Week 6--- ati hw & ch 38 Flashcards
normal pH range
7.35 to 7.45
CO2 range
35 to 45 mmhg
HCO3- range
bicarbonate
21 to 28 mEq/L
PO2 range
80 to 100hg
Respiratory acidosis
ph less than <7.35
*Co2 >45
HCO3 normal
Respiratory Alkalosis
(AHHHHH-kalosis)
*hyperventilation causing excess CO2 release
pH: >7.45
*CO2: <35
HCO3: normal
Metabolic Alkalosis
pH: >7.45
CO2: normal
*HCO3 : > 28
Metabolic Acidosis
pH: <7.35
CO2 : normal
*HCO3: <21
R.O.M.E.
*** relationship w PH
R. —respiratory
O. —opposite (pH w/ CO2)
M. —metabolic
E. —equal (pH w/ HCO3)
pH will determine if
acidosis <7.35
or
alkalosis >7.45
hyperventilation
vs
hypoventilation
hypo = more CO2 is retained & body is more acidic
hyper = CO2 is excreted and body is more basic
how long to infuse blood
over a 4 hour time period
When applying IV to a client with a high risk for bleeding…
apply blood pressure cuff set to 30 mmHg
universal blood donor
O- blood
universal recipient
AB+
Blood type A- can donate to
A-, A+, AB-, AB+
Blood type A+ can donate to
A+, AB+
Blood type B- can donate to
B-, B+, AB-. AB+
Blood type B+ can donate to
B+, AB+
Blood type AB- can donate to
AB-, AB+
Blood type AB+ can donate to
AB+
Blood type O- can donate to
universal donor
Blood type O+ can donate to
O+ A+, B+, AB+
Blood type A- can receive from
A- or O-
Blood type A+ can receive from
A+, A-, O+, or O-
Blood type B- can receive from
B-, or O-
Blood type B+ can receive from
B+, B-, O+, O-
Blood type AB- can receive from
A-, B-, AB- or O-
Blood type AB+ can receive from
Everyone
Blood type O- can receive from
O-
Blood type O+ can receive from
O+, O-
during a blood transfusion the nurse should
check on the client every 15 minutes
2 nurse check
tubing w/ a filter
Iv solution for blood transfusion & dehydration
0.9% NaCl (sodium chloride)
WBC count normal range
5,000 to 10,000
normal platelet count
150,000 to 400,000
potassium range
3.5 to 5 mEq/L
*intracellular
sodium range
136 to 145 mEq/L
*extracellular
calcium range
9 to 10.5 mg/dL
absorption dependent on Vitamin D
Magnesium range
1.3 to 2.1 mEq/L
*Mg has a long 1/2 life–takes 24 hrs to decrease levels
definition of dehydration
excess water loss without a loss of sodium
*increased urine specific gravity (>1.030)
*hypernatremia
hypovolemia is
decrease in blood volume due to body fluid or blood loss
symptoms:
-tachycardia & tachypnea
-hypotension
-thirst
-decreased skin tugor & urine output
serum osmolality
increased = dehydration
285 to 295 mOsm/kg
potassium is responsible for
transmission of electrical impulses & conduction of nerve cells in the heart
3.5 to 5
hypokalemia
<3.5 mEq/L
symptoms:
- muscle weakness
-hypotension
-fatigue
-constipation
- cardiac arrhythmias
hypokalemia is caused by;
amphotericin B
diabetic ketoacidosis
diuretics
excessive sweating
metabolic alkalosis
theophylline
for hypokalemia admin potassium at
10 to 20 mEq/hr
hyperkalemia
> 5 mEq/L
symptoms:
-n/v
-deep tendon reflexes
- dysrhythmias
patients with hyperkalemia are at an increased risk for
hypoglycemia
hyperkalemia could be caused by:
acidosis
ACE Inhibitors
burns
dehydration
diabetes mellitus
NSAID
potassium diuretics
sepsis
trreatment for hyperkalemia may include
calcium gluconate
calcium chloride
insulin
hemodialysis
resin medication
hyponatremia
<136 mEq/L
**older adults = higher risk
symptoms:
-confusion
-headache
-irritability
-lethargy
-seizure/coma
hyponatremia can be caused by
burns
excess water/alcohol
*Thiazide Diuretics
vomiting
diarrhea
treatment for hyponatremia may include
3% sodium chloride
BMP or CMP
urinalysis
limiting fluid intake
Iv administration
hypernatremia
> 145 mEq/L
w/ plasma osmolality >295 mOsm/kg
symptoms:
-confusion
-lethargy
- irritability
hypernatremia is caused by
