Foundations Exam Three Flashcards
What is culture shock?
acute experience of not comprehending the culture in which one is situated
ex: person coming from a country where healthcare doesn’t utilize technology coming to the United States
What is a key informant?
people who know certain aspects of their culture better than others who are willing to share their views
Who are the key informants about hospital culture?
Nurses
What is ethnicity?
a self-conscious, past-oriented form of identity based on a notion of shared cultural and perhaps ancestral heritage/ current position with the larger society
Race vs Ethnicity?
Race: considered biological traits
Ethnicity: refers to social characteristics
What does institutional racism lead to?
Racial and ethnic health disparities
List some consequences for victims of racism and discrimination
- Increased stress
- Incidence of chronic conditions
- Incidence of mental health conditions
- Decreased quality of life
What is a minority?
A group of people within a society whose members have different ethnic, racial, national, religious, sexual, political, linguistic, or other characteristics of a society
Who is more likely to experience healthcare disparities?
Minorities are more likely to experience a difference in access to healthcare
What traits should organizations have?
- Welcoming environment to everyone
- Avoid stereotypes and assumptions
- Use preferred names and pronouns
- Avoid judgement
- Phrase questions in a way that doesn’t exclude patients
What is ageism?
Stereotype, prejudice, and discrimination against people based on their age
How do nurses combat ageism?
Gerontological nursing courses
How does a nurse provide culturally competent care?
Self-reflect and consider their own biases and beliefs.
Understand them and how to keep them from changing the way you interact with a patient
What questions promote culturally competent care?
- Open-ended
- Focus on specifics the patient provides and inquire further
- Avoid questions that describe an assumption about a person or their beliefs
What are some things to remember when using an interpreter?
- Speak to patient directly
- Speak slowly
- Use simple sentences
- Avoid metaphors
- Allow more time for the interview process
- Use interpreter as key informant
- Attempt to use the same interpreter for each interaction if possible
- Do not use a family member
What is the normal volume output for urine?
30 mL/hour
What does the color of urine indicate?
Hydration status
Dark amber urine? =
dehydrated patient
Clear urine? =
adequate hydration
What is the normal clarity of urine?
Clear or see through urine
What type of urine should you assess?
What urine should you not assess?
Assess clarity of fresh urine, not urine that has been sitting for a while
What causes the odor of urine?
Ammonia
What does a strong or offensive odor of urine indicate ?
Infection
What are the lifespan considerations for newborns/infants? : Urinary
They urinate frequently and have no bladder control
What are the lifespan considerations for toddlers and preschoolers?
They develop voluntary urine control and are learning toilet training
What are the lifespan considerations for school-age children and adolescents?
They experience nocturnal enuresis (bed wetting)
What are the lifespan considerations for adults and older adults?
With older age, incontinence or nocturia
An older adult with confusion is a strong indicator for a UTI
Voiding? =
Urination
Dysuria? =
Painful urination
Polyuria?=
Excessive urination
Anuria? =
Severely decreased or absent urine
How much urine output is considered anuria?
less than 100 mL/day
Oliguria? =
Decreased urination
How much urine output is considered oliguria?
less than 400 mL/day
Urinary Retention? =
Urine remains in the bladder after voiding
Nocturia? =
Waking up to void at night
Frequency? =
Voids frequently in small amounts
Hematuria? =
Blood in the urine
Pyuria? =
When urine contains pus
Incontinence? =
involuntary loss of urine from the bladder
What kind of fluids impact urination?
Any intake of fluids
- Oral
- Intravenous
- Nasogastric or PEG tube
What hormone makes the body retain fluid?
Antidiuretic Hormone (ADH)
What triggers the release of ADH?
Increased plasma osmolarity (# of solutes per solvent)
- Blood filled with solutes because there is not enough water (retains the water)
How many mL is in one ounce?
30 mL
How can the body lose fluid?
Vomiting, diarrhea, diaphoresis, wound drainage, urine, burns or blood loss
How do we record the body losing fluid?
As output
In what range should the output match the input?
Within 200-300 mL
What does it indicate if output is less than input?
Dehydrated kidney perfusion or dehydration
What do you use to get urine output without a catheter?
Graduate, hat, urinal, bedpan
How does hypotension impact fluid?
- Leads to poor renal perfusion
- Kidneys are unable to filtrate
How does decreased muscle tone impact fluid?
