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fundamentals test four material > fluid, electrolyte, and acid base balances > Flashcards

fluid, electrolyte, and acid base balances Flashcards

1
Q 
poor skin turgor
pale
dry skin
low BP
increased HR and R and Temp
confused, weight loss, lethargy.
In child, dark circles under eyes, lifeless, sunken fontanel
A

dehydrated patient

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2
Q

weight gain
edema
high BP, increased R, SOB, JVD, cough, crackles
copious amounts of white frothy sputum which could be blood tinged. Patient in tripod position because of orthopnea. Needs O2. Low O2 sats.

A

Too much fluid/Hypervolemia

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3
Q

transports nutrients to cells and wastes from cells
transports hormones, enzymes, blood cells
facilitates cellular metabolism
acts as a solvent for electrolytes and nonelectrolytes
helps maintain normal body temp
facilitates digestion and promotes elimination
acts as a tissue lubricant

A

functions of water

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4
Q

found inside cells
2/3 of body fluid
40% of body weight
Most stable body fluid

A

Intracellular fluid

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5
Q

fluid outside cells

A

extracellular fluid

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6
Q

fluid that surrounds cells

reserve fluid

A

interstitial fluid

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7
Q

fluid in blood vessels (plasma)

least stable fluid

A

intravascular fluid

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8
Q

CSF, peritoneal, bile duct, biliary, synovial, intraocular, and pericardial fluids

A

transcellular

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9
Q

1/3 of body fluids is

A

extracellular fluid

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10
Q

60% of average healthy adult and 70-80% of healthy infants is

A

water

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11
Q

solvent

A

liquid

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12
Q

solute

A

any substance dissolved in solution

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13
Q

requires energy

movement of ions against osmotic pressure to an area of higher pressure

A

Active transport

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14
Q

passive movement of electrolytes or other particles down the concentration gradient

A

diffusion

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15
Q

movement from an area of lesser to an area of greater concentration

A

osmosis

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16
Q

movement across a membrane, under pressure, from higher to lower pressure

A

filtration

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17
Q

water passes from an area of lesser solute concentration to greater concentration until equilibrium is established

Major force in body fluid movement and IV therapy
water moves into and out of cells and capillaries

A

Osmosis

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18
Q

tendency of solutes to move freely throughout a solvent “downhill”

A

diffusion

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19
Q

requires energy for movement of substances through cell membrane from lesser solute concentration to higher solute concentration

A

active transport

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20
Q

passage of fluid through permeable membrane from area of higher to lower pressure

A

filtration

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21
Q

concentration of solute (particles) per kg of water

A

Osmolality

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22
Q

concentration of solute (particles) per liter of fluid (this does not have to be water)

A

Osmolarity

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23
Q

concentration of solute (particles) in the plasma

A

serum osmolality

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24
Q

275-295 milliosmoles/liter

A

Normal serum osmolality

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25
Q

If serum osmolality is high

A

the patient is dry

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26
Q

If serum osmolality is low

A

patient is wet

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27
Q

have the same osmolality as normal plasma

A

isotonic fluids

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28
Q

neither makes cell swell or shrink

A

I SO PERFECT ISOTONIC

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29
Q

no osmotic pressure difference is created so fluid remains in ECF

used to replace fluid volume quickly

given to trauma patients who are bleeding, shock, severe NVD

be careful with CHF patients

tonicity is similar to blood

A

Isotonic IV fluid

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30
Q

given for losses from burns and diarrhea

A

Normal saline 0.9%

(sodium and chloride in water) provides no calories or free water

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31
Q

sodium, chloride, calcium, potassium, and lactate
Provides no calories or free water
Most resembles electrolyte concentration of plasma

A

Lactated Ringer’s- LR

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32
Q

having lower osmolality than normal plasma

A

hypotonic

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33
Q

less than 290 mOsm\L

A

Hypotonic

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34
Q

pulls water out of blood vessels into cells
used to prevent and treat cellular dehydration
patients require frequent monitoring

A

hypotonic

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35
Q

CONTRAINDICATED in acute brain injuries, large burns, major trauma, liver disease. patients at risk for 3rd spacing, increased cranial pressure, CVA, stroke, brain surgery,

A

hypotonic intravenous fluid

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36
Q

fluid trapped in interstitial spaces (fluid around cell)

A

3rd spacing

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37
Q

5% dextrose in water

A

hypotonic IV fluid

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38
Q

isotonic in bag but quickly changes in body

free water shifts from vessels into cells

A

5% dextrose in water

Hypotonic IV fluid

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39
Q

provides free water to cells along with sodium and chloride

1/2 of each liter moves into cells and 1/2 stays in vascular space

A

1/2 NS- 0.45% Normal Saline

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40
Q

having a higher osmolality/tonicity than normal plasma
causes water to be pulled from cells into blood vessels
increases vascular volume
decreases cell water
can cause vascular overload
monitor patient closely

