Fundies II Exam 2

Positive ions (cations) are:

Na+, Ca+, K+, Mg+

ROME mnemonic

Respiratory Opposite Metabolic Equal

Water loss leads to ______

tachycardia, hypotension, cool and dry skin, weakness, confusion, decreased cardiac output, falsely decreases electrolyte values in general; may see a low HCT and Hgb due to hemoconcentration of the blood

Glomerulus

The process of filtration begins at the __________

Calcium

the most abundant cation in the body, stored primarily in the bones maintained by PTH and calcitonin; promotes normal nerve and muscle activity, aids in cardiac contractions, promotes blood clotting, and responsible for bone & teeth formation

common urinary diagnostic procedure

urodynamic studies cystoscopy IV pyelogram retrograde pyelogram renal ultrasound CT scan

Lactated ringers and normal saline

Two most common isotonic IV solutions. Used for dehydration/fluid resuscitation.

Brawny edema

• Fluid can no longer be displaced secondary to excessive interstitial fluid accumulation • No pitting • Tissue palpates as firm or hard • Skin surface shiny, warm, moist

respiratory acidosis causes

• Respiratory depression - anesthesia, overdose, increased ICP • Conditions affecting pulmonary function - airway obstruction, COPD, Pneumonia, Atelectasis

Dehydration or excess water loss causes

Vomiting, diarrhea, burns, diuretic use, laxative abuse Diabetes insipidus Inadequate fluid intake

Which statement most accurately describes the process of osmosis?

Water moves from an area of lower solute concentration to an area of higher solute concentration.

Aldosterone

Water reabsorption is also regulated by _________ produced by the adrenal cortex, which increases Na+ and water reabsorption in the body and decreases Na+ and water excretion in the urine

Implanted venous access catheter

When providing chemotherapeutic agents, which catheter is accessed with a non-coring needle?

Daily weights

Which method will provide the nurse with the best indication of the client's fluid status?

Chvstek's sign

a test for hypocalcemia hyper-reflexibility of facial nerve

nephron

basic functional and structural unit of the kidney

functional incontinence

caused by factors outside the urinary tract/inability to reach the toilet in time

total incontinence

continuous, unpredictable loss of urine

Meds that influence electrolytes:

diuretics, steroids, laxatives, chemo, IVF's, TPN (aka - Hyperalimentation)

Hyperkalemia signs and symptoms

dysrhythmias, ECG changes= peaked T waves, ST elevation, v-fib, cardiac arrest diarrhea, hypotension, bradycardia, N&V, numbness, tingling, paresthesia, skeletal muscle weakness

Sodium is the major ___________ cation

extracellular; responsible for muscle & heart contractions, transmission of nerve impulses, and maintaining kidney urine concentration

Hypokalemia

(K+ deficit in the ECF) low K+ in the blood due to diuretic use, diarrhea, vomiting, excessive sweating and Cushing's syndrome (excess cortisol production)

Hyperkalemia

(K+ excess in the ECF) high K+ in the blood due to renal failure, burns, large amounts of IV or PO intake of K+ and adrenal insufficiency

respiratory alkalosis causes

- Anxiety - Fever - Hyperventilation - PE

Fluid homeostasis is maintained by the following:

- Osmosis - Diffusion - Active transport - Filtration

ANP decreases blood volume and pressure by:

-Increasing the glomerular filtration rate -Decreasing of reabsorption of Na+ by nephrons -Inhibiting the release of renin, aldosterone and ADH

Types of urinary incontinence

-stress -transient -overflow -functional -mixed -reflex -total

30 mL = ? oz

1 oz

Urine specific gravity

1.005-1.030

Sodium (Na+) normal range

135-145 mEq/L

Potassium (K+) normal range

3.5-5.0 mEq/L

1 cup

8 oz or 240 ml

Calcium (Ca+) normal range

8.6-10.2 mg/dL

Hypokalemia signs and symptoms

A SIC WALT A- Alkalosis S- Shallow Respirations I- Irritability C- Confusion & drowsiness W- Weakness & fatigue A- Arrhythmias L- Lethargy T- Thready Pulse -Decreased intestinal mobility -Vomiting -Paralytic Ileus

Packed red blood cells are administered 1 unit over 2 to 3 hours for no longer than 4 hours.

