notes ch 11 and pp Flashcards

Question

Furosemide and electrolytes

Answer 1

promotes excretion of magnesium posing a risk of magnesium deficiency. Symptoms include muscle weakness, tremor, twitching, and dysrhythmias. increases urinary excretion of calcium. This action has been exploited to treat hypercalcemia. Furosemide reduces high-density lipoprotein (HDL) cholesterol and raises low-density lipoprotein (LDL) cholesterol and triglycerides.

Answer 2

functions-blood pressure/blood volume/ Ph, water balance muscles, nerves, \ Most abundant cation in EXTRAcellular fluid*Maintains osmotic pressure of extracellular fluid*Regulates renal retention & excretion of water*Responsible for stimulation of neuromuscular reactions & maintains SBP. . Vital for muscle and cardiac contraction &nerve impulse transmission. ”. Na levels affects fluid volume/distribution of other electrolytes

Answer 3

functions-blood pressure/blood volume/ Ph, water balance muscles, nerves, \ Most abundant cation in EXTRAcellular fluid*Maintains osmotic pressure of extracellular fluid*Regulates renal retention & excretion of water*Responsible for stimulation of neuromuscular reactions & maintains SBP. . Vital for muscle and cardiac contraction &nerve impulse transmission. ”. Na levels affects fluid volume/distribution of other electrolytes

Answer 4

over 145 red/rosy bid bloated, causes edema, full bounding pulse, flush skin edema, low grade fever, polydypsia(increast thirst), Late signs_swoolen dry tounge increaser muscle tone, nausea vomiting Both: restlessness fatigue and GI cramp in both

Answer 5

depressed and deflated seizures, coma, increase HR, weak thready pulse, resp arrest Both: restlessness fatigue and GI cramp in both Both have abdominal cramping

Answer 6

bones, blood -clotting factors beats-regulates HR

Answer 7

Bone pain-leaving bones into blood | Kidney stones, muscle weakness, decreased DTR, constipation

Answer 8

weak bones, risk bleeding, dystrythmias diarrhea, Trousseaus(BP arm twirk) Chvosteks(cheek smile when stroke cheek) circumoral tingling risk for fractures risk for bleeding cardiac dysrythmias-not strong heart beats

Answer 9

maintain muscle and heart contraction | Some control over intracellular osmolarity and volumeRegulate protein synthesis, glucose use and storage

Answer 10

``` heart tight and contracted hypotension and bradycardia, GI tight and contracted: diarrhea hyperactive Bowel tones, Neuromuscular-tight and contracted early-muscles twitch burnoing sensations then numbness hands and feet and around the mouth(paresthesia) Late-muscular paralysis increased DTR profound/severe muscle weakness/heaviness respiratory failure confusion ```

Answer 11

Heart low and slow-weak pulse, Irregular hr-changes from slow to fast Dystrythmias Muscles-weak muscles, muscle cramping, flaccid paralysis DTR reduced respiratory failure confusion-irritability andxiety to altered mental status GI-low and slow-decreased motility, hypoactive bowel tonesconstipation, abdominalk distension paralytic ileus-can cause small bowel obsttruction orthostatic hypotension

Answer 12

Hyper--swoolen dry toungue ,, narusea vomiting, confusion Hypo-excessive diarrhea, vomiting, sweating fever-only difference between Cl and Na Normal level: 98 to 106 mEq/LImbalance occurs as a result of other electrolyte imbalancesTreat underlying electrolyte imbalance or acid-base problem

Answer 13

calm keep peace in heart, uterus, DTR needed for calcium and vit d absorption best friend calcium Normal level: 1.3 to 2.1 mg/dLCritical for skeletal muscle contraction, carbohydrate metabolism, ATP formation, vitamin activation, cell growth

Answer 14

``` cardiac-calm and quiet-Heart blocks brady cardia hypoension DTR calm quiet-decreased lungs-depressed shallow respirations GI-calm -hypoactive bowel sounds ``` Both-neuro confused irritable lungs shallow

