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FnE Flashcards

1
Q

FVE

Causes
Heart failure
Renal failure
3 things with alot of sodium

A

Too much fluid in vascular space

Heart is weak-C.O. goes down-Kidney perfusion goes down-UO goes down

Kidneys are not working

Ivf with sodium
Effervescent soluble meds
Canned/processed foods

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2
Q

Aldosterone

Its found in?

Normal function is

Diseases with too much:

Diseases with too little:

A

Steroid,mineralocorticoid

Adrenal glands, on top of kidney

When blood volume goes down, aldosterone is secreted ehich retains sodium and water and excretes potassium

Hyperaldosteronism
Cushings

Addisons

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3
Q

ADH

Too much ADH
USG
Blood

Not enough ADH
USG
Blood

Found in the
Drug ADH replacement

A

Antidiuretic hormone. Makes you retain just water

SIADH. Too many letters too much water
Usg is concentrated
Blood is diluted

DI or diabetes insipidus. When you see DI think diuresis
Usg is dilute
Blood is concentrated

Pituitary
Vasopressin(Pitressin) and Desmopressin acetate

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4
Q

More volume means

Less volume means

Concentrated makes #s

Dilute makes #s

A

More pressure

Less pressure

Go UP (for USG, HGb, and Na)

Go Down (for USG, HGB, and Na)

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5
Q

Bed rest induces

A

Diuresis by releasing ANP( which is the opposite of aldactone) and decrease production of ADH

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6
Q

FVD

Causes
Loss of fluid from
Third
Diseases with polyuria

S/S
Weak
Pulse
RR
BP
Cold and clammy
A

Fluid volume deficit

Anywhere. Examples are thoracentesis, paracentesis, vomiting and hemorrhage

Spacing( when fluid is in a place that does you no good). Like burns and ascites

Like DM. Polyuria: think shock first

Weak and thready
Increase because heart is trying to compensate by pumping
Increases because body perceives it as a hypoxia
Bp will go down. Remember less volume less pressure
Diverting the fluid by vasoconstriction to vital organs

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7
Q

Isotonic solution

Uses on clients that lost fluids through

Dont use with clients with

A

Goes into vascular space and stays there

N/V, burns, sweating and trauma

HPN,renal disease,cardiac disease

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8
Q

Hypotonic solution

They rehydrate but

Uses with clients who has

Could lead to FVD

A

The fluid shifts out of vascular space and makes the cells swell

They rehydrate but does not cause hypertension

HPN, cardiace diseases, renal problems and needs fluid replacement

Because fluid moves out and causes cellular edema and decreased blood pressure

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9
Q

Hypertonic solutions

Uses are those clients with severe

Could cause fluid volume

A

Packed with particles and they attract fluid into the vascular space and causes cells to shrink

Hyponatremia, burns or ascites

Excess due to fluid shifting towards the vascular space

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10
Q

Joint commission top 5 high alert meds

I³OS

Double check with

A 
Insulin
IV anticoagulants
Injectable potassium chloride
Opiates and Narcotics
Sodium chloride solns above 0.9 percent

Must be double check with a 2nd licensed Nurse

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11
Q

Magnesium and calcium is excreted by

Calcium and phosphorus has an

Magnesium and calcium think

They act like

A

The kidneys but can be lost in other ways like the GI

Inverse relationship

MUSCLES FIRST!!!

Sedatives!!

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12
Q

Hypermagnesemia

Causes:
Renal failure
Antacids

S/S:
Flushing and
Magnesium causes vaso

Treatment:
Ventilator
Dialysis
Calcium Gluconate
-it is administered
A

The kidneys cannot excrete the excess magnesium
Some Antacids contain alot of magnesium

Flushing and warmth
Causes vasodilation

Ventilator if RR is less than 12
Dialysis to remove excess magnesium not excreted by the kidneys
This is the ANTIDOTE for magnesium toxicity. Reverses the arrhythmias and RR. It is administered IVP very slowly at a max rate of 1.5-2ml/min

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13
Q

Hypercalcemia

Causes:
Hyperparathyroidism
Diuretics
Immobilization

S/S:
Bones are
Kidney stones

Treatment:
Move and
Hydrate
Diet
Steroids
Other meds like:
Biphospates
Calcitonin
A

There is too much PTH(parathormone) which responds when serum calcium gets low it pulls the calcium from the bone into the blood
Diuretics, specifically THIAZIDES,they retain calcium
Must bear weight to keep calcium in the bone. Calcium goes to blood if you are immobile

Brittle due to not enough calcium in the bones they are in the blood
Kidney stones that are made up of calcium

Move and bear weight
Increase fluids prevent kidney stones
Increase in phosphorus because they have an inverse relationship. Anything with protein has phosphorus
Steroids decreases calcium
Biphosphates is a form of phosphorus
Calcitonin pushes calcium back into the bone

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14
Q

Signs and symptoms that are common in clients with Hypermagnesemia and Hypercalcemia

DTRS
Muscle tone
Arrhythmias
LOC
Pules and RR

Because they are

A 
goes down
Weak and flaccid
Yes
Decreased
Decreased

SEDATED. Remember magnesium and calcium acts like a sedative.

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15
Q

Hypomagnesemia

Causes:
Diarrhea
Alcoholism
-ADH
-vomit

S/S
Think
Act like

Treatment
Give Mg
Check kidney function
Seizure precautions

What do you do if client starts flushing and sweating when you start IV Mg?