A

hypertonic IV fluids

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41
Q

increased BP
causes cells to shrink/dehydrate
helps stabilize BP, increased urine output, increased peripheral edema/3rd spacing/interstitial fluid around cells/can be damaging to veins

A

hypertonic IV fluids

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42
Q

excessive breakdown of fat often seen in diabetic patients

A

ketosis

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43
Q

provides water to cells

provides some calories, enough to prevent ketosis

A

D5 1/2 NS: 5% dextrose in a 0.45% Saline

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44
Q

provides free water and calories to cells

A

D5NS: 5% dextrose in 0.9% saline

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45
Q

used for patients with dangerously low serum sodium levels of 115 mg/dL or less
given via IV pump
requires frequent monitoring of vitals, neuro status, lung sounds, and urinary output

Pt can become fluid overloaded. 1st sign is neuro deficit and lungs start filling with fluid

A

3% and 5% Saline

Hypertonic IV fluid

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46
Q

used on a limited basis to treat hypoglycemia
given via IV push or IV pump
irritating to veins

A

10% or 50% Dextrose

Hypertonic IV fluids

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47
Q

Dextran, Plasma, Hetastarch, and Albumin (protein)

A

colloid volume expanders

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48
Q

decrease blood volume
used to treat 3rd spacing either alone or with crystalloids
pull fluids from tissues into vessels

A

volume expanders

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49
Q

a large particle that normally does not pass through cell and capillary membranes, do not readily dissolve into true solutions

A

colloid

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50
Q

increasing the number of colloids causes an increase in

A

osmolality

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51
Q

salt that dissolves readily

A

crystalloid

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52
Q

used to treat low blood volume in burn patients

A

albumin

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53
Q

8 primary organs of homeostasis

A

kidneys, cardiovascular system, lungs, adrenal glands, thyroid gland, parathyroid glands, GI tract, and nervous system

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54
Q

normally filter 135-180 L plasma, excrete 1.5 L of urine a day

A

kidneys

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55
Q

pumps and carries nutrients and water in the body

A

cardiovascular system

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56
Q

regulate oxygen and carbon dioxide levels of blood

A

lungs

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57
Q

help body conserve sodium, save chloride and water, and excrete potassium

A

adrenal glands

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58
Q

increases blood flow in body and increases renal circulation

A

thyroid gland

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59
Q

regulate the level of calcium in ECF

A

parathyroid glands

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60
Q

absorbs water and nutrients that enter body through this route

A

GI tract

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61
Q

acts as a switchboard to inhibit and stimulate fluid balance (thirst center and ADH storage)

A

Nervous system

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62
Q

most water absorption occurs in the

A

colon

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63
Q

causes water retention

A

ADH

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64
Q

prompts fluid retention

hormone that regulates electrolyte levels

A

aldosterone

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65
Q

body’s own natural steroids

A

glucocorticoids

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66
Q

promote retention of sodium and water

adrenal cortex makes

A

cortisol/glucocorticoids

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67
Q

released from cells in heart in response to excessive blood volume. promotes sodium wasting, causes fluid loss

A

ANP/atrial natriuretic peptide

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68
Q

found in brain tissue and stored in myocardium

blood test used to predict CHF of fluid volume excess

A

BNP/brain natriuretic peptide

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69
Q

fluid and solute are lost in proportional amounts

A

isotonic fluid loss/hypovolemia

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70
Q

normal serum osmolality

fluid losses are primarily in vascular space

A

isotonic fluid loss

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71
Q

hemorrhage, vomiting, GI suction, diarrhea, fever, excessive heat, burns, diuretics

A

causes of isotonic fluid loss/hypovolemia/dehydration

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72
Q

more water is lost than solute

A

hypertonic dehydration

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73
Q

Patient will be dry.
serum osmolality is increased, pulling fluid into the vessels from the cells
cells shrink and become dehydrated

A

hypertonic dehydration

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74
Q

inadequate fluid intake
severe isotonic fluid losses
diabetes insipidus
increased solute intake without proportional increase in water

A

causes of hypertonic dehydration

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75
Q

excessive thirst and urination
caused by inadequate ADH
Loss of 5-15 L/day

A

symptoms of hypertonic dehydration

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76
Q

extracellular body spaces that do not normally contain fluid

Physiologically useless

A

3rd spacing fluid

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77
Q

massive trauma
malnutrition
protein deficiency
crush injuries, burns, sepsis, cancer, intestinal obstruction, abdominal surgery, liver dysfunction, starvation, cirrhosis, chronic alcoholism, heart failure, renal failure

A

Causes of 3rd spacing

hypovolemia

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78
Q

Most common type of dehydration

A

Isotonic

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79
Q

dehydration due to N/V/D, hemorrhage, etc.

