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Fundamentals > Exam 2 > Flashcards

Exam 2 Flashcards

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
Q

Hypertonic fluid 4 considerations

A

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)

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26
Q

Crystalloid solutions (color and 3 kinds)

A

Clear
Iso/hypo/hypertonic

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27
Q

Colloid solutions (color and 2 types)

A

Not clear
Blood products
Parenteral nutrition (TPN and PPN)

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28
Q

Who receives colloids

A

Patients who are malnutritioned and can’t receive large molecule IV solutions

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29
Q

What kind of solution can be given with blood products

A

Isotonic

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30
Q

Fluid overload symptoms (lungs, mental state, CV, urine output, weight, veins and edema?)

A

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

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31
Q

What is an EID used for

A

To regulate infusions

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32
Q

Parenteral nutrition (when is it prescribed, what does it contain, forms)

A

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

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33
Q

Total parenteral nutrition (TPN)

A

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

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34
Q

PPN

A

Not nutritionally complete
<2000 cals/day
Peripheral vein
Short-term support
Isotonic
No more than 10% dextrose and 5% amino acids

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35
Q

Implications for parenteral nutrition

A

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

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36
Q

4 routes of central venous access

A

PICC line
Central line
Tunneled catheter
Implanted access

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37
Q

Site selection (4)

A

Large veins with distal portion punctured first
Site with bone as natural splint
Avoid veins directly above movable joints
Avoid lower extremities

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38
Q

infiltration (5 s&s, 3 action, 3 prevention)

A

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

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39
Q

Phlebitis (5 s&s, 4 action, 4 prevention)

A

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

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40
Q

Infection (s&s 3 local and 4 systemic, 4 action, 3 prevention)

A

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

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41
Q

Fluid overload (5 s&s, 4 action, 3 prevention)

A

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

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42
Q

Air embolism (6 s&s, 3 action, 4 prevention)

A

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

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43
Q

Cranial nerves in order

A

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

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44
Q

Which cranial nerves are sensory, motor, and both

A

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)

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45
Q

4 Central venous access sites

A

PICC line
Central line
Tunneled catheter
Implanted access

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46
Q

Tests for cerebellar function

A

Gait, balance, romberg test, coordination of skilled movements, finger-to-finger, finger-to-nose, heel-to-shin

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47
Q

What mini mental state score indicates significant cognitive impairment

A

20 or below

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48
Q

Bicep reflex (where is it and how do you do it)

A

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

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49
Q

Tricep reflex (where is it and how do you do it)

A

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
Q

Quadriceps (where is it and how do you do it)

A

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
Q

Achilles (where is it and how do you do it)

A

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
Q

What does a hyperactive or brisk tendon reflex response mean

A

An upper neuron disorder is suspected

53
Q

Modifiable stroke risk factors (11)

A

High BP, high cholesterol, diabetes, afib, carotid stenosis, atherosclerosis, tobacco use, physical inactivity, obesity, excessive alcohol intake, illegal drug use

54
Q

Non-modifiable stroke risk factors (5)

A

Increasing age, gender (male), family history, prior stroke or TIA, race (African American, hispanic, or asian)

55
Q

FAST (regarding stroke)

A

Facial drooping
Arm weakness
Speech difficulties
Time

56
Q

Stereognosis

A

Depth perception, ability to identify an object by touch

57
Q

Graphesthesia

A

Sensing something written on you (doctor draws an 8 on your hand and you can identify it)

58
Q

What makes up the CNS

A

Brain and spinal cord

59
Q

What makes up the peripheral nervous system

A

Cranial nerves, spinal nerves, reflex arc, and ANS

60
Q

Glascow coma scale values

A

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
Q

Eye response GCS

A
  1. Spontaneously
  2. To speech
  3. To pain
  4. No response
62
Q

Verbal response GSC

A
  1. Oriented to time, person, and place
  2. Confused
  3. Inappropriate response
  4. Incomprehensible words
  5. No response
63
Q

Motor response GSC

A
  1. Obeys command
  2. Move to localized pain
  3. Flex to withdraw from pain
  4. Abnormal flexion
  5. Abnormal extension
  6. No response
64
Q

What mimics a heart attack in the lungs

A

Pleurisy

65
Q

What cavities does the thoracic cavity consist of

A

Mediastinum and pleural

66
Q

Parts of the lung tree

A

Larynx
Trachea
Bifurcation of the trachea (where it splits into two)
Left and right main bronchus
Secondary bronchi
Tertiary or segmental bronchi
Bronchioles

