Test 3 Flashcards
Different IV gauges smallest to largest
24-smallest and shortest inch - used in kids and peds
22 used in elderly or kids
20-radiology patients
18-16-14: biggest for trauma patients
What IV site is most commonly used
Most common is basilic and cephilic in arm
Most commonly used in trauma patient IV size
16-18
Most common IV site in trauma patients
Peripheral IV in the forearm/antecubital area
If not able then- central lines- femoral, subclavian, or jugular sites using large bore
How to hang IV fluids
Always on a primary line (gravity tubing) (not a pump)
How to hang antibiotics
Hung on a secondary line which connects to the primary tubing by the Y-port
Be sure primary and secondary line meds are compatible together
(Normal saline is ok to use with any med)
Program the pump, before accessing IV you flush the line- start secondary line (antibiotic) then start the primary line which will flush the secondary line
Sodium normal lab value
135-145
Potassium normal levels
3.5-5
Calcium normal levels
9-10.5
Magnesium normal levels
1.8-2.6
S/s of hyponatremia
What is happening and what is being affected with each one, common causes
Hyponatremia causes: diuretic use, diarrhea, heart failure, liver disease, renal disease, and the syndrome of inappropriate ADH secretion (SIADH).
affects the brain Lethargy Headache Confusion Apprehension Seizures Coma
Too much sodium loss or too much water (dilution)
S/s of hypernatremia
What is happening and what is being affected with each one, common causes
Affects the brain
Wherever sodium goes, water follows. (headache) *affects the brain
Caused by dehydration, vomiting, diarrhea, medications
(too much sodium in the blood)
FRIED - Fever/Flushed, Restless, Increased fluid retention/BP, Edema, Decreased urinary output
Or
SALT- Skin flushed, Agitation, Low-grade Fever, Thirst
Hypernatremia causes: Dehydration or a loss of body fluids from prolonged vomiting, diarrhea, sweating or high fevers. Dehydration from not drinking enough water.
S/s of hyperkalemia
What is happening and what is being affected with each one, common causes
Affects the heart
MURDER
M uscle weakness U rine, oliguria, anuria R espiratory distress D ecreased cardiac contractility E CG changes R eflexes, hyperreflexia (twitching increased reflexes), areflexia (absent reflexes)
caused by kidney disease (check potassium drip continuously) can affect heart and numbness as well.
Kidney disease is the most common cause of hyperkalemia, Addison’s disease, can lead to hyperkalemia, and Too much potassium in the diet
S/s of hypokalemia
What is happening and what is being affected with each one, common causes
Affects the heart - threads pulse, arrhythmias/bradycardia/tachycardia
Shallow respiration’s
Decreased intestinal mobility
Alkalosis
Confusion
Weakness ,lethargic, fatigue
The heart and sensory/numbness is affected
Can be caused by diuretics (main cause), or vomiting, diarrhea, dehydration
Hypocalcemia s/s
What is happening and what is being affected with each one, common causes
Very awake and muscles are affected and twitching- may cause trousseaus sign or Chvostek’s sign
Hypoparathyroidism is a main cause of hypocalcemia
S/s: Muscle cramps Increased DTR Numbness/tingling Convulsions Arrhythmias Both signs Increased QT interval (increased risk of heart attack or abnormal rhythms)
Hypercalcemia s/s
What is happening and what is being affected with each one, common causes
person is very SEDATED also affect muscles
S/s: muscle weakness Decreased DTR Polyuria Anorexia Nausea/vomiting Arrhythmias Heart block Hypertension
Shortened QT interval (increased risk of heart attack or abnormal rhythms)
Hypercalcemia: person is very SEDATED also affect muscles
Need Vitamin D to retain calcium
Hypercalcemia is usually a result of overactive parathyroid glands.
Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements.
Hypermagnesemia s/s
What is happening and what is being affected with each one, common causes
person is very SEDATED also affect muscles
Decreased DTR (deep tendon reflexes) Flushing Muscle weakness Lethargy Decreased respiration’s Bradycardia Hypotension
Hypermagnesemia causes- kidney disease and liver failure
Ventilator if R < 12
Dialysis if in kidney failure
Watch kidney function and seizure precautions
Hypomagnesemia s/s
What is happening and what is being affected with each one, common causes
Causes:
hypomagnesemia are decreased gastrointestinal (GI) absorption and increased renal loss. Decreased GI absorption is frequently due to diarrhea, malabsorption, and inadequate dietary intake.
