Exam 2 Flashcards
(166 cards)
1
Q
What is the physiological exchange of gases, oxygen, and carbon dioxide between the cells of the body and the atmosphere called?
A
Respiration
2
Q
What is the mechanical automatic act of movement of gases in and out of the lungs called?
A
Ventilation
3
Q
What are the 3 processes of respiration?
A
- Ventilation- mechanical movement of lungs
- Diffusion- movement of 02 and CO2 between alveoli and red blood cells
- Perfusion- distribution of red blood cells to and from pulmonary capillaries
4
Q
What are the 3 variables to assess in regard to respirations?
A
- Rate
- Rhythm- spacing between breaths
- Character- depth and quality
5
Q
What does Eupnea mean?
A
normal rate and depth of breathing
6
Q
What does apnea mean?
A
cessation of breathing (stopping of breathing)
7
Q
What is tachypnea?
A
respiratory rate is too high (more than 24 breaths per minute)
8
Q
What is bradypnea?
A
respiratory rate is too low (less than 12 breaths per minute)
9
Q
What are Kussmaul’s respirations?
A
regular, rapid, deep respirations
10
Q
What are Cheyne-stokes respirations?
A
alternating periods of deep, rapid respirations followed by periods of apnea
11
Q
What are the 5 steps to a respiratory assessment?
A
- Interview
- Inspection
- Palpation
- Percussion
- Auscultation
12
Q
What does hemoptysis mean?
A
sputum containing blood
13
Q
What is tactile fremitus? what are the different significant findings of it?
A
palpation where client folds arms and repeats out loud “99”
increased fremitus - indicates inflamed lung tissue
decreased fremitus- indicates are and fluid in pleural areas
14
Q
What are the 4 sounds heard in the cup and clap technique for percussion of the lungs?
A
- Resonance- hallow sounds heard over normal lung tissue
- Hyperresonance- lungs hyperinflated with air
- Dullness- heard over organs; liver or heart
- Flat- heard over bone
15
Q
What abnormal breath sounds are described by coarse or fine, intermittent sounds that are heard on inhalation or expiration, and commonly heard on the dependent lobes? What does this finding indicate?
A
Crackles (Rales)
Indicates fluid in lungs
16
Q
What abnormal breath sounds are described as, high-pitched sounds heard during inspiration or expiration, that are commonly found in patients with asthma? What does this finding indicate?
A
Wheezes
Indicates narrowing of airways
17
Q
What abnormal breath sounds are described as high-pitched wheeze-like sounds, that are louder over the throat, and often seen in children? What does this finding indicate?
A
Stridor
Indicates upper airway obstruction, choking, infection, inflammation (croup)
18
Q
What abnormal breath sounds are described as low-pitched, snoring-like, that may clear after a cough? What does this finding indicate?
A
Rhonchi
Indicates secretions in large airways
19
Q
What abnormal breath sounds are described as a grating sound, like two pieces of leather rubbing together, heard during inhalation and exhalation? What does this finding indicate?
A
Pleural Friction Rub
Indicates inflamed surfaces of the pleura rubbing together
20
Q
Normal air is what percent of fraction of inspired oxygen? (Fi02)
A
21%
21
Q
One liter of oxygen starts at _____% of fraction of inspired oxygen? How much does it increase by with each additional liter?
A
24%
4%
22
Q
How many lobes does the right lung have? What are they?
A
3 lobes
RUL, RML, RLL
23
Q
How many lobes does the left lung have? What are they?
A
2 lobes
LUL, LLL
24
Q
How often should you use the incentive spirometer?
A
10 times an hour
25
When using a suction to clear an airway, how many times and for how long each time do you do it?
3 times, 10-15 seconds each time
26
When should you use a humidifier when administering oxygen?
If the rate is greater than or equal to 4L per minute
27
What does dyspnea mean?
difficulty breathing or shortness of breath
28
What are the 5 devices used for oxygen delivery?
