Exam Five - NUR 113
What are some s/s of hypercalcemia and hypophosphatemia?
*Kidney stones*; bone pain; decreased DTR; constipation
What is the medical treatment for hypokalemia?
*Monitor ECG*; increase dietary K+; K+ replacement
What is the medical treatment for hyperkalemia?
*Monitor ECG; Kaexylate (usually in enema)*; calcium gluconate; limit dietary K+
What are some s/s of hypernatremia and hyperchloremia?
*Red beefy dry tongue*; edema; flushed; LOC changes
What is the nursing management of hyperkalemia?
*Safety*; monitor med effects; restrict diet; no salt subs; no k-sparing diuretics
What is the nursing management for a patient with hypernatremia and hyperchloremia?
*Watch for cerebral edema; rehydrate slowly*; DW, I&O, VS; avoid Alkaseltzer
What do PPIs commonly end in?
-prazole
What do H2 receptor blockers commonly end in?
-tidines
What is the typical creatinine range?
0.7-1.4
1 kg of weight equals how many L of fluid needed for fluid replacement?
1
What is the typical range for urine specific gravity?
1.005-1.030
What is an example of a hypotonic solution?
1/2 NS
What is the typical BUN range?
10-20
What is the range for sodium?
135-145
What is the treatment of H. pylori?
2 antibiotics and 1 PPI
When would surgical correction of cleft lip occur?
2-3 months
What is the potassium range?
3.5-5.0
What is the range for hematocrit in females?
40-48%
What is the range for hematocrit in males?
42-50%
What diet would a patient with PUD be on?
6 smalls meals/day; no caffeine/alcohol; limit dairy; don't eat late at night
When would surgical correction of cleft palate occur?
6-12 months
At what point in gestation does a cleft lip develop?
6-8 weeks
How would gastritis be assessed?
72 hour diet recall; abdominal assessment
At what point in gestation does a cleft palate develop?
8-12 weeks
A client is admitted to the hospital in a malnourished state. The nurse understands the client is at high risk for which of the following conditions as a result of decreased nutrition? A. Infection B. Diarrhea C. Fever D. Tumor formation
A
A client recovering from a cholecystectomy has a nasogastric tube, decreased reflexes, pulse of 110, weak and irregular, and blood pressure of 80/50 mm Hg. The client is weak, mildly confused, and has a serum of potassium level of 3 mEq/L. Based on the assessment data, which is the priority nursing action? A. Notify the healthcare provider B. Withhold the prescribed spironolactone C. Instruct the client on foods high in potassium D. Administer a prescribed potassium supplement
A
After teaching the parent of an infant who has had a surgical repair for a cleft lip about the use of elbow restraints at home, the nurse determines that the teaching has been successful when the parent makes which statement? All in quotes A. We will only remove the restraints one at a time to check the skin under them for redness B. We will keep the restraints on during the day while he is awake, but take them off when we put him to bed at night C. After we get home we will not have to use the restraints because our child does not suck on his hands and fingers D. We will be sure to keep the restraints on all the time until we come to see the healthcare provider for a follow up visit
A
After teaching the parents of a neonate born with a cleft lip and cleft palate about appropriate feeding techniques, the nurse determines that the mother needs further instruction when the mother makes which statement? All in quotes A. I should clean her mouth each feeding B. I should feed her in an upright position C. I need to remember to burp her often D. I may need to use a special nipple for feeding
A
Infant presents to the ER with a recent diagnosis of pyloric stenosis. The infant continues to demonstrate projectile vomiting and signs of severe dehydration. Which intervention should the nurse give the highest priority after the assessment? A. Fluid and electrolyte replacement B. Obtaining a family history C. Calling the doctor for immediate surgery D. Placing an NG tube for feeding assistance
A
On the second postoperative day after repair of cleft palate, what should the nurse use to feed the toddler? A. A cup B. Straw C. Rubber tip syringe D. Large-holed nipple
A
The client with a gastric ulcer is admitted to the hospital. The nurse should assess the client for intake of which of these substances that increases the risk of developing a gastric ulcer? A. ASA B. Chili C. Acetaminophen D. Coffee
A
The nurse is assigned to an infant who just had cleft palate repair. She knows that the main goal is to protect the suture line. Which action by the parent tells the nurse additional teaching is needed? A. After feeding has been completed, dad lays the baby supine in the crib. B. The nurse observes the dad feeding the infant while holding in an upright position. C. Dad rocks the infant at the first sign of distress or upset. D. Dad checks the infant to make sure the elbow restraints are still positioned properly.
