Unit #1 Flashcards
Lab value: Sodium (Na+)
135-145
Lab value: Potassium (K+)
3.5-5.0
lab value: Calcium (Ca+)
8.5-10.5
lab value: Magnesium (Mg+)
1.3-2.1
lab value: Chloride (Cl-)
97-110
lab value: Phosphate (PO4)
2.5-4.5
lab value: Hydrogen ion concentrate or potential of Hydrogen (pH)
7.35-7.45
lab value: Partial pressure of Oxygen (PaO2)
80-100
lab value: Carbon dioxide (CO2)
35-45
lab value: Partial pressure of Carbon Dioxide (PaCO2)
35-45
lab value: Bicarbonate (HCO3)
24-30
lab value: Carbonic Acid (H2CO3)
1.2
lab value: BUN
8-25
lab value: Creatinine
0.6-1.5
lab value: Glucose
65-110
lab value: Serum Osmolality
280-300
lab value: Hematocrit percentage (Hct)
36%-52%
S/Sx of Hypernatremia
fluid overload- will see: lethargy, drowsiness, stupor, or comatose)
deep tendon reflexes decrease- will see muscle weakness, twitching, etc.
Disease process with Hypernatremia
Kidney failure- poor kidney excretion
Tx for Hypernatremia
Diuretics to promote Na loss
ie: Lasix or Bumex
S/Sx of Hyponatremia
Sudden onset acute confusion or increased confusion- can see seizures, coma, or death
General muscle weakness- will see decrease tendon reflexes
Disease process for Hyponatremia
Prolonged use of diuretics
tx for Hyponatremia
decreased use of diuretics, give IV fluids
S/Sx of Hyperkalemia
Bradycardia, hypotension, ECG changes (peak T waves)
tingling/burning sensations followed by numbness in hands and feet
Disease process for Hyperkalemia
hospitalized pts undergoing treatment, chronically ill, elderly pts, or kidney failure
Tx for Hyperkalemia
Give Potassium-excreting diuretics (loop diuretics- lasix)
Stop all potassium food/drug sources
S/Sx of Hypokalemia
Shallow respirations, check mucus membranes and nail beds
muscle weakness, orthostatic hypotension
Disease process for Hypokalemia
Cushing’s syndrome, diuretics, corticosteroids, insulin drip (regular insulin)
Tx for Hypokalemia
Give IV or PO potassium, change to potassium sparing diuretics
S/Sx of Hypercalcemia
Renal stones, bone pain, abdominal pain, N/V
Polyuria, insomnia
Disease process for Hypercalcemia
Hyperparathyroidism
Tx for Hypercalcemia
re-hydration, increase salt intake
S/Sx of Hypocalcemia
petechiae, Chvostek’s sign (facial twitch on one side)
Disease process for Hypocalcemia
Hypoparathyroidism, vitamin D deficiency
Tx for Hypocalcemia
IV calcium gluconate
S/Sx of Hypmagnesemia
Weakness, N/V, decreased Resp rate
Decreased BP, decreased blood Calcium
Disease process for Hypermagnesemia
Kidney failure, over dose of antacids and laxatives
Tx for Hypermagnesemia
IV calcium gluconate
S/Sx of Hypomagnesemia
muscle cramps, abnormal Heart rate or rhythms
tremors, parasthesia
Disease process for Hypomagnesemia
Chronic diarrhea, malabsorption, alcoholism. or diuretics
Tx for Hypomagnesemia
PO Magnesium or IV Magnesium Sulfate
To decrease pH level, give:
Bicarb
5% dextrose in water
hypotonic or isotonic
0.9% Sodium Chloride
isotonic
5% dextrose in 0.9% Sodium Chloride
Hypertonic
5% dextrose in 0.45% Sodium Chloride
Hypertonic
Lactated Ringers
isotonic
3% normal Saline
Hypertonic
5% dextrose in Lactated Ringers
hypertonic or isotonic
Isotonic solutions are similar to:
blood serum (stays in the vascular space and expands volume)
Hypertonic solutions:
pulls fluids out of cells, into the vascular space (given for fluid overload)
Hypotonic solutions:
pull fluids into the cells, out of the vascular space (given for dehydration)
3 advantages of IV therapy:
Therapeutic effect is quicker
Control over rate of administration
