test 4 Flashcards
what causes edema
too much interstitial fluid
fluid that lives in its own space, inst related to cardiac output
transcellular
too much transcellular fluid
third spacing
cation electrolytes
sodium, potassium, calcium, magnesium
anion electrolytes
chloride, bicarbonate, phosphate, sulfate
intracellular electrolytes
potassium, magnesium, phosphate
extracellular electrolytes
sodium, chloride, bicarbonate
transport that requires energy
active
transport that doesn’t require energy
passive
osmosis
movement of water from low to high concent
concentration of solvent to solute
osmolality
serum osmolality
comes from blood sample
urine osmolality
comes from pee sample
fluid volume deficient
less fluid
fluid volume excess
more fluid
crystalloids
cheap, act quickly in body, very rare to cause reactions in people, tiny particles in fluid so they can cross into or out of vessels easily, so can hydrate or pull fluid
ex: 0.9 NS, lactated ringers, 5% dextrose
colloids
large molecules, don’t move quickly, they stay in blood vessels, and don’t cross membranes easily. Very expensive. Patients can have reactions
ex- blood products, dextran, gelatin solutions
diffusion
solute moves from high to low to equal concent.
movement of water and smaller products from high to low pressure
filtration
what are the 3 major systems involved in fluid regulation
endocrine, renal and nervous system
what is thrist triggered by
hypothalamus due to changes in plasma osmolality
sensible
measurable
insensible
not measurable
ADH
increase water absorption, decrease urine output
from pit gland, releases when BP drops
renin angiotensin
brings BP up when drops, angiotensin 1 turns to 2, clamps vessels holding onto water and sodium
aldosterone
increased potassium output, increases sodium absorption
BNP
brain natriuretic peptide. hormone is released when there is a lot of stretch in ventricle, opens up vessels and tries to drop BP
Patients with CHF have elevated BNP
the higher the number, the worse
normal soidum level
135-145 mEq
what is sodium involved in
regulating water balance, controls extracellular fluid volume, stimulates nerve conduction and controls contractility of muscles
can affect mental status
most abundant electrolyte in body
normal potassium levels
3.5 to 5.0 mEq/L
a little change outside range can cause issues
what does potassium do
helps cells uptake water and nutrients
helps heart contract
helps nerves carry messages
helps digest
balances body fluids
foods high in potassium
salmon, sweet potatoes, bananas
normal rage of calcium
8.5 to 10.5
what does calcium do
involves in muscle contraction, wound healing, nerve impulses, bone structure, cellular metabolism
what controls calcium, and how much calcium lives in bone
parathyroid
99%
good sources of calcium
dairy, nuts, leafy greens
magnesium normal levels
1.5-2.5
what does magnesium do
regulate calcium
cleans bowel
relaxes skeletal and smooth muscle
energy production
regulates heart contractility
good souces of magnesium
dark chocolate, leafy greens, beans, pumkin seeds
normal chloride levels
95 to 105 mEq/L
what does chloride do
helps cells take in and out materials
helps muscles contract
helps nerves carry messages
helps with oxygenation of body
helps body digest
what electrolyte works with sodium
chloride
if sodium goes up, chloride goes up
normal phosphorus level
2.5 to 4.5 mEq/L
what does phosphorus do
forms and keeps strong bones and teeth
helps maintain energy levels
forms genetic materials
helps form cell membranes
helps oxygen delivery in body
helps maintain normal acid balance
hypovolemia symptoms
low fluid volume
poor skin turgor
dry mucous membrane
hypertension
weight loss
tachycardia, tachypnea
oliguria
legarthy
hypervolemia
increased fluid volume
SOB from pulm congestion
neuro changes from sodium changes
weight gain
presence of S3 heart sound
bounding pulse, hypertension
edema
nausea, anorexia
BMP
looks at electrolytes, except magnesium, and looks at glucose and kidney function
H&H
Hematocrit (Osmolarity of blood- amount of blood cells in sample) and hemoglobin (RBC)
IncreaseD levels may be FVD
BUN and creatine
BUN- blood urea nitrogen
creatinine- protein breakdown.
