Unit 3 Flashcards
What is hyperkalemia?
having too much potassium
What are signs and symptoms of hyperkalemia?
muscle twitches -> cramps -> paresthesia irritability & anxiety decreased BP EKG changes Dysrhythmias - irregular rhythm abdominal cramping diarrhea
What does the acronym MURDER stand for?
signs and symptoms of hyperkalemia M-uscle cramps U-rine abnormalities R-espiratory distress D-ecreased cardiac contractility E-KG changes R-eflexes
What is hypernatremia?
high sodium levels
What does the acronym MODEL in hypernatremia stand for?
Causes of increased sodium levels M-medications, meals-high sodium intake O-osmotic diuretics D-diabetes insipidus E-excessive H2O loss L-low H2O intake
What is the acronym FRIED stand for in hypernatremia?
signs and symptoms of hypernatremia F-Fever-low grade, flushed skin R-Restless-irritable I- increased fluid retention, increased BP E- edema- peripheral and pitting D-decreased urine output, dry mouth
What is hyponatremia?
low sodium levels
serum sodium less than 135 mEq/L
What is hyponatremia caused by?
dilution as a result of excess H2O or increased Na loss
What are some situations that cause Hyponatremia?
GI suctioning diarrhea vomiting diuretics inadequate salt intake fluid shift from ICF to ECF by hypertonic solutions
What is hypokalemia?
deficit or low in potassium
What does A SIC WALT stand for in hypokalemia?
A-lkalosis S-hallow respirations I-rritability C-onfusion, drowsiness W-eakness, fatigue A-rrhythmias L-ethargy T-hready pulse \+ decreased intestinal motility, nausea/vomiting, ileus
What is insulin?
functions as a substitute for the endogenous hormone. effects are the same as normal endogenous insuilin.
What is the function of insulin?
restores the diabetic patient’s ability to :
metabolize carbs, fats, and proteins,
store glucose in the liver,
convert glycogen to fat stores
What is human insulin?
derived from recombinant DNA technologies. produced by bacteria and yeast.
What is the goal of human insulin?
tight glucose control
What is the onset for rapid acting insulin?
5 to 15 minutes
What is the duration of rapid acting insulin?
short duration
When should a person be given rapid-acting insulin?
just before eating a meal
How is rapid-acting insulin given?
subcutaneously or via continuous subcutaneous infusion pump. not by IV
What are some rapid acting insulins?
insulin lispro (Humalog) insulin aspart (NovoLog) insulin glulisine (Apidra)
What is a type of short acting insulin?
regular insulin (Humulin R)
What is the onset?
30 to 60 minutes
What is unique about short acting insulin?
only insulin product that can be given by IV bolus, IV infusion, or even IM.
What is a type of intermediate-acting insulin?
insulin isophane suspension (also called NPH)
What does intermediate acting insulin look like?
cloudy in appearance
What unique about intermediate acting insulin?
slower in onset and more prolonged duration then endogenous insulin.
What are types of long-acting insulin?
glargine (Lantus)
detemir (Levenir)
What is the appearance of long-acting insulin?
clear, colorless solution
How often is long-acting insulin given?
usually dosed once a day
What is long-acting insulin referred to as?
basal insulin
What is unique about long-acting insulin?
must be given alone, do not mix with other insulins.
What should you remember about fixed combinations of insulin?
They are premixed; do not mix them with other insulins
What are types of fixed insulin combinations?
Humulin 70/30 Novolin 70/30 Humulin 50/50 NovoLog 75/25 Humalog Mix 75/25
What is sliding-scale insulin dosing?
subcutaneous short acting or regular insulin doses adjusted according to blood glucose test results.
When are sliding scales used?
typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings.
How is the subcutaneous insulin ordered on a sliding scale?
ordered in an amount that increases as the blood glucose increases
What is the disadvantage of sliding scale insulin dosing?
delays insulin administration until hyperglycemia occurs; results in large swings in glucose control
What is basal bolus insulin dosing?
mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus.
What is the preferred method of treatment with insulin for hospitalized diabetic patients?
basal-bolus insulin dosing
What are the medications used for basal-bolus insulin dosing?
basal insulin- long acting insulin (insulin glargine)
bolus insulin- rapid acting insulin (insulin lispro or insulin aspart)
What do we have to consider when talking about “nutritional status”?
nutrient, I & O’s, body’s needs, glucose, fluids and electrolytes.
What are major indicators of nutritional status?
albumin, pre-albumin, and glucose.
What are normal albumin levels?
3.5-5 g/dL
Where is albumin synthesized?
the liver
What is the half-life of albumin?
18-24 days
What is pre-albumin?
an early indicator of acute changes of nutritional status.
What are normal pre-albumin levels?
