May result from decrease intake, or increase excretion of fluids, as well as fluid shifts
Tell me about fluid volume deficit
Fluid and electrolyte deficiencies may be related to situations involving strenuous exercise, extreme heat, or dryness and conditions that increase Amitabha metabolic rate such as fever
What’s the normal rage for an healthy adult as it pertains to I and O and urine specific gravity
Average about 2,500ml fluid intake and output over 3 days
1.005 to 1.030
Who are more vulnerable to fluid deficiciet conditions related to a less effected thirst mechanism
Elderly
What are some examples of excess urinary output ?
Vomit
Diarrhea
Pronounce perspiration , diarrhea , draining wound and excessive urinary output
What are some ways in which a pt medical regimen may lead to fluid and electrolytes imbalances
Diuretics ( both fluid and potassium )
Food ( high in potassium, or if potassium is not included in diet, or potassium drug therapy not started
Hypokalemia often follows
What are the common practices that threaten fluid balance ? (5)
Enemas
Laxitives
Antacids
Over the counter drugs
Herbs to promote ruination
What are some s/s we teach pt to report in relationship to fluid imbalances? (6)
Rapid weight gain and loss
Swollen fingers feet and ankles
Puffy eyelids :
Muscle weakness
Change in skin sensation
Scanty or profuse urine production
How would you treat fluid volume deficit
Increase foods with high water content ( citrus fruits, melons celery)
For hypokalemia : increase foods with high potassium content ( banana apricot melon broccoli potatoes raisins Lima beans )
What foods should you avoid with hypernatrimia
Foods high in sodium like processed cheese lunch meats canned soup and veggie , salted snacks , eliminate table salt
How do you avoid over treatment and metabolic alkalosis
Minuit Abgs for increased ph after each 50-100 mEq of sodium bicarbonate
How do you disguise the unpleasant taste of potassium supplements and decrease gastric irritation
By dilution
What do we asses for with magnesium sulfate (3)
Decreased restlessness and irritability, decrease muscle tremors and control of convulsion
Intravenous potassium
Never administered via intravenous bolus and the infusion rate for intravenous potassium chloride requires careful monitoring. The maximum rates should be 10 mEQ/hr for pt with cardiac monitoring
What does an admission error result in?
Sudden hyperkalemia leading to fatal cardiac arrest
Tell me about sodium?
Most abundant in ECF
Hyponatremia refers to sodium deficit in ECF cause by loss of sodium or gain of water
What happens with decreation of sodium
Causes fluid to move by osmosis from the less concentrated ECF compartment to the Icf space
Leads to swelling of cells resulting in confusion, hypotension, edema muscle cramps, weakness and dry skin
What happens wirh increase sodium hypernatremia
Cause by excessive water, loss or an overall excess of sodium
fluid deprivation
lack of fluid consumption
communicate thirst
diarrhea an
excess insensible water loss. ( burns and hyperventilation)
Why causes the cells to shrink in hypernatremia
Fluids move from the cells because of the increase extra cellular osmotic pressure,
What cells are affected by hypernatrima ?
The central nervous system resulting in
Neurologic impairment
Restlessness
Weakness
Disorientation
Delusion
Hallucinations
What is the major intracellular electrolyte
Potassium ( k) common electrolytes abnormality
Loss through vomiting diarrhea,
Gastric suctioning
Alkalosis
Diuretics
Typical signs of hypokalemia
Muscle weakness
Leg cramps
Fatigue
Parenthesis’s
Dysthymias
What happens with excess potassium
Can result in:
Renal failure
Hypo aldosteronism
Potassium chloride
Heparin
Ace
NSAID’s
Potassium sparing diuretics
What are the vascular access devices?
Peripheral venous catheters
Midline catheter
Central venous access device
Midline catheter
Inserted peripherally normally just above or below the anticubital , Fossa into the proximal Basilica, or a celiac bien
Greater than 3 inch
The distal tip terminates in the basaltic, cephaluc or brachial vein at or below the axillary level and distal to the shoulder
What solutions should we avoid using the midline?(3)
Vesicant
Hyperosmolar
Irritating solutions
Central venous
Integral component of pt care in acute, ambulatory and subacute care settings
Homes
Long term care facilities
What can we use the central venous access device for? (6)
Iv fluids
Medication
Blood products
Tpn
Hemodynamic monitoring
Blood sampling
All cvad
Requires radiographic confirmation of position after insertion and before use
What determines they type of CVAD used (5)
Type of carev
Limited body acess
Irritating drugs
Pt request
Long term use
Picc line
Insert at the beside or intervention radiology unit
Radiographic verification always required before use
Maybe have single or multiple lumens
Advantage using picc lines
Less risk of complications such as infection and pneumothorax
When should you not use the antecubital vein?
