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Med Surg Exam 1 > Med Surg Exam 1 > Flashcards

Med Surg Exam 1 Flashcards

1
Q

Antidiuretic hormone (ADH)

A

Controls how much fluid leaves the body in urine and causes reabsorption of water.

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2
Q

Aldosterone

A

Reabsorption of water and sodium

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3
Q

Renin

A

Released when there is a decreased blood flow to the kidneys.

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4
Q

Osmosis

A

Movement of liquid across membrane. Water moves by osmosis. When there are differences in concentration of fluids, osmotic pressure will move water from lesser concentrated to more greater concentrated until they are equal.

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5
Q

Diffusion

A

Substances move across the membrane until they are evenly distributed.

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6
Q

Filtration

A

Movement of water & solutes by pushing force on one side of the membrane. (Pressure)

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7
Q

Isotonic

A

Equal solute concentration

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8
Q

Hypertonic

A

Greater concentration (cell shrinks)

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9
Q

Hypotonic

A

Less concentration (cells swell)

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10
Q

The most accurate measure of fluid gain or loss for any age group

A

Weight change (1kg = 1 L of fluid)

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11
Q

S/S of dehydration

A

Thirst
Poor skin turgor
Rapid, weak, thready pulse
Slightly elevated temp
Increased hematocrit
High urine specific gravity with low volume

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12
Q

S/S of overhydration

A

Weight gain
Slow, bounding pulse
Firm subcutaneous tissues
Crackles in lungs
Lethargy, possible seizures
Decreased serum sodium
Decreased hematocrit from hemodilution
Low urine specific gravity with high volume

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13
Q

Older Adult Care Point on volume deficient

A

Age-related decline in total body water and decrease thirst sensation and taste. If urinary incontinence is a problem, the person becomes reluctant to drink extra fluids. THIRST IS A LATE SIGN OF DEHYDRATION IN OLDER PATIENTS.

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14
Q

Fluid volume deficient contributes to

A

Constipation
Orthostatic hypotension with related dizziness and falls
Makes the person more susceptible to infection

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15
Q

Measuring BP & Pulse (orthostatic ir postural hypotension)

A

A systolic BP drop of 20 accompanied by a pulse rate increase of 10 BPM at 1 min after position change suggests a fluid deficit.

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16
Q

Older patients (rehydration)

A

Rehydrate cautiously. Any pt who has cardiac problems is at risk for fluid overload from IV infusions. Infuse slow. If IV infusion falls behind DO NOT try to infuse at a faster rate than ordered.

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17
Q

Normal hematocrit values

A

35-54 mL of RBC per 100mL of whole blood, depending on age and sex. If excess water, less RBC due to dilution by water

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18
Q

Specific gravity ranges

A

1.010 - 1.025 (urine concentration)

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19
Q

Sodium values

A

135-145

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20
Q

Potassium Values

A

3.5 - 5

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21
Q

Calcium Values

A

9 - 10.5

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22
Q

Magnesium Values

A

1.5 - 2.5

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23
Q

Phosphate Values

A

2 - 4.5

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24
Q

Chloride Values

A

98 - 106

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25
Q

Hyponatremia S/S

A

CNS & neuromuscular changes, fatigue, lethargy, headache, mental confusion altered LOC, anxiety, coma, anorexia, nausea, vomiting, muscle cramps, seizures, decreased sensation, decreased BP

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26
Q

Hypernatremia S/S

A

Dry mucosa, taut skin turgor, intense thirst, flushed skin, oliguria, possibly elevated temp., weakness, lethargy, irritability, twitching, seizures, coma, intracranial bleeding, low-grade fever

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27
Q

Hypokalemia S/S

A

Abdominal pain, paralytic ileus, gaseous distensión of intestines, cardiac dysrhythmias, muscle weakness, decreased reflexes, paralysis, urinary retention, increased urinary pH, lethargy, confusion, ECG changes

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28
Q

Hyperkalemia S/S

A

Muscle weakness, fatigue, hypotension, nausea, parenthesias, paralysis, cardiac dysrhythmias, ECG changes

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29
Q

Hypocalcemia S/S

A

Paresthesias, abdominal cramps, weak pulse, decreased BP, seizures, muscle spasm, positive Chvostek sign, positive Trousseau sign, cardiac dysrhythmia, wheezing, dyspnea, difficulty swallowing, colic, cardiac failure, excessive blood transfusions