Obesity
Multiple pregnancies
Chronic Constipation
Continuous bladder drainage
Some other factors that impact fluid?
Hypotension Decreased muscle tone Surgery Medications Diet Body positions Cognition/ Psychological Factors Obstructions
How does surgery impact fluid?
Volume deficit loss (blood loss, NPO)
Urinary retention from anesthesia
When do patients need to void after surgery?
Within 8 hours of surgery
How do medications impact fluid?
Diuretics = increase urine output
What types of medications promote urinary retention?
Opioids, tricyclic, antihistamines
How does diet impact fluid?
Alcohol and caffeine promote diuresis
Salty foods promote retention
How can body position impact fluid?
Difficult to use a bedpan or urinal while laying flat on the bed
How can cognition or psychological factors impact fluid?
- Neurological conditions, brain tumor, stroke, confusion can all impair drinking or voiding
- Heat can promote urination, cold can prevent it
- Hearing water running can promote urination
How can obstruction impact fluid?
Tumor, renal stones, prostate
- Kinked or clogged urinary catheters
- Increases risk of urinary stasis and infection
Name 3 risk factors for a UTI
- Female Anatomy
- Sexual Intercourse
- Urinary Catheters
Why are females more prone to UTIs?
- Shorter urethra
- Incorrect wiping after bowel movements
Catheter- Associated UTI
A UTI that develops when a catheter is in place greater than 48 hours prior to the onset of infection
What is one of the most common healthcare acquired infections?
UTIs
4 Important pieces of information on UTI education
- Adequate water intake
- Aim to void at least every 4 hours
- Void immediately after sexual intercourse
- Wash hands carefully with soap and water
How much is adequate water intake?
6-8 glasses of water a day
- Around 2 L
Why should you void after intercouse?
To flush the microorganisms
Signs and Symptoms of UTI
- Fever
- Flank pain
- Dysuria
- Frequency
- Urgency
- Pyuria
- Hematuria
Timed Voiding?
- Used for cognitive or physical impairment
- Void on a fixed schedule
- Urge urinary incontinence
Prompted Voiding?
- Take time to check to see if there is a need to void
- Functional and total urinary incontinence
Habit retraining?
- Schedule bathroom trips around when incontinence episodes occur
- Functional and total urinary incontinence
Bladder training?
- Schedule voiding times with a narrow range of 2 hours
- Eventually widen range to 4 hours
- Urge and reflex urinary incontinence
What is a urinary diversion?
Surgical procedure to alter the pathway of urine elimination
When is a urinary diversion commonly performed?
After the removal of the bladder (cystectomy)
Two types of urinary diversion
- Ileal conduit
- Neobladder
What happens if a patient doesn’t void after surgery?
Order a bladder ultrasound; a noninvasive way to estimate urine in bladder
When do you order a bladder ultrasound?
Performed if a patient is not voiding, or right after a void if urinary retention is a concern
If a bladder scan shows urine present and the inability to urinate, what happens next?
In and out catheter, intermittent catheter, or straight catheter
Random urine specimen?
Can be poured from non sterile container into cup
Clean catch urine specimen?
Sterile cup or bedpan
- Seek specimen without microorganisms
24-hour urine specimen?
- Specific measurements of kidney’s excretion of substances
- Educate all personnel and family about the need to keep all urine for the 24 hour period
Catheter urine specimen?
- In and out to obtain specimen at a specific time
- Indwelling, can collect from a port near the top of catheter (not from the drainage bag)
What are reagent strips used for during urine tests?
To detect substances and their amounts such as pH, glucose, protein, ketones
Why do we complete a urine culture and sensitivity?
To determine microorganisms that caused the UTI and determine the correct antibiotic to use
Why would there be a formation of ketones in the urine?
There is a breakdown of fat
- Don’t have adequate carbs and need an alternative fuel source
Why would blood urea nitrogen be elevated?
Impaired kidneys are unable to excrete urea
What does increase creatinine indicate?
Increased creatinine indicates renal impairment
* More sensitive indicator than BUN for renal impairment *
How is creatinine clearance obtained?
- Need creatinine level from urine and blood
- Need the amount of urine developed in 24 hours
What does creatinine clearance estimate?
Estimates the kidneys glomerular filtration ability
What is the best indicator of kidney function?
GFR
When should you use an external catheter?
- Sphincter damage
- Spinal cord injury
- Impaired skin integrity in areas where incontinence occurs
Why would you use an intermittent or straight catheter?