A

Magnesium can be excreted through the GI. There are alot of magnesium in the GI
Alcoholics are not eating well and they vomit which includes magnesium and also alcohol suppresses ADH that is why you diurese

Think MUSCLES FIRST
ACT LIKE SEDATIVES

Of course give magnesium
Kidney function must always be assessed to before and after giving magnesium
They act like sedatives so if they dont have enough magnesium their muscles are hyperactive

STOP the infusion

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16
Q

Foods high in magnesium

SONGS

A 
Spinach
brOcolli
    Nuts/seeds
    Green leafy vegetables
  fiSh
17
Q

Hypocalcemia

Causes:
Hypoparthyroidism
Radical neck
Thyroidectomy

S/S
Think
They act like a

Treatment:
Give Ca
-heart monitor
Vit D
Phospate binders:
- sevelamer hydrochloride and calcium acetate
A

All of these could lead to a decrease in PTH thus decrease in calcium because PTH pulls calcium from the bone into the blood

Think Muscles First
They act like a sedative so if there is not enough Calcium the muscles would be hyper or rigid

Of course calcium is given PO. Can also be given IV but must be given SLOWLY. Always make sure the client should be on a heart monitor
Helps in the absorption of calcium
Phosphate binders binds phosphate and is excreted to the GI tract. Remember phosphate and phosphorus has a inverse relationship

18
Q

Signs and symptoms of Hypomagnesemia and Hypocalcemia

Muscle tone
Seizure
Stridor and Laryngospasm
\+Chvosteks
\+Trousseaus
Arrhythmias
DTRs
Swallowing problems
A

Rigid and tight
Yes
Because airway is a smooth muscle
Tapping the cheeks
By leaving BP cuff inflated could lead to spasm
( these two are mostly seen on hypocalcemia)
Yes because heart is a muscle
Decreased
Esophagus is a smooth muscle and aspiration precautions must be observed

19
Q

Sodium
Think
The sodium level is dependent on

Has S/S of life

A

Neuro changes. The brain does not like it when the sodium is messed up.
How much water you have in the blood

Life threatening Arrhythmias

20
Q

Hypernatremia

Equals
Not enough

Causes:
Hyperventilation
Heat stroke
DI

S/S
Dry
Thirsty
Swollen
Neuro

Treatment
Restrict
Hydrate with
Daily weights and I and O

Feeding tube clients tend to

A

Dehydration
Not enough water in the blood and there is too much sodium. Remember concentrated makes numbers go up and diluted makes numbers go down. This is true for Na, HGB and USG

Hyperventilation could lead to insensible fluid loss
Heat stroke which there is loss of water
Diabetes insipidus where the client is diuresing alot

Dry mouth
Thirsty which means you are already dehydrated
Swollen tongue
Neuro changes

Sodium must be restricted
Hydrate with water because fluids make sodium go down
Daily weights and Intake and output is measured because if you have a sodium problem then you have a Fluid problem

They tend to get dehydrated

21
Q

Hyponatremia

Too much
Not enough

Causes:
Drinking only water for fluid replacement
Psychogenic polydipsia
SIADH
D5W (sugar and water)

S/S
H➡️S➡️C

Treatment:
Give
Restrict
Hypertonic

A

Water
Sodium

This only replaces water and dilutes the blood
This is a mental disorder wherein the patient loves to drink WATER
Syndrome of inappropriate antidiuretic hormone is retaining too much water
This could cause hypotension. The fluid moves out of the cell

HEADACHE
SEIZURE
COMA

Of course sodium must be given
Water
If with neuro problems, give hypertonic soln which is packed with particles. This is one of the high alert medications (I³OS)

22
Q

Potassium

Can cause life-threatening
Excreted by

Sodium and potassium has a

A

Can cause life-threatening Arryhythmias
Excreted by the kidneys

Inverse relationship

23
Q

Hyperkalemia

Causes:
Kidney trouble
Spironolactone(Aldactone)

S/S:
Begins with
Then to muscle
Then flaccid
Ecg changes
-tall,brady,prolonged, ventricular
Treatment:
Dialysis
Calcium gluconate
Glucose and insulin
Sodium Polystyrene sulfonate
A

Kidneys wre sick and cannot excrete potassium
This diuretic makes you retain Potassium

Muscle twitching
Muscle weakness
Flaccid paralysis

Tall and peaked T waves, Bradycardia, Prolonged PR interval, Ventricular Fibrillation

Because kidneys are not working
Decreases arrhythmias
Insulin carries glucose and potassium into the cell. Anytime you give IV insulin, worry about hypokalemia and hypoglycemia
Aka Kayexalate, exchanges Sodium for Potassium in the GI tract

24
Q

Hypokalemia

Causes:
Vomiting
NG suction
Diuretics
Not eating

S/S
Muscle C and Muscle W
Ecg changes
-prominent,pvc,ventricular

Treatment:
Give
Diuretics
Eat more

A

Vomiting and NG suction could cause potassium loss because we have a lot of potassium in our stomach
Diuretics like furosemide are potassium wasting diuretics
Not eating food that have potassium or not eating anything at all (alcoholics)

Muscle Cramps then and muscle Weakness
Prominent U waves
Premature ventricular contractions
Ventricular tachycardia

Of course give more potassium
Diuretics which spares potassium- spironolactone(aldactone)
Eat more potassium rich foods

25
Q

Major problems with oral poatssium?

In giving IV potassium, must assess?

Always put IV potassium on a

Never give potassium

Burns during infusion?

A

Gi upset, must be given with food

Urinary output before/during

PUMP

IV push, IM, SubQ

Yes!!

26
Q

Phosphate and adenosine triphosphate

A

Phosphate is necessary for energy in the production of adenosine triphosphate or ATP, and when not produced leads to Generalized weakness

Thursss (17 decks)

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