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Nursing 101 > Exam3 > Flashcards

Exam3 Flashcards

1
Q

What can you anticipate with increased BUN

A

Found with impaired renal function

Eg , shock, heart failure, salt and water depletion diabetic ketoacidosis and burns

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2
Q

What can you anticipate with increase creatinine

A

Heart failure , shock and dehydration

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3
Q

What is the squally urine ph

A

4.6- 8.2

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4
Q

Lower and higher than normal ph can occur in what what conditions?

A

Metabolic acidosis , diabetic ketosis, and diarist

Higher: respiratory alkalosis , potassium depletion, and chronic renal failure

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5
Q

What test commonly used to determine the adequacy of oxygenation and ventilation?

A

Arterial blood gases

It also assess with treatment of acid base and balance

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6
Q

Tell me about excess fluid volume

A

May result from increased fluid intake, or decreased excretion, such as occurs with progressive renal disease is dysfunction of the heart I’m certain cancers

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7
Q

Tell me about fluid volume deficit

A

May result from decrease intake, or increase excretion of fluids, as well as fluid shifts

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8
Q

Tell me about fluid volume deficit

A

Fluid and electrolyte deficiencies may be related to situations involving strenuous exercise, extreme heat, or dryness and conditions that increase Amitabha metabolic rate such as fever

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9
Q

What’s the normal rage for an healthy adult as it pertains to I and O and urine specific gravity

A

Average about 2,500ml fluid intake and output over 3 days

1.005 to 1.030

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10
Q

Who are more vulnerable to fluid deficiciet conditions related to a less effected thirst mechanism

A

Elderly

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11
Q

What are some examples of excess urinary output ?

A

Vomit
Diarrhea
Pronounce perspiration , diarrhea , draining wound and excessive urinary output

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12
Q

What are some ways in which a pt medical regimen may lead to fluid and electrolytes imbalances

A

Diuretics ( both fluid and potassium )
Food ( high in potassium, or if potassium is not included in diet, or potassium drug therapy not started

Hypokalemia often follows

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13
Q

What are the common practices that threaten fluid balance ? (5)

A

Enemas
Laxitives
Antacids
Over the counter drugs
Herbs to promote ruination

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14
Q

What are some s/s we teach pt to report in relationship to fluid imbalances? (6)

A

Rapid weight gain and loss
Swollen fingers feet and ankles
Puffy eyelids :
Muscle weakness
Change in skin sensation
Scanty or profuse urine production

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15
Q

How would you treat fluid volume deficit

A

Increase foods with high water content ( citrus fruits, melons celery)

For hypokalemia : increase foods with high potassium content ( banana apricot melon broccoli potatoes raisins Lima beans )

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16
Q

What foods should you avoid with hypernatrimia

A

Foods high in sodium like processed cheese lunch meats canned soup and veggie , salted snacks , eliminate table salt

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17
Q

How do you avoid over treatment and metabolic alkalosis

A

Minuit Abgs for increased ph after each 50-100 mEq of sodium bicarbonate

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18
Q

How do you disguise the unpleasant taste of potassium supplements and decrease gastric irritation

A

By dilution

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19
Q

What do we asses for with magnesium sulfate (3)

A

Decreased restlessness and irritability, decrease muscle tremors and control of convulsion

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20
Q

Intravenous potassium

A

Never administered via intravenous bolus and the infusion rate for intravenous potassium chloride requires careful monitoring. The maximum rates should be 10 mEQ/hr for pt with cardiac monitoring

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21
Q

What does an admission error result in?

A

Sudden hyperkalemia leading to fatal cardiac arrest

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22
Q

Tell me about sodium?

A

Most abundant in ECF

Hyponatremia refers to sodium deficit in ECF cause by loss of sodium or gain of water

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23
Q

What happens with decreation of sodium

A

Causes fluid to move by osmosis from the less concentrated ECF compartment to the Icf space

Leads to swelling of cells resulting in confusion, hypotension, edema muscle cramps, weakness and dry skin

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24
Q

What happens wirh increase sodium hypernatremia

A

Cause by excessive water, loss or an overall excess of sodium
fluid deprivation
lack of fluid consumption
communicate thirst
diarrhea an
excess insensible water loss. ( burns and hyperventilation)

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25
Q

Why causes the cells to shrink in hypernatremia

A

Fluids move from the cells because of the increase extra cellular osmotic pressure,

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26
Q

What cells are affected by hypernatrima ?

A

The central nervous system resulting in
Neurologic impairment
Restlessness
Weakness
Disorientation
Delusion
Hallucinations

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27
Q

What is the major intracellular electrolyte

A

Potassium ( k) common electrolytes abnormality

Loss through vomiting diarrhea,
Gastric suctioning
Alkalosis
Diuretics

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28
Q

Typical signs of hypokalemia

A

Muscle weakness
Leg cramps
Fatigue
Parenthesis’s
Dysthymias

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29
Q

What happens with excess potassium

A

Can result in:
Renal failure
Hypo aldosteronism
Potassium chloride
Heparin
Ace
NSAID’s
Potassium sparing diuretics

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30
Q

What are the vascular access devices?