- Temporary for a single voiding session or specimen collection
(In-and-out catheter)
What is the most important focus for all catheters?
Sterile technique!
Indications for catheterization?
- Critically or actually ill patients that need accurate intake and output measurements
- Urinary retention that persists despite multiple intermittent or straight catheter attempts
- Management of urinary incontinence with. stage III or IV pressure ulcer on the trunk
The higher the number on the catheter the _____ the lumen
Larger
Most common size of catheter?
16 french
Coude catheter
Catheter tube with bend created in it
When is it smart to use a coude catheter?
When a patient has prostate problems
Catheter tube with one port and balloon
Indwelling catheter
Catheter tube with 2 ports and a balloon
Bladder irrigation
How often should you empty the drainage bag of a catheter?
Every 8 hours if not more frequently to prevent the development of microorganisms
Where should you always keep drainage bag?
Below the bladder
How often should you clean catheter if no bowel movement present?
At least once a shift
What should you use for catheter cleaning?
Soap and water
Newborn and Infant Lifespan Considerations: Bowel Elimination
Meconium: green substance forming the feces for infants
- Stool color dependent upon type milk ingested
- Frequent and multiple bowel movements a day
Light yellow stool indicates baby ingested ___ milk
Breast milk
Darker yellow stool indicates baby ingests ___ milk
Formula
Toddler and preschooler lifespan considerations: bowel elimination
Duodenocolic reflex (stimulation of defecation) - Toilet training after 22 months
School-age child and adolescent lifespan considerations: bowel elimination
- Bowel function reaches adult standard
- Peer pressure may contribute to constipation
Adult and older adult lifespan consideration: Bowel elimination
Bowel movement frequency decreases; GI motility slows
- Increased fluid and fiber in diet
What do the intestines do besides make stool?
Segmentation and peristalsis
What do segmentation and peristalsis do?
Alternating contraction and relaxation of intestinal smooth muscle
Propels the intestinal contents along the entire length of the small and large intestines
What stimulates peristalsis
The walls of the intestine
Ambulation
Duodenocolic reflex: when partially digested food enters the duodenum
What is absorbed in the duodenum and jejunum?
Nutrient and electolytes
What is absorbed in the ileum?
Vitamins, iron, and fluid
Valsalva Maneuver
Take a deep breath against a closed glottis
Contract the abdominal muscles
Contract the pelvic floor muscles
What effect can the valsalva maneuver have on other body systems?
Dizziness, unclog the ears, lower BP, reset heart rhythm
What impact does soluble fiber have on bowel elimination
Increases GI transit time
oat bran, barley, and nuts
What impact does insoluble fiber have on bowel elimination?
Decreases GI transit time
whole grains, fresh fruits, and vegetables
Which fiber promotes loose stools?
Insoluble
What % of feces is water?
75%
What takes priority for water, body cells or stool?
Body cells
Increased GI motility = ____ stool
Loose
- The slower the system, the more water can be absorbed to be used by the body
Move less, defecate ____
Less
How does pregnancy affect bowel elimination
Iron supplements + growing fetus = constipation
Opioids cause? (bowel elimination)
Constipation
Antibiotics cause? (bowel elimination)
Diarrhea
To examine the lower GI tract with a camera, what must be out of the lower GI tract?
Stool
Colonoscopy
When the colon is diverted through a stoma
Ileostomy
When the ileum is diverted through a stoma
What is something to consider with an ileostomy?
No large intestine = potential issue with loss of fluid and electrolytes
What are the normal stoma assessment findings?
Healthy pink & present on the abdominal surface
Abnormal stoma assessment findings?
- Cyanotic/ purple/ pale
- Dusky or bluish tint can indicate inadequate circulation
- If the stoma retracts feces can enter the abdominal cavity and cause peritonitis
When should the ostomy pouch be emptied?
One-fourth to one-third of the way full
What do you rinse the pouch with after emptying it?
Clean warm tap water; 60 mL syringe works well
What if fecal contents leak around where the pouch is attached to the skin?
The entire bag must be removed and replaced
Normal abdominal inspection findings
Symmetric and slightly rounded
Abnormal abdominal inspection findings and what does it indicate?
Hollow or scaphoid = malnutrition
Distended = obstruction
What is performed after inspection of abdomen?
Auscultation (performed before palpation and percussion)
Normal bowel sounds?
