Fundamentals Quiz 5 Review Flashcards
Potassium
3.5 - 5 mEq/L
Sodium
136-145 mEq/L
Calcium
9-10.5 mg/dL
Magnesium
1.3-2.1 mEq/L
Chloride
98-106 mEq/L
Phosphorus
3-4.5 mEq/L
Hematocrit (HCT)
Men: 40-54%
Women: 36-48%
Normal blood osmolarity
275-295 mOsm/kg
Urine specific gravity
1.005-1.030
Hypokalemia
Shallow breathing, respiratory distress, weak irregular pulse, muscle cramping, muscle weakness, hypoactive, bowel sounds, constipation, NV, and abdominal distention
Hypercalcemia
Bone pain, decreased reflexes, dysrhythmias, NV, weakness, and confusion
Hypocalcemia
Diarrhea, numbness and tingling, weak threading pulse, abdominal cramping, hyperactive bowel sounds
Tremors: patients cannot get up alone because of safety
Hypernatremia
Orthostatic hypotension, Tachycardia, hyperthermia, fatigue, disorientation, seizures, thirst, dry sticky mucous membranes, hyperactive bowel sounds.
Hyponatremia
Hypothermia, tachycardia, rapid thready pulse, hypotension, headache, confusion, orthostatic hypotension, muscle weakness
Dehydration symptoms
Hypernatremia, dry mouth, cracked lips, thirst, dry mucous membranes, NV
Normal urine output
30 mL
Should be pale yellow
Normal ph range
7.35-7.45
Acidosis- ph
<7.35
Alkalosis-ph
> 7.45
CO2 normal range
35-45 mmHg
Acidosis- CO2
> 45 mmHg
Alkalosis- CO2
<35 mmHg
Normal HCO3 range
22-26 mEq/L
Acidosis - HCO3
<22 mEq/L
Alkalosis - HCO3
> 26 mEq/L
Respiratory acidosis
Increased CO2
Decreased pH
Respiratory alkalosis
Decreased CO2
Increased pH
Metabolic Acidosis
Decreased HCO3
Decreased pH
Metabolic alkalosis
Increased HCO3
Increased pH
Risk factors Hypovolemia
Excessive GI loss: Nasogastric suctioning, vomiting, diarrhea
Excessive skin loss: diaphoresis without water and fluid replacement
Excessive renal system losses: diuretic therapy, kidney disease, adrenal insufficiency
Third spacing: burns
Hemorrhage or plasma loss
Causes of dehydration
Hyperventilation or excessive perspiration without water replacement
Prolonged fever
Diabetic ketoacidosis
Insufficient water intake
Diabetes insipidas
Osmotic diuresis
Excessive intake of salt, salt tablets, or hypertonic IV fluids
Hypovolemia and dehydration lab findings
HCT: increased for both (greater than 55%)
Blood osmolarity: Dehydration: increased (greater than 295 mOsm/kg)
Urine specific gravity: Dehydration: increased (greater than 1.030)
Blood sodium: Dehydration: increased sodium (greater than145 mEq/L)
BUN: increased (greater than 25 mg/dL)
for dehydration there is increased protein, electrolytes and glucose
On average 6-25mg/dL for BUN is considered normal
Nursing care for Hypovolemia/dehydration
Measure the clients weight daily at the same time of the day using the same scale
Alert the provider to a urine output less than 30 mL/hr
Hypovolemia/dehydration expected findings
Hypothermia (hypovolemia) or hyperthermia (dehydration)
Tachycardia, thready pulse, hypotension
Hypoxia
Risk factors for hyponatremia
GI losses: vomiting, nasogastric suctioning, diarrhea, tap water enemas
Renal losses
Skin losses
heart failure, cirrhosis, nephrotic syndrome
Excessive IV administration of dextrose 5% in water
NPO status
Hyperglycemia
Older adult clients are at greater risk due to an increased incidence of chronic illnesses, use of diuretic meds, and risk for insufficient sodium intake.
