Exam 2 Flashcards
(131 cards)
1
Q
SMART acronym for writing patient goals
A
Specific Measurable Attainable Realistic Timed
2
Q
Independent nursing interventions
A
Actions that a nurse initiates w/out supervision or direction
3
Q
Correctly written nursing interventions include?
A
Actions, frequency, quantity, method, and the person to perform them
4
Q
A nurse assesses a 78-year-old patient who weighs 108.9 kg (240 lbs) and is partially immobilized because of a stroke. The nurse turns the patient and finds that the skin over the sacrum is very red and the patient does not feel sensation in the area. The patient has had fecal incontinence on and off for the last 2 days. The nurse identifies the nursing diagnosis of Risk for Impaired Skin Integrity. Which of the following outcomes is appropriate for the patient?
Patient will be turned every 2 hours within 24 hours.
Patient will have normal bowel function within 72 hours.
Patient’s skin integrity will remain intact through discharge.
Erythema of skin will be mild to none within 48 hours.
A
Erythema of skin will be mild to none within 48 hours.
Turning the patient every 2 hours in a 24-hour period is an intervention. Both “Patient will have normal bowel function within 72 hours” and “Patient’s skin integrity will remain intact through discharge” are goals.
5
Q
Which of the following factors does a nurse consider in setting priorities for a patient’s nursing diagnoses? (Select all that apply.)
Numbered order of diagnosis on the basis of severity
Notion of urgency for nursing action
Symptom pattern recognition suggesting a problem
Mutually agreed on priorities set with patient
Time when a specific diagnosis was identified
A
Notion of urgency for nursing action
Symptom pattern recognition suggesting a problem Mutually agreed on priorities set with patient
These three factors are considered in setting priorities for a patient’s nursing diagnoses or collaborative problems. The other options are inappropriate because a numbering system and time of identification hold little meaning when a patient’s condition changes.
6
Q
A patient has the nursing diagnosis of Nausea. The nurse develops a care plan with the following interventions. Which are examples of collaborative interventions? (Select all that apply.)
Providing mouth care every 4 hours
Maintaining intravenous (IV) infusion at 100 mL/hr
Administering prochlorperazine (Compazine) via rectal suppository
Consulting with dietitian on initial foods to offer patient
Controlling aversive odors or unpleasant visual stimulation that triggers nausea
A
Maintaining intravenous (IV) infusion at 100 mL/hr Consulting with dietitian on initial foods to offer patient
Controlling aversive odors or unpleasant visual stimulation that triggers nausea
Providing mouth care every 4 hours and controlling aversive odors or unpleasant visual stimuli that triggers nausea are both independent nursing interventions. Administering prochlorperazine via suppository is a dependent intervention.
7
Q
A nurse begins the night shift being assigned to five patients. She learns that the floor will be a registered nurse (RN) short as a result of a call in. A patient care technician from another area is coming to the nursing unit to assist. The nurse is required to do hourly rounds on all patients, so she begins rounds on the patient who has recently asked for a pain medication. As the nurse begins to approach the patient’s room, a nurse stops her in the hallway to ask about another patient. Which factors in this nurse’s unit environment will affect her ability to set priorities? (Select all that apply.) Policy for conducting hourly rounds Staffing level Interruption by staff nurse colleague RN’s years of experience Competency of patient care technician
A
Policy for conducting hourly rounds
Staffing level
Interruption by staff nurse colleague
Many factors within the health care environment affect your ability to set priorities, including model for delivering care, the workflow routine and staffing levels of a nursing unit, and interruptions from other care providers. Available resources (e.g., policies and procedures) also affect priority setting. The nurse’s years of experience and the competency of the patient care technician are not part of the environment.
8
Q
ACT OF URINATION
A
- Brain structures influence bladder function.
- Voiding: Bladder contraction + urethral sphincter and pelvic floor muscle relaxation
- Bladder wall stretching signals micturition center.
- Impulses from the micturition center in the brain respond to or ignore this urge, thus making urination under voluntary control.
- When a person is ready to void, the central nervous system sends a message to the micturition centers, the external sphincter relaxes and the bladder empties.