Heard within 5-15 seconds
Hyperactive bowel sounds
More frequently than 5 seconds
How long do you listen to confirm bowel sounds absent?
1 -2 minutes per quadrant
Signs of constipation
bloating, fullness, an urge to defecate without an ability to pass stool, malaise, los of appetite, nausea, vomiting, and abdominal distention
Fecal Impaction
Usually the result of untreated and unrelieved constipation; several days of constipation followed by an involuntary loose bowel movement that does not relieve feeling of bloating or fullness
How is fecal impaction diagnosed
Digital rectal exam
What type of gastric motility is diarrhea?
Increased gastric motility
What type of bowel sounds for diarrhea?
Hyperactive
Some causes of diarrhea?
Medications, medical conditions, emotional changes
Symptoms of diarrhea
Cramping, nausea, burning sensation, anal inflammation, bleeding and breakdown
What can lead to fecal incontinence
Neurological injury, spinal cord injury, or altered mental status
What foods increase flatulence
High fiber foods
What causes flatulence?
Bacterial activity in the large intestine
A type of test that detects the presence of blood in feces?
Fecal Occult blood test
What is a fecal occult blood test recommended for?
Screening tool for colorectal cancer; blood in stool may indicate cancer or polys in the colon or rectum
Radiopaque
Substance swallowed or instilled in the rectum and then imaging is performed as it proceeds through the GI tract
What does a radiopaque detect
Abnormalities in the large and small bowel
What is done after a radiopaque?
Barium can harden stool and cause constipation or an impaction; increase fluids and administer a laxative
Barium can make the stool appear chalky
Esophagogastroduodenoscopy (EGD)
upper GI test
Sigmoidoscopy
Lower GI test
- Colorectal cancer screening every 5 years
Colonoscopy
Lower GI tests
- Colorectal cancer screening every 10 years (5 years if high risk)
What is done after a lower GI test?
Monitor for bleeding or dull abdomen pain
Antidiarrheals
Loperamide Bismuth subsalicylate (Pepto Bismol)
Fecal Microbiota Transplantation
- Used for persistent clostridium difficile infection
- Healthy stool from a human donor placed in GI tract
- 90% effective in reducing infection rate
How do you treat IBS
Steroids
What can you utilize for bowel training
Pelvic floor exercises, abdominal massage, and biofeedback
Why should you perform an enema
- Promote bowel movement
- Clear bowel area before a procedure
Small volume enema
mineral oil and steroids
Large volume enema
tap water or saline
Return-flow enema
Removes flatus
Indications for NG tube insertion
Gastric decompression, gastric lavage, or gastric feeding
Newborn is ___ % fluid
80%
Fluid decreases in childhood to ___ %
65%
Adults average ___% fluid
55%
Older adults are around ___% fluid
50%
Osmolality
particles in a given weight of fluid
Osmolarity
particles in a given volume of fluid
A method of determining if someone is over hydrated or dehydrated?
Serum osmolarity
Normal range for serum osmolarity
280 to 300
Too high serum osmolarity indicates?
Dehydration
Too low serum osmolarity indicates?
Fluid overload
Intracellular fluid and fraction of fluid volume
intracellular = fluid inside the cell
2/3 of fluid volume
Primary electrolytes for intracellular fluid
Potassium
Phosphate
Sulfate
Extracellular fluid and fraction of fluid volume
extracellular = fluid outside the cell
1/3 fluid volume
Primary electrolytes for extracellular fluid
Sodium
Chloride
Bicarbonate
What is the fluid called that is inside the blood vessels
Intravascular space
What is the fluid called in between the cells
Interstitial space
What three components determine the fluid balance in between intravascular and interstitial
Protein: keeps fluid in vascular space (colloid oncotic pressure)
Blood vessel integrity: keeps fluid in vascular space
Hydrostatic pressure: pushes fluid into the interstitial space
Osmotic pressure
Impacted by osmolality: pressure exerted to prevent movement of water out of the intravascular space
Colloid oncotic pressure: proteins attract water and hold onto water
What determines hydrostatic pressure
Arterial blood pressure
Venous pressure
Rate of blood flow
Isotonic
Equal concentration of water and electrolytes
Hypotonic
Concentration of electrolytes outside the cell is lower
Hypertonic
Concentration of electrolytes outside the cell is higher
The higher the concentration of a solute or substance, the ____ the concentration of water
Lower
Water flows from ___ to ____
High to low
Crystalloids
Aqueous solution with electrolytes
Colloids
Contain large molecules that do not transport outside of the intravascular space (Volume expanders)
What is the function of colloids
Function to increase the osmotic pressure in the intravascular space leading to fluid being pulled into the intravascular space
EX: albumin, dextran, hetastarch
When are packed red blood cells (PRBCs) used
used for blood loss
- 1 unit roughly increases hemoglobin by 1g/dL
When are platelets used
given where there is a reduced level of platelets ?