15-36 mg/dL
What is the half life of pre-albumin?
3-4 days
What do low levels of albumin and pre-albumin indicate?
malnutrition, malabsorption, liver disease, or protein loss through burns and wounds.
What are normal levels of glucose?
fasting- 70-110 mg/dL
random- <126 mg/dL
What levels of glucose indicate low blood sugar (hypoglycemia)?
<70 mg/dL
What levels of glucose indicate high blood sugar (hyperglycemia)?
> 110 mg/dL
How is glucose an indicator of nutritional status?
body needs energy for cells to work. too little or too much indicates poor nutrition.
What are the two types of diabetes?
Type 1 & Type 2
What is type 1 diabetes?
juvenile diabetes. pancreas does not produce insulin.
What is type 2 diabetes?
insulin-resistant. over exposed to glucose.
What is hypoglycemia?
low blood sugar, limits fuel supply to body.
What are signs and symptoms of hypoglycemia?
cold, clammy, weakness to comatose.
What are causes of hypoglycemia?
insufficient food intake, excess physical exertion, or too much hypoglycemia meds.
What is hyperglycemia?
high blood sugar. sign of endocrine dysfunction. diabetes mellitus.
What are signs and symptoms of hyperglycemia?
DKA, frequent urination.
Anxiety, sweaty, hungry, confused, blurred or double vision, shaky, irritable, and cool, clammy skin.
What are the causes of hyperglycemia?
too much concentrated carbs, stress, and too little hypoglycemia meds.
What is the treatment for diabetes?
diet and exercise.
oral meds and insulin injections.
***know table in notes
Purposes of gastric feeding tubes?
gastric suction, feeding, medication, decompression, or lavage.
What is lavage?
inserting and removing cool water for cessation of bleeding.
What is gavage?
using gravity to feed patient via feeding tube
What are nasogastric tubes?
through nose to stomach
What is nasoenteral tubes?
through nose to intestine
What is a PEG tube?
a tube going through the abdominal wall into the stomach through a surgical incision.
What is enteral?
through the GI tract
What is parenteral?
through the circulatory system
What is the purpose of the air-vent on a salem tube?
prevents tube from sticking to the lining of the stomach
How do you check the placement of an NG tube?
xray and aspirating contents and checking pH levels.
When checking pH of the gastric aspirate, what must the pH be?
below 4.
How often should you check for residual?
continuous feedings - every four hours
intermittent feedings- before administration
When should you be concerned about residual?
more than 100 mL or more than 1/2 of amount to be given.
How often do you change feeding tubes?
every 24 hours
What is the onset of rapid acting insulin?
10 to 30 minutes
What is the peak of rapid actin insulin?
30 min to 3 hours
What is the duration of rapid acting insulin?
3 to 5 hours
What is the onset of short acting insulin?
10 to 30 minutes
What is the peak of short acting insulin?
2 to 5 hours
What is the duration of short acting insulin?
up to 12 hours
What is the onset of intermediate acting insulin?
1.5 to 4 hours
What is the peak of intermediate acting insulin?
4 to 12 hours
What is the duration of intermediate acting insulin?
up to 24 hours
What is the onset of long acting insulin?
0.8 to 4 hours
What is the peak of long acting insulin?
minimal peak
What is the duration of long acting insulin?
up to 24 hours
Which nutrient’s primary function is growth and repair of tissue?
proteins
What are four functions of water?
regulate body temperature
lubricates joints
helps dissolve minerals
protects body organs and tissues
What are ways fluids and electrolytes come in and out of the body?
urine, feces, vomit, sweat, breathing
What are the purposes of fluid administration?
to maintain or replace water, electrolytes, vitamins, and proteins to administer calories to increase blood volume to restore acid-base balance to administer medications
What is the normal fluid intake without an IV?
2,500 mL/day
What is the normal fluid output without and IV?
1,400-1,500 mL/day of urine
What occurs with fluid deficit?
dehydration. increased breathing over time. poor skin turgor- tenting. edema is rare. urine color is concentrated or dilute. weight is decreased. vital signs = systolic BP decreases, HR increases.
What occurs with fluid overload?
breathing has wheezing and crackles. HR increases, BP increases. decreased urine output. edema present. JVD.
What are the three types of IV fluids?
isotonic, hypotonic, hypertonic.
What are uses of isotonic fluids?
dehydration, hypovolemia, promotes diuresis, kcal for energy, and pre and post blood transfusions.
Examples of isotonic fluids
0.9% NS, Lactated Ringers
What are uses of hypotonic fluids?
hydration, supply daily salt, electrolyte replacement, fluid challenge.
Examples of hypotonic fluids.
