Fluid balance, CHF, Clotting Flashcards
WHat treats digoxin toxicity?
Digoxin immune fab, phenytoi or lidocaine
Why would you give morphine for CHF?
slows breathing to decrease oxygen demand, decreases anxiety
Why is low BP bad for a graft patient?
circulation has to be good or you could have clotting, and it could be a sign of hypovolemic shock
normal INR
0.9-1.2… on Coumadin 2-3
visual lab routine special
nurse watches out for these with diuretics
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
I think pt has FVE. Hct is 20, BUN is 8. Am I right?
Probably. Hct and BUN are usually low because of hemodilution in FVE, and normal HCT is 37-54, normal BUN is 9-23.
Why would you give aminophillin (Norphyll) for CHF?
it is a bronchodilator and vasodilator
6 p’s of nbypass surgery
pallor, paralysis, paresthesia, pulselessness, pain, poikolothermia
Watch out for these signs of compartment or worsening compartment syndrome.
look: slow cap refill, pallor, edema
touch: cold,
ask: numb, tingling, pain
look ask listen routine special
CHF nursing assessments
look: edema, JVD
ask: LOC
routine: I&O
listen: lung sounds, heart sounds,
special: daily weight
Look at my BUN. It’s 81. Do I have HF or none?
HF. Normal BUN is 9-23, and your kidneys aren’t getting good circulation
Why is hypokalemia so bad for CHF pts?
it causes tachycardia
normal PTT
55-75 sec
Arterial insufficientcy- dangle or raise legs?
dangle
sx of abdominal aortic aneurism
abdominal, flank or back pain (gnawing), pulsating abd mass, nausea
Isotonic IV fluids are
0.9% NS, Lacttated Ringers, D5W
a/o means
alert and oriented
give special listen routine
CHF nursing interventions
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
Fluid volume excess inteventions
raise HOB, notify MD, slow the IV fluids, monitor VS
signs of digitalis toxicity
hypokalemia, visual disturbance, fatigue, arrhythmia, anorexia
my creatinine level is 5. is that ok?
no. normal is 0.5 to 1.3. Your kidneys are not working.
What is the tool to remove a clot?
fogarty catheter
What labs do you need to give digoxin?
potassium and digoxin
Nurse process planning for dehydration
rehydration, comfort measures, medication therapy for the cause, client education
BUN is 8. Are they more likely dehydrated or overhydrated?
overhydrated. Those buns are floating in so much water there are only 8 per square meter instead of the normal 9-23.
infant FVE shown by
bulging fontanel
Causes of hypertonic dehydration
watery diarrhea, inadequate fluid intake, diabetes isipidous, too much solute intake
My patient’s digoxin level is 2.1 mg/dL. Can I give the next dose?
no. Normal is 0.8 to 2.0
What could happen to blood vessels to impair perfusion?
atherosclerosis (gunk in artery), arteriosclerosis (narrowing), vessel insufficiency, clots
Why check potassium with digoxin?
it causes diuresis, so potassium can be lost
Why give ACE inhibitors for FVE?
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
Normal resp rate
12-20
why would right sided HF cause kidney malfunction?
blood is diverted away from kidneys because it is needed more elsewhere
Why would you give nitroglycerine for CHF?
it is a vasodilator, decreasing afterload
CHF nursing diagnoses
fluid volume excess r/t ind cardiac output, anxiety r/t dyspnea & heart dysfunction
-prils are
antihypertensives
Why would you elevate my head when I have CHF?
blood will pool in your legs, decreasing preload
CABG means
coronary artery bypass graft
side effects of beta blockers
bradycardia, lethargy, GI disturbance, low BP, depression, CHF symptoms. Don’t stop taking suddenly!
afterload def
resistance that must be overcome to circulate blood
Class 1 cardiac disability means high or low level of disability?
low, zero physical limitations
FVE diagnostics
chest xray, Hct, BUN, ABG
Why would you want digoxin to slow the haert rate for CHF?
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
beta blockers affect this organ. How do they work?