Answer 15

``` cardiac- v-fib-tachycardia- DTR- wild-increased eyes-abnormal eye movement(nystagmus) GI-diarrhea Both-neuro confused irritable lungs shallow ```

Answer 16

opposite of calcium needed for bonew and teeth formation help regulate calcium always inverse-if phosphate is high calcium is low Normal level: 3.0-4.5 mg/dLFound in bonesActivates vitamins and enzymes; assists in cell growth and metabolismPlasma levels of calcium and phosphorus exist in a balanced reciprocal relationship

Answer 17

Trousseaus sign Chvosteks sign diarrhea Weak bones risk for fractures Weak blood decreased clotting-risk for bleeding Heart beats weak dysrhythmias

Answer 18

``` swoolen slow- COnstipatioon decreased dtr muscle weakness decreased heart rate and respiratory rate Increased BP kidney stones from renal calculi ```

Answer 19

Movement of fluid through cell or blood vessel membrane because of differences in water pressure (hydrostatic pressure) This is related to water volume pressing against confining walls

Answer 20

Water-pushing pressure”Force that pushes water outward from a confined space through a membraneAmount of water in any body fluid space determines pressureExample: Blood pressureMoving whole blood from the heart to capillaries where filtration occurs to exchange water, nutrients, and waste products between the blood and tissues

Answer 21

Develops with changes in normal hydrostatic pressure differences

Answer 22

Free movement of particles (solute) across permeable membrane from area of higher to lower concentrationImportant in transport of most electrolytes; other particles diffuse through cell membranesSodium pumpsGlucose cannot enter most cell membranes without help of insulin

Answer 23

Act together at capillary membrane to maintain normal ECF and ICF volumesThirst mechanism is example of how osmosis helps maintain homeostasisFeeling of thirst caused by activation of brain cells responding to changes in ECG osmolarity

Answer 24

nsensible water loss – Through skin, lungs, stool

Answer 25

Minimum urine amount needed to excrete toxic waste products = 400 to 600 mL/day

Answer 26

Closely linked to/affected by electrolyte concentrationsFluid intakeFluid loss

Answer 27

Aldosterone is secreted by the adrenal cortex whenever sodium levels in the extracellular fluid (ECF) are low. Aldosterone prevents both water and sodium loss. When aldosterone is secreted, it acts on the kidney nephrons, triggering them to reabsorb sodium and water from the urine back into the blood. This action increases blood osmolarity and blood volume. Aldosterone also promotes kidney potassium excretion.

Answer 28

Antidiuretic hormone (ADH), or vasopressin, is released from the posterior pituitary gland in response to changes in blood osmolarity. The hypothalamus contains the osmoreceptors that are sensitive to changes in blood osmolarity. Increased blood osmolarity, especially an increase in the level of plasma sodium, results in a slight shrinkage of these cells and triggers ADH release from the posterior pituitary gland. Because the action of ADH retains just water, it only indirectly regulates electrolyte retention or excretion. ADH acts on kidney nephrons, making them more permeable to water. As a result, more water is reabsorbed by these tubules and returned to the blood, decreasing blood osmolarity by making it more dilute. osmolarity decreases with low plasma sodium levels, the osmoreceptors swell slightly and inhibit ADH release. Less water is then reabsorbed, and more is excreted in the urine, bringing extracellular fluid (ECF) osmolarity up to normal.

Answer 29

Natriuretic peptides (NPs) are hormones secreted by special cells that line the atria of the heart (atrial natriuretic peptide [ANP]) and the ventricles of the heart. (The peptide secreted by the heart ventricular cells is known as brain natriuretic peptide [BNP].) These peptides are secreted in response to increased blood volume and blood pressure, which stretch the heart tissue. NP binds to receptors in the nephrons, creating effects that are opposite of aldosterone. Kidney reabsorption of sodium is inhibited at the same time that urine output is increased. The outcome is decreased circulating blood volume and decreased blood osmolarity.

