Fluid, Electrolyte, & Acid-Base Imbalances, IV Therapy, Integumentary Disorders,EX

Question 1

Differentiate between crystalloid & colloid solutions

Answer 1

Crystalloid solution is water and undissolved substance its has three types
Colloid solution- water molecule and undissolved substances (blood product)

Question 2

Describe the difference between isotonic, hypotonic, and hypertonic solutions.

Answer 2

Isotonic - contains same amount of concentration as normally found in the plasma ( helps maintain fluid balance
Hypotonic- fewer dissolved substance compared with the plasma, re hydrate the client (dehydrated patients) cells swell
Hypertonic- more concentrated draws fluid out the cell

Question 3

difference between whole blood, packed cells, blood products, and plasma
Expanders.

Answer 3

Whole blood is administered when a client needs fluids restoration as well as blood cells.
Packed cells are preferred for client who need cellular replacement but do not need/ be harm by additional fluids
Blood products- that are extracted from blood plasma, albumin, granulocytes and cryoprecipitate. Administered to clients that need specific product not all
Plasma Expanders- non blood pull fluid into the vascular space more effective then hypertonic solution

Question 4

nursing responsibilities when preparing the patient for IV therapy.

Answer 4

Educated the patient Purpose IV site location & any limitations Length of the procedure
Signs of complications, gather equipments, verified the patient,

Question 5

Describe nursing actions involved in performing venipuncture, including sites and
devices commonly used.

Answer 5

Assess the client to detect alterations in fluid volume, follow the agency infection control policies, using aseptic technique when caring for the IV site or changing the equipment

Question 6

Explain equipment that must be replaced during IV therapy

Answer 6

Solutions are replaced after infusion or 24hr, IV tubings every 72 hrs, Y tubing for blood can be reused one time, venipuncture devices are replaced every 72- 96 hrs or immediately if complications occur.

Question 7

List complications of IV therapy and signs/symptoms for which the nurse monitors.

Answer 7

Phlebitis- inflammation of the vein, Thrombus formation- development of a clot, Localized edema if devices fail to remain in the vein, Circulatory overload - if the volume of infusing solution exceeds the heart’s ability to circulate effectively. Infection, air embolism

Question 8

Discuss the purpose of a medication lock.

Answer 8

It allow intermittent access to the vein

Question 9

Describe the nursing process for the patient requiring IV therapyThe nursing process for a patient requiring IV (intravenous) therapy involves several key steps:

Answer 9

Assessment: The nurse assesses the patient’s condition, including their medical history, current health status, vital signs, and specific needs related to IV therapy.
2. Planning: Based on the assessment, the nurse develops a care plan tailored to the patient’s needs. This plan includes selecting the right IV solution (e.g., saline, medication infusion), determining the insertion site, calculating the infusion rate, and considering any precautions or additional interventions needed.

3. Implementation: This step involves the actual insertion of the IV catheter into the patient’s vein using sterile technique. The nurse administers the prescribed IV solution, monitors the infusion rate, and ensures proper functioning of the IV line.
4. Evaluation: Continuous monitoring of the patient’s response to IV therapy is essential. The nurse assesses the patient for any signs of complications (such as infiltration, infection, or adverse reactions), evaluates the effectiveness of the therapy, and adjusts the care plan as necessary.
5. Education and Follow-up: The nurse provides education to the patient and caregivers about the IV therapy, including the purpose, potential side effects, signs of complications, and proper care of the IV site. Follow-up care may involve routine assessment, changing IV sites, or discontinuing the therapy based on the patient’s progress.

Question 10

List 3 chemical substances that are found in the body fluid

Answer 10

Electrolyte- substance that carry electrical charge
Acid- substance that releases hydrogen into fluid
Bases- substances that bind with hydrogen

Question 11

2 main fluid locations in the human body and 2 subdivisions.

Answer 11

Extracellular
- Intrsituital, intravascular
Intracellular - K+ lives there

Question 12

Identify 4 ways in which the body normally loses fluid

Answer 12

Sweating, urination, breathing, bowel movements

Question 13

identify 5 processes in which water and dissolved chemicals are relocated in the body.

Answer 13

Osmosis, filtration, passive diffusion, facilitated diffusion, active transport

Question 14

2 types of fluid imbalances

Answer 14

Hypovolemia, Hypervolemia, and third-spacing

Question 15

Differentiate between the 3 types of edema.

