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Fundamentals- NUR 111 > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

What is hyperkalemia?

A

having too much potassium

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2
Q

What are signs and symptoms of hyperkalemia?

A 
muscle twitches -> cramps -> paresthesia
irritability & anxiety
decreased BP
EKG changes
Dysrhythmias - irregular rhythm 
abdominal cramping
diarrhea
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3
Q

What does the acronym MURDER stand for?

A 
signs and symptoms of hyperkalemia
M-uscle cramps
U-rine abnormalities
R-espiratory distress
D-ecreased cardiac contractility
E-KG changes
R-eflexes
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4
Q

What is hypernatremia?

A

high sodium levels

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5
Q

What does the acronym MODEL in hypernatremia stand for?

A 
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
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6
Q

What is the acronym FRIED stand for in hypernatremia?

A 
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
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7
Q

What is hyponatremia?

A

low sodium levels

serum sodium less than 135 mEq/L

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8
Q

What is hyponatremia caused by?

A

dilution as a result of excess H2O or increased Na loss

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9
Q

What are some situations that cause Hyponatremia?

A 
GI suctioning
diarrhea
vomiting
diuretics
inadequate salt intake
fluid shift from ICF to ECF by hypertonic solutions
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10
Q

What is hypokalemia?

A

deficit or low in potassium

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11
Q

What does A SIC WALT stand for in hypokalemia?

A 
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
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12
Q

What is insulin?

A

functions as a substitute for the endogenous hormone. effects are the same as normal endogenous insuilin.

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13
Q

What is the function of insulin?

A

restores the diabetic patient’s ability to :
metabolize carbs, fats, and proteins,
store glucose in the liver,
convert glycogen to fat stores

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14
Q

What is human insulin?

A

derived from recombinant DNA technologies. produced by bacteria and yeast.

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15
Q

What is the goal of human insulin?

A

tight glucose control

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16
Q

What is the onset for rapid acting insulin?

A

5 to 15 minutes

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17
Q

What is the duration of rapid acting insulin?

A

short duration

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18
Q

When should a person be given rapid-acting insulin?

A

just before eating a meal

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19
Q

How is rapid-acting insulin given?

A

subcutaneously or via continuous subcutaneous infusion pump. not by IV

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20
Q

What are some rapid acting insulins?

A 
insulin lispro (Humalog)
insulin aspart (NovoLog)
insulin glulisine (Apidra)
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21
Q

What is a type of short acting insulin?

A

regular insulin (Humulin R)

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22
Q

What is the onset?

A

30 to 60 minutes

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23
Q

What is unique about short acting insulin?

A

only insulin product that can be given by IV bolus, IV infusion, or even IM.

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24
Q

What is a type of intermediate-acting insulin?

A

insulin isophane suspension (also called NPH)

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25
Q

What does intermediate acting insulin look like?

A

cloudy in appearance

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26
Q

What unique about intermediate acting insulin?

A

slower in onset and more prolonged duration then endogenous insulin.

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27
Q

What are types of long-acting insulin?

A

glargine (Lantus)

detemir (Levenir)

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28
Q

What is the appearance of long-acting insulin?

A

clear, colorless solution

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29
Q

How often is long-acting insulin given?

A

usually dosed once a day

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30
Q

What is long-acting insulin referred to as?

A

basal insulin

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31
Q

What is unique about long-acting insulin?

A

must be given alone, do not mix with other insulins.

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32
Q

What should you remember about fixed combinations of insulin?

A

They are premixed; do not mix them with other insulins

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33
Q

What are types of fixed insulin combinations?

A 
Humulin 70/30
Novolin 70/30
Humulin 50/50
NovoLog 75/25
Humalog Mix 75/25
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34
Q

What is sliding-scale insulin dosing?

A

subcutaneous short acting or regular insulin doses adjusted according to blood glucose test results.

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35
Q

When are sliding scales used?

A

typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings.

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36
Q

How is the subcutaneous insulin ordered on a sliding scale?

