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Foundations of Nursing > Foundations Exam Three > Flashcards

Foundations Exam Three Flashcards

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1
Q

What is culture shock?

A

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

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2
Q

What is a key informant?

A

people who know certain aspects of their culture better than others who are willing to share their views

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3
Q

Who are the key informants about hospital culture?

A

Nurses

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4
Q

What is ethnicity?

A

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

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5
Q

Race vs Ethnicity?

A

Race: considered biological traits
Ethnicity: refers to social characteristics

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6
Q

What does institutional racism lead to?

A

Racial and ethnic health disparities

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7
Q

List some consequences for victims of racism and discrimination

A
  • Increased stress
  • Incidence of chronic conditions
  • Incidence of mental health conditions
  • Decreased quality of life
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8
Q

What is a minority?

A

A group of people within a society whose members have different ethnic, racial, national, religious, sexual, political, linguistic, or other characteristics of a society

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9
Q

Who is more likely to experience healthcare disparities?

A

Minorities are more likely to experience a difference in access to healthcare

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10
Q

What traits should organizations have?

A
  • 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
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11
Q

What is ageism?

A

Stereotype, prejudice, and discrimination against people based on their age

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12
Q

How do nurses combat ageism?

A

Gerontological nursing courses

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13
Q

How does a nurse provide culturally competent care?

A

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

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14
Q

What questions promote culturally competent care?

A
  • Open-ended
  • Focus on specifics the patient provides and inquire further
  • Avoid questions that describe an assumption about a person or their beliefs
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15
Q

What are some things to remember when using an interpreter?

A
  • 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
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16
Q

What is the normal volume output for urine?

A

30 mL/hour

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17
Q

What does the color of urine indicate?

A

Hydration status

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18
Q

Dark amber urine? =

A

dehydrated patient

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19
Q

Clear urine? =

A

adequate hydration

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20
Q

What is the normal clarity of urine?

A

Clear or see through urine

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21
Q

What type of urine should you assess?

What urine should you not assess?

A

Assess clarity of fresh urine, not urine that has been sitting for a while

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22
Q

What causes the odor of urine?

A

Ammonia

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23
Q

What does a strong or offensive odor of urine indicate ?

A

Infection

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24
Q

What are the lifespan considerations for newborns/infants? : Urinary

A

They urinate frequently and have no bladder control

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25
Q

What are the lifespan considerations for toddlers and preschoolers?

A

They develop voluntary urine control and are learning toilet training

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26
Q

What are the lifespan considerations for school-age children and adolescents?

A

They experience nocturnal enuresis (bed wetting)

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27
Q

What are the lifespan considerations for adults and older adults?

A

With older age, incontinence or nocturia

An older adult with confusion is a strong indicator for a UTI

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28
Q

Voiding? =

A

Urination

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29
Q

Dysuria? =

A

Painful urination

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30
Q

Polyuria?=

A

Excessive urination

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31
Q

Anuria? =

A

Severely decreased or absent urine

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32
Q

How much urine output is considered anuria?

A

less than 100 mL/day

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33
Q

Oliguria? =

A

Decreased urination

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34
Q

How much urine output is considered oliguria?

A

less than 400 mL/day

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35
Q

Urinary Retention? =

A

Urine remains in the bladder after voiding

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36
Q

Nocturia? =

A

Waking up to void at night

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37
Q

Frequency? =

A

Voids frequently in small amounts

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38
Q

Hematuria? =

A

Blood in the urine

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39
Q

Pyuria? =

A

When urine contains pus

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40
Q

Incontinence? =

A

involuntary loss of urine from the bladder

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41
Q

What kind of fluids impact urination?

A

Any intake of fluids

  • Oral
  • Intravenous
  • Nasogastric or PEG tube
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42
Q

What hormone makes the body retain fluid?

A

Antidiuretic Hormone (ADH)

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43
Q

What triggers the release of ADH?

A

Increased plasma osmolarity (# of solutes per solvent)

  • Blood filled with solutes because there is not enough water (retains the water)
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44
Q

How many mL is in one ounce?

