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nur 334 > F+E > Flashcards

F+E Flashcards

1
Q

fluid overview

A

fluid processes -> diffusion and osmosis
colloidal osmotic P (oncotic P) -> albumin = pulling power (fluid in IV, 3rd space if not)
hydrostatic P -> pushing -> HF (IV -> interstitum)

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2
Q

FVE: cm

A

HA, confusion, lethargy, peripheral edema, JVD (IVF), S3, bounding pulse (IVF), htn, centravenous P - F in RA (ICU), polyuria (w normal function), dyspnea, pulm edema, muscle spasms, weight gain (water), seizures and coma (hypoNa)
pulm edema, peripheral edema, 3rd spacing

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2
Q

FVE: causes

A

excess isotonic or hypotonic -> older (HF)
HF, RF (not peeing), primary polydipsia (drink lots of water), endocrine (SIADH, cushing S, long term corticosteroids - also fluid retention)

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3
Q

FVD: causes

A

high insensible water loss or perspiration (high fever, heatstroke) -> insensible means cannot be measured in cylinder - breathing/fever/sweat)
SM insipidous -> endocrine
osmotic diuresis -> mannitol
hemorrhage
low intake -> no thirst, obtunded, older (most common issue)
GI loss: v, ng, d, fistula drainage
overuse of diuretics
3rd spacing: burns bc increase in cap perm, pancreatitis

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4
Q

FVD: cm

A

restless, drowsy, lethargy, confusion
thirst dry mucus (elderly!)
cold clammy
decreased turgor, decreased cap refill
postural hypoT, increased pulse (tachy bc CO = Hr x SV, so it is to maintain CO), decreased CVP
urine output, [] urine
increased RR
weak, dizzy, weight loss (water), seizure, coma

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5
Q

fluid status nc

A

daily weight (same scale, clothes, time)
I+O but unreliable
labs: BUN, Na, hct but can all be false high/low; urine and serum osmolality -> particles/solution -> [] specifically

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6
Q

FVD: nc

A

mild: oral rehyd
severe: replaces with blood (esp if d/t blood loss) or balances IV solutions (NS, LR)

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7
Q

FVE: nc

A

HF, CKD, liver
restrict

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8
Q

fluid status nc: CV

A

monitor VS
FVE = bounding
FVD = tachy to keep BP wnl, weak/thready, orthostatic hypoT

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9
Q

fluid status nc: resp

A

FVE = risk for pulm edema

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10
Q

fluid status nc: pt safety

A

Na
change in LOC, orthostatic

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11
Q

fluid status nc: skin care

A

dry v pitting edema

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12
Q

fluid status nc: fluid therapy

A

rate, hc, needed?

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13
Q

delegate

A

RN interprets assessment findings
daily weights and VS
other freq oral care
I+O, skin care and position change, encourage oral fluids as appropriate, elevate edematous extremities (FVE)

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14
Q

Na

A

major ecf cation, sucks and governs osmolality (most particles in body are Na), activate muscle/nerve cells (AP)
135 - 145

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15
Q

hyperNa: causes

A

> 145
excessive intake: hypertonic IVF, tube feed without h2o supplements - free water usually added
inadequate h2o intake: elderly, anorexia, v/d, depressed
excessive loss of h2o (Na retained): insensible water loss, d, diuretics
diseases: diabetes insipidous and cushings S are endocrine, uncontrolled DM like ketoacidosis

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16
Q

hypoNa: causes

A

< 135
excess loss: GI, renal, diuretics, skin (burns, wounds)
inadequate intake
excessive h2o gain (low Na dilution): hypotonic IVF
diseases: SIADH (counterpart to DI), HF and KF = fluid retention, cirrhosis

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17
Q

hyperNa: cm

A

cellular shrink: mental change -> HA, irritable, difficulty [], confusion, seizure, coma
if also ECF v deficit: postural hypoT, tachy, weak

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18
Q

hyperNa: nc

A

depends on cause
water loss = add h2o
Na excess = remove
monitor serum Na/osmolality
gradually over 48hr for cerebral edema

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19
Q

hypoNa: cm

A

cellular shrinking: mental change -> drowsy, restless, confused, lethargy, seizures, coma
if also ecf V excess: weight gain and htn

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20
Q

hypoNa: nc

A

mild: restrict F (HF, KF, liver disease), loop diuretic
acute: small IV hypertonic NS (3%)
avoid rapid correction (24-46hr)
safe env precaution prn

21
Q

K

A

intracellular cation, helps regulate cell excitability and electrical status

22
Q

hyperK: causes

A

excess intake: parenteral admin (40meq KCl), renal insufficiency (not clearing well)
shift out of cell: acidosis (pH), tissue catabolism, intense exercise
fail to eliminate: renal disease (oliguria), adrenal insuff