A

ordered in an amount that increases as the blood glucose increases

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37
Q

What is the disadvantage of sliding scale insulin dosing?

A

delays insulin administration until hyperglycemia occurs; results in large swings in glucose control

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38
Q

What is basal bolus insulin dosing?

A

mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus.

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39
Q

What is the preferred method of treatment with insulin for hospitalized diabetic patients?

A

basal-bolus insulin dosing

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40
Q

What are the medications used for basal-bolus insulin dosing?

A

basal insulin- long acting insulin (insulin glargine)

bolus insulin- rapid acting insulin (insulin lispro or insulin aspart)

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41
Q

What do we have to consider when talking about “nutritional status”?

A

nutrient, I & O’s, body’s needs, glucose, fluids and electrolytes.

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42
Q

What are major indicators of nutritional status?

A

albumin, pre-albumin, and glucose.

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43
Q

What are normal albumin levels?

A

3.5-5 g/dL

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44
Q

Where is albumin synthesized?

A

the liver

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45
Q

What is the half-life of albumin?

A

18-24 days

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46
Q

What is pre-albumin?

A

an early indicator of acute changes of nutritional status.

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47
Q

What are normal pre-albumin levels?

A

15-36 mg/dL

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48
Q

What is the half life of pre-albumin?

A

3-4 days

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49
Q

What do low levels of albumin and pre-albumin indicate?

A

malnutrition, malabsorption, liver disease, or protein loss through burns and wounds.

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50
Q

What are normal levels of glucose?

A

fasting- 70-110 mg/dL

random- <126 mg/dL

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51
Q

What levels of glucose indicate low blood sugar (hypoglycemia)?

A

<70 mg/dL

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52
Q

What levels of glucose indicate high blood sugar (hyperglycemia)?

A

> 110 mg/dL

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53
Q

How is glucose an indicator of nutritional status?

A

body needs energy for cells to work. too little or too much indicates poor nutrition.

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54
Q

What are the two types of diabetes?

A

Type 1 & Type 2

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55
Q

What is type 1 diabetes?

A

juvenile diabetes. pancreas does not produce insulin.

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56
Q

What is type 2 diabetes?

A

insulin-resistant. over exposed to glucose.

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57
Q

What is hypoglycemia?

A

low blood sugar, limits fuel supply to body.

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58
Q

What are signs and symptoms of hypoglycemia?

A

cold, clammy, weakness to comatose.

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59
Q

What are causes of hypoglycemia?

A

insufficient food intake, excess physical exertion, or too much hypoglycemia meds.

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60
Q

What is hyperglycemia?

A

high blood sugar. sign of endocrine dysfunction. diabetes mellitus.

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61
Q

What are signs and symptoms of hyperglycemia?

A

DKA, frequent urination.

Anxiety, sweaty, hungry, confused, blurred or double vision, shaky, irritable, and cool, clammy skin.

62
Q

What are the causes of hyperglycemia?

A

too much concentrated carbs, stress, and too little hypoglycemia meds.

63
Q

What is the treatment for diabetes?

A

diet and exercise.
oral meds and insulin injections.

***know table in notes

64
Q

Purposes of gastric feeding tubes?

A

gastric suction, feeding, medication, decompression, or lavage.

65
Q

What is lavage?

A

inserting and removing cool water for cessation of bleeding.

66
Q

What is gavage?

A

using gravity to feed patient via feeding tube

67
Q

What are nasogastric tubes?

A

through nose to stomach

68
Q

What is nasoenteral tubes?

A

through nose to intestine

69
Q

What is a PEG tube?

A

a tube going through the abdominal wall into the stomach through a surgical incision.

70
Q

What is enteral?

A

through the GI tract

71
Q

What is parenteral?

A

through the circulatory system

72
Q

What is the purpose of the air-vent on a salem tube?

A

prevents tube from sticking to the lining of the stomach

73
Q

How do you check the placement of an NG tube?

A

xray and aspirating contents and checking pH levels.

74
Q

When checking pH of the gastric aspirate, what must the pH be?

