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Fundamentals > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Intravascular fluid

A

Fluid inside the blood and lymphatic vessels

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2
Q

Intracellular fluid

A

Fluid located within the cells

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3
Q

Interstitial fluid

A

Fluid between cells

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4
Q

Osmolality

A

The proportion of dissolved particles in a given weight of fluid (mOsm/kg)

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5
Q

Osmolarity

A

The concentration of dissolved substances in a given volume of liquid (mOsm/L)

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6
Q

How does body fluid osmolality control fluid in the body

A

Hypothalamic cells monitor changes of body fluid osmolality which controls secretion of ADH which adjusts the amount of water excreted in urine

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7
Q

Cations (4)

A

Sodium (Na+)
Potassium (K+)
Calcium (Ca++)
Magnesium (Mg++)

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8
Q

Anions (3)

A

Chloride (Cl-)
Bicarbonate (HCO3-)
Phosphate (HPO4-)

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9
Q

Sodium (normal values and manifestations)

A

Normal value: 135-145 mEq/L
Hyponatremia: Headache, lethargy, apathy, confusion, N/V/D, fluid overload, abdominal cramping, muscle cramps and spasms
Hypernatremia: dry mucous membranes, restlessness, hyperactivity, tachy, HTN, edema possible, weight gain, mental changes

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10
Q

Potassium (normal values and manifestations)

A

Normal value: 3.5-5 mEq/L
Hypokalemia: tachy and arrhythmias
Hyperkalemia: Brady and dysrhythmias

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11
Q

Calcium (normal values and manifestations)

A

Normal serum: 4.3-5.3 mEq/L
8.9-10.1 mg/dL
Hypocalcemia: Muscle spasms of the face, laryngeal spasms, tetany, seizures
Hypercalcemia: muscle flaccidity, bone tenderness/pain, fractures, calcium in urine, kidney stones, constipation, HTN

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12
Q

2 pairs of electrolytes

A

Calcium and phosphate are opposites
potassium and magnesium are the same

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13
Q

Phosphate (normal values and manifestations)

A

Normal serum: 1.7-2.6 mEq.L
2.5-4.5 mg/dL
Hypophosphatemia: Poor motor and nerve function, weakness, slow GI, low blood counts
Hyperphosphatemia: Muscle cramps, twitching, tetany

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14
Q

Magnesium (normal values and manifestations)

A

Normal serum: 1.5-1.9 mEq/L
1.8-2.3 mg/dL
Hypomagnesemia: arrhythmias, tachy
Hypermagnesemia: dysrhythmia, brady

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15
Q

Chloride normal value

A

95-108 mEq/L

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16
Q

Bicarb normal value

A

22-26 mEq/L

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17
Q

Diffusion

A

Movement of molecules from high to low concentration

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18
Q

Osmosis

A

movement of a fluid through a semipermeable membrane

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19
Q

Active transport

A

Molecules need energy to move from low to high concentration

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20
Q

Filtration

A

Transfer of water and dissolved substances through a permeable membrane from a region of higher pressure to a lower pressure (no ATP)

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21
Q

What decreases in older adults and by how much (3)

A

Kidney mass, blood flow, and GFR
10% every decade after 30

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22
Q

ECF volume deficit (3 other names, causes, treatment)

A

Hypovalemia, saline deficit, and isotonic dehydration
Causes: Inadequate intake or abnormal losses (V/D)
Treatment: IV replacement of sodium, chloride, and water
Oral rehydration such as salty liquids like broth or tomato juice
IV normal saline
Protect patient from injury secondary to orthostatic hypotension

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23
Q

Isotonic 3 considerations

A

Monitor for signs of fluid overload, especially with history of renal or CV disease
Don’t use in patients with liver disease or metabolic acidosis

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24
Q

Hypotonic solution 4 considerations

A

Monitor for iv fluid depletion and CV collapse
Don’t give to patients at risk for increased intercranial pressure- head trauma, neurosurgery, and CVA (Can lead to shift of fluid into brain cells)
Also don’t give to patients at risk of third spacing (burn victims, trauma, liver failure, severe protein malnutrition)