9
Q
FACTORS INFLUENCING
URINATION
A
- Growth and development
- Sociocultural factors
- Psychological factors
- Personal habits
- Fluid intake
- Pathological conditions: diabetes mellitus, MS, stroke. Pt’s either have overactivity or deficient
- Surgical procedures
- Medications
- Diagnostic Examinations
10
Q
COMMON URINARY ELIMINATION
PROBLEMS
A
• Urinary retention • An accumulation of urine due to the inability of the bladder to empty • Urinary tract infection • Results from catheterization or procedure • Urinary incontinence • Involuntary leakage of urine • Urinary diversion - Diversion of urine to external source
11
Q
Function of kidneys
A
Filter waste products of metabolism from the blood
12
Q
Function of ureters
A
Transport urine from the kidneys to the bladder
13
Q
Function of the bladder
A
Holds urine until the volume in the bladder triggers a sensation of urge, indicating the need to pass urine
14
Q
Define micturition
A
Occurs when the brain gives the bladder permission to empty, the bladder contracts, the urinary sphincter relaxes, and urine leaves the body through the urethra
15
Q
Functional unit of the kidneys
A
Nephron, they remove waste products from the body and play a major role in the regulation of fluid and electrolyte balance.
-each nephron contains a cluster of capillaries called glomerulus which filters water, glucose, amino acids, urea, uric acid, creatinine, and major electrolytes
16
Q
Erythropoietin
A
Produced by the kidneys, it stimulates RBC production and maturation in bone marrow
-pt’s w/chronic kidney conditions cannot produce sufficient quantities of this hormone; therefore they are prone to anema
17
Q
How do kidneys play a role in BP control?
A
Via the renin-angiotensin system (i.e. release of aldosterone and prostacyclin)
- in times of renal ischemia (decreased blood supply), renin is released from juxtaglomerular cells
- Renin functions as an enzyme to convert antiotensinogen (a substance synthesized by the liver) into angiotensin I
- angiotensin I is converted to angiotensin II in the lungs.
- Angiotensin II causes vasoconstriction and stimulates aldosterone release from the adrenal cortex
- Aldosterone causes retention of water, which increases blood volume
- The kidneys also produce prostaglandin E2 and prostacyclin, which help maintain renal blood flow through vasodilation.
- These mechanisms, increase arterial BP and renal blood flow
18
Q
Alcohol decreases?
A
The release of antidiuretic hormone, thus increasing urine production
19
Q
Some drugs change the color of urine (e.g. phenazopyridine-orange, riboflavin-intense yellow)
A
.
20
Q
Transient incontinence
A
- caused by medical conditions
- common reversible causes: delirium, inflammation, medications etc.
- Nursing interventions: look for reversible causes, notify health care provider of any suspected reversible causes
21
Q
Functional incontinence
A
Loss of continence because of causes outside urinary tract, usually related to functional deficits such as altered mobility and manual dexterity
- toilet access restricted by: sensory impairments, cognitive impairments, altered mobility, etc.
- nursing interventions: adequate lighting in bathroom, individualized toileting program, mobility aids
22
Q
Goal and outcome
A
Goal: broad statement that describes a desired change in a patient such as a patient will understand postop risks.
Outcome: is measurable change such as a pt will know s/s and symptoms of wound infection
23
Q
Which of the following factors does a nurse consider in setting priorities for a patient’s nursing diagnosis (select all that apply)
A
1) numbered order of diagnosis on the basis of severity
2) Notion of urgency for nursing action
3) Symptom pattern recognition suggesting a problem
4) Mutually agreed on priorities set w/pt
5) Time when a specific diagnosis was identified
24
Q
Factors influencing urinary elimination
A
Growth and development, sociocultural factors, psychological factors, personal habits, fluid intake, pathological conditions, surgical procedures, medications, diagnostic exams
25
Postvoid residual (PVR)
The amount of urine left in the bladder after voiding and is measured either by ultrasound (bladder scan) or straight catherterization
26
Characteristics of urine
Color, clarity, odor
27
Patient education for a healthy bladder
Maintain adequate hydration, keep good voiding habits, keep the bowels regular, prevent UTIs, stop smoking
28
An intravenous pyelogram (IVP) involves what?