1. Nasal Cannula
2. Simple Face Mask
3. Partial Non-Rebreather Mask
4. Non-Rebreather Mask
5. Venturi Mask
29
What mask is used for short-term use, using oxygen concentrations ranging from 40%-60%, has a flow rate of 5-10L per minute, that has holes at the side of the mask allowing the escape of exhaled CO2?
Simple Face Mask
30
What mask uses nasal prongs, delivers 28%-44% concentrations, at 2-6L per minute?
Nasal Cannula
31
Which way should the tips of the nasal cannula be placed in the patient's nose?
Downward
32
What mask is a high flow device, ranging from 2-15L per minute, that provides set and accurate oxygen concentrations, ranging from 24%-60%, depending on the adapters used?
Venturi Mask
33
What mask provides highest oxygen concentration (anywhere from 70%-100%), also has a reservoir bag, which contains one-way valves that prevents exhaled air from entering bag and room air from entering the mask?
Non-rebreather mask
34
What mask uses a reservoir bag, using only ONE one-way valve, allowing inhalation of some exhaled air mixed with oxygen being supplied, at concentrations of 50-90%?
Partial Non-rebreather mask
35
What is the patient's bill of rights?
the right to consent, question, or refuse any diagnostic test
36
What are the 3 phases of diagnostic studies?
1. Pre-testing phase
2. Testing phase
3. Post-testing phase
37
What testing phase is when you receive the provider's order, the procedure is scheduled, obtain consent, educate the patient, and preparation and instructions are given?
Pre-testing phase
38
What testing phase is when you prepare the patient for the procedure, you maintain safety, provide comfort and reassurance, give medications, assist provider, and collect specimens?
Testing phase
39
What testing phase is when you monitor vital signs, use interventions related to complications, provide discharge instructions, and notify provider of abnormal results?
Post-testing phase
40
What blood test is usually done by a respiratory therapist, taken from an artery instead of a vein, and you must apply pressure to the site when done?
Arterial Blood Gas (ABG)
41
What must you label all blood samples with immediately?
Name, DOB, Account #
Date and time drawn
Initials of who dew the blood
Site source
42
What test consists of a series of tests that determine the number, variety, percentage, concentrations, and quality of red and white blood cells, usually taken for a vein?
Complete Blood Count (CBC)
WBC, RBC, Hgb, Hct, Platelets, Leukocytes, monocytes
43
What is the difference between a CBC and a CBC with differential?
the CBC with differential will give you a CBC but with specific measurements of individual white blood cells (monocytes, eosinophil, basophils, lymphocytes, neutrophils)
44
What blood test is used to show levels of glucose, BUN, Creatinine, Sodium, Potassium, Chloride, and Carbon Dioxide?
Basic Metabolic Panel (BMP) aka Chem 7-
45
What blood test is used to include everything from a BMP but also levels of calcium, albumin, total protein, and liver enzymes?
Complete Metabolic Panel aka Chem 14-
46
If a lipid panel is ordered how long do they need to fast for?
12 hours
47
What are the normal ranges for sodium, potassium, magnesium, chloride, calcium, and phosphate?
Sodium: 135-145 mEq/L
Potassium: 3.5-5 mEq/L
Magnesium: 1.6-2.2 mEq/L
Chloride: 97-107 mEq/L
Calcium: 8.2-10.2 mg/dL
Phosphate: 2.5-4.5 mEq/L
48
What test is used to evaluate the intrinsic system of blood clot formation and heparin therapy? What is the normal range for this test?
Activated Partial Thromboplastic Time (aPTT)
23-32 seconds
49
What tests are used to evaluate the extrinsic system of blood clotting? What is the normal range of this test?
Prothrombin Time (PT)
8-13 seconds
50
What test evaluates Coumadin/Warfarin therapy? What are the normal levels?
International Normalized Ratio (INR)
0.8-1.2 seconds
51
What does Creatine Phosphokinase (CPK) test for?
a muscle enzyme/protein that shows some sort of muscle injury, non-specific
52
What do high CK-MB and troponin levels indicate?
heart attack
53
What are the normal levels for cholesterol, triglycerides, HDL, and LDL?
cholesterol: less than 200 mg/dl
triglycerides: less than 150 mg/dl
HDL: 60 mg/dl or higher
LDL: 60-130 mg/dl
54
What radiological test used to assess tissues and structures inside the body such as joints, chest, and abdomen, and requires removal of jewelry?