If another vein is available,
Not the best choice because fjextion of arm can displace the iv catheter over time
( picc line may be inserted at a later time if needed )
Why should you not use the veins in the leg of an adult
Danger of stagnation of peripheral circulation and possible serious complications
Factors that contribute to difficult iv cannula placement (5)
Obesity
Extreme of age
Hypovolemia
Prior iv drug abuse
Multiple hospitalization requiring access
What should we advice the pt about iv
That some medication may cause pain and discomfort and urge them to report any discomfort
When should you change dressing? (5)
Damp
Loosened
Soiled immediately
Site tenderness
Drainage
5% ( D5W ) Isotonic
Used in fluid loss
Dehydration
Hypernatremia
Avoid acess volume because it doesn’t have sodium in serum
Brain sweeping of hyponatremic encephalopathy can cause death
0.9 nacl ( normal saline ) isotonic
Not desirable as routine because only provide na and cl provided in excessive amount
Treat : hypovolemia
Metabolic alkalosis
hyponatremia
Hypochloremia
Blood transfusions
Lactates ringer ( isotonic )
Multiple electrolytes
Same concentration as plasma
( lacking mg2 po4 3 )
Treat: hypovolemia
Burns
Fluid from gastrointestinal sources
Metabolic acidosis
0.33 Na Cl ( strength normal saline )
Provides water
Na , cl
Allow kidney to select and retain needed amount
Treat: hypernatremia
0.45 nacl ( half strength saline ) hypo
Also provide na cl and free water
Basic fluid for maintenance needs
Treat: hypernatremia ( because contains a lil sodium that dilute the plasma while not allowing it to drop too rapidly
5%dextrose in 0.9 nacl hyper
Treat: siadh
Temporarily used to treat hypovolemia if plasma expander is not available
What is cathartic
Medication that strongly increases gastrointestinal mobility and promotes defecation
What is a stoma ?
An artificial opening from waste excretion located on the body SURFACE
Tell me about the large intestine?
Primary organ of Bowel elimination , lower part of the gi tract
Aka the colon extend from the ileocecal valve to the anus.
What are some functions of the large intestine aka colon
Absorption of water, formation of feces, and the expulsion of the feces from the body
What are some situations where there’s an issue with absorption ?
When waste pass through too quickly making the stool soft and watery ( diarrhea)
Stool remains in the colon too long /if too much water is absorbed stool becomes hard and dry ( constipation)
Valsalva maneuver is contraindicated for which pts
Cardiovascular and other illnesses because
The process of bearing down increase pressure in abdominal and thoracic cavity which result in decrease blood flow to the atria and ventricle which temp lower cardiac output
Breast milk/ breastfed vs formula
Breast milk is easier to absorbed
Breastfed have more frequent stool , which is yellow ,golden, lose with little odor
Formula fed infants vary from yellow to brown , paste like in consistency with strong order due to protein breakdown, stool may have curds and mucus
Medication that promotes or inhibit peristalsis
Cathartics and laxatives
Antidiarreheal medications
Medications that decrease gi molitily with potential constipation (4)
Opioids
Antacids containing aluminum
Orion sulfate
Anticholinertgic
What type of medication can cause diarrhea?
Meds with magnesium such as otc antacids
If severe drugs may need to discontinue
Medication and stool color
Potentially gi bleeding with anticoagulants/aspirin : pink to red and black
Iron salts: black stool from the oxidation of iron
Antacids: may cause a white discoloration or speckling in the stool
Antibiotic: green gray color related to impaired digestion
What are some situations that can interfere with the normal timing of a pt bowel movement
Barium enema : may Cause impaction / constipation if not completely eliminated after procedure
Stress of waiting for a result
Changes in food intake
Using enemas and cathartics as cleansing before diagnosis studies of the gi
What’s the sequence for abdominal assessment?
Inspect
Auscultation
Percussion
Palpation
Tell me about hypo active bowel sounds vs hyperactive
Indicate diminish bowel motility commonly caused by abdominal surgery or late bowel obstruction
Increase bowel motility , commonly caused by diarrhea, gastroenteritis or early bowel obstruction
Tell me about absent bowel sounds!
Evidence only after listening for 5 min
Commonly associated with peritonitis, paralytic ileus or prolong immobility
Characteristics odor of the stool is
Due to indole and skatole caused by putrefaction and fermentation in lower intestinal tract
Influence by : ph value , presence of blood in stool , excessive putrefaction
Who’s at high risk for constipation (6)
Pt on bedrest/ decrease mobility
Medication like opioids and anticholinergics
Pt with reduce fluid bulk, or fiber in diet
Pt with depression
Pt with cns disease
Local lesions that cause pain
How can we stimulate peristalsis (5)
Castro oil
Cascara
Senna
Phenolphthalein
Dulcolax
What is the mechanism of magnesium hydroxide and sodium phosphate
Act by drawing water into the intestines stimulating peristalsis
What are food low in fiber
Eggs, well cooked meat, fish, poultry, refrained bread and creak products
Wel cooked fruits and veggies
What is the greatest concern of medication?