A
The nurse is caring for a client with a feeding tube who has been experiencing loose watery stools. The client has poor skin turgor, tachycardia, lethargy, and hyperactive reflexes. Which intervention would the nurse include in the plan of care? A. Monitor intake, output, and daily weight B. Apply restraints to protect the feeding tube C. Monitor hypertonic intravenous therapy D. Assess electrocardiogram readings
A
The nurse is obtaining a health history from a client who has a sliding hiatal hernia associated with reflux. The nurse should ask the client about the presence of which symptom? A. Heartburn B. Jaundice C. Anorexia D. Stomatitis
A
The nurse teaches the client with GERD about ways to minimize symptoms. Which of the following statements made by the client indicates that more teaching is needed? (All in quotes) A. I will be sure to drink tea instead of coffee B. I will take a walk after I eat C. I will try to eat smaller meals more frequently D. I will sleep with the head of the bed elevated about 12 inches
A
Which measure would be most effective in helping the infant with cleft lip and palate to retain oral feedings? A. Burp the infant at frequent intervals B. Feed the infant small amounts at one time C. Place the end of the nipple far to the back of the infant's tongue D. Maintain the infant in a supine position while feeding
A
The nurse is caring for a client with hypophosphatemia admitted from the emergency department. Which symptoms does the nurse suspect the client was experiencing prior to being hospitalized? Select all that apply. A. Chronic diarrhea B. Hyperventilation C. Vomiting 4-5 times D. Numbness and tingling E. Excessive use of Vitamin D
A, B, C
Which priority assessment(s) will the nurse perform on a client receiving continuous TPN? Select all that apply. A. Monitor daily weights B. Monitor output C. Monitor glucose levels D. Monitor oral intake E. Monitor daily gait
A, B, C
A client is being treated for PUD. The nurse anticipates orders for which medications that might be used to decrease stomach acid content or protect the stomach? SATA A. PPI such as Omeprazole (Prilosec) or Lansoprazole (Prevacid) B. Bismuth compounds (Pepto-Bismol) to stimulate mucosal bicarbonate C. NSAIDs such as Ibuprofen (Motrin) to reduce the inflammation D. Laxatives such as Bisacodyl (Dulcolax) to prevent constipation E. Sucralfate (Carafate) to form a barrier against acid and Pepsin in the ulcer base
A, B, E
The nurse is caring for a client with an electrolyte imbalance. Which should the nurse consider as contributing to this client's health problem? Select all that apply. A. Vomiting B. Constipation C. Medications D. Imaging studies E. Cosmetic procedures
A, C
A client has a serum potassium level of 3.2 mEq/L. Which menu choice should the nurse suggest to the client? Select all that apply. A. Spinach B. Fried eggs C. Baked cod D. Baked potato E. Ham and cheese omelet
A, C, D
The clinic nurse is reviewing feeding regimens with the mother of an infant recently diagnosed with pyloric stenosis. While waiting for an appointment with the surgeon, the mother is instructed to remember which of the following steps to minimize vomiting after feedings? Select all that apply. A. Keep the infant upright for at least 30 minutes after feeding. B. Rock the baby to sleep after feeding. C. Thicken the formula with cereal and use a nipple with a large hole. D. Feed the infant slowly and take breaks often. E. Give the infant larger feedings more frequently.