X-Ray
55
What test is used for patients presenting signs of dysphagia, GERD, severe indigestion, and the diagnosis of esophageal strictures and tumors? What are some major considerations of this test?
Barium Swallow
requires consent, no jewelry, no pregnancy, NOP 8 hours, assess for allergies
56
What test uses a high-speed rotational radiologic camera, providing more detailed images than an x-ray, that sometimes requires a radiopaque contrast? What are some considerations for this test?
Computerized Axial Tomography (CAT scan)
NPO 4-12 hours with radiopaque contrast, assess for seafood/iodine allergies, warm flushing sensation with IV contrast
57
What test uses magnetic field and computer-generated radio waves, used to capture detailed images of organs, tissues, and skeletons, that allows ZERO metal objects in the room, and patients with claustrophobia will have a hard time tolerating?
Magnetic Resonance Imaging (MRI)
58
What test uses MRI technology, is used to obtain images of blood flow in the blood vessels, and is used instead of an angiography for patients that are allergic to iodine contrast?
Magnetic Resonance Angiography (MRA)
59
What is a Positron Emission Tomography (PET) Scan used for? What is the biggest nursing consideration in regard to this test?
Used to detect cancer and cancer metastasis
patients should increase fluid intake and avoid close contact with pregnant women and small children for 24 hours
60
What test uses high frequency sound waves pass through the skin and organs are echoed back through a transducer to create a computer-generated image? What are some specific examples?
Ultrasound
echocardiogram, sonogram, doppler
61
What test is used to record the electrical activity of the heart and detects conduction problems such as arrhythmias, areas of damage, and ischemia?
Electrocardiogram (ECG/EKG)
62
What test is used to evaluate the size of the heart, pumping function, and the structures of valves, chambers, and their walls?
Echocardiogram
63
What are the two different types of an echocardiogram and what are their differences?
Transthoracic and Transesophageal
Transthoracic- ultrasound version
Transesophageal (TEE)- requires sedation and uses a long tube down the esophagus to see pictures of heart without ribs and lungs in the way
64
What are the 3 types of cardiac stress tests and the differences between them?
Stress EKG- most common, resting EKG is done followed by EKG while exercising
Nuclear stress test- radioactive tracer is injected intravenously and image of heart is taken at rest and after exercise/medication is administered
Stress Echo- used ultrasound to capture images pre and post cardiac stress
65
A test that uses x-rays to view body's blood vessels, using a contrast dye, and inserting a catheter into a main artery? What are considerations of this test?
Angiography
sterile procedure, done in surgical setting, NPO after midnight, assess for iodine allergies, mild sedative to relax patient during procedure
66
What are some examples of endoscopic procedures and some considerations regarding them?
endoscopy- esophagus, upper GI
colonoscopy
bronchoscopy- view airways
cystoscopy- bladder
surgical setting, general anesthesia, NPO after midnight
67
What is the mental state characterized by an acute disturbance of cognition, manifested by short term confusion, excitement, disorientation, and clouded consciousness?
Delirium
68
What is a disease process in which there is progressive decline in cognitive ability in the presence of clear consciousness?
Dementia
69
What is the difference between primary dementia and secondary dementia?
Primary- neurocognitive regression is the major sign itself of an organic brain disease and is not related to another illness
Secondary- caused by or related to another disease or condition
70
What is the term used for "creating imaginary events to fill in memory gaps"?
confabulation
71
What is pseudodementia?
symptoms of depression that mimic those of neurocognitive disorders
72
What is sundowner's syndrome?
A phenomenon in neurocognitive disorders in which symptoms seem to worsen in the late afternoon/evening
73
What are the 3 criteria used to diagnose mild vs major NCD?
1. mild vs significant decline in cognitive function
2. modest vs substantial impairment in cognitive performance
3. cognitive deficits DO or DO NOT interfere with independence
74
What is the term used to describe cognitive functions closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning, and speaking?