Answer 30

most important body fluids to keep in balance for optimal function are the blood volume (plasma volume) and the fluid inside the cells (intracellular fluid). Maintaining blood volume at a sufficient level for blood pressure to remain high enough to ensure adequate PERFUSION is critical for life. the kidney is a major regulator of water and sodium balance to maintain blood pressure and perfusion to all tissues and organs, the kidneys monitor blood pressure, blood volume, blood oxygen levels, and blood osmolarity (related to sodium concentration). When kidneys sense that any one of these parameters is getting low, they secrete a substance called renin that sets into motion a group of hormonal and blood vessel responses to ensure that blood pressure is raised back up to normal.

Answer 31

any change in the blood indicating that PERFUSION is at risk. Low blood pressure is a triggering event- it reduces perfusion to tissues and organs. Anything that reduces blood volume (e.g., dehydration, hemorrhage) below a critical level always lowers blood pressure. Low blood oxygen levels also are triggering events because with too little oxygen in the blood it cannot supply the needed oxygen and the tissues and organs could die. A low blood sodium level also is a triggering event because sodium and water are closely linked. Where sodium goes, water follows. So anything that causes the blood to have too little sodium prevents water from staying in the blood. The result is low blood volume with low blood pressure and poor tissue perfusion. kidneys sense that PERFUSION is at risk, cells in the kidney tubule secrete renin into the blood. Renin then activates angiotensinogen. Activated angiotensinogen is angiotensin I, which is activated by the enzyme angiotensin-converting enzyme or ACE to its most active form, angiotensin II Angiotensin II starts several actions to increase blood volume and blood pressure. First it constricts arteries and veins throughout the body which increases peripheral resistance and reduces the size of the vascular bed, which raises blood pressure as a compensatory mechanism without adding more blood volume. Angiotensin II constricts the size of the arterioles that feed the kidney nephrons which results in a lower glomerular filtration rate and a huge reduction of urine output. Decreasing urine output prevents further water loss so more is retained in the blood to help raise blood pressure. Angiotensin II also causes the adrenal glands to secrete the hormone aldosterone. Aldosterone is nicknamed the “water-and-sodium-saving hormone” because it causes the kidneys to reabsorb water and sodium, preventing them from being excreted into the urine. This response allows more water and sodium to be returned to the blood, increasing blood pressure, blood volume, and PERFUSION.

Answer 32

any change in the blood indicating that PERFUSION is at risk. Low blood pressure is a triggering event- it reduces perfusion to tissues and organs. Anything that reduces blood volume (e.g., dehydration, hemorrhage) below a critical level always lowers blood pressure. Low blood oxygen levels also are triggering events because with too little oxygen in the blood it cannot supply the needed oxygen and the tissues and organs could die. A low blood sodium level also is a triggering event because sodium and water are closely linked. Where sodium goes, water follows. So anything that causes the blood to have too little sodium prevents water from staying in the blood. The result is low blood volume with low blood pressure and poor tissue perfusion. kidneys sense that PERFUSION is at risk, cells in the kidney tubule secrete renin into the blood. Renin then activates angiotensinogen. Activated angiotensinogen is angiotensin I, which is activated by the enzyme angiotensin-converting enzyme or ACE to its most active form, angiotensin II Angiotensin II starts several actions to increase blood volume and blood pressure. First it constricts arteries and veins throughout the body which increases peripheral resistance and reduces the size of the vascular bed, which raises blood pressure as a compensatory mechanism without adding more blood volume. Angiotensin II constricts the size of the arterioles that feed the kidney nephrons which results in a lower glomerular filtration rate and a huge reduction of urine output. Decreasing urine output prevents further water loss so more is retained in the blood to help raise blood pressure. Angiotensin II also causes the adrenal glands to secrete the hormone aldosterone. Aldosterone is nicknamed the “water-and-sodium-saving hormone” because it causes the kidneys to reabsorb water and sodium, preventing them from being excreted into the urine. This response allows more water and sodium to be returned to the blood, increasing blood pressure, blood volume, and PERFUSION. Renin-angiotensin II pathway is greatly stimulated with shock, or when stress response is stimulated