When is fresh frozen plasma used (FPP)
used for trauma, burns, shock, or bleeding and clotting disorders
When is cryoprecipitate (derived from plasma) used
used for clients with hereditary disorders that lead to inadequate clotting
Nursing considerations for blood products
Blood type and Rh factor protein are determined to match a person with the righ type of donor
Type and crossmatch performed
Universal donor
O negative
Universal recipient
AB positive
Signs of transfusion reaction
Fever, chills
Altered blood pressure
Respiratory difficulty
Signs of an allergic reaction
Dehydration
Loss of body water but electrolytes remain consistent
Fluid volume deficit
Loss of both fluid and electrolytes
- Can also include a loss of circulating blood volume and perfusion to tissues
- Hypovolemia
Dehydration Causes
- Inadequate water intake
- Increased gastrointestinal losses (vomiting or diarrhea)
- Fever
- Medications that decrease the body’s thirst response
- Diabetic keotacidosis
Lab tests that can correlate with dehydration
Elevated serum osmolality Elevated creatinine Elevated BUN Increase urine specific gravity Hypernatriemia
Why would hypernatremia correlate with dehydration if the electrolytes remain constant?
The electrolyte level is constant, but the amount of body fluid is reduced. The serum is more concentrated and electrolyte levels will be higher due to concentration
Fluid Volume Deficit S/SX
- Hypotension
- Tachycardia
- Orthostatic Hypotension
- Decreased urine output
- Flat neck veins
- Weak pulse
Third Spacing
Too much fluid in interstitial space and not enough in the intravascular space
What is lacking with third spacing?
protein
How do we give protein IV?
Albumin, in comes in different percentages
What about crystalloids, what tonicity can we administer for third spacing?
Hypertonic
What causes a reduced colloid oncotic pressure?
Reduced levels of albumin (protein keeps fluid in intravascular space)
What happens to fluid when there is a reduced colloid oncotic pressure?
Fluid goes out of the intravascular space and into the interstitial space (into third space)
- Edema
SATA
The nurse is caring for a client with a suspected urinary tract infection. What signs or symptoms are present with a urinary tract infection?
- Hematuria
- Oliguria
- Dysuria
- Polyuria
- Nocturia
Hematuria and Dysuria
SATA
The nurse is caring for a client that has problems with a bowel routine. What history or assessment information about the client could contribute to developing constipation.
- Exercises 5 days/week
- Daily iron supplements
- Takes opioids
- Recent use of antibiotics
- An established daily routine
Daily iron supplement &
Takes opioids
SATA
A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical manifestations should the nurse monitor?
- Bicarbonate excess
- Kussmaul’s respirations
- Flushing
- Circumonral paresthesia
- Lethargy
Bicarbonate excess &
Circumoral paresthesia
How can someone have a fluid volume deficit if they have too much fluid somewhere?
The extracellular and intracellular compartments both need a certain level of fluid to operate smoothly
Sometimes treatment is about making the fluid move from one area to another area within a compartment without giving more fluid overall
Fluid Volume Excess Causes
Heart Failure Renal Failure Cirrhosis Excess IV fluid Medications that cause sodium and water retention
S/SX of fluid volume excess
- Weight gain of more than 0.5 kg/day
- Hypertension
- Bounding pulse
- Distended neck veins (jugular vein distention)
- Dyspnea
- Crackles
- Orthopnea (can’t breathe while laying down)
Fluid Volume Excess Medications?
