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NU 340 > Ch. 13 > Flashcards

Ch. 13 Flashcards

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1
Q

dehydration means that there is a lack of ___ in the body

A
  • fluid intake is less than what is needed to meet the body’s fluid needs
  • no water or no salt or both
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2
Q

causes of dehydration

A
  • inadequate fluid intake
  • loss of sodium in diet (ie maybe they completely cut out sodium from diet)
  • loss of fluid and electrolytes (ie. vomiting and diarrhea, or diabetes insipidus, excessive sweating)
  • excessive caffeine intake, alcohol intake
  • fever of 102/103- diaphoretic
  • medication: diuretics
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3
Q

adverse effects of dehydration: 0% body weight loss

A

thirst

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4
Q

adverse effects of dehydration: 2% body weight loss

A
  • stronger thirst
  • vague discomfort
  • loss of appetite
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5
Q

adverse effects of dehydration: 3% body weight loss

A
  • decreasing blood volume
  • impaired physical performance
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6
Q

adverse effects of dehydration: 4% body weight loss

A
  • increased effort for physical work
  • nausea
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7
Q

adverse effects of dehydration: 5% body weight loss

A
  • difficulty concentrating
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8
Q

adverse effects of dehydration: 6% body weight loss

A
  • failure to regulate excess temperature
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9
Q

adverse effects of dehydration: 8% body weight loss

A
  • dizziness
  • labored breathing with exercise
  • increased weakness
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10
Q

adverse effects of dehydration dehydration: 10% body weight loss

A
  • muscle spasms
  • delirium
  • wakefulness
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11
Q

adverse effects of dehydration: 11% body weight loss

A
  • inability of decreased blood volume to circulate normally
  • failing renal function
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12
Q

clinical manifestations of dehydration

A
  • cardiovascular changes: decreased plasma volume, increased HR, low BP
  • respiratory changes: increased RR
  • skin changes: dry, moist (fever)
  • neurologic changes: confusion, lethargic
  • renal changes: decreased urinary output, dark/concentrated urine
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13
Q

laboratory assessments of dehydration

A

elevated:
- hemoglobin
- hematocrit
- serum osmolarity
- glucose
- BUN
- electrolytes

hemoconcentration causes the blood to be very concentrated and elevate these levels

*assess in correlation with physical findings, labs on their own don’t conclude dehydration

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14
Q

analysis/patient problems of dehydration

A
  • poor perfusion due to excess fluid loss or inadequate fluid intake
  • potential for injury due to blood pressure changes and muscle weakness
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15
Q

dehydration: nurse management

A
  • safety
  • strict I&O**
  • monitor labs
  • monitor cardiovascular/ respiratory status
  • daily weights**
  • skin care, oral care (very dry- make sure that they are moist/clean)
  • monitor for complications
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16
Q

1L of water is ____ lb of water, which is __ kg

A

2.2 lbs, 1 kg

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17
Q

weight change of 1 lb = fluid volume change of ___ mL

A

500 mL

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18
Q

fluid overload

A
  • excess of body fluid
  • hypervolemia
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19
Q

dilution of sodium and potassium can lead to ___

A
  • seizures
  • coma
  • death
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20
Q

severe fluid overload can lead to ___

A
  • heart failure
  • pulmonary edema (RRT needed)
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21
Q

hyponatremia

A
  • sodium level below 136mEq/L
    (more common than hyper)
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22
Q

causes of hyponatremia

A
  • increased sodium loss
  • excess water- dilutional (kidneys are not working well)
  • dehydration* most likely cause
  • liver disease
  • adrenal insufficiency
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23
Q

clinical manifestations of hyponatremia

A
  • sodium loss vs fluid gain
  • *neurologic: lethargic, seizures, confusion
  • CV: low BP, high HR
  • skin: dry, decreased skin turgor
  • GI: nausea, diarrhea

