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MedSurg > S3 E1 > Flashcards

S3 E1 Flashcards

1
Q

Hypertonic

A

Pushes water out
Shrinks
Tx: hyponeutremia

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2
Q

Hypertonic solutions

A

D5 NS
D5 1/2 NS
3% NS

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3
Q

Concerns it giving hypertonic solutions

A

Fluid overload
⬆️ Na (neuro assessment)

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4
Q

Isotonic

A

⬆️ fluid volume
Without moving in or out
Give with blood

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5
Q

Isotonic solutions

A

LR
9% NS

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6
Q

Hypotonic

A

Push water into cell
Swells
Tx: hyper neutremia, hyperosmotic

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7
Q

Hypotonic solutions

A

. 45% NS
D5 in H20

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8
Q

Diffusion

A

Movement of molecules from⬆️ to⬇️ concentration

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9
Q

Osmosis

A

Movement of H20 from⬇️ to⬆️ concentration

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10
Q

Why do fluids move?

A
  • Preserve tissue perfusion
  • H2O and Na balance
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11
Q

1st space said

A

Fluid is Where it belongs

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12
Q

2nd space fluid

A

Abnormal blind in interstitial space
Edema

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13
Q

3rd spacing fluid

A

Fluid moves into extracellular&extravascular
Difficult to move back into cell
Ascites

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14
Q

Hemoconcentration

A

High & dry
⬇️ fluid
Thick, sludge
⬆️ lab values
Fluid dehydration

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15
Q

Solution to corrected hemoconcentration

A

Isotonic
NS

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16
Q

Hemodilution

A

Low & liquidy
⬆️ fluid⬇️ sodium
⬇️ lab values
🚨Fluid overload = renal/heart failure

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17
Q

Dehydration

A

Pure water loss
⬇️ ICF
Hyper osmolar
⬆️ Na
Thirst & neuro symptoms

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18
Q

How to replace water deficit for a patient with dehydration

A

Orally
IVF (NS or LR)
Blood
Depends on cause

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19
Q

Hypovolemia

A

Electrolyte & H2O ⬇️
ECF is impacted
Array or symptoms

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20
Q

How to treat a patient who is hypovolemic

A

Correct hypovolemic symptoms 1st
Orally and diet
Replace NA & H2O
Isotonic (NS or LR)
Blood transfusion

🚨 prevent hypovolemic shock

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21
Q

Labs you may see with hypovolemia (9)

A

Albumin
Bun
Creatinine
Hematocrit
Serum sodium
Serum osmolality (280 - 295)
Urine Osmo
Specific gravity (1.005 - 1.030)
Daily wts

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22
Q

Symptoms of hypovolemic shock (10)

A

AMS
Pale/blush, cool moist skin
Rapid breathing
Restlessness/irritable
Excessive thirst
Rapid and week pulse
Cause and/or vomiting
⬇️ BP
⬇️ urine output
Absent bowel sounds

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23
Q

Sodium normal values, ECF or ICF

A

136 - 145
ECF

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24
Q

Potassium lab values, ECF or ICF

A

3.5-5.0
ICF

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25
Q

Magnesium lab values, ECF or ICF

A

1.3-2.1
ICF

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26
Q

Calcium lab values, ECF or ICF

A

9.0-10.5
ECF

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27
Q

Sodium major roles

A

Neuro
BP control
Fluid balance
Nerve impulse

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28
Q

Potassium major roles

A

Kardiac
Heartbeat
Cardiac rhythm
Nerve function

29
Q

Magnesium major roles

A

Muscle 💪 Contraction
Assist in ATP production = Energy ⚡️

30
Q

Calcium major roles

A

Strong bones 🦴
Blood clotting
Muscle contraction

31
Q

Phosphate major role

A

Bone formation

32
Q

How to correct imbalances?

A

Acute vs chronic
Oral replacement
Diet/nutrition
IVF
Electrolyte replacement PO/IV
Restrictions
Dialysis
Meds

33
Q

What imbalance is this?

Cell shrinkage = Neuro impairment
Cause: acute dehydration

A

Hypernatremia

34
Q

What imbalance is this?

Mental status change
Muscle weakness
Seizures with very low values

A

Hyponatremia

35
Q

Acute hyponatremia tx

A

Get pt hx
3% NS
Slow infuse
No more than 6-12 meq/L in first 24 hrs

36
Q

Chronic hyponatremia tx

A

Water restriction
Review meds
Correct slowly

37
Q

Nursing process

A

Assess
Analysis/diagnosis
Planning
Implementation
Evaluation

38
Q

Hypokalemia s/s

A

Telemetry changes
Hyperexcitability
PVCs, VT, VF
T-wave depression
Weakness
Excess vomiting
Paralytic ileus
Resp depression

39
Q

Hyperkalemia : relative excess causes

A

Trauma/crush injury
Uncontrolled diabetes
Acidosis
Inappropriate blood draw technique
Addisons disease