Intravenous injection of an iodine based contrast media. Patients that have had a previous hypersensitivity reaction to contrast media in the past are at high risk for another reaction. Informed consent is required. There is no need for a full bladder such as with a pelvic ultrasound or to save any urine for testing. There is no instrumentation of the urinary tract such as with cystoscopy
29
A post-op patient with a three-way indewelling urinary catheter and continuous bladder irrigation (CBI) complains of lower abdominal pain and distention. What should be the nurses initial intervention?
Assess intake and output
30
An appropriate first action would be to assess the patency of the drainage system. Urine output in the drainage urine and irritant, the irritant should be stopped immediately, the catheter may be occluded and the bladder distended
.
31
Pelvic muscle training is effective in treating
Stress urinary incontinence
32
Bladder retraining is?
Behavioral therapy
33
Behavioral therapy that includes pelvic muscle training should be offered as?
First-line treatment for stress, urge, and mixed incontinence in women of all ages
34
Common causes of constipation
- irregular bowel habits and ignoring urge to defecate
- chronic illnesses (parkinson's, MS, rheumatoid arthritis, chronic bowel diseases, depression, eating disorders)
- low-fiber diet high in animal fats (meats, and carbs); low fluid intake
- stress (illness of family member, death of loved one, divorce)
- physical inactivity
- medications, especially use of opiates
- changes in life or routine such as pregnancy, aging, travel
- neurological conditions that block nerve impulses to the colon (stroke, spinal cord injury, tumor)
- chronic bowel dysfunction (colonic inertia, irritable bowel)
35
Signs of dehydration in adults
Signs of dehydration in adults:
- thirst
- less frequent urination than usual
- dark-colored urine
- dry skin
- fatique
- dizziness
- light-headedness
36
Signs of dehydration in infants and young children
- dry mouth/tongue
- no tears when crying
- no wet diapers for 3 hours or more
- sunken eyes or cheeks or soft spot in the skull
- high fever
- listlesness or irritability
37
The proper position for the patient on a bedpan is?
With the head of the bed elevated 30-45 degrees
38
Which skills must a patient with a new colostomy be taught before discharge from the hospital?
- How to change the pouch
- How to empty the pouch
- How to open and close the pouch
39
Initial steps of chronic constipation
Increase fluid and fiber, exercise 30 min/day, schedule time to use the toilet every day
40
Frequent or continuous oozing of liquid stools occurs when?
Liquid fecal matter above the impacted stool seeps around the fecal impaction
41
pH
<7.35 is acidic
| >7.45 is alkalosis
42
HCO
22-26
43
PaCO2
35-45
44
Left sided heart failure
Decreased function of left ventricle, resulting in decreased cardiac output
45
S/S of left sided heart failure
Fatigue, SOB, dizziness, and confusion due to tissue hypoxia and decrease cardiac output b/c left ventricle is failing, blood pools in the pulmonary circulation > pulmonary congestion
46
Clinical findings for left sided heart failure
Crackles, hypoxia, SOB on exertion, cough, paroxysmal nocturnal dyspnea
47
Right sided heart failure
Impaired function of right ventricle, results from pulmonary disease or long term left sided heart failure. Blood backs up in the systemic circulation
48
Clinical findings for right sided heart failure
Weight gain, distended neck veins, hepatomegaly and splenogaly, and dependent peripheral edema
49
Effects of aging on assessment findings of the cardiopulmonary system: function Heart
Muscle contraction
pathophysiological change: thickening of the ventricular wall, increased collagen and decreased elastin in the heart muscle
Clinical findings: Decreased cardiac output, diminished cardiac reserve
50
Effects of aging on assessment findings of the cardiopulmonary system: function blood flow
Pathophysiological change: Heart valves become thicker and stiffer, more often in the mitral and aortic valves
Clinical findings: systolic murmur
51