A, C, D
The nurse understands that both hyperchloremia and hypochloremia have which similar clinical manifestations? Select all that apply. A. Fatigue B. Hypertension C. Kidney disease D. Muscle weakness E. Metabolic alkalosis
A, D
Which pain or discomfort is most associated with gastroesophageal reflux disease (GERD)? Select all that apply. A. Chest B. Scapula C. Lower jaw D. Substernal E. Epigastric
A, E
What is the most common complaint for a child with PUD?
Abdominal pain around navel
If a patient has a calcium and phosphorus imbalance, what should be monitored?
Albumin levels
What is a major cause of hypomagnesemia?
Alcoholism
What kind of diuretic is potassium sparing?
Aldactone
What kind of antibiotic could be given for H. pylori?
Amoxicillin, Biaxin, Flagyl
What kind of medications are commonly used for treatment of GI disorders?
Antacids, H2 receptor blockers, PPIs
What drug class is Zovirax?
Antiviral
What should the nurse check before administering Digoxin?
Apical pulse
What is an example of third-spacing?
Ascites
What is the main concern with stomatitis?
Aspiration
What is the nursing management for hypercalcemia and hypophosphatemia?
Assess for calcium crisis; ambulation; safety; gentle handling; no antacids
If a patient has stomatitis, what should the nurse do?
Assess oral mucosa; ask about nutritional intake (spicy food; alcohol)
What is the nursing management of hypocalcemia and hyperphosphatemia?
Assess; weight-bearing exercises; IV Ca admin; no fleet enemas
When does GERD usually occur? In what position?
At night; supine
What is given to reduce secretions from an EGD?
Atropine
A client calls the medical clinic and reports symptoms of stomach burning, decreased appetite, and indigestion the past month. Which question is priority for the nurse to ask the client? A. When was your last bowel movement? B. Have you noticed any dark tarry stools? C. Do you take glucocorticoids for anything? D. How long has this been going on?
B
A client has a serum potassium level of 6 mEq/L. Which health problem should the nurse attribute to this electrolyte value? A. Laxative abuse B. Acute renal failure C. Nasogastric drainage D. Malabsorption drainage
B
A client is admitted with severe diarrhea and is positive for Chvostek's and Trousseau's signs. Which of the following electrolyte imbalances would the nurse suspect the client is experiencing? A. Hypercalcemia B. Hypocalcemia C. Hyperchloremia D. Hypochloremia
B
The mother of an infant with a cleft lip asks when the repair will be scheduled. What is the nurse's best response? A. At birth B. During the first 6 months of life C. After 6 months of age D. At one year of age
B
The nurse prepares a teaching plan for a client with low magnesium levels. Which foods should the nurse include as high sources of magnesium? A. Butter of cheese B. Spinach or butter beans C. Boiled macaroni or white rice D. Grilled chicken sandwich or grilled lamb sandwich
B
The nurse should question the client with GERD about the use of which type of medications that decrease LES tone? A. Antidepressants B. Calcium channel blockers C. Antiestrogen agents D. Alpha-adrenergic blocking agents
B
What is the first action of the nurse for a client on continuous TPN with increased urine output? A. Decrease TPN infusion rate B. Assess blood glucose level C. Decrease IV infusion rate D. Assess diuresis level
B
Which of the following assessments is essential for the nurse to make when caring for a client who has just had an esophagogastroduodenoscopy (EGD)? A. Auscultate bowel sounds B. Check gag reflex C. Monitor gastric pH D. Measure abdominal girth
B
While discussing post op care for a child before cleft lip surgery, a mother states her child uses thumbsucking to fall asleep each night. What is the nurse's best response to the mother? A. "It would be best to try to wean your child from that behavior now." B. "After surgery, your child will be restrained to prevent thumb and finger sucking." C. "After surgery, it will be too painful, so your child won't have a desire for thumb sucking." D. "After surgery, a special pacifier will be given in order to comfort your child."
