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QUIZ 4 Flashcards

1
Q

What is FVD

A

-loss of water and electrolytes

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2
Q

What is dehydration

A

-loss of water without electrolytes

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3
Q

What are the 7 causes of FVD

A
  1. GI LOSS(V,D, NGT SUCTION)
  2. SKIN LOSS
  3. WOUND LOSS.
  4. RENAL LOSS
  5. THIRD SPACING(burns).
  6. HEMORRHAGE.
  7. ALTERED INTAKE
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4
Q

What is a complication of dehydration

A

-hypovolemic shock

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5
Q

What are the 4 causes of dehydration

A
  1. Hyperventilation
  2. Prolonged fever
  3. Diabetic ketoacidosis
  4. Eneteral feedings w/o enough H2O
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6
Q

How does the body compensate dehydration

A

sympathetic nervous system or ADH

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7
Q

What are the 8 signs and symptoms of FVD

A
  1. Hyperthermia
  2. Tachycardia
  3. Thready pulse
  4. Hypotension.
  5. Decreased CVP
  6. Tachypnea
  7. Hypoxia
  8. Decreased capillary refill
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8
Q

Is the hematocrit increased or decreased in hypovolemia and dehydration?

A

increased

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9
Q

What is the osmolality to concur that the patient is experiencing fluid volume deficiency ?

A

-295 mOsm/kg

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10
Q

The urine specific gravity is _____ in order to concur that the patient is dehydrated

A

greater than 1.030

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11
Q

The sodium level is ______ in order for to concur that the patient is experiencing fluid volme deficit?

A

greater than 145 meq/L

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12
Q

What 4 labs are increased in FVD

A

-PROTEIN,
BUN,
ELECTROLYTES,
AND GLUCOSE

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13
Q

What fluid replacements should be given in FVD

A

-lactated ringers, 0.9% sodium chloride and blood transfusions

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14
Q

When you discover the patient fluid volume deficient, what should you do first ?

A

initiate and maintain IV access

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15
Q

What is fluid volume excess by definition

A

retention of water and sodium

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16
Q

Is blood volume increased or decreased in fluid volume excess?

A

-increased

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17
Q

What happens to the patient’s hematocrit, electrolytes and protein when they are overhydrated?

A

-it is decreased

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18
Q

How does the body compensate fluid volumes excess?

A

-natriuretic peptides are increased and aldosterone is decreased

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19
Q

4 risk factors of fluid volume excess

A
  1. CHF
  2. Cirrhosis
  3. Kidney failure
  4. Interstitial to plasma fluid
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20
Q

What are some expected findings of fluid volume excess ?

A
  1. Tachycardia
  2. Muscle weakness
  3. Increased CVP.
  4. Tachypnea.
  5. Dyspnea
  6. Weight gain
  7. Edema
  8. Neck vein distention
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21
Q

What is an important nursing intervention for a fluid volume excess patient ?

A

-daily weight at same time with the same scale

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22
Q

Electrolytes, BUN, and serum osmolality is ____ when the patient is experiencing fluid volume excess ?

A

decreased

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23
Q

What is the regular level for sodium ?

A

-135-145 mEq/L

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24
Q

What is the pneumonic for hypernatremia causes ?

A

H – Hyper-cortisolism – Cushings, Hyperventilation
I – Increased Intake, IV solutions
G – GI causes – Feed without water.
H – Hypertonic solutions

S – Sodium excretion decreased – with steroids
A – Aldosterone increased
L – Loss of fluids
T – Thirst Impairment