Great for pts who cannot tolerate otehr routes
3 disadvantages of IV therapy:
CANNOT reverse toxic dose as quickly or effectively
Increased drug to drug interference
Can be more expensive
3 common complications of IV therapy:
Phlebitis- inflammation of vein
Infiltration- fluids leak into tissues
Thrombosis- blood clot in vein caused by extremes in osmolarity or pH
Advantages and Disadvantages of PICC lines
Advantage: decreased r/f infection, short-term use
Disadvantage: easily damaged
Advantages and Disadvantages of Tunneled CVC
long-term (wks-months), harsh meds, no surgery, is placed RAD, 1-3 lumens
Disadvantage: Radiation exposer, used weeks-months
Advantages and Disadvantages of Implanted Ports
Advantage: long-term 1+ years, 1-2 lumens, decrease r/f infection
Disadvantage: needle stick access, surgically implanted
Advantages and Disadvantages of Non-Tunneled CVC
Advantage: short-term, 1-4 lumens
Disadvantage: Increased r/f infection, easy to fall out
Acid-Base Balance
occurs through control of Hydrogen ion production and elimination
the body wants homeostasis
Increase Hydrogen ions = decreased pH =
ACIDOSIS
Decrease Hydrogen ions = increased pH =
ALKALOSIS
Abnormal Acid-Base causes:
reduces the function of hormones and enzymes, changes distribution of electrolytes causing fluid/electrolyte imbalance, changes excitable membranes making body systems more or less active, and decreases the effectiveness of many drugs (acidosis)
Acids
releases hydrogen ions to increase pH
Bases
bind to hydrogen ions decreasing pH
Buffers
react to acids or bases depending on the acid-base balance
Carbonic Acid (H2CO3) is considered:
an UNSTABLE element
Sources of Acids:
Carbohydrates
Fats
Lactic acid
Cell destruction
**COPD pts need low carb, high protein diet to decrease CO2 retention
**Increased lactic acid- depleted O2 stores with sepsis
Sources of Bicarbonate:
Oral intake of bicarb Pancreatic production Kidney reabsorption Breakdown of carbonic acid **Needs kidney function to produce bicarb, to pee out acids (kicks in @ 24hr)
1st line of defense:
Buffers
Buffers
chemicals buffers: bicarb or phosphate (binds to H to pee it out)
protein buffers: albumin or globulins or hemoglobin
**Bicarb- Hgb acts like a sponge and pulls in extracellular acid- will let go of extra acids when in acidotic state
2nd line of defense:
Respiratory system (kicks in quickly and short lived)
Respiratory System:
Acidotic state= Increased rate and depth of breathing to get rid of acids (blow off CO2)
Increased H+ = increased acid = Increased K+ (goes outside the cell) = CARDIAC ISSUES, muscle, respiratory, and CNS dysfunction
3rd line of defense:
Kidneys
Kidneys
takes 24-48 hours to respond
increase excretion and reabsorption rates
Excrete BICARB when blood H+ levels low, reabsorbs bicarb when blood H+ is high
**Formation of ammonium or phosphate in urine traps H+ for excretion
Compensation:
body adapts to attempt to correct changes in blood pH and maintain A-B balance within normal range (7.35-7.45)
Respiratory compensation- rapid but easily overwhelmed
Kidney compensation- requires time, production/reabsorption of bicarb
*** Means body mechanisms are working; pH is maintained.
Acidosis
pH below 7.35
Causes of Metabolic Acidosis:
DKA, starvation, seizures, heavy exercise. fever, hypoxia, ischemia, kidney or liver failure, dehydration, diarrhea
Causes of Respiratory Acidosis:
Respiratory depression, electrolyte imbalance, inadequate chest expansion, airway obstruction, head trauma, increased intracranial pressure.
