Exam 1, Deck 2 Flashcards Preview

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Flashcards in Exam 1, Deck 2 Deck (78):
1

Potassium levels:
- Intracellularly
- Intravascularly

- Intracellular: As high as 150 m#q
- Intravascular: 3.5-5.2

2

Four causes of hypokalemia

- Loss from GI tract
- Diet
- Diuretics (except aldactone)
- Enema or laxative abuse

3

Some sxs of hypokalemia (4)

- Constipation
- ECG changes
- Lower leg weakness
- Paresthesia

4

A hypokalemic patient as at higher risk of...

(why?)

Dig toxicity

Because digoxin is positive cardiac inotropic drug

5

Three types of K+ to administer to a hypoakalemic patient:

- Klor, KDor (PO)
- KCl (IV, if severe)

6

Notes about administration of K+ (3)

- Never IV push or bolus
- Must be diluted
- No more than 40mEq/L (in 1000mL of fluid)

7

Three requirements patient must meet in order to recieve K+

- BUN WNL
- Creatinine WNL
- Normal urine output

8

ECG changes with hypokalemia

Lower T wave

9

ECG changes with hyperkalemia

Peaked T (almost as high as QRS)

10

Most common cause of Hyperkalemia

Kidney failure

11

Three other causes of Hyperkalemia

- Intake of excess K+
- Crush injuries / burns
- Addison's disease

12

Electrolyte imbalances of Addison's (2)

- Hyponatremia
- Hyperkalemia

13

Physical assessment of Hyperkalemic patient (4)

- HR is slow/weak/absent
- ECG changes
- Irregular heartbeat
- Acidosis

14

Symptoms of Hyperkalemia (3)

Nausea
Paresthesias
Muscle cramps

15

How does hyperkalemia lead to acidosis?

As potassium rises, kidneys try to excrete it. In the process, kidneys hold onto H+ levels

16

Hyperkalemia: Interventions (6)

- Calcium Gluconate
- IV fluids
- IV Na Bicarbonate
- Hemodialysis
- Kayexalate
- Insulin and Glucose IV

17

Why would you give Calcium Gluconate to a Hyperkalemic patient

It doesn't change K+ levels, but protects the myocardium and buys time.

18

Why would you give IV fluids to a hyperkalemic patient

To help the kidneys flush it out

19

Why would you give Sodium bicarbonate to a hyperkalemic patient

Helps when acidosis is at play: Bicarb makes body alkalotic, convinces body to get rid of potassium

20

Why would you give Kayexalate to a hyperkalemic patient

Binds to potassium in bowel and brings it out with fecal material (*administered PO or as retention enema)

21

Why would you give Insulin and glucose IV to a hyperkalemic patient?

SHOVE EVERYTHING INTO THE CLOSET BEFORE THE GUESTS COME

Only administered in the most severe cases (6.8 or above)

Drives potassium into cells

Short term solution

22

Absorption rate of calcium

30-50% of calcium ingested is absorbed

23

Functions of calcium (3)

- Needed for muscle contraction
- Essential for blood clotting
- Necessary for electrical conduction of the heart

24

Three causes of hypocalcemia

- Inadequate intake of calcium / anorexia
- Renal failure
- Lasix

25

Signs of Hypocalcemia (4)

- Muscle cramping
- Twitching
- Tetany / convulsions
- Cardiac arhytmias

26

Assessment of hypocalcemia

- Trousseau's Sign (claw w BP)
-Chvostek's Sign (cheek flick twitch)

27

Hypercalcemia - causes (3)

- Increased bone reabsorption
- Cancers (bone and others)
- Immobility

28

Symptoms of Hypercalcemia (3)

- Lethargy / weakness
- Decreased reflexes
- Constapation

29

Hypercalcemia interventions (4)

- Decrease intake
- Lasix
- Calcitonin
- Ambulation

30

"Acidity" is a measure of...

H+ concentration

31

In acid-base balance, Kidneys control the _______ component.

Metabolic

32

In acid-base balance, Lungs control the _______ component.

Respiratory

33

Kidneys: Mechanism for controlling Acid-Bae

Controlling sodium bicarbonate (HCO3)

**Secondary mechanism: Controlling H+

34

Lungs: Mechanism for controlling acid-base

Controlling carbon dioxide (CO2)

35

What does CO2 do to acid-base balance?
- High CO2 = ________
- Low CO2 = _________

High CO2 = low ph (acidic)
Low CO2 = high pH (basic)

36

Mechanism with which CO2 affects pH balance:

CO2 + H20 --> H2CO3 (carbonic acid)

37

Mechanism with which HCO3 affects pH balance:

H2CO3 (carbonic acid) breaks down into HCO3 and H+

38

SaO2 def:

Saturation of hemoglobin with O2

39

PaO2: def

Partial pressure of oxygen dissolved in arterial plasma

40

What blood gas level would make you start thinking about intubation?

PaO2 of <60

41

SaO2 of < _____ &
PaO2 of < _____ are considered to be hypotonic

SaO2 < 90%
PaO2 < 60

42

How would you measure the PaO2? What is the normal value?