Increase- more protein breaking down, FVD
urine specific group
What’s in urine, high number means more particles then fluid= FVD
hyponatremia
low sodium, fluid excess
drop CVP
headache/seizures,coma
confusion
orthostatic hypertension
abdominal cramps, N/V, anorexia
muscle weakness
Hypernatremia
low fluids, high sodium
tachycardia
dry mucous membrane
dehydration
low urine
restlessness, irritability
headache/seizures,coma
confusion
orthostatic hypertension
abdominal cramps
muscle weakness
hypokalemia
low potassium
dysrhythmias
conduction defects
fasciculations and tetany
weakness and paralysis
abdominal distention
polyuria
ileus, N/V
hyperkalemia
dysrhythmias
conduction disturbances
weakness
paresthesias (tingling)
Paralysis
hyperreflexia
cramping
N/V/D
hypercalcemia
too much calcium
decreased neuronal excitability- anxiety, depression, cognitive
cardiac arrhythmias
lack of appetite
constipation
hypocalcemia
not enough calcemia
increased neuronal excitability
seizures
hypocalcemic tetany
positive trousseau sign
hypocalcemia
when inflating BP cuff, hand will spasm
positive chvostek sign
shoes hypocalcemia
tapping facial nerve, facial twitch
hypomagnesemia
low magnesium
confusion
increased deep tendon reflex
seizures
muscle cramps
tremors
insomnia
tachycardia
hypermagnesemia
flushing
decreased deep tendon reflex
muscle weakness
lethargy
decreased respiration
bradycardia
hypotension
hyponatremia intervention
fluid restriction
resuscitation- IV admin
lots of fluid fast
routine maintenance- IV admin
gentle hydration over a period of time
-for people who are at risk
replacement- IV admin
if we lost fluid and need it replaced
redistribution- IV admin
changes where fluid is in body
5 Rs iv fluid admin
resuscitation
routine maintenance
replacement
redistribution
reassessment
isotonic solution
flood stays in blood vessels
same as blood serum
ex- LR, NS
Hypotonic solution
fluid is pushed out of blood vessels into cells, good for if cells are dehydrated, such as from high blood sugar
lower than blood serum
1/2 NS
Hypertonic solution
fluid is pulled from into cells into blood vessels, good if edema present. but could cause overload. vesicant, can cause damage to tissue
higher than blood serum
D5NS
what electrolyte should you monitor reflexes
magnesium
what electrolyte should you monitor heart rhythm, rate and BP
potassium
what electrolyte should you monitor with edema
sodium
When sodium goes up, what electrolyte goes down
potassium
when calcium goes up, what electrolyte goes down
phosphorus
when magnesium goes down, what electrolyte goes up
phosphorus
when calcium goes up, what vitamin also goes up
vitamin D
When magnesium goes down, what other electrolytes go down
calcium and potassium
What size needle needed for blood transfusions
20 gauge or bigger (bigger is smaller numbers)
how long is a blood cross good for
3 days
what do u need for blood transusion
Type and cross
Need consent- must be from physician, RN can sign as a witness
Explain and educate
Baseline assessment and vitals- especially temp
Physical assessment- cardio and resp
Make sure unit knows you are giving blood- dedicated to that room, other people will need to look after your patients
Have a second IV site available- if something Goes wrong meds cant be given in blood line
2 verifications- verify right patient and right blood, bag and EMAR.
Special tubing needed for blood
who can verify blood before tranfusion
Can be done with 2 RN, 1 RN 1 LPN, cant be PCT
what is the only solution that can be ran with blood
normal saline
why do we start giving blood slowly
incase of a reaction
check vitals within 5-15 mins, look for any skin changes, pallor, SOB ,anything that wasn’t there before
keep in mind reactions could also occur days later
what do you do if reaction occurs with blood transfusion
- stop transfusion
- saline flush
- notify physician
normal hemoglobin level for male
14-17 g/dL
normal female hemoglobin level
12-15 g/dL
universal blood donor
O-
what blood type can receive blood from any donor
AB+
what do you do with the blood if a reaction occurs during transfusion
send it back to lab for future testing
perioperative
when surgeon and patient decide a surgery is going to happen. Could be months before
intraoperative
in the OR
postoperative
when the surgeon no longer thinks patient needs follow up and is no longer in recovery
never errors for surgery
surgery on wrong patient/part/wrong surgery
foreign body entering
post infection
intraoperative death
ablative surgery
removing tissue that isn’t doing what its supposed to do. Doesn’t mean its diseased
diagnostic surgery
scan or blood test that leads us to believe there is a bigger picture, opening and biopsy, ex is a mass
palliative surgery
for better quality of life, usually related to pain, immobility, etc.
Could be from nerve issues or significant scarring
reconstructive/cosmetic surgery
could be from major trauma, or issue, or just personal looks
transplant surgery
taking out something that doesn’t work and replace
procurement surgery
taking organs/tissue from body to harvest and transplant
RN calls procurement office every time someone dies (unless its a crime) to see if patients are candidates for donation
emergent surgery
needs to happen then and now, life saving, consent may not be asked
urgent surgery
surgery that needs to happen within 24 hours, try to get consent but might not be able
elective surgery
any surgery that isn’t emergent or urgent
could be planned months in advance
why does mental status impact surgical risk
patient may not be able to understand how to take care of themself after surgery
what are some medications that could pose surgical risk
Blood thinners, insulin (may not be able to eat and drink for awhile), steroids, BP meds
personal/ lifestyle habits that can create surgical risk
smoking, alcohol, obesity, underweight (poor wound healing), drug use
what does NPO status depend on for surgery
the type of surgery being preformed
surgical physical preparation (what we do for patients before they go to OR)
NPO
skin prep
Bladder and bowel
removing personal items
prosthetic management
anti embolism stockings
circulating nurse
OR nurse that does non sterile things, such as monitors and documents
scrub nurse
OR nurse that sterilizes and can assist with procedures
POST OP care
Vital signs, airway, level of consciousness, positioning, wounds/dressings, IV, comfort
on the unit care
get SBAR from post op nurse
manage diet, activity, SCDs, ambulation, signs/symptoms, follow up care that is needed
monitor vitals frequently
what can anesthesia cause
abdominal distention
constipation/ileus
urinary retention
should be back to normal within hours