Neurocognitive
75
What is a neurocognitive disorder?
impairment in the cognitive functions of thinking, reasoning, memory, and learning
76
What are some examples of conditions that can result in reversible/temporary NCD?
stroke, depression, side effects of medications, nutritional deficiencies, metabolic disorders, brain tumors
77
What is apraxia?
inability to carry out purposeful motor activities despite intact motor function and the inability to use objects properly
78
What are the 7 stages of progression in Alzheimer's disease (AD)?
Stage 1- no symptoms
Stage 2- Very mild changes
Stage 3- Mild cognitive decline
Stage 4- Moderate cognitive decline
Stage 5- Moderately severe cognitive decline
Stage 6- Severe cognitive decline
Stage 7- very severe cognitive decline
79
What are the clinical manifestations for early stage AD?
typically involves stages 1-3
forgetfulness, withdrawal, decreased mental awareness, preoccupation with self, personality changes
80
What are the clinical manifestations for middle stage AD?
typically involves stages 4 and 5
memory impairment for recent events, confusion, impaired judgement, inability to preform ADL's independently
81
What are the clinical manifestations of end stage AD?
involves stages 6 and 7
disorientation, psychomotor symptoms (wandering, agitation, aggression), loss of communication skills, vegetative state
82
What is Vascular Neurocognitive Disorder?
intellectual deterioration occurring from cerebrovascular disease or impaired blood flow to the brain
83
What are some examples of other etiologies of NCD?
1. Frontotemporal- shrinking of frontal and temporal lobes
2. Lewy Body Disease- like AD but more rapid
3. Traumatic Brain Injury
4. Parkinson's Disease
5. HIV
6. Huntington's Disease
7. Substance Induced
8. Prion Disease (Cruetzfeldt-Jakob's disease)
84
What is the biggest priority of care with someone who has a NCD and examples of interventions?
Risk for Injury/Safety
Modify environment to promote safety, use night lights, locked doors from outside, alarm systems to alert when client is out of chair/bed/house
85
What are the 3 nasoenteral routes for enteral feeding and when are they used? How are they inserted?
Nasogastric (NG)- through nose, down esophagus, into stomach
Nasoduodenal (ND)- through nose, down esophagus, into duodenum
Nasojejunal (NJ)- through nose, down esophagus, into jejunum
Used if feedings are required for fewer than four weeks
through the nose and down into the stomach or small intestine
86
What are the 3 gastric routes for enteral feeding and when are they used? How are they inserted?
1. Gastrostomy (G Button)- tube inserted into stomach that uses a balloon to keep in place
2. Percutaneous Endoscopic Gastrostomy (PEG)- tube inserted into stomach through abdomen wall
3. Jejunostomy (J) Tube: surgically inserted into the jejunum
Used when feedings are long term (4-6 weeks or greater)
Surgically or endoscopy inserted
87
What is an orogastric tube?
tube inserted through the mouth, down the esophagus, into the stomach or small intestine
88
What are the 3 different tubes used for an NG tube? What are the differences?
1. Levin: Small bore, Single lumen
2. Salem Sump: Large bore, Double lumen
3. Dobhoff: Longer, Small bore, Weighted
89
What is the Gold Standard for Enteral Tube Verification?
X-RAY after initial insertion
90
What are the 3 methods used to verify an enteral feeding tube is working correctly?
1. Gastric Residual Volume- less than 500ml every 6 hours
2. Aspirate gastric contents and observe appearance
3. Check the PH of gastric contents with nitrazine paper- should be 5.0 pH or less
91
What is the difference between an open system and closed system for enteral feedings?
open system- refill bag same bag with formula
closed system- comes premade already in bag
92
What is continuous delivery of enteral feedings?
Constant distribution of nutrition evenly over 24 hours.
most common
93
What are the 4 types of intermittent enteral feedings?
1. Regular/periodic (30-60 minutes),
2. Bolus method ( over 5-10 mins)
3. Gravity: continuous, no precise rate
4. Cyclic: regularly, less than 24 hours
94
How much water do you flush the enteral feeding tube with before med administration, in between each individual med, and at the end of med administration?