40
Q

Hyperkalemia : actual excess causes

A

⬆️ K intake
Renal failure
K sparing diuretics

41
Q

Hyperkalemia s/s

A

Peaked T-waves

42
Q

Hyperkalemia tx (C A BIG KLD)

A

Calcium gluconate
Albuterol
Bicarbonate
Insulin
Glucose(dextrose)
Kayexalate
Loop diuretic
Dialysis

43
Q

Hypokalemia tx

A

Treat underlying cause
PO/IV replacement (never IVP or bolus)
IV K?
Monitor tele, resp and LOC

44
Q

Hypercalcemia/ hyperparathyroidism s/s

A

Groans (constipation, N/V)
Moans (fatigue, lethargy, depression)
Bones (bone pain)
Stones (kidney stones)
Overtones (psychiatric, depression,
confusion, psychosis)
Can’t pick up the phone (muscle weakness,
lack of coordination)

45
Q

Hypocalcemia

A

Tetany
Chvosteks sigh (cheek)
Trousseau sign (arm)

46
Q

Hypocalcemia tx

A

Replace Ca
⬆️Ca in diet
Calcium gluconate via IV
Calcium carbonate (tums)

47
Q

Hypercalcemia tx

A

Treat underlying issue
⬇️ Ca in diet
Hydrate 3-4L/day
⬆️ wt baring activity
Loop diuretics

48
Q

SEVERE Hypercalcemia tx

A

Calcitonin
NS
Bisphosphonate

49
Q

Hypomagnesemia s/s

A

Confusion
Tremors
Hyperactive DTR
Chvosteks sign (cheek)
Trousseau sign (arm)

50
Q

Hypermagnesemia s/s

A

Smooth muscle reflexes
-flushing
-hypotension
Lethargy
NVD
Impaired reflexes (⬇️DTR)
Resp/cardiac arrest

51
Q

Hypomagnesemia tx

A

Treat underlying cause (stop meds, etc)
IV and PO replacement
Diet ⬆️ in Mg

52
Q

Hypermagnesemia tx

A

Avoid food with Mg
⬆️ fluid & diuretics (if kidneys are good)
IV calcium gluconate

53
Q

What is caused by…(resp/met acid/alk)

Chronic resp disease (copd)
Barbiturate/sedative overdose
Chest wall abnormality
Severe pneumonia
Atelectasis
Resp muscle weakness
Mechanical hypoventilation
Pulmonary edema

A

Resp acidosis

54
Q

What is caused by…(resp/met acid/alk)

Hyperventilation
Stimulated resp center
Liver failure
Mechanical hyperventilation

A

Resp alkalosis

55
Q

What is caused by…(resp/met acid/alk)

DKA
Lactic acidosis
Starvation
Diarrhea
Renal tubular acidosis
Renal failure
GI fistula
Shock

A

Metabolic acidosis

56
Q

What is caused by…(resp/met acid/alk)

Vomiting
NG suctioning
Diuretic therapy
Hypokalemia
Excess NaHCO3 intake
Mineralocorticoid use

A

Metabolic alkalosis

57
Q

Resp acidosis symptoms

A

Headache
Neuro symptoms
Seizures
⬇️ BP
Hyperkalemia
Hypoventilation

58
Q

Symptoms of (resp/met acid/alk)

Headache
Neuro symptoms
Seizures
⬇️ BP
Hyperkalemia
Hypoventilation

A

Resp Acidosis

59
Q

Symptoms of (resp/met acid/alk)

⬆️ RR
⬆️ HR
N/V
Tetany

A

Resp alkalosis

60
Q

Symptoms of (resp/met acid/alk)

Headache
Lethargy
NVD
Coma
Death

A

Metabolic acidosis

61
Q

Symptoms of (resp/met acid/alk)

Irritability
Lethargy
Confusion
Headache
⬇️ RR
Tachycardia
Dysrhythmias
NV
Muscle cramps
Tetany

A

Metabolic alkalosis

62
Q

Assessment and interventions for metabolic acidosis

A

ABCs
VS
Cardiac
GI
Resp
I/Os
Monitor muscle strength

63
Q

Assessment and interventions for metabolic alkalosis

A

ABCs
Labs (Ca, K, repeat ABGs)
GI
Cardiac
Neuromuscular
Resp

64
Q

DKA risk factors

A

Illness/infection
Inadequate insulin dose
Undiagnosed T1DM
Lack of education/understanding
resources/neglect

65
Q

DKA s/s

A

Early
Lethargy
Weakness
Later
Dehydration
Acetone breath
Tachycardia
Orthostatic hypotension
Kussmaul resps
Glucose >250
pH <7.30
Bicarbonate <16
⬆️ K
Ketones in urine and serum

66
Q

DKA nurse management ASSESSMENTS

A

May not always need hospitalization

Assess for:
Fever
NVD
AMS
cause of DKA
HCP communication

67
Q

Normal glucose value

A

70-100

68
Q

Normal HgA1C

A

<6.5%

MedSurg (3 decks)

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