burns
excess sweating
diabetes
vomiting
treatment for hypernatremia
0.45% NaCl
decrease sodium levels SLOWLY to prevent edema
ionized calcium levels
calcium binds to protein, so ionized calcium levels are a separate order to analyze 50% of total calcium
levels should be between 4.5 to 5.6
hypocalcemia
< 9 mg/dL (ionized < 4.5)
symptoms:
-chest pain
-wheezing
-dysphagia
-dryness
-numbness in fingers & toes
hypocalcemia can be caused by;
glucocorticoids (-one)
H2 Blockers (-dine)
hypoparathyroidism
low Vitamin D
low albumin levels
loop diuretics (-ide)
proton pump inhibitors (-azole)
menopause (low estrogen)
Chvostek Sign
indicates low Calcium or Magnesium
(+) = twitching of facial muscles when tapped 2 cm in front of tragus of ear
Trousseau Sign
indicates low Calcium or Magnesium
(+) = flexion of wrist, thumb, & finger joints w/ hyperextension of fingers when blood pressure cuff is 20mmHg above client’s systolic for 3-5 min
treatment for hypocalcemia
Vitamin D supplements
Calcium injections
hypercalcemia
> 10.5 mg/dL (ionized >5.6)
symptoms:
–elevated PTH
–N/V
-constipation
-anorexia
-kidney stones
-polyuria
-thirst
hypercalcemia symptoms mnemonic
abdominal MOANS, painful BONES, kidney STONES, GROANS, & neurologic OVERTONES
hypercalcemia is caused by
*thiazide diuretics
*prolonged bed rest
Vitamin D toxicity
cancer
hyperparathyroidism
treatment for hypercalcemia includes
IV saline bolus w/ loop diuretic
hemodialysis
hypomagnesemia
< 1.3 mEq/L
symptoms:
-muscle cramps
-numbness
-weakness
-N/V
hypomagnesemia is caused by:
*hypocalcemia
*hypokalemia
loop diuretics
thiazide diuretics
proton pump inhibitos
antibiotics
burns
treatment for hypomagnesemia
- slow admin of IV magnesium w/ 2 nurse verification
-monitoring urine
-adverse effects: flushing, sweating, & respiratory depression
hypermagnesemia
> 2.1 mEq/L
ABSENT PATELLAR REFLEX
*24hrs to decrease levels bc of long Mg half life
symptoms:
-loss of deep tendon reflex
-nausea & dizziness
-confusion
-bradycardia
-hypotension
-weakness
-bladder paralysis
hypermagnesemia is caused by:
*opiods
*hypothyroidism
antacids
acidotic state
analgesics
laxatives
kidney disease
trauma
treatment for hypermagnesemia
calcium carbonate
calcium gluconate
IV diuretics
ECG
serum blood test
urine specific gravity range
1.005 - 1.030
*elevated = dehydration
hypovolemia is caused by:
*Third spacing (fluids sequestered in body cavities)
-severe burns
-excessive sweat
-diuretics
treatment for hypovolemia includes
0.9% normal saline
IV Ringers lactate
hypervolemia
excess body fluid
symptoms:
-jugular vein distention
-bounding pulse
-hypertension
hypervolemia is caused by
-hypertension meds (vasodilators, calcium channel blockers, glitazones)
-pregnancy
-cirrhosis
-liver failure
nursing interventions for hypervolemia
-daily weight
-limit fluid intake
-diuretics
nursing interventions for rehydration
-record intake & output HOURLY
*child = 5ml every 5 to 10 min
hypotonic solution
0.45% NaCl
fewer solutes outside than inside cell
*hypernatremia
*diabetic ketoacidosis
isotonic solution
0.9% NaCl
Lactated Ringers
5% dextrose
hypertonic solution
more solutes outside than inside cell
3% NaCl
5 & 10% dextrose
tidal volume
amount of air inspired and expired with each breath
vital capacity
maximum volume of air that is expelled after maximal inspirationt
total lung capacity
volume of air remaining in the lung after maximal inspiration
tactile fremitus
vibration felt in the chest wall during palpation or auscultation found when speaking
right vs left heart failure
right = edema
left = lungs
nasal cannula
prongs in nares
1 to 6 Liters per minute
24% - 44% oxygen
regurgitation
leaking heart valves that do not close
sounds like a murmur
