FLUIDS & ELECTROLYTES Flashcards
1
Q
nursing diagnosis for hypercalcemia (4)
A
1 risk for falls or injury
2 dysrhythmias
3 bone pain
4 decreased functional/ ADL
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
3
Q
hypocalcemia disease state
A
1 kidney disease
2 abuse of diuretics
3 acute pancreatitis
4 primary hypoparathyroidism
4
Q
hypocalcemia clinical signs (5)
A
1 depression 2 numbness 3 hyperreflexia 4 chvostek's sign 5 trousseau's sign
5
Q
chvostek’s sign
A
tapping of facial nerves
6
Q
trosseau’s sign
A
carpal spasms
7
Q
hypocalcemia cardiac signs
A
1 elongation of ST segments
2 prolonged QT interval
3 ventricular tachycardia
8
Q
nursing diagnosis hypocalcemia (4)
A
1 risk for injury
2 neuromuscular changes
3 dysrhythmias
4 respiratory changes
9
Q
nursing intervention for hypocalcemia
A
1 IV or oral replacement
2 oral Ca supplements
3 dietary management
10
Q
problem present in hypercalcemia
A
problem is the shifting of bone supply of calcium to the plasma
11
Q
problem present in hypocalcemia
A
problem is depleted calcium supply in bones and plasma
12
Q
phosphate normal value
A
2.8 - 4.5 mg/dl
13
Q
importance of phosphate
A
essential to muscle, RBC, neuro functions
14
Q
excretion of phosphate
A
kidneys
15
Q
PO4 >4.5 mg/dl level
A
hyperphosphatemia
16
Q
hyperphosphatemia disease state (3)
A
1 kidney disease
2 chemotherapy
3 hypoparathyroidism
17
Q
hyperphosphatemia clinical signs (3)
A
1 muscle problem
2 soft tissue
3 tetany
18
Q
nursing intervention for hyperphosphatemia (2)
A
1 supplement and oral phosphate binder
2 vit d replacement
19
Q
chloride normal value
A
97-107 mEq/ L
20
Q
chloride also present in (4)
A
1 pancreatic juice
2 sweat
3 saliva
4 bile
21
Q
Cl <97 mEq/ L level
A
hypochloremia
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
23
Q
Cl > 108 mEq/ L level
A
hyperchloremia
24
Q
hyperchloremia clinical signs
A
1 tachypnea
2 weakness
3 lethargy
25
hyperchloremic metabolic acidosis
loss of HCO3 cause increase in CI ions which is the form of acidifying salts
26
hyperchloremia nursing intervention
1 NaHCO3 replacement
2 restore electrolyte imbalance
3 IV hypotonic solutions
27
magnesium normal value
1.3 - 2.3 mEq/ L
28
location of absorption for magnesium
small distal bowel
29
function of magnesium
acts directly on myoneural junction
30
mg imbalances causes
neuromuscular irritability and contractility
31
effect of mg to cardiovascular system
peripheral vasodilation of arteries and arterioles
32
Mg <1.3 mEq/ L level
hypomagnesemia
33
hypomagnesemia nursing assessment (3)
1 ETOH withdrawal
2 GI losses
3 sepsis & burns
34
hypomagnesemia nursing intervention
1 administer IV MgSO4 (rate not exceed 67 mEq/ 8 hrs
| 2 diet management = tofu, green leafy vegetables
35
Mg > 2.3 mEq/ L level
hypermagnesemia
36
hypermagnesemia nursing assessment
oral intake of mylanta and antacids with Mg
37
hypermagnesemia clinical signs
1 low bp
2 n & v
3 lethargy
4 depressed rr
38
hypermagnesemia nursing intervention
1 discontinue source of Mg (IV, TPN)
2 administer diuretics
3 Ca gluconate - antagonist to cardiac and neuromuscular effects of high Mg
39
foley cath urine output for entero cutaneous fistula
800ml/ day
40
e-fistula output
6-8 liters a day
41
hypovolemia nursing assessment
skin turgor for adults
clavicle
42
hypovolemia nursing assessment
skin turgor for older adults
forehead and chest
43
hypovolemia nursing assessment
skin turgor for children
inner thigh and abdomen
44
sulfuric acid in the body is produced by
protein metabolism
45
phosphoric acid in the body is produced by
protein metabolism
46
ketoacid in the body is produced by
incomplete lipid metabolism
47
Hyperosmolality
Low body fluid volume
48
Ureteroscopy
Used for distal ureteral calculi
49
Percutaneous Nephrostolithotomy
May be combined with extracorporeal shock wave lithotripsy
50
what is MDRD
modification of diet in renal disease
51
Stones
Can be broken apart with hydraulic shock waves or laser besm
52
another way of doing filtration?