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25
Hypertonic fluid 4 considerations
Closely monitor for fluid overload because solutions expand intravascular component Avoid in patients with renal or cardiac impairment as well as intracellular dehydration (diabetic ketoacidosis)
26
Crystalloid solutions (color and 3 kinds)
Clear Iso/hypo/hypertonic
27
Colloid solutions (color and 2 types)
Not clear Blood products Parenteral nutrition (TPN and PPN)
28
Who receives colloids
Patients who are malnutritioned and can't receive large molecule IV solutions
29
What kind of solution can be given with blood products
Isotonic
30
Fluid overload symptoms (lungs, mental state, CV, urine output, weight, veins and edema?)
Dyspnea, SOB, pulmonary edema, orthopnea, tachypnea Anxiety, mental status changes, restlessness High BP, bounding pulse, increase pulse rate Jugular distension, peripheral edema weight gain Decreased urine
31
What is an EID used for
To regulate infusions
32
Parenteral nutrition (when is it prescribed, what does it contain, forms)
Prescribed when a patient's GI tract is not functioning or can't consume sufficient nutrients orally or enterally Contains carbs, amino acids, lipids, electrolytes, vitamins, and minerals TPN and PPN
33
Total parenteral nutrition (TPN)
provides nutritionally complete solution 2000 cals/day Central vein For patients with high caloric needs and >7 days Hypertonic (makes cells shrink) >10% dextrose and >5% amino acids
34
PPN
Not nutritionally complete <2000 cals/day Peripheral vein Short-term support Isotonic No more than 10% dextrose and 5% amino acids
35
Implications for parenteral nutrition
Infection and thrombophlebitis Metabolic complications such as refeeding syndrome or hyper/hypoglycemia Fluid overload or air embolism I&Os and daily weights Lab work No solutions or medications added to PPN or TPN Use EID and filtered tubing Daily solution orders
36
4 routes of central venous access
PICC line Central line Tunneled catheter Implanted access
37
Site selection (4)
Large veins with distal portion punctured first Site with bone as natural splint Avoid veins directly above movable joints Avoid lower extremities
38
infiltration (5 s&s, 3 action, 3 prevention)
S&S: Swelling, coolness, discomfort at site, slowed infusion rate, absence of blood return Action: Discontinue IV and start in another location, apply warm soak to decrease swelling Prevention: Select a site over long bones that act as splint, avoid sites over joints, consider manufactured stabilization devices
39
Phlebitis (5 s&s, 4 action, 4 prevention)
S&S: Pain, warmth, redness at site, vein may feel hard, slowed infusion rate Action: Discontinue IV, restart in another location, apply warm soaks for discomfort, do not irrigate Prevention: Change IV site every 72h, use large veins and needles rather than catheters, dilute meds well and infuse slowly, use central line for irritating solutions
40
Infection (s&s 3 local and 4 systemic, 4 action, 3 prevention)
Local S&S: Redness, warmth, purulent drainage at site Systemic: Fever, chills, malaise, elevated WBCs Action: Discontinue IV, restart in another location, culture catheter tip and blood, treat with abx Prevention: Strict asepsis, handwashing, change tubing every 96h
41
Fluid overload (5 s&s, 4 action, 3 prevention)
S&S: Elevated vitals (BP, pulse, and respirations), dyspnea, crackles, neck vein distention, weight gain Action: Slow IV to keep open rate, notify provider, place patient in high/semi-high fowler, administer oxygen Prevention: Monitor rates carefully, use EID, don't catch up when IV gets behind
42
Air embolism (6 s&s, 3 action, 4 prevention)
S&S: Pain in chest, shoulder, or back, dyspnea, hypotension, thready pulse, cyanosis, LOC Action: Place on left side in Trendelenburg position (head lower than feet), notify provider, monitor vitals Prevention: Tape all connectors or use luer lock, air-eliminating filters, EID for central venous, instruct patient to use valsalva maneuver (when you pop your ears) when changing or discontinuing a central line
43
Cranial nerves in order
Oh, oh, oh, to touch and feel very good velvet, such heaven! olfactory optic oculomotor trochlear trigeminal abducens facial vestibulocochlear glossopharyngeal Vagus Spinal accessory Hypoglossal