Flush with 30 mL before
Flush with 15-30 mL in between
Flush with 30-60 mL at the end
95
What does the acronym "ALERT" stand for in enteral feedings?
A: Aseptic technique
L: Label enteral equipment
E: Elevate the head of bead
R: Right client, Right formula, Right tube
T: Trace all lines back to patient
96
What are the 7 parts of a Medication Order?
1. Client's Name
2. Date and Time of Order
3. Name of medication
4. Dosage of Medication
5. Route of Medication
6. Frequency of administration
7. Signature of person who prepared order
97
What are the 5 Cardinal Rights of Medication Administration?
Right Patient
Right Medication
Right Dose
Right Route
Right Time
98
What are the 3 additional Rights Polk State has added in regard to medication administration?
Right Technique- correct needle gauge and length, appropriate injection site, can oral tablet be crushed, etc.
Right Approach- communicated with patient based on age and condition, approaching patient with confidence
Right Documentation- Electronic vs Written
99
What is the difference between a routine order, PRN order, and a STAT order?
Routine: 30-60 minute window before and after ordered time
PRN: given on a "as needed" basis
STAT: Give NOW and only once
100
What are the 3 checks of medication administration?
1. Provider's order to MAR- (in chart)
2. Verify medication label with eMAR - (in med room)
3. Verify eMAR to medication- ( by bedside) scan patients arm band, 2 client identifiers, then scan medication
101
What are important liquid oral medication administration steps? (4 steps)
1. Gently Shake
2. Palm the label
3. Pour at eye level
4. Discard excess liquid in sink
102
When should an oral syringe be used when administering liquid medication?
When it is 10mL or less
103
What are important steps when administering sublingual medication? (2 steps)
1. Do not swallow pill
2. Do not drink anything until completely dissolved
104
What is the proper technique for eye drops?
into the conjunctival sac, not letting tip of dropper touch any part of the eye, and have patient close eyes gently to distribute medication
105
What is the biggest difference in preparing a meter-dosed inhaler and dry powdered inhaler?
meter-dosed you shake and dry powdered you do not shake
106
What are the 5 rules for ALL inhalers?
1. Inhale over 3-5 seconds
2. Have client hold breath for 10 seconds after each inhalation
3. Wait at least 1 minute between each dose
4. Wait 2-5 minutes between doses of DIFFERENT inhalers
5. Keep inhaler and canister clean
107
What is the biggest consideration when administering nasal medication?
Alternating nostrils every other day
108
How do you insert and administer a rectal suppository?
through anus, past internal sphincter, and along rectal wall
approximately 4 inches deep
patient stay lying on side or flat for 5 minutes
109
What is the difference in administering vaginal suppositories and vaginal creams/foams? How long should they stay lying on their back?
suppository- insert with entire length of finger
Cream/Foam- inset applicator 2-3 inches
10 minutes
110
What are the proper steps and nursing considerations when applying a transdermal patch? (6 steps)
1. Remove old patch, and discard appropriately
2. Cleanse skin with mild soap and water
3. Assess skin for any breaks or rashes
4. Rotate application sites
5. Press firmly to skin for 10 seconds
6. Date, Time, and Initial on piece of tape next to patch
111
What are some examples of medication errors? (7 examples)
1. Wrong prescription/Order
2. Giving extra or wrong dose
3. Giving med to wrong patient
4. Giving by wrong route or rate
5. Using incorrect technique
6. Deteriorated or expired drug
7. Not giving drug when due or within prescribed time
112
What is medication reconciliation? 3 specific times you do this?
A process used to ensure an accurate list of all medications the client is taking at every point of transfer
on admission, when transferring between units, at discharge
113
What is a substance such as a molecule or particle in a solution called?
Solute
114
What is the term for the liquid in which the solute is dissolved?