dialysis
53
Used in removing fragments
(1) Forceps
(2) graspers
(3) basket
54
is it possible to transplant a baby’s kidney to an adult?
yes
55
Under ______ guidance, needle is advanced into collecting system
Fluoroscopic or ultrasound
56
what is the formula used for glomerular filtration rate?
cockroft-gault formula
57
Goals of care for Cystitis (3)
(!) Relief of pain and discomfort (2) Increase knowledge of preventive measures and treatment (3) Prevent complications
58
Medications for UTI
Antimicrobial agents, antispasmodic agent, aspirin
59
Pain management for UTI (5)
Encourage increase OFI (2) Avoid irritants (3) Frequent voiding (4) Administer meds (5) Apply heat
60
Urinary irritants examples (5)
(1) coffee (2) tea (3) citrus (4) spices (5) cola and alcohol
61
Patient with UTI is experiencing fatigue, NV, and pruritus. What should you do?
Notify MD
62
Used for stones in renal collecting system and larger than 2.5 cm in diameter
Percutaneous Nephrostolithotomy
63
what are the dietary sources of phosphorous?
chicken, milk, legumes, carbonated beverages
64
Complications in percutaneous nephrostolithotomy
(1) hemorrhage
(2) infection
(3) extravasation of urine
65
Weeks maximum for ureteral stent
3 weeks
66
Management for recurrent UTI (3)
(1) Ascorbic acid 1000 mg daily (2) Cranberry juice (3) Increase OFI and void 2-3 hrs
67
Non-Pharmacologic Management
Dietary protein is restricted(oliguria and BUN elevated)
Carbohydrates are increased to provide energy and reduce catabolism
Potassium and sodium intake is restricted
68
How many stents used for 2 kidney stones to keep urine from flowing
2
69
Complications
```
Hypertension, heart failure, endocarditis
Fluid and electrolyte imbalances
Malnutrition
Hypertensive Encephalopathy
CKD
```
70
Nursing Assessment
Obtain px hx (WOF px with lupus)
Recent fluid gain
Edema
Engorged neck veins
71
Nursing Diagnosis
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
72
Pain Management
Headache- Paracetamol
Malaise, fatigue
Flank pain
Anorexia
73
Promoting Renal Functions
```
Monitor VS, I/O, weight gain
Maintain fluid restrictions
Maintain Dietary restrictions
Encourage rest during the acute phase
Medications (Antihypertensive, Diuretics, H2 blockers)
```
74
Improving Fluid Imbalance
```
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
Nursing Alert
Hypertensive encephalopathy is a medical emergency
76
urethral bypass
Bladder catheterization bypasses the urethra
77
Nursing intervention for nephrotic syndrome
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
Nephrotic Syndrome
syndorme not a diagnosis
79
Nursing intervention for nephrotic syndrome
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
what is nephrolithiasis
kidney stones, stones, calculi formed in urinary tract
81
ureterolithiasis
stone in ureters
82
ureterolithiasis
stone in ureters
83
Clinical manifestation
Insidious onset of pitting dependent edema, periorbital, edema and ascites; weight gain
fatigue, headache, malaise, irritability
Marked albuminuria
Hyperlipidemia
84
Diagnostic Evaluation
```
Urinalysis
24-hour protein casts, appear foamy
Creatinine decreased
Protein electrophoresis
Needle biopsy of kidney
```
85
Management
```
Treatment underlying glomerular disease
Diuretics
Corticosteroids or immunosuppressants
Cyclosporine
Management of edema
```
86
Complications (Nephrotic Syndrome)
ECFVD(hypovolemia)
Thromboembolic complications
Altered drug metabolism
Progression to CKD
87
nursing interventions for nephrotic syndrome
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
nephroliathiasis
kidney stone disease, stones, calculi
89
composition of kidney stones
calcium oxalate
crystals
soft drinks
90
It is dilated with mechanical dilators or high pressure balloon dilator until nephroscope can be inserted up against stone
Urinary tract
91
Included in the percutaneous nephrostomy so the doctor could see the isntrument and for better visualization
Eyepiece and light
92
Chemolysis is used for (3)
Struvite
Uric acid
Cystine stones
93
When do patients receive antimicrobial agents to maintain sterile urine?
