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F&E Flashcards

1
Q

What are ways you can lose water?

A

urine
stool
insensible -lungs, skin

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2
Q

Fluid Volume Deficit is also known as?

A

hypovolemia, isotonic dehydration

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3
Q

Hemorrhage
____________
Diarrhea
Burns
________ therapy
Fever
Impaired _______

A

What are causes of Fluid Volume Deficit ?
Hemorrhage
Vomiting
Diarrhea
Burns
Diuretic therapy
Fever
Impaired thirst

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4
Q

This is an equal loss of sodium and water and results in __________.

A

isotonic dehydration hypovolemia or Fluid Volume Deficit

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5
Q

Weight ________
Thirst
____________ changes in pulse rate and bp
Weak, ________ pulse
__________ urine output
Dry _________ membranes
Poor ________ _________
dry __________

A

Signs/Symptoms of isotonic
dehydration

Weight loss
Thirst
Orthostatic changes in pulse rate and bp
Weak, rapid pulse
Decreased urine output
Dry mucous membranes
Poor skin turgor
dry tongue

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6
Q

Signs/Symptoms of isotonic dehydration

A

Weight loss
Thirst
Orthostatic changes in pulse rate and bp
Weak, rapid pulse
Decreased urine output
Dry mucous membranes
Poor skin turgor
dry tongue

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7
Q

Blood pressure drop over 20 mm Hg systolic or 10 mg Hg diastolic or both

A

Orthostatic Hypotension

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8
Q

Orthostatic Hypotension is defined as?

A

Blood pressure drop over 20 mm Hg systolic or 10 mg Hg diastolic or both

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9
Q

for dehydration, Labs show ?

A

Increased hgb and hct (is artificial, not true elevation, a constant amount of solute diluted in less solvent)
Increased urine specific gravity
Increased BUN and creatinine

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10
Q

Increased hgb and hct (is artificial, not true elevation, a constant amount of solute diluted in less solvent)
Increased urine specific gravity
Increased BUN and creatinine

A

lab results with dehydration

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11
Q

normal Hemoglobin Men ?

A

Men 13.5 to 17.5 grams per deciliter

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12
Q

normal hemoglobin for women?

A

12.0 to 15.5 grams per deciliter

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13
Q

What is the normal hematocrit for men?

A

Men 45% to 52%

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14
Q

What is the normal hematocrit for women?

A

Women 37% to 48%

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15
Q

: a red protein responsible for transporting oxygen in the blood of vertebrates.

A

HGB

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16
Q

–carries oxygen through the bloodstream

A

hemoglobin

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17
Q

what labs are falsely elevated when someone is dehydrated?

A

hemoglobin and hematocrit

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18
Q

is a measure of the RBCs with plasma separated out.

A

hematocrit

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19
Q

What are treatments/interventions for isotonic dehydration

A

for FVD:
Fluid Management
Diet therapy – Correct with oral fluid replacement.
Oral rehydration therapy – Solutions containing glucose and electrolytes. E.g., Pedialyte
IV therapy – Type of fluid ordered depends on the type of dehydration and the client’s cardiovascular status.

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20
Q

if the patient doesnt have low sodium, low potassium, or high potassium, what type of solution will they receive for their dehydration?

A

NS or LR, an isotonic fluid

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21
Q

What are assessments for isotonic dehydration?

A
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22
Q

Daily weights should be ______ thing in the am. If they are weighed on a bed scale, you need to make sure the same things are on the bed each time (such as 1 pillow 1 blanket). Patients who end up with multiple blankets and pillows on the bed can weigh significantly different from day to day. Also should make sure that the patient is weighed on the same ____ if at all possible.