A

30 mL

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45
Q

How can the body lose fluid?

A

Vomiting, diarrhea, diaphoresis, wound drainage, urine, burns or blood loss

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46
Q

How do we record the body losing fluid?

A

As output

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47
Q

In what range should the output match the input?

A

Within 200-300 mL

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48
Q

What does it indicate if output is less than input?

A

Dehydrated kidney perfusion or dehydration

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49
Q

What do you use to get urine output without a catheter?

A

Graduate, hat, urinal, bedpan

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50
Q

How does hypotension impact fluid?

A
  • Leads to poor renal perfusion

- Kidneys are unable to filtrate

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51
Q

How does decreased muscle tone impact fluid?

A

Obesity
Multiple pregnancies
Chronic Constipation
Continuous bladder drainage

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52
Q

Some other factors that impact fluid?

A 
Hypotension
Decreased muscle tone
Surgery
Medications
Diet
Body positions
Cognition/ Psychological Factors
Obstructions
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53
Q

How does surgery impact fluid?

A

Volume deficit loss (blood loss, NPO)

Urinary retention from anesthesia

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54
Q

When do patients need to void after surgery?

A

Within 8 hours of surgery

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55
Q

How do medications impact fluid?

A

Diuretics = increase urine output

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56
Q

What types of medications promote urinary retention?

A

Opioids, tricyclic, antihistamines

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57
Q

How does diet impact fluid?

A

Alcohol and caffeine promote diuresis

Salty foods promote retention

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58
Q

How can body position impact fluid?

A

Difficult to use a bedpan or urinal while laying flat on the bed

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59
Q

How can cognition or psychological factors impact fluid?

A
  • 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
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60
Q

How can obstruction impact fluid?

A

Tumor, renal stones, prostate

  • Kinked or clogged urinary catheters
  • Increases risk of urinary stasis and infection
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61
Q

Name 3 risk factors for a UTI

A
  • Female Anatomy
  • Sexual Intercourse
  • Urinary Catheters
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62
Q

Why are females more prone to UTIs?

A
  • Shorter urethra

- Incorrect wiping after bowel movements

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63
Q

Catheter- Associated UTI

A

A UTI that develops when a catheter is in place greater than 48 hours prior to the onset of infection

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64
Q

What is one of the most common healthcare acquired infections?

A

UTIs

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65
Q

4 Important pieces of information on UTI education

A
  • Adequate water intake
  • Aim to void at least every 4 hours
  • Void immediately after sexual intercourse
  • Wash hands carefully with soap and water
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66
Q

How much is adequate water intake?

A

6-8 glasses of water a day

- Around 2 L

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67
Q

Why should you void after intercouse?

A

To flush the microorganisms

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68
Q

Signs and Symptoms of UTI

A
  • Fever
  • Flank pain
  • Dysuria
  • Frequency
  • Urgency
  • Pyuria
  • Hematuria
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69
Q

Timed Voiding?

A
  • Used for cognitive or physical impairment
  • Void on a fixed schedule
  • Urge urinary incontinence
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70
Q

Prompted Voiding?

A
  • Take time to check to see if there is a need to void

- Functional and total urinary incontinence

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71
Q

Habit retraining?

A
  • Schedule bathroom trips around when incontinence episodes occur
  • Functional and total urinary incontinence
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72
Q

Bladder training?

A
  • Schedule voiding times with a narrow range of 2 hours
  • Eventually widen range to 4 hours
  • Urge and reflex urinary incontinence
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73
Q

What is a urinary diversion?

A

Surgical procedure to alter the pathway of urine elimination

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74
Q

When is a urinary diversion commonly performed?

A

After the removal of the bladder (cystectomy)

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75
Q

Two types of urinary diversion

A
  • Ileal conduit

- Neobladder

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76
Q

What happens if a patient doesn’t void after surgery?

A

Order a bladder ultrasound; a noninvasive way to estimate urine in bladder

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77
Q

When do you order a bladder ultrasound?

