module 5.1, 5.2, 5.3 NSG 155

Question 0

loop diuretics

Answer 0

examples (lasix,bumex) they lose k+, calcium and sodium, given for SIADH and FVE, know BP, k level, creatinine, BUN before you give also STOP them when a pt has FVD or is dehydrated or metabolic alkalosis K low)

Question 1

Normal electrolyte levels

Answer 1

k- 3.5-5.0 (potassium)
na- 136-145 (sodium)
ca- 9.0-10.5 ( calcium) 
mg- 1.3-2.1 (magnesium)
phosphorous- 3.0-4.5
cl- 98-106 (chloride)
albumin- 3.4-5
hemoglobin 12-16 female 14-18 male
hematocrit 36-47 female 42-52 male

Question 2

hyponaturemia

Answer 2

less than 136 low sodium caused by diuertics, ace inhibitors, addisons patient, diarrhea and vomitting, drowning, renal failure, diabetic, may have altered LOC, cerebral edema, anxious, hyper, muscle weakness, twitching, orthostatic hypotension, tachycardia treat the cause, increase intake, give normal saline or lactated ringers (isotonic) or a hypertonic IV solution, restrict fluids to people with water intoxication (dilutional hyponaturemia) (low na but over hydrated)

Question 3

hypernaturemia

Answer 3

sodium over 145- caused by steroids, sweating, cushings pt, over infusing IV, infection, fever pt will have a decreased LOC, muscle twitching, full bounding pulse, pad the side rails because they can seize, give a loop, hypotonic IV, eat low sodium less than 2 gram, stop smoking, exercise, fresh fruits and veggies

Question 4

hypokalemia

Answer 4

potassium less than 3.5- caused by loops, steroids, ng tubes vomiting, diarhhea, metabolic alkalosis, these pts have arrhythmia, shallow respirations, low BP, altered LOC, hypoactive bowel sounds, distended abdomen, leg cramps give IV at 10 an hour ONLY on a pump never IV push, monitor site for phlebitis because k is a vesicant and is very irritating to skin, increase potassium intake, give supplements STOP digoxin because of possible dig toxicity

Question 5

hyperkalemia

Answer 5

potassium above 5- caused by excessive intake, too much IV, k sparing diuretics(aldactalone,spiractalone) can cause muscle weakness, arrythmias, cardiac arrest, GI upset, give k-exelate, give a loop, give insulin d50

Question 6

calcium

Answer 6

when calcium is up, phosphate is down, when calcium is low, the pt can have trousseaus and chvoteks, nerve impulses, skeletal, muscle contractions, if pt had thyroid or neck surgery they can also have low calcium,

Question 7

hypoalbuminemia

Answer 7

low protein, caused by dehydration, malnutrition, dehydration, starving, dieting, burns liver disease, chronic infection

Question 8

normal ABG levels

Answer 8

pH- 7.35-7.45
HCO3- 21-28
pCo2- 35-45
02- 80-100

Question 9

respiratory acidosis

Answer 9

co2 above 45, pH below 7.35, they are hypo ventilating, also caused by narcotics, COPD, head/neck trauma, obesity, cushings, asthma, smoking. give them pain meds, tell them to cough and deep breathe, mechanically ventilate, steroids, low flow o2, give narcan for opioid overdose, make sure their LOC is WNL (earliest sign of hypoxia)

Question 10

respiratory alkalosis

Answer 10

co2 below 35, pH above 7.45, caused mostly by fear and anxiety, also aspirin toxicity, they are hyperventilating (give a mask or paper bag) give mucomyst for aspirin tox

Question 11

metabolic acidosis

Answer 11

HCO3 below 21 pH below 7.35, caused by renal disease, uncontrolled diabetic, DKA, seizures, diarhhea(out your ass) k-sparings, your gonna see and increases RR, kussmauls respirations, give k-exelate to get rid of k, also give d50 w/ insulin

Question 12

metabolic alkalosis

Answer 12

HCO3 above 28 pH above 7.45, k is low, caused by antacid use (tums) TPN therapy, they are going to complain of muscle weakness, vomiting, you want to give antiemetics

Question 13

hypothyroidism

Answer 13

under active thyroid gland due to thyroidectomy, atrophy of the gland, autoimmune disorders, there is an increased TSH and a decreased t3 and t4, people have slow metabolism, happens to women more than men, they also have cardiomegaly, activity intolerance, high cholesterol, slurred slow speech, altered LOC, and are overweight, treat with synthroid and if they had a thyroidectomy make sure they take this med all their life. put them on a low calorie diet

Question 14

hyperthyroidism

Answer 14

sustained release of thyroid hormone (over active) increased level of t3 and t4 and a decreased level of TSH, causes are autoimmune (graves) or goiters, everything speeds up so tachycardia, increased metabolism, increased systolic BP, frequent bowel movements, fast RR, warm moist skin, muscle weakness, restlessness, increased temperature give an anti thyroid med PTU, a b-blocker to manage their hypertension and tachycardia(propranolol, inderal) an iodine solution SSKI, Lugol) and tapazole

Question 15

thyroidectomy

Answer 15

removal of all ( total) or part of the thyroid gland (subtotal) women who are of child bearing age usually have a subtotal thyroidectomy and before either surgery is done the client must have a normal (euthroid) state with iodine if they have a total then they must take synthroid lifelong and if they have a partial they may still produce some thyroid hormone. teach them how to support their head and neck while turning before surgery also teach them how to cough and deep breathe before surgery, and after surgery have calcium gluconate at the bed side because the surgery will cause hypocalcemia and look for chvoteks and trousseaus and stridor can be the first sign of hypocalcemia. check the front and back of their dressings to make sure they are not bleeding have a crash cart, calcium and a trach kit at the bedside also, the parathyroid glands may accidently be removed so this is a risk of doing the surgery

Question 16

cushings syndrome

Answer 16

excessive secretion of cortisol from the adrenal glands, excess glucocorticoids, excess secretion of ACTH and aldosterone, pt’s will have weight gain, pinpoint pupils, low potassium and high sodium, high blood glucose, delayed wound healing and poor nutrition, do strict i&O’s and a low sodium diet, and restrict fluid, highest risk is a patient on long term steroids, if they have an adrenalectomy it’s to remove the adrenal glands due to hyperfunction, if they can’t operate on pt due to cancer of adrenal cortex, MITOTANE is given

Question 17

addisons disease

Answer 17

hypo function of the adrenal cortex, due to surgery, autoimmune disease, trauma, tumors, atrophy of the gland, they are going to have a bronzy appearance due to an increases MSH and have increased potassium and low sodium, give them d50 w/ insulin, and a loop diuretic, they are going to have hypoglycemia, weight loss, nausea, anorexia, diarrhea, the goal is to replace glucocorticoids and mineralcorticoids by giving a synthetic aldosterone (cortisone, Florinef) make sure they take this med with meals to prevent to GI upset or bleed. pt may have addisonian crisis (hypovolemic shock due to lack of aldosterone