A

first, scale

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23
Q

t/f: you cant measure sweat or fluid loss from breath

A

true

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24
Q

make sure that they’re getting good ______ ______ : prevents nasty fissures and blisters

A

oral care

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25
Monitor postural heart rate and bp when getting patients out of bed
nursing implications for isotonic dehydration
26
What are common causes of fluid volume excess?
CHF early renal failure IV therapy excessive sodium ingestion corticosteroids
27
all pumps should have a safety mechanism when you pull tubing out it locks it: anytime you pull pump off IV pump it is ______.
locked
28
t/f: Techs should not be taking IV off pump to run it through a shirt or anything
true
29
CHF early renal failure IV therapy excessive sodium ingestion corticosteroids
common causes of fluid volume excess
30
Increased BP Edema Weight gain Bounding pulse Venous distention Pulmonary edema Dyspnea Orthopnea (diff. breathing when supine) crackles
Signs/Symptoms of fluid volume excess
31
what are signs/symptoms of fluid volume excess?
Increased BP Edema Weight gain Bounding pulse Venous distention Pulmonary edema Dyspnea Orthopnea (diff. breathing when supine) crackles
32
What happens to the HGB and HCT when someone has fluid volume excess ?
decreased HGB and HCT
33
What happens to urine specific gravity with FVE?
decreased urine specific gravity
34
What is the urine specific gravity normal range?
Normal range 1.002 and 1.030 
35
A high specific gravity (over 1.030) is seen in ____________________
dehydration (fluid volume deficit)
36
A low specific gravity (over 1.002) is suggestive of _______________________________
the kidneys inability to concentrate urine/fluid volume excess
37
What are treatments/interventions for fluid volume excess?
Drug therapy Diuretics may be ordered if renal failure is not the cause. Restriction of sodium and saline intake I/O Weight
38
So this patient will not have IV fluids and will be on a low sodium (often 2 gm sodium diet) they wont have IV fluids, they’ll have a saline lock generally going to have restricted sodium (normal is 2 grams per day)
patient with FVE
39
What are s/s of fluid volume excess?
40
Which systems are predominately affected by the FVE?
not so much neurologic, mostly resp cardio and gi can affect neruo though
41
_______and_______ don’t tolerate large shifts of fluid as well as others.. Become dehydrated easier as well as have fluid volume excess easier.
infants and children
42
buretrol
43
is used with infants and it goes under the IV bag about the pump and you only put enough fluid in there for a short time
buretrol:
44
Prior medical history Acute illness Chronic illness Environmental factors Diet Lifestyle Medications
factors that can cause FVE
45
Body systems I/O Weight Labs
assessments for FVO
46
Elderly are more sensitive to changes in fluid volume Skin turgor is not very reliable on elderly May deliberately restrict fluid intake to prevent incontinence Fluid loss needs to be replaced more slowly and cautiously in the elderly
Gerontological hydration considerations
47
What is the normal level of potassium
3.5 to 5 mmol/L
48
______ in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli
Decrease
49
What are contributing factors for hypokalemia?
Diuretics Shift into cells Digoxin Water intoxication Corticosteroids Diarrhea Vomiting
50
Shallow respirations ___________ confusion ___________ arrhythmias lethargy _________ pulse decreased __________ motility
s/s: hypokalemia Shallow respirations irritability confusion weakness arrhythmias lethargy thready pulse decreased intestinal motility
51
s/s of hypokalemia
Shallow respirations irritability confusion weakness arrhythmias lethargy thready pulse decreased intestinal motility
52
hypokalemia interventions
Assess and identify those at risk Encourage potassium-rich foods: bananas, avocados K+ replacement (IV or PO) Monitor lab values D/c potassium-wasting diuretics Treat underlying cause Potassium is never given by IV push or intramuscularly- given slowly in IV fluids
53
_______ is never given by IV push or intramuscularly- given slowly in IV fluids
Potassium
54
If _______ is given through an IV it is either part of a primary bag of solution or is premixed in a potassium cocktail that is given at a slow rate prescribed concentration. IV push could cause cardiac arrest or cardiac dysrhythmias and should never be done. Potassium that isn’t already mixed in primary IV bags should be kept in the pharmacy only.