A

Performed if a patient is not voiding, or right after a void if urinary retention is a concern

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78
Q

If a bladder scan shows urine present and the inability to urinate, what happens next?

A

In and out catheter, intermittent catheter, or straight catheter

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79
Q

Random urine specimen?

A

Can be poured from non sterile container into cup

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80
Q

Clean catch urine specimen?

A

Sterile cup or bedpan

- Seek specimen without microorganisms

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81
Q

24-hour urine specimen?

A
  • 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

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82
Q

Catheter urine specimen?

A
  • 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)

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83
Q

What are reagent strips used for during urine tests?

A

To detect substances and their amounts such as pH, glucose, protein, ketones

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84
Q

Why do we complete a urine culture and sensitivity?

A

To determine microorganisms that caused the UTI and determine the correct antibiotic to use

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85
Q

Why would there be a formation of ketones in the urine?

A

There is a breakdown of fat

- Don’t have adequate carbs and need an alternative fuel source

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86
Q

Why would blood urea nitrogen be elevated?

A

Impaired kidneys are unable to excrete urea

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87
Q

What does increase creatinine indicate?

A

Increased creatinine indicates renal impairment

* More sensitive indicator than BUN for renal impairment *

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88
Q

How is creatinine clearance obtained?

A
  • Need creatinine level from urine and blood

- Need the amount of urine developed in 24 hours

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89
Q

What does creatinine clearance estimate?

A

Estimates the kidneys glomerular filtration ability

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90
Q

What is the best indicator of kidney function?

A

GFR

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91
Q

When should you use an external catheter?

A
  • Sphincter damage
  • Spinal cord injury
  • Impaired skin integrity in areas where incontinence occurs
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92
Q

Why would you use an intermittent or straight catheter?

A
  • Temporary for a single voiding session or specimen collection
    (In-and-out catheter)
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93
Q

What is the most important focus for all catheters?

A

Sterile technique!

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94
Q

Indications for catheterization?

A
  • 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
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95
Q

The higher the number on the catheter the _____ the lumen

A

Larger

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96
Q

Most common size of catheter?

A

16 french

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97
Q

Coude catheter

A

Catheter tube with bend created in it

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98
Q

When is it smart to use a coude catheter?

A

When a patient has prostate problems

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99
Q

Catheter tube with one port and balloon

A

Indwelling catheter

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100
Q

Catheter tube with 2 ports and a balloon

A

Bladder irrigation

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101
Q

How often should you empty the drainage bag of a catheter?

A

Every 8 hours if not more frequently to prevent the development of microorganisms

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102
Q

Where should you always keep drainage bag?

A

Below the bladder

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103
Q

How often should you clean catheter if no bowel movement present?

A

At least once a shift

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104
Q

What should you use for catheter cleaning?

A

Soap and water

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105
Q

Newborn and Infant Lifespan Considerations: Bowel Elimination

A

Meconium: green substance forming the feces for infants

  • Stool color dependent upon type milk ingested
  • Frequent and multiple bowel movements a day
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106
Q

Light yellow stool indicates baby ingested ___ milk

A

Breast milk

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107
Q

Darker yellow stool indicates baby ingests ___ milk

A

Formula

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108
Q

Toddler and preschooler lifespan considerations: bowel elimination

A 
Duodenocolic reflex (stimulation of defecation)
- Toilet training after 22 months
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109
Q

School-age child and adolescent lifespan considerations: bowel elimination

A
  • Bowel function reaches adult standard

- Peer pressure may contribute to constipation

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110
Q

Adult and older adult lifespan consideration: Bowel elimination

A

Bowel movement frequency decreases; GI motility slows

- Increased fluid and fiber in diet

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111
Q

What do the intestines do besides make stool?

A

Segmentation and peristalsis

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112
Q

What do segmentation and peristalsis do?