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30
Q

Hypercalcemia

A

Anorexia, nausea, abdominal pain, constipation, muscle weakness, oliguria, confusion, renal calculi, pathological fractures, dysrhythmias, cardiac arrest

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31
Q

Hypomagnesemia S/S

A

Insomnia, hyperactive reflexes, leg/foot cramps, twitching, tremors, seizures, cardiac dysrhythmias, positive Chvostek & Trousseau sign, vertigo, hypocalcemia, hypokalemia

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32
Q

Hypermagnesemia S/S

A

Hypotension, sweating and flushing, nausea and vomiting, muscle weakness, paralysis, respiratory depression, cardiac dysrhythmias

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33
Q

Hypophosphatemia S/S

A

Confusion, seizures, numbness, weakness, possible coma, chronic state: rickets and osteomalacia

34
Q

Hyperphosphatemia

A

Anorexia, nausea, vomiting

35
Q

Foods high in sodium

A

Buttermilk
Casserole & pasta mixes
Catsup
Cheese (all kinds)
Frozen vegetables with sauces
Prepared mustard
Softened water
Tomato or vegetable juice

36
Q

Foods high in potassium

A

Baked potato with skin
Orange juice
Pinto beans
Spinach
Tomatoes
Winter squash
Raisins, seedless

37
Q

Normal pH

A

7.35 - 7.45

38
Q

Respiratory acidosis

A

Slow, shallow respirations
Respiratory congestion or obstruction

pH <7.35
PaCO2 >45

39
Q

Metabolic acidosis

A

Shock (poor circulation)
Diabetic ketoacidosis
Renal failure
Diarrhea

pH <7.35
HCO3 <22

40
Q

Respiratory alkalosis

A

Hyperventilation

pH >7.45
PaCO2 <33

41
Q

Metabolic alkalosis

A

Vomiting
Excessive antacid intake
Hypokalemia

pH >7.45
HCO3 >26

42
Q

Dextrose in Water

A

5%
Isotonic

10%
Hypertonic

43
Q

Saline

A

0.45%
Hypotonic

0.9%
Isotonic

44
Q

Multiple Electrolyte Solutions

A

Ringer solution
Isotonic

Lactated Ringer
Isotonic

45
Q

Control of fluid is balanced by

A

Hormones and thirst mechanism

46
Q

The kidney is a major factor in the

A

Regulation of fluid and electrolyte balance in the body

47
Q

Edema can be treated with

A

Diuretic medications, low sodium diet, elastic stockings and compression devices

48
Q

TPN is used when

A

A patient cannot obtain adequate nutrition by other means

49
Q

PaCO2 normal ranges
(Partial pressure of carbon dioxide)

A

35 - 45

50
Q

HCO3
(Bicarb)

A

22 - 28

51
Q

3 mechanisms that balance pH

A
  1. Buffer systems
  2. Respiratory system
  3. Renal system
52
Q

Respiratory acidosis

A

pH <7.35
PaCO2 >45

Causes:
Airway obstruction, pneumonia, asthma, chest injuries, pulmonary edema, COPD, opiate use that depresses the RR

53
Q

Metabolic Acidosis

A

pH <7.35
HCO3 <22

Causes: diarrhea, renal failure, diabetic ketoacidosis, hyperkalemia, sepsis

54
Q

Respiratory Alkalosis

A

pH >7.45
PaCO2 <35

Causes: anxiety, high fever, overdose of aspirin

55
Q

Metabolic Acidosis

A

pH >7.45
HCO3 >26

Causes: vomiting, GI suction, hypokalemia, excessive use of antacids with bicarbonate

56
Q

Glucose range

A

70-110

57
Q

Creatinine normal values

A

0.5-1.2

58
Q

Blood Urea Nitrogen (BUN)

A

10-20

59
Q

pH urine

A

4.6 - 8

60
Q

WBC in urine

A

0-4

61
Q

The kidneys

A
  1. Regulate the electrolytes
  2. Eliminate metabolic wastes
  3. Regulate fluid volume
  4. Assist in acid base balance
  5. Regulate BP
  6. Metabolize vitamin D
62
Q

Age-related changes (urinary)

A
  1. Kidney function degrades (GFR)
  2. Secretion of renin, aldosterone, vit D decrease
  3. Bladder muscles weaken, may lead to residual urine & incontinence
  4. Decrease ability to concentrate urine
63
Q

Examples of potentially nephrotoxic substances

A

Antiinfectives
ACE inhibitors (captopril)
Antineoplastic agents (cisplatinmethotrexate)
Immunosuppressants (cyclosporine)
NSAIDs (salicylates, ibuprofen)
Other drugs (acetaminophen, furosemide)
IV contrast media
Heavy metals (lithium, gold salts, lead)
Environmental (pesticides, snake venom)
Recreational drugs (cocaine, heroin)

64
Q

Dysuria

A

Pain or discomfort during urination. (Burning)

Usually caused by inflammation in either the bladder or the urethra.