A client has been diagnosed with a gastrointestinal bleed and the health care provider has ordered a transfusion. At what rate should the nurse administer the client's packed red blood cells?

0.9% saline solution (NS)

A client is admitted to the emergency department with a closed head injury and multiple fractures. Which IV solution should the nurse plan to administer?

maintenance of cell size

A group of nursing students is reviewing information about body fluid and locations. The students demonstrate understanding of the material when they identify which of the following as a function of intracellular fluid?

Normal saline and Lactated Ringer's solution

A nurse caring for a client who is hypovolemic anticipates orders from a healthcare provider for IV replacement therapy. Which IV solutions should the nurse identify as appropriate for this client?

Lethargy

A nurse is admitting a client who has a serum calcium level of 12.3 mg/dL and initiates cardiac monitoring. Which of the following findings should the nurse expect during the initial assessment?

Weak, irregular pulse

A nurse is assessing a client who has hypokalemia as a result of nausea, vomiting, and diarrhea. Which of the following findings should the nurse expect?

Poor skin turgor, hypotension and flat neck veins

A nurse is assessing a client who reports frequent vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect?

Confusion Rationale: confusion is common in hypo and hypernatremia

A nurse is assessing a client with a possible fluid and electrolyte imbalance. Which manifestation, if identified in this client, should the nurse associate with the development of either hyponatremia or hypernatremia?

Bounding pulse, pitting edema, and crackles upon auscultation

A nurse is assessing an older adult client who is receiving IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess?

Tingling of the extremities; Rationale: A client who undergoes a total thyroidectomy is at risk for parathyroid injury which can lead to hypocalcemia. The nurse should monitor the client for reports of tingling and numbness of the extremities and around the mouth, muscle tremors, cramps and cardiac dysrhythmias.

A nurse is caring for a client who had total thyroidectomy and a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect?

-client with major trauma or burns -client with liver and renal failure -client with inflammatory bowel disease -client with colitis and bloody diarrhea

A nurse is caring for a clients who may require total parenteral nutrition (TPN). Which client(s) is a candidate for TPN? Select all that apply.

Increased hydrostatic pressure Rationale: The edema that occurs with heart failure is caused by decreased cardiac output with a back-up of blood resulting from increased hydrostatic pressure.

A nurse is preparing an education plan for a client with heart failure who is experiencing edema. As part of the plan, the nurse wants to describe the underlying mechanism for why the edema develops. Which mechanism will nurse likely address?

Client has an NG tube to gastric suction.

A nurse is reviewing the medical record of a client who has a potassium level of 3.0 mEq/L. Which of the following findings should the nurse recognize as a potential causative factor?

Diet ginger ale, chicken bouillon, and grape juice

A nurse planning oral rehydration for a client with FVD (fluid volume deficit)should include which choices in a clear liquid diet?

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.

every 72 hours

After surgery, a client is on IV therapy for the next 4 days. How often should the nurse change the IV tubing for this client?

Fluids or foods calculated as part of intake

All fluids and foods (ice cream, sherbet, Jell-o) that are liquid at room temperature should be calculated for intake.

Metabolic alkalosis

high pH, high HCO3

Respiratory alkalosis

high pH, low CO2 loss of CO2 from the lungs

Hypernatremia

high sodium in blood which draws water out of the cells (edema) -(Na+ excess in ECF) - cells shrink and move out; water loss

Trousseau and Chvostek's signs observed in

hypocalcemia

Hypocalcemia causes

inadequate calcium intake, impaired calcium absorption, excessive calcium loss, elevated phosphorus, low albumin, vitamin D deficiency

SG greater than 1.030

indicates fluid volume deficit, dehydration

SG of less than 1.010

indicates fluid volume excess

Potassium is the major ______ cation

intracellular; important for protein synthesis,use and storage of glucose, and maintenance of excitability ofcellular membranes in the heart & nervous system

stress incontinence

involuntary loss of urine related to an increase in intra-abdominal pressure

Respiratory acidosis

low pH, high CO2 retention of CO2 by the lungs

Metabolic acidosis

low pH, low HCO3 Inability of kidney to excrete acid or conserve base

Hyponatremia

low sodium in the blood which draws back water into the cells - (Na+ deficit in ECF) - leads to swelling of the cells and move in; water gain

total parenteral nutrition (TPN)

nutritional therapy that bypasses the gastrointestinal tract for patients who are unable to take food orally; meets the patient's nutritional needs with a highly concentrated, hypertonic nutrient solution administered intravenously through a central vein (usually arm, neck or chest)

