CH.22-MEDSURG

Which tube is a nasoenteric feeding tube?

dobbhoff

hypocalemia caused by:

end-stage kidney disease, diarrhea,wound drainage, low vitamin D levels, ALKALOSIS

symptoms of hypokalemia

weak slow pulse & BP, nausea, vomiting, decrease specific gravity of urine. (Everything in body is slowed down); shallow breathing, constipation

hypertonic iv solutions

-3% saline -5% Saline -10% Dextrose in Water -5% Dextrose in 0.9% Saline -5% Dextrose in 0.45% Saline -5% Dextrose in LR -Causes the cell to shrink over time, fluid overload w/pulmonary edema -Give to patients with cerebral edema (reduces pressure), hyponatremia (pulls sodium back into the intravascular system)

hypotonic IV Solutions

0.45% Saline, 0.22% Saline, 0.33% Saline -Cause cell lyses -Deplete circulatory systems fluids -These solutions hydrate the cell -Don't use in patients with an increase in intracranial pressure, burns, trauma its w/ hypovolemia. preferred in patients with diabeties

normal magnesium levels

1.3-2.1 mEq/L

1 kg=

1000ml, 1 L

normal sodium range

135-145

respiratory buffers

2nd line of defense, controls the level of hydrogen ions in the body by regulating carbon dioxide levels (changing breathing levels)

normal phosphorous levels

3-4.5 mg/dL

normal potassium range

3.5-5.0 mEq/L

kidney buffers

3rd line of defense, regulates bicarb levels

normal calcium range

9-10.5 mg/dL

normal chloride levels

98-106 mEq/L

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

hypovalemia

AKA Isotonic dehydration; decreased blood volume due to lack of water and electrolytes

A nurse is performing an assessment for a client who presents to the clinic with an erythemic, fissuring lip lesion with white hyperkeratosis. What does the nurse suspect that these findings are characteristic of?

Actinic cheilitis

chemical & protein buffers

Are the first line of defense; Either bind or release hydrogen ions as needed; Respond quickly to changes in pH

causes of hypervolemia:

Heart failure,Kidney disease, Cirrhosis, burns Prolonged use of corticosteroids, Hyperaldosteronism

Chvostek's sign

Hypocalcemia (facial muscle spasm upon tapping of facial nerve)

Hypovalemia lab values

Increased: Hematocrit ( x>50%), BUN(X>25 mg), urine specific gravity (x>1.030), Blood sodium (x>145), blood osmolality (x>295)

hypocalcemia

CATS Convulsions, Arrythmias, Tetany, spasms and stridor, hyperactive bowel sounds

respiratory alkalosis (hyperventilation)

CO2 eliminated faster than it is produced; S/S: Inability to concentrate, numbness & tingling, deep respirations

Hypomagnesemia EKG results

Presence of PVC's & prolonged PR interval

lab tests of hypervolemia

Decreased: HCT, HGB, BUN due to plasma dilution, urine gravity

lab tests for hyponatremia

Decreased: urine sodium (x<20), urine gravity (1.002 to 1.004)

Hypomagnesemia causes

Diarrhea, Celiac's disease, Crohn's disease, Alcoholism, metabolic acidosis, M.Infarction, heart failure

causes of hypokalemia

Diuretics (Lasix), Diarrhea, GI loss, polyuria, kidney problems

hypovalemic

ECF fluid is low

For a client with salivary calculi, which procedure uses shock waves to disintegrate the stone?

Lithotripsy

Hyperkalemia symptoms "MURDER"

Muscle weakness, Urine, oliguria, anuria, Respiratory distress, Decreased cardiac contractility, Reflexes, hyperreflexia, or areflexia (flaccid), diarrhea, hyperactive bowel sounds

A client has been taking a 10-day course of antibiotics for pneumonia. The client has been having white patches that look like milk curds in the mouth. What treatment will the nurse educate the client about?

Nystatin

dumping syndrome

Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.

Which term describes an inflammation of the salivary glands?

Sialadenitis

transcellular fluid

The fluid that is contained within specialized body compartments such as cerebrospinal, pleural, and synovial cavities

bad side effects of metoclopramide

Uncontrolled rhythmic movements of the face or limbs

hyponatremia causes

Vomiting, Diuretics, Excessive administration of dextrose and water IVs, Burns, wound drainage Excessive water intake, SIADH, hyperglycemia,

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed?