A

below 4.

75
Q

How often should you check for residual?

A

continuous feedings - every four hours

intermittent feedings- before administration

76
Q

When should you be concerned about residual?

A

more than 100 mL or more than 1/2 of amount to be given.

77
Q

How often do you change feeding tubes?

A

every 24 hours

78
Q

What is the onset of rapid acting insulin?

A

10 to 30 minutes

79
Q

What is the peak of rapid actin insulin?

A

30 min to 3 hours

80
Q

What is the duration of rapid acting insulin?

A

3 to 5 hours

81
Q

What is the onset of short acting insulin?

A

10 to 30 minutes

82
Q

What is the peak of short acting insulin?

A

2 to 5 hours

83
Q

What is the duration of short acting insulin?

A

up to 12 hours

84
Q

What is the onset of intermediate acting insulin?

A

1.5 to 4 hours

85
Q

What is the peak of intermediate acting insulin?

A

4 to 12 hours

86
Q

What is the duration of intermediate acting insulin?

A

up to 24 hours

87
Q

What is the onset of long acting insulin?

A

0.8 to 4 hours

88
Q

What is the peak of long acting insulin?

A

minimal peak

89
Q

What is the duration of long acting insulin?

A

up to 24 hours

90
Q

Which nutrient’s primary function is growth and repair of tissue?

A

proteins

91
Q

What are four functions of water?

A

regulate body temperature
lubricates joints
helps dissolve minerals
protects body organs and tissues

92
Q

What are ways fluids and electrolytes come in and out of the body?

A

urine, feces, vomit, sweat, breathing

93
Q

What are the purposes of fluid administration?

A 
to maintain or replace water, electrolytes, vitamins, and proteins
to administer calories
to increase blood volume
to restore acid-base balance
to administer medications
94
Q

What is the normal fluid intake without an IV?

A

2,500 mL/day

95
Q

What is the normal fluid output without and IV?

A

1,400-1,500 mL/day of urine

96
Q

What occurs with fluid deficit?

A

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.

97
Q

What occurs with fluid overload?

A

breathing has wheezing and crackles. HR increases, BP increases. decreased urine output. edema present. JVD.

98
Q

What are the three types of IV fluids?

A

isotonic, hypotonic, hypertonic.

99
Q

What are uses of isotonic fluids?

A

dehydration, hypovolemia, promotes diuresis, kcal for energy, and pre and post blood transfusions.

100
Q

Examples of isotonic fluids

A

0.9% NS, Lactated Ringers

101
Q

What are uses of hypotonic fluids?

A

hydration, supply daily salt, electrolyte replacement, fluid challenge.

102
Q

Examples of hypotonic fluids.

A

1/2 NS (0.45%)

103
Q

What does hypertonic fluids do?

A

pull body water into intravascular space

104
Q

What are uses of hypertonic fluids?

A

dehydration, restore fluid after extracellular fluid shift, stabilize BP.

105
Q

Examples of hypertonic fluids.

A

D5 1/2 NS, D50%, 3% NS.

106
Q

How long can a fluid bag hang?

A

no more than 24 hours

107
Q

What are electronic infusion devices?

A

IV pumps. more accuracy of flow, monitors pressure. Regulates flow of mL/hr of fluids using positive pressure.

108
Q

What are advantages of controllers?

A

accuracy, control, time saver, detect pressure and infiltration.

109
Q

What are disadvantages of controllers?

A

some complicated to use, false sense of security.

110
Q

What are minibags used for?

A

for piggyback or intermittent infusion usually 30 min

111
Q

What is an INT?

A

Intermittent infusion device?

112
Q

What is the purpose of an INT?

A

intermittent administration of meds or fluids. venous access in case of emergencies.

113
Q

What are the advantages of INT?

A

saves patient from multiple sticks, conserves veins, and freedom of motion- no IV poles

114
Q

What are butterfly needles?

A

used short term, meds or bolus. also used for scalp veins for infants.

115
Q

What are problems with butterfly needles?

A

less stable, can damage vein wall.