*affects neuro the most

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24
Q

hyponatremia interventions

A
  • treat underlying cause
  • sodium replacement
  • monitor
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25
hyponatreamia interventions: sodium replacement
- IV (hypertonic) (0.9% NS) - diet (foods with sodium) - medications (mannitol if dilutional)
26
hyponatremia interventions: monitor for
- I/O - urine specific gravity - BP, CV, respiratory status - neurologic status - daily weights - edema (effect from the treatment- fluid volume overload)
27
hypernatremia
- serum sodium level over 145 mEq/L
28
causes of hypernatremia
- dehydration - excessive sodium intake (high sodium diet)* most likely cause - regulatory abnormalities - hypercortisolism - kidney disease
29
clinical manifesations of hypernatremia
- neurologic - renal: underlying kidney disease - cardiovascular: elevated BP - respiratory (if caused by dehydration) - integumentary (if caused by dehydration)
30
hypernatremia interventions
- safety (seizure monitoring) - medication: diuretic (lasix) - IV therapy: sodium free fluids initially - diet: low sodium diet, fluids if dehydrated - monitor: VS, I&O, daily weights, edema *depends on cause (water loss or sodium gain)
31
hypernatremia interventions: diet
- fluids if dehydrated - low sodium diet
32
hypernatremia interventions: monitor for
- VS - I/O - daily weights - edema
33
hypokalemia
serum potassium level below 3.5mEq/L *can be life threatening because every body system is affected
34
causes of hypokalemia
- abnormal losses: diuretics, GI losses (vomiting, NG tube, diarrhea) - other conditions: metabolic and respiratory alkalosis - fluid overload - insulin administration - hyperaldoseteronism
35
clinical manifestations of hypokalemia
- cardiovascular: irregular beat and rhythm- should be on heart monitor - metabolic: muscle weakness, falls
36
hypokalemia interventions
- safety - potassium replacement (PO or IV) - educations: diet (citrus, banana), diuretic use (electrolyte checks)
37
potassium replacement IV should not be faster than _____
10 mEq/hr **NO FASTER
38
can potassium replacement be given as IV push?
no- never - can cause cardiac arrest --> heart stops --> kill patient
39
hyperkalemia
serum potassium greater than 5.0 mEq/L
40
what is the most severe problem that results from hyperkalemia?
cardiovascular changes - also the most common cause of death in patients with hyperkalemia
41
causes of hyperkalemia
- dehydration - kidney disease - acidosis - adrenal insufficiency - crush injuries - medication (potassium-sparing diuretic: spironolactone, ACE-Inhibitors) - blood transfusion
42
clinical manifestations of hyperkalemia
- cardiovascular - neurologic: muscle weakness - GI: diarrhea
43
hyperkalemia interventions
- safety - drug therapy - monitoring - health teaching
44
drug therapy for hyperkalemia
- sodium polystyrene (drink- causes patient to have a BM, gets rid of potassium through BM) - IV insulin (pulls potassium from blood stream back into cell) and glucose (balancing out the blood sugar)
45
hyperkalemia interventions: monitoring
- cardiac - life threatening - neurologic
46
hyperkalemia interventions: health teaching
- diet (no citrus, low sodium diet) - avoid salt substitutes - increase fluid intake (helps dilute potassium)
47
hypocalcemia
total serum calcium level below 9.0 mg/dL
48
causes of hypocalcemia
- dietary intake - inadequate absorption - increased phosphorus - decreased PTH - vit D deficiency - hypothyroidism - hypoparathyroidism - kidney disease - excessive intake of phosphorus-containing foods and drinks
49
clinical manifestations of hypocalcemia
- neurologic (tingling/numbness) - cardiovascular changes (bradycardia, EKG changes) - intestinal changes (cramping) - skeletal changes (charlie horse, tingling in muscle) chvostek's sign: decrease calcium in the blood results in facial twitching when the facial nerve is tapped
50
hypocalcemia inteventions
- drug therapy (Vit D) - nutritional therapy (encourage foods high in calcium: yogurt, milk) - environmental management (potentially, seizure precautions) - injury prevention strategies (taking vitamins to prevent bone fractures