- Diuretics ex: - Lasix --> furosemide - Spironolactone - Bumetanide, hydrochlorothiazide
Functions of Electrolytes (5)
- Maintaining balance of water in the body
- Balancing the blood pH
- Moving nutrients into the cells
- Moving wastes out of cells
- Maintaining proper function of the body’s muscles, heart, nerves, and brain
Hypokalemia causes
Diuretics Metabolic alkalosis Folic Acid deficiency Gastrointestinal losses Decreased intake of potassium
S/SX of hypokalemia
Mild & severe
Mild: cardiac arrhythmias, constipation, fatigue
Severe: respiratory paralysis, paralytic ileum, tetany, hypotension, rhabdomyolysis, life threatening arrhythmias
Hypokalemia TX
Priority is determine underlying cause
- Potassium supplementation
- Making dietary changes
- IV potassium
What if hypokalemia cause is due to using a potassium wasting diuretic?
- Switch to potassium sparing diuretic (spironolactone)
Do we push potassium?
NO, only given IV through a slow infusion
Hyperkalemia causes
- Acute renal failure
- Dehydration
- Diabetes
- Burns
- Acidosis
- Blood transfusion
Hyperkalemia s/sx
mild & severe
Mild: N/V, muscle aches, weakness, dysrhythmias
Severe: paralysis, heart failure, death
Hyperkalemia tx
- Hemodialysis if the cause is acute renal failure
- Loop diuretics if renal failure not present
- Sodium polystyrene sulfonate (Kayexalate) = binds to potassium and excreted in feces
- IV insulin (helps push potassium into cell)
Hyponatremia causes
- Severe N/D
- Drinking excess water
- Excess alcohol intake
- Thiazide diuretics
- Liver or heart disease
Hyponatremia s/sx
mild & severe
Mild: nausea, feeling unwell
Severe: cerebral edema, lethargy, confusion, irritability, seizure, coma
Hyponatremia tx
- Sodium levels must be raised slowly to prevent rapid fluid shifts in neurologic cells (tonicity)
- Fluid restriction if too much water consumed
- If thiazide diuretics causes; isotonic IV fluids
- Due to underlying liver or cardiac problems = alter treatment for these probs
Hypernatremia causes
- Dehydration (vomiting, chronic kidney disease, impaired thirst response)
- Consumption of high sodium items
Hypernatremia s/sx
Similar to hyponatremia (neurological problems)
Hypernatremia tx
- Restore fluid status
- Hypotonic fluids, but if there is shock of low BP then isotonic
- If sodium lowered too quickly = cerebral edema (slow tx)
- Educate clients on dietary measures to reduce sodium intake
Hypocalcemia causes
- Inadequate vitamin D
- Decreased estrogen production
- Hypoparathyroidism
- Renal disease
- Low albumin levels
- Stimulant laxatives
- Chronic steroid use
- Proton pump inhibitors
What tests for hypocalcemia?
Chvostek and Trousseau sign
Hypocalcemia s/sx
- Chest pain
- Dysrhythmias
- Renal calculi
- Numbness and tingling
- Muscle cramping
- Confusion
- Osteopenia
- Dental problems
What does serum calcium account for?
All calcium, whether it is in the free ionized form or bound to proteins
What does ionized calcium account for?
It detects the active or unbound form of calcium in the body
Most accurate representation
When is ionized calcium test run?
If s/sx appear or abnormal serum levels of calcium suggest an issue
Chvostek’s Sign
contraction of the ipsilateral facial muscle elicited by tapping the facial nerve just anterior to the ear (twitching of lip to spasm of all facial muscles)
Trosseau’s Sign
Induction of carprpedal spasm by inflation of a sphygmomanometer above SBP for 3 minutes
- Adduction of the thumb
- Flexion of the metacarpophalangeal joints
- Extension of the interphalangeal joints
- Flexion of the wrist
Hypocalcemia tx
- Calcium and vitamin D supplementation
- Increased dietary intake
- Calcium injections
Hypercalcemia causes
- Cancer
- Hyperparathyroidism
- Vitamin D toxicity
What over the counter meds for heartburn contains calcium carbonate?
TUMS
- Too much can lead to hypercalcemia
Hypercalcemia s/sx
mild & severe
Mild: constipation, abdominal pain, N/V
Severe: confusion, renal failure, arrthymias, coma, death
Hypercalcemia tx
- Administer phosphate (inverse relationship w calcium)
- IV saline bolus
- Loop diuretic
- Hemodialysis in severe cases
Hypomagnesemia causes
- Chron’s disease or celiac disease
- Diarrhea or pancreatitis
- Type 2 diabetes
- Presence of hypokalemia and hypercalcemia
- Decreased intake
- Increased renal excretion
Hypomagnesemia s/sx
mild & severe
mild: decreased appetite, fatigue, nausea, weakness
Severe: muscle cramps, numbness and tingling, tetany, and personality changes
Hypomagnesemia tx
- Oral or IV magnesium
What might have to be treated first before magnesium can be given?