Answer 33

Disrupt renin-angiotensin II pathway by reducing amount of ACE produced With less angiotensin II, less vasoconstriction and reduced peripheral resistance  Greater excretion of water and sodium in urine By locking angiotensin II receptors, blood pressure lowersPatients with hypertension often take ACE-inhibitor medications

Answer 34

``` Fluid intake/retention does not meet body’s fluid needs; results in fluid volume deficit Assessment History Physical assessment/clinical manifestations: Cardiovascular Respiratory Skin Neurologic Renal ```

Answer 35

Mannitol-proximal convoluted tubule Na Cl out 65% Furosemide thick segment ascending limb of henlies loop Na Cl out20% Thiazides early distyal convvoluted tubule-Na Cl out 10 % Spironolactone Triamterene late distal convoluted tubule and collecting duct (distal nephron) 1-5%

Answer 36

1 L of water weighs 2.2 lb, equal to 1 kgWeight change of 1 lb = fluid volume change of about 500 mL

Answer 37

AssessmentPatient safetyPulmonary edemaDrug therapyNutrition therapyMonitoring of intake and output (I&O)

Answer 38

``` 3.5-5.5L osmolarity-270-310 NA-135-145 K 3.5-5 Cl-96-109 Ca-8.5-10 Mg-1.6 protein-7-8 ```

Answer 39

``` volume 10L Osmolarity-270-310 Na-135-145 K-3.5-5 Cl-118 Ca-7-9 Mg-1.3 Prpotein-2 ```

Answer 40

``` volume-30 L osmo-270-310 Na-14 K-140 Cl-4-6 Ca-1-8 Mg-6-30 Protein-16 ```

Answer 41

At risk for most electrolyte imbalances from age-related organ changes Have less total body water than younger adults; more at risk for fluid imbalances; more likely to be taking drugs affecting fluid or electrolyte balance

Answer 42

While monitoring a patient who has fluid overload, the nurse would be most concerned about which assessment finding?A.Bounding pulse B.Neck vein distentionC.Pitting edema in the feet D.Presence of crackles in the lungs

Answer 43

A.Dehydration B.Hypokalemia *C.Hyponatremia D.Hypocalcemia

Answer 44

A.IV fluid replacement B.Oral rehydration therapy with tea C.Oral rehydration therapy with water *D.Oral rehydration therapy with a solution containing glucose and electrolytes

Answer 45

Most diuretics share the same basic mechanism of action: blockade of sodium and chloride reabsorption. By blocking the reabsorption of these prominent solutes, diuretics create osmotic pressure within the nephron that prevents the passive reabsorption of water. Hence, diuretics cause water and solutes to be retained within the nephron and thereby promote the excretion of both

Answer 46

The increase in urine flow that a diuretic produces is directly related to the amount of sodium and chloride reabsorption that it blocks. drugs that act early in the nephron have the opportunity to block the greatest amount of solute reabsorption. As a result, these agents produce the greatest diuresis.

Answer 47

can cause hypovolemia (from excessive fluid loss), acid-base imbalance, and altered electrolyte levels. ***These adverse effects can be minimized by using short-acting diuretics and by timing drug administration such that the kidney is allowed to operate in a drug-free manner between periods of diuresis. Both measures will give the kidney periodic opportunities to readjust the ECF so as to compensate for any undesired alterations produced under the influence of diuretics.

Answer 48

These drugs produce more loss of fluid and electrolytes than any other diuretics. They are known as loop diuretics because their site of action is in the loop of Henle.