Nursing care for hyponatremia
Weight the client daily at the same time of day using the same scale
Encourage client to change positions slowly
Monitor respiratory status if muscle weakness is present
Encourage foods and fluids high in sodium (cheese, milk, condiments)
hypertonic oral or IV fluids can help with elevating serum sodium levels
Hypernatremia
Blood sodium level greater than 145 mEq/L
Causes hypertonicity of the blood. Causes a shift of water out of the cells, making the cells dehydrated
Risk factors for hypernatremia
Water deprivation (NPO)
Heat stroke
Excessive sodium intake: hypertonic IV fluids and tube feedings, bicarbonate intake
Excessive sodium retention: kidney failure, Cushing’s syndrome (body makes too much cortisol), aldosteronism, some medications (glucocoritcosteroids)
Fluid loss: fever, diaphoresis, burns, respiratory infection, diabetes inspidus, hyperglycemia, watery diarrhea
Hypernatremia nursing care
Provide oral hygiene and other comfort measures to decrease thirst
Monitor level of consciousness and ensure safety
Maintain prescribed diet (low sodium, no added salt)
Encourage oral fluids as prescribed
For fluid loss: Administer hypotonic or isotonic (non-sodium) IV fluids (helps to hydrate the blood cells)
With excess sodium: Encourage water intake and discourage sodium intake
Administer loop diuretics if impaired kidney excretion is the cause of hypernatremia (one of furosemide, bumatemide adverse effects is hyponatremia)
** Most diuretics help the kidneys remove salt and water through the urine. This lowers the amount of fluid flowing through the veins and arteries. As a result, blood pressure goes down.**
Potassium imbalances
Plays a vital role in cell metabolism, transmission or nerve impulses, functioning of cardiac, lung, muscle tissues, and acid base balance
Hypokalemia
Blood potassium level less than 3.5 mEq/L
Result of an increased loss of potassium from the body, decreased intake and absorption of potassium, or movement of potassium into the cells
Risk factors of hypokalemia
Hyperaldosteronism (this is because aldosterone helps control blood pressure by holding onto salt and releasing potassium from the blood)
Prolonged administration of non-electrolyte containing IV solutions (5% dextrose in water)
Receiving total parenteral nutrition
Metabolic alkalosis (increasing aldosterone which contributes to retaining water, releasing Hydrogen ions in the urine and gaining mor HCO3 [bicarbonate] in the blood)
GI losses
Renal losses
Skin losses
Nursing care for hypokalemia
Treat underlying cause
Replace potassium (avocados, dried fruit, cantaloupe, bananas, potatoes, spinach)
Provide oral potassium supplementation
IV potassium administration can be required, it should always be diluted and administered slowly
NEVER IV BOLUS (high risk of cardiac arrest)
Monitor and maintain adequate urine output
Ministro for shallow respirations and diminished breath sounds
Monitor clients receiving digoxin. Hypokalemia increases the risk for digoxin toxicity
Hyperkalemia
Blood potassium level greater than 5 mEq/L
Result of increased intake of potassium, movement of potassium out of the cells or inadequate renal excretion
Potentially life threatening due to risk of cardiac arrhythmias and cardiac arrest
Risk factors for hyperkalemia
Increased total body potassium
ECF shift: insufficient insulin, diabetic ketoacidosis, tissue catabolism
Uncontrolled diabetes mellitus (this is due to the lack of insulin causing hyperglycemia which causes the increase of potassium in extra cellular fluid)
Decreased excretion of potassium due to kidney failure, potassium sparing diuretics (spironolactone), severe dehydration, adrenal insufficiency
Age: older adult clients at greater risk due to decreased kidney function
Nursing care hyperkalemia
Implement continuous ecg monitoring
Decrease potassium intake
Dialysis might be required with high potassium levels
Administer it fluids with dextrose and regular insulin to promote the movement of potassium from ECF to the ICF
Administer sodium polystyrene sulfonate as prescribed
Medications for hyperkalemia
To increase potassium excretion
- loop diuretics (furosemide) if kidney function is adequate
Sodium polystyrene sulfonate given orally or as an enema. Polystyrene increases the excretion of potassium from the GI
Calcium gluconate, albuterol, and patiromer
Calcium imbalances
Calcium is found in the body’s cells, bones, and teeth
Essential for proper functioning of the cardiovascular, neuromuscular, and endocrine systems, as well as blood clotting, and bone and teeth formation
Hypocalcemia risk factors
Increased calcium output : chronic diarrhea, laxative misuse, steatorrhea with pancreatitis
Inadequate calcium intake or absorption: malabsorption syndromes (crohn’s disease), vitamin D deficiency
Calcium shift from ECF into bone or to an inactive form: rapid infusion of citrates blood transfusion, post thyroidectomy, hypoparathyroidism, hypoalbuminemia, alkalosis, pacreatitis, hyperphophatemia
Hypocalcemia nursing care
Administer oral or IV calcium supplements and vitamin D supplements
Initiate seizure and fall precautions
Encourage foods high in calcium, including dairy products and dark green vegetables.
