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MedSurg > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Hypertonic solution & examples

A

Solute outside, water inside (water moves out)
Cell shrinks
5% saline, 3% saline, D5, D6

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2
Q

Isotonic solution & examples

A

Equal solute/water
0.9% saline, LR

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3
Q

Hypotonic solution & examples

A

Solute inside, water outside
Cell swells
0.45% saline, 0.225% NS

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4
Q

S/S of dehydration

A

Tachycardia
Hypotension
Weak pulses
Hypernatremia
Poor skin turgor
Dry mucous membranes
Low urine output
Concentrated urine/serum

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5
Q

Interventions for dehydration

A

Offer minimum 2-4oz/hr
Sit on side of bed for 1 min before getting up

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6
Q

S/S of fluid overload

A

HTN
Bounding pulses
Low sodium
Polyuria
Dilute urine/serum
Crackles
JVD

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7
Q

S/S of CHF

A

Dyspnea at rest
JVD
AMS hypoxia
Rapid/shallow respirations
Pitting edema
Weight gain

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8
Q

S/S of hyponatremia

A

Seizure-coma-death
Anorexia/ N/V
Tendon reflex decreased
Limp muscle (weakness)
Orthostatic hypotension
Stomach cramping

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9
Q

Causes of hyponatremia

A

Diuretics, SIADH, low aldosterone, GI wound drainage, FVO, decreased intake of Na

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10
Q

S/S of hypernatremia

A

Flushed skin
Restlessness
Increased fluid retention & BP
Edema
Decreased urine output
Dry mouth

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11
Q

S/S of hyperkalemia

A

Muscle weakness
Urine output little or none
Respiratory failure
Decreased cardiac contractility (weak pulse)
Early muscle twitches/cramps
Rhythm changes

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12
Q

S/S if hypokalemia

A

Lethargic
Low, shallow respirations
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Hyporeflexia

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13
Q

Causes of hypokalemia

A

Drugs
Inadequate consumption of K
Too much water intake
Cushings syndrome
Heavy fluid loss

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14
Q

Causes of hyperkalemia

A

Adrenal insufficiency
Addisons disease
Renal failure
Excessive potassium intake
Drugs (NSAIDS, ACE inhibitors)

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15
Q

S/S if high Mg

A

Weakness, drowsiness
Respiratory depression
Bradycardia

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16
Q

Causes of high magnesium

A

Loss tendon reflex syndrome

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17
Q

Treatment of high Mg

A

Calcium gluconate

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18
Q

S/S of low Mg

A

Torsades de pointe
Respiratory arrest
Nystagmus

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19
Q

Causes of low Mg

A

Diuretics
Alcohol
Burns

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20
Q

S/S of low calcium

A

Positive chvostecks sign
Hyperactive reflexes
Carpal/pedal spasms
Tetany
Seizures
Laryngospasms
Dysrhythmias
Trousseaus sign

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21
Q

Causes of low calcium

A

Low intake of calcium
Hypoparathyroidism

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22
Q

Causes of high calcium

A

Hyperparathyroidism
Low Ca output from use of thiazide diuretics

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23
Q

S/S of high calcium

A

Confusion
Cardiac arrest if seizure
Painful bones
Renal stones
Abd groans
Sitting on throne

