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MED SURGE > QUIZ 4 > Flashcards

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
Q

What is the pneumonic for hypernatremia signs and symptoms ?

A 
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

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26
Q

How do you treat hypernatremia?

A

-restrict sodium intake, move patient closer to nursing station, iso or hypo IV, educate about diet and signs and symptoms

27
Q

What is euvolemic hyponatremia?

A

-water increased but the sodium stays the same

28
Q

What are the 2 causes of euvolemic hyponatremia?

A

SIADH + Diabetes insipidus

29
Q

What is another name for dehydration?

A

-hypovolemic hyponatremia

30
Q

What is another name for Edema?

A

-hypervolemic hyponatremia

31
Q

What is the pneumonic for the signs and symptoms of hyponatremia?

A

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
Q

What are the steps of how to treat hypovolemic hyponatremia?

A

Administer IV – Hypertonics – given via central line – Monitor closely – infuse slowly

33
Q

What are the steps to treat hypervolemic hyponatremia ?

A

-Restrict fluids – order diuretics in some cases.

34
Q

What are steps to treat SIADH?

A

-Treat with Declomycin, Convaptan, Tolvaptan (Antagonist to ADH)

35
Q

What are the steps to treat lithium ?

A

-Check drug levels, increase salt in diet.

36
Q

What are normal level of potassium?

A

-3.5-5.1

37
Q

What is the pneumonic for the causes of hypokalemia?

A

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
Q

What are the 7 L’s of hypokalemia

A 
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
Q

What are the ECG changes of hypokalemia?

A
  • ST depression
  • flattened T wave
  • presence of U wave
  • prolonged QRS
  • Ventricular dysrhythmias
  • bradycardia
40
Q

What foods are high in potassium ?

A 
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
Q

What are causes of hyperkalemia ?

A

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
Q

What are signs and symptoms of hyperkalemia ?

A

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
Q

What is the drug to lower potassium ?

A

-Kayexalate

44
Q

What are the causes of hypocalcemia ?

A

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
Q

What are the signs and symptoms of hypocalcemia ?

A

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
Q

In terms of IV calcium how is administerd

A

-slowly

47
Q

What oral medications can treat hypocalcemia ?

A

-vitamin D and calcium

48
Q

What are some food with calcium ?

A 
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
Q

2 things that need to be monitored if the patient is experiencing hypocalcemia ?

A
  1. Fractures

2. laryngeal spasm

50
Q

Erythropoietin releases in response to:

A

-hypoxia and decreased renal flow

51
Q

What system regulates blood pressure using the kidneys?

A

-RAAS

52
Q

What are the 3 lower urinary tract infections ?

A
  1. Cystitis
  2. Urethritis.
  3. Prostatitis
53
Q

What are the 2 upper urinary tract infections ?

A
  1. Uretritis

2. Pyelonephritis

54
Q

What are causes of UTI ?

A

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
Q

What is the nurse’s role in for UA

A

-Obtain clean catch specimen

56
Q

What is the scope used mostly for recurrent UT and what does it assess

A

cystocopy and it assesses the inside of the bladder and urethra

57
Q

Your patient had an increased creatinine level and decreased GFR. What does this mean ?

A

Renal issue

58
Q

Your patient has an increased BUN, What does this mean ?

A

Fluid volume deficit

59
Q

What type of bath can be used if your patient has a UTI

A

Warm sitz bath

60
Q

How often should a UTI patient void

A

-every 3 to 4 hours

61
Q

What are 3 complications of UTI ?

A
  1. Urosepsis/septic shock
  2. CKD
  3. HTN
62
Q

What are lab tests used to diagnosis renal calculi ?

A

-UA, RBC, WBC, CRYSTALLURIA, serum Ca+2

63
Q

What are diagnostic procedures used to diagnose renal calculi?

A

KUB, IVP(contraindicated if obstruction), CT, MRI, Renal US, cystoscopy

64
Q

Always administer ________ first in renal calculi patients

A

-analgesics

MED SURGE (2 decks)

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