B
A client has been diagnosed with gastroesophageal reflux disease (GERD). What are the risk factors for GERD? Select all that apply. A. BMI of 19 B. Smoking C. Pregnancy D. Hiatal hernia E. Drinking alcohol
B, C, D, E
Examples of insensible fluid loss: Select all that apply. A. Blood B. Perspiration C. Nasogastric drainage D. Third spacing E. Wound drainage
B, D
What is Trousseau's sign?
BP cuff inflated and causes arm to curl
What two diagnostics are used to measure kidney function?
BUN and creatinine
What are examples of foods that could be eaten on a soft bland diet?
Bananas, applesauce, cooked fruits and veggies, mashed potatoes, pasta, turkey, chicken, eggs
What are some dietary sources of potassium?
Bananas, potatoes, salt substitutes, chocolate, mushrooms, dried fruits, nuts, seeds
How will a person with hypernatremia and hyperchloremia look?
Big and bloated
If a patient is getting D10 to correct hypoglycemia from TPN, what should be done every 6 hours?
Blood sugars
What does phosphorus effect?
Bone and teeth formation
What does calcium effect?
Bones, blood (clotting), beats
What are osmotic diuretics used for?
Brain injuries, burns, to pull fluid off quickly
What does a patient with hypomagnesemia act like?
Buck wild
What is the postop interventions for a patient who underwent a pyloromyotomy for pyloric stenosis?
Burp frequently; feedings; monitor weight
A client diagnosed with PUD wants to know why antibiotics are being given. The nurse's best answer would be: (All in quotes) A. Antibiotics help calm the stomach and decrease the symptoms B. Antibiotics decrease Dumping Syndrome, which can lead to PUD C. H. pylori is a bacterial cause for PUD, and antibiotics will treat the cause D. The excess acid can be decreased when the stomach is sterile
C
A client with hypoparathyroidism reports numbness and tingling in the fingers and around the mouth. For which electrolyte imbalance should the nurse assess this client? A. Hyperkalemia B. Hyponatremia C. Hypocalcemia D. Hypermagnesemia
C
A female neonate born vaginally at term with a cleft lip and cleft palate is admitted to the regular nursery. Which action should the nurse take the first time that the parents visit the neonate in the nursery? A. Explain the surgical interventions that will be performed B. Stress that this defect is not life-threatening C. Emphasize the neonate's normal characteristics D. Reassure the parents about the success rate of surgery
C
A nurse has just completed teaching with a mother of a child diagnosed with a cleft palate. Which statement by the mother indicates that she needs more review? A. "I will need a special bottle or nipple with a cross-cut opening since my baby cannot form a good suction." B. "I need to make my baby eat slowly for 20-30 minutes while sitting up." C. "I need to aim the bottle's nipple straight in and to the side of my baby's mouth." D. "I need to stop and burp my baby often while feeding so that he doesn't choke on spit up."
C
Prior to giving an analgesic for pain to a postoperative client who has a history of PUD, the nurse should check to see that the medication does not contain which of the following? A. Opioid product B. Acetaminophen (Tylenol) C. ASA D. Hydrocodone
C
The nurse enters the room of an infant who is an hour post op from a pyloric stenosis repair. The mother is crying because the baby vomited a small amount immediately after feeding. As the nurse consoles the mother, what is the best response to give to the mother? A. "I need to go call the healthcare provider to take the baby back to surgery." B. "As long as it is not projectile, the baby will be fine." C. "It is most likely because the anesthesia hasn't worn off yet." D. "Keep feeding the baby until he holds the formula down."
C
The nurse is caring for a client with acute digoxin toxicity. Serial electrocardiograms have been performed and the client is placed on continuous cardiac monitoring for which electrolyte disturbance? A. Hypomagnesemia B. Hypercalcemia C. Hyperkalemia D. Hypokalemia
C
The nurse is caring for a client with hypocalcemia. In addition to assessing the client's calcium level, which other assessment would the nurse make a priority? A. Drug toxicity B. Symptoms of glaucoma C. Other electrolyte levels D. EEG results
C
When the nurse is developing the POC for an infant with a cleft lip before corrective surgery is performed, what should be the priority? A. Maintaining skin integrity in the oral cavity B. Using techniques to minimize cavity C. Altering the usual method of feeding D. Preventing the infant from putting fingers in mouth
C
Which medical condition can contribute to hyperchloremia in the body? A. Thyroidectomy B. Paget's disease C. Kidney failure D. Pernicious anemia
C
The client with GERD has heartburn. Which item should be eliminated from the diet? A. Lean beef B. Air-popped corn C. Hot chocolate D. Raw veggies
C, D
What is the medical treatment for hypermagnesemia?