Watch kidney function and seizure precautions
s/s: Increased DTR Confusion Neuromuscular irritability Seizures Muscle cramps Tremors Insomnia Tachycardia
person is very alert and awake also affect muscle twitching
Immunogens and the immune response (S/S)?
Immunogens-immune response from antigen
Immune response: redness, heat, swelling, pain ,Loss of function of immflamation.
teaching points of Hypervolemia
Excessive fluid in the ECF
- Body tries to defend by urinating more, and edema formation
- Daily weight
- Ensure safety, restore normal fluid balance, provide supportive care, prevent future overloads
- Risk for skin breakdown: Turn and Repo Q2H
- May need O2
- Diuretics (If Kidney function is good)
- Fluid and Na+ restrictions
- Monitor I & O
teaching points of Hypovolemia
a. Circulating blood volume is decreased = decreased perfusion
b. Body defends by vasoconstriction & peripheral resistance
c. Daily weight
d. Orthostatic BP (lying, sitting, standing), monitor HR
e. Prevent further fluid loss, increase fluid volume back to normal and provide safety
f. Mild-Mod deficit: PO Fluids
g. Severe deficit: IVF (monitor HR and output)
S/s for Hypervolemia
Hypervolemia:
HPN, WT gain, crackles, frothy sputum, distended neck vein, edema, increased CVP, bounding pulse, subjective cues.
S/s for Hypovolemia
Hypovolemia:
HTN, WT loss, tented dry skin, increased resp and pulse, cool skin, oliguria (little urine), flat neck veins, lethargy, subjective cues.
Standard Precautions:
applies to the care of all patients
Transmission based precautions: outlines precautions to take based on the mode of transmission of the infection.
- Gloves • For touching blood, body fluids, secretions, excretions, contaminated items; for touching mucous membranes and nonintact skin
- Gown • During procedures and patient-care activities when contact of clothing/exposed skin with blood/body fluids, secretions, and excretions is anticipated
- Mask, eye protection (goggles), face shield* • During procedures and patient-care activities likely to generate splashes or sprays of blood, body fluids, secretions, especially suctioning, endotracheal intubation
Remember that gloves are an essential part of infection control and should always be worn as part of Standard Precautions.
Either handwashing or use of alcohol-based hand rubs should be done before donning and after removing gloves.
Airborne Precautions
- Private room required with monitored negative airflow (with appropriate number of air exchanges and air discharge to outside or through HEPA filter); keep door(s) closed
- Special respiratory protection: • Wear PAPR for known or suspected TB • Susceptible people not to enter room of patient with known or suspected measles or varicella unless immune caregivers are not available • Susceptible people who must enter room must wear PAPR or N95 HEPA filter*
- Transport: patient to leave room only for essential clinical reasons, wearing surgical mask Diseases that are known or suspected to be transmitted by air:
• Measles (rubeola) • Mycobacterium tuberculosis, including multidrug-resistant TB (MDRTB) • Varicella (chickenpox)†; disseminated zoster (shingles)†
Droplet Precautions
- Private room preferred: if not available, may room patient with same active infection with same microorganisms if no other infection present; maintain distance of at least 3 feet from other patients if private room not available
- Mask: required when working within 3 feet of patient
- Transport: as for Airborne Precautions Diseases that are known or suspected to be transmitted by droplets:
• Diphtheria (pharyngeal) • Streptococcal pharyngitis • Pneumonia • Influenza • Rubella • Invasive disease (meningitis, pneumonia, sepsis) caused by Haemophilus influenzae type B or Neisseria meningitidis • Mumps • Pertussis
Contact Precautions
Contact Precautions
- Private room preferred: if not available, may cohort with patient with same active infection with same microorganisms if no other infection present
- Wear gloves when entering room
- Wash hands with antimicrobial soap before leaving patient’s room
- Wear gown to prevent contact with patient or contaminated items or if patient has uncontrolled body fluids; remove gown before leaving room
- Transport: patient to leave room only for essential clinical reasons; during transport, use needed precautions to prevent disease transmission
- Dedicated equipment for this patient only (or disinfect after use before taking from room) Diseases that are known or suspected to be transmitted by direct contact: • Clostridium difficile • Colonization or infection caused by multidrug-resistant organisms (e.g., MRSA, VRE) • Pediculosis • Respiratory syncytial virus • Scabies
Tetanus (Tdap) Vaccination
What is it?
When is it necessary?
When to get a booster?
What to ask patient?