Answer 49

: Furosemide acts in the thick segment of the ascending limb of Henle's loop to block reabsorption of sodium and chloride. By blocking solute reabsorption, furosemide prevents passive reabsorption of water. Use of furosemide can produce excessive loss of sodium, chloride, and water. Severe dehydration can result. Dehydration can promote hypotension, thrombosis, and embolism. Furosemide is a powerful drug that is generally reserved for situations that require rapid or massive mobilization of fluid.

Answer 50

(1) pulmonary edema associated with congestive heart failure (CHF); (2) edema of hepatic, cardiac, or renal origin that has been unresponsive to less efficacious diuretics; and (3) hypertension that cannot be controlled with other diuretics. especially useful in patients with severe renal impairment, since, unlike the thiazides (see later in the chapter), the drug can promote diuresis even when renal blood flow and glomerular filtration rate (GFR) are low Use of furosemide can produce excessive loss of sodium, chloride, and water. Severe dehydration can result. Dehydration can promote hypotension, thrombosis, and embolism.

Answer 51

Furosemide increases urinary excretion of magnesium, posing a risk of magnesium deficiency. Symptoms include muscle weakness, tremor, twitching, and dysrhythmias. Furosemide increases urinary excretion of calcium. This action has been exploited to treat hypercalcemia. Furosemide reduces high-density lipoprotein (HDL) cholesterol and raises low-density lipoprotein (LDL) cholesterol and triglycerides.

Answer 52

Monitor for signs of dehydration- Signs of evolving dehydration include dry mouth, unusual thirst, and oliguria (scanty urine output). Impending dehydration can also be anticipated from excessive loss of weight. Signs of hypotension include dizziness, light-headedness, and fainting. If blood pressure falls precipitously, furosemide should be discontinued Hypokalemia can be minimized by consuming potassium-rich foods (e.g., dried fruits, nuts, spinach, potatoes, bananas), taking potassium supplements, or using a potassium-sparing diuretic. Because of the risk of hearing loss, caution is needed when loop diuretics are used in combination with other ototoxic drugs When furosemide is taken by a diabetic patient, he or she should be especially diligent about monitoring blood glucose content.

Answer 53

Diuretics are the most common cause of adverse medication reactions and interactions in older adults. Monitor closely for dehydration and cardiac dysrhythmias.

Answer 54

Diuretics can be used safely in children, just in smaller doses. Side effect profiles are similar to those for adults.

Answer 55

Animal studies revealed that furosemide can cause maternal death, abortion, and fetal resorption. Risks and benefits must be considered for administration during pregnancy.

Answer 56

Furosemide may decrease breast milk production through excessive diuresis. Data are lacking regarding transmission of drug from mother to infant via breast milk.

Answer 57

Furosemide can produce excessive loss of sodium, chloride, and water. Severe dehydration can result. Dehydration can promote thrombosis and embolism. If dehydration occurs, furosemide should be withheld. The risk of dehydration and its sequelae can be minimized by initiating therapy with low doses, adjusting the dosage carefully, monitoring weight loss every day, and administering furosemide on an intermittent schedule. Furosemide can cause a substantial drop in blood pressure. At least two mechanisms are involved: (1) loss of volume and (2) relaxation of venous smooth muscle, which reduces venous return to the heart. Hypokalemia.Potassium is lost through increased secretion in the distal nephron. If serum potassium falls below 3.5 mEq/L, fatal dysrhythmias may result. Ototoxicity.- Rarely, loop diuretics cause hearing impairment. Hyperglycemia- Elevation of plasma glucose is a potential, albeit uncommon, complication of furosemide therapy. Hyperuricemia- Elevation of plasma uric acid is a frequent side effect of treatment. patients predisposed to gout, elevation of uric acid may precipitate a gouty attack Pregnancy- In animals loop diuretics have caused maternal death, abortion, fetal resorption, and other adverse effects- only use if you have to.