Ca gluconate IV; diuretics; isotonic fluids; hemodialysis
What are some things that weaken the lower esophageal sphincter?
Caffeine, vomiting, lifting, bending over
If calcium levels are at 17, what does the patient need?
Calcitonin
What is magnesium best friends with?
Calcium
What is the medical treatment of hypocalcemia and hyperphosphatemia?
Calcium gluconate IV w/ positive T&C; Ca, vit D, antacids; maybe dialysis
What does a patient with hypermagnesemia act like?
Calm and quiet
What is the most common type of stomatitis in children?
Canker sores, cold sores
What are some dietary sources of sodium/chloride?
Canned foods; processed meats; salty snack foods; cheese; ketchup
If calcium levels are at 17, it increases the risk of?
Cardiac arrest
A patient with sodium and chloride issues needs to be hydrated slowly in order to prevent what?
Cerebral edema
How would the nurse monitor the effects of Mag meds on a patient with hypomagnesemia?
Check DTRs
What may improve lip seal if a baby has a cleft lip?
Cheek support
What are some s/s of GERD?
Chest pressure; heartburn; reflux; nausea; dyspepsia; belching with sour taste
What electrolyte is paired with sodium?
Chloride
What are some dietary sources of magnesium?
Chocolate, green leafy vegetables, meats, nuts, seafood, whole grains
What is the diet for patients with pyloric stenosis?
Clear liquids (Pedialyte); progress to formula or breast milk
What is an early sign of FVD in elderly patients?
Confusion
A client has a history of taking over-the-counter magnesium supplements. Which finding would indicate to the nurse that the client is experiencing hypermagnesemia? A. Tetany B. Hypertension C. Hyperreflexia D. Paralytic ileus
D
A client has a potassium level of 9.0 mEq/L. Which nursing intervention is priority? A. Administer a laxative B. Administer spironolactone C. Place client on a potassium-restricted diet and limit fluid intake D. Prepare the client for dialysis and place the client on a heart monitor
D
A client has a serum sodium level of 150 mEq/L. The nurse reports the serum sodium level to the healthcare provider who prescribes dietary instructions based on the sodium level. Which food item does the nurse instruct the client to avoid? A. Peas B. Cauliflower C. Low-fat yogurt D. Processed oat cereals
D
A client recovering from a thyroidectomy reports a new onset of numbness and tingling around the mouth. Which finding indicates the client's serum calcium level is low? A. Confusion B. Dehydration C. Excessive urination D. Positive Chvostek's sign
D
A client recovering from a thyroidectomy reports numbness and tingling around the mouth and the tips of the fingers. Which intervention should be implemented first? A. Notify the healthy care provider immediately B. Prepare to administer calcium gluconate IVP C. Check the serum calcium and magnesium levels D. Tap the cheek about two centimeters anterior to the ear lobe
D
A client with a serum sodium level of 115 mEq/L has been receiving an intravenous infusion of 3% normal saline (NS) at 50 mL/hr for 16 hours. This morning the client feels tired and short of breath. Which action should the nurse make a priority? A. Slow the infusion B. Check the latest sodium level C. Notify the healthcare provider D. Assess for signs of fluid overload
D
A client's total parenteral nutrition (TPN) has 50 mL remaining in the bag and the new one has not been sent by the pharmacy. What is the priority nursing action? A. Hang 0.9% Sodium Chloride B. Hang 5% Dextrose in water C. Hang 0.45% Sodium Chloride D. Hang 10% Dextrose in water
D
Following an endoscopy, the client is told they have Barrett's esophagus without dysplasia due to uncontrolled gastroesophageal reflux disease. Which is the priority for this client? A. Endoscopic resection B. Immediate cryotherapy procedure C. One-month endoscopic follow-up D. Proton pump inhibitors treatment