Nephrotoxic : causing kidney damage
Abusing analgesics ( aspirin/ ibuprofen
Antibiotics : gentamicin
What are some physiological changes that can affect urination in older adults
Diminished ability of kidney to concentrate urine ( nocturia night peeing )
Decrease bladder contractility may lead to urine de ruin and stasis which increases possible uti
Dresses bladder muscle tone , decrease the possibility of holding urine in bladder which increase frequent urination
Neuromuscular problems , joint probs ,
Alteration is thought process, and weakness’s, affect reaching the restroom in time
Tell me about diuretics
Cause increase urine production, may include possible urge incontinence
Sedative and tranquilizers may diminish awareness of the need to void
Tell me about when the body is dehydrated
The kidney reabsorbed fluid, urine produce is more concentrated and decrease in amount
Conversely with fluid overload the kidney excrete a large quantity of dilute urine
Tell me the effects of alcohol
Produce diuretic effect by inhibiting the release of antidiuretic harmones, increasing urine production
Affects of food and beverages
Food high in water increase urine production
Foods high in sodium content cause sodium and water reabsorption and retention, decreasing urine output
Affect odor: asparagus, onions
Color : beets
What can decrease the muscle tone of a pt ( 4)
Pt with indweling catheters ( muscle not being stretched/ used
Childbearing
Muscle atrophy due to decrease estrogen levels in menopause
Damage to muscle from trauma
What is renal failure vs acute renal failure
Condition where the kidney fail to remove metabolic end products from blood and unable to regulate fluid, electrolytes and ph balance
Sudden decline in kidney function, resulting from sever dehydration , anaphylactic shock, pyelonephristis and ureteral obstruction
What is chronic kidney disease vs chronic renal failure
End result of irreparable damage to the kidneys ,
Developing slowly over many years
Causes by condition such as diabetes, hypertension and glomerulonephritis
What do we asses for when looking at urine ?
Color
Odor
Clarity
Presence of sediment : protein, blood, glucose, bacteria and ketone
Not any abnormalities
Monitor ph and specific gravity
Specific gravity
Measure of concentration of dissolved solids in the urine ( 1.015 to 1.025)
Concentrated will have a higher specific gravity
In the absence of kidney disease, a higher specific gravity usually indicates dehydration and lower is over hydration
Normal ph of urine
6.0
Range : 4.6 to 8
How do you measure output for incontinent pt?
Note number of times pt is incontinent any notable urine characteristics ( color odor )
Intervention: scheduling toileting every 2 hrs
UTI in lower vs upper tract
Lower track is short term ( 1 large dose vs 3 7 days of smaller doses
Longer antimicrobial therapy
Pt education can help with uti recurrence
What can cause transient inconsistence
Medical treatment such as diuretics or iv administration
Confusion ( secondary to acute illness)
Infection
Stress incontinence (5
Commonly occurs during coughing sneezing laughing or other physical activities
Childbirth
Menopause
Obesity
Straining from chronic constipation
Brand new injury/ acute injury
Apply cold therapy
Vasoconstriction ( contrict blood vessels)
Reduce swelling
Decrease blood flow
Promotes comfort
Reduce muscle spasms
Old injury /chronic injury
Apply warm therapy
Vasodilation ( widen blood vessels)
Increase tissue metabolism
Reduce blood viscosity
Reduce muscle tension
Relieves pain
Phlebitis vs infiltration
Inflammation of the veins , red warm swelling site , can use hot/cold
When needle goes through the vein
Fluid enters tissues instead of bien
Can use hot/cold
Color pale swelling of site
Warms helps vasodilation
Barriers to use for hot and cold therapy
Paper towel,
cloth
pillowcases
Sheets
Check every 15-20 min tops
What are the different types of application
Ice pack/patch
Hot pack/patch
Hypothermia blanket
Measure pt temp and what the machine is set at
Small probe inserted into rectum that connects to the machine giving pt temp
Turn pt to avoid burning
Indwelling/ Foley catheter
Catheter that remains in place for continuous urine drainage
Has an inflatable balloon at one end to prevent slipping out from bladder
Straight catheter / intermittent
Single use catheter
Used to drain the bladder for shorter periods
Lower risk of CAUTI :
Nonsocomial
Improper insertion
Improper catheter
Trauma
Altered body system
Condom catheter/ urinary stealth
External urinary Catheter that’s worn like a condom
Prevention of cauti
Foley care
Asepsis
Maintain patency
Check for kinks
Secure to leg
Assess abdominal discomfort
What are the 3 domains of teaching
Cognitive : teach back, test memory and knowledge
Psychomotor : demonstrating
Affective : change in behavior
Teach acronym
Tune into pt
Edit pt info
Act on every teaching moment
Clarify often
Honor the pt as a partner in education process
What are the 3 important questions
What is the main problem
What do I need to do
Why is it important for me to do it
What are the possible causes of acute kidney injury?
Dehydration
Anaphylactic shock
Sepsis
Ureteral obstruction
Possible causes of chronic kidney failure
Diabetes
hypertension
Glomerulonephritis
Progress can lead to kidney failure
