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MEDICAL SURGICAL > FLUIDS & ELECTROLYTES > Flashcards

FLUIDS & ELECTROLYTES Flashcards

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USMLE® Step 1 flashcards
1
Q

nursing diagnosis for hypercalcemia (4)

A

1 risk for falls or injury
2 dysrhythmias
3 bone pain
4 decreased functional/ ADL

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2
Q

nursing interventions for hypercalcemia (4)

A

1 provision of safety/ fall prevention
2 encourage weight bearing activity
3 force fluids 3-4L
4 1st bolus 500ml then 200ml

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3
Q

hypocalcemia disease state

A

1 kidney disease
2 abuse of diuretics
3 acute pancreatitis
4 primary hypoparathyroidism

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4
Q

hypocalcemia clinical signs (5)

A 
1 depression
2 numbness
3 hyperreflexia
4 chvostek's sign
5 trousseau's sign
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5
Q

chvostek’s sign

A

tapping of facial nerves

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6
Q

trosseau’s sign

A

carpal spasms

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7
Q

hypocalcemia cardiac signs

A

1 elongation of ST segments
2 prolonged QT interval
3 ventricular tachycardia

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8
Q

nursing diagnosis hypocalcemia (4)

A

1 risk for injury
2 neuromuscular changes
3 dysrhythmias
4 respiratory changes

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9
Q

nursing intervention for hypocalcemia

A

1 IV or oral replacement
2 oral Ca supplements
3 dietary management

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10
Q

problem present in hypercalcemia

A

problem is the shifting of bone supply of calcium to the plasma

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11
Q

problem present in hypocalcemia

A

problem is depleted calcium supply in bones and plasma

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12
Q

phosphate normal value

A

2.8 - 4.5 mg/dl

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13
Q

importance of phosphate

A

essential to muscle, RBC, neuro functions

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14
Q

excretion of phosphate

A

kidneys

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15
Q

PO4 >4.5 mg/dl level

A

hyperphosphatemia

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16
Q

hyperphosphatemia disease state (3)

A

1 kidney disease
2 chemotherapy
3 hypoparathyroidism

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17
Q

hyperphosphatemia clinical signs (3)

A

1 muscle problem
2 soft tissue
3 tetany

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18
Q

nursing intervention for hyperphosphatemia (2)

A

1 supplement and oral phosphate binder

2 vit d replacement

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19
Q

chloride normal value

A

97-107 mEq/ L

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20
Q

chloride also present in (4)

A

1 pancreatic juice
2 sweat
3 saliva
4 bile

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21
Q

Cl <97 mEq/ L level

A

hypochloremia

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22
Q

nursing intervention for hypochloremia (3)

A

1 prolonged NGT/ fast suction instead of low intermittent suction
2 low salt intake
3 drug interaction with aldosterone, ACTH, bicarbonate replacement

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23
Q

Cl > 108 mEq/ L level

A

hyperchloremia

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24
Q

hyperchloremia clinical signs

A

1 tachypnea
2 weakness
3 lethargy

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25
Q

hyperchloremic metabolic acidosis

A

loss of HCO3 cause increase in CI ions which is the form of acidifying salts

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26
Q

hyperchloremia nursing intervention

A

1 NaHCO3 replacement
2 restore electrolyte imbalance
3 IV hypotonic solutions

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27
Q

magnesium normal value

A

1.3 - 2.3 mEq/ L

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28
Q

location of absorption for magnesium

A

small distal bowel

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29
Q

function of magnesium

A

acts directly on myoneural junction

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30
Q

mg imbalances causes

A

neuromuscular irritability and contractility

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31
Q

effect of mg to cardiovascular system

A

peripheral vasodilation of arteries and arterioles

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32
Q

Mg <1.3 mEq/ L level

A

hypomagnesemia

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33
Q

hypomagnesemia nursing assessment (3)

A

1 ETOH withdrawal
2 GI losses
3 sepsis & burns

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34
Q

hypomagnesemia nursing intervention

A

1 administer IV MgSO4 (rate not exceed 67 mEq/ 8 hrs

2 diet management = tofu, green leafy vegetables

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35
Q

Mg > 2.3 mEq/ L level

A

hypermagnesemia

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36
Q

hypermagnesemia nursing assessment

A

oral intake of mylanta and antacids with Mg

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37
Q

hypermagnesemia clinical signs

A

1 low bp
2 n & v
3 lethargy
4 depressed rr

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38
Q

hypermagnesemia nursing intervention

A

1 discontinue source of Mg (IV, TPN)
2 administer diuretics
3 Ca gluconate - antagonist to cardiac and neuromuscular effects of high Mg