A

Alternating contraction and relaxation of intestinal smooth muscle

Propels the intestinal contents along the entire length of the small and large intestines

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113
Q

What stimulates peristalsis

A

The walls of the intestine

Ambulation

Duodenocolic reflex: when partially digested food enters the duodenum

114
Q

What is absorbed in the duodenum and jejunum?

A

Nutrient and electolytes

115
Q

What is absorbed in the ileum?

A

Vitamins, iron, and fluid

116
Q

Valsalva Maneuver

A

Take a deep breath against a closed glottis
Contract the abdominal muscles
Contract the pelvic floor muscles

117
Q

What effect can the valsalva maneuver have on other body systems?

A

Dizziness, unclog the ears, lower BP, reset heart rhythm

118
Q

What impact does soluble fiber have on bowel elimination

A

Increases GI transit time

oat bran, barley, and nuts

119
Q

What impact does insoluble fiber have on bowel elimination?

A

Decreases GI transit time

whole grains, fresh fruits, and vegetables

120
Q

Which fiber promotes loose stools?

A

Insoluble

121
Q

What % of feces is water?

A

75%

122
Q

What takes priority for water, body cells or stool?

A

Body cells

123
Q

Increased GI motility = ____ stool

A

Loose

- The slower the system, the more water can be absorbed to be used by the body

124
Q

Move less, defecate ____

A

Less

125
Q

How does pregnancy affect bowel elimination

A

Iron supplements + growing fetus = constipation

126
Q

Opioids cause? (bowel elimination)

A

Constipation

127
Q

Antibiotics cause? (bowel elimination)

A

Diarrhea

128
Q

To examine the lower GI tract with a camera, what must be out of the lower GI tract?

A

Stool

129
Q

Colonoscopy

A

When the colon is diverted through a stoma

130
Q

Ileostomy

A

When the ileum is diverted through a stoma

131
Q

What is something to consider with an ileostomy?

A

No large intestine = potential issue with loss of fluid and electrolytes

132
Q

What are the normal stoma assessment findings?

A

Healthy pink & present on the abdominal surface

133
Q

Abnormal stoma assessment findings?

A
  • Cyanotic/ purple/ pale
  • Dusky or bluish tint can indicate inadequate circulation
  • If the stoma retracts feces can enter the abdominal cavity and cause peritonitis
134
Q

When should the ostomy pouch be emptied?

A

One-fourth to one-third of the way full

135
Q

What do you rinse the pouch with after emptying it?

A

Clean warm tap water; 60 mL syringe works well

136
Q

What if fecal contents leak around where the pouch is attached to the skin?

A

The entire bag must be removed and replaced

137
Q

Normal abdominal inspection findings

A

Symmetric and slightly rounded

138
Q

Abnormal abdominal inspection findings and what does it indicate?

A

Hollow or scaphoid = malnutrition

Distended = obstruction

139
Q

What is performed after inspection of abdomen?

A

Auscultation (performed before palpation and percussion)

140
Q

Normal bowel sounds?

A

Heard within 5-15 seconds

141
Q

Hyperactive bowel sounds

A

More frequently than 5 seconds

142
Q

How long do you listen to confirm bowel sounds absent?

A

1 -2 minutes per quadrant

143
Q

Signs of constipation

A

bloating, fullness, an urge to defecate without an ability to pass stool, malaise, los of appetite, nausea, vomiting, and abdominal distention

144
Q

Fecal Impaction

A

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

145
Q

How is fecal impaction diagnosed

A

Digital rectal exam

146
Q

What type of gastric motility is diarrhea?

A

Increased gastric motility

147
Q

What type of bowel sounds for diarrhea?

A

Hyperactive

148
Q

Some causes of diarrhea?

A

Medications, medical conditions, emotional changes

149
Q

Symptoms of diarrhea

A

Cramping, nausea, burning sensation, anal inflammation, bleeding and breakdown

150
Q

What can lead to fecal incontinence

A

Neurological injury, spinal cord injury, or altered mental status

151
Q

What foods increase flatulence

A

High fiber foods

152
Q

What causes flatulence?

A

Bacterial activity in the large intestine

153
Q

A type of test that detects the presence of blood in feces?