67
Q

How to find tactile fremitus

A

Have the patient say “99” or “blue moon” and it will vibrate

68
Q

What sound does a normal lung make when you percuss

A

Resonance

69
Q

What sound does a fluid filled lung make when you percuss

A

Dullness

70
Q

What causes decorticate rigidity

A

Hemispheric injury in the cerebral cortex

71
Q

What causes decerebrate rigidity

A

Lesion in the brain stem at mid or upper pons

72
Q

What is splinting

A

Deep breathing and coughing together

73
Q

Quad cough

A

Put pressure on abdomen during forced exhalation

74
Q

What does pursed-lip breathing do

A

Decreases amount of CO2 in blood

75
Q

Normal breath sounds and where (bronchial, bronchovesicular, vesicular)

A

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
Q

Where are adventitious lung sounds heard (5)

A

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
Q

Discontinuous vs continuous lung sounds

A

Crackles are discontinuous
everything else is continuous

78
Q

Levels of dyspnea

A

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
Q

Incentive spirometry

A

Inhale through the tube like a straw

80
Q

Nasal cannula

A

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
Q

Venturi mask

A

24-50% 3-8 L/min
Precise and consistent O2 concentration
Make sure to adjust according to specifications
Noise; may cause claustrophobia

82
Q

Simple mask

A

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
Q

Reservoir mask (non-rebreather)

A

Up to 90%+ 10-15 L/min
Used for critically ill patient
Use sufficient flow to keep O2 reservoir inflated

84
Q

Incubator

A

22-40%
Enclosure used for environmental control for newborn infants
Extremely precise, accuracy varies each time unit is opened

85
Q

Empathy

A

The ability to look at things from another’s perspective

86
Q

Positive regard

A

Assumption that the pt is worthwhile and has value and dignity; avoids labeling

87
Q

Honesty

A

Open, direct, sincere

88
Q

Trust

A

Demonstrate to patients, families, and significant others that they can rely on nurses without doubt, question, or judgement

89
Q

Self-awareness and self-reflection

A

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
Q

Non Therapeutic responses (6)

A

Rescue feelings
False reassurance
Giving advice
Changing the subject
Being moralistic
Nonprofessional involvement

91
Q

Metacommunication

A

Interpretation of communication

92
Q

Congruent relationship

A

Same message as communication

93
Q

Incongruent relationship

A

Mixed message

94
Q

SOAP

A

Subjective
Objective
Assessment
Plan

95
Q

PIE

A

Problem
Intervention
Evaluation

96
Q

FOCUS DAR

A

Focus, data, action, response

97
Q

I PASS the BATON

A

Introduction, patient, assessment, situation, safety concerns, (the), background, actions, timing, ownership, next

98
Q

CUS

A

I am concerned, I am uncomfortable, this is a safety issue

99
Q

How to close a screen

A

Space f4

100
Q

What are responsible for control of motor functions (3)

A

Cerebellum
Cerebral cortex
Basal ganglia

101
Q

Jerry Lewis

A

Muscular dystrophy in male children

102
Q

Where does gas exchange happen in the lungs

A

Alveoli

103
Q

What are the mediastinum

A

Cavities that enclose the lungs

104
Q

Where is the base of the lungs

A

Sitting on the diaphragm

105
Q

What are pleurae

A

Serous membranes that form an envelope between the lungs and chest wall

106
Q

Visceral pleurae

A

Lines the lung tissue, inner layer surrounding lung

107
Q

Parietal pleurae

A

Lines the entire lung, most outer layer of lung

108
Q

Posterior

A

Upper lobes t1-t4

109
Q

Test for nerve I

A

Olfactory: Identify a smell

110
Q

Test for nerve II

A

Optic: Snellen chart

111
Q

Test for nerve III

A

3, 4, 6, make my eyes do tricks!
Oculomotor: PERRLA

112
Q

Test for nerve IV

A

3, 4, 6, make my eyes do tricks!
Trochlear: EOM

113
Q

Test for nerve VI

A

3, 4, 6, make my eyes do tricks!
Abducens: EOM

114
Q

Test for nerve V

A

Trigeminal: Touch face and identify sharp vs dull

115
Q

Test for nerve VII

A

Facial: Puff cheeks

116
Q

Test for nerve VIII

A

Vestibulocochlear: Rinne and weber, whisper voice test, romberg

117
Q

Test for nerve IX

A

Glossopharyngeal: gag reflex and say ahhh

118
Q

Test for nerve X

A

Vagus: Gag reflex and say ahhh

119
Q

Test for nerve XII

A

Hypoglossal: move tongue all around, then push hand with tongue in cheek

120
Q

Test for nerve XI

A

Spinal accessory: pt pushes shoulders up and face against hand

Fundamentals (5 decks)

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