D
The client with GERD has a chronic cough. Which possible problem would the nurse assess for? A. Development of laryngeal CA B. Irritation of the esophagus C. Esophageal scar tissue formation D. Aspiration of gastric contents
D
The client with GERD is prescribed Famotidine (Pepcid). In order to provide effective teaching, the nurse must include which information about the action of the drug? A. It improves gastric motility B. It coats the distal portion of the esophagus C. It increases the gastric pH D. It decreases the secretion of gastric acid
D
The nurse enters the room for hourly checks on a postoperative child after a cleft palate repair. As the nurse removes the elbow restraints to perform the assessment, which finding requires intervention? A. Warm fingertips and hands B. Capillary refill <2 seconds C. Quick reflexes with elbow movement D. Skin redness near the armpit
D
The nurse is teaching a client with stomatitis about managing oral discomfort. Which instruction is most appropriate? A. Drink hot tea at frequent intervals B. Gargle with an antiseptic mouthwash C. Use an electric toothbrush D. Eat a soft, bland diet
D
The nurse provides care for a client with a serum potassium level of 5.4 mEq/L. Which finding should the nurse expect on the client's electrocardiogram (ECG)? A. ST depression B. Inverted T waves C. Prominent U waves D. Tall peaked T waves
D
Upon assessment of a client in renal failure, the nurse observes a mental status change with hyperactive deep tendon reflexes. She inflates the blood pressure cuff to a level above his systolic pressure for 3 minutes and Trousseau's sign is positive. The nurse recognizes this as which electrolyte imbalance? A. Hypermagnesemia B. Hypomagnesemia C. Hypercalcemia D. Hypocalcemia
D
If a patient on TPN develops hypoglycemia, what can be hung to reverse it?
D10
What is an example of a hypertonic solution?
D5NS
Which fluid enters the body as isotonic and becomes hypotonic?
D5W
Which type of fluid should never be given to head injury patients?
D5W and hypotonic fluids
What are some s/s of hypermagnesemia?
Decreased HR, BP, bowel sounds, and DTR; heart blocks; muscle weakness
What are symptoms of FVD?
Decreased skin and tongue turgor; dry mucosa; decreased urine output; altered mental status
If hematocrit is high, what does that indicate?
Dehydration
If the fontanels are sunken, what could be indicated?
Dehydration
How will a patient with hyponatremia and hypochloremia look?
Depressed and deflated; dry
If renal failure was the underlying cause of FVE, how would it be treated?
Dialysis
What are some s/s of hypoglycemia?
Diaphoresis, change in LOC
This is the movement of solutes from an area of higher concentration to one of lower concentration
Diffusion
A patient with a magnesium alteration may have toxicity to what med?
Digoxin
If heart failure was the underlying cause of FVE, how would it be treated?
Diuretics
What are medications that affect electrolyte balance?
Diuretics, antibiotics, antacids, anticonvulsants, heparin, beta-blockers, laxatives, chemotherapy
Which type of PUD is relieved with food or antacids?
Duodenal
What is the most common symptom of GI problems?
Dyspepsia
What are some s/s of hypomagnesemia?
ECG changes; T wave inversion; increased HR, DTR, bowel sounds; LOC changes
How is gastritis diagnosed?
EGD with biopsy, stool sample, H. pylori test
How is GERD diagnosed?
EGD; pH probe test; barium swallow
What is an example of interstitial fluid buildup?
Edema
If a patient with FVE is SOB, what should the nurse do?
Elevate HOB
What is the treatment for GERD?
Elevate HOB; avoid eating while lying down; increase fluid intake; decrease stress; loose clothes; no eating at bedtime
What are examples of aspiration precautions?