116
Q

How are IV catheters sized?

A

sized by diameter. the smaller the diameter, the larger the gauge. the smaller the gauge, the more rapidly fluid can be delivered.

117
Q

What are problems with IV catheters?

A

vessel damage, infection, phlebitis, and catheter embolus.

118
Q

What are PICC lines?

A

peripherally inserted central catheter

119
Q

Characteristics of PICC lines

A

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

120
Q

What gauges are used for most adult infusions?

A

20-22G

121
Q

What gauge is used for blood transfusion, OR, and L&D?

A

18 or 16G

122
Q

With IVs, what should a patient call a nurse for?

A

pain, swelling, leaking, bleeding at site, alarms sounding, air bubbles in line, or fluids running quickly or slowly.

123
Q

How often should you assess an IV?

A

q2h

124
Q

Riverside polices for IVs

A 
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
125
Q

Complications of IV therapy

A

local-infiltration, phlebitis, infection

systemic- septicemia, speed shock, air embolism, circulatory overload

126
Q

What is infiltration?

A

extravasation of injected fluid into subcutaneous tissues.

127
Q

What are the signs and symptoms of infiltration?

A

blanching, cool to touch, swelling

128
Q

What is the treatment for infiltration?

A

elevate arm, discontinue line

129
Q

What is phlebitis/thrombophlebis?

A

inflammation of vein with possible clot

130
Q

What are signs and symptoms of phlebitis?

A

pain, redness, tenderness, warm, edema, palpate vein cord.

131
Q

What is the treatment for phlebitis?

A

DC IV, apply cold/heat, elevate.

do not massage- can dislodge clot or spread infection

132
Q

What is infection?

A

invasion of pathogens that are localized in surrounding tissues

133
Q

What could cause infection in IV site?

A

fluid/equipment contamination, prolonged IV site, poor technique in care

134
Q

What are the signs and symptoms of infection?

A

drainage, edema, tenderness, redness

135
Q

What is the treatment for infection?

A

DC IV, culture catheter tip, monitor closely, administer meds as ordered

136
Q

What is circulatory overload?

A

large volume of fluid infusing rapidly. occurs more often in children and elderly.

137
Q

What are the signs of symptoms of circulatory overload?

A

JVD, HTN, hypovolemia, dyspnea, frothy sputum, can lead to cardiac or respiratory distress.

138
Q

What is the treatment of circulatory overload?

A

decrease IV rate, high fowlers, maintain site. Notify MD stat!

139
Q

What is septicemia?

A

systemic spread of pathogens from a localized site

140
Q

What are the signs and symptoms of septicemia?

A

gradual/sudden rise of temp, chills, tachycardia, headache, gastric complaints, can lead to septic shock

141
Q

What is the treatment of septicemia?

A

blood cultures, catheter trip culture, antibiotics, treat s/s

142
Q

What is air embolism?

A

air into venous system, more common with central lines

143
Q

What are signs and symptoms of air embolism?

A

chest pain, dyspnea, cyanosis, low back pain, hypotension, weak, thready pulse, loss of consciousness.

144
Q

What is the treatment of air embolism?

A

pt will die without prompt action.

Trendelenburg position, left side, administer O2, Notify MD stat.

145
Q

What is speed shock?

A

too rapid introduction of medication into circulatory system.

146
Q

What are the signs and symptoms of speed shock?

A

flushing face, headache, syncope, tachycardia, apprehension-anxiety, fear, chills, back pain, dyspnea.

147
Q

What is the treatment of speed shock?

A

stop infusion stat! notify MD stat!

148
Q

What is an allergic reaction?

A

antigen/antibody response to blood products or drugs. may occur shortly or hours later.

149
Q

What are the signs and symptoms of an allergic reaction?

A

hives, rash, fever, dyspnea, itching, edema, shock.

150
Q

What is the treatment for allergic reaction?

A

stop infusion, maintain line w/ D5W & new tubing. Notify MD stat

Fundamentals- NUR 111 (4 decks)

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