A

Isotonic

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80
Q

equal losses of fluid and particles (electrolytes)

A

Isotonic dehydration

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81
Q

greater losses of particles (electrolytes)

Can lead to seizures

A

hypotonic dehydration

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82
Q

greater losses of fluid than electrolytes

Can lead to brain swelling or cerebral edema

A

hypertonic dehydration

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83
Q

When dehydrated you lose electrolytes and potassium and water. potassium leaves cell and is in the vascular space. If rehydrated then potassium:

A

Moves from extracellular fluid into cells and serum potassium drops

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84
Q 
thirst
mental status changes
concentrated urine and low urine output
dark amber or dark brown urine
dry skin
decreased skin turgor and elasticity
dry mucous membranes
sunken eyeballs
flat neck veins
skin tenting
poor skin turgor
acute weight loss
In baby, may have sunken fontanel, hypotension, decreased BP, increased HR, increased resp rate
A

assessment for dehydration

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85
Q

mental status changes

A

1st sign of dehydration in elderly and infants

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86
Q

in elderly you check skin turgor:

A

over chest

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87
Q

acute weight loss

A

most important sign in infants and young children of dehydration
Most accurate reflection of fluid balance

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88
Q

labs to check for dehydration

A

BUN, creatinine, serum electrolyte panel, urinalysis, and urine specific gravity

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89
Q

hemoconcentration

high hematocrit and BUN (false high)

A

diagnostic finding in dehydration

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90
Q

high urine specific gravity

A

dehydration

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91
Q

normal specific gravity value

A

1.0053-1.030

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92
Q

high serum osmolality greater than 300 mOsm/kg

high serum sodium greater than 150 mEq/L

A

hypertonic dehydration

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93
Q

Who is at risk for dehydration:

A

infants and young children
Elderly
People with acute or chronic illnesses
environmental causes (vigorous exercise, work outside)
diet and lifestyle (stroke, bulimia, etc.)

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94
Q

infants at risk for dehydration because of:

A

higher total body percentage of water 80%
kidneys are immature
larger BSA
higher metabolic rate
Watch closely because they get dehydrated quickly

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95
Q

Most at risk for dehydration:

A

acute and chronically ill patients

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96
Q

Why are elderly at risk for dehydration:

A

low amount of total body water
less muscle mass
kidneys lose function
diminished thirst mechanism

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97
Q

Who are people with acute illness that are at risk for dehydration:

A

surgery losses and drains
gastroenteritis
burns
cirrhosis

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98
Q

priority nursing diagnoses for dehydration:

A 
deficient fluid volume
acute confusion
deficient knowledge regarding disease management
risk for electrolyte imbalance
risk for injury
altered comfort
risk for impaired skin integrity
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99
Q

What are nursing interventions that are appropriate for dehydration:

A

Oral fluid replacement: if mild patient can drink
commercial oral rehydration solutions. May only tolerate small sips at first.
AVOID FRUIT JUICE, SODA, AND SPORTS DRINKS
Parenteral fluid replacement/IV- isotonic fluids, may require bolus or TPN
daily weights, vitals, mental status and behavior, urinary output, IV infusion rate, I&0, Lung sounds.
assist with rehydration.
provide comfort measures

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100
Q

most frequently used oral replacement fluid

A

0.9% NS isotonic fluid

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101
Q

What should you avoid if dehydrated patient:

A

fruit juice, soda, and sports drinks

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102
Q

How do you weigh patient with dehydration or imbalance?

A

Same scale, same time of day, and same clothes or naked

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103
Q

standard urinary output

A

60 mL/hr

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104
Q

To measure adequacy of interventions for dehydrated patient:

A 
adequate urinary output
stable HR and BP
skin with normal turgor
mucous membranes moist and pink
return to usual mental status
HCT, BUN, serum osmolality, and electrolytes return to normal
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105
Q

To determine patient’s adequate urinary output range:

A

0.5 mL/hr x Wt in Kg of patient

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106
Q

excessive retention of water and sodium in ECF

A

hypervolemia

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107
Q

above normal amounts of water in extracellular spaces

A

overhydration

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108
Q

excessive ECF accumulates in tissue (interstitial) spaces

A

edema

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109
Q

movement of fluid from space surrounding cells to blood

A

interstitial-to-plasma shift

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110
Q

increased BP, bounding pulse, fast and shallow respirations, JVD, pale and cool skin, increased urinary output, rapid weight gain, edema, lung crackles, dyspnea, and ascites

A

signs and symptoms of hypervolemia

too much fluid in body veins

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111
Q

more fluid that particles (usually sodium)

serum osmolality falls, shifting fluid into cells (high and dry, low and wet)

A

hypotonic fluid excess-water intoxication

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112
Q

repeated plain water enemas
overuse of hypotonic fluids or too painful infusion
drinking too much water
SIADH (syndrome of inappropriate ADH)
excess ADH causes kidneys to retain water but not sodium
Psychogenic polydipsia