Elevate HOB; suction at bedside; thicken liquids; chin to chest
What does active transport require?
Energy
If a patient is taking aspirin but they are at risk of developing a gastric ulcer, what is a good option?
Enteric-coated aspirin
How often should tubing be changed for TPN?
Every 24 hours
What is a high risk complication of IV Calcium?
Extravasation
What is the treatment of pyloric stenosis?
FE maintenance; NG tube; NPO; pyloromyotomy
What is an example of H2 receptor blockers?
Famotidine
This is the movement of water AND solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure
Filtration
What are some s/s of hypokalemia?
Flat T waves; decreased bowel sounds; paralytic ileus; muscle cramps; decreased DTR
What does sodium and chloride primarily effect?
Fluids
What is an example of a loop diuretic?
Furosemide
This GI disease can trigger an asthma attack
GERD
What should the nurse watch for if a patient has hypokalemia?
GI pain, distention
Which type of PUD occurs after/during a meal?
Gastric
What are the three different types of PUD?
Gastric, duodenal, stress
How is PUD diagnosed?
H pylori test; endoscopy; barium swallow; upper GI series; CBC; stool specimen
What are some signs a patient getting rehydrated after being admitted with a sodium and chloride imbalance is developing cerebral edema?
HA; n/v; increased BP; confusion
What is an example of a thiazide diuretic?
HCTZ
What does potassium effect?
Heart
What are patients with PUD at risk for?
Hemorrhage
What is an example of something that would call for large amounts of LR?
Hemorrhage
What are some common causes of GERD?
High fat diet; hiatal hernia; pregnancy; obesity
This type of fluid pulls fluid out of cells
Hypertonic
What kind of solution would be used to decrease edema?
Hypertonic
This type of fluid would be given for severe dehydration
Hypotonic
What medical treatment would be given for hypernatremia and hyperchloremia?
Hypotonic IV (1/2 NS)
What is the nursing management of FVE?
I&O and DW; assess; monitor med responses (diuretics); promote adherence to fluid restrictions; monitor/avoid sources of excess sodium; promote rest; semi-fowlers
What are some nursing interventions for FVD?
I&O, DW, VS; monitor for symptoms; measures to minimize fluid loss; administer fluids
What are the 3 main things that should be monitored with a fluid volume problem?
I&O, VS, daily weight
What is the nursing management for hypokalemia?
IV K+ (dilute - *never IVP*); monitor I&O; watch for Digoxin toxicity
What is dyspepsia?
Indigestion
What is stomatitis?
Inflammation of the mouth
This type of fluid is given for volume expansion
Isotonic
What is a major cause of hypermagnesemia?
Kidney injury
What are some s/s of hyponatremia and hypochloremia?
LOC changes; weak pulse; increased HR; hypotension
If a patient is receiving TPN, what should the nurse do to the port that it is going into?
Label it
What kind of diuretic is Lasix?
Loop
What is everything like if a patient has hypokalemia?
Low and slow
If a dietary problem was the underlying cause of FVE, how would it be treated?
Low salt diet; fluid restriction
What is the medical treatment for hypomagnesemia?
Mag sulfate; dietary mag; monitor for decreased Ca
If a patients protein levels are low, what kind of problems do they have?
Magnesium
What is an example of an osmotic diuretic?
Mannitol
What are some nursing interventions for third-spacing?
Measure abdominal girth (if ascites present); monitor albumin and total protein levels
What are some dietary sources of calcium/phosphorus?
Milk, cheese, yogurt, legumes, molasses, green leafy vegetables
What is the nursing management for hypermagnesemia?
Monitor ECG; assess; no antacids or laxatives; watch renal function (BUN, creatinine)
What is the nursing management for hypomagnesemia?
Monitor ECG; safety; assessment; med administration
What is the treatment for PUD?
Monitor weight loss; watch for perforation; decrease stress
If urine specific gravity is increased, is urine more or less concentrated?
More
What does magnesium effect?
Muscles
What is the treatment of gastritis?