Solvent
115
What is the movement of fluid through a permeable cell membrane called?
filtration
116
What is the movement of particles across a cell membrane from areas of low concentration to areas of high concentration called?
active transport
117
What is the term for the concentration of a solution expressed as the total number of solute particles per liter?
osmolarity
118
What is the term for a measure of the number of dissolved particles within a fluid?
osmolality
119
What is the ability of a solution around a cell to cause that cell to gain or lose water called?
tonicity
120
What is the movement of water through a semi permeable membrane from and area of lower particle concentration to an area of higher particle concentration and moves from hypotonic to hypertonic?
Osmosis
121
What is the term used for the movement of particle across a permeable membrane from an area of higher concentration to an area of lower concentration?
Diffusion
122
What is the difference between an isotonic solution, hypotonic solution, and hypertonic solution?
1. Isotonic solutions- Have the same osmolality as blood; No fluid shift between ECF & ICF
2. Hypotonic solutions- Have lower osmolality (number of dissolved particles) than blood; Fluid shifts the ECF to the ICF (blood into cells)
3. Hypertonic solutions- Have higher osmolality (number of dissolved particles) than blood; Fluid shifts the ICF to the ECF (fluid shift out of cells)
123
What are two examples of isotonic solutions and what are they typically used for?
Normal Saline and Lactated Ringer's
Dehydration
124
What are two types of hypotonic solution and what is an example for when you would use them?
0.45% sodium chloride and 0.225% sodium chloride
Hypernatremia
125
What is a type of hypertonic solution and what is an example for when you would use it?
3% sodium chloride
Hyponatremia
126
What are crystalloids? What is an example of a crystalloid?
they are solutes that readily dissolve.
Ex: electrolytes- sodium, potassium, hydrogen..
127
What are colloids? What are some examples of colloids?
large molecules that do not dissolve readily; these usually stay within the vascular space.
Ex: proteins- albumin, plasma, dextran (used to treat edema)
128
What are the four main routes of fluid loss?
urine, skin, lungs, feces
129
What is aldosterone responsible for?
sodium regulator
prevents sodium and water loss by reabsorbing sodium and water from the urine back into the blood
prevents potassium from getting too high
130
What is anti-diuretic hormone (ADH) responsible for?
water regulator
controls blood pressure by conserving the fluid volume of your body by reducing the amount of water passed out in the urine
131
What is atrial natriuretic peptide (ANP) responsible for?
inhibits renin secretion and acts on kidneys to increase sodium excretion
132
What is hypervolemia?
Also called Fluid Volume Excess
Abnormal increase in the blood volume of the blood stream or intravascular space.
Occurs when there is more fluid in the body than is needed
133
What are 4 diseases that effect sodium, water, and potassium absorption?
Cushing’s
Increased cortisol levels causes an increased absorption of sodium
Hyperaldosteronism
release of too much aldosterone
Loss of potassium and increase in sodium.
Corticosteroids
Causes sodium and fluid retention
Addison’s Disease
Adrenal insufficiency; not enough aldosterone & cortisol
134
What are the clinical manifestations of Fluid Volume Excess (Hypervolemia)?
1. Neurological issues- confusion, headache, seizures
2. Muscle Spasms
3. Bounding pulse
4. JVD
5. Edema
6. Polyuria
7. Hypertension
8. Fluid in lungs/crackles
9. Ascites (abdominal swelling)
10. Hepatomegaly (enlarged liver)
11. Splenomegaly (enlarged spleen)
12. Low-specific urine gravity
135
What is hypovolemia?
Also called fluid volume deficit
Abnormal decrease in the blood volume of the blood stream or intravascular space.
Occurs when there is not enough fluid to meet the body's needs
136
What are the clinical manifestations of fluid volume deficit (hypovolemia)?
1. Neurologic- thirsty, lightheaded, confusion
2. Orthostatic Hypotension
3. Muscle weakness, fatigue
4. Weak pulse
5. Dry mucous membranes, decreased turgor
6. Amber or dark urine
7. Decreased urine output
8. Increased pulse and respiratory rate
9. Nausea and vomiting
137
What are the normal levels of an ABG test? What does the ABG test show?
ABG test measures the balance of oxygen, carbon dioxide, and acid-base balance in the blood to see how well your lungs and kidneys are working.