A

causes of hypotonic fluid excess-water intoxication

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113
Q

what causes hypotonic fluid excess in infants and young children:

A

improper mixing of formula

giving water bottles instead of pacifier

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114
Q

severe or prolonged isotonic fluid volume excess occurs in

A

patients with heart failure and renal failure

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115
Q

compulsive water drinker

A

psychogenic polydipsia

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116
Q

how does edema form:

A 
caused by hypertension
increased capillary hydrostatic pressure
decreased capillary oncotic pressure
lymphatic obstruction
sodium excess
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117
Q

edema is caused by

A

injury, inflammation, malnutrition, liver disease

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118
Q

assessment of fluid overload

A 
high central venous pressure
JVD
engorged hand veins
gallop/S3
hepatomegaly and splenomegaly
anasarca
tense or bulging fontanel
peripheral edema
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119
Q

generalized edema

A

anasarca

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120
Q

check for peripheral edema in ambulatory patients in:

A

legs, ankles and feet

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121
Q

check for edema in nonambulatory patients in:

A

sacrum and back

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122
Q

2 mm
slight indentation
normal contours
associated with interstitial fluid volume 30% above normal

A

1+ pitting edema

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123
Q

4 mm
deeper pit after pressing
lasts longer than 1+
fairly normal contour

A

2+ pitting edema

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124
Q

6 mm
skin swelling obvious by inspection
remains several seconds after pressing
deep pit

A

3+ pitting edema

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125
Q

deep pit
8mm
remains for prolonged time after pressing, possibly minutes
frank swelling

A

4+ pitting edema

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126
Q 
will not pit
skin taut, warm, shiny
May see water leaking from pores
fluid can no longer be displaced secondary to excessive interstitial fluid accumulation
no pitting
tissue palpates as firm or hard
A

Brawny edema

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127
Q 
increased RR
irritated dry hacky cough- early sign
LIFE THREATENING
Tachypnea, dyspnea, irritated cough
Moist productive cough with white frothy sputum-late sign
labored breathing
crackles
A

Pulmonary edema

128
Q

early sign of pulmonary edema

A

irritated dry hacky cough

129
Q

late sign of pulmonary edema

A

moist productive cough with white frothy sputum

130
Q

vital signs
normal heart rate, full or bounding pulse, increasing BP
third spacing
acute rapid weight gain
urinary output and concentration
polyuria in patients with normal heart and kidney function
decreased output in patients with heart or kidney disease

A

hypervolemia assessment

131
Q

chest x-ray: pleural effusions

hemodilution: HCT low, BUN low

A

assessment of fluid excess

132
Q

Who is at risk for fluid volume excess:

A

Elderly due to decreased heart and kidney function
infants up to 2 yrs due to immature kidneys
children 2-12 yrs less stable regulatory responses
acute illness stress response promotes
chronic illness cardiovascular and renal disease
medications long term glucocorticoids promote fluid retention

133
Q

fluid volume excess
altered comfort
risk for impaired skin integrity
knowledgeable deficit

A

priority nursing diagnoses for fluid volume excess

134
Q

restrict fluid intake as ordered
Monitor lung sounds
watch for signs and symptoms of pulmonary edema: tachypnea, SOB, cough-early signs
give meds as rx’d: LOOP and thiazide diuretics, potassium sparing diuretics
Monitor electrolytes during diuretic therapy
accurate intake and output counts
monitor weight

A

nursing interventions for fluid volume excess

135
Q

most accurate way to measure fluid status

A

monitor weight: same scale, same time of day, same clothes or naked

136
Q

early signs and symptoms of pulmonary edema

A

tachypnea, SOB, cough

137
Q

Pt teaching for excess fluid overload

A

teach patients with peripheral edema to elevate legs
teach about sodium restricted diet
teach risk factors for fluid volume excess
teach patient to weigh daily at home
Notify PCP of weight gain of 2.2 lbs. in 24 hrs

138
Q

controls and regulates volume of body fluids

A

sodium

139
Q

chief regulator of cellular enzyme activity and water content

A

potassium

140
Q

nerve impulse, blood clotting, muscle contraction, B12 absorption

A

calcium

141
Q

metabolism of carbs and proteins, vital actions involving enzymes

A

magnesium

142
Q

maintains osmotic pressure in blood, produces hydrochloric acid

A

chloride

143
Q

body’s primary buffer system

A

bicarbonate

144
Q

involved in important chemical reactions in body, cell division, and hereditary traits

A

phosphate

145
Q

where sodium goes,

A

chloride goes too

146
Q

the major cation of the ECF

A

sodium

147
Q

normal sodium level

A

135-145 mEq\L

148
Q

primary function is regulation of fluid volume

A

sodium

149
Q

reabsorbed and secreted in kidneys

A

sodium

150
Q

minimal loss through feces and perspiration

A

sodium

151
Q

low levels can be caused by excessive water intake-heavy water drinkers

A

sodium

152
Q

Adults need about 3.8 grams daily to replace daily losses and maintain blood levels
Intake should not exceed 5.8 grams daily

