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Lake Land 2016 > Fluid balance, CHF, Clotting > Flashcards

Fluid balance, CHF, Clotting Flashcards

1
Q

WHat treats digoxin toxicity?

A

Digoxin immune fab, phenytoi or lidocaine

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2
Q

Why would you give morphine for CHF?

A

slows breathing to decrease oxygen demand, decreases anxiety

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3
Q

Why is low BP bad for a graft patient?

A

circulation has to be good or you could have clotting, and it could be a sign of hypovolemic shock

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4
Q

normal INR

A

0.9-1.2… on Coumadin 2-3

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5
Q

visual lab routine special

nurse watches out for these with diuretics

A

visual: signs of dehydration
labs: potassium level (up or down depnding on whether wasting or sparing), low sodium, low chloride, high blood sugar,
routine: low BP, watches I&O
special: weight gain

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6
Q

I think pt has FVE. Hct is 20, BUN is 8. Am I right?

A

Probably. Hct and BUN are usually low because of hemodilution in FVE, and normal HCT is 37-54, normal BUN is 9-23.

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7
Q

Why would you give aminophillin (Norphyll) for CHF?

A

it is a bronchodilator and vasodilator

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8
Q

6 p’s of nbypass surgery

A

pallor, paralysis, paresthesia, pulselessness, pain, poikolothermia

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9
Q

Watch out for these signs of compartment or worsening compartment syndrome.

A

look: slow cap refill, pallor, edema
touch: cold,
ask: numb, tingling, pain

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10
Q

look ask listen routine special

CHF nursing assessments

A

look: edema, JVD
ask: LOC
routine: I&O
listen: lung sounds, heart sounds,
special: daily weight

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11
Q

Look at my BUN. It’s 81. Do I have HF or none?

A

HF. Normal BUN is 9-23, and your kidneys aren’t getting good circulation

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12
Q

Why is hypokalemia so bad for CHF pts?

A

it causes tachycardia

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13
Q

normal PTT

A

55-75 sec

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14
Q

Arterial insufficientcy- dangle or raise legs?

A

dangle

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15
Q

sx of abdominal aortic aneurism

A

abdominal, flank or back pain (gnawing), pulsating abd mass, nausea

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16
Q

Isotonic IV fluids are

A

0.9% NS, Lacttated Ringers, D5W

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17
Q

a/o means

A

alert and oriented

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18
Q

give special listen routine

CHF nursing interventions

A

give: O2/digoxin/diuretics as ordered,
special: sodium/fluid restriction, daily weights, watch for side effects (digoxin, diuretics), monitor ekg changes,
listen: assess heart sounds, assess for cough/dyspnea
routine: i&O, rest, comfort care, avoid stress, pt education

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19
Q

Fluid volume excess inteventions

A

raise HOB, notify MD, slow the IV fluids, monitor VS

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20
Q

signs of digitalis toxicity

A

hypokalemia, visual disturbance, fatigue, arrhythmia, anorexia

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21
Q

my creatinine level is 5. is that ok?

A

no. normal is 0.5 to 1.3. Your kidneys are not working.

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22
Q

What is the tool to remove a clot?

A

fogarty catheter

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23
Q

What labs do you need to give digoxin?

A

potassium and digoxin

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24
Q

Nurse process planning for dehydration

A

rehydration, comfort measures, medication therapy for the cause, client education

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25
Q

BUN is 8. Are they more likely dehydrated or overhydrated?

A

overhydrated. Those buns are floating in so much water there are only 8 per square meter instead of the normal 9-23.

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26
Q

infant FVE shown by

A

bulging fontanel

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27
Q

Causes of hypertonic dehydration

A

watery diarrhea, inadequate fluid intake, diabetes isipidous, too much solute intake

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28
Q

My patient’s digoxin level is 2.1 mg/dL. Can I give the next dose?

A

no. Normal is 0.8 to 2.0

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29
Q

What could happen to blood vessels to impair perfusion?

A

atherosclerosis (gunk in artery), arteriosclerosis (narrowing), vessel insufficiency, clots

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30
Q

Why check potassium with digoxin?

A

it causes diuresis, so potassium can be lost

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31
Q

Why give ACE inhibitors for FVE?

A

It will stop the RAAS system so it will thirst from being stimulated, keep the body from making ADH, prevent vasoconstriction, prevent sodium retention, prevent water retention, allow diuresis

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32
Q

Normal resp rate

A

12-20

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33
Q

why would right sided HF cause kidney malfunction?

A

blood is diverted away from kidneys because it is needed more elsewhere

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34
Q

Why would you give nitroglycerine for CHF?

A

it is a vasodilator, decreasing afterload

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35
Q

CHF nursing diagnoses

A

fluid volume excess r/t ind cardiac output, anxiety r/t dyspnea & heart dysfunction

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36
Q

-prils are

A

antihypertensives

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37
Q

Why would you elevate my head when I have CHF?

A

blood will pool in your legs, decreasing preload

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38
Q

CABG means

A

coronary artery bypass graft

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39
Q

side effects of beta blockers

A

bradycardia, lethargy, GI disturbance, low BP, depression, CHF symptoms. Don’t stop taking suddenly!

40
Q

afterload def

A

resistance that must be overcome to circulate blood

41
Q

Class 1 cardiac disability means high or low level of disability?

A

low, zero physical limitations

42
Q

FVE diagnostics

A

chest xray, Hct, BUN, ABG

43
Q

Why would you want digoxin to slow the haert rate for CHF?

A

ventricles will fill more completely with the blood that has backed up into the veins, the heart will use less oxygen for its work, heart size decreases, diureses occurs

44
Q

beta blockers affect this organ. How do they work?