23
Q

hypoK: causes

A

excess loss: G (v/d), kidney, skin (diaphoresis), dialysis (CKD), loop and thiazide diuretics (question k sparing or need for supplement
shift into cells: high insulin release (IV dextrose), insulin therapy (w/ dka), alkalosis
lack of K intake: starvation or low diet with k, no K in IVF if NPO

24
Q

hyperK: cm

A

ekg change -> cardiac dysrhythmias (put pt in tele)
fatigue, irritable, muscle weak
loss of tone
paresthesia
confusion

25
Q

hyperK: nc

A

stop intake
increase excretion: loop and thiazide diuretics, dialysis, patiromer or Na polystyrene sulfonate (take hrs - days to work)
K into cell: insulin and dextrose, NaCO2 if acidotic (temporary fixes, keep pt safe long enough to address cause)

26
Q

hypoK: cm

A

ekg change
fatigue, muscle weak, cramps
paresthesia

27
Q

hypoK: nc

A

increase med intake (oral or IV)
increase PO intake (food)
IV KCl -> safety alert: always dilute, never push, should not exceed 10meq/hr unless in ICU setting and has CVAD, infiltration can cause necrosis
hypoK precipitates digitoxicity (digoxin for HF) - narrow therapeutic index

28
Q

K foods

A

fruits: apricot, avocado, banana, cantaloupe, dried fruits, grapefruit juice, honeydew, oranges, prunes, raisins
veggies: baked/refried/black beans, butternut squash, cooked broccoli, raw carrots, greens (x kale), canned mushrooms, potatoes (white and sweet), cooked spinach, tomatoes or products, veggie juices
other: bran or bran products, choc, granola, all milk, nutritional supplements, nuts and seeds, PB, salt substitutes, salt free broth, yogurt

29
Q

Ca

A

effects membrane potentials and nerve excitability
most Ca inside bone, provide bone strength
1% in cells (1/2 p bound, other 1/2 ionized/avail)

30
Q

hyperCa: causes

A

hyperparaT
hematologic: cancer -> perineoplastic disorders, cancers secrete things with no purpose (lung cancer!)
others less common

31
Q

hypoCa: causes

A

renal fail
paraT deficiency or removed
multiple blood transF (citrate used in blood binds with Ca)

32
Q

hyperCa: cm

A

excess is like sedative -> decrease excitability of muscles and nerves
confusion, psychosis
seizures, coma

33
Q

hyperCa: nc

A

mild: stop Ca meds, decrease Ca diet, increase weight bearing and maintain adequate hydration
severe: IV isotonic saline, bisphosphonate (pamidronate if cancer) and calcistronin injections (increase renal excretion but short term)

34
Q

hypoCa: cm

A

tetany (nerve excitability and sustains muscle contraction): chvostek (face), trousseau (carpal)
ekg changes

35
Q

hypoCa: nc

A

mild: diet high in Ca rich foods, Ca supplements + vit D
S: IV Ca gluconate

35
Q

Mg

A

stabilize heart and smooth muscle

36
Q

hyperMg: causes

A

renal rail and high Mg: CKD with Maalox
IV Mg (preg)

37
Q

hypoMg: causes

A

GI loss and malN (low intake): d, v, NG suction, chronic OH, prolonged malN

38
Q

hyperMg: cm

A

nerves and muscles slowed down
lethargy, drowsy, muscle weak, decreased DTRs

39
Q

hyperMg: nc

A

avoid drugs and limit intake (green veggies, nuts, bananas, oranges, PB, choc)
dialysis if CKD
FF if kidneys okay -> urinary excretion
IV Ca gluconate if S (oppose excess Mg on cardiac muscle)

40
Q

hypoMg: cm

A

nerves and muscles reved up
like hypoCa: confusion, muscle cramp, tremors, seizure, vertigo, hypoactive DTRs, chvosteks/trousseaus, increased P/BP/dysrhythmias

41
Q

hypoMg: nc

A

treat cause and S
oral: mylanta, MgSO4
IV MgSO4: several days, IVP if needed (rapid can cause hypoT)

42
Q

P

A

inverse to Ca

43
Q

hyperP: causes

A

renal fial, lax/enemas w/ P, hypoparaT

44
Q

hypoP: causes

A

malN, vit D def, chronic OH, severe d

45
Q

hyperP: cm

A

usually asymp
typically only S of hyperCa = muscle spasms, paresthesia, tetany

46
Q

hypoP: cm

A

CNS depress (confusion, coma)
muscle weak (resp muscles)

46
Q

hyperP: nc

A

treat cause
Ca based P binders (CaCO3)
hemodialysis if severe

47
Q

hypoP: nc

A

IV (long time) v oral replace (dairy, P supplement)
resolve CKD or hyperCa

nur 334 (10 decks)

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