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25
What is the pneumonic for hypernatremia signs and symptoms ?
``` F-flushed skin and fever R-Restless, irritable, anxious I-increased BP and fluid retention E-edema D- decreased urine output ``` S-skin flushed A-agitation L-low grade fever T-thirst
26
How do you treat hypernatremia?
-restrict sodium intake, move patient closer to nursing station, iso or hypo IV, educate about diet and signs and symptoms
27
What is euvolemic hyponatremia?
-water increased but the sodium stays the same
28
What are the 2 causes of euvolemic hyponatremia?
SIADH + Diabetes insipidus
29
What is another name for dehydration?
-hypovolemic hyponatremia
30
What is another name for Edema?
-hypervolemic hyponatremia
31
What is the pneumonic for the signs and symptoms of hyponatremia?
S – Seizures and Stupor A – Abdominal cramping, Attitude Changes (Confusion) L - Lethargy T – Tendon Reflexes diminished, Trouble concentrating L – Loss of Urine, Less Apetite O – Orthostatic Hypotension, Overactive Bowel sounds S – Shallow respirations (Late sign) S – Spasm of muscles
32
What are the steps of how to treat hypovolemic hyponatremia?
Administer IV – Hypertonics – given via central line – Monitor closely – infuse slowly
33
What are the steps to treat hypervolemic hyponatremia ?
-Restrict fluids – order diuretics in some cases.
34
What are steps to treat SIADH?
-Treat with Declomycin, Convaptan, Tolvaptan (Antagonist to ADH)
35
What are the steps to treat lithium ?
-Check drug levels, increase salt in diet.
36
What are normal level of potassium?
-3.5-5.1
37
What is the pneumonic for the causes of hypokalemia?
D – Drugs – Overuse of Laxatives, Diuretics, Corticosteroids I – Inadequate intake - Anorexia, Nausea, T – Too much water intake – Dilute K in blood C – Cushing’s Syndrome – Increased Aldosterone H – Heavy Fluid Loss – Nausea, Diarrhea, NG suction, Vomiting, Wound drainage, Sweating.
38
What are the 7 L’s of hypokalemia
``` L -- Lethargic L – Low Shallow Respiration L – Loss of Urine L – Lethargic Cardiac Activities L – Leg Cramps L – Limping Muscles L – Low BP and HR ```
39
What are the ECG changes of hypokalemia?
- ST depression - flattened T wave - presence of U wave - prolonged QRS - Ventricular dysrhythmias - bradycardia
40
What foods are high in potassium ?
``` P – Potatoes and Pork O – Oranges T - Tomatoes A – Avocados S – Strawberries S – Spinach F I- sh M U shroom M – Melons – Cantaloupe **Carrots, Raisins and Bananas ```
41
What are causes of hyperkalemia ?
C – Cellular movement from Intracellular to Extracellular (Burns, Acidosis) A – Adrenal Insufficiency – Addison’s R – Renal Failure E – Excessive Intake D – Drugs (K sparing diuretics eg Aldactone, ACE inhibitor)
42
What are signs and symptoms of hyperkalemia ?
M – Muscle Weakness U – Urine production low or absent R – Respiratory failure – failure of accessory muscles, Seizures D – Decreased cardiac contractility – weak pulse, low BP, Diarrhea E – Early signs of Muscle twitching or cramps, Late – signs of profound muscle weakness R – Rhythm changes – Tall peaked T wave, prolonged PR interval, ST segment depression, Loss of P wave, widening QRS, Ventricular fibrillation, and ventricular standstill
43
What is the drug to lower potassium ?
-Kayexalate
44
What are the causes of hypocalcemia ?
L – Low PTH O – Oral intake inadequate W – Wound drainage – Esp GI system where calcium is absorbed C – Celiac and Crohn’s disease A – Acute Pancreatitis L – Low Vit D C – Chronic Kidney issues – Wasting of calcium I – Increased Phosphorous in blood (PTH and Calcitonin) U – Using medication – Mag supplements, Laxatives, Loop diuretics M – Mobility – Long term immobility
45
What are the signs and symptoms of hypocalcemia ?
C – Confusion R – Reflexes hyperactivity A – Arrythmias (Prolonged QT and ST) M – Muscle spasm in Calves or Feet – Tetany/Seizures P – Positive Trousseau’s and Chevostek’s (Cheeks)
46
In terms of IV calcium how is administerd
-slowly
47
What oral medications can treat hypocalcemia ?
-vitamin D and calcium
48
What are some food with calcium ?
``` Young Sally’s Calcium Serum Continues To Randomly Mess-up Y – Yogurt S – Sardines C – Cheese S – Spinach C – Collard greens and brocolli T – Tofu R – Rhubarb M - Milk ```
49
2 things that need to be monitored if the patient is experiencing hypocalcemia ?
1. Fractures | 2. laryngeal spasm
50
Erythropoietin releases in response to:
-hypoxia and decreased renal flow
51
What system regulates blood pressure using the kidneys?
-RAAS
52
What are the 3 lower urinary tract infections ?
1. Cystitis 2. Urethritis. 3. Prostatitis
53
What are the 2 upper urinary tract infections ?
1. Uretritis | 2. Pyelonephritis
54
What are causes of UTI ?
H – Hormone Changes – Birth Control, Pregnancy – Changes normal flora. HYGEINE – not cleaning properly. A – Antibiotics – Changes Normal Flora R – Renal Stones – prevents drainage of urine D – Diabetes – Compromised circulation, Weak Immune system, Urinary Retention (Diabetic Neuropathy causes weak nerves, Glucose in urine) T – Toiletries – Tampons, bubble baths, powders and perfumes used in bubble bath/tampons or sanitary pads. O – Obstructive prostatic hypertrophy – Males only known as BPH – causes urinary retention and decreased antimicrobial fluid. V – Vesico-ureteral reflux – VUR – Mostly in pediatrics – Urine back flows into kidneys causing infection. O – Overextended bladder – Bladder not emptied – Immobile persons, weak bladder muscles, Old aged, nurses. Neurogenic bladder I – Invasive procedures – Indwelling catheters – Intercourse (especially if spermicides are used – Void after sex), Incontinence of stool D – Decreased immune system – Viral or Fungal
55
What is the nurse’s role in for UA
-Obtain clean catch specimen
56
What is the scope used mostly for recurrent UT and what does it assess
cystocopy and it assesses the inside of the bladder and urethra
57
Your patient had an increased creatinine level and decreased GFR. What does this mean ?
Renal issue
58
Your patient has an increased BUN, What does this mean ?
Fluid volume deficit
59
What type of bath can be used if your patient has a UTI
Warm sitz bath
60
How often should a UTI patient void
-every 3 to 4 hours
61
What are 3 complications of UTI ?
1. Urosepsis/septic shock 2. CKD 3. HTN
62
What are lab tests used to diagnosis renal calculi ?
-UA, RBC, WBC, CRYSTALLURIA, serum Ca+2
63
What are diagnostic procedures used to diagnose renal calculi?
KUB, IVP(contraindicated if obstruction), CT, MRI, Renal US, cystoscopy
64
Always administer ________ first in renal calculi patients
-analgesics

MED SURGE (2 decks)

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