Normal pH: 7.35-7.45
Normal PaCO2: 35-45mm Hg (Respiratory/Lungs)
Normal Bicarbonate (HCO3): 21-28
(Kidneys/Metabolic)
138
What are the signs and symptoms of respiratory acidosis?
dysrhythmias, muscle weakness, hyperkalemia, dizziness, headache, hypoventilation, dyspnea, drowsiness
139
What are some causes of respiratory acidosis?
COPD, pneumonia, narcotics, sedatives
140
What are the signs and symptoms of respiratory alkalosis?
hyperventilation, tachycardia, hypokalemia, numbness & tingling of extremities, hyper reflexes, muscle cramping, seizures, and anxiety and irritability
141
What are come of the causes of respiratory alkalosis?
hyperventilation, anxiety, stress, pain, fear, mechanical ventilation
142
What are the signs and symptoms of metabolic acidosis?
headache, decreased BP, hyperkalemia, muscle twitching, warm & flushed skin, N/V/D, confusion & drowsiness, Kussmaul respirations
143
What are some causes of metabolic acidosis?
Excessive intake of acid (aspirin), DKA, Renal failure, shock, severe diarrhea
144
What are the signs and symptoms of metabolic alkalosis?
restlessness, dysrhythmias, confusion, dizziness, hypokalemia, N/V/D, tremors, muscle cramps, tingling in fingers and toes
145
What are some causes of metabolic alkalosis?
severe vomiting, excessive GI suctioning, diuretics, excessive bicarbonate intake
146
What are the signs and symptoms of hypernatremia?
"FRIED"
Fatigue
Restless, agitated
Increased Reflexes
Extreme thirst (PRIMARY SYMPTOM)
Decreased urine output & secretions
147
What are the signs and symptoms of hyponatremia?
" SALT LOSS"
S seizures and stupor
A abdominal cramping
L lethargy
T tendon reflexes diminished, trouble concentrating
L loss of urine & appetite
O orthostatic hypotension, overactive bowel sounds
S spasm of the muscles
S shallow respirations (VERY VERY LATE SIGN)
148
What are the signs and symptoms of hyperkalemia?
"MURDER"
M muscle weakness
U Urine output little to none
R respiratory failure (LATE)
D decreased cardiac contractility
E EARLY muscles twitches and cramps
R rhythm changes (TALL T WAVE)
149
What are the signs and symptoms of hypokalemia?
" SEVEN L's"
L lethargic
L limp muscles (weakness)
L leg cramps
L lots of urine (think diuretics)
LATE SIGNS!!
L low, shallow breathing
L low BP & heart rate
L lethal dysrhythmia
150
What are the signs and symptoms of hypercalcemia?
"WEAK"
W weakness of the muscle
E ECG changes (shortened QT interval)
A absent reflexes, altered mental status, abdominal distention
K kidney stone formation
151
What are the signs and symptoms of hypocalcemia?
"CRAMPS"
C convulsions
R reflexes
A arrhythmia
M muscle spasms (calves/feet – tetany)
P positive signs (Chvostek’s and Trousseau)
152
What are the signs and symptoms of hypermagnesemia?
"LETHARGIC"
L lethargic
E ECG changes (wide QRS, prolonged QT)
T tendon reflexes diminished can progress to absent (very bad & late)
H hypotension (poor vascular tone)
A arrhythmias (bradycardia and progressive heart block)
R red hot face, flushing (vasodilation)
G GI complaints (N/V)
I impaired breathing (diaphragm is weak)
C confusion (neurologic impairment)
153
What are the signs and symptoms of hypomagnesemia?
"TWITCH"
T Trousseau’s sign and Chvostek’s sign
W weakness
I increased tendon reflexes
T Torsades de Pointe (abnormal rhythm) and tetany
C calcium and potassium levels low
H hypertension
154
What are the signs and symptoms of hypophosphatemia?
"BONE"
B bone pain & fractures
O osteomalacia (bone softening and bowed legs)
N neuro changes (irritable, confused, and in extreme cases seizures)
E erythrocyte destruction (can lead to hemolytic anemia)
155
What are the common electrolytes, their function, and there normal lab ranges?