A

Peripheral venous catheters
Midline catheter
Central venous access device

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31
Q

Midline catheter

A

Inserted peripherally normally just above or below the anticubital , Fossa into the proximal Basilica, or a celiac bien

Greater than 3 inch
The distal tip terminates in the basaltic, cephaluc or brachial vein at or below the axillary level and distal to the shoulder

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32
Q

What solutions should we avoid using the midline?(3)

A

Vesicant
Hyperosmolar
Irritating solutions

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33
Q

Central venous

A

Integral component of pt care in acute, ambulatory and subacute care settings
Homes
Long term care facilities

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34
Q

What can we use the central venous access device for? (6)

A

Iv fluids
Medication
Blood products
Tpn
Hemodynamic monitoring
Blood sampling

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35
Q

All cvad

A

Requires radiographic confirmation of position after insertion and before use

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36
Q

What determines they type of CVAD used (5)

A

Type of carev
Limited body acess
Irritating drugs
Pt request
Long term use

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37
Q

Picc line

A

Insert at the beside or intervention radiology unit

Radiographic verification always required before use
Maybe have single or multiple lumens

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38
Q

Advantage using picc lines

A

Less risk of complications such as infection and pneumothorax

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39
Q

When should you not use the antecubital vein?

A

If another vein is available,
Not the best choice because fjextion of arm can displace the iv catheter over time

( picc line may be inserted at a later time if needed )

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40
Q

Why should you not use the veins in the leg of an adult

A

Danger of stagnation of peripheral circulation and possible serious complications

41
Q

Factors that contribute to difficult iv cannula placement (5)

A

Obesity
Extreme of age
Hypovolemia
Prior iv drug abuse
Multiple hospitalization requiring access

42
Q

What should we advice the pt about iv

A

That some medication may cause pain and discomfort and urge them to report any discomfort

43
Q

When should you change dressing? (5)

A

Damp
Loosened
Soiled immediately
Site tenderness
Drainage

44
Q

5% ( D5W ) Isotonic

A

Used in fluid loss
Dehydration
Hypernatremia

Avoid acess volume because it doesn’t have sodium in serum

Brain sweeping of hyponatremic encephalopathy can cause death

45
Q

0.9 nacl ( normal saline ) isotonic

A

Not desirable as routine because only provide na and cl provided in excessive amount

Treat : hypovolemia
Metabolic alkalosis
hyponatremia
Hypochloremia
Blood transfusions

46
Q

Lactates ringer ( isotonic )

A

Multiple electrolytes
Same concentration as plasma
( lacking mg2 po4 3 )

Treat: hypovolemia
Burns
Fluid from gastrointestinal sources
Metabolic acidosis

47
Q

0.33 Na Cl ( strength normal saline )

A

Provides water
Na , cl
Allow kidney to select and retain needed amount

Treat: hypernatremia

48
Q

0.45 nacl ( half strength saline ) hypo

A

Also provide na cl and free water

Basic fluid for maintenance needs

Treat: hypernatremia ( because contains a lil sodium that dilute the plasma while not allowing it to drop too rapidly

49
Q

5%dextrose in 0.9 nacl hyper

A

Treat: siadh
Temporarily used to treat hypovolemia if plasma expander is not available

50
Q

What is cathartic

A

Medication that strongly increases gastrointestinal mobility and promotes defecation

51
Q

What is a stoma ?

A

An artificial opening from waste excretion located on the body SURFACE

52
Q

Tell me about the large intestine?

A

Primary organ of Bowel elimination , lower part of the gi tract
Aka the colon extend from the ileocecal valve to the anus.

53
Q

What are some functions of the large intestine aka colon

A

Absorption of water, formation of feces, and the expulsion of the feces from the body

54
Q

What are some situations where there’s an issue with absorption ?

A

When waste pass through too quickly making the stool soft and watery ( diarrhea)

Stool remains in the colon too long /if too much water is absorbed stool becomes hard and dry ( constipation)

55
Q

Valsalva maneuver is contraindicated for which pts

A

Cardiovascular and other illnesses because
The process of bearing down increase pressure in abdominal and thoracic cavity which result in decrease blood flow to the atria and ventricle which temp lower cardiac output

56
Q

Breast milk/ breastfed vs formula

A

Breast milk is easier to absorbed

Breastfed have more frequent stool , which is yellow ,golden, lose with little odor

Formula fed infants vary from yellow to brown , paste like in consistency with strong order due to protein breakdown, stool may have curds and mucus

57
Q

Medication that promotes or inhibit peristalsis

A

Cathartics and laxatives

Antidiarreheal medications

58
Q

Medications that decrease gi molitily with potential constipation (4)

A

Opioids
Antacids containing aluminum
Orion sulfate
Anticholinertgic

59
Q

What type of medication can cause diarrhea?