A

sodium

153
Q

older adults, African Americans, people with chronic diseases like diabetes, hypertension, kidney disease

A

sodium restriction

154
Q

dietary sources of sodium

A

table salt NaCl-also good source of iodine

soy sauce, cured pork, canned foods, processed foods, salty seasonings, processed cheeses

155
Q

drink every fluid they can find, even toilet water and bird baths

A

psychogenic polydipsia

156
Q

sodium less than 135 mEq/L

A

hyponatremia

157
Q

common causes of hyponatremia

A

diuretics, GI fluid losses, hormonal disturbance

158
Q

anorexia, nausea, vomiting
weakness, lethargy, confusion
muscle cramps, muscle twitching, seizures

A

signs and symptoms of hyponatremia

159
Q

increase oral sodium intake

if severe, IV saline infusion

A

treatment for hyponatremia

160
Q

sodium greater than 145 mEq/L

A

hypernatremia

161
Q

excessive sodium intake, water deprivation, increased water loss through sweating, heat stroke

A

causes of hypernatremia

162
Q

thirst, elevated temp, dry mouth, sticky mucous membranes

A

signs and symptoms of hypernatremia

163
Q

hallucinations, irritability, lethargy, seizures

A

severe hypernatremia

164
Q

sodium restriction, increase water intake

A

treatment for hypernatremia

165
Q

found in ECF

functions with sodium to regulate serum osmolality and blood volume

A

chloride

166
Q

normal level is 95-108 mEq/L

A

chloride

167
Q

found in gastric juice
involved in regulating acid/base balance
buffer in gas exchange in RBCs
found in the same foods as sodium

A

chloride

168
Q

chloride greater than 108 mEq/L

A

hyperchloremia

169
Q

chloride less than 95 mEq/L

A

hypochloremia

170
Q

usually associated with hyponatremia

hypokalemia, or metabolic alkalosis

A

chloride problem

171
Q

major cation of ICF

A

potassium

172
Q

normal levels are 3.5-5.0 mEq/L

A

potassium

173
Q

key electrolyte in cellular metabolism

A

potassium

174
Q

regulates conduction of cardiac rhythm

A

potassium

175
Q

excreted and absorbed through kidneys

losses through vomiting and diarrhea, potassium wasting diuretics

A

potassium

176
Q

dietary recommendation of at least 4.7 grams/day

A

potassium

177
Q

potassium restriction in

A

chronic kidney disease

178
Q

common food sources of potassium:

A

bananas, oranges, apricots, dates, tomatoes, spinach, dairy products, and meats

179
Q

chief regulator of all electrolytes

A

potassium

180
Q

common causes of hypokalemia

A

potassium wasting diuretics, GI losses,steroids, anorexia, or bulemia

181
Q

fatigue, anorexia, N/V, dysrhythmias, parasthesias

A

signs and symptoms of hypokalemia

182
Q

numbness/tingling

A

parasthesias

183
Q

potassium supplementation-diet, medications

IV potassium must be DILUTED

A

treatment for hypokalemia

184
Q

potassium less than 3.5 mEq/L

A

hypokalemia

185
Q

potassium greater than 5.0 mEq/L

A

hyperkalemia

186
Q

common cause of hyperkalemia

A

potassium sparing diuretics and renal failure

187
Q

signs and symptoms of hyperkalemia

A

muscle weakness, dysrhythmia

188
Q

Kayexalate

A

binds potassium in gut to treat hyperkalemia

189
Q

Insulin

A

drives potassium back into cells to treat hyperkalemia

190
Q

glucose

A

encourage potassium back in cells to treat hyperkalemia

191
Q

treatment for hyperkalemia

A

meds such as kayexalate, insulin, and glucose if severe, dialysis
dietary measures-caution against intake

192
Q

treatment of hypokalemia

A

order EKG to check heart function and rhythm

193
Q 
M.U.R.D.E.R.
M-muscle weakness
U- urine, oliguria, anuria
R- respiratory distress
D-decreased cardiac contractility
E- ECG changes
R- reflexes, hyperreflexia or areflexia (flaccid)
A

signs and symptoms of increased potassium levels

194
Q 
M- Medications- Ace inhibitors, NSAIDs
A- Acidosis- metabolic and respiratory
C- Cellular destruction - burns, traumatic injury
H- Hypoaldosteronism, hemolysis
I- Intake - excessive
N- Nephrons, renal failure
E- Excretion - impaired
A

causes of increased potassium

195
Q

responsible for bone health, neuromuscular, and cardiac function

A

calcium

196
Q

Normal level is 8.5-10.5 mg/dL

A

calcium

197
Q

essential factor in blood clotting

A

calcium

198
Q

99% located in bone and teeth, 1% in circulating blood

A

calcium

199
Q

serum losses lead to bone losses

A

calcium

200
Q

adults and adolescents need dietary intake of calcium of

A

1200-1500 mg/day

201
Q

dietary sources of calcium

A

milk, milk products, daily green leafy vegetables, salmon

202
Q

sign of hypocalcemia

A

If you inflate BP cuff on arm above normal systolic BP, patient’s hand will flex
Chvostek’s sign- tap face below zygoma and you will see unilateral twitch if positive sign

