Adult health exam 1

what vitamin is calcium controlled by

D

has an inverse relationship with phosphorus

calcium

hypocalcemia

calcium <8.5

facilitates the outward flow of H2O from the capillary-->interstitial space

capillary hydrostatic pressure (BP)

manifestations of hyponatremia

confusion, nausea, vomiting, seizures, coma

treatment of hyperphosphatemia

correction of hypocalcemia

A client's arterial blood gas report indicates that pH is 7.25, Pco 2 is 35 mm Hg, and HCO 3 is 20 mEq/L (20 mmol/L). Which client should the nurse consider is most likely to exhibit these results?Incorrect1 A) A 54-year-old with vomiting B) A 17-year-old with panic attacks C) A 24-year-old with diabetic ketoacidosis D) A 65-year-old with advanced emphysema

C low pH and bicarb levels are metabolic acidosis which can be caused by excess ketones vomiting most likely will be metabolic alkalosis panic attacks most likely will be metabolic alkalosis from hyperventilation advanced emphysema most likely will be respiratory acidosis.

pulling force of solution exerted by colloids (protein) within the vascular space

colloidal oncotic pressure

what can loop diuretics cause

hypokalemia

when do you monitor vitals after hanging blood

prior to transfusion, 15 minutes after initiation, then every hour after for 4 hours

what conditions cause respiratory alkalosis

psychological responses (anxiety/fear), pain, fever, sepsis, pregnancy, meds

what does the hormone calcitonin do

reduces the blood calcium level when it gets above normal

causes of hyperphosphatemia

renal failure, chemo, excessive ingestion of milk, large intakes of D

causes of metabolic acidosis

renal failure, diabetic ketoacidosis, starvation, hypoxia

ROME

respiratory opposite, metabolic equal

electrolyte that plays a role in generation/transmission of nerve impulses

sodium

hyponatremia

sodium <135

hypernatremia

sodium >145, causes hyperosmolality which=dehydration

shift of fluid from the intravascular compartment into a third or extra space within the extracellular compartment, often a body cavity

third spacing can result in dehydration

manifestations of hypernatremia

thirst, lethargy, agitation, seizures, coma

what does metabolic acidosis usually mean is going on in the body

tissue hypoxia (body part is deprived of adequate O2)

why must serum sodium levels be reduced gradually

to avoid cerebral edema

metabolic acidosis

too much electrolytes not enough fluids (acid base imbalance)

A nurse is caring for a client after abdominal surgery and encourages the client to turn from side to side and to engage in deep-breathing exercises. What complication is the nurse trying to prevent? A)Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

C Shallow respirations and atelectasis compromise gas exchange in the lungs; an increased carbon dioxide level leads to respiratory acidosis Metabolic acidosis occurs with diarrhea Metabolic alkalosis is caused by excessive vomiting. Respiratory alkalosis is caused by increased expiration of carbon dioxide

where is phosphate essential

function of muscle, RBC, nervous system maintenance requires adequate renal function

what conditions cause respiratory acidosis

head injury/meds such as narcotics, sedatives, anesthesia ex: morphine impaired respiratory muscle function r/t spinal cord injury, pulmonary disorders

signs of metabolic acidosis

headache, confusion, restlessness, lethargy, warm flushed skin, Kussmaul's respirations, nausea/vomiting

high concentration of solutes has _____ drawing power (high/low?)

high

does higher/lower osmolality have a greater pulling power

higher

metabolic problems

how concentrated blood is before it gets to kidney to be processed

movement of water from area of high pressure-->area of low pressure

hydrostatic pressure

manifestations of hypomagnesemia

hyperactive deep tendon reflexes, tremors, seizures, cardiac arrhythmias

what kind of breathing results in respiratory alkalosis

hyperventilation

controls the thirst reflex and osmoreceptors (detects changes in osmotic pressure)

hypothalamus

what kind of breathing results in respiratory acidosis

hypoventilation

causes of edema

increase in capillary hydrostatic pressure decrease in plasma oncotic pressure increases in capillary permeability lymph obstruction

what do diuretics do

increase water excretion by blocking the reabsorption of Na+ (where Na+ goes, water goes)

what stimulates osmoreceptors

increased ECF osmolality

thrombophlebitis

inflammation of 1 or multiple veins by a blood clot or thrombus

phlebitis

inflammation of the vein

what can cause metabolic alkalosis

ingestion of antacids, gastric suction, diuretics

PICC line

inserted into basilica, cephalic, or brachial veins and enters superior vena cava

fluid located outside of cells between cells and vessels

interstitial fluid

facilitates the inward movement of H2O from the interstitial space-->capillary

interstitial hydrostatic pressure

plasma, lymph, least stable (loss/gain are in response to fluid intake)

intravascular fluid

treatment for hyperkalemia

kayexalate

manifestations of hypermagnesemia

lethargy, reflexes impaired, respiratory/cardiac arrest

symptoms of respiratory alkalosis

lightheadedness, numbness, tingling, if Co2 becomes extremely high drowsiness and unresponsiveness may occur