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24
Q

Normal blood ph

A

7.35-7.45

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25
Normal paCO2
35-45
26
Normal HCO3
22-26
27
Causes of respiratory acidosis
Hypoventilation Inadequate chest expansion Airway obstruction
28
S/S of respiratory acidosis
Respiratory depression Weak decreased pulses
29
Tx of respiratory acidosis
Ambu bag, prepare for intubation
30
Causes of Respiratory alkalosis
Hyperventilation Pulmonary embolism Pneumonia ARDS (mech ventilation)
31
Tx of respiratory alkalosis
Breathe in paper bag if from anxiety
32
Signs of metabolic acidosis
Kussmaul respirations (deep and rapid)
33
Causes of metabolic acidosis
Diarrhea Alcohol intoxication Dehydration Renal failure DKA Sepsis Burns
34
Tx of metabolic acidosis
Administer IV bicarbonate
35
Causes of metabolic alkalosis
Vomitting Blood transfusions Overhydration Antacid abuse
36
S/S of metabolic alkalosis
Muscle weakness Twitching Cramps
37
Tx of metabolic alkalosis
Stop antacids Stop suctioning Stop vomitting
38
3 main symptoms of diabetes
Polyuria Polydipsia (thirsty) Polyphagia (eating a lot)
39
Type 1 diabetes
Often younger/Caucasian populations Produces no insulin at all
40
Type 2 diabetes often in who
Older adults and minorities
41
Other name for Hgb A1c
Glycosylated hemoglobin
42
Postprandial BS
Blood sugar taken after meals Should be less that 180
43
Diet for diabetics
No missed meals Don’t decrease intake during exercise or consume alcohol Take metformin with meals
44
How exercise affects diabetics
Lowers sugar by increasing carbohydrate metabolism
45
Teaching for diabetics and exercise
Check BS while exercising- can lead to hypoglycemia Don’t exercise around time insulin peaks (regular- 2-4hrs; NPH- 4-10hrs) Take snack before exercising Don’t exercise if BS <100
46
Sick day rules for diabetics
Continue taking insulin and diabetic pills as usual (never stop taking) Drink extra calorie free liquids Weigh everyday (losing wt sign of high BS) Self monitor BS q2-3hrs Check temp morning and night
47
Foot care for diabetics
Inspect feet daily Never wash with hot water Neuropathy- low sensation, high risk for injury Moisturize but NOT in between toes Socks to bed, no heating pad or hot water bottles Hard sole shoes- no open toed or flip flops
48
Insulin administration
Abdomen- 2 in from umbilicus Pens good in fridge for 3 weeks Roll NPH in hand before injection Store pens upright to prevent clogging
49
Steps of drawing up insulin
Check expiration date Roll NPH between hands Inject air in NPH, inject air in regular, draw up regular and then draw up NPH
50
Somogyi effect
Early morning HYPERglycemia due to rebound from late night HYPOglycemia Early AM levels less than 50-60 7AM levels greater than 180
51
How to prevent somogyi effect
HS snack or adjusting insulin dosage
52
Dawn phenomenon
Everyone has it- growth hormone released at night Lantas (ultra lente) instead of NPH eliminates this phenomenon
53
Cystitis
Infection and inflammation of bladder Usually caused by UTI
54
S/S of cystitis
Traces of blood, dark, cloudy or strong smelling urine Pain just above pubic bone, lower back or abdomen Burning, frequency and urgency of urination
55
Interventions for cystitis
Empty bladder completely Wipe from front to back 2-3 L daily No long baths
56
Urinary incontinence
Decrease in muscle tone= irritation and urgency
57
Stress incontinence
Urine leaks when laughing, coughing, lifting heavy objects, etc
58
Overactive bladder
Urge incontinence Caused by urinary muscle spasms Usually from multiple pregnancies, overweight, genetic weaknesses
59
Teaching for urinary incontinence
Avoid caffeine Bladder training- void q2hrs Kegel exercises 10x/day
60
Renal calculi (Nephrolithiasis)
Kidney stones Higher risk in diabetics, fluid volume deficit or family hx Severe flank pain
61
Urolithiasis
Stones in urinary tract
62
Tx for nephrolithiasis
Pass with fluids (4L/day) Pain managed with NSAIDS (ketorolac, morphine IV, antispasmodic agent oxybutynin/ditropan) Strain all urine Monitor I&Os
63
Nephrolithiasis diet
Don’t eat diet high in oxalates If stone contains Uric acid- low purine diet
64
Diet high in oxalates
Beer Chocolate Nuts Berries Spinach Grains