203
Q

calcium less than 8.5 mg/dL

A

hypocalcemia

204
Q

common causes of hypocalcemia

A

malabsorption, hypoparathyroidism

205
Q

signs and symptoms of hypocalcemia

A

diarrhea, numbness and tingling in extremities, muscle cramps,tetany, convulsions (seizures), positive trousseau’s sign and chvostek’s sign

206
Q

treatment for hypocalcemia

A

encourage increased calcium intake
if severe, monitor airway and place on seizure precautions
parenteral calcium infusion

207
Q

common causes of hypercalcemia

A

malignant bone disease

hyperparathyroidism

208
Q

calcium level of 10.5 mg/dL or more

A

hypercalcemia

209
Q

muscle weakness, polyuria, polydipsia, bizarre behavior

A

signs and symptoms of hypercalcemia

210
Q

treatment for hypercalcemia

A

eliminate calcium supplements
limit calcium rich foods
dialysis

211
Q

normal phosphorus level

A

2.5-4.5 mg/dL

212
Q

found in ICF, bone, skeletal muscle, nerve tissue

A

phosphorus

213
Q

helps metabolize proteins, fats, and carbs

A

phosphorus

214
Q

essential for functioning of muscles, nerves, and RBCs

A

phosphorus

215
Q

can be associated with elevated calcium levels
complication of refeeding after severe malnourishment
administering TPN without adequate phosphorus
prolonged use of aluminum and magnesium based antacids
severe vomiting and diarrhea
prolonged gastric suction
increased calcium, low phosphate

A

hypophophatemia

216
Q

phosphate less than 2.6 mg/dL

A

hypophosphatemia

217
Q

phosphate greater than 4.5 mg/dL

A

hyperphosphatemia

218
Q 
hypocalcemia
excessive intake
vitamin D excess
massive blood transfusions
large milk intake
rhabdomyolysis (break down of striated/skeletal muscle)
A

hyperphosphatemia symptoms

219
Q

rhabdomyolysis happens in

A

people who do extreme physical exercise. Patients in one position for too long.

220
Q

used in more than 300 chemical reactions

A

magnesium

221
Q

normal levels 1.5-2.5 mEq/L

A

magnesium

222
Q

necessary for protein and DNA synthesis

A

magnesium

223
Q

only 1% found in circulating blood, 99% in ICF and bone

A

magnesium

224
Q

deficiency is rare- occurs mostly in alcoholics and those with absorption disorders (pancreatitis, burns)

A

magnesium

225
Q

dietary recommendation of 18-30 mEq/day

A

magnesium

226
Q

dietary sources of magnesium

A

most foods

green vegetables, cereal grains, nuts

227
Q

common causes of hypomagnesemia

A

chronic alcoholism

excessive loss of fluids from GI tract (NG suction)

228
Q

Symptoms of hypomagnesemia

A

tremors, increased reflexes, positive Chvostek’s and Trousseau’s signs

229
Q

treatment of hypomagnesemia

A

carefully administer magnesium salts as ordered
place patient on seizure precautions
encourage patient to eat magnesium rich foods

230
Q

magnesium of less than 1.5 mEq/L

A

hypomagnesemia

231
Q

common causes of hypermagnesemia

A

renal failure
adrenal insufficiency
excessive intake of magnesium-containing antacids

232
Q

signs and symptoms of hypermagnesemia

A

vasodilation and flushing
nausea and vomiting
depressed DTR’s

233
Q

treatment for hypermagnesemia

A

notify PCP

dialysis

234
Q

the amount of acid or base in a solution

A

pH

235
Q

substance containing hydrogen ions that an be liberated or released

A

acid

236
Q

substance that can trap hydrogen ions

A

base

237
Q

normal arterial blood and body tissue pH is

A

735-7.45

238
Q

the lower the pH the ________ the acid

A

stronger

239
Q

the higher the pH the __________ the base

A

stronger

240
Q

pH below __________ or above _____ is usually FATAL

A

6.9 or 7.8

241
Q

pH requires

A

TIGHT control

242
Q

homeostatic regulators of hydrogen ions

A

respiratory mechanisms and renal mechanisms

243
Q

work rapidly to restore homeostasis. regulate acid-base balance by either eliminating or retaining carbon dioxide

