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NRAD 201D > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

Explain the Calcium Regulation cycle if Ca2+ levels are too HIGH

A

Thyroid releases CALCITONIN, which:
Increases Ca2+ deposition in bones
Decreases Ca2+ uptake in intestines
Decreases Ca2+ reabsorption in kidneys

Calcium levels fall and return to homeostasis

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2
Q

Explain the Calcium Regulation cycle if Ca2+ levels are too LOW

A

Parathyroid releases PTH which:
Increases Ca2+ and phosphorus release from bones
Increases Ca2+ uptake in intestines
Increases Ca2+ reabsorption and phosphate excretion in kidneys

Ca2+ levels rise and return to homeostasis

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3
Q

Which type of serum calcium is biologically active and what are a few of its functions?

A

Free-ionized calcium is biologically active. It is essential in nerve impulse transmission, muscle and myocardial contractions, and cross-linking of fibrin threads (clot formation)

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4
Q

What are the causes of hypocalcemia?

A

Vitamin D deficiency/ impaired absorption of Vitamin D
Kidney disease (Can’t reabsorb Ca2+)
Hypoparathyroidism (not able to secrete enough PTH)
Hypoalbuminemia (low bound Ca2+ = low total Ca2+)
Hyperphosphatemia (Binds to Ca2+)
Hypomagnesemia (severe) (Mg2+ needed for PTH release)
Diuretics (cause excretion)
Chronic alcohol use ( impairs the absorption of Ca2+ in the GI tract)

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5
Q

What are the symptoms of hypocalcemia?

A

Hyperreflexia
Tetany (Chvostek/Trousseau)
Numbness & tingling in extremities and around mouth (d/t early AP threshold)
Cardiac dysrhythmias ( d/t early depolarization)

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6
Q

What are the nursing implications for hypocalcemia?

A

Increase Vit D and Ca2+ intake
Monitor post-op thyroid/ neck surgery pts for symptoms of hypocalcemia
Hold diuretics
Assess sensation, reflexes, and cardiac rhythm
Monitor Vit D, Ca2+, PO4, Mg2+, albumin (possibly PTH level)

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7
Q

What are the causes of hypercalcemia?

A

Hyperparathyroidism (secretes excess PTH)
Cancer with bone metastasis (osteolytic) and other cancers (produce factors that cause excess PTH release )
Excess Ca2+ intake and antacids (contain calcium)

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8
Q

What are the symptoms of hypercalcemia?

A

Hyporeflexia
Muscle weakness
Lethargy, confusion, cardiac dysrhythmias
Kidney stones (hypercalciuria)

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9
Q

What are the nursing implications for a patient with hypercalcemia?

A

Monitor Ca2+ level
Low Ca2+ diet
Assess mentation, reflexes, and cardiac rhythm
Maintain adequate hydration
Increase weight bearing exercises
Filter urine if needed (to catch kidney stones to be sent to the lab)

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10
Q

What are the functions of Phosphate?

A

Helps convert C6H12O6 (carbs), proteins, and fat into energy (ATP)
Essential for muscle function (because muscle needs ATP)
RBCs need phosphate to release O2 to body cells
Nervous system - produces and maintains myelin sheath
Acid-base buffering system

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11
Q

What are the causes of hypophosphatemia?

A

Inadequate intake
Malabsorption issues (chronic alcoholism, celiac disease (causes diarrhea))
Chronic diarrhea
Vitamin D deficiency
Daily use of phosphate-binding anatacids (Mg+, Al3+, Ca2+ - TUMS)
Hyperparathyroidism (increases PTH)

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12
Q

What are the symptoms of severe Hypophosphatemia (1.8 or lower)?

A

Similar to hypercalcemia sxs
Confusion
Muscle weakness
Respiratory muscle weakness
Cardiac dysrhythmias

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13
Q

What are the nursing implications for hypophosphatemia?

A

Increase vitamin D & phosphate intake
Assess neuro, respiratory and cardiac rhythm
Assess use of antacids
Monitor vitamin D, Mg+, Ca2+, and phosphate levels

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14
Q

What are the causes of hyperphosphatemia? (>4.5 mg/dL)

A

Renal failure
hypoparathyroidism
chronic use of phosphate enemas

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15
Q

What are the symptoms of hyperphosphatemia?