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39
Q

foley cath urine output for entero cutaneous fistula

A

800ml/ day

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40
Q

e-fistula output

A

6-8 liters a day

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41
Q

hypovolemia nursing assessment

skin turgor for adults

A

clavicle

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42
Q

hypovolemia nursing assessment

skin turgor for older adults

A

forehead and chest

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43
Q

hypovolemia nursing assessment

skin turgor for children

A

inner thigh and abdomen

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44
Q

sulfuric acid in the body is produced by

A

protein metabolism

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45
Q

phosphoric acid in the body is produced by

A

protein metabolism

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46
Q

ketoacid in the body is produced by

A

incomplete lipid metabolism

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47
Q

Hyperosmolality

A

Low body fluid volume

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48
Q

Ureteroscopy

A

Used for distal ureteral calculi

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49
Q

Percutaneous Nephrostolithotomy

A

May be combined with extracorporeal shock wave lithotripsy

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50
Q

what is MDRD

A

modification of diet in renal disease

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51
Q

Stones

A

Can be broken apart with hydraulic shock waves or laser besm

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52
Q

another way of doing filtration?

A

dialysis

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53
Q

Used in removing fragments

A

(1) Forceps
(2) graspers
(3) basket

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54
Q

is it possible to transplant a baby’s kidney to an adult?

A

yes

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55
Q

Under ______ guidance, needle is advanced into collecting system

A

Fluoroscopic or ultrasound

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56
Q

what is the formula used for glomerular filtration rate?

A

cockroft-gault formula

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57
Q

Goals of care for Cystitis (3)

A

(!) Relief of pain and discomfort (2) Increase knowledge of preventive measures and treatment (3) Prevent complications

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58
Q

Medications for UTI

A

Antimicrobial agents, antispasmodic agent, aspirin

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59
Q

Pain management for UTI (5)

A

Encourage increase OFI (2) Avoid irritants (3) Frequent voiding (4) Administer meds (5) Apply heat

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60
Q

Urinary irritants examples (5)

A

(1) coffee (2) tea (3) citrus (4) spices (5) cola and alcohol

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61
Q

Patient with UTI is experiencing fatigue, NV, and pruritus. What should you do?

A

Notify MD

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62
Q

Used for stones in renal collecting system and larger than 2.5 cm in diameter

A

Percutaneous Nephrostolithotomy

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63
Q

what are the dietary sources of phosphorous?

A

chicken, milk, legumes, carbonated beverages

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64
Q

Complications in percutaneous nephrostolithotomy

A

(1) hemorrhage
(2) infection
(3) extravasation of urine

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65
Q

Weeks maximum for ureteral stent

A

3 weeks

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66
Q

Management for recurrent UTI (3)

A

(1) Ascorbic acid 1000 mg daily (2) Cranberry juice (3) Increase OFI and void 2-3 hrs

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67
Q

Non-Pharmacologic Management

A

Dietary protein is restricted(oliguria and BUN elevated)
Carbohydrates are increased to provide energy and reduce catabolism
Potassium and sodium intake is restricted

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68
Q

How many stents used for 2 kidney stones to keep urine from flowing

A

2

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69
Q

Complications

A 
Hypertension, heart failure, endocarditis
Fluid and electrolyte imbalances 
Malnutrition
Hypertensive Encephalopathy
CKD
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70
Q

Nursing Assessment

A

Obtain px hx (WOF px with lupus)
Recent fluid gain
Edema
Engorged neck veins

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71
Q

Nursing Diagnosis

A

Ineffective (Renal) Tissue Perfusion r/t damage function AEB azotemia
ECFVE (Fluid Excess) r/t decreased GFR AEB +3 edema, crackles, weight gain
Electrolyte imbalance r/t decreased renal function AEB hyperkalemia, hypocalcemia, hyperphosphatemia, hypermagnessemia and low HCO3

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72
Q

Pain Management

A

Headache- Paracetamol
Malaise, fatigue
Flank pain
Anorexia

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73
Q

Promoting Renal Functions

A 
Monitor VS, I/O, weight gain
Maintain fluid restrictions 
Maintain Dietary restrictions 
Encourage rest during the acute phase 
Medications (Antihypertensive, Diuretics, H2 blockers)
74
Q

Improving Fluid Imbalance

A 
Carefully monitor fluid status 
Negative fluid balance 
Daily weight (early AM post void) 
Monitor pulmonary artery pressure and CVP
Monitor for signs and symptoms of hf 
Observe hypertensive encephalopathy
75
Q