1. Sodium- regulation of fluid volume (135-145)
2. Potassium- cell metabolism and regulation of muscle contraction and nerve signals (3.5-5.0)
3. Magnesium- biochemical reaction in body such as muscle and nerve function (1.6-2.2)
4. Chloride- binds with other ions like sodium and potassium (97-107)
5. Calcium- bone health, neuromuscular & cardiac function, and blood clotting
6. Phosphate- binds with calcium in teeth and bones (2.5-4.5)
156
What are some causes of hyponatremia and different examples on how to fix it?
Causes: NPO, excessive sweating, diuretics, GI suctioning, excessive hypotonic solutions, decreased aldosterone, SIADH
Management: increase oral sodium intake, hypertonic saline solutions, and isotonic solutions for hypovolemic hyponatremia to restore both sodium and fluid volume
157
What are some causes of hypernatremia and different examples on how to fix it?
Causes: excessive sodium intake, decreased fluid intake, hypertonic tube feedings, excessive hypertonic fluids, hyperaldosteronism, diabetes, cushing's disease, corticosteroids, burns, excessive sweating, vomiting & diarrhea
Management: restrict oral sodium intake, ensure adequate water intake, hypotonic IV solutions, steroids to decrease cerebral edema, tylenol for headache, antiemetic for N/V/D, antiepileptic for seizures, administration of diuretics that promote sodium loss
158
What are some causes of hyperkalemia and different examples on how to fix it?
Causes: Renal failure, hypoaldosteronism, addison's disease, excessive potassium intake, burns, tissue trauma, surgery, acidosis
Management: limit potassium rich foods and supplements, medications to lower potassium (insulin or potassium binder)
159
What are some causes of hypokalemia and different examples on how to fix it?
Causes: NPO, V/D, diuretics (loop/thiazide), prolonged GI suctioning, anorexia & bulimia, hyperaldosteronism, alkalosis
Management: increase intake of potassium rich foods, potassium supplements
160
What is Chvostek's sign and Trousseau's sign and what do they indicate?
they both indicate hypocalcemia
Trousseaus- carpopedal spasm when blood pressure cuff is inflated
Chvosteks- abnormal twitching of muscles activated by the facial nerve
161
What are some causes of hypocalcemia and different examples on how to fix it?
Causes: inadequate intake of calcium or vitamin D, malnutrition, hypoalbuminemia, parathyroid dysfunction, celiac disease, gastric bypass, blood transfusions, certain medications
Management: parathyroid injection, calcium and vitamin D supplements, IV calcium gluconate, bisphosphonate medications (inhibit bone destruction and preserve bone mass)
162
What are some causes of hypercalcemia and different examples on how to fix it?
Causes: bone cancer, parathyroid disease, hyperthyroidism
Management: Calcitonin, limit calcium intake, discontinue supplements, bisphosphonate medications (inhibit calcium reabsorption)
severe hypercalcemia requires dialysis
163
What are some causes of hypophosphatemia and different examples on how to fix it?
Causes: malnutrition, V/D, malabsorption, kidney disease
Management: increase phosphorus and decrease calcium intake, phosphate supplements
164
What are some causes of hyperphosphatemia and different examples on how to fix it?
Causes: renal failure, excessive use of phosphate-based laxatives
Management: discontinue phosphorus supplements, limit phosphate intake and increase calcium intake, saline diuresis to promote secretion, medications like diuretics and phosphate binders
165
What are some causes of hypomagnesemia and different examples on how to fix it?
Causes: malabsorption, chronic alcoholism, prolonged gastric suctioning
Management: oral supplements, increased magnesium diet, avoid alcohol
Severe hypomagnesemia- slow IV administration of magnesium sulfate
166
What are some causes of hypermagnesemia and different examples on how to fix it?
Causes: renal failure, adrenal insufficiency, excessive replacement
Management: discontinue meds that contain magnesium, restrict dietary intake
Severe hypermagnesemia: monitor vital signs, frequent neuro and cardiac assessments, dialysis, loop diuretics
