Flashcards in Assessment Deck (35)
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1
Vibration produced when patient articulates "99"
Tactile fremitus
2
Vesicular
soft and low-pitched breezy sounds heard over most of peripheral lung fields; inspiration >= expiration
3
medium-pitched, moderately loud sounds heard over the mainstem bronchi; inspiration=expiration
Bronchovesicular
4
loud, coarse blowing sounds head over the trachea; inspiration <= expiration
Bronchi
5
abnormal lung sounds caused by fluid or inflammation
Adventitious
6
grating sound or vibration heard during inspiration and expiration
pleura friction rub
7
squeaky sounds heard during inspiration and expiration associated with narrowed airways
sibilant wheeze
8
musical sounds or vibrations commonly heard on expiration
sonorous wheeze
9
abnormal sounds caused by turbulence within a heart valve
murmurs
10
Bruit
turbulence within a blood vessel
11
same concentrations as body fluids
Isotonic fluids
12
Hypertonic solution
solute concentration greater than that of body fluids
13
hypotonic solution
solute concentration less than that of body fluids
14
fluid deficit causes
vomiting
diarrhea
GI suction
sweating and warm weather
decreased intake; increased caffeine and alcohol intake
hyperthermia
diuretics
15
signs and symptoms of fluid deficit
weight loss
decreased skin turgor
oliguria
concentrated urine
postural hypotension
weak, rapid pulse
increased hematocrit, hemoglobin, BUN, Na, serum osmolality
Hyperthermia- increased pulse, decreased BP, disorientation
orthostatic hypotension, falls, pressure ulcers, constipation, dry oral mucous
16
increase in the interstitial compartment, intravascular compartment or both
fluid overload - isotonic gain
17
causes of fluid overload
heart failure
renal failure
Cirrhosis of the liver
excessive ingestion of Na
excessive or too rapid intravenous infusion
18
signs and symptoms of fluid overload
edema
distended veins
increased BP
bounding pulse
crackles; increased RR, shallow respiration
decreased hematocrit and BUN (5-20 mg/dL)
weight gain
19
cause of hypokalemia (<3.5 mEq/L)
vomiting
gastric suction
prolonged diarrhea
diuretics and steroids
inadequate intake
20
signs and symptoms of hypokalemia
anorexia, N/V
weak peripheral pulses
muscle weakness, paresthesias; decreased deep tendon reflexes
impaired urine concentration
ventricular dysrhythmias
potential for digitalis toxicity
shallow respirations
21
hyperkalemia causes (> 5.0 mEq/L)
renal failure
use of K supplements
burns
crushing injuries
severe infection
K-sparing diuretics
ACE inhibitors
22
signs and symptoms of hyperkalemia
EKG changes-peaked T waves, wide QRS complexes
dysrhythmias, ventricular fibrillation, heart block
cardiac arrest
muscle twitching and weakness
numbness in hands and feet and around mouth
nausea
Diarrhea
23
causes of hyponatremia (<135 mEq/L)
vomiting
diuretics
excessive administration of dextrose and water IVs
burns, wound drainage
excessive water intake
SIADH
kidneys unable to excrete free water
24
sign and symptoms of hyponatreia
nausea
muscle cramps
confusion
muscular twitching, coma
seizures
headache
delirium
25
causes of hypernatremia (>145)
hyperventilation
diabetes insipidus
hypertonic tube feedings without water supplements
ingestion of OTC drugs such as Alka-Seltzer
saltwater
inadequate water ingestion
26
signs and symptoms of hypernatremia
Elevated temperature
weakness
Disorientation
irritability and restlessness
thirst
dry, swollen tongue
sticky mucous membranes
postural hypotension with decrease ECF
hypertension with normal or increase ECF
tachycardia
mental status changes, coma
27
causes of hypocalcemia
hypoparathyroidism
pancreatitis
renal failure
steroids and loop diuretics
inadequate intake
post thyroid surgery
28
signs and symptoms of hypocalcemia
tetany
hyperactive reflexes
confusion
paresthesias
irritability
seizures
29
causes of hypercalcemia
malignant neoplastic diseases
hyperparathyroidism
prolonged immobilization
excessive intake
immobility
excessive intake of calcium carbonate antacids
30
signs and symptoms of hypercalcemia
lack of coordination
anorexia, N/V
confusion, decreased level of consciousness
personality changes
dysrthythmias, heart block, cardiac arrest
31
causes of hypomagnesemia
alcoholism
GI suction
Diarrhea
intestinal fistulas
poorly controlled diabetes mellitus
malabsorption syndrome
32
signs and symptoms of hypomagnesemia
increased neuromuscular irritability
tremors
tetany
hyperactive deep tendon reflexes
seizures
dysrhythmias
disorientation
confusion
33
causes of hypermagnesemia
renal failure
excessive magnesium administration (antacids, cathartics)
34
signs and symptoms of hypermagnesemia
depresses the CNS
depresses cardiac impulse transmission
cardiac arrest
facial flushing
muscle weakness
absent deep tendon reflexes
paralysis
shallow respirations
35
