Test One Flashcards
1
Q
What foods (7) are good sources of sodium?
A
Cheese, salt, seafood, processed meats, canned vegetables and soups, ketchup, snacks (pretzels/potato chips)
2
Q
What foods (14) are good sources of potassium?
A
Meats, fish, vegetables (potato, carrot, mushroom, tomatoes), fruits (oranges, bananas, apricots, cantaloupe, dried fruit), nuts and seeds, chocolate and licorice
3
Q
What foods (6) are good sources of Calcium?
A
bone meal, dairy products (milk, cheese, yogurt), leafy green vegetables, legumes, nuts, and whole grains
4
Q
What foods (8) are good sources of Magnesium?
A
Dry beans and peas, green leafy vegetables, meats, nuts, seafood, whole grains, chocolate
5
Q
What are the fluid compartment consequences of hypotonic overhydration?
A
ECF compartment volume expands, ICF volume expands
6
Q
Which condition is most likely to cause formation of edema?
A
Decreased plasma osmotic pressure, increased plasma hydrostatic pressure
7
Q
Hypertonic dehydration – What would be the fluid compartment consequences?
A
ECF compartment expands, ICF contracts
8
Q
Extracellular fluids (ECF) are composed of ____, ______, and ______.
A
Interstitial fluid, transcellular fluid, and intravascular fluid
9
Q
What is first spacing?
A
fluid spacing in balance, fluid is where it should be, just the right amount in ICF and ECF
10
Q
What is second spacing?
A
When fluid flows into the interstitial space, aka edema
11
Q
What is third spacing?
A
fluid accumulation in areas that normally have no fluid or a minimal amount of fluids (ascites or edema with burns)
- Trapped fluid=fluid loss
- in an area that is physiologically inaccessible (body can’t use it)
12
Q
Thirds spacing takes fluid away from…
A
normal fluid compartments (hypovolemia)
13
Q
How do you get rid of third spacing?
A
surgically (parencentecisis/thoracentesis) or by hypertonic solution
14
Q
Ascities can lead to __________, or if it gets absorbed it can lead to _______
A
hypovolemia, hypervolemia
15
Q
What 4 areas can third spacing happen in?
A
Peritoneal, pericardial, pleural, joint cavities (also bowel, abdomen or within soft tissues)
16
Q
What’s the difference between hypertonic dehydration and hypotonic dehydration?
A
Hypertonic: water loss exceeds electrolyte loss, fluid moves from ICF to plasma and interstitial spaces–> cellular dehydration and shrinkage
Hypotonic: electrolyte loss exceeds water loss, fluid moves from plasma and interstitial into the cells, causing a plasma volume deficit and cells to swell
17
Q
What happens when you give a hypertonic IV solution?
A
water moves out of cells (ICF), into the bloodstream
18
Q
What happens when you give a hypotonic IV solution?
A
water moves into the cells and expands them
19
Q
D5W (5% dextrose in water) is isotonic, hypertonic, or hypotonic?
A
Hypotonic (isotonic solution out of body, but once in the body it’s hypotonic (because the 5% is so little and used up instantly))
20
Q
What is hydrostatic pressure?
A
A pushing pressure, like a fire hose on full blast
-force exerted by weight of a solution
21
Q
What happens when a difference exists in the hydrostatic pressure on two sides of a membrane?
A
water and difussible solutes move out of the solution that has the higher hydrostatic pressure by filtration
22
Q
At the arterial end of a capillary, they hydrostatic pressure is _____ than osmotic pressure; therefore fluids and diffusible solutes…
A
higher; move out of the capillary
23
Q
At the venous end of the capillary, the hydrostatic pressure is _____ than osmotic pressure; therefore fluids and some solutes…
A
lower, move into the capillary
24
Q
What is Osmotic pressure?
A
a pulling pressure
-determined by concentration of solutes in solution
25
Where do solvents move when osmotic pressure is unequal?
solutes move from less concentrated solute side to more concentrated solute side
26
What is diffusion?