1/2 NS (0.45%)
What does hypertonic fluids do?
pull body water into intravascular space
What are uses of hypertonic fluids?
dehydration, restore fluid after extracellular fluid shift, stabilize BP.
Examples of hypertonic fluids.
D5 1/2 NS, D50%, 3% NS.
How long can a fluid bag hang?
no more than 24 hours
What are electronic infusion devices?
IV pumps. more accuracy of flow, monitors pressure. Regulates flow of mL/hr of fluids using positive pressure.
What are advantages of controllers?
accuracy, control, time saver, detect pressure and infiltration.
What are disadvantages of controllers?
some complicated to use, false sense of security.
What are minibags used for?
for piggyback or intermittent infusion usually 30 min
What is an INT?
Intermittent infusion device?
What is the purpose of an INT?
intermittent administration of meds or fluids. venous access in case of emergencies.
What are the advantages of INT?
saves patient from multiple sticks, conserves veins, and freedom of motion- no IV poles
What are butterfly needles?
used short term, meds or bolus. also used for scalp veins for infants.
What are problems with butterfly needles?
less stable, can damage vein wall.
How are IV catheters sized?
sized by diameter. the smaller the diameter, the larger the gauge. the smaller the gauge, the more rapidly fluid can be delivered.
What are problems with IV catheters?
vessel damage, infection, phlebitis, and catheter embolus.
What are PICC lines?
peripherally inserted central catheter
Characteristics of PICC lines
vein in arm, subclavian, internal jugular, or femoral vein. for long term use. 3-10 days. multiple lumens for simultaneous infusions. nontunneled central venous catheter
What gauges are used for most adult infusions?
20-22G
What gauge is used for blood transfusion, OR, and L&D?
18 or 16G
With IVs, what should a patient call a nurse for?
pain, swelling, leaking, bleeding at site, alarms sounding, air bubbles in line, or fluids running quickly or slowly.
How often should you assess an IV?
q2h
Riverside polices for IVs
change primary tubing q72h change minibag tubing q24h change TPN tubing q24h change IV site q72h discard unused solution after 24h (lipids after 12h) maintain IV as a closed system assess and document IV site q2h
Complications of IV therapy
local-infiltration, phlebitis, infection
systemic- septicemia, speed shock, air embolism, circulatory overload
What is infiltration?
extravasation of injected fluid into subcutaneous tissues.
What are the signs and symptoms of infiltration?
blanching, cool to touch, swelling
What is the treatment for infiltration?
elevate arm, discontinue line
What is phlebitis/thrombophlebis?
inflammation of vein with possible clot
What are signs and symptoms of phlebitis?
pain, redness, tenderness, warm, edema, palpate vein cord.
What is the treatment for phlebitis?
DC IV, apply cold/heat, elevate.
do not massage- can dislodge clot or spread infection
What is infection?
invasion of pathogens that are localized in surrounding tissues
What could cause infection in IV site?
fluid/equipment contamination, prolonged IV site, poor technique in care
What are the signs and symptoms of infection?
drainage, edema, tenderness, redness
What is the treatment for infection?
DC IV, culture catheter tip, monitor closely, administer meds as ordered
What is circulatory overload?
large volume of fluid infusing rapidly. occurs more often in children and elderly.
What are the signs of symptoms of circulatory overload?
JVD, HTN, hypovolemia, dyspnea, frothy sputum, can lead to cardiac or respiratory distress.
What is the treatment of circulatory overload?
decrease IV rate, high fowlers, maintain site. Notify MD stat!
What is septicemia?
systemic spread of pathogens from a localized site
What are the signs and symptoms of septicemia?
gradual/sudden rise of temp, chills, tachycardia, headache, gastric complaints, can lead to septic shock
What is the treatment of septicemia?
blood cultures, catheter trip culture, antibiotics, treat s/s
What is air embolism?
air into venous system, more common with central lines
What are signs and symptoms of air embolism?
chest pain, dyspnea, cyanosis, low back pain, hypotension, weak, thready pulse, loss of consciousness.
What is the treatment of air embolism?
pt will die without prompt action.
Trendelenburg position, left side, administer O2, Notify MD stat.
What is speed shock?
too rapid introduction of medication into circulatory system.
What are the signs and symptoms of speed shock?
flushing face, headache, syncope, tachycardia, apprehension-anxiety, fear, chills, back pain, dyspnea.
What is the treatment of speed shock?
stop infusion stat! notify MD stat!
What is an allergic reaction?
antigen/antibody response to blood products or drugs. may occur shortly or hours later.
What are the signs and symptoms of an allergic reaction?
hives, rash, fever, dyspnea, itching, edema, shock.
What is the treatment for allergic reaction?
stop infusion, maintain line w/ D5W & new tubing. Notify MD stat