A

respiratory mechanisms

244
Q

if pH is low respirations

A

increase (rapid and deep) causes a drop in carbon dioxide

245
Q

If hyperventilating you get

A

alkalotic; respiratory alkalosis

246
Q

any clinical condition that increases respiratory rate and depth can cause lungs to eliminate CO2 and cause decreased PACO2 and increased pH causing

A

RESPIRATORY ALKALOSIS

247
Q

pH increases respirations decrease, body retains CO2, increased carbonic acid level retention, increased acid leads to

A

respiratory acidosis

248
Q

if pH is high respirations _________________ causing body to retain carbon dioxide which increases the carbonic acid level

A

decrease (slow and shallow)

249
Q

effective but slow if pH is high will excrete bicarb, this can take up to 3 days to normalize pH level

A

, renal mechanism/kidneys

250
Q

disturbance alters the carbonic acid portion of the buffering system

A

respiratory

251
Q

disturbance alters the bicarbonate portion of the buffering system

A

metabolic

252
Q

normal PCO2 range is

A

35-45 mmHg

253
Q

normal HCO3 level is

A

22-26 mEq/L

254
Q

ROME

A

Respiratory opposite metabolic equal

255
Q

occur when carbonic acid or bicarbonate levels become disproportionate

A

acid base imbalances

256
Q

primary excess of carbonic acid in ECF (PCO2 greater than45 and pH less than 7.35)

A

respiratory acidosis

257
Q

primary deficit of carbonic acid in ECF (PCO2 less than 35 and pH greater than 7.45)

A

respiratory alkalosis

258
Q

proportionate deficit of bicarbonate in ECF (HCO3 less than 22 and pH less than 7.35)

A

metabolic acidosis

259
Q

primary excess of bicarbonate in ECF (HCO3 greater than 26 and pH greater than 7.45

A

metabolic alkalosis

260
Q

causes of respiratory acidosis

A 
acute and chronic respiratory disease
CNS depression
neuromuscular disease
retention of PCO2
common in patients with chronic respiratory diseases
261
Q

signs and symptoms of respiratory acidosis

A

acute: increased pulse and respirations, decreased LOC
chronic: weakness, HA
example pH 7.30 PCO2 47

262
Q

Interventions for respiratory acidosis

A

O2, adequate hydration

263
Q

causes of respiratory alkalosis

A

hyperventilation, extreme anxiety

high fever, early sepsis

264
Q

signs and symptoms of respiratory alkalosis

A

confusion, difficulty concentrating, lightheadedness, palpitations, sweating

265
Q

interventions for respiratory alkalosis

A

encourage slow, deep breaths (paper bag)
sedatives
Morphine or Ativan may be given to decrease respiratory rate

266
Q

causes of metabolic acidosis

A

uncontrolled DM

excessive GI fluid losses

267
Q

signs and symptoms of metabolic acidosis

A

N/V

Increased respiratory rate, peripheral vasodilation, hyperkalemia

268
Q

interventions for metabolic acidosis

A

correction of underlying problem

bicarbonate IV

269
Q

causes of metabolic alkalosis

A

excessive acid loss- vomiting or gastric suctioning

hypokalemia

270
Q

signs and symptoms of metabolic alkalosis

A

dizziness, tingling of extremities, hypertonic muscles

271
Q

interventions for metabolic alkalosis

A

give salt p.o. or sodium rich foods

272
Q

reduces transfusion reactions

A

typing and cross matching

273
Q

A person with group A blood can donate blood to

A

A and AB

274
Q

A person with group A blood can receive blood from

A

A & O

275
Q

A person with group B blood can give blood to

A

B & AB

276
Q

A person with group B blood can receive blood from

A

B & O

277
Q

A person with group AB blood can donate blood to

A

AB only

278
Q

A person with group AB blood can receive from

A

all: A, B, AB, and O

279
Q

A person with type O blood can give blood to

A

all: A, B, AB, and O

280
Q

A person with type O blood can receive blood from

A

O only

281
Q

identifies major antigens
helps reduce risk of transfusion reactions
RBCs from donor blood is mixed with plasma from recipient, a reagent is added, observed for clumping and if no clumping should be safe to give blood

A

crossmatching

282
Q

blood products include:

A 
whole blood
RBCs or PRBCs
Plasma 
WBCs
plasma derivatives- albumin
autologous transfusion-
283
Q

helps with oxygen transport

A

PRBCs

284
Q

patient can receive their own blood- prior to surgery donate and it is given back postop

A

autologous transfusion

285
Q

given to neutropenic patients

A

WBCs

286
Q

stay with patient for __________ of transfusion

A

first 5 minutes

287
Q

when monitoring tranfusions:

A 
verify doctor's orders
baseline vitals
inspect IV site
18 gauge preferred, no less than 20 gauge IV catheter
verify blood by 2 RN's
vitals q 15 min x 4 then 30 min until completed
flush with hanging saline after infusion
blood must infuse in 4 hours or less
288
Q

the longer blood hangs the more likely

A

it is to grow bacteria

289
Q

some patients may receive __________ between transfusions, especially if heart failure patient