65
Bladder cancer risk factor
Smoking MAJOR risk
66
S/S of bladder cancer
Blood in urine Pain with urination
67
Dx of bladder cancer
UA Cytology Cystoscopy Biopsy
68
Pyelonephritis
Kidney infection caused by bacteria (usually e. Coli) Caused by females with poor hygiene or Foley catheters Reduce nylon underwear or stockings
69
S/s of pyelonephritis
Headache Abd + flank pain CVA tenderness and pain radiating down ureter due to inflammation Nocturia Fever/chills N/V Tachycardia Tachypnea Malaise/fatigue
70
Glomerulonephritis
Inflammation of glomeruli (capillaries in kidneys) Unable to handle waste products (protein, Na, K, Phosphorus) Usually triggered by other infection
71
S/S of glomerulonephritis
Hematuria Proteinuria N/V Anorexia
72
Tx of glomerulonephritis
Abts Small freq meals Avoid foods high in protein, Na and K Monitor kidney function Monitor for HTN and FVO
73
Polycystic kidney disease
Genetic disorder- gets progressively worse until transplant Growths can be up to 30 lbs Leads to end-stage kidney disease
74
S/S of Polycystic kidney disease
Flank pain Bloody/cloudy urine Enlarged abdomen
75
Adverse effects of polycystic kidney disease
Severe headache = sign of HTN crisis
76
Polycystic kidney disease interventions/teaching
Control HTN - low Na diet Daily weights Ace inhibitors can cause hyperkalemia Avoid NSAIDS treat pain and avoid constipation Drink fluids, high fiber diet and walk
77
Acute kidney injury
Sudden episode of kidney failure, occurs within hours or few days Causes buildup of fluid, electrolytes, and waste products (K, Mg, Na, Ca)
78
Most at risk for acute kidney injury
Diabetics NSAID abuse CT contrast dye Metformin
79
S/S of acute kidney disease
Oliguria/anuria (little or no urine) Swelling in legs, ankles and around eyes Fatigue/tiredness SOB Confusion-seizure-coma Chest pain/pressure
80
Nephrosclerosis
Progressive renal impairment caused by poorly controlled HTN
81
S/S of nephrosclerosis
Anorexia N/V Pruritis Somnolence/confusion Wt loss Unpleasant taste in mouth
82
Atherosclerotic renal artery stenosis
Narrowing of arteries
83
Arteriosclerosis
Hardening of arteries
84
At risk for renal vascular disease
Diabetics CAD Aortoiliac occlusive disease
85
Risk factors for renal vascular disease
Older age HTN High cholesterol Diabetics Smoking Heavy alcohol/drug abuse
86
BPH
Non-malignant Common in older men and African Americans
87
S/S of BPH
Groin/Abd pain testicular/scrotal issues Infections Nocturia Frequency/urgency Post-void dribbling Straining
88
Medication Tx for BPH
5-alpha reductase inhibitors (finasteride, dutasteride) -shrinks prostate Alpha-blocking agents (tamsulosin, alfuzosin) - decreases pressure in urethra Watch for orthostatic hypotension
89
TURP after teaching
Continuous bladder irrigation (urine goal- pink-tinged, REPORT burgundy) REPORT confusion or bradycardia Teach catheter care Avoid baths Post op dribbling or spasms expected
90
Nephrostomy tube
Inserted surgically into kidneys when they’re backed up with urine
91
Teaching for nephrostomy tube
Fluids 2L/day MINIMUM Inspect often for kinks in tube Measure for drainage, position and dressing intact Report decreased urine output (clog/dehydration)- assess abd for distention or pain Dressing changed weekly-STERILE Place on side with tube up for dressing change
92
Testicular cancer
Common in ages 15-34 High recovery and curable even at end stage Typical sign- lump or swelling in testicle
93
Tx of testicular cancer
Surgery (orchiectomy) Radiation Chemo Use sperm bank before treatment
94
Causes of erectile function
Medications Poor blood flow Drink too much alcohol Too tired
95
Tx of erectile dysfunction
PDE5 inhibitors - sildenafil (viagra, -afil) causes blood vessels to dilate, improving blood flow
96
Teaching for -afil drugs
Don’t take it on nitrate drug for CP or heart problems Can cause sudden vision loss Take 30-60 min before intercourse Allow 24 hrs between each tablet minimize alcohol Facial flushing possible Report erection that lasts longer than 4 hrs (priapism) or painful
97
Calcium level
9-10.5
98
Magnesium level
1.5-2.5
99
Potassium level
3.5-5
100
Sodium level
135-145

MedSurg (5 decks)

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