Heart. They block epinephrine form stimulating HR and BP. They reduce HR, contraction force, and rate of conduction
Nicotine’s effect on blood vessels
vasoconstrictor
Why is decreasing venous return a goal of CHF treatment?
to decrease preload
Where do you do inflow graft?
above the superficial femoral arteries
WHy take beta blockers?
antihypertensive
O2 and CO2- low or high in FVE
02 low, CO2 high
MD will order this for FVE
fluid restriction, diuretics, ACE inhibitors
Serum osmolality is 265. Is FVE likely?
yes, normal is 280-300 in adults. Osmolality increases in dehydration, decreases in FVE.
Why heparing and Coumadin?
Coumadin will be needed outpatient, and it has a long onset.
signs of venous insufficiency
legs: brown discoloration, edema, dry flaky skin, ankle/calf ulcers. they DO have pulse and cap refill, pain helped by leg elevation
FVE nursing diagnosis
impaired gas exchange
What causes graft occlusion?
clots, infection
What happens to heart rate when dehydration subsides
it decreases because oxygen carrying blood is more available
Hct is 61. Are they more likely dehydrated or overhydrated?
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.
why would right sided HF cause nocturia
lying down with edema will cause fluid reabsorption
avg water intake, minimum water intake
daily: 2600mL, minimum 1500mL
How does cholesterol affect afterlaod?
increases it by increasing resistance to blood flow
Client’s ABG PO2 is 70, PCO2 is 50. Is FVE likely?
yes, normal PO2 is 80-100, normal CO2 is 35-45
Assessments for FVE
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
manifestation of left sided HF
exertional dyspnea, orhtopnea, cough, adventitious breath sounds, restlessness, anxiety, cynaosis, increased HR, fatigue, crackles, wheezes, blood tinged sputum
DVT interventions
bed rest, warmth to vasodilate, elevate limb to reduce pressure
Causes of hypotonic fluid excess
tap water enema, water intoxication, pushing IV fluids too fast
Why would you give digoxin for CHF?
increase contractility,
Why would FVE cause anorexia and nausea?
ascites
Where do you do an outflow grafts?
below the superficial femoral arteries
why do you cough with left sided heart failure
increased pressure in the heart has caused blood to back up into the pulmonary circulation
priority aneurism intervention
maintain BP
Hypertonic IV fluids are
3.0% saline, D5NS, D51/2NS, D5LR, Normosol-R
prompt
Surgery stress causes FVE by what mechanism?
Stress causes renin secretion.
Type of FVE in kidney failure
isotonic
70x70=4900 means what to me
heart pumps 70mL 70 times a minute, 4900ml a minute (@5L)
normal aPTT
23.3-31.9 sec
Why does it matter if PAD id from venous or arterial occlusion?
Elevate legs if venous. Elevate head if arterial.
list vasodilators
nitroglycerine, hydralazine (Apresoline), minoxidil (Rogaine)
Avoid this on heparin
vitamin K, aspirin, bleeding risk
PAD interventions
positioning, avoid nicotine/stress/cold
Hypotonic fluids are
1/2 NS (0.45%), 1/4 NS
why would leg, arm, etc. muscles atrophy in R sided HF?
reduced perfusion
PAD assessments
tissue perfusion, treatent compliance, wound care, education, home hazards (rugs, hot water)
What time should thiazide diuretics be given?
morning because they have long half-life
2 kinds of positive inotropic drugs
beta blockers and digitalis
Name important drug suffixes.
-zide for thiazide diuretics, pril for ACE inhibitors, -sartan for ANgiotensin II receptor blockers, olol for beta blockers,
noram glucose levels
74-106
Why does super high blood sugar causes confusion?
Sugar is a solute that pulls water out of brain cells.
Pt with FVE has sodium level of 119. WHy?
The sodium is diluted.
nursing assessment Qs for dehydration
history, age, acute weight loss, thirst, urine volume, urine color
Preload def
wall stress in ventricales at the end of the Filling phase (diastole)
manifestation of right sided HF
dependent edema, hepatomegaly and liver tenderness, ascites, GI distress, anorexia and nausea, respiratory distress, nocturia, fatigue, DJV, weight gain, increased BP
what lab values do we monitor with heparin
PT, PTT, INR
monitor during dehydration therapy for
confusion, IV infiltration, lung sounds, BP, urine output, heart rate
Nurse interventions for FVE
elevate HOB, client education, monitor for signs of dehydration or electrolyte imbalance due to therapy
Causes of hypotonic dehydration
water intoxication, renal failure