Assessment for ACIDOSIS:
History: smoking Hx, diet, opioid use, etc.
Skin- pale skin, mottling (decreased perfusion)
Psychsocial- change in behavior
Labs- electrolytes and ABGs
S/Sx of Respiratory Acidosis:
low pH, high CO2, high K+, normal or low bicarb, low PaO2
S/Sx of Metabolic Acidosis:
low pH, low to normal CO2, low bicarb, normal or low PaO2, increased anion gap
**heart problems caused by increased K+ = wide QRS complex
Intervention for Metabolic Acidosis:
hydration, medications (insulin and anidiarrheals), cardiac monitoring, close observation, fall precautions, skin care, treat underlying cause, bicarb replacement
Interventions for Respiratory Acidosis:
improve ventilation and oxygenation, medications (bronchodilators, anti-inflammatories), cardiac monitoring, pulmonary hygiene, ventilator support, frequent vital signs, respiratory assessment
** CYANOSIS IS LATE FINDING
Alkalosis
pH greater than 7.45
Causes of Metabolic Alkalosis:
increase in base excess or decrease of acid, results of base ingestion; massive blood transfusion, NG suctioning or vomiting, thiazide diuretics
Causes of Respiratory Alkalosis:
excessive loss of CO2 from fear, pain, inadequate ventilator support, fever, CNS lesions, salicylate toxicity, shock, early stage pulmonary problems
S/Sx of Alkalosis:
dizziness, tingling, cramps, agitation, confusion, hyperfelxia, tetany, twitches, weakness, hypokalemia, depressed respiratory effort, hypotension, elevated HR, thready pulse, hyperventilation
Interventions for Alkalosis:
prevent loss of H+, K+, Ca+, Cl-
restore fluid balances
patient safety for muscle weakness, CNS changes, hypotension, falls
Assess therapy used (NG suctioning, diuretics) to prevent further H+ loss
HYDRATION
Oxyhemoglobin Disassociation Curve
Oxygen and Acid-Base changes the ability of teh oxygen to jump off changes
** can reach a point when oxygen can no longer jump off
Question: A nursing instructor is explainig acid-base imbalance to a group of nursing students. Which statements by the instructor are correct regarding the body’s attempt to restore acid-base balance?
renal compensation is slow and long lasting
respiratory compensation is fast but temporary
Question: A nurse is caring fora client who is at risk for metabolic acidosis. Which mechanism should the nurse identify as the first line of defense against changes in the pH of the blood?
Buffers: Bicarbonate, Phosphorus, and Hemoglobin
Question: A nurse obtains the recent medical history of a newly admitted client. Which factors in the client’s history should the nurse identify as placing the client at risk for respiratory acidosis?
Oxycodone use and PNA
causes decreased respiratory efforts
Question: The nurse prepares to interpret the ABG values of a client diagnosed with an acid-base imbalance. Which values are most important for the nurse to consider?
pH
PaO2
PaCO2
HCO3
Question: A nurse assesses a pregnant client in her first trimester of pregnancy who has been vomiting for 3 days. The client is diagnosed with hyperemesis gravidarum. The nurse should correctly identify that the client is experiencing which fluid and acid-base imbalance?
Fluid volume deficit and metabolic Alkalosis
Qualitative
focuses on MEANING and INTERPRETATION of human experience
**not always reliable, similar to subjective data
Quantitative
MEASURABLE information and statistical analysis
PICOT
Population Intervention Comparison Outcome Time
Fantastic Four research databases:
Cochrane Library Joanna Briggs Institute Medline (MedPub) CINAHL **AHRQ-- free research library
Steps of EBP Process:
- ask the burning questions
- Find best evidence available to answer questions
- Critically appraise relevant evidence
- Make recommendations
- Implement accepted recommendations
- Evaluate outcomes.