PCO2 <35

alkalosis

pH >7.45 =

alkalosis

hormone that increases the resorption of water from distal renal tubules

antidiuretic hormone (ADH)

how do you prevent PICC line infections

aseptic technique

ANP hormone is where

atria

what is the goal when caring for a PT with dehydration

maintain fluid volume at a functional level

causes of hypophosphatemia

malnourishment, alcohol withdrawal, phosphate-binding antacids

manifestations of hypophosphatemia

muscle weakness, arrhythmias

when would you need a central line (PICC)

need antibiotics/meds for weeks/months need to receive large amount of blood/fluid quickly CHEMO require nutrition bc bowels are not working correctly

what does potency of the IV mean

no clots at the tip of the cannula and cannula is not against vein wall

what type of mask would you give someone for acidosis

nonbreather

what is potassium necessary for

normal cardiac rhythms

only type of fluid allowed to run with blood

normal saline no meds

what is hypoventilation

not getting enough oxygen to brain

concentration of solute in a solvent

osmolality

process of drawing water

osmotic pressure

what should you never push IV

potassium

manifestations of hypocalcemia

trousseau's and chvostek's sign

BNP hormone is where

ventricles

causes of hypercalcemia

vitamin D overdose, immobilization, hyperparathyroidism

what does aldosterone regulate

volume regulator

what is the first thing to check PT for when possible fluid volume deficit

weight loss

how do you set up blood

with fluid running simultaneously (normal saline)

potassium

3.5-5.0

PCO2 normal range

35-45

magnesium

1.5-2.5

extracellular fluid makes up what fraction of all body fluids

1/3 (20%)

sodium

135-145

what do you need when sending blood to be sampled

2 nurses signatures

what do you need when hanging blood

2 nurses to verify at the bedside

phosphate

2.4-4.1

intracellular fluid makes up what fraction of all body fluids

2/3 (40%)

HCO3 normal range

22-26

IV solution to treat hyponatremia

3% hypertonic NaCl

how long can blood be hung

4 hours

how many minutes apart are blood samples (2) taken

5

Iv solution to treat hypernatremia

5% dextrose in water, diuretics

normal pH range

7.35-7.45

calcium

8.5-10.5

The nurse is teaching a group of students about assessing for respiratory system manifestations of alkalosis as a nursing priority. Which statement made by the student nurse indicates the need for further teaching? Select all that apply. A) I should assess for low blood pressure." B) "I should assess for increased digitalis toxicity." C) "I should assess for a decreased rate of ventilation in respiratory alkalosis." D) "I should assess for an increased depth of ventilation in respiratory alkalosis." E) "I should assess for a decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis."

A, B, C Should assess for low blood pressure and increased digitalis toxicity as CARDIOVASCULAR manifestations of alkalosis, not respiratory manifestation. Should assess for increased rate of ventilation in respiratory alkalosis. Should assess for increased depth of ventilation in respiratory alkalosis. -RIGHT Should check for decreased respiratory effort associated with skeletal muscle weakness in metabolic alkalosis. -RIGHT

universal recipient

AB+

The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply. A) "The client's Chvostek sign would be negative." B) "The client's Trousseau sign would be positive." C) "The client would be suffering from paresthesias." D) "The client would show signs of anxiety and irritability." E) "The client's central nervous system should have a decrease activity in case alkalosis."

B, C, E If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. Will have a positive Trousseau sign and have anxiety and irritability The Chvostek sign would also be positive, not negative The central nervous system should have increased activity with alkalosis, not decreased.

hypokalemia

K <3.5

hyperkalemia

K >5.0

universal donor

O-

what would you expect to see with fluid volume excess

SOB, crackles in lungs, tachycardia

PCO2 >45

acidosis

pH <7.35 =

acidosis

important protein that maintains oncotic pressure

albumin

HCO3 >26

alkalosis

what is aldosterone release triggered by

a drop in BP, volume, or Na or a rise in K

HCO3 <22

acidosis

manifestations of hypercalcemia

decreased memory, confusion, disorientation, fatigue

causes of hypocalcemia

decreased production of PTH, multiple blood transfusions, alkalosis

what does ADH do

decreases urinary output (urine concentration goes up) which decreases osmolality

what areas should you avoid when inserting IV

dialysis graft/fistula mastectomy side

most common cause of dehydration

diarrhea

3 causes of dehydration

diarrhea, vomiting, inability to drink adequately

signs of metabolic alkalosis

dizziness, lethargy, disorientation, weakness, nausea, vomiting, muscle twitching (not enough calcium in body) most difficult to treat

symptoms of respiratory acidosis

dyspnea, respiratory distress, shallow respirations, headache, restlessness, tachycardia

metabolic alkalosis

excess of base or loss of acid (too much fluid, not enough electrolytes)

movement through cell or blood vessel bc of hydrostatic pressure (water movement and dissolved particles in water)

filtration

hydrostatic pressure

force of water against capillary wall