potassium
55
An ______ in K+ causes increased excitability of cells.
increase
56
contributing factors to hyperkalemia
Increase in K+ intake Renal failure K+ sparing diuretics Shift of K+ out of the cells
57
Increase in K+ intake Renal failure K+ sparing diuretics Shift of K+ out of the cells
contributing factors to hyperkalemia
58
muscle cramps weakness paralysis drowsiness decreased bp ekg changes dysrhythmias abdominal cramping diarrhea oliguria
s/s of hyperkalemia
59
s/s of hyperkalemia
muscle cramps weakness paralysis drowsiness decreased bp ekg changes dysrhythmias abdominal cramping diarrhea oliguria
60
what are nursing interventions for hyperkalemia ?
Need to restore normal K+ balance: Eliminate K+ administration Inc. K+ excretion Lasix Kayexalate (Polystyrene sulfonate) Infuse glucose and insulin Cardiac Monitoring
61
What medications are given for an emergent need to decreased K+?
insulin and glucose -intracellular shift of potassium
62
What is given for a nonemergent need to decrease potassium?
kayexalate
63
Causes loss of K + through the bowel ______ binds with K+ in the bowel
Kayexalate
64
hyperkalemia: Shouldn’t be used if emergent high level as it isn’t immediate is not used for an emergent situation, ________ and ________ is used in an emergency
insulin and glucose
65
What are normal sodium blood levels?
135 to 145 mEq/L
66
What are contributing factors to hyponatremia?
Excessive diaphoresis Wound Drainage NPO CHF Low salt diet Renal Disease Diuretics May occur due to fluid overload in a surgical patient
67
Excessive diaphoresis Wound Drainage NPO CHF Low salt diet Renal Disease Diuretics May occur due to fluid overload in a surgical patient
contributing factors to hyponatremia
68
What are assessment finding for hyponatremia?
Neuro - Generalized skeletal muscle weakness. Headache / personality changes. Resp.- Shallow respirations CV - Cardiac changes depend on fluid volume GI – Increased GI motility, Nausea, Diarrhea (explosive) GU - Increased urine output
69
Neuro - Generalized skeletal muscle weakness. Headache / personality changes. Resp.- Shallow respirations CV - Cardiac changes depend on fluid volume GI – Increased GI motility, Nausea, Diarrhea (explosive) GU - Increased urine output
assessment findings for hyponatremia
70
significant ______: extreme diarrhea, possible loss of consciousness
hyponatremia
71
Restore Na levels to normal and prevent further decreases in Na. Increase oral sodium intake and restrict oral fluid intake. Don’t want to correct too quickly (12 meq in 24 hours) If the person also has excess fluid they may restrict fluids.
interventions/treatments for hyponatremia
72
interventions/treatments for hyponatremia?
Restore Na levels to normal and prevent further decreases in Na. Increase oral sodium intake and restrict oral fluid intake. Don’t want to correct too quickly (12 meq in 24 hours) If the person also has excess fluid they may restrict fluids.
73
An ______ diuretic is a type of diuretic that inhibits reabsorption of water and sodium (Na)
osmotic
74
What are causes of increased serium sodium?
medications, meals osmotic diuretics diabetes insipidus excessive H2O loss low H2O intake
75
medications, meals _________diuretics diabetes ______ ___________H2O loss low H2O _________
cases of increased serum sodium medications, meals osmotic diuretics diabetes insipidus excessive H2O loss low H2O intake
76
Hyperaldosteronism _______ failure _________________________ Increase in oral Na intake Na containing IV fluids _____________ urine output with increased urine concentration Diarrhea ________________ Fever __________________
Contributing Factors to hypernatremia Hyperaldosteronism Renal failure Corticosteroids Increase in oral Na intake Na containing IV fluids Decreased urine output with increased urine concentration Diarrhea Dehydration Fever Hyperventilation
77
contributing factors to hypernatremia?
Hyperaldosteronism Renal failure Corticosteroids Increase in oral Na intake Na containing IV fluids Decreased urine output with increased urine concentration Diarrhea Dehydration Fever Hyperventilation
78
Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes Resp. – Pulmonary edema CV – HR and BP depend on vascular volume. GU – Dec. urine output. Inc. specific gravity Skin – Dry, flaky skin. Edema r/t fluid volume changes.
Assessment findings: hypernatremia
79