Nursing Alert

A

Hypertensive encephalopathy is a medical emergency

76
Q

urethral bypass

A

Bladder catheterization bypasses the urethra

77
Q

Nursing intervention for nephrotic syndrome

A

1 increase circulating fluid volume and decrease edema
2 monitor daily weight, i&o, CVP - may cause orthostatic hypotension
3 sodium and fluid restriction if edema is severe

78
Q

Nephrotic Syndrome

A

syndorme not a diagnosis

79
Q

Nursing intervention for nephrotic syndrome

A

1 increase circulating fluid volume and decrease edema
2 monitor daily weight, i&o, CVP - may cause orthostatic hypotension
3 sodium and fluid restriction if edema is severe

80
Q

what is nephrolithiasis

A

kidney stones, stones, calculi formed in urinary tract

81
Q

ureterolithiasis

A

stone in ureters

82
Q

ureterolithiasis

A

stone in ureters

83
Q

Clinical manifestation

A

Insidious onset of pitting dependent edema, periorbital, edema and ascites; weight gain
fatigue, headache, malaise, irritability
Marked albuminuria
Hyperlipidemia

84
Q

Diagnostic Evaluation

A 
Urinalysis
24-hour protein casts, appear foamy 
Creatinine decreased 
Protein electrophoresis 
 Needle biopsy of kidney
85
Q

Management

A 
Treatment underlying glomerular disease 
Diuretics 
Corticosteroids or immunosuppressants
Cyclosporine 
  Management of edema
86
Q

Complications (Nephrotic Syndrome)

A

ECFVD(hypovolemia)
Thromboembolic complications
Altered drug metabolism
Progression to CKD

87
Q

nursing interventions for nephrotic syndrome

A

1 increasing circulating volume and decreasing edema
2 monitor i&o, daily weight, urine specific gravity, CVP - may cause orthostatic hypertension
3 sodium and fluid restriction

88
Q

nephroliathiasis

A

kidney stone disease, stones, calculi

89
Q

composition of kidney stones

A

calcium oxalate
crystals
soft drinks

90
Q

It is dilated with mechanical dilators or high pressure balloon dilator until nephroscope can be inserted up against stone

A

Urinary tract

91
Q

Included in the percutaneous nephrostomy so the doctor could see the isntrument and for better visualization

A

Eyepiece and light

92
Q

Chemolysis is used for (3)

A

Struvite
Uric acid
Cystine stones

93
Q

When do patients receive antimicrobial agents to maintain sterile urine?

A

Before
During
After

94
Q

Offers pathway for introduction of solvent to be infused into stone

A

Percutaneous stone dissolution (chemolysis)

95
Q

Introduced at continuous rate so patient can tolerate w/o flank pain or elevation of intrarenal pressure above 25 cm H2O

A

Irrigating solution

96
Q

Acidic stone

A

Hemiacidirin

Suby Solution G

97
Q

Alkaline stone

A

Tham-E

Acetylcystine

98
Q

Success rate of chemolytic drugs

A

85%

99
Q

Complications of chemolysis

A

Infection
Thrombophlebitis
Pulmonary embolism

100
Q

Can also be used to fragment stones

A

Electrohydraulic
Ultrasonic
Laser equipment

101
Q

What color of suture are used in stents for post op patients?

A

Blue or yellow (depending if connected to left or right kidney)

102
Q

Removal of stones from kidney pelvis

A

Pyelolithotomy

103
Q

Intraoperativr injection of coagulum into the renal pelvis

A

Coagulum pyelithotomy

104
Q

Incision into kidney for removal of stone( if in the calyx)

A

Nephrolithotomy

105
Q

Removal of kidney

A

Nephrectomy

106
Q

Removal of stone in ureter

A

Ureterolithotomy

107
Q

Removal of stone from bladder

A

Cystolithotomy

108
Q

Open surgical procedure complications

A
  • Bleeding / perirenal hematoma
  • Obstruction (from remaining fragments)
  • Infection
  • Impaired renal function
109
Q

Nursing assessment for open surgical procedure

A

Assess pain location, radiation and severity
Observe presence of sx (n&v, diarrhea, frequent urination in small amounts, oliguria, anuria)
Examine urine for hematuria
Monitor signs of UTI

110
Q

NDX

A

Acute Pain
Impaired Urinary Elimination
Risk for infection

111
Q

NM to control pain

A

Give prescribe opioid analgesic

Monitor patient for increasing pain, respiratory depression, drop in bp

112
Q

Interventions on how to maintain urine flow

A

Administer fluids orally or IV
Monitor urine i/o, blood
Strain urine through strainer or gauze