Answer 15

Pitting edema, dependant edema- affected by gravity Brawny/ generalized edema-Fluid can no longer be
displaces excessive accumulation

Question 16

Explain the concept of 3rd spacing.

Answer 16

ts fluid that moves out of the intravascular & intracellular space into the tissue compartments were it
become trap and useless

Question 17

Explain the concept of 3rd spacing.

Answer 17

Its fluid that moves out of the intravascular & intracellular space into the tissue compartments were it
become trap and useless

Question 18

Discuss the role of acid and bases in the body.

Answer 18

Acid- substance that releases hydrogen into fluid
Bases- substances that bind with hydrogen

Question 19

Describe 2 major acid-base imbalances and subdivisions of each

Answer 19

Metabolic Acidosis & Metabolic Alkalosis
Respiratory Acidosis & metabolic Alkalosis

Question 20

arterial blood gas findings to determine acid-base imbalances.

Answer 20

PH levels 7.35-7.45
CO2 35-45 Hco3 21-28

Question 21

Fluids consists of

Answer 21

water, electrolytes, acids and bases

Question 22

Intracellular VS
Extracellular

Answer 22

Intracellular fluid inside the cell wall
Extracellular fluid outside the cell walls

Question 23

Hypovolemia- VS Dehydration

Answer 23

Hypovolemia- decrease vascular fluid
Dehydration- decrease of overall fluid in the body

Question 24

LPN Job Duties With IVs

Answer 24

Start IVs
Maintain IV access
Administer most IV solution except ( Blood Products)
Hang most IV piggybacks

Question 25

Reasons why we use IVs

Answer 25

For rapid drug effect
Restricted oral intake
Therapy requires continuous therapeutic blood levels
TPN ( Nutritional needs)
Blood transfusion

Question 26

IVs Solutions

Answer 26

Crystalloid Solutions- water based with dissolved sugar & or electrolytes (Crystal Clear)
Isotonic- contains the same concentration as the dissolve substance
- administer to help maintain fluids when client temporary cannot eat or drink
Hypotonic- contains fewer dissolved substance
- administer to client that experience excessive fluid loss or no intake
Hypertonic - contains more concentration substance
- administer to draw out fluid

Colloid Solutions - used to replace circulating blood volume

Question 27

Teaching provide IV therapy

Answer 27

Purpose
IV site location & any limitations
Length of the procedure
Signs of complications

Question 28

peripheral VS central iv

Answer 28

Peripheral IV - Inserts in the arm but runs to the SVC
Central IV- Inserts in the chest and runs directly to SVC

Question 29

Complications of IV Therapy

Answer 29

Infection, Phlebitis, Blood clot, Air bolus, Infiltration, Circulatory overload

Question 30

TPN ( Total Parenteral Nutrition)

Answer 30

Uses for severe malnourishment, inability to digest or absorb nutrition
Requires a filtered tubing & CVC/PICC
Monitor blood glucose closely

Question 31

Blood Transfusion

Answer 31

Requires 20G or higher
No medication can be added to blood
Y-type tubing

Question 32

If wrong blood type is giving

Answer 32

causes ( Flank (back) pain), Difficulty breathing, tachycardia, Hypotension
Septic- Infected blood ( fever, chills)
Rash, Itchiness, tingling fingers, Flushing face

Question 33

Body fluid is made up of 4 components

Answer 33

Water
Electrolytes
Acids
Bases

Question 34

Most body water is located

Answer 34

within cell ( intracellular fluid) mostly K+ lives there

Question 35

How do we move fluids

Answer 35

Osmosis, Filtration, Diffusion, Active transport-

Question 36

Third Spacing

Answer 36

movement of fluid from intravascular to interstitial space (useless fluid)

Question 37

What causes third spacing?

Answer 37

Malnutrition( Hypoalbuminemia), Burns, Allergic reaction, poor dietary choice (high NA in diet)

Question 38

Assessment findings, Management of third spacing

Answer 38

Assessment findings
Edema, elevated H&H
Management
Fluids, Albumin infusion, correcting nutrition
Correcting third-spacing to quickly can lead to fluid shift that may stress out the cardiovascular system, shock or hypotension

Question 39

Sodium- essential for maintaining what?

Answer 39

normal nerve and muscle activity, regulating osmotic pressure, and preserving acid-base balance.