- Restore calcium or potassium balance
Hypermagesemia causes
- Kidney disease
- Acidosis
- Hypothyroidism
- Trauma
- Meds that increase dwell time of food in the intestines (opioids or anticholinergics)
- Laxatives or antacids that contain magnesium (milk of magnesium, mag citrate)
Hypermagesemia s/sx
mild & severe
Mild: dizziness, nausea, weakness, confusion
Severe: confused, blurred vision, headache, bladder paralysis, bradycardia, reduced respiratory rate, loss of deep tendon reflexes, death
Hypermagesemia tx
- Something given to prevent cardiac problems similar to hyperkalemia
EX: calcium chloride and calcium gluconate - IV saline with diuretics
- Severe cases may require hemodialysis
How quick does the respiratory system respond to acid-base changes?
Immediately but effect is weak
How quick does the renal system respond to acid-base changes?
Hours to day but effect is stronger
Normal pH value
Acidosis value
Alkalosis value
Normal = 7.35-7.45 Acidosis = < 7.35 Alkalosis = > 7.45
Normal PaCO2
Acidosis
Alkalosis
Normal = 35-45 mmHg Acidosis = > 45 Alkalosis = < 35
Normal HCO3
Acidosis
Alkalosis
Normal = 22-26 mEq/L Acidosis = < 22 Alkalosis = > 26
Metabolic Acidosis causes
Diabetic Ketoacidosis
Lactic Acid Accumulation
Severe diarrhea
Renal disease
Metabolic acidosis renal compensation
Kidneys will attempt to produce more bicarb; however usually the bicarb deficit exceeds the amount the kidneys can produce
Metabolic acidosis respiratory compensation
Hyperventilation; resp compensation is usually weak and underlying problem is not addressed
Metabolic Acidosis Clinical Manifestations
Kussmauls Respirations
Lethargy, fatigue, coma
Hypertension, dysrhythmias (renal failure –> hypertension)
Hyperkalemia
Why would metabolic acidosis result in hyperkalemia
At the cellular level the body reacts to a low pH by exchanging hydrogen ions with potassium ions (they both have +1 charge)
Metabolic Acidosis TX
Kidneys are impaired = hemodialysis
DKA = insulin administration
Shock state = fluid replacement or other shock treatment is priority
Metabolic Alkalosis causes
Vomiting (hydrochloric acid)
Gastric suction
Bicarb gain
Metabolic alkalosis compensation
Renal excretion of bicarb
- Respiratory, decrease RR
Metabolic alkalosis clinical manifestations
Hyperactive reflexes Paresthesia Tetany Seizures Respiratory Depression
Metabolic alkalosis tx
Adequate hydration (0.9% sodium chloride)
Argenine hydrochloride
A diuretic: diamox
Respiratory Acidosis cause
Hypoventilation
Respiratory failure
Injury to the medulla
Overdose of opioids, benzos, alcohol (anything w sedative effects)
Respiratory Acidosis compensation
Compensation only through renal compensation
Kidneys will retain bicarb ions or excrete hydrogen ions (slow process)
Respiratory Acidosis Clinical Manifestations
Mental status changes may occur first (irritability, disorientation, lethargy, coma, headache)
Tachycardia
Respiratory Acidosis Tx
- Treat underlying cause*
- For an obstructive type of breathing condition (BiPAP) or mechanical ventilation in severe cases
- Sedative medication overdoses (narcan)
- Oxygen administration
- HOB elevated
- Antibiotics if pneumonia involved
Respiratory Alkalosis causes
Anxiety Fear Pain Trauma Anemia Asthma Pulmonary Embolism Cerebrovascular accident or stroke
Respiratory alkalosis compensation
Bicarb shifts into cells in exchange for chloride ions
If alkalosis persists, renal excretion of bicarb can happen
Respiratory alkalosis clinical manifestations
Neuromuscular symptoms (paresthesia, dizziness, vertigo, tetany)
Cardiovascular symptoms (tachycardia, dysrhymias, excessive diaphoresis)
Respiratory alkalosis TX
- Fix underlying cause*
- Pain or anxiety = intervention that targets
- Asthma = bronchodialator
- Anemia = restoration of hemoglobin
