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 )