A

diuretics

290
Q

types of transfusion reactions:

A

Allergic, bacterial febrile, hemolytic, circulatory overload

291
Q

flushing, itching, rash, urticaria, hives, anaphylaxis

A

Allergic reaction to transfusion

292
Q

fever, increased BP, and chills

A

bacterial reaction to transfusion

293
Q

fever, chills, and flushing

A

febrile reaction to transfusion

294
Q

RBCs destruction, fever, chills, SOB, chest pain, back pain. caused by infusing incompatible blood

A

hemolytic transfusion reaction

295
Q

One of the most serious types of transfusion reactions

A

hemolytic

296
Q

hypervolemia, cough, crackles, increased BP

A

circulatory overload

297
Q

transfusion reaction nursing interventions:

A

immediately stop the transfusion
disconnect the tubing from the patient
Infuse 0.9% NS
Vital signs, cardiac and respiratory assessment
Notify physician
Send the blood back to the blood bank, call the lab to come draw a blood sample and take a urine specimen (sometimes ordered) according to policy

298
Q

IV insertion and maintenance

A

Choose the right site: site that meets patient’s need for fluids, in hand or lower arm, In trauma or cardiac arrest use antecubital fossa (bend of arm), use nondominant limb if possible, avoid using veins that lie over joints, avoid veins in feet of patients with diabetes or circulatory problems, avoid limbs with injuries, loss of sensation.
Know why IV is placed
A lot of facilities require physician’s orders for IV placed in lower extremities

299
Q

complications of IV therapy:

A 
infiltration
infection
phlebitis, thrombophlebitis
extravasation
severed catheter
allergic reaction
air embolism
speed shock
fluid overload
300
Q

fluid leaks into tissue outside of vein

A

infiltration

301
Q

purulent drainage and redness

A

infection

302
Q

red, inflammation of vein, red streak up arm

A

phlebitis

303
Q

inflammation of vein

A

thrombophlebitis

304
Q

similar to infiltration with tissue damage

red, hot

A

extravasation

305
Q

part of catheter shears off and causes an embolus

requires calling PCP

A

severed catheter

306
Q

itching at site, redness, anaphylaxis, laryngeal edema, runny nose

A

allergic reaction

307
Q

obstruction of blood vessel caused by air bubble

A

air embolism

308
Q

sudden physiologic reaction to IV med or fluids given too quickly

A

speed shock

309
Q

LOC, cardiac arrest, dyspnea, SOB, crackles, tachypnea

A

fluid overload

310
Q

the worst type of complication of IV therapy

A

extravasation

311
Q

documentation of IV therapy

A

how patient tolerated
date, time, type of catheter
Label actual site with date, time, and gauge size, and your initials
# of attempts
insertion site and its appearance
the type and amount of fluid being infused and the rate
any patient teaching

312
Q 
There once was a tekkie named Chvos, 
whose calcium was so low it was lost!
He'd tap on his face
on the facial nerve space
Till his face twitched and his eyes almost crossed.
A

Chvostek’s sign

313
Q 
There once was a bride named Eve Snow, 
Whose groom's parathyroid was low.
His calcium decked
And both arms were so flexed
that poor Eve carried her own trousseau.
A

Trousseau’s sign

314
Q

Normal thirst or may refuse some fluids
A moist mouth and tongue
Normal to slightly decreased urine output, normal specific gravity, and serum osmolality
less than 3% weight gain
normal HR, P, breathing, and warm extremities
cap refill less than 2 seconds
instant recoil on skin turgor test
eyes not sunken (and/or fontanel in baby)
this can be managed at home with oral hydration

A

mild dehydration

315
Q

dry mouth and tongue
tired, restlessness, irritability, increased thirst
decreased urine output to slightly elevated urine specific gravity and serum osmolality
3-9% weight loss
normal to increased HR and P, normal to fast breathing, and cool extremities
cap refill greater than 2 seconds
recoil on skin turgor test in less than 2 seconds
slightly sunken eyes (and/of fontanel in baby)
may or may not be treatable at home, more aggressive approach may be needed
an IV bolus of fluid may or may not be given

A

marked or moderate dehydration

316
Q

Poor drinking or may be unable to drink
lethargy, parched mouth and tongue
Minimal to no urine output, elevated urine specific gravity and serum osmolality
greater than 9% weight loss
increased HR, weak pulses, deep breathing, and cool mottled extremities
cap refill that is very prolonged or minimal
recoil on skin turgor test is more than 2 seconds
deeply sunken eyes (and/or fontanel in baby)
Considered MEDICAL EMERGENCY!!!
Patient is at risk for shock and death!!!
requires aggressive IV rehydration

A

severe dehydration

fundamentals test four material (5 decks)

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