113
Q

Nursing rep for calcium and oxalate stones

A 
Instruct diet (avoid excess Ca and P) 
Teach purpose of drug therapy
114
Q

Nursing rep for uric acid stones

A

Teach methods to alkanize urine
Instruct to test urine pH
Allopurinol (cannot be taken for years)
Reduction of dietary purine intake

115
Q

Most common cause of AKI

A

Acute tubular necrosis

116
Q

Diagnostic criteria of AKI

A

Acute reduction in urine output

Elevation in serum creatinine

117
Q

Primary cause of death in AKI

A

Infection

118
Q

A syndrome of varying causation that results in a sudden decline in renal function

A

Acute Kidney Injury

119
Q

factors in nephrolithiasis

A

1 hypercalcemia
2 hypercalciuria
3 poor fluid intake
4 immobility

120
Q

causes of nephrolithiasis

A

1 excessive oxalate absorption in inflammatory bowel
2 living in mountainous
3 staghorn calculi

121
Q

clinical manifestations

A

1 pain pattern depends on site
2 large ureteral stones produce
3 obstruction seen in UTZ

122
Q

diagnostic evaluation

A

1 kidney, ureters and bladder radiography
2 IVU
3 spiral ct scan
4 urinalysis
5 lab work - serum kidney function test, electrolytes

123
Q

management for kidney stones

A

1 if small stones, hydration
2 pain control and reassurance
3 hospitalize

124
Q

what is extracorporeal shock wave lithotripsy

A

Noninvasive technique and treatment of choice for stones less than 2 cm in diameter

125
Q

For stones below the iliac crest

A

ureteroscopy may be performed.

126
Q

A shock wave

A

a large, condensed wave of energy produced by high-speed motion

127
Q

patient positioning for extracorporeal shock wave lithotripsy

A

1 Patient is placed on specially designed table and immersed in a water bath or placed on an adjustable stretcher positioned over a cushion of water
2 Water bath model
3 Cushion model

128
Q

The patient was hospitalized 1 week ago and underwent a renal surgery. He is conscious, given medications for recovery, and has an indwelling foley catheter. After 2 days, the patient tested positive for UTI. What should you do as a nurse?

A

Discontinue or remove indwelling catheter. If the patient needs it, make sure to change it every 3rd day of the week and secure it properly.

129
Q

You have a patient with increased BUN, creatinine, and antistreptolysin O titer. Moreover, the patient also has decreased albumin and serum complement. The patient’s urine has blood and appears tea or brown in color. What is this renal alteration?

A

ACUTE GLOMERULONEPHRITIS (AGN)

130
Q

Age group where AGN most frequently occurs

A

SCHOOL-AGE CHILDREN

131
Q

Gender where AGN most frequently occurs

A

BOYS

132
Q

Ratio of occurrence in boys to girls respectively.

A

2:1

133
Q

Pathognomonic sign of AGN

A

Tea-colored urine (old blood)

134
Q

Why does the urine become tea-colored?

A

Bilirubin in urine mixes with blood

135
Q

3 early signs of AGN

A

(1) Hematuria (2) Tea-colored urine (3) Proteinuria

136
Q

Patients with AGN experience blood leakage, if so, what clinical manifestation will be seen with them?

A

Anemia

137
Q

Most common bacterial cause of AGN

A

Group A- Beta Hemolytic Streptococcus

138
Q

Other clinical manifestation of AGN:

MNEMONIC: HOPES

A

Hypertension, Oliguria, Pulmonary edema (elderly), Edema, Sore throat

139
Q

In AGN the BUN and creatinine (which is usually elevated in kidney injury) returns to a normal level because?

A

There is increased urinary frequency

140
Q

In AGN, there is hypertension due to disrupted RAAS mechanism. What medication is given to correct the timing of RAAS stimulation?

A

ACE inhibitors

141
Q

Diagnostic tests for AGN (3)

A

(1)Urinalysis (2) 24-hr urine (3) Kidney Needle Biopsy

142
Q

During 24 hr urine collection, the nurse should label the container with what following data? (3)

A

(1)Patient name (2) Date and time started (3) Date and time ended

143
Q

What is the proper procedure of 24 hr urine collection method?