Diffusion of a solute from higher concentration to lower concentration (through permeable or semipermeable membranes)
27
What is osmosis?
movement of solvent across a membrane from lower to higher solute concentration
28
What is filtration?
movement of solutes and solvents by hydrostatic pressure (from higher pressure to lower pressure)
29
Which movement process is this?
| movement of fluid (water) between intravascular and interstitial spaces
Filtration
30
Which movement process is this?
| Movement of solutes or fluid between extracellular and intracellular compartments
Diffusion and osmosis
31
What causes edema?
excess fluid in interstitial space
-occurs as a result of alterations in oncotic pressure, hydrostatic pressure, capillary permeability, and lymphatic obstruction
32
What is ascities?
The accumulation of excess fluid in the peritoneal cavity (third spacing)
33
____ process occurs when hydrostatic pressures differ on each side of the membrane
filtration
34
Hydrostatic pressure moves water from the _____ into the ____
from capillaries into interstitial fluid
35
What 3 factors alter hydrostatic pressure?
blood volume, force of contraction (of the heart on the arteries), and resistance of blood vessels (vasocontricted or vasodilated)
36
The compartment with higher concentration of solute has the _____ osmotic pressure
higher
37
What causes dehydration?
Inadequate intake of fluids and solutes, fluid shifts, loss of bod fluids, chronic illness, excessive fluid replacement (hypotonic), kidney disease, chronic malnutrition
38
Prolonged diarrhea--> which type of dehydration?
hypertonic dehydration
39
Hypovolemia is what kind of dehydration?
Isotonic dehydration (water and dissolved electrolytes lost in equal proportions)
40
Who is at risk for dehydration?
elderly, obese, very young
41
What 2 factors stimulate the thirst mechanism?
- Decrease in ECF volume
| - Increase in ECF osmolarity (osmotic pressure)
42
Anti-diuretic hormone (ADH) makes the kidneys _______
increase water reabsorption, decreases urine output
43
Isotonic IV solutions increase...
ECF volume (don't enter the cells because no osmotic force exists to shift fluids)
44
Hypotonic IV solutions cause movement of water (where)...
into cells by osmosis
45
Hypertonic IV solutions cause movement of water (where)...
from cells into the extracellular fluid by osmosis
46
Colloid IV solutions pull fluid from... to...
from the interstitial compartments into the vascular compartment (used to increase vascular fluid rapidly, like with a hemorrhage or severe hypovolemia)
47
What is infiltration?
seepage of the IV fluid out of the vein and into the surrounding tissue
48
What is phlebitis?
inflammation of the vein, can cause a clot to form (thrombophlebitis)
49
What is extravasation?
The escape of fluid from its physiologic contained space, e.g., bile, blood, cerebrospinal fluid (CSF), into the surrounding tissue
50
Which IV complication is this?
| tachycardia, chest pain, hypotension, cyanosis, decrease LOC
air embolism
51
Which IV complication is this?
| Decrease in blood pressure, pain along the vein; weak, rapid pulse; cyanosis of the nail beds; loss of consciousness
catheter embolism
52
Which IV complication is this?
| increase BP, distended jugular veins, rapid breathing, dyspnea, moist cough and crackles
circulatory overload
53
Which IV complication is this?
| Ecchymosis, immediate swelling and leakage of blood at the sit, and hard/painful lumps at the site
hematoma
54
Which IV complication is this?
Local-redness, swelling, and drainage at the site
Systemic-chills, fever, malaise, headache, nausea, vomiting, backache, and tachycardia
Infection
55
Which IV complication is this?
| Edema, pain, and coolness at the site; may or may not have a blood return
Infiltration
56
Which IV complication is this?
| Heat, redness, tenderness at the site; not swollen or hard; IV infusion sluggish
Phlebitis (inflammation of the vein)
57
Which IV complication is this?
| Skin color changes, sloughing of the skin, discomfort at the site
tissue damage
58
Which IV complication is this?
| Heard and cordlike vein; heat, redness, tenderness at site; IV infusion sluggish
Thrombophlebitis (clot that forms due to phlebitis)
59
Lactated Ringer's solution contains...
calcium chloride, potassium chloride, sodium chloride, and sodium lactate in water for injection. It is used intravenously to replace electrolytes.