Assessment findings: hypernatremia
Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes Resp. – Pulmonary edema CV – HR and BP depend on vascular volume GU – Dec. urine output. Inc. specific gravity Skin – Dry, flaky skin. Edema r/t fluid volume changes.
80
What are interventions/treatments for a patient with hypernatremia with FVD
(FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.
81
Interventions/treatment for hypernatremia
Interventions/Treatment Drug therapy (FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics. Diet therapy Mild – Ensure water intake decrease sodium intake
82
Contributing factors to hypocalcemia ?
Dec. oral intake Lactose intolerance Dec. Vitamin D intake End stage renal disease Diarrhea Acute pancreatitis Hyperphosphatemia Immobility Removal or destruction of parathyroid gland
83
Dec. oral intake Lactose intolerance Dec. Vitamin D intake End stage renal disease Diarrhea Acute pancreatitis Hyperphosphatemia Immobility Removal or destruction of parathyroid gland
contributing factors to hypocalcemia
84
___________ is required for proper absorption of calcium (often a patient can get enough through diet especially if the person gets outside in the sun)
Vitamin D
85
assessment findings with hypocalcemia?
irritable muscle twitches Positive Trousseau’s sign. Positive Chvostek’s sign
86
– involuntary contraction of muscles related to low calcium
Tetany
87
what are treatments for hypocalcemia?
NEED FOODS HIGH IN CALCIUM AND VITAMIN D
88
What does this picture indicate and what is the clinical meaning?
Positive Trousseau's sign, indicates low calcium levels
89
What does this image depict and what is the clinical meaning?
Chvostek's sign, hypocalcemia
90
Twitching of the facial muscles in response to gentle tapping of the facial nerve just anterior to the ear indicates what clinical finding which means the patient is a risk for ?
Chvostek's sign, hypocalcemia
91
What are interventions/treatments for hypocalcemia?
Drug Therapy Calcium supplements Vitamin D Diet Therapy High calcium diet Prevention of Injury Seizure precautions
92
Excessive calcium intake Excessive vitamin D intake Renal failure Hyperparathyroidism Malignancy Hyperthyroidism
contributing factors to hypercalcemia
93
Renal failure Hyperparathyroidism Malignancy Hyperthyroidism
contributing factors to hypercalcemia minus excessive calcium intake and excessive vitamin D intake bc theyre kind of dead giveaways
94
what are contributing factors to hypercalcemia ?
Excessive calcium intake Excessive vitamin D intake Renal failure Hyperparathyroidism Malignancy Hyperthyroidism
95
What are assessment findings associated with hypercalcemia?
Neuro – Disorientation, lethargy, coma, profound muscle weakness Resp. – Ineffective resp. movement CV - Inc. HR, Inc. BP. , Bounding peripheral pulses, Positive Homan’s sign. Late Phase – Bradycardia, Cardiac arrest GI – Dec. motility. Dec. BS. Constipation GU – Inc. urine output. Formation of renal calculi
96
Neuro – Disorientation, lethargy, coma, profound muscle weakness Resp. – Ineffective resp. movement CV - Inc. HR, Inc. BP. , Bounding peripheral pulses, Positive Homan’s sign. Late Phase – Bradycardia, Cardiac arrest GI – Dec. motility. Dec. BS. Constipation GU – Inc. urine output. Formation of renal calculi
assessment findings associated with hypercalcemia
97
muscle weakness, not twitches slow, shallow breaths can form renal calculi or kidney stones
findings associated with hypercalcemia
98
confusion muscle weakness bone pain kidney stone excessive urination cardiac arrest arrhythmias
s/s of hypercalcemia
99
s/s of hypercalcemia
confusion muscle weakness bone pain kidney stone excessive urination cardiac arrest arrhythmias
100
What are interventions/treatments for hypercalcemia?
Eliminate calcium administration Drug Therapy Isotonic NaCL (Inc. the excretion of Ca) Diuretics Calcium reabsorption inhibitors (Phosphorus) Cardiac Monitoring
101
Eliminate calcium administration Drug Therapy Isotonic NaCL (Inc. the excretion of Ca) Diuretics Calcium reabsorption inhibitors (Phosphorus) Cardiac Monitoring
interventions/treatments for hypercalcemia
102
Twitching of the facial muscles in response to gentle tapping of the facial nerve just anterior to the ear indicates what clinical finding which means the patient is a risk for ?
Chvostek's sign, hypocalcemia
103
levels for Hypocalcemia
<9.0mg/dL
104
levels for Hypercalcemia
>10.5mg/dL

Acute and Chronic (15 decks)

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