44
Which cranial nerves are sensory, motor, and both
olfactory (s) optic (s) oculomotor (m) trochlear (m) trigeminal (b) abducens (m) facial (b) vestibulocochlear (s) glossopharyngeal (b) Vagus (b) Spinal accessory (m) Hypoglossal (m)
45
4 Central venous access sites
PICC line Central line Tunneled catheter Implanted access
46
Tests for cerebellar function
Gait, balance, romberg test, coordination of skilled movements, finger-to-finger, finger-to-nose, heel-to-shin
47
What mini mental state score indicates significant cognitive impairment
20 or below
48
Bicep reflex (where is it and how do you do it)
C5, C6 Arm facing up, put thumb on base of bicep tendon in the antecubital fossa and hit your thumb with the sharp side of the hammer
49
Tricep reflex (where is it and how do you do it)
C7, C8 Have patient's arm hang loose at a right angle and stroke the tricep tendon (just above the olecranon process) with the sharp side of the hammer
50
Quadriceps (where is it and how do you do it)
Patellar, L2, L3, L4 Client performs Jendrassik maneuver and you strike the patellar tendon just below the patella with the flat side of the hammer If patient remains supine, support the back of their knee while the leg is flexed at a 45 degree angle
51
Achilles (where is it and how do you do it)
L5-S2 Gently dorsiflex the foot at the ankle and position the joint at 90 degrees or until resistance is felt. Strike the achilles tendon with the either side
52
What does a hyperactive or brisk tendon reflex response mean
An upper neuron disorder is suspected
53
Modifiable stroke risk factors (11)
High BP, high cholesterol, diabetes, afib, carotid stenosis, atherosclerosis, tobacco use, physical inactivity, obesity, excessive alcohol intake, illegal drug use
54
Non-modifiable stroke risk factors (5)
Increasing age, gender (male), family history, prior stroke or TIA, race (African American, hispanic, or asian)
55
FAST (regarding stroke)
Facial drooping Arm weakness Speech difficulties Time
56
Stereognosis
Depth perception, ability to identify an object by touch
57
Graphesthesia
Sensing something written on you (doctor draws an 8 on your hand and you can identify it)
58
What makes up the CNS
Brain and spinal cord
59
What makes up the peripheral nervous system
Cranial nerves, spinal nerves, reflex arc, and ANS
60
Glascow coma scale values
13-15 means mild brain injury 9-12 is moderate 3-8 is severe Eye response out of 4 Verbal response out of 5 Motor response out of 6
61
Eye response GCS
4. Spontaneously 3. To speech 2. To pain 1. No response
62
Verbal response GSC
5. Oriented to time, person, and place 4. Confused 3. Inappropriate response 2. Incomprehensible words 1. No response
63
Motor response GSC
6. Obeys command 5. Move to localized pain 4. Flex to withdraw from pain 3. Abnormal flexion 2. Abnormal extension 1. No response
64
What mimics a heart attack in the lungs
Pleurisy
65
What cavities does the thoracic cavity consist of
Mediastinum and pleural
66
Parts of the lung tree
Larynx Trachea Bifurcation of the trachea (where it splits into two) Left and right main bronchus Secondary bronchi Tertiary or segmental bronchi Bronchioles
67
How to find tactile fremitus
Have the patient say "99" or "blue moon" and it will vibrate
68
What sound does a normal lung make when you percuss
Resonance
69
What sound does a fluid filled lung make when you percuss
Dullness
70
What causes decorticate rigidity
Hemispheric injury in the cerebral cortex
71
What causes decerebrate rigidity
Lesion in the brain stem at mid or upper pons
72
What is splinting
Deep breathing and coughing together
73
Quad cough
Put pressure on abdomen during forced exhalation
74
What does pursed-lip breathing do
Decreases amount of CO2 in blood
75
Normal breath sounds and where (bronchial, bronchovesicular, vesicular)
Bronchial: heard over trachea (high pitch and intensity) Bronchovesicular: Heard over major bronchi (moderate pitch and intensity) Vesicular: Heard over healthy lung tissue (low pitch and intensity)
76
Where are adventitious lung sounds heard (5)
Crackles are heard in lower lobes Rhonchi are heard in the upper lobes and usually clear after coughing Wheezes are heard over the trachea Friction rub: Heard at the base Stridor: Heard in upper airways