A

Heart. They block epinephrine form stimulating HR and BP. They reduce HR, contraction force, and rate of conduction

45
Q

Nicotine’s effect on blood vessels

A

vasoconstrictor

46
Q

Why is decreasing venous return a goal of CHF treatment?

A

to decrease preload

47
Q

Where do you do inflow graft?

A

above the superficial femoral arteries

48
Q

WHy take beta blockers?

A

antihypertensive

49
Q

O2 and CO2- low or high in FVE

A

02 low, CO2 high

50
Q

MD will order this for FVE

A

fluid restriction, diuretics, ACE inhibitors

51
Q

Serum osmolality is 265. Is FVE likely?

A

yes, normal is 280-300 in adults. Osmolality increases in dehydration, decreases in FVE.

52
Q

Why heparing and Coumadin?

A

Coumadin will be needed outpatient, and it has a long onset.

53
Q

signs of venous insufficiency

A

legs: brown discoloration, edema, dry flaky skin, ankle/calf ulcers. they DO have pulse and cap refill, pain helped by leg elevation

54
Q

FVE nursing diagnosis

A

impaired gas exchange

55
Q

What causes graft occlusion?

A

clots, infection

56
Q

What happens to heart rate when dehydration subsides

A

it decreases because oxygen carrying blood is more available

57
Q

Hct is 61. Are they more likely dehydrated or overhydrated?

A

dehydrated because they have hemoconcentration. That drop of water has 61 critters crowded onto it, and if there was more water, each would have 37-54 critters on it.

58
Q

why would right sided HF cause nocturia

A

lying down with edema will cause fluid reabsorption

59
Q

avg water intake, minimum water intake

A

daily: 2600mL, minimum 1500mL

60
Q

How does cholesterol affect afterlaod?

A

increases it by increasing resistance to blood flow

61
Q

Client’s ABG PO2 is 70, PCO2 is 50. Is FVE likely?

A

yes, normal PO2 is 80-100, normal CO2 is 35-45

62
Q

Assessments for FVE

A

neck- JVD,

chest: CVP (central venous pressure), crackles, wheezing,
ankles: periph edema,
routine: VS (BP, HR, RR), urine output
special: acute weight gain, high urine concentration

63
Q

manifestation of left sided HF

A

exertional dyspnea, orhtopnea, cough, adventitious breath sounds, restlessness, anxiety, cynaosis, increased HR, fatigue, crackles, wheezes, blood tinged sputum

64
Q

DVT interventions

A

bed rest, warmth to vasodilate, elevate limb to reduce pressure

65
Q

Causes of hypotonic fluid excess

A

tap water enema, water intoxication, pushing IV fluids too fast

66
Q

Why would you give digoxin for CHF?

A

increase contractility,

67
Q

Why would FVE cause anorexia and nausea?

A

ascites

68
Q

Where do you do an outflow grafts?

A

below the superficial femoral arteries

69
Q

why do you cough with left sided heart failure

A

increased pressure in the heart has caused blood to back up into the pulmonary circulation

70
Q

priority aneurism intervention

A

maintain BP

71
Q

Hypertonic IV fluids are

A

3.0% saline, D5NS, D51/2NS, D5LR, Normosol-R

72
Q

prompt

Surgery stress causes FVE by what mechanism?

A

Stress causes renin secretion.

73
Q

Type of FVE in kidney failure

A

isotonic

74
Q

70x70=4900 means what to me

A

heart pumps 70mL 70 times a minute, 4900ml a minute (@5L)

75
Q

normal aPTT

A

23.3-31.9 sec

76
Q

Why does it matter if PAD id from venous or arterial occlusion?

A

Elevate legs if venous. Elevate head if arterial.

77
Q

list vasodilators

A

nitroglycerine, hydralazine (Apresoline), minoxidil (Rogaine)

78
Q

Avoid this on heparin

A

vitamin K, aspirin, bleeding risk

79
Q

PAD interventions

A

positioning, avoid nicotine/stress/cold

80
Q

Hypotonic fluids are

A

1/2 NS (0.45%), 1/4 NS

81
Q

why would leg, arm, etc. muscles atrophy in R sided HF?

A

reduced perfusion

82
Q

PAD assessments

A

tissue perfusion, treatent compliance, wound care, education, home hazards (rugs, hot water)

83
Q

What time should thiazide diuretics be given?

A

morning because they have long half-life

84
Q

2 kinds of positive inotropic drugs

A

beta blockers and digitalis

85
Q

Name important drug suffixes.

A

-zide for thiazide diuretics, pril for ACE inhibitors, -sartan for ANgiotensin II receptor blockers, olol for beta blockers,

86
Q

noram glucose levels

A

74-106

87
Q

Why does super high blood sugar causes confusion?

A

Sugar is a solute that pulls water out of brain cells.

88
Q

Pt with FVE has sodium level of 119. WHy?

A

The sodium is diluted.

89
Q

nursing assessment Qs for dehydration

A

history, age, acute weight loss, thirst, urine volume, urine color

90
Q

Preload def

A

wall stress in ventricales at the end of the Filling phase (diastole)

91
Q

manifestation of right sided HF

A

dependent edema, hepatomegaly and liver tenderness, ascites, GI distress, anorexia and nausea, respiratory distress, nocturia, fatigue, DJV, weight gain, increased BP

92
Q

what lab values do we monitor with heparin

A

PT, PTT, INR

93
Q

monitor during dehydration therapy for

A

confusion, IV infiltration, lung sounds, BP, urine output, heart rate

94
Q

Nurse interventions for FVE

A

elevate HOB, client education, monitor for signs of dehydration or electrolyte imbalance due to therapy

95
Q

Causes of hypotonic dehydration

A

water intoxication, renal failure

Lake Land 2016 (9 decks)

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