A

Fecal Occult blood test

154
Q

What is a fecal occult blood test recommended for?

A

Screening tool for colorectal cancer; blood in stool may indicate cancer or polys in the colon or rectum

155
Q

Radiopaque

A

Substance swallowed or instilled in the rectum and then imaging is performed as it proceeds through the GI tract

156
Q

What does a radiopaque detect

A

Abnormalities in the large and small bowel

157
Q

What is done after a radiopaque?

A

Barium can harden stool and cause constipation or an impaction; increase fluids and administer a laxative

Barium can make the stool appear chalky

158
Q

Esophagogastroduodenoscopy (EGD)

A

upper GI test

159
Q

Sigmoidoscopy

A

Lower GI test

- Colorectal cancer screening every 5 years

160
Q

Colonoscopy

A

Lower GI tests

- Colorectal cancer screening every 10 years (5 years if high risk)

161
Q

What is done after a lower GI test?

A

Monitor for bleeding or dull abdomen pain

162
Q

Antidiarrheals

A 
Loperamide
Bismuth subsalicylate (Pepto Bismol)
163
Q

Fecal Microbiota Transplantation

A
  • Used for persistent clostridium difficile infection
  • Healthy stool from a human donor placed in GI tract
  • 90% effective in reducing infection rate
164
Q

How do you treat IBS

A

Steroids

165
Q

What can you utilize for bowel training

A

Pelvic floor exercises, abdominal massage, and biofeedback

166
Q

Why should you perform an enema

A
  • Promote bowel movement

- Clear bowel area before a procedure

167
Q

Small volume enema

A

mineral oil and steroids

168
Q

Large volume enema

A

tap water or saline

169
Q

Return-flow enema

A

Removes flatus

170
Q

Indications for NG tube insertion

A

Gastric decompression, gastric lavage, or gastric feeding

171
Q

Newborn is ___ % fluid

A

80%

172
Q

Fluid decreases in childhood to ___ %

A

65%

173
Q

Adults average ___% fluid

A

55%

174
Q

Older adults are around ___% fluid

A

50%

175
Q

Osmolality

A

particles in a given weight of fluid

176
Q

Osmolarity

A

particles in a given volume of fluid

177
Q

A method of determining if someone is over hydrated or dehydrated?

A

Serum osmolarity

178
Q

Normal range for serum osmolarity

A

280 to 300

179
Q

Too high serum osmolarity indicates?

A

Dehydration

180
Q

Too low serum osmolarity indicates?

A

Fluid overload

181
Q

Intracellular fluid and fraction of fluid volume

A

intracellular = fluid inside the cell

2/3 of fluid volume

182
Q

Primary electrolytes for intracellular fluid

A

Potassium
Phosphate
Sulfate

183
Q

Extracellular fluid and fraction of fluid volume

A

extracellular = fluid outside the cell

1/3 fluid volume

184
Q

Primary electrolytes for extracellular fluid

A

Sodium
Chloride
Bicarbonate

185
Q

What is the fluid called that is inside the blood vessels

A

Intravascular space

186
Q

What is the fluid called in between the cells

A

Interstitial space

187
Q

What three components determine the fluid balance in between intravascular and interstitial

A

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

188
Q

Osmotic pressure

A

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

189
Q

What determines hydrostatic pressure

A

Arterial blood pressure
Venous pressure
Rate of blood flow

190
Q

Isotonic

A

Equal concentration of water and electrolytes

191
Q

Hypotonic

A

Concentration of electrolytes outside the cell is lower

192
Q

Hypertonic

A

Concentration of electrolytes outside the cell is higher

193
Q

The higher the concentration of a solute or substance, the ____ the concentration of water

A

Lower

194
Q

Water flows from ___ to ____

A

High to low

195
Q

Crystalloids

A

Aqueous solution with electrolytes

196
Q

Colloids

A

Contain large molecules that do not transport outside of the intravascular space (Volume expanders)

197
Q

What is the function of colloids

A

Function to increase the osmotic pressure in the intravascular space leading to fluid being pulled into the intravascular space

EX: albumin, dextran, hetastarch

198
Q

When are packed red blood cells (PRBCs) used

A

used for blood loss

- 1 unit roughly increases hemoglobin by 1g/dL

199
Q

When are platelets used

A

given where there is a reduced level of platelets ?