Before
During
After
94
Offers pathway for introduction of solvent to be infused into stone
Percutaneous stone dissolution (chemolysis)
95
Introduced at continuous rate so patient can tolerate w/o flank pain or elevation of intrarenal pressure above 25 cm H2O
Irrigating solution
96
Acidic stone
Hemiacidirin
| Suby Solution G
97
Alkaline stone
Tham-E
| Acetylcystine
98
Success rate of chemolytic drugs
85%
99
Complications of chemolysis
Infection
Thrombophlebitis
Pulmonary embolism
100
Can also be used to fragment stones
Electrohydraulic
Ultrasonic
Laser equipment
101
What color of suture are used in stents for post op patients?
Blue or yellow (depending if connected to left or right kidney)
102
Removal of stones from kidney pelvis
Pyelolithotomy
103
Intraoperativr injection of coagulum into the renal pelvis
Coagulum pyelithotomy
104
Incision into kidney for removal of stone( if in the calyx)
Nephrolithotomy
105
Removal of kidney
Nephrectomy
106
Removal of stone in ureter
Ureterolithotomy
107
Removal of stone from bladder
Cystolithotomy
108
Open surgical procedure complications
* Bleeding / perirenal hematoma
* Obstruction (from remaining fragments)
* Infection
* Impaired renal function
109
Nursing assessment for open surgical procedure
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
NDX
Acute Pain
Impaired Urinary Elimination
Risk for infection
111
NM to control pain
Give prescribe opioid analgesic
| Monitor patient for increasing pain, respiratory depression, drop in bp
112
Interventions on how to maintain urine flow
Administer fluids orally or IV
Monitor urine i/o, blood
Strain urine through strainer or gauze
113
Nursing rep for calcium and oxalate stones
```
Instruct diet (avoid excess Ca and P)
Teach purpose of drug therapy
```
114
Nursing rep for uric acid stones
Teach methods to alkanize urine
Instruct to test urine pH
Allopurinol (cannot be taken for years)
Reduction of dietary purine intake
115
Most common cause of AKI
Acute tubular necrosis
116
Diagnostic criteria of AKI
Acute reduction in urine output
| Elevation in serum creatinine
117
Primary cause of death in AKI
Infection
118
A syndrome of varying causation that results in a sudden decline in renal function
Acute Kidney Injury
119
factors in nephrolithiasis
1 hypercalcemia
2 hypercalciuria
3 poor fluid intake
4 immobility
120
causes of nephrolithiasis
1 excessive oxalate absorption in inflammatory bowel
2 living in mountainous
3 staghorn calculi
121
clinical manifestations
1 pain pattern depends on site
2 large ureteral stones produce
3 obstruction seen in UTZ
122
diagnostic evaluation
1 kidney, ureters and bladder radiography
2 IVU
3 spiral ct scan
4 urinalysis
5 lab work - serum kidney function test, electrolytes
123
management for kidney stones
1 if small stones, hydration
2 pain control and reassurance
3 hospitalize
124
what is extracorporeal shock wave lithotripsy
Noninvasive technique and treatment of choice for stones less than 2 cm in diameter
125
For stones below the iliac crest
ureteroscopy may be performed.
126
A shock wave
a large, condensed wave of energy produced by high-speed motion
127
patient positioning for extracorporeal shock wave lithotripsy
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
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?
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
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?
ACUTE GLOMERULONEPHRITIS (AGN)
130
Age group where AGN most frequently occurs
SCHOOL-AGE CHILDREN
131
Gender where AGN most frequently occurs
BOYS
132
Ratio of occurrence in boys to girls respectively.
2:1
133
Pathognomonic sign of AGN
Tea-colored urine (old blood)
134
Why does the urine become tea-colored?
Bilirubin in urine mixes with blood
135
3 early signs of AGN
(1) Hematuria (2) Tea-colored urine (3) Proteinuria
136
Patients with AGN experience blood leakage, if so, what clinical manifestation will be seen with them?