51
hypercalcemia
total serum calcium level above 10.5 mEq/L
52
causes of hypercalcemia
- hyperparathyroidism - increased CA or Vit D - malignancy - prolonged immobilization - hyperthyroidism
53
clinical manifestations of hypercalcemia
- effects of hypercalcemia occur first in excitable tissues - cardiovascular (most important) - GI - renal
54
hypercalcemia interventions
- drug therapy - dialysis - cardiac monitoring
55
hypercalcemia interventions: drug therapy
- IV 0.9% sodium chloride - furosemide - calcium chelators
56
agents that prevent hypercalcemia
- phosphorus - calcitonin - biphosphonates - prostaglandin synthesis inhibitors
57
hypophosphatemia
serum phosphorous level below 3 mEq/L
58
hyperphosphatemia
serum phosphorous level above 4.5 mEq/L
59
what two ions exist in the blood in a balanced reciprocal relationship?
- calcium and phosphorous
60
assessment of hypophosphatemia
- low phosphorus , high calcium
61
assessment of hyperphosphatemia
- high phosphorus, low calcium
62
management of hypophosphatemia
think high calcium (hypercalcemia interventions) - drug therapy (IV 0.9% NS, furosemide, calcium chelators - dialysis - cardiac monitoring
63
management of hyperphosphatemia
- drug therapy (Vit D) - nutritional therapy (encourage foods high in calcium: yogurt, milk) - environmental management (potentially, seizure precautions) - injury prevention strategies (taking vitamins to prevent bone fractures
64
hypomagnesemia
serum magnesium level below 1.3 mEq/L
65
effects of hypomagnesemia are caused by
- increased membrane excitability - accompanying serum calcium and potassium imbalances - malnutrition - alcoholism - ketoacidosis
66
clinical manifestations of hypomagnesemia
- neuromuscular changes - CNS changes
67
interventions for hypomagnesemia
- drugs: IV mag sulfate
68
hypermagnesemia
serum magnesium level above 2.6 mEq/L
69
when magnesium excess occurs, excitable membranes are ___
less excitable - need a stronger than normal stimulus to respond
70
clinical manifestations of hypermagnesemia
- cardiac changes - CNS changes - neuromuscular changes - respiratory changes
71
hypermagnesemia interventions
- magnesium-free IV fluids - furosemide - calcium
72
percentage of the body composed of fluid
> 50%
73
body fluids deliver _____ to all tissues and cells in the body
nutrients and electrolytes
74
two main compartments of body fluids
1. ECF 2. ICF
75
three processes that control fluid and electrolyte balance
1. filtration 2. diffusion 3. osmosis
76
filtration
movement of fluid through cell or blood vessel membrane because of differences in water pressure (hydrostatic pressure) - water volume pressing against confining walls
77
diffusion
free movement of particles (solute) across permeable membrane from area of HIGHER to LOWER concentration
78
osmosis
movement of water only through a semipermeable membrane to achieve an equilibrium of osmolarity from area of LOWER concentration to HIGHER concentration
79
clinical example of filtration
blood pressure
80
hydrostatic pressure is
"water pushing pressure" - force that pushes water outward from a confined space through a membrane
81
what determines the amount of pressure? (re: hydrostatic pressure)
the amount of water in any body fluid space
82
example of hydrostatic pressure
blood pressure - moving whole blood from the heart to capillaries where filtration occurs to exchange water, nutrients, and waste products between the blood and tissues
83
this process is important in the transport of most electrolytes
diffusion
84
other particles diffuse through ____
cell membranes
85
clinical example of diffusion
- transport of most electrolytes and other particles through cell membrane - sodium pumps
86
glucose cannot enter most cell membranes without help of ___
insulin
87
osmolarity
number of milliosmoles in a liter of solution
88
osmolality
number of milliosmoles in a kilogram of solution
89
1L of H2O = __ kg
1 kg
90
normal osmolarity for bodily fluids:
270-300 mOsm/L
91
