QUIZ 4 Flashcards
What is FVD
-loss of water and electrolytes
What is dehydration
-loss of water without electrolytes
What are the 7 causes of FVD
- GI LOSS(V,D, NGT SUCTION)
- SKIN LOSS
- WOUND LOSS.
- RENAL LOSS
- THIRD SPACING(burns).
- HEMORRHAGE.
- ALTERED INTAKE
What is a complication of dehydration
-hypovolemic shock
What are the 4 causes of dehydration
- Hyperventilation
- Prolonged fever
- Diabetic ketoacidosis
- Eneteral feedings w/o enough H2O
How does the body compensate dehydration
sympathetic nervous system or ADH
What are the 8 signs and symptoms of FVD
- Hyperthermia
- Tachycardia
- Thready pulse
- Hypotension.
- Decreased CVP
- Tachypnea
- Hypoxia
- Decreased capillary refill
Is the hematocrit increased or decreased in hypovolemia and dehydration?
increased
What is the osmolality to concur that the patient is experiencing fluid volume deficiency ?
-295 mOsm/kg
The urine specific gravity is _____ in order to concur that the patient is dehydrated
greater than 1.030
The sodium level is ______ in order for to concur that the patient is experiencing fluid volme deficit?
greater than 145 meq/L
What 4 labs are increased in FVD
-PROTEIN,
BUN,
ELECTROLYTES,
AND GLUCOSE
What fluid replacements should be given in FVD
-lactated ringers, 0.9% sodium chloride and blood transfusions
When you discover the patient fluid volume deficient, what should you do first ?
initiate and maintain IV access
What is fluid volume excess by definition
retention of water and sodium
Is blood volume increased or decreased in fluid volume excess?
-increased
What happens to the patient’s hematocrit, electrolytes and protein when they are overhydrated?
-it is decreased
How does the body compensate fluid volumes excess?
-natriuretic peptides are increased and aldosterone is decreased
4 risk factors of fluid volume excess
- CHF
- Cirrhosis
- Kidney failure
- Interstitial to plasma fluid
What are some expected findings of fluid volume excess ?
- Tachycardia
- Muscle weakness
- Increased CVP.
- Tachypnea.
- Dyspnea
- Weight gain
- Edema
- Neck vein distention
What is an important nursing intervention for a fluid volume excess patient ?
-daily weight at same time with the same scale
Electrolytes, BUN, and serum osmolality is ____ when the patient is experiencing fluid volume excess ?
decreased
What is the regular level for sodium ?
-135-145 mEq/L
What is the pneumonic for hypernatremia causes ?
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
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
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
What is euvolemic hyponatremia?
-water increased but the sodium stays the same
What are the 2 causes of euvolemic hyponatremia?
SIADH + Diabetes insipidus
What is another name for dehydration?
-hypovolemic hyponatremia
What is another name for Edema?
-hypervolemic hyponatremia
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
What are the steps of how to treat hypovolemic hyponatremia?
Administer IV – Hypertonics – given via central line – Monitor closely – infuse slowly
What are the steps to treat hypervolemic hyponatremia ?
-Restrict fluids – order diuretics in some cases.
What are steps to treat SIADH?
-Treat with Declomycin, Convaptan, Tolvaptan (Antagonist to ADH)
What are the steps to treat lithium ?
-Check drug levels, increase salt in diet.
What are normal level of potassium?
-3.5-5.1
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.
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
What are the ECG changes of hypokalemia?
- ST depression
- flattened T wave
- presence of U wave
- prolonged QRS
- Ventricular dysrhythmias
- bradycardia
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 BananasWhat 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)
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
What is the drug to lower potassium ?
-Kayexalate
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
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)
In terms of IV calcium how is administerd
-slowly
What oral medications can treat hypocalcemia ?
-vitamin D and calcium
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
2 things that need to be monitored if the patient is experiencing hypocalcemia ?
- Fractures
2. laryngeal spasm
Erythropoietin releases in response to:
-hypoxia and decreased renal flow
What system regulates blood pressure using the kidneys?
-RAAS
What are the 3 lower urinary tract infections ?
- Cystitis
- Urethritis.
- Prostatitis
What are the 2 upper urinary tract infections ?
- Uretritis
2. Pyelonephritis
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
What is the nurse’s role in for UA
-Obtain clean catch specimen
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
Your patient had an increased creatinine level and decreased GFR. What does this mean ?
Renal issue
Your patient has an increased BUN, What does this mean ?
Fluid volume deficit
What type of bath can be used if your patient has a UTI
Warm sitz bath
How often should a UTI patient void
-every 3 to 4 hours
What are 3 complications of UTI ?
- Urosepsis/septic shock
- CKD
- HTN
What are lab tests used to diagnosis renal calculi ?
-UA, RBC, WBC, CRYSTALLURIA, serum Ca+2
What are diagnostic procedures used to diagnose renal calculi?
KUB, IVP(contraindicated if obstruction), CT, MRI, Renal US, cystoscopy
Always administer ________ first in renal calculi patients
-analgesics