Effects of aging on assessment findings of the cardiopulmonary system: function conduction system
- Pathophysiological change: SA node becomes fibrotic from calcification; decrease of number of pacemaker cells in SA node
- Clinical findings: increased PR, QRS, Q-T intervals, decreased amplitude of QRS complex. Irregular heart rhythm
52
Effects of aging on assessment findings of the cardiopulmonary system: function arterial vessel compliance
- Pathophysiological change: calcified vessels, loss of arterial distensibility, decreased elastin in vessel walls, more tortuous vessels
- clinical findings: hypertension w/an increase in systolic blood pressure
53
Effects of aging on assessment findings of the cardiopulmonary system: function breathing mechanics
- Pathophysiological change: decreased chest wall compliance, loss of elastic recoil. Decreased respiratory muscle mass/strength
- clinical findings: prolonged exhalation phase. Decreased vital capacity
54
Effects of aging on assessment findings of the cardiopulmonary system: function oxygenation
- Pathophysiological change: Increased ventilation/perfusion mismatch. Decreased alveolar surface area. Decreased carbon dioxide diffusion capacity
- clinical findings: Decreased PaO2, decreased cardiac output, slightly increased PaCO2
55
Effects of aging on assessment findings of the cardiopulmonary system: function breathing control/breathing pattern
- Pathophysiological change: decreased responsiveness of central and peripheral chemoreceptors to hypoxemia and hypercapnia
- clinical findings: increased respiratory rate. Decreased tidal volume
56
Effects of aging on assessment findings of the cardiopulmonary system: function lung defense mechanisms
- Pathophysiological change: decreased number of cilia, decreased IgA production and humoral and cellular immunity
- clinical findings: decreased airway clearance, diminished cough reflex, increased risk for infection
57
Effects of aging on assessment findings of the cardiopulmonary system: function sleep and breathing
- pathophysiological change: Decreased respiratory drive. Decreased tone of upper airway muscles
- clinical findings: increased risk of aspiration and respiratory infection, decreased PaO2, snoring, obstructive sleep apnea
58
Cause of Xanthelasma (yellow lipid lesions on eyelids)
Hyperlipidemia
59
Cause of corneal arcus (whitish opaque ring around junction of cornea and sclera)
Abnormal finding in young to middle-age adults with hyperlipidemia (normal finding in older adults with arcus senilis)
60
Cause of pale conjunctivae
anemia
61
Cause of cyanotic conjunctivae
Hypoxemia
62
Cause of petechiae on conjunctivae
Fat embolus or bacterial endocarditis
63
Cause of cyanotic mucous membranes
Decreased oxygenation (hypoxia)
64
Cause of pursed-lip breathing
Associated w/chronic lung disease
65
Cause of distention (neck veins)
Associated w/right-sided heart failure
66
Cause of flaring nares
Air hunger, dyspnea
67
Cause of chest retractions
Increased work of breathing, dyspnea
68
Cause of chest asymmetry
Chest wall injury
69
Cause of skin peripheral cyanosis
Vasoconstriction and diminished blood flow
70
Cause of central cyanosis
Hypoxemia
71
Cause of decreased decreased skin turgor
Dehydration (normal finding in older adults as a result of decreased skin elasticity)
72
Cause of dependent edema
Associated w/right and left sided heart failure
73
Cause of periorbital edema
Associated with kidney disease
74
Cause of cyanosis in fingertips and nail beds
Decreased cardiac output or hypoxia
75
Cause of splinter hemorrhages of fingertips and nailbeds
Bacterial endocarditis
76
Cause of clubbing
Chronic hypoxemia
77
Low flow delivery oxygen delivery system: nasal cannula
FiO2 delivered: 1-6L/min: 24-44%
Advantages: Safe and simple, easily tolerated, effective for low concentrations, does not impede eating or talking, inexpensive, disposable
Disadvantages: unable to use w/nasal obstruction, drying to mucous membranes, can dislodge easily, may cause skin irriation or breakdown around ears or nares, pt's breathing pattern (mouth or nasal) affects exact FiO2
78
Low flow delivery oxygen delivery system: Simple face mask