77
Discontinuous vs continuous lung sounds
Crackles are discontinuous everything else is continuous
78
Levels of dyspnea
Level I: Patient can walk 1 mile before experiencing SOB Level II: Patient has SOB after walking 100 yards on level ground or climbing a flight of stairs Level III: The patient has SOB while talking or performing ADLs Level IV: The patient has SOB during periods of no activity Orthopnea: Patient has SOB while lying down
79
Incentive spirometry
Inhale through the tube like a straw
80
Nasal cannula
22-44% 1-6L/min Most commonly used because of convenience and patient comfort Rule of four, 1L is 22%, 2L is 26%, etc. Maximum is 6 L/min to minimize drying of nasal mucosa Nasal passage must be patent Delivered O2 concentration depends on breathing pattern Consistent results with normal breathing pattern
81
Venturi mask
24-50% 3-8 L/min Precise and consistent O2 concentration Make sure to adjust according to specifications Noise; may cause claustrophobia
82
Simple mask
40-60% 6-10 L/min Most common midrange O2 delivery device Minimum of 5L required to prevent the patient from rebreathing CO2 Delivered O2 concentration depends on breathing pattern Not suitable for COPD because of possible excess oxygen
83
Reservoir mask (non-rebreather)
Up to 90%+ 10-15 L/min Used for critically ill patient Use sufficient flow to keep O2 reservoir inflated
84
Incubator
22-40% Enclosure used for environmental control for newborn infants Extremely precise, accuracy varies each time unit is opened
85
Empathy
The ability to look at things from another's perspective
86
Positive regard
Assumption that the pt is worthwhile and has value and dignity; avoids labeling
87
Honesty
Open, direct, sincere
88
Trust
Demonstrate to patients, families, and significant others that they can rely on nurses without doubt, question, or judgement
89
Self-awareness and self-reflection
Being aware of one's own personality, values, cultural background, and style of communication; taking responsibility for actions; and being separate from, but connected to, others
90
Non Therapeutic responses (6)
Rescue feelings False reassurance Giving advice Changing the subject Being moralistic Nonprofessional involvement
91
Metacommunication
Interpretation of communication
92
Congruent relationship
Same message as communication
93
Incongruent relationship
Mixed message
94
SOAP
Subjective Objective Assessment Plan
95
PIE
Problem Intervention Evaluation
96
FOCUS DAR
Focus, data, action, response
97
I PASS the BATON
Introduction, patient, assessment, situation, safety concerns, (the), background, actions, timing, ownership, next
98
CUS
I am concerned, I am uncomfortable, this is a safety issue
99
How to close a screen
Space f4
100
What are responsible for control of motor functions (3)
Cerebellum Cerebral cortex Basal ganglia
101
Jerry Lewis
Muscular dystrophy in male children
102
Where does gas exchange happen in the lungs
Alveoli
103
What are the mediastinum
Cavities that enclose the lungs
104
Where is the base of the lungs
Sitting on the diaphragm
105
What are pleurae
Serous membranes that form an envelope between the lungs and chest wall
106
Visceral pleurae
Lines the lung tissue, inner layer surrounding lung
107
Parietal pleurae
Lines the entire lung, most outer layer of lung
108
Posterior
Upper lobes t1-t4
109
Test for nerve I
Olfactory: Identify a smell
110
Test for nerve II
Optic: Snellen chart
111
Test for nerve III
3, 4, 6, make my eyes do tricks! Oculomotor: PERRLA
112
Test for nerve IV
3, 4, 6, make my eyes do tricks! Trochlear: EOM
113
Test for nerve VI
3, 4, 6, make my eyes do tricks! Abducens: EOM
114
Test for nerve V
Trigeminal: Touch face and identify sharp vs dull
115
Test for nerve VII
Facial: Puff cheeks
116
Test for nerve VIII
Vestibulocochlear: Rinne and weber, whisper voice test, romberg
117
Test for nerve IX
Glossopharyngeal: gag reflex and say ahhh
118
Test for nerve X
Vagus: Gag reflex and say ahhh
119
Test for nerve XII
Hypoglossal: move tongue all around, then push hand with tongue in cheek
120
Test for nerve XI
Spinal accessory: pt pushes shoulders up and face against hand

Fundamentals (5 decks)

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