200
Q

When is fresh frozen plasma used (FPP)

A

used for trauma, burns, shock, or bleeding and clotting disorders

201
Q

When is cryoprecipitate (derived from plasma) used

A

used for clients with hereditary disorders that lead to inadequate clotting

202
Q

Nursing considerations for blood products

A

Blood type and Rh factor protein are determined to match a person with the righ type of donor

Type and crossmatch performed

203
Q

Universal donor

A

O negative

204
Q

Universal recipient

A

AB positive

205
Q

Signs of transfusion reaction

A

Fever, chills
Altered blood pressure
Respiratory difficulty
Signs of an allergic reaction

206
Q

Dehydration

A

Loss of body water but electrolytes remain consistent

207
Q

Fluid volume deficit

A

Loss of both fluid and electrolytes

  • Can also include a loss of circulating blood volume and perfusion to tissues
  • Hypovolemia
208
Q

Dehydration Causes

A
  • Inadequate water intake
  • Increased gastrointestinal losses (vomiting or diarrhea)
  • Fever
  • Medications that decrease the body’s thirst response
  • Diabetic keotacidosis
209
Q

Lab tests that can correlate with dehydration

A 
Elevated serum osmolality
Elevated creatinine
Elevated BUN
Increase urine specific gravity
Hypernatriemia
210
Q

Why would hypernatremia correlate with dehydration if the electrolytes remain constant?

A

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

211
Q

Fluid Volume Deficit S/SX

A
  • Hypotension
  • Tachycardia
  • Orthostatic Hypotension
  • Decreased urine output
  • Flat neck veins
  • Weak pulse
212
Q

Third Spacing

A

Too much fluid in interstitial space and not enough in the intravascular space

213
Q

What is lacking with third spacing?

A

protein

214
Q

How do we give protein IV?

A

Albumin, in comes in different percentages

215
Q

What about crystalloids, what tonicity can we administer for third spacing?

A

Hypertonic

216
Q

What causes a reduced colloid oncotic pressure?

A

Reduced levels of albumin (protein keeps fluid in intravascular space)

217
Q

What happens to fluid when there is a reduced colloid oncotic pressure?

A

Fluid goes out of the intravascular space and into the interstitial space (into third space)
- Edema

218
Q

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
A

Hematuria and Dysuria

219
Q

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
A

Daily iron supplement &

Takes opioids

220
Q

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
A

Bicarbonate excess &

Circumoral paresthesia

221
Q

How can someone have a fluid volume deficit if they have too much fluid somewhere?

A

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

222
Q

Fluid Volume Excess Causes

A 
Heart Failure
Renal Failure
Cirrhosis
Excess IV fluid
Medications that cause sodium and water retention
223
Q

S/SX of fluid volume excess

A
  • 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)
224
Q

Fluid Volume Excess Medications?

A 
- Diuretics 
ex:
- Lasix --> furosemide
- Spironolactone
- Bumetanide, hydrochlorothiazide
225
Q

Functions of Electrolytes (5)

A
  • 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
226
Q

Hypokalemia causes

A 
Diuretics
Metabolic alkalosis
Folic Acid deficiency
Gastrointestinal losses
Decreased intake of potassium
227
Q

S/SX of hypokalemia

Mild & severe

A

Mild: cardiac arrhythmias, constipation, fatigue

Severe: respiratory paralysis, paralytic ileum, tetany, hypotension, rhabdomyolysis, life threatening arrhythmias

228
Q

Hypokalemia TX

A

Priority is determine underlying cause

  • Potassium supplementation
  • Making dietary changes
  • IV potassium
229
Q

What if hypokalemia cause is due to using a potassium wasting diuretic?