FiO2: 6-12L/min: 35-50%
Advantages: useful for short periods such as patient transportation
-Disadvantages: contraindicated for patients who retain CO2, may induce feelings of claustrophobia, therapy interrupted with eating and drinking, increased risk of aspiration
79
Low flow delivery oxygen delivery system: partial and nonrebreather masks
- FiO2: 10-15L/min: 60-90%
- Advantages: useful for short periods, delivers increased FiO2, easily humidifies O2, does not dry mucous membranes
- Disadvantages: hot and confining; may irritate skin; tight seal necessary, interferes w/eating and talking, bag may twist or kink; should not totally deflate
80
Low flow delivery oxygen delivery system: Oxygen-conserving cannula (oxymizer)
- FiO2: 8L/min: up to 30-50%
- Advantages: indicated for long term use O2 in home, allows increased O2 concentration and lower flow
- Disadvantages: cannula cannot be cleaned, more expensive than standard cannula
81
High-flow delivery devices: venturi mask
- FiO2: 24-50%
- Advantages: provides specific amount of oxygen with humidity added, administers low, constant O2
- Disadvantages: mask and added humidity may irritate skin, therapy interrupted with eating and drinking, specific flow rate must be followed
82
Extracellular volume deficit
Sudden weight loss (overnight), postural hypotension, tachycardia, thready pulse, dry mucous membranes, poor skin turgor, slow vein filling, flat neck veins when supine, dark yellow urine if severe; thirst, restlesness, confusion, hypotension; oliguria (urine output below 30ml/hr); cold, clammy skin; hypovolemic shock
83
Extracellular volume excess
Sudden weight gain (overnight), edema (especially in dependent areas), full neck veins when upright or semi-upright or semi-upright, crackles in lungs. If severe: confusion, pulmonary edema
84
Which assessment do you interpret as a transfusion reaction?
Chills, tachycardia, flushing
85
To assess ECV deficit
Fullness of neck veins when supine (means good) if they are flat that means there is an ECV deficit
86
Hypokalemia
SLOWS THINGS DOWN Bilateral muscle weakness that begins in quadriceps and may ascend to respiratory muscles, abdominal distention, decreased bowel sounds, constipation, dysrhythmias
87
Hyperkalemia
SPEEDS THINGS UP Bilateral muscle weakness in quadriceps, transient abdominal cramps, diarrhea, dysrhythmias, cardiac arrest if severe
88
Hypocalcemia
SPEEDS THINGS UP numbness and tingling of fingers, toes, and cicumoral (around mouth) region, positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), hyperactive reflexes, muscle twitching and cramping; carpal and pedal spasms, tetany, seizures, laryngospasm, dysrhythmias
89
UTI's are usually caused by
Escherichia coli
90
Typically a sense of urgency occurs when the bladder fills to?
400-600mL
91
Several areas in the brain are involved in bladder control;
cerebral cortex, thalamus, hypothalamus and brainstem.
92
There are two micturition centers in the spinal cord
one that coordinates inhibition of bladder contraction and the other that coordinates bladder contractility.
93
In older adults, the ability to hold urine between the initial desire to void and an urgent need to void decreases. Older adults are at increased risk for?
urinary incontinence due to chronic illness and factors that interfere with mobility, cognition, and manual dexterity.
94
*Important to note that ANY TIME the sterile urinary tract is catheterized, there is increased risk for?
infection. Urinary tract infections (UTIs) are usually caused by Escherichia coli. Symptoms of a lower urinary tract infection (bladder) can include: burning or pain with urination (dysuria), irritation of the bladder (cystitis) characterized by urgency, frequency, incontinence, suprapubic tenderness, and foul-smelling cloudy urine.
95
Most common urinary elimination problems involve?
The inability to store urine or fully empty the urine from the bladder, these issues can result from infection, irritable, or overactive bladder, obstruction of urine flow, impaired bladder contractility, or issues that impair innervation to the bladder resulting in sensory or motor dysfunction.