Question 40

Hyponatremia

Answer 40

Causes- Lack of sodium
Excessive diaphoresis (sweating), excessive ingestion of plain water, administration of nonelectrolyte IV fluids, excessive diuresis, loss of GI secretion Vomiting
Signs & symptoms-
Mental confusion, muscular weakness, anorexia, restlessness, elevated blood temp, tachycardia, nausea, vomiting and personal changes.
Treatment-
Oral administered sodium (foods high in sodium), IV solution

Question 41

Hypernatremia

Answer 41

Cause-
water diarrhea, excessive salt intake without sufficient water intake, high fever, decrease water intake, excessive administration of solution that contain sodium, severe burns, excessive water loss without loss of sodium
Sign & symptoms
Thirsty, dry sticky mucous membrane, decrease urine output, fever, rough dry tongue, lethargic
Treatment
Drink water, IV hypotonic solution

Question 42

Hyperkalemia

Answer 42

Causes
Severe renal failure (kidney cannot excrete potassium), severe burns, administration of potassium-sparing diuretics, overuse of potassium supplements,crushing injuries,
Signs Symptoms
Diarrhea, nausea, muscle weakness, parentheses, and cardiac arrhythmia
Treatment
Decrease intake of potassium, IV administration

Question 43

Hypokalemia

Answer 43

Causes- potassium- wasting, loss of fluid from the GI, large dose of corticosteroids
Signs Symptoms
Fatigue,muscle/ weakness, and paresthesia, anorexia, nausea,vomiting cardiac arrhythmia
Treatment
Oral intake of potassium-rich foods, potassium oral replacement

Question 44

Magnesium

Answer 44

transmission of nerve impulses and muscle excitability

Question 45

Hypomagnesemia

Answer 45

Causes
Chronic alcoholism, diabetic ketoacidosis, severe renal disease, severe burns, severe malnutrition, pregnancy-induced hypertension, intestinal malabsorption syndromes, excessive diuresis
Sign Symptoms
Tachycardia, cardiac arrhythmia, neuromuscular irritability, paresthesia of extremities, leg and foot cramps, hypertension, mental changes *positive Chvostek and trousseau sign, dysphagia and seizure
Treatment
Administer oral magnesium/ rich food, treat with IV

Question 46

Hypermagnesemia

Answer 46

Causes- renal failure, excessive use of antacids or laxative
Signs symptoms
Flushing, warmth, hypertension, lethargy, drowsiness, bradycardia, muscle weakness, depressed respiration and coma
Treatment
Decreasing of oral magnesemia, hemodialysis

Question 47

Integumentary system
Consist on

Answer 47

hair, nails, skin, sebaceous glands and nerve endings

Question 48

Integumentary system function

Answer 48

Provided protection
Temp regulation
Sensory information
Chemical synthesis-(Vitamin D production)

Question 49

Layer of the skin

Answer 49

epidermis -outerlayer
Dermis- Contains a lot of elastic fibers, blood vessels, sensory/motor nerves, sweat &
sebaceous glands, & hair follicles
Subcutaneous (hypodermis)- fat, connective tissue

Question 50

Proteins of the skin

Answer 50

Keratin- tough protein to provide protection in epidermis
Melanin- protect the skin for sun damage

Question 51

Glands

Answer 51

Sebaceous(oil) - produce sebum to lubricate skin prevent dry/cracked/skin/hair ( overproduction produce acne)
Eccrine- located everywhere ( releases excess water/electrolytes)
Apocrine- nipple, genital,eyelid,ear canal (odorless unless mix with bacteria)

Question 52

Dermatitis

Answer 52

inflammation of the skin: localized or generalized
Etiology- Allergic contact or primary irritant
Signs symptoms- blood vessel dilation, itching, vesiculation
Diagnostic finding- visual examination, skin patch test
Medical management- flushing skin with cool water, topical corticosteroids, wet dressing

Question 53

Acne Vulgaris

Answer 53

affects the sebaceous glands and hair follicles
Etiology- overproduction of sebum
Signs and symptoms-Oily scalp, comedones (black head)
Diagnostic finding- visual examination
Medical management- facial cleaning drying agents
containing benzoyl peroxide; topical, oral drugs; antibiotics; removal with
instruments; dermabrasion
Nursing Management- educated the patient

