Test 2 Flashcards

1
Q

What is “Third Spacing”?

A

Loss of extracellular fluid into space that doesn’t contribute to equilibrium. It isn’t increasing blood volume, or carrying nutrients or oxygen, or doing anything useful, just hanging out in the tissues outside of the cells.

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2
Q

The difference between osmosis and diffusion is what? How do they both differ from the sodium/potassium pump?

A

Osmosis is the movement of water across a membrane, diffusion is the movement of stuff across the membrane, and the Na/K pump uses ATP while the other two don’t.

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3
Q

How do people lose fluids and electrolytes?

How do they gain them?

A

LOSS:
Kidneys- pee everything out
Skin- sweat/burns
Lungs - respiration (300ml /day with increased rr)
GI - large losses due to diarrhea
Heart - increases blood flow to kidneys

GAIN:
Drinking and eating

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4
Q

What is average healthy urine output?

A

60ml/hr

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5
Q

If Na is high, do we make more or less ADH? If it’s low? Why?

A

If Na is high we want to dilute it, so we make more ANTIdiuretic Hormone to hold on to the water. If it’s low, we make less so that we don’t further dilute it.

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6
Q

What is the importance of the RAAS?

A

Renin-Angiotensin-Aldosterone System:Primary way we balance our bp. It is a chain of chemicals released to help body increase BP & blood volume (vasoconstriction, sodium/water retention)

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7
Q

What are gerontological considerations regarding fluid homeostasis?

A

Kidney don’t work as well, hold on to the K, don’t release Na

Skin turgor is no longer as reliable an indicator of dehydration.

Fluid deficit actually causes delirium

They don’t want to pee, so they don’t drink

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8
Q

What is the difference between fluid volume deficit and dehydration?

A

FVD you lose everything- all the fluid and the electrolytes therein. Dehydration, you lose the fluid, keep the electrolytes.

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9
Q

The Three Major kinds of shock are :
One has subsets, what are they?

A

Shock is literally your body’s response to cells not getting what they need to function-

That happens 3 ways:

Hypovolemic shock- there is no blood to move to cells

Cardiogenic shock - there is no working pump to move the blood

Distributive Shock - The heart is pumping, and there exists enough blood, but there is a hitch in the get along. Hitches are : Sepsis, Neurogenic, and Anaphylactic

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10
Q

What is the only thing that can go in the same line as blood?

A

Normal Saline

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11
Q

What are the symptoms of FVE?

A

1 Edema/weight gain
2 Distended neck veins /bounding pulses
3 Crackles
4 Increased RR and Urine output as the body tries to pee it out and breathe it off

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12
Q

What’s the classic sign of fluid volume deficit?

A

Orthostatic hypotension

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13
Q

What are the symptoms of FVD?

A

1) Orthostatic Hypotension
2) Weight loss
3) Decreased skin turgor
4) Thirst
5) Oliguria and cool skin as your body vasoconstricts to keep fluid central
6) Fatigue/weakness/cramps

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14
Q

What is nursing management of FVD?

A

I&O at least every 8 hours, sometimes hourly​

Daily weight​

Vital signs closely monitored​

Skin and tongue turgor, mucosa, urine output, mental status​

Measures to minimize fluid loss​

Administration of oral fluids​

Administration of parenteral fluids​

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15
Q

What is nursing management of FVE?

A

I&O and daily weights; assess lung sounds (crackles), edema, other symptoms; monitor responses to medications i.e. diuretics​

Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions​

Monitor, avoid sources of excessive sodium, including medications ​

Promote rest ​

Semi-Fowler’s position​ for orthopnea​

Skin care, positioning/turning​

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16
Q

How does medical management of FVE differ from FVD?

A

FVE means diuretics, Na restrictions and possibly diallysis, FVD is basically fluid replacement.

17
Q

What is the definition of hyponatremia? What does it look like? Why does that make sense?

A

Def: Na < 135

It looks like dehydration, which makes sense because where Na goes, H2O goes, and the Na isn’t here.

Symptoms: headache, confusion/neuro probs, poor skin turgor, dry mouth, drop in BP, nausea, abd cramping

18
Q

How does hyponatremia usually occur in the hospital?

A

Over hydration of surgical patient

19
Q

What organ is most affected by Na imbalance? Different question, What should you think of when you think of Na?

A

The brain. Too high or low and people start acting real weird.

Think water when you think Na.

20
Q

How is hyponatremia treated?

A

Treat underlying condition

Water RESTRICTION - it looks like dehydration but isn’t- we don’t want to dilute the blood any more

Same as fluid imbalances- daily wieght, Is&Os, watch labs, CNS changes

Replace Na

Possible ADH receptor antagonists (pee more)

Watch for Li intoxication if patient is on lithium and has low Na, also diuretics can cause hyponatremia, so double check orders

21
Q

What is the definition of hypernatremia? What does it look like?

A

Na > 145

Also looks like dehydration which also makes sense because there is elevated Na in dehydration

Hypo is cool because vasoconstriction, Hyper is elevated temperature,

SWOLLEN dry tongue, sticky mucus membranes, lethargy, restlessnes SEIZURES, N/V/A -

Looks a lot like low Na - High has seizures, elevated temps, and swollen tongue that Low doesn’t have.

Pts in both cases are confused and generally ADR

21
Q

Neurogenic shock looks like what?

A

Activation of the parasympathetic nervous system.

LOW hr, low bp, dry warm skin

22
Q

Mnemonic for hyPERcalemia:

A

Stones, bones, groans, thrones, and moans

The mnemonic painful bones (abnormal bone remodeling), renal stones (kidney stones from hypercalciuria), abdominal groans (hypercalcemia-induced ileus and abdominal pain), thrones (urinary frequency), and psychic moans (depression) can be used to recall the common symptoms of hypercalcemia

23
Q

Mnemonic for hyPERkalemia

A

MURDER
Muscle weakness
Urine: oliguria, anuria
Respiratory distress
Decreased cardiac contractility
EKG changes: peaked T waves; QRS widening
Reflexes: hyperreflexia or areflexia (flaccid)

24
Q

How do you treat IV infiltration?

A

*Stop iv

*Replace iv, can use proximal site on same limb

*Warm compress and elevation if happened for a long time or isotonic and neutral pH

*Cold compress if recent, caustic, or hypertonic

25
Q

How is treatment of extravasation different from infiltration?

A

*Stop infusion
*Call Doctor
*Follow protocol
*New IV in other limb
*Do neurovascular assessments of affected limb

26
Q

What do you do if your IV site gets thrombophlebitis?

A

*Stop infusion
*Cold compress, then warm compress
*Elevate limb
*New IV in new limb
*If no pus- clean skin with alcohol, then culture catheter

If pus, culture pus, then clean skin

27
Q

What is the difference between endocrine and exocrine glands?

A

Endocrine release hormones into the blood stream. Exocrine release things onto the skin or into the GI tract

27
Q

What are the glands of the endocrine system?

A

pituitary, pineal, thryoid, parathyrois, adrenal, pancreatic islets, ovaries and testes

27
Q

What is pheochromocytoma?

A

A tumor on the adrenal gland that secretes catecholamines, like epi, norepi and dopamine.

28
Q

What is the specific gravity of urine of someone with DI?
What is the diagnostic test for DI? When do you stop the test?

A

1.001 - 1.005

Withhold fluids and see if the osmoloality of the urine goes up. In regular dehydration it will, in DI, you keep dumping.

The test stops when you lose 3-5% of your body weight, you get tachycardic or hypotensive.

29
Q
A