Arterial stick
Normal = 80-100

43

Abnormal ABG profile of respiratory acidosis:

pH: Low
PaCO3: High

44

Abnormal ABG profile of metabolic acidosis:

pH: Low
HCO3: Low

45

Abnormal ABG profile of respiratory alkalosis:

pH: High
PaCO2: Low

46

Abnormal ABG profile of metabolic alkalosis:

pH: High
H2CO3: High

47

Interpreting ABG's:
4 steps

1) Look at the number
2) Look at the pH
3) Is the problem respiratory or metabolic?
4) Determine compensation (absent / partial complete)

48

Function of Allen test

Test that must be positive to proceed with testing ABGs

49

Allen test: Steps (4)

1) Patient forms tight fist
2) Apply pressure at wrist (ulnar and radial)
3) Patient opens wrist. Palm should be pale.
4) Release ulnar

50

What does a positive Allen test look like? Why is this important?

Palm turns pink within 15 seconds of releasing Ulnar (then you know that it is safe to use radial)

51

What precautions do you take with the blood drawn from ABGs? (2) Why?

Precautions:
- Heparinize the container so it doesn't clot
- Put it on ice to decrease BMR

IT IS LIVING TISSUE

52

After taking an ABG, what do you do and why?

Pressure for 10-15 minutes

To prevent bleeding / hematoma

53

How do you know if the problem with the ABG is respiratory or metabolic?

If the PaCO2 has the same acid/base status as the pH, it's respiratory.

If the HCO3 has the same acid/base status as the pH, it's metabolic,

54

Common causes of respiratory acidosis (2)

- Depression of the respiratory center
- Decreasing aerating surface of hte lung

55

Four things that could depress the respiratory center

- Opioids
- Barbituates / Benzos
- Anesthesia
- Head trauma

56

Four problems that would decrease the aerating surface of hte lung

- COPD
- Pneumonia
- Airway obstruction
- Chest wall trauma

57

Nursing assessment of a patient with respiratory acidosis (4)

- Ashen color
- Change in mental status due to hypoxia
- pH <7.35
- Change in respiratory rate

58

How does respiratory rate change with acidosis? Why? (2)

- If due to a CNS problem: Slow and shallow

- If due to decreased lung surface area: Quicker RR

59

Respiration assistance for pt in respiratory acidosis
- If severe
- If mild
- Other note

- Intubation if severe, cannula if mild
- COPD: LOW FLOW O2

60

Why do you give low flow CO2 to a COPD patient

Because of the Haldene effect

61

What is the Haldene effect

Increased levels of O2 will actually bump up PaCO2 levels, and COPD patients can't compensate.

62

Respiratory acidosis: Nursing interventions for...
- Opioids (2)
- Benzos

- Assess RR before administering opioids
- Opioid antidote = narcan

- Benzo antidote = Romazicon

63

Common causes of respiratory alkalosis (3)

Hyperventilation
Pain
Head trauma (medulla)

64

Respiratory Alkalosis: Nursing assessment (3)

Lightheadedness / dizziness
Tetany

65

Why does respiratory alkalosis cause tetany?

Because alkalosis can interfere with calcium utilization, so tetany can develop. Claw-like hands.

66

Nursing intervention for respiratory alkalosis

Rebreather mask (paper bag) -- allows patient to rebreathe CO2

67

How does DKA occur?

- Glucose is not being metabolized because of lack of insulin
- so body breaks down fatty acids, which yield ketones (acidic)

hence KETOACIDOSIS

68

Common causes of metabolic acidosis (6)

- Diabetes mellitus (DKA)
- Starvation
- ASA overdose
- Renal failure
- Severe diarrhea
- Tissue anoxia

69

Why does tissue anoxia occur and what does it do to acid/base balance?

Tissue anoxia occurs if the patient is not breathing -- body switches to anaerobic metabolism, which produces acid.

70

Nursing assessment of metabolic acidosis (3)

- Lethargy --> coma
- High serum K+
- Kussmaul breathing to compensate

71

What is Kussmaul breathing?

Deep, rapid respirations to compensate for acidosis

72

Nursing interventions for metabolic acidosis (3)

- Amp of sodium bicarb
- Check potassium (may be high)
- Treat the cause (insulin, food, lavage)

73

Common causes of metabolic alkalosis (3)

- Loss of HCl (due to gastric loss)
- Excessive intake of sodium bicarb
- Fluid and electrolyte loss

74

Explain how fluid loss can lead to alkalosis

Body compensates by saving sodium and water, subsequently wastes H+ (result: alkalosis)

75

Two sources of HCl loss

- Vomiting
- Gastric suction

76

Nursing assessment of metabolic alkalosis (2)

- Low serum potassium
- Shallow slow respirations

77

Why would you see low serum potassium in metabolic acidosis?

Because cells take in potassium to compensate for alkalinity (release H+)

78

Nursing interventions for metabolic alkalosis (2)

- KCl
- Fluid (NS, LR)