(A) Have the client void and discard the urine, collect all urine specimen from the patient, label the container with date/time started, on the 24th hr instruct the patient to void again, Nurse will add date/time ended

(B) Collect all urine specimen from the patient, label the container with date/time started, on the 12th hr instruct the patient to void again, Nurse will add date/time ended

(C) Have the client void and discard the urine, label the container with date/time started,collect all urine specimen from the patient, on the 24th hr instruct the patient to void again, Nurse will add date/time ended

(D) Collect all urine specimen from the patient, label the container with date/time started, on the 24th hr instruct the patient to void again, Nurse will add date/time ended

A

(C) Have the client void and discard the urine, label the container with date/time started,collect all urine specimen from the patient, on the 24th hr instruct the patient to void again, Nurse will add date/time ended

144
Q

Normal level of BUN

A

10-20

145
Q

Normal creatinine levels

A

0.5-1.5

146
Q

What medication is initiated in AGN patients to eliminate infection?

A

Antibiotics

147
Q

If the patient has edema what medication do we give?

A

Diuretics, example is Lasix or Furosemide

148
Q

What is the ideal fluid balance of patients with AGN? Positive or negative?

A

Negative fluid balance

149
Q

Nursing responsibilities for AGN patients taking antibiotics

A

Remind the patient to take the full course of antibiotics even if symptoms are resolved early.

150
Q

AGN patients develop edema due to decreased oncotic pressure allowing fluids to shift to interstitial tissues. What does a nurse do?

A

Restrict fluid intake

151
Q

All patients with a bladder catheter in place will

develop ___ within 3 to 4 days of catheterization.

A

UTI

152
Q

Usually after __ hours, the catheter is already

filled with bacteria

A

72

153
Q

Inserted via ___ technique

A

sterile

154
Q

All Foley catheters must be changed every ___ days

in a hospital setting

A

5-7

155
Q

It takes ___ days for the bacteria to quadruple in

amount

A

5 1/2

156
Q

In nursing home, ___ catheter is being used
because it does not attract bacteria unlike the foley
catheter

A

silicon

157
Q

if allergic to betadine, do not use alcohol but ___

A

peroxide

158
Q

The ___ concentrations of ammonia inactivates

complement and inhibits migration of PMNs

A

high

159
Q

Patients with high bacteria count are __ __ in dipstick test

A

nitrates positive

160
Q 
Bacteria can enter the bloodstream and cause
\_\_ \_\_ (\_\_)
A

septic shock (urosepsis)

161
Q

Urosepsis is fatal, that’s why is should be

treated in _ days

A

3

162
Q

signs and symptoms of cystitis

A 
Burning sensation upon urination
Frequency
Urgency (often need to pee)
Suprapubic pain
Dysuria (painful urination)
Incontinence
Nocturia
Occasional discharge of pus in the urine or from the
urethra
163
Q

signs and symptoms of pyelonephritis

A 
cystitis symptoms plus
Fever
Chills
Costovertebral angle pain/ tenderness
Nausea and vomiting [@] hydration is necessary
Headache
Malaise
Hypotension (seen in severe cases, which can lead to septic shock)
164
Q

In septic shock, watch out for _____

A

somnolence (drowsiness, looking sleepy)

165
Q

Dysuria common in ____, which is an STD usually associated with UTI

A

gonorrhea

166
Q

urinalysis

A

Should be performed in all patients with a possible

urinary tract infection (UTI)

167
Q

significant findings (2) of urinalysis are

A

More than 10 white blood cells per high power
field indicates pyuria

Leukocyte esterase dipstick is usually sensitive

168
Q

Urinalysis showing many epithelial cells is likely
____ by ____ ____ in women and is
therefore inaccurate in indicating infection.

A

contaminated

vaginal secretion

169
Q

___ ___ may be reported as contaminated as well.

A

urine culture

170
Q

Make sure to inform the patient on how to properly

collect, by first wiping the opening of urethra ___ times and catching their urine ___

A

3

midstream

171
Q

why catching it in midstream?

A

because bacteria is loaded on first centimeter of urethra

172
Q

most patients with UTI have ___ urine

A

cloudy

173
Q

urine gram stain

A

Done for clients suspected with pyelonephritis

174
Q

what are the significant findings of urine gram stain?

A

one bacterium per high-power field indicates >10^5 organisms per mL of clean-catch, mid-stream urine

175
Q

This bacterial concentration in combination with ___

indicates active infection

A

pyuria

176
Q

what is the bacterium per high-power field in male?

A

10^4

177
Q

urine culture

A

Is required in quantitation of bacteria to differentiate

contamination from true infection

178
Q

urine culture

A

To find out the type of bacteria

179
Q

urine culture

A

Not required in sexually active adult women with early

symptoms of cystitis

180
Q

urine culture

A

More than 10^5 organisms per mL of urine indicates infection

181
Q

urine culture

A

Have to do Sensitivity to identify what kind of antibiotic

to use

182
Q

Honeymoon cystitis

A

common bacteria is staphylococcus found on the skin

MEDICAL SURGICAL (3 decks)

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