65
Q

Renal biopsy

A

Purpose: to diagnose the cause of kidney disease, to detect cancer
Procedure: local anesthesia is given, needle is inserted into kidney using ultrasound (10 min procedure)
Preparation: NPO for 6-8hrs, blood tests done prior
Postoperative care: must lie on back for 6-24hrs, expect blood in urine for first 24 hrs. Drink 3000mL to flush urinary system
Home instructions: avoid strenuous activity, report bright red bleeding, dysuria

66
Q

Urinalysis

A

To detect bacteria, blood, casts, and other abnormalities of the urine.

67
Q

Blood urea nitrogen (BUN)

A

To evaluate kidney function and hydration status.

High levels can indicate poor kidney function, dehydration or increased breakdown of body protein)

Lower levels are found in severe liver damage, excessive hydration, and protein deficiency.

68
Q

Serum creatinine

A

To evaluate kidney function.

Creatinine is a waste product, excreted by the kidneys.

69
Q

BUN/creatinine ratio

A

To help distinguish between renal causes and normal causes of abnormal values.

Levels of BUN in the blood are 10-20x higher than creatinine. BUN levels change due to multiple conditions. Creatinine stays relatively constant.

70
Q

Kidneys, ureters, bladder (KUB)

A

To visualize the urinary structures or radiopaque stones.

Single radiographic view of the lower abdomen done without contrast medium.

71
Q

Intravenous pyelogram (IVP)

A

To visualize the kidneys, ureters, bladder. To detect obstructions related to stones or tumors. Rarely used; CT and ultrasound more common.

An iodine-based contrast is given via IV injection, then radiographs are taken at timed intervals, showing the flow of the contrast through renal system

72
Q

Cystogram

A

Can be done with contrast as a voiding cystogram. Can be done with radioactive material — radionuclide cystogram also called a bladder scan.

To visualize the contour of the bladder.

Radiographs are taken before and after sodium iodine is instilled into the bladder through urethral catheter. Or a radionuclide is instilled into the bladder through the catheter, and scanning is done

73
Q

Renal angiography

A

To assess renal arterial system function and identify areas of obstruction to blood flow.

Under local anesthesia, a catheter is threaded through the femoral artery and up the aorta to the renal artery, and a contrast agent is injected. Angiography is preformed to detect complications in a transplanted kidney, to evaluate mass, or to check the extent of kidney trauma.

74
Q

Cystoscopy

A

To examine the interior of the bladder.

Under short-acting or local anesthesia, a cystoscope is passed up the urethra into the bladder. The scope can be guided into a ureter to extract a stone or to biopsy lesions in the bladder. Sedation may be needed.

75
Q

Urethral pressure study

A

To determine urethral pressure needed to maintain urinary continence.

A small catheter with pressure sensing capabilities ie inserted into the bladder. As the pt voids, the varying pressures of the smooth muscle of the urethra are recorded.

76
Q

Renal biopsy

A

To obtain tissue specimen to determine causes of renal disease, to check for malignancy, or to evaluate extent of transplant rejection.

Pt is placed in prone position with pillow under abdomen. A local anesthesia is given. CT or ultrasound is used to identify the position for biopsy needle insertion into the lower lobe of the kidney. The pt must hold breath while needle is inserted and withdrawn. A tissue sample is extracted and sent to the lab.

77
Q

Hematuria definition

A

Blood in urine

78
Q

Cystitis

A

Inflammation of the bladder

79
Q

Anuria definition

A

Absence of urine.

Pts with chronic renal failure who are on dialysis.

80
Q

Oliguria definiton

A

Diminished or abnormally decreased flow of urine.

May result from dehydration, renal failure, or obstruction. Urine output less than 400mL/day

81
Q

Polyuria definition

A

Abnormally high and dilute urine output.

The result of excessive solutes and increased excretion of water. Possible causes include hypercalcemia, diabetes insipidus, uncontrolled diabetes mellitus, increased fluid intake

82
Q

Nocturia definition

A

Urination that occurs during the night

May be related to decrease ability of the aging kidney to concentrate urine.

Med Surg Exam 1 (1 decks)

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