Nursing diagnosis: urinary functioning as the ETIOLOGY

Anxiety Caregiver role strain risk for infection impaired skin integrity

food sources of potassium

Avocados, spinach (leafy greens), salt substitutes, bananas

Hypokalemia causes

B.A.D. L.O.A.D. B-arters/Conns syndrome(hyperaldosteronism) A-lkalosis D-iuretics L-axative abuse O-ther causes: insulin overdose, vomiting, NG suctioning A-cute glucose load D-iarrhea

Hypernatremia signs and symptoms

Big and bloated; edema; thirst, confusion, hallucinations, HTN; flushed skin, dry mucous membranes, swollen red tongue; low urine output, restlessness, increased heart rate, convulsions, and postural hypotension

alkalosis

pH above 7.45

Acidosis

pH below 7.35

Hypocalcemia Signs and Symptoms: CATS

C Convulsions A Arrhythmias T Tetany S Stridor and spasms

Acidosis symptoms

CNS: Headache, fatigue, confusion, loss of consciousness, coma Resp: SOB, coughing Cardio: arrhythmia, increased HR Muscular: seizures, weakness GI: nausea, vomiting, diarrhea

Alkalosis symptoms

CNS: confusion, lightheadedness, stupor, coma PNS: hand tremor, numbness and tingling in the face, hands, or feet Muscular: twitching, prolonged spasms GI: nausea, vomiting

Fluid volume excess symptoms

Changes in LOC, Confusion, Headache, Seizures pulmonary congestion, bounding pulse, increased BP and JVD, presence of S3, tachycardia, anorexia, nausea, dependent pitting edema

Electrolytes

Chemical substances that when placed in a solution, break apart into electrically charged particles (ions) with + and -charges

Negative ions (anions) are:

Cl, Phosphate, Sulfate

Hyponatremia signs and symptoms

poor skin turgor, sunken eyes, dry tongue, lethargy, diarrhea, headache, confusion, apprehension, seizures, coma, resp arrest, tachycardia, hypotension, n+v, CEREBRAL EDEMA, increased ICP

Metabolic acidosis causes

DKA, severe diarrhea, renal failure, shock

Metabolic alkalosis signs and symptoms

Dizziness; dysrhythmias; numbness and tingling of fingers, toes, and circumoral region; muscle cramps; tremors

Metabolic alkalosis causes

Excessive gastric drainage, Vomiting, Potassium depletion (diuretic therapy), Burns, Excessive Sodium Bicarb admin (antacids), hypercortisolism

D5 1/2 NS (D5NS)

Hypertonic IV solution used for sodium (Na+) and volume replacement. GO SLOW. Monitor BP, HR, quality of lung sounds, serum Na and urine output.

The adrenal cortex regulates sodium by _____

releasing aldosterone to increase sodium reabsorption, by maintaining extracellular fluid volume, and by excreting potassium

Hyperkalema causes

renal failure, LOW aldosterone, burns, adrenal insufficiency Use of: potassium supplements, heparin, ACE inhibitors (-pril), k+ sparing diuretics

Nursing management of fluid volume excess

I&O and daily weights; assess lung sounds, edema; cardio assessment; fluid restrictions, promote rest; semi-Fowler's position for orthopnea; skin care, positioning/ turning

D5W (5% dextrose in water)

IV solution that is isotonic in the bag, hypotonic in the body. DO NOT GIVE TO INFANTS OR HEAD INJURIES- MAY CAUSE CEREBRAL EDEMA.

Nursing diagnosis: urinary functioning as the PROBLEM

Incontinence Pattern alteration urinary retention

Metabolic acidosis signs and symptoms

Kussmaul respirations; warm flushed skin, decreased BP, headache; malaise, confusion, hyperkalemia, muscle twitching