Scope of Nursing
Promote health and prevent illness/injury
**generalist- know a lot about a lot of things
QSEN KSAs
Communication Compassion Culture Patient education and empowerment Respect patients and family
SBAR
Situation Background Assessment Recommendations **communication tool
Delegation
transferring of tasks/activity
always accountable for tasks delegated
**NEVER delegate to someone if not in their scope
Supervision
guidance, direction, evaluation, follow-up to ensure task performed appropriately
Delegation vs Supervision
Delegation is pt care related
Supervision is workplace/efficiency related
Five Rights of Delegation
Right TASK Right CIRCUMSTANCES Right PERSON Right COMMUNICATION Right SUPERVISION
Question: The nurse is caring for a patient who has been admitted for heart failure. The patient begins to display signs of confusion. The nurse obtains vital signs showing that the BP dropped from 132/78 to 108/60, and his pulse is 115bpm. What is the appropriate action?
Activate the Rapid Response Team.
Question: The nurse observes an increased incidence of contaminated blood cultures as indicated by lab report, thus requiring that the blood be redrawn. what quality improvement step could the nurse implement to reduce the blood culture contamination rates?
Evaluate trends and develop a plan for improvement.
Homeostasis
Proper functioning of all body systems
Filtration
Movement of fluid through cells or blood vessels
Hydrostatic Pressure
“water-pushing pressure”
ie: blood pressure
Diffusion
movement of particles across a permeable membrane
Osmosis
Movement of water
Minimum urine output need to excrete toxic waste
400-600ml/day
Aldosterone balances
Sodium (Na+)
Antiduretic hormone holds on to
water
Natriuretic peptides are the body’s attempt to rid
water
normal value 449mg/mL
Kidneys- are major regulators of:
water and sodium balance,
maintains blood and perfusion pressure
Renin-angiotensin 2 pathway is stimulated by
shock or stress response
Minimum urine per hour
30mL, below 30 requires intervention.
ACE Inhibitors
block angiotensin 2 receptors, the blood pressure lowers
1 Liter water weighs
2.2 pounds = 1 kg
Weight change of 1 pound =
fluid volume change of 500mL
**best way to measure: DAILY WEIGHT
Drink MORE water with diuretics to:
STOP R-A pathway from kicking in
Alcoholics will have INCREASED BP because
of the Renin-Angiotensin pathway effect on body
Fluid Overload:
Listen to HR and Lungs
give Lasix
restrict sodium/fluids
will see: edema, numbness, crackles, increased BP and RR, altered LOC; HA, renal failure, decreased urine
Potassium is _____ and Sodium is ______.
K+ is intracellular
Na+ is extracellular
Hyponatremia is caused by
NPO status, diaphoresis, decreased intake of Na, fluid overload, dehydration
To increase NA: given IV Lasix
Hypernatremia is caused by
Increased intake of Na, Increased aldosterone, too much IVF
To decrease Na: give ISOTONIC fluids
Potassium regulates
protein synthesis, glucose use and storage
Hypokalemia is caused by
NG suctioning, diuretics, NPO, Vomiting or diarrhea
To increased K+: give IVF, PO/IV K+
Hyperkalemia is caused by
renal failure, crush injury, burns, Potassium sparing diuretics, salt substitutes/food intake, Diabetes
To decrease K+: give Kayexalate, IVF, dialysis
Calcium is responsible for:
heart health, muscle health, and bone health
Hypocalcemia is caused by:
decreased vitamin D, hypoparathyroidism, Chrone’s disease, pancreatitis, Short-bowel syndrome
to assess: check cheek and BP cuff response
Hypercalcemia is caused by:
increased calcium intake, bone demineralization, osteoporosis, dehydration.
Phosphorus is in a reciprocal relation ship with:
Calcium
Increased phosphorus = Decreased Calcium
Decreased phosphorus = Increased Calcium
Hypophosphatemia is caused by
antacids and starvation
Hyperphosphatemia is caused by
renal failure and alcoholism
Magnesium is responsible for:
neurovascular systems, muscle contraction/relaxation
** if Ca+ increased Mg+ increased \ if Ca+ decreased Mg+ decreased