A
  • Switch to potassium sparing diuretic (spironolactone)
230
Q

Do we push potassium?

A

NO, only given IV through a slow infusion

231
Q

Hyperkalemia causes

A
  • Acute renal failure
  • Dehydration
  • Diabetes
  • Burns
  • Acidosis
  • Blood transfusion
232
Q

Hyperkalemia s/sx

mild & severe

A

Mild: N/V, muscle aches, weakness, dysrhythmias

Severe: paralysis, heart failure, death

233
Q

Hyperkalemia tx

A
  • 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)
234
Q

Hyponatremia causes

A
  • Severe N/D
  • Drinking excess water
  • Excess alcohol intake
  • Thiazide diuretics
  • Liver or heart disease
235
Q

Hyponatremia s/sx

mild & severe

A

Mild: nausea, feeling unwell

Severe: cerebral edema, lethargy, confusion, irritability, seizure, coma

236
Q

Hyponatremia tx

A
  • 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
237
Q

Hypernatremia causes

A
  • Dehydration (vomiting, chronic kidney disease, impaired thirst response)
  • Consumption of high sodium items
238
Q

Hypernatremia s/sx

A

Similar to hyponatremia (neurological problems)

239
Q

Hypernatremia tx

A
  • 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
240
Q

Hypocalcemia causes

A
  • Inadequate vitamin D
  • Decreased estrogen production
  • Hypoparathyroidism
  • Renal disease
  • Low albumin levels
  • Stimulant laxatives
  • Chronic steroid use
  • Proton pump inhibitors
241
Q

What tests for hypocalcemia?

A

Chvostek and Trousseau sign

242
Q

Hypocalcemia s/sx

A
  • Chest pain
  • Dysrhythmias
  • Renal calculi
  • Numbness and tingling
  • Muscle cramping
  • Confusion
  • Osteopenia
  • Dental problems
243
Q

What does serum calcium account for?

A

All calcium, whether it is in the free ionized form or bound to proteins

244
Q

What does ionized calcium account for?

A

It detects the active or unbound form of calcium in the body

Most accurate representation

245
Q

When is ionized calcium test run?

A

If s/sx appear or abnormal serum levels of calcium suggest an issue

246
Q

Chvostek’s Sign

A

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)

247
Q

Trosseau’s Sign

A

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
248
Q

Hypocalcemia tx

A
  • Calcium and vitamin D supplementation
  • Increased dietary intake
  • Calcium injections
249
Q

Hypercalcemia causes

A
  • Cancer
  • Hyperparathyroidism
  • Vitamin D toxicity
250
Q

What over the counter meds for heartburn contains calcium carbonate?

A

TUMS

- Too much can lead to hypercalcemia

251
Q

Hypercalcemia s/sx

mild & severe

A

Mild: constipation, abdominal pain, N/V

Severe: confusion, renal failure, arrthymias, coma, death

252
Q

Hypercalcemia tx

A
  • Administer phosphate (inverse relationship w calcium)
  • IV saline bolus
  • Loop diuretic
  • Hemodialysis in severe cases
253
Q

Hypomagnesemia causes

A
  • Chron’s disease or celiac disease
  • Diarrhea or pancreatitis
  • Type 2 diabetes
  • Presence of hypokalemia and hypercalcemia
  • Decreased intake
  • Increased renal excretion
254
Q

Hypomagnesemia s/sx

mild & severe

A

mild: decreased appetite, fatigue, nausea, weakness

Severe: muscle cramps, numbness and tingling, tetany, and personality changes

255
Q

Hypomagnesemia tx

A
  • Oral or IV magnesium
256
Q

What might have to be treated first before magnesium can be given?