Answer 58

have effects similar to those of the loop diuretics. Like the loop diuretics, thiazides increase renal excretion of sodium, chloride, potassium, and water. In addition, thiazides elevate plasma levels of uric acid and glucose. The principal difference between the thiazides and loop diuretics is that the maximum diuresis produced by the thiazides is considerably lower than the maximum diuresis produced by the loop diuretics. In addition, whereas loop diuretics can be effective even when urine flow is decreased, thiazides cannot.

Answer 59

Hydrochlorothiazide promotes urine production by blocking the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule The primary indication for hydrochlorothiazide is hypertension Thiazides are preferred drugs for mobilizing edema associated with mild to moderate heart failure. Diabetes insipidus is a rare condition characterized by excessive production of urine. In patients with this disorder, thiazides reduce urine production by 30% to 50%. Thiazides promote tubular reabsorption of calcium and may thereby decrease the risk of osteoporosis in postmenopausal women. thiazides promote renal calcium retention, they may counteract the calcium loss associated with menopause and may thereby help preserve bone integrity.

Answer 60

Thiazides increase excretion of magnesium, sometimes causing magnesium deficiency. Symptoms include muscle weakness, tremor, twitching, and dysrhythmias. Loss of sodium, chloride, and water can lead to hyponatremia, hypochloremia, and dehydration. Hypokalemia- thiazides can cause hypokalemia from excessive potassium excretion. Hyperglycemia-thiazides can elevate plasma levels of glucose. Significant hyperglycemia develops only in diabetic patients, who should be especially diligent about monitoring blood glucose. Hyperuricemia-The thiazides, like the loop diuretics, can cause retention of uric acid, thereby elevating plasma uric acid. Thiazides can increase levels of LDL cholesterol, total cholesterol, and triglycerides.

Answer 61

blocks the actions of aldosterone in the distal nephron. Since aldosterone acts to promote sodium uptake in exchange for potassium secretion, inhibition of aldosterone has the opposite effect: retention of potassium and increased excretion of sodium

Answer 62

Hypertension and edema- used most commonly in combination with a thiazide or loop diuretic. In patients with severe heart failure, spironolactone reduces mortality and hospital admissions. spironolactone can be used for primary hyperaldosteronism, premenstrual syndrome , polycystic ovary syndrome, and acne in young women.

Answer 63

can cause a variety of endocrine effects, including gynecomastia, menstrual irregularities, impotence, hirsutism, and deepening of the voice. The potassium-sparing effects of spironolactone can result in hyperkalemia, a condition that can produce fatal dysrhythmias- monitor heart. If serum potassium rises above 5 mEq/L or if signs of hyperkalemia develop (e.g., abnormal heart rhythm), spironolactone should be discontinued and potassium intake restricted. Injection of insulin can help lower potassium levels by promoting potassium uptake into cells. When given long term to rats in doses 25 to 250 times those used in humans, spironolactone has caused benign adenomas of the thyroid and testes, malignant mammary tumors, and proliferative changes in the liver. To promote safe administration, NIOSH suggests donning a protective gown and two sets of gloves when cutting or crushing tablets.

Answer 64

are IV fluids that contain larger non–water-soluble molecules that increase the osmotic pressure in the plasma volume. These fluids are most useful in helping to maintain plasma volume with a lower infused volume.

Answer 65

Crystalloids are IV fluids that contain water, minerals (electrolytes), and sometimes other water-soluble substances such as glucose. These fluids rapidly disperse to all body fluid compartments and are most useful when dehydration includes both the intracellular and extracellular compartments.

Answer 66

normal serum osmolarity for adults is between 270 and 300 mOsm/L. Parenteral solutions within that normal range are isotonic fluids greater than 300 mOsm/L are hypertonic fluids less than 270 mOsm/L are hypotonic. Hypertonic solutions are used to correct altered FLUID AND ELECTROLYTE BALANCE and acid-base imbalances by moving water out of the body's cells and into the bloodstream. Parenteral nutrition solutions are hypertonic. hypotonic infusates move water into cells to expand them. Patients receiving either hypertonic or hypotonic fluids are at risk for phlebitis and infiltration.