When the residual is greater than 200 mL

Foods high in potassium:

[p]otatoes, [o]ranges, [t]omatoes, [a]vacados, [s]trawberries, [s]pinach, f[I]sh, M[U]shrooms, [M]elons Milk, whole grains, citrus fruits, broccoli, lean meats, legumes

hypovalemia treatment:

blood, RBC's, plasma, lactated ringers, normal saline (isotonic IV's), vasoconstrictors,

hyperkalemia caused by:

acidosis (mostly metabolic), trauma (tissue damage)

foods low in potassium

applesauce, green beans, cabbage, lettuce, peppers, grapes, blueberries, cooked summer squash, cooked turnip greens, pineapple, raspberries, peaches, whole grains, cereals

albuterol is used for:

chronic hyperkalemia

foods high in magnesium

dark leafy greens, nuts & seeds, seafood, peanut butter, cocoa

Rebound hypoglycemia is a complication of parenteral nutrition caused by

feedings stopped too abruptly

Hypokalemia EKG signs:

flattened/ invertedT wave, ST Depression, prominent U wave, prolonged PR interval

pulmonary edema

fluid in the lungs; tachycardia, distended neck veins, ascending crackles

intravascular fluid

fluid within blood vessels; liquid part of blood or plasma

loop diuretics

furosemide, bumetanide, torsemide

hypervolemic

high blood volume in ECF

metabolic alkalosis

high pH, high HCO3; results from TPN/Blood transfusions, vomiting, NG suction, cushing's syndrome, hypokalemia S/S: Tachycardia, hypotension or normal, tetany, muscle weakness and tingling, confusion, and convulsions

respiratory acidosis (hypoventilation)

increased PCO2, decreased pH, increased HCO3; initial tachycardia and hypertension (worsens as acidosis worsens); pale or cyanotic

lab tests for hypernatremia:

increased serum Na >145 mEq/L; increased serum osmolarity >300 mOsm/L

What kind of IV Fluids should be given for hyponatremia?

isotonic

Risk factors for hypernatremia:

kidney problems, Cushing's syndrome, Aldosteronism

interstitial fluid

liquid found between the cells of the body that provides much of the liquid environment of the body

hyponatremia

low sodium in the blood; water moves from ECF to ICF (Causing cells to swell)

metabolic acidosis

low(acidic) pH, low HCO3; comes from diabetic ketoacidosis, liver failure, diarrhea S/S: bradycardia, hypotension, confusion, warm red skin, kussmaul respirations

anions

negatively charged ions (gain electrons); EX) phosphate, chloride, sulfate, bicarb, proteins

euvolemic

normal blood volume in ECF

potassium

plays a vital role in the transmission of nerve pulses, cells metabolism; cardiac, lung, and muscle tissues

Which condition is caused by improper catheter placement and inadvertent puncture of the pleura?

pneumothorax

cations

positively charged ions; EX) magnesium, potassium, sodium, calcium, hydrogen ions

compensation of pH

process where the body attempts to correct changes and imbalances in the pH

hypocalcemia EKG results:

prolonged QT interval & ST segment

hypervolemia symptoms:

tachycardia, hypertension, SOB, blurry vision, ascites, distended abdomen/ liver, cold skin, distended neck veins, crackles

symptoms of hypovalemia

tachycardia, hypotension, dizziness, thin & dry tongue, decreased urination (oliguria), flattened neck veins, sucken eyes, seizures

Vital signs of hyponatremia

tachycardia, hypothermia, muscle weakness with respiratory compromise, decreased reflexes, seizures, dizziness, hyperactive bowel sounds, abdominal cramping, nausea

symptoms of hypernatremia:

tachycardia, ortho. hypotension, restlessness & muscle twitching, decreased reflexes, dry mucous membranes, nausea

Hypomagnesemia symptoms

tremor, hyperactive deep reflexes, disoriented, cramps, tachycardia, High BP, seizures, cardiac arrhythmias, positive Chvostek's & trousseaus signs, hypoactive bowel sounds, constipation, depression

Causes of hypovalemia:

vomiting, diarrhea, kidney problems, burns