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Acute and Chronic > F&E > Flashcards

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
Q

Monitor postural heart rate and bp when getting patients out of bed

A

nursing implications for isotonic dehydration

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26
Q

What are common causes of fluid volume excess?

A

CHF
early renal failure
IV therapy
excessive sodium ingestion
corticosteroids

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27
Q

all pumps should have a safety mechanism when you pull tubing out it locks it: anytime you pull pump off IV pump it is ______.

A

locked

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28
Q

t/f: Techs should not be taking IV off pump to run it through a shirt or anything

A

true

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29
Q

CHF
early renal failure
IV therapy
excessive sodium ingestion
corticosteroids

A

common causes of fluid volume excess

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30
Q

Increased BP
Edema
Weight gain
Bounding pulse
Venous distention
Pulmonary edema
Dyspnea
Orthopnea (diff. breathing when supine)
crackles

A

Signs/Symptoms of fluid volume excess

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31
Q

what are signs/symptoms of fluid volume excess?

A

Increased BP
Edema
Weight gain
Bounding pulse
Venous distention
Pulmonary edema
Dyspnea
Orthopnea (diff. breathing when supine)
crackles

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32
Q

What happens to the HGB and HCT when someone has fluid volume excess ?

A

decreased HGB and HCT

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33
Q

What happens to urine specific gravity with FVE?

A

decreased urine specific gravity

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34
Q

What is the urine specific gravity normal range?

A

Normal range 1.002 and 1.030

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35
Q

A high specific gravity (over 1.030) is seen in ____________________

A

dehydration (fluid volume deficit)

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36
Q

A low specific gravity (over 1.002) is suggestive of _______________________________

A

the kidneys inability to concentrate urine/fluid volume excess

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37
Q

What are treatments/interventions for fluid volume excess?

A

Drug therapy
Diuretics may be ordered if renal failure is not the cause.
Restriction of sodium and saline intake
I/O
Weight

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38
Q

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)

A

patient with FVE

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39
Q

What are s/s of fluid volume excess?

A
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40
Q

Which systems are predominately affected by the FVE?

A

not so much neurologic, mostly resp cardio and gi

can affect neruo though

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41
Q

_______and_______ don’t tolerate large shifts of fluid as well as others.. Become dehydrated easier as well as have fluid volume excess easier.

A

infants and children

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42
Q
A

buretrol

43
Q

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

A

buretrol:

44
Q

Prior medical history
Acute illness
Chronic illness
Environmental factors
Diet
Lifestyle
Medications

A

factors that can cause FVE

45
Q

Body systems
I/O
Weight
Labs

A

assessments for FVO

46
Q

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

A

Gerontological hydration considerations

47
Q

What is the normal level of potassium

A

3.5 to 5 mmol/L

48
Q

______ in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli

A

Decrease

49
Q

What are contributing factors for hypokalemia?

A

Diuretics
Shift into cells
Digoxin
Water intoxication
Corticosteroids
Diarrhea
Vomiting

50
Q

Shallow respirations
___________
confusion
___________
arrhythmias
lethargy
_________ pulse
decreased __________ motility

A

s/s: hypokalemia

Shallow respirations
irritability
confusion
weakness
arrhythmias
lethargy
thready pulse
decreased intestinal motility

51
Q

s/s of hypokalemia

A

Shallow respirations
irritability
confusion
weakness
arrhythmias
lethargy
thready pulse
decreased intestinal motility

52
Q

hypokalemia interventions

A

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
Q

_______ is never given by IV push or intramuscularly- given slowly in IV fluids

A

Potassium

54
Q

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.

A

potassium

55
Q

An ______ in K+ causes increased excitability of cells.

A

increase

56
Q

contributing factors to hyperkalemia

A

Increase in K+ intake
Renal failure
K+ sparing diuretics
Shift of K+ out of the cells

57
Q

Increase in K+ intake
Renal failure
K+ sparing diuretics
Shift of K+ out of the cells

A

contributing factors to hyperkalemia

58
Q

muscle cramps
weakness
paralysis
drowsiness
decreased bp
ekg changes
dysrhythmias
abdominal cramping
diarrhea
oliguria

A

s/s of hyperkalemia

59
Q

s/s of hyperkalemia

A

muscle cramps
weakness
paralysis
drowsiness
decreased bp
ekg changes
dysrhythmias
abdominal cramping
diarrhea
oliguria

60
Q

what are nursing interventions for hyperkalemia ?

A

Need to restore normal K+ balance:
Eliminate K+ administration
Inc. K+ excretion
Lasix
Kayexalate (Polystyrene sulfonate)
Infuse glucose and insulin
Cardiac Monitoring

61
Q

What medications are given for an emergent need to decreased K+?

A

insulin and glucose -intracellular shift of potassium

62
Q

What is given for a nonemergent need to decrease potassium?

A

kayexalate

63
Q

Causes loss of K + through the bowel
______ binds with K+ in the bowel

A

Kayexalate

64
Q

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

A

insulin and glucose

65
Q

What are normal sodium blood levels?