simple face mask
5 to 8L per minute
40% to 60% oxygen
retains CO2
partial rebreather mask
10 to 15 L per minute
60% to 90% oxygen
**reservoir bag
Nonrebreather mask
10 to 15 L per minute
80% to 95% oxygen
not for clients w COPD
Venturi Mask
barrel at base of mask
4 to 10 L per minute
24% to 50%
A nurse in a provider’s pffice is caring for a client who states that, for the past week, “I have felt tired during the day & cannot sleep at night.” Which of the following responses should the nurse ask when collecting data about the client’s difficulty sleeping? (sap)
1.”Have your working hours changed recently?”
- “Do you feel confused in the late afternoon?”
- “Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day?”
- “Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep?”
- “Tell me about any personal stress you are experiencing.”
1.”Have your working hours changed recently?”
- “Do you drink coffee, tea, or other caffeinated drinks? If so, how many cups per day?”
- “Has anyone ever told you that you seem to stop breathing for a few seconds while you are asleep?”
- “Tell me about any personal stress you are experiencing.”
A nurse is talking with a client about ways to help sleep & rest. Which of the following recommendations should the nurse give to the client to promote sleep & rest? (sap)
- Practice muscle relaxation techniques
2.Exercise each morning
- Take an afternoon nap
- Alter the sleep environment for comfort
- Limit fluid intake at least 2 hours before bedtime
- Practice muscle relaxation techniques
2.Exercise each morning
- Alter the sleep environment for comfort
- Limit fluid intake at least 2 hours before bedtime
A nurse is caring for a client who has been following the facility’s routine & bathing in the morning. However, at home, the client always takes a warm bath just before bedtime. Now the client is having difficulty sleeping at night. Which of the following actions should the nurse take first?
- Rub the client’s back for 15 min before bedtime
- Offer the client warm milk and crackers at 2100
- Allow the client to take a bath in the evening
- Ask the provider for a sleeping medication
- Allow the client to take a bath in the evening
A nurse is preparing a presentation at a local community center about sleep hygiene. When explaining REM sleep, which of the following characteristics should the nurse include? (sap)
- REM sleep provides cognitive restoration
- REM sleep lasts about 90 min
- It is difficult to awaken a person in REM sleep
- Sleepwalking occurs during REM sleep
- Vivid dreams are common during REM sleep
- REM sleep provides cognitive restoration
- It is difficult to awaken a person in REM sleep
- Vivid dreams are common during REM sleep
A nurse is instructing a client who has narcolepsy about measures that might help with self-management. Which of the following statements should the nurse identify as an indication that the client understands the instructions?
- “I’ll add plenty of carbohydrates to my meals.”
- “I’ll Take a short nap whenever I feel a little sleepy.”
- “I’ll make sure I stay warm when I am at my desk at work.”
4.”It’s okay to drink alcohol as long as I limit it to one drink per day.”
- “I’ll Take a short nap whenever I feel a little sleepy.”
sleep apnea is
more than 5 breathing cessations lasting longer than 10 seconds per hour during sleep resulting in decreased O2 saturation levels
REM Sleep
20 min long – 90 min after falling asleep & 90 min recurrences
cognitive restoration
difficult to awaken
vivid dreaming
NREM sleep
stage 1 = very light sleep - few min
stage 2 = deeper sleep 10 to 20 min
stage 3 = slow wave or delta sleep
psychological rest and restoration
reduced sympathetic activity