60
In IV needles, the ________ the gauge number the ______ the diameter of the lumen
smaller, larger
61
For standard IV fluid and clear liquid IV medications, use a ___ or ___ gauge lumen IV needle
22 or 24
62
If the patient has very small veins, use a ____ or ___ gauge lumen
24 or 25
63
For rapid emergency fluid administration, blood products, or anesthetics, us __,__, __, __ gauge lumen
large-diameter gauge lumen; 14, 16, 18 or 19
64
For peripheral fat emulsion (lipid) infusion use a ___ or ___ gauge lumen
20 or 21
65
What are the normal lab values for sodium?
136-145
66
What 4 functions does Na do?
- Nerve impulse transmission
- Skeletal muscle and cardiac contraction
- Maintain electrical balance: slower depolarization
- Determine osmolality of ECF
67
What 3 ways does your body regulate Na?
- lost through skin, Gi, and Gu tract
- Aldosterone, ADH, NP regulation
- Thirst mechanism
68
What are 3 causes of hyponatremia?
1) Excessive loss: diuretics, burns, sweating, comiting, lax. abuse, suctioning, renal disease, etc
2) Excessive H2o gain: D5W overload, polidipsia (thirst), water retension
3) Inadequate intake: anorexia, alcholism
69
Which electrolyte imbalance is this?
confusion, blurred vision, irritability, headache, convulsions, n/v/d, hyperactive BS, dec BP, dec HR, weak pulses, muscle weakness, dec DTR
hyponatremia
70
List some nursing interventions (5) for hyponatremia
- Monitor I &O, weigh daily
- Prevent hypernatremia and fluid overload
- Drug therapy: isotonic or hypertonic solution
- Nutrition therapy: restrict water, increase Na intake
- Assess s/s, lab values
71
What are 2 causes of hypernatremia?
1) Excessive intake: hypertonic solution (TPN), hypertonic TF
2) Water loss: diarrhea, insensible loss, osmotic diuretic, insufficient ADH
72
Which electrolyte imbalance is this?
confusion, forgetful, restless, decreased LOC, seizure, lethargic, coma, muscle twitching, weakness, decreased DTR
73
What is the normal range for K?
3.5-5.0
74
What are K functions? (3)
- Determine osmolarity or ICF
- Generate action potentials, and depolarization
- Regulate protein synthesis, metabolize and storage of glucose/CHO
75
As K goes into a cell, Na goes...
out of the cell
76
What are 3 ways the body regulates K?
- Renal excretion
- Aldosterone (increase excretion of K via kidneys)
- Na/K pump
77
How does the Na/K pump regulate K?
it removes extra Na from ICF, extra K from ECF
78
Loop diuretic promote ____ excretion
K excretion
79
What are (3) causes of hypokalemia?
- Decreased intake: anorexia, ETOH
- Increased loss: increased aldosterone,diuretics, GI loss, trauma, burn, etc
- Shift during metabolic acidosis, treatment of DKA (K moves from ECF to ICF)
80
What electrolyte imbalance is this?
shallow ineffective RR, weakness, cramp, flaccid paralysis, decreased DTR, decreased BP, lethargy, confusion, coma, n/v/a, anorexia, paralytic ileus, decreased bowel sounds
hypokalemia
81
Oral K must be... before given
diluted!
82
How fast can you give K?
No IV push, no faster than 10mEq/hr, no >100 mEq/L of IV solution
83
Why is giving digoxin and lasix scary?
lasix decrease K and dig increased cardiac output
| -try to use a K sparing diuretic instead
84
What are the 3 causes of hyperkalemia?
- Excessive intake
- Decreased loss: K sparing diuretic, renal failure, bowl obstruction, decreased aldosterone (Addison't disease)
- Shift of K into ECF: burn, crushing injury, metabolic acidosis
85
Which electrolyte imbalance is this?
| decreased HR, decreased BP, paresthesia, irritability, confusion, weakness, flaccid paralysis, n/v/d, cramping
hyperkalemia
86
How does using insulin and glucose decrease K (nursing intervention for hyperkalemia)?
causes K into the cell (ICF) from ECF
87
T/F
| You can use dialysis for hyperkalemia
True
88
What are the normals for Ca?
9.0-10.5
89
What are the functions (4) for Ca?