Hypercalcemia causes
When total blood calcium level greater than 10.5 mg/dL
Thiazide diuretic or long-term glucocorticoid use, Paget’s disease, hyperthyroidism and hyperparathyroidism
Bone cancer
Hypercalcemia nursing care
Restricting calcium and increasing fluid intake
Monitor the client for pathological fractures
Magnesium is found
Primarily found in the bones
Smaller amounts is found within the body cells.
A very small amount is found in ECF.
Hypomagnesemia risk factors
Increased magnesium output: GI losses, thiazide or loop diuretics, often associated with Hypocalcemia
Shift into inactive form: rapid infusion of citrates blood
Inadequate magnesium intake or absorption: malnutrition, alcohol use disorder, laxative misuse
Hypomagnesemia nursing care
Discontinue magnesium-losing medications
Magnesium replacement can be required orally or IV if severe
(Oral magnesium can cause diarrhea
Encourage foods high in magnesium, including whole grains and dark green vegetables
Hypermagnesemia causes
Kidney or adrenal impairment and increased intake of medications containing magnesium (laxatives, antacids)
Hypermagnesemia nursing care
Perform frequent focused assessments. Notify provider on changes or absent reflexes
Administer loop diuretics and magnesium free IV fluids
Administer calcium gluconate for severe cardiac changes
Sleep cycle
non-rapid eye movement (NREM) sleep
Rapid eye movement (REM) sleep
REM sleep accounts for 20% - 25% of sleep time
Stage 1 REM
Very light sleep
Only a few min long
Muscle relaxation
Loss of awareness and surroundings
Vital signs and metabolism decrease
Awakens easily
Feels relaxed and drowsy
Stage 2 NREM
Deeper sleep
10 - 20 minutes long
Vital signs and metabolism continue to slow
Requires slightly more stimulation to awaken
Increased relaxation
Stage 3 NREM
Slow wave sleep or delta sleep
Vital signs decreasing
More difficult to awaken
Psychological rest and restoration
Reduced sympathetic activity
REM
Vivid dreaming
About 90 min after falling asleep, recurring every 90 min
Longer with each sleep cycle
Average length 20 min
Varying vital signs
Very difficult to awaken
Cognitive restoration
Sleep duration
Infants and toddlers: 9-15 hrs a day
Adolescents: 9-10 hrs a day
Adults 7-8 hrs a day
Acute insomnia
Lasts a few days possibly due to personal or situational stressors
Chronic insomnia
Lasts a month or more
Intermittent insomnia
Sleeping well for a few days and then having insomnia for a few days
Sleep apnea
More than five breathing cessations lasting longer than 10 seconds per hour during sleep
Results in decreased arterial oxygen saturation levels
Narcolepsy
Sudden attacks of sleep that are often uncontrollable
Increases risk for injury
Hypersomnolescence disorder
Excessive daytime sleepiness lasting at least 3 months
Impairs social and vocational activities
Increased risk for accident or injury related to sleepiness
Sleep apnea nursing action
Consider continuous positive airway pressure (CPAP) devices for clients with sleep apnea to promote opening of airways during sleep
Medications for insomnia
To be used as a last resort
- benzodiazepine like medications
- zolpidem
-eszopiclone
-zaleplon
Hypoventilation
Body is more acidic due to the increase in CO2
Hyperventilation
Body is more basic due to the increased excretion of CO2
Nasal cannula
Oxygen concentration of 1 -4 L/min
Simple face mask
Oxygen concentration of 5-8 L/min
Partial and non rebreather masks
Oxygen concentration of 10-15 L/min
Left sided heart failure
“L” FOR LUNG
Causes crackling in the lungs due to the blood backing up into pulmonary circulation
Right sided heart failure
Can cause peripheral edema
PaO2 range
80-100