A

135 to 145 mEq/L

66
Q

What are contributing factors to hyponatremia?

A

Excessive diaphoresis
Wound Drainage
NPO
CHF
Low salt diet
Renal Disease
Diuretics
May occur due to fluid overload in a surgical patient

67
Q

Excessive diaphoresis
Wound Drainage
NPO
CHF
Low salt diet
Renal Disease
Diuretics
May occur due to fluid overload in a surgical patient

A

contributing factors to hyponatremia

68
Q

What are assessment finding for hyponatremia?

A

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
Q

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

A

assessment findings for hyponatremia

70
Q

significant ______: extreme diarrhea, possible loss of consciousness

A

hyponatremia

71
Q

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.

A

interventions/treatments for hyponatremia

72
Q

interventions/treatments for hyponatremia?

A

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
Q

An ______ diuretic is a type of diuretic that inhibits reabsorption of water and sodium (Na)

A

osmotic

74
Q

What are causes of increased serium sodium?

A

medications, meals
osmotic diuretics
diabetes insipidus
excessive H2O loss
low H2O intake

75
Q

medications, meals
_________diuretics
diabetes ______
___________H2O loss
low H2O _________

A

cases of increased serum sodium
medications, meals
osmotic diuretics
diabetes insipidus
excessive H2O loss
low H2O intake

76
Q

Hyperaldosteronism
_______ failure
_________________________
Increase in oral Na intake
Na containing IV fluids
_____________ urine output with increased urine concentration
Diarrhea
________________
Fever
__________________

A

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
Q

contributing factors to hypernatremia?

A

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
Q

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.
A

Assessment findings: hypernatremia

79
Q

Assessment findings: hypernatremia

A

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
Q

What are interventions/treatments for a patient with hypernatremia with FVD

A

(FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.

81
Q

Interventions/treatment for hypernatremia

A

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
Q

Contributing factors to hypocalcemia ?

A

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
Q

Dec. oral intake
Lactose intolerance
Dec. Vitamin D intake
End stage renal disease
Diarrhea

Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid gland

A

contributing factors to hypocalcemia

84
Q

___________ is required for proper absorption of calcium (often a patient can get enough through diet especially if the person gets outside in the sun)

A

Vitamin D

85
Q

assessment findings with hypocalcemia?

A

irritable muscle twitches
Positive Trousseau’s sign.
Positive Chvostek’s sign

86
Q

– involuntary contraction of muscles related to low calcium

A

Tetany

87
Q

what are treatments for hypocalcemia?

A

NEED FOODS HIGH IN CALCIUM AND VITAMIN D

88
Q

What does this picture indicate and what is the clinical meaning?

A

Positive Trousseau’s sign, indicates low calcium levels

89
Q

What does this image depict and what is the clinical meaning?

A

Chvostek’s sign, hypocalcemia

90
Q

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 ?

A

Chvostek’s sign, hypocalcemia

91
Q

What are interventions/treatments for hypocalcemia?

A

Drug Therapy
Calcium supplements
Vitamin D

Diet Therapy
High calcium diet
Prevention of Injury
Seizure precautions

92
Q

Excessive calcium intake
Excessive vitamin D intake
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism

A

contributing factors to hypercalcemia

93
Q

Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism

A

contributing factors to hypercalcemia minus excessive calcium intake and excessive vitamin D intake bc theyre kind of dead giveaways

94
Q

what are contributing factors to hypercalcemia ?

A

Excessive calcium intake
Excessive vitamin D intake
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism

95
Q

What are assessment findings associated with hypercalcemia?

A

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
Q

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

A

assessment findings associated with hypercalcemia

97
Q

muscle weakness, not twitches

slow, shallow breaths

can form renal calculi or kidney stones

A

findings associated with hypercalcemia

98
Q

confusion
muscle weakness
bone pain
kidney stone
excessive urination
cardiac arrest
arrhythmias

A

s/s of hypercalcemia

99
Q

s/s of hypercalcemia

A

confusion
muscle weakness
bone pain
kidney stone
excessive urination
cardiac arrest
arrhythmias

100
Q

What are interventions/treatments for hypercalcemia?

A

Eliminate calcium administration
Drug Therapy
Isotonic NaCL (Inc. the excretion of Ca)
Diuretics
Calcium reabsorption inhibitors (Phosphorus)
Cardiac Monitoring

101
Q

Eliminate calcium administration
Drug Therapy
Isotonic NaCL (Inc. the excretion of Ca)
Diuretics
Calcium reabsorption inhibitors (Phosphorus)
Cardiac Monitoring

A

interventions/treatments for hypercalcemia

102
Q

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 ?

A

Chvostek’s sign, hypocalcemia

103
Q

levels for Hypocalcemia

A

<9.0mg/dL

104
Q

levels for Hypercalcemia

A

> 10.5mg/dL

Acute and Chronic (15 decks)

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