A

hyperreflexia
tetany (Chvostek/Trousseau signs)
numbness and tingling to extremities and around the mouth
cardiac dsythythmias

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16
Q

What are the nursing implications for pts with hyperphosphatemia?

A

Restrict food high in phosphate (dairy products)
Assess use of phosphate related meds
Assess sensation, reflexes, cardiac rhythm
Monitor calcium, phosphate, magnesium, and possibly PTH levels
They may need phosphate-binders and diuretics

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17
Q

How is urea nitrogen formed?

A

The liver produces ammonia (NH3) from protein breakdown and then converts the nitrogen to urea. Then urea travels to the kidneys to be excreted.

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18
Q

What do BUN levels indicate?

A

Liver and Kidney function

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19
Q

What does an elevated BUN level indicate?

A

increased protein intake, kidney disease, fluid volume deficit (hypovolemia/dehydration)

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20
Q

What does a decreased BUN level indicate?

A

Liver disease, low protein diet, fluid volume excess (hypervolemia)

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21
Q

What are the nursing implications for a patient with BUN imblances?

A

Assess protein levels, hydration status, assess other liver and kidney function tests (liver function panel)

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22
Q

What is creatinine?

A

A waste product from protein digestion and normal muscle breakdown. (It is proportional to the mass of skeletal muscle)

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23
Q

What is creatinine a sensitive indicator of?

A

Kidney function (it is excreted by kidneys)

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24
Q

What could an elevated Creatinine level indicate?

A

kidney damage, acute myocardial infarction, high protein intake, fluid volume deficit