NG tube; no irritants; FE replacement; stress management; diet (NPO, progress as tolerated)
What are two isotonic fluids?
NS and LR
What is a surgical treatment for GERD?
Nissan fundoplication
What are risk factors of PUD?
O blood type; H pylori; no antigens in saliva
What is an example of PPIs?
Omeprazole
This is the movement of water from an area of lower solute concentration to an area of higher solute concentration
Osmosis
Mannitol is an example of what kind of diuretic?
Osmotic
What kind of diuretic is given IV only?
Osmotic
If the fontanels are bulging, what could be indicated?
Overhydration
What are some s/s of hyperkalemia?
Peaked T waves; increased bowel sounds; increased DTR; muscle weakness
What electrolyte is the inverse of calcium?
Phosphorus
What should be monitored if a patient is on a diuretic?
Potassium levels
What is the classic triad of pyloric stenosis?
Projectile vomiting; visible peristalsis; palpable olive-shaped mass
What would be given IV to help with third spacing?
Protein from albumin
What is Chvostek's sign?
Push the cheek and it spasms
What is the nursing management for hyponatremia and hypochloremia?
Raise level *slowly*; watch for acidosis; assess sodium intake
A client with PUD is takin Ranitidine. What is the expected outcome of this drug?
Reduce gastric acid secretion
What is the goal with hypernatremia and hyperchloremia?
Rehydrate cells
What is the medical treatment for hyponatremia and hypochloremia?
Restrict fluids; oral salt; meds to remove free H2O
What are s/s of perforation?
Severe pain; absent bowel sounds; distention; rigidity
How would IV mag be given to a patient with hypomagnesemia?
Slow
If a patient is showing signs of cerebral edema while getting rehydrated, what should the nurse do?
Slow fluids and call MD
How should IV Calcium be administered?
Slow via pump; mix w/ D5W
What kind of diet should a patient with GI concerns be on?
Soft bland diet; no fried or spicy foods; no alcohol or caffeine
What is the non-surgical treatment of cleft lip/palate?
Special nipple; breastfeed; burp often
What would a patient with hypocalcemia and hyperphosphatemia look like?
Stiff, tingly, and twitchy
What are some measures to minimize fluid loss for a patient with FVD?
Stop diarrhea; decrease SOB; decrease sweating
What is an example of a mucosal blocker used for PUD?
Sucralfate (Carafate)
What are some postop considerations for a patient who had surgery for a cleft lip/palate?
Supine, side-lying; arm restraints; nothing in mouth
What is diaphoresis?
Sweating
What would a patient with hypercalcemia and hypophosphatemia look like?
Swollen and slow; moans, groans, and stones
What are some things that should be taught to a patient taking diuretics?
Take early; move slowly; weigh daily
What type of diuretic is HCTZ?
Thiazide
What does a patient with hyperkalemia look like?
Tight and contracted
What is a complication that occurs from FVD and FVE?
Tissue hypoxia
What is the medical management of FVE?
Treat underlying cause!
What is the medical treatment of hypercalcemia and hypophosphatemia?
Treat underlying cause; IV fluids; diuretics; parathyroidectomy; IV phosphorus; vit D
What are some s/s of hypocalcemia and hyperphosphatemia?
Trousseau's and Chvostek's sign; tetany; circumoral tingling
How is a patient tested for H. pylori?
Urea breath test, serum titers, fecal sample
What is some patient teaching that would be given to a patient with stomatitis?
Use a soft-bristled toothbrush; avoid alcohol based mouthwashes; avoid lemon glycerin swabs; no irritating foods
What are signs of gastritis?
Vomiting; stomach burn; upset stomach; loss of appetite; blood vomiting; black stool
What are some GERD induced respiratory issues?
Wheezing; hoarseness; chronic cough
If K+ is being given PO, how should it be given?
With 8 oz of water
What kind of antiviral is given for stomatitis?
Zovirax
What does urine specific gravity measure?
kidneys ability to concentrate urine