96
Common forms of UI are?
urge or urgency UI (involuntary leakage associated with urgency) and stress UI (involuntary loss of urine associated with effort or exertion, on sneezing or coughing. Urinary incontinence associated with chronic retention of urine (formally called Overflow UI) is urine leakage caused by an overfull bladder
97
All specimens collected and sent for laboratory testing need to be labeled with?
the patient’s name, date, time, and type of collection.
98
The plan of care for urinary elimination alterations must include?
realistic and individualized goals along with relevant outcomes. Goals should be a collaborative effort between the nurse and the patient.
99
It is important to establish priorities of care based on the?
patient’s immediate physical and safety needs, patient expectations and readiness to perform some self-care activities
100
Maintaining normal urinary elimination helps to prevent many problems. Many measures that promote normal voiding are?
independent nursing interventions.
101
Integrating the patient’s habits into the care plan fosters a more normal voiding pattern.
Create as much privacy as possible by closing the door and bedside curtain; asking visitors to leave a room when a bedside commode, bedpan, or urinal is used; and masking the sounds of voiding with running water. Respond to requests for assistance with toileting as quickly as possible. Avoid the use of incontinence containment products unless needed for uncontrolled urine leakage. Some containment products may be difficult to remove and interfere with prompt toilet access.
102
Adequate fluid intake will help flush out solutes or particles that collect in the urinary system and decrease bladder irritability. If the patient needs to increase fluid intake, set a?
schedule for drinking extra fluids, identify fluid preferences, increase high fluid foods such as fruits, and encourage fluid intake in small volumes frequently. Excessive fluid intake should be avoided. To prevent nocturia, suggest that the patient avoid drinking fluids 2 hours before bedtime.
103
Patients with indwelling catheters require regular perineal hygiene, especially after a bowel movement, to reduce the risk for?
CAUTI.
104
A critical part of routine catheter care is reducing the risk for CAUTI. A key intervention to prevent infection is?
maintaining a closed urinary drainage system. Another key intervention is prevention of urine back flow from the tubing and bag into the bladder.
105
Prompt removal of an indwelling catheter after no longer needed is a key intervention that has proven to decrease the incidence and prevalence of?
HAUTI (hospital-acquired urinary tract infections) and is one of the ”never events” identified by the Centers for Medicare and Medicaid Services (CMS).
106
Teach patients about foods and fluids that cause bladder irritation and increase symptoms such as frequency, urgency, and incontinence. Teach patients to avoid common irritants such as?
artificial sweeteners, spicy foods, citrus products, and especially caffeine. Encourage patients with edema to elevate the feet for a minimum of a few hours in the afternoon to help diminish nighttime voiding frequency.
107
Age influences bowel elimination
Older adults may have decreased chewing ability. Peristalsis declines and esophageal emptying slows. This impairs absorption by the intestinal mucosa. Muscle tone in the perineal floor and anal sphincter weakens, and may cause difficulty in controlling defecation.
108
Regular daily food intake helps maintain a regular pattern of peristalsis in the colon. Fiber in the diet provides the?
bulk in the fecal material. Bulk-forming foods help remove the fats and waste products from the body. Some foods may also produce gas, which distends the intestinal walls and increases colonic motility.
109
While individual fluid needs vary with the person, however, recommended fluid intake, again, is about?
2.5L daily. Fluid liquefies intestinal contents by absorbing into the fiber from the diet and creating a larger, softer stool mass. This increases peristalsis and promotes movement of stool through the colon.
110
Physical activity promotes?
Peristalsis.
111
Prolonged emotional stress impairs the function of almost all body systems. During emotional stress, the digestive process is?
accelerated and peristalsis is increased.
112
Constipation is a symptom, not a disease, and there are many possible causes.