Nail through foot,
ask is your tetanus up to date
Tetanus prophylaxis is necessary for burns or any break in skin integrity. (active immunity)
booster q 10 years.
Extracellular fluids=
edema= sodium
Calcium?
intracellular fluids=
potassium and magnesium
Know aldosterone, NP, RAS and ADH and how they work to regulate fluid balance in the body.
ADH:(Antidiuretic hormone)
RAS: renin angiotensin system
NP??? natriuretic peptide
Antidiuretic hormone (ADH) is a hormone that helps your kidneys manage the amount of water in your body.
holds onto H2O. nonapeptide that is synthesized in the hypothalamus. regulate the amount of water excreted by the kidneys.
RAS- renin angiotensin system: a hormone system that regulates blood pressure and fluid and electrolyte balance, as well as systemic vascular resistance. When blood volume or sodium levels in the body are low, or blood potassium is high, cells in the kidney release the enzyme, renin. Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin
NP: natriuretic peptide hormone secreted from the cardiac atria.
The main function of ANP is causing a reduction in expanded extracellular fluid (ECF) volume by increasing renal sodium excretion.
corticosteroid hormone which stimulates absorption of sodium by the kidneys and so regulates water and salt balance. helps maintain blood pressure (BP) and water and salt balance in the body by helping the kidneys retain sodium and excrete potassium.
Aldosterone
. Know how to take orthostatic BP and what else should you monitor when taking this? (HR)
Monitor the heart rate as well.
- Have the patient lie supine for 10 minutes and obtain blood pressure and HR. …
- Take blood pressure and HR immediately after the patient arises and ask about dizziness
- After the patient maintains an upright posture for 3 minutes, obtain blood pressure and HR again.
Know isotonic, hypotonic and hypertonic solutions. Know when to use them and some examples of each.
—————————-
same osmolality as blood
stays in vascular space)
When to use? Fluid and ltye replacement Is needed
Example? is diffusion, the movement of molecules from an area of high concentration to an area of low concentration.
Passive Transports:
1. Isotonic Solutions:
lower osmolality(chemistry)than blood
(moves from vascular space into cells)
When to use? When Cellular hydration is needed
Example? A hypotonic solution is any solution that has a lower osmotic pressure than another solution.
Hypotonic Solutions
: higher osmolality than blood
moves from the cells into the ECF
When to use?
To increase urine output post op, DKA, hypovolemia, vascular expansion , third spacing
Example? Corn syrup, gluose, Saline solution, or a solution that contains salts, is hypertonic. …
A solution of 5% dextrose (sugar) and 0.45% sodium chloride is an example of a hypertonic solution - so is a solution of 5% dextrose and 0.9% sodium chloride.
Hypertonic Solutions
Chvostek’s sign- How to test for it and which electrolyte imbalance is it tested for?
-twitching of facial muscles/nerve by ear (looks like smile) due to hypocalcemia
Trousseau’s sign- How to test for it and which electrolyte imbalance is it tested for?
when your taking BP and the hands spasms or flexes upward- caused by inflating BP cuff above systolic pressure for 3 minutes.
Hypocalcemia
ABGs Normal Lab values & How to determine which imbalance the patient has
PH
CO2
HCO3
pH: 7.35-7.45.
PaCO2): 35-45 mmHg.
HcO3: 22-26
Look back at webex at her explanation
Tic tac toe method
Respiratory/Kidney/Chemical regulatory mechanisms for acid/base imbalances? (How do they work together)
There are three mechanisms which diminish pH changes in body fluid:
The kidneys help maintain the acid–base balance by excreting hydrogen ions into the urine and reabsorbing bicarbonate from the urine.
There are three mechanisms which diminish pH changes in body fluid:
buffers; respiratory; renal. (a) Proteins are the most important buffers in the body. They are mainly intracellular and include haemoglobin.
Metabolic Acidosis-what causes it? S/S
occurs when the body produces too much acid.
Causes: It can also occur when the kidneys are not removing enough acid from the body.
Symptoms include nausea, vomiting, fast breathing, and lethargy.
Metabolic Alkalosis- what causes it? S/S
Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range
Common causes: include prolonged vomiting, hypovolemia, diuretic use, and hypokalemia.
s/s:
• Confusion (can progress to stupor or coma)
• Hand tremor.
• Lightheadedness.
• Muscle twitching.
• Nausea, vomiting.
• Numbness or tingling in the face, hands, or feet.
• Prolonged muscle spasms (tetany)