osmosis and filtration work together to ___
act at capillary membrane to maintain normal ECF and ICF volumes
92
example of how osmosis helps maintain homeostasis:
thirst mechanism
93
the feeling of thirst is caused by ___
activation of brain cells responding to changes in the ECF osmolarity
94
fluid types
- isosmotic or isotonic (normotonic) - hyperosmotic or hypertonic-osmolarity - hypo-osmotic or hypotonic-osmolarity
95
isosmotic or isotonic (normotonic): osmolarity
270-300
96
hyperosmotic or hypertonic-osmolarity: osmolarity
> 300
97
hypo-osmotic or hypotonic-osmolarity: osmolarity
< 270
98
fluids are regulated through the
thirst drive
99
fluids enter the body mostly as
liquids
100
adults need ___ (amount) of water per 1000kcal
1000mL per 1000kcal
101
fluids loss occurs through
several routes - sweating - urine
102
minimum amount of urine needed to excrete toxic waste products is ___
400-600mL
103
insensible water loss is (amount)
500-1000mL
104
what 3 hormones control fluid and electrolyte balance
1. aldosterone 2. antidiuretic hormone (ADH) 3. Natriuretic peptides
105
what are the most important fluids to keep in balance?
- blood (plasma) volume - intracellular fluid
106
what organ is the major regulator of water and sodium?
the kidneys
107
the kidneys maintain ____ and ___ to all tissues/organs
- blood pressure and perfusion to all tissues/organs
108
what do the kidneys secrete when they sense a low parameter?
renin
109
RAAS (renin-angiotensin-aldosterone system) is greatly stimulated when ____
- when in shock - when stress response is stimulated
110
electrolyte imbalance can occur in healthy people as a result of
changes in fluid intake and output
111
electrolyte imbalance includes:
- sodium - potassium - calcium - magnesium
112
causes of hypermagnesemia
- kidney disease - hypoparathyroidism - adrenal insufficiency
113
causes of hypochloremia
- fluid overload - excessive vomiting or diarrhea - adrenal insufficiency - diuretic therapy
114
causes of hyperchloremia
- metablic acidosis - respiratory alkalosis - hypercortisolism
115
causes of hypo-osmolarity
- fluid overload - hyponatremia - hypoproteinemia - malnutrition
116
causes of hyperosmolarity
- dehydration - hypernatremia - hyperglycemia
117
normal sodium range
136-145 mEq/L
118
normal potassium range
3.5-5.0 mEq/L
119
normal calcium range
9.0-10.5 mg/dL (2.25-2.62 mmol/L)
120
normal chloride range
98-106 mEq/L
121
normal magnesium range
1.3-2.1 mEq/L (0.65-1.05 mmol/L)
122
sodium often enters the body through
foods and fluids - smoked or pickled foods, snack foods, condiments
123
where sodium goes, ___ follows
water
124
major cation of ICF:
potassium
125
potassium is highest in what? (food)
- meat - fish - many vegetables - fruits
126
calcium enters the body through
intake of dairy products - milk - cheese - yogurt
127
absorption of calcium requires what vitamin?
the active form of Vit D
128
calcium stored in what part of the body?
bones
129
what hormone is released when more calcium is needed?
PTH (parathyroid hormone)
130
what hormone is present when there is excess calcium?
the thyroid gland secretes TCT (thyrocalcitonin)
131
magnesium is stored in what body parts?
- bone - cartilage
132
magnesium assists with:
- skeletal muscle contration - carbohydrate metabolism - generation of energy stores - vitamin activation - blood coagulation - cell growth
133
dehydration: nursing priorites
1. fluid replacement-IV fluids 2. drug therapy 3. patient safety
134
difference in treatment of mild vs severe dehydration
mild: regular fluids severe: IV fluids
135
assessments for fluid overload
- shortness of breath - edema - crackles in lungs - high BP - distention of jugular vein
136
fluid overload: nursing priorities
1. patient safety (falls) 2. restore normal fluid balance 3. prevent future fluid overload - drug therapy: diuretic (ie. furosemide- monitor electrolytes with diuretics) - nutrition therapy (low-sodium diet) - strict monitoring of I/O's, daily weights
137
IV potassium causes what sensation to patients?
burning

NU 340 (26 decks)

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