A
  • Restore calcium or potassium balance
257
Q

Hypermagesemia causes

A
  • 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)
258
Q

Hypermagesemia s/sx

mild & severe

A

Mild: dizziness, nausea, weakness, confusion

Severe: confused, blurred vision, headache, bladder paralysis, bradycardia, reduced respiratory rate, loss of deep tendon reflexes, death

259
Q

Hypermagesemia tx

A
  • Something given to prevent cardiac problems similar to hyperkalemia
    EX: calcium chloride and calcium gluconate
  • IV saline with diuretics
  • Severe cases may require hemodialysis
260
Q

How quick does the respiratory system respond to acid-base changes?

A

Immediately but effect is weak

261
Q

How quick does the renal system respond to acid-base changes?

A

Hours to day but effect is stronger

262
Q

Normal pH value
Acidosis value
Alkalosis value

A 
Normal = 7.35-7.45
Acidosis = < 7.35
Alkalosis = > 7.45
263
Q

Normal PaCO2
Acidosis
Alkalosis

A 
Normal = 35-45 mmHg
Acidosis = > 45
Alkalosis = < 35
264
Q

Normal HCO3
Acidosis
Alkalosis

A 
Normal = 22-26 mEq/L
Acidosis = < 22
Alkalosis = > 26
265
Q

Metabolic Acidosis causes

A

Diabetic Ketoacidosis
Lactic Acid Accumulation
Severe diarrhea
Renal disease

266
Q

Metabolic acidosis renal compensation

A

Kidneys will attempt to produce more bicarb; however usually the bicarb deficit exceeds the amount the kidneys can produce

267
Q

Metabolic acidosis respiratory compensation

A

Hyperventilation; resp compensation is usually weak and underlying problem is not addressed

268
Q

Metabolic Acidosis Clinical Manifestations

A

Kussmauls Respirations
Lethargy, fatigue, coma
Hypertension, dysrhythmias (renal failure –> hypertension)
Hyperkalemia

269
Q

Why would metabolic acidosis result in hyperkalemia

A

At the cellular level the body reacts to a low pH by exchanging hydrogen ions with potassium ions (they both have +1 charge)

270
Q

Metabolic Acidosis TX

A

Kidneys are impaired = hemodialysis

DKA = insulin administration

Shock state = fluid replacement or other shock treatment is priority

271
Q

Metabolic Alkalosis causes

A

Vomiting (hydrochloric acid)
Gastric suction
Bicarb gain

272
Q

Metabolic alkalosis compensation

A

Renal excretion of bicarb

- Respiratory, decrease RR

273
Q

Metabolic alkalosis clinical manifestations

A 
Hyperactive reflexes
Paresthesia
Tetany
Seizures
Respiratory Depression
274
Q

Metabolic alkalosis tx

A

Adequate hydration (0.9% sodium chloride)
Argenine hydrochloride
A diuretic: diamox

275
Q

Respiratory Acidosis cause

A

Hypoventilation
Respiratory failure
Injury to the medulla
Overdose of opioids, benzos, alcohol (anything w sedative effects)

276
Q

Respiratory Acidosis compensation

A

Compensation only through renal compensation

Kidneys will retain bicarb ions or excrete hydrogen ions (slow process)

277
Q

Respiratory Acidosis Clinical Manifestations

A

Mental status changes may occur first (irritability, disorientation, lethargy, coma, headache)
Tachycardia

278
Q

Respiratory Acidosis Tx

A
  • 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
279
Q

Respiratory Alkalosis causes

A 
Anxiety
Fear
Pain
Trauma
Anemia
Asthma
Pulmonary Embolism
Cerebrovascular accident or stroke
280
Q

Respiratory alkalosis compensation

A

Bicarb shifts into cells in exchange for chloride ions

If alkalosis persists, renal excretion of bicarb can happen

281
Q

Respiratory alkalosis clinical manifestations

A

Neuromuscular symptoms (paresthesia, dizziness, vertigo, tetany)

Cardiovascular symptoms (tachycardia, dysrhymias, excessive diaphoresis)

282
Q

Respiratory alkalosis TX

A
  • Fix underlying cause*
  • Pain or anxiety = intervention that targets
  • Asthma = bronchodialator
  • Anemia = restoration of hemoglobin

Foundations of Nursing (3 decks)

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