Question 54

Rosacea

Answer 54

skin disorder manifests in variety of ways generally characterized by rosy cheeks
Cause- genetic, bacteria of the skin,UV light exposure,
Etiology- Helicobacter pylori, mites, telangiectases
Signs and Symptoms
Intermittent blushing, papules, pustules, facial swelling, rhinophyma
Medical and Surgical Management: oral antibiotics, topical medications, pulsed
light treatment

Question 55

Plaque Psoriasis

Answer 55

Chronic, noninfectious inflammatory skin disorder
Etiology - likely genetic predisposition, keratinocytes, plaque
Signs and symptoms- Erythema with silvery scales, lesions
Diagnostic finding- visual examination, skin biopsy
Medical management - symptomatic treatment, drug therapy, biologic therapy,
Photochemotherapy

Question 56

Furuncles, Furunculosis, Carbuncles

Answer 56

Furuncle- is a boil Furunculosis- multiple furuncle Carbuncle- furuncle drain pus
Etiology- skin infection, diabetes mellitus
Signs and symptoms- Painful pustule surrounded by erythema, fever, anorexia, weakness, malaise (discomfort)
Diagnostic finding Culture of exudate identifies the pathogen
Medical management- hot, wet soaks; antibiotics; surgical incision, drainage (I&D)

Question 57

Scabies

Answer 57

common infection skin diseases
Etiology - itchy mites; spread from skin to skin
Signs symptoms - itching , excoriation( abrasion of the skin) webs of fingers other inner crevice
Diagnostic findings- visual examination, ink or mineral oil test
Medical management- scabicide application; thorough bathing, clean clothing,
avoiding contact with those infected

Question 58

Dermatophytosis (Ringworm, athlete foot, jock itch)

Answer 58

Signs and symptoms- rings of papules or vesicles, sore skin
Medical management- oral, topical antifungal agent

Question 59

Herpes Zoster ( Shingles)

Answer 59

Inflammation in the dermatome( a skin vesicle area that follows the nerve pathway
Signs and symptoms
Fever, headache, vesicles, itching
Medical management
Oral or topical acyclovir; corticosteroid, vaccine
Nursing management
Avoid contact with immunocompromised and people who have not had chickenpox

Question 60

Skin Cancer

Answer 60

Exposure to UV radiation; low skin melanin
Signs and symptoms
New appearance of growth; change in skin color; skin lesion
Diagnostic findings
Visual inspection, biopsy
Medical management
Electrodesiccation, surgical excision, cryosurgery, radiation therapy
Nursing management
Exam ABCDE

Question 61

Scleroderma

Answer 61

Scleroderma is an autoimmune connective tissue and rheumatic disease that causes
inflammation in the skin and other areas of the body. When an immune response tricks tissues
into thinking they are injured, it causes inflammation, and the body makes too much collagen,
leading to scleroderma.
Calcinosis: Calcium skin deposits
Raynaud’s phenomenon: A condition in which the blood vessels of the fingers and toes spasm when triggered by factors, such as cold, stress or illness. Cold, painful or numb fingers and toes result, which in severe cases may become gangrenous. Learn more about Raynaud’s phenomenon.
Esophageal dysfunction: Problems with the esophagus
Sclerodactyly: Skin damage on fingers
Telangiectasia: Spider veins

Question 62

Alopecia

Answer 62

Pathophysiology and Etiology: alopecia areata, androgenetic alopecia (male
pattern baldness)
Assessment Findings: Signs and Symptoms
Thinning hair
Diagnostic Findings: determined by suspected physical disorder
Medical and Surgical Management: treating the underlying medical disorder, drug
therapy, hair replacement surgery, hair grafting, scalp reduction, skin flap transfer
Nursing Management

Question 63

Onychomycosis

Answer 63

Fungal infection
Signs and symptoms
Thick, distorted; yellow friable nails
Diagnostic finding
Visual inspection, microscopic examination
Medical management
Prolonged systemic drug therapy, nail removal, surgery

Question 64

Pediculosis (Head Lice)

Answer 64

Etiology - transmitted through direct contact
Signs and symptoms
Itching of the scalp; small, yellow-white ovals(nits) attached to hair shaft; small gray nymphs; silvery eggs(nits) attached to hair shaft
Diagnostic finding
Scalp, hair inspection
Medical management
Pediculicides, mechanical removal