Anemia
137
Most common bacterial cause of AGN
Group A- Beta Hemolytic Streptococcus
138
Other clinical manifestation of AGN:
| MNEMONIC: HOPES
Hypertension, Oliguria, Pulmonary edema (elderly), Edema, Sore throat
139
In AGN the BUN and creatinine (which is usually elevated in kidney injury) returns to a normal level because?
There is increased urinary frequency
140
In AGN, there is hypertension due to disrupted RAAS mechanism. What medication is given to correct the timing of RAAS stimulation?
ACE inhibitors
141
Diagnostic tests for AGN (3)
(1)Urinalysis (2) 24-hr urine (3) Kidney Needle Biopsy
142
During 24 hr urine collection, the nurse should label the container with what following data? (3)
(1)Patient name (2) Date and time started (3) Date and time ended
143
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
(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
Normal level of BUN
10-20
145
Normal creatinine levels
0.5-1.5
146
What medication is initiated in AGN patients to eliminate infection?
Antibiotics
147
If the patient has edema what medication do we give?
Diuretics, example is Lasix or Furosemide
148
What is the ideal fluid balance of patients with AGN? Positive or negative?
Negative fluid balance
149
Nursing responsibilities for AGN patients taking antibiotics
Remind the patient to take the full course of antibiotics even if symptoms are resolved early.
150
AGN patients develop edema due to decreased oncotic pressure allowing fluids to shift to interstitial tissues. What does a nurse do?
Restrict fluid intake
151
All patients with a bladder catheter in place will
| develop ___ within 3 to 4 days of catheterization.
UTI
152
Usually after __ hours, the catheter is already
| filled with bacteria
72
153
Inserted via ___ technique
sterile
154
All Foley catheters must be changed every ___ days
| in a hospital setting
5-7
155
It takes ___ days for the bacteria to quadruple in
| amount
5 1/2
156
In nursing home, ___ catheter is being used
because it does not attract bacteria unlike the foley
catheter
silicon
157
if allergic to betadine, do not use alcohol but ___
peroxide
158
The ___ concentrations of ammonia inactivates
| complement and inhibits migration of PMNs
high
159
Patients with high bacteria count are __ __ in dipstick test
nitrates positive
160
```
Bacteria can enter the bloodstream and cause
__ __ (__)
```
septic shock (urosepsis)
161
Urosepsis is fatal, that’s why is should be
| treated in _ days
3
162
signs and symptoms of cystitis
```
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
signs and symptoms of pyelonephritis
```
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
In septic shock, watch out for _____
somnolence (drowsiness, looking sleepy)
165
Dysuria common in ____, which is an STD usually associated with UTI
gonorrhea
166
urinalysis
Should be performed in all patients with a possible
| urinary tract infection (UTI)
167
significant findings (2) of urinalysis are
More than 10 white blood cells per high power
field indicates pyuria
Leukocyte esterase dipstick is usually sensitive
168
Urinalysis showing many epithelial cells is likely
____ by ____ ____ in women and is
therefore inaccurate in indicating infection.
contaminated
| vaginal secretion
169
___ ___ may be reported as contaminated as well.
urine culture
170
Make sure to inform the patient on how to properly
| collect, by first wiping the opening of urethra ___ times and catching their urine ___
3
| midstream
171
why catching it in midstream?
because bacteria is loaded on first centimeter of urethra
172
most patients with UTI have ___ urine
cloudy
173
urine gram stain
Done for clients suspected with pyelonephritis
174
what are the significant findings of urine gram stain?
one bacterium per high-power field indicates >10^5 organisms per mL of clean-catch, mid-stream urine
175
This bacterial concentration in combination with ___
| indicates active infection
pyuria
176
what is the bacterium per high-power field in male?
10^4
177
urine culture
Is required in quantitation of bacteria to differentiate
| contamination from true infection
178
urine culture
To find out the type of bacteria
179
urine culture
Not required in sexually active adult women with early
| symptoms of cystitis
180
urine culture
More than 10^5 organisms per mL of urine indicates infection
181
urine culture
Have to do Sensitivity to identify what kind of antibiotic
| to use
182
Honeymoon cystitis
common bacteria is staphylococcus found on the skin