- Bone and tooth strength
- Blood clotting
- Neuromuscular conduction via Na/K pump
- Cardiac contractions
90
How is Ca regulated? (3)
- need Vit D for GI absorption
- filtered in glomerulus, reabsorbed in tubes
- PTH and calcitonin
91
What are the causes of hypocalcemia? (3)
- Excessive binding of Ca
- Inadequate intake/absorption
- Diseases like acute pancreatitis, hypoparathyroidism, hyperphosphatemia, thyroid cancer, Crohn's, fistual drain, RF, increased calcitonin
92
What are the s/s of hypocalcemia?
osteoporosis, muscle cramp/spasm, Chvostek's and Trousseau's sign, paresthesia, increased DTR, convulsions, increased peristalsis, n/v/d, ecchymosis, petechiae, excessive bleeding, arrhythmia, cardiac arrest
93
What are some (4) nursing interventions for hypocalcemia ?
- Drug therapy: Ca Gluconate
- Ca and Vit D supplements
- Thyoidectomy, Gi/renal disorders
- Seizure precautions, prevent falls, excessive bleeding
94
What are the 2 causes for hypercalcemia?
- Loss from bones (immobilization, bone cancer, etc
| - Excessive intake: antacids, large dose of vit D
95
What are the s/s of hypocalcemia?
decreased DTR, decreased muscle tone, bone pain, fractures, clots, decreased motility, stones, renal damage, lethargy, coma, depressed activity, arrythmia, cardiac arrest
96
What are some nursing interventions for hypercalcemia?
- Drug therapy (NS and diuretics, calcium chelators, phosporous, calcitonin, etc)
- Dialysis
- High fiber food
97
What are the 3 functions of phosphorus?
- Formation of bone and teeth (most in bones)
- Activating vitamins and enzymes, forming ATP
- Assist in cell growth and metabolism
98
What are 2 ways body regulates phosphorus?
- PTH
| - Phos and Ca have an inverse relationship
99
What are 3 causes of hypophosphatemia?
- decreased phos intake
- Use of aluminum hydroxide or Mg-based antacids
- Hyperparathyroidm, renal failure, DM, cancer
100
What are the s/s of hypophosphatemia?
similar symptoms to hypercalcemia
-decreased cardiac output, decreased HR, decreased BP, weakness, rhabdomyolysis, decreased RR, decreased ventilation, irritability, seizure, coma
101
Whar are 3 causes of hyperphosphatemia?
- increased oral intake
| - Renal insufficiency, hypoparathyroidism, cancer treatments
102
What are the s/s of hyperphosphatemia?
same as hypocalcemia
-Chvostek's and Trousseau's sign, paresthesia, increased DTR, increased peristalsis, N/v/d, ecchymosis, petechiae, excessive bleeding, arrhythmia, cardiac arrest
103
How do you correct hyperphosphatemia?
IV Ca gluconate, Ca and vit D supplements, etc
104
What are the functions of Mg? (4)
- Assist in skeletal/cardiac muscle contraction
- Participate in CHO, protein, liquids, Vit B12 metabolism
- Facilitate ATP formation
- Contribute in vasodilation of peripheral arteries
105
Where is Mg regulated?
in the kidneys
106
What are the s/s of hypomagnesmia?
increased HR, decreased BP, arrhythmia, memory loss, confusion, tremor, ataxia, cramps, spasticity, tetany, increased DTR, Chvostek's and Trousseau's sign, decreased motility nausea, distention
107
What IV therapy is done to correct hypomagnesmia?
Mg Sulfate (look our for increased MG by checking DTR, BP, ad RR and monitor renal function)
108
What are the s/s of hypermagnesmia?
decreased impulses, decreased BP, vasodilation, decreased HR, arrhythmia, cardiac arrest, lethargy, decreased DTR, weakness, decreased ventilation
109
What is the normal range for magnesium?
1.3-2.1
110
What is the normal range for phosphorus?
3.0-4.5
111
What is the normal range for Chloride?
98-106
112
What are the 3 functions of chloride?
- Active component of renal physiology (goes with Na)
- Balance acid-base (decreased Cl causes renal retention of bicarb -->metabolic alkalosis)
- Form gastric acid HCl
113
Which are the most important things to monitor when someone urinates a lot?