Improper diet, reduced fluid intake, lack of exercise and certain medications can cause constipation. When intestinal motility slows, the fecal mass becomes exposed over time to the intestinal walls and most of the fecal water content is absorbed. Little water is left to soften and lubricate the stool. Constipation is a significant source of discomfort
113
Sigmoid colostomy
more formed stool
114
Transverse colostomy
thick liquid to soft consistency
115
Ileostomy
fecal effluent leaves the body before it enters the colon, creating frequent, liquid stools
116
Fluid homeostasis is the dynamic interplay of three processes
Fluid intake and absorption, fluid distribution, and fluid output. To maintain fluid balance, fluid intake must equal fluid output. Because some of the normal daily fluid output (e.g., urine, sweat) is a hypotonic salt solution, people must have an equivalent fluid intake of hypotonic sodium-containing fluid (or water plus foods with some salt) to maintain fluid balance (intake equal to output).
117
Fluid intake occurs orally through drinking but also through eating because most foods contain some water. Food metabolism creates additional water. Average fluid intake from these routes for healthy adults is about
2300 mL, although this amount can vary widely depending on exercise habits, preferences, and the environment. Other routes of fluid intake include intravenous (IV), rectal (e.g., enemas), and irrigation of body cavities that can absorb fluid.
118
Fluid output normally occurs through four organs
the skin, lungs, GI tract, and kidneys.
119
The GI tract plays a vital role in fluid balance.
Approximately 3 to 6 L of fluid moves into the GI tract daily and then returns again to the ECF. The average adult normally excretes only 100 mL of fluid each day through feces. However, diarrhea causes a large fluid output from the GI tract.
120
The kidneys are the major regulator of fluid output because they respond to hormones that influence urine production.
When healthy adults drink more water, they increase urine production to maintain fluid balance. If they drink less water, sweat a lot, or lose fluid by vomiting, their urine volume decreases to maintain fluid balance. These adjustments primarily are caused by the actions of antidiuretic hormone (ADH), the renin-angiotensin-aldosterone system (RAAS), and atrial natriuretic peptides (ANPs).
121
ADH regulates the osmolality of the body fluids by influencing how much water is excreted in urine. It is synthesized by?
neurons in the hypothalamus that release it from the posterior pituitary gland. ADH circulates in the blood to the kidneys, where it acts on the collecting ducts.
122
People normally have some ADH release to maintain fluid balance. More ADH is released if body fluids become more concentrated. Factors that increase ADH levels include?
severely decreased blood volume (e.g., dehydration, hemorrhage), pain, stressors, and some medications.
123
The RAAS regulates ECF volume by influencing?
how much sodium and water are excreted in urine. It also contributes to regulation of blood pressure.
124
Aldosterone circulates to the kidneys, where it causes ?
resorption of sodium and water in isotonic proportion in the distal renal tubules. Removing sodium and water from the renal tubules and returning it to the blood increases the volume of the ECF.
125
To maintain fluid balance, normally some action of the?
RAAS occurs
126
ANP also regulates ECV by?
influencing how much sodium and water are excreted in urine. Cells in the atria of the heart release ANP when they are stretched (e.g., by an increased ECV). ANP is a weak hormone that inhibits ADH by increasing the loss of sodium and water in the. Thus ANP opposes the effect of aldosterone.
127
Sodium imbalances:
contribute to cerebral dysfunction (confusion, lethargy)
128
Potassium imbalances:
Potentially life threatening cardiac dysrhythmias, cardiac arrest
129
Calcium imbalances:
neuromuscular excitability, hypercalcemia= lethargy
130
Magnesium imbalances:
neuromuscular excitability, lethargy, decreased DTR critically low magnesium levels can lead to lethal cardiac dysrhythmias
131
Environment: hot environments increase fluid output through sweating. Sweat is a hypotonic sodium-containing fluid. Excessive sweating without adequate replacement of salt and water can lead to ECV deficit, hypernatremia, or clinical dehydration. Ask patients about their normal level of physical work and whether they engage in vigorous exercise in hot environments. Do patients have fluid replacements containing salt available during exercise and physical activity?
Environment: hot environments increase fluid output through sweating. Sweat is a hypotonic sodium-containing fluid. Excessive sweating without adequate replacement of salt and water can lead to ECV deficit, hypernatremia, or clinical dehydration. Ask patients about their normal level of physical work and whether they engage in vigorous exercise in hot environments. Do patients have fluid replacements containing salt available during exercise and physical activity?