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25
What does a decreased Creatinine level indicate?
inadequate protein intake
26
What are the nursing implications for Creatinine imbalances?
Assess hydration, protein levels, urine output and color
27
What are the functions of Magnesium (Mg2+)?
transmission of nerve impulses - muscle contraction and relaxation needed for PTH secretion needed to maintain K+ level via renal channels regulation of insulin secretion by pancreatic cells - stimulates glucose uptake from skeletal muscle
28
What organs regulate magnesium?
The kidneys and GI tract
29
What are the causes of hypomagnesemia?
chronic alcoholism inadequate intake Diarrhea diuretics
30
What are the symptoms of hypomagnesemia?
Resemble hypocalcemia sxs, (decreased PTH will cause hypocalcemia) increased excitability, tetany (Chvostek's/Trousseau's) decreased insulin sensitivity and secretion will increase glucose levels increased blood pressure and heart rate (low magnesium causes vasocontriction) Cardiac dysrhythmias
31
What are the nursing implications for hypomagnesmia?
increase magnesium intake IV/PO Assess labs: - calcium, phosphate, potassium, and glucose levels Assess vitals: -sensation, reflexes, cardiac rate/rhythm, BP Review medications
32
What are the causes of hypermagnesmia?
renal failure IV/PO magnesium containing medications
33
what are the symptoms of severe hypermagnesmia?
lethargy muscle weakness diminished deep tendon reflexes decreased blood pressure and heart rate depresses heart conduction (ECG changes)
34
What are the nursing implications for hypermagnesmia?
Assess: intake of Mg containing meds kidney function neuromuscular function BP, HR, rhythm possibly diuretics and IV calcium to oppose Mg
35
What cells secrete insulin?
pancreatic beta cells of the islet of langerhans
36
What are the causes of hypoglycemia?
insufficient food intake excessive physical exertion hypoglycemic agents
37
What are the symptoms of hypoglycemia?
fatigue weakness headache dizziness confusion slurred speech coma (if very severe)
38
What are the nursing implications for hypoglycemia?
assess neurological status monitor glucose consider dietary modifications
39
What are the causes of hyperglycemia?
excessive glucose intake insulin deficiency emotional/physical stressors corticosteroid use (reduces the action of insulin) parenteral therapy
40
What are the signs and symptoms of hyperglycemia?
polydipsia polyuria polyphagia fatigue blurry vision infections or injuries heal more slowly than usual
41
What are the nursing implications for hyperglycemia?
Assess: dietary intake glucose output corticosteroid use wound healing
42
What are the symptoms of low hemoglobin?
fatigue, weakness, pale skin, SOB, dizziness or lightheadedness, irregular HR, chest pain, headace
43
What are the nursing implications for low hemoglobin/ hematocrit?
Measure VS and monitor trends, respiratory status, surgical sites and drains
44
What do isotonic fluids have a similar osmolality to?
Plasma
45
Where do Isotonic fluids remain?
in the ECF
46
What do Isotonic fluids increase
intravascular volume
47
What are a few examples of Isotonic fluids?
0.9% Sodium Chloride ("NS") Lactated Ringer's (LR) 5% Dextrose in water (D5W)* (dextrose is rapidly absorbed and becomes hypotonic
48
What are the indications for isotonic fluids?
resusitation (NS) replacement to increase volume, used with other IV Txs (NS) mild hyponatremia (NS) hypercalcemia (except LR)
49
Which IV fluid is most similar to the composition of blood?
Lactated Ringer's (aka sodium lactate)
50
When is Lactated Ringer's contraindicated?
liver disease, alkalosis
51
When is Lactated Ringer's indicated?
Replacement and maintenance (surgery)
52
What are the nursing implications for isotonic fluids?
Assess for hypervolemia: - pulmonary edema -hemodilution -peripheral edema Assess electrolytes during therapy
53
What are types of hypotonic fluids?
5% Dextrose in water (D5W) 0.2% Sodium Chloride (1/4 NS) 0.45% Sodium Chloride (1/2 NS)
54
What are the indications for hypotonic fluids?
hyernatremia, hyperosmolar hyperglycemia
55
Why is D5W both an isotonic solution and a hypotonic one?
It is isotonic in the bag but hypotonic once dextrose metabolizes
56
What is the indication for D5W?
Hypernatremia
57
What are the nursing implications for hypotonic fluids?
As they can increase cellular swelling monitor for cognitive changes from cerebral edema They should be administered for a short period of time They may cause intravascular depletion and worsen existing hypovolemia and hypotension
58
What are the types of hypertonic fluids?
3% NS 5% Dextrose 0.9% sodium chloride (D5NS) 5% Dextrose Lactated Ringer's (D5LR) tonicity is increased with added electrolytes
59
What are the indications for hypertonic fluids?
Severe hyponatremia (3% NS) (ICU) Expand intravascular volume Cerebral edema Maintain/ replace electrolytes
60
What are the indications for Colloid IVF (Albumin)?
fluid volume deficit low albumin levels for patients who cannot tolerate large infusions (liver/ kidney disease)
61
What are the nursing implications for Albumin in IVF?
Monitor for fluid volume overload Assess for pulmonary edema Assess protein and albumin levels
62
When is Albumin use contraindicated?
In patients with HF
63
What is edema?
the accumulation of fluid in the interstitial space (aka second spacing)
64
What are the causes of edema?
increased venous hydrostatic pressure (IV fluids, HF) Decreased plasma oncotic pressure (low plasma protein) Increased interstitial oncotic pressure (accumulation of protein in interstitial space)
65
What are the S/sx of edema?
peripheral edema increased BP Polyuria Weight gain Crackles in lungs and dyspnea
66
What is third spacing?
fluid accumulates (gets trapped) in non-functional areas between cells
67
What are the causes of third spacing?
liver disease Burns Trauma Sepsis
68
What are the signs and symptoms of third spacing?
hypotension edema decreased urine output
69
What is the difference between hypovolemia and dehydration?
hypovolemia - loss of water and solutes (sweating, diarrhea, trauma, burns, diuretics) Dehydration - loss of water alone (not drinking enough water)
70
What are the signs and symptoms of dehydration?
Tachycardia Orthostatic hypotension Thirst Dry mucous membranes Poor skin turgor oliguria weight loss
71
What should be assessed in a patient with or suspected of dehydration?
skin turgor and mucous membranes intake and output urine color and quantity urine specific gravity (>1.025) Labs
72
Explain the Anti-diuretic Hormone (ADH) feedback loop
increased osmolality sensed by hypothalamic osmoreceptors and activate the release of ADH which cause: kidneys to retain more water decrease water loss by sweat glands arteriole vasoconstriction Osmolality decreases and ADH secretion decreases or stops

NRAD 201D (6 decks)

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