Potassium levels and dysrhythmias
114
What's the other name for aspirin?
acetylsalicylic acid
115
What are the s/s of aspirin poisoning?
In acute poisoning, signs vary with increasing doses from mild lethargy and hyperpnea to coma and convulsions. Sweating, dehydration, hyperpnea, hyperthermia, and restlessness may be present with moderate doses. In chronic poisoning, tinnitus, skin rash, bleeding, weight loss, and mental symptoms may be present. Aspirin poisoning in very young infants may produce very few signs and symptoms other than dehydration or hyperpnea.
116
Lack of insulin causes K...
depletion
117
Lack of insulin causes increased fluid loss from hyperglycemia which causes excessive potassium_____________________
is excreted in urine
118
_______ K level may occur in acidosis becuase of the shift of K from ___ to _____
high serum K levels, from inside the cells to the blood
119
Serum K levels in DM may be _____ or ____ depending on hydration, severity of acidosis, and the pts response to the treatment
low (hypokalemia) or high (hyperkalemia)
120
K is the major cation of the ....
intracellular fluid
121
The Na/K pump moves extra sodium from the ____ and moves extra potassium from the _____
ICF to the ECF, K: from the ECF to the cell
122
Hypokalemia is life threatening because...
it affects every body system
123
Which diuretic increase excretion of K
loop diuretics, bumetanide, and thiazide diuretics
124
What are the K sparing diuretics?
spironolactone, trimeterene, and amiloride
125
What is the management of epistaxis?
- POsition the pt upright and leaning forward to prevent blood from entering stomach and prevent aspiration
- Keep pt quiet to reduce anxiety and BP
- Apply direct lateral pressure the nose for 10 minutes (apply ice compresses to the nose and face)
- Nasal packing with gauze or nasal tampons
- Don't blow nose for 24 hours after bleeding stops
- if posterior bleed, could need posterior packing, epistaxis catheters, or gel tampon
126
What medication is used in step one asthma?
as needed relief inhaler (rapid acting beta 2-agonist)
127
What additional medication is used in step 2 asthma?
daily treatment with either Low-dose inhaled corticosteroid (ICS) or leukotriene modifier
128
What additional medication is used with step 3 asthma?
One of these 4 options:
1) low dose ICS AND long acting beta-2 agonist
2) Medium dose or high dose ICS
3) Low-dose ICS and leukotriene modifier
4) Low-dose ICS and sustained release theophylline
129
What additional medication is used with step 4 asthma?
Step one and step three plus... One or more of these options:
1) Medium-dose or high-dose ICS and long acting beta 2-agonist
2) Leukotriene modifier and sustained-release theophylline
130
What additional medication is used with step 5 asthma?
plus either
- oral glucocorticosteroid
- Anti-IgE treatment (immunoglobuline E)
131
What happens when you give them a drug that acts on (increases) the sympathetic nervous system?
HR and BP increase, tachycardia, palpitations, angina, arrhythmias, hypertension
132
Asthma is a _______airway obstruction caused by ____________ or ________________
reversible, inflammation or hyperresponsiveness (bronchoconstriction)
133
What are the managements for asthma? ASTHMA abbrev.
```
A: Adrenergics (beta 2 agonists)
S: Steroids
T: Theophylline
H: Hydration
M: Mask O2
A: Anticholinergics
```
134
Aspirin overdose leads to which pH imbalance? What is the respiratory symptom?
Metabolic acidosis, Kussmaul respirations (increased rate and depth)
135
Hypokalemia results in which ABG problem?
respiratory alkalosis
136
If disassociation curve shifts to the left, then hemoglobin...
-examples of left curve shift...
holds onto the O2
| -cold or alkalosis (conserves energy and holds onto O2)
137
If disassociation curve shifts to the right, then hemoglobin...
-examples of right curve shift...
releases O2
| -hot (hyperthermia) or acidosis
138
What 3 things does aldosterone increase?
- increases Na and Cl
- increases H20 reabsorption
- increases K excretion
139
Uncontrolled diabetes puts you at a high risk for...
dehydration
140
Ca and phosphate have a ____ relationship
inverse