A

Meds with magnesium such as otc antacids
If severe drugs may need to discontinue

60
Q

Medication and stool color

A

Potentially gi bleeding with anticoagulants/aspirin : pink to red and black

Iron salts: black stool from the oxidation of iron

Antacids: may cause a white discoloration or speckling in the stool

Antibiotic: green gray color related to impaired digestion

61
Q

What are some situations that can interfere with the normal timing of a pt bowel movement

A

Barium enema : may Cause impaction / constipation if not completely eliminated after procedure

Stress of waiting for a result
Changes in food intake

Using enemas and cathartics as cleansing before diagnosis studies of the gi

62
Q

What’s the sequence for abdominal assessment?

A

Inspect
Auscultation
Percussion
Palpation

63
Q

Tell me about hypo active bowel sounds vs hyperactive

A

Indicate diminish bowel motility commonly caused by abdominal surgery or late bowel obstruction

Increase bowel motility , commonly caused by diarrhea, gastroenteritis or early bowel obstruction

64
Q

Tell me about absent bowel sounds!

A

Evidence only after listening for 5 min

Commonly associated with peritonitis, paralytic ileus or prolong immobility

65
Q

Characteristics odor of the stool is

A

Due to indole and skatole caused by putrefaction and fermentation in lower intestinal tract

Influence by : ph value , presence of blood in stool , excessive putrefaction

66
Q

Who’s at high risk for constipation (6)

A

Pt on bedrest/ decrease mobility
Medication like opioids and anticholinergics
Pt with reduce fluid bulk, or fiber in diet
Pt with depression
Pt with cns disease
Local lesions that cause pain

67
Q

How can we stimulate peristalsis (5)

A

Castro oil
Cascara
Senna
Phenolphthalein
Dulcolax

68
Q

What is the mechanism of magnesium hydroxide and sodium phosphate

A

Act by drawing water into the intestines stimulating peristalsis

69
Q

What are food low in fiber

A

Eggs, well cooked meat, fish, poultry, refrained bread and creak products
Wel cooked fruits and veggies

70
Q

What is the greatest concern of medication?

A

Nephrotoxic : causing kidney damage
Abusing analgesics ( aspirin/ ibuprofen
Antibiotics : gentamicin

71
Q

What are some physiological changes that can affect urination in older adults

A

Diminished ability of kidney to concentrate urine ( nocturia night peeing )

Decrease bladder contractility may lead to urine de ruin and stasis which increases possible uti

Dresses bladder muscle tone , decrease the possibility of holding urine in bladder which increase frequent urination

Neuromuscular problems , joint probs ,
Alteration is thought process, and weakness’s, affect reaching the restroom in time

72
Q

Tell me about diuretics

A

Cause increase urine production, may include possible urge incontinence

Sedative and tranquilizers may diminish awareness of the need to void

73
Q

Tell me about when the body is dehydrated

A

The kidney reabsorbed fluid, urine produce is more concentrated and decrease in amount

Conversely with fluid overload the kidney excrete a large quantity of dilute urine

74
Q

Tell me the effects of alcohol

A

Produce diuretic effect by inhibiting the release of antidiuretic harmones, increasing urine production

75
Q

Affects of food and beverages

A

Food high in water increase urine production

Foods high in sodium content cause sodium and water reabsorption and retention, decreasing urine output

Affect odor: asparagus, onions
Color : beets

76
Q

What can decrease the muscle tone of a pt ( 4)

A

Pt with indweling catheters ( muscle not being stretched/ used

Childbearing
Muscle atrophy due to decrease estrogen levels in menopause
Damage to muscle from trauma

77
Q

What is renal failure vs acute renal failure

A

Condition where the kidney fail to remove metabolic end products from blood and unable to regulate fluid, electrolytes and ph balance

Sudden decline in kidney function, resulting from sever dehydration , anaphylactic shock, pyelonephristis and ureteral obstruction

78
Q

What is chronic kidney disease vs chronic renal failure

A

End result of irreparable damage to the kidneys ,
Developing slowly over many years

Causes by condition such as diabetes, hypertension and glomerulonephritis

79
Q

What do we asses for when looking at urine ?

A

Color
Odor
Clarity
Presence of sediment : protein, blood, glucose, bacteria and ketone

Not any abnormalities
Monitor ph and specific gravity

80
Q

Specific gravity

A

Measure of concentration of dissolved solids in the urine ( 1.015 to 1.025)

Concentrated will have a higher specific gravity

In the absence of kidney disease, a higher specific gravity usually indicates dehydration and lower is over hydration

81
Q

Normal ph of urine

A

6.0

Range : 4.6 to 8

82
Q

How do you measure output for incontinent pt?

A

Note number of times pt is incontinent any notable urine characteristics ( color odor )

Intervention: scheduling toileting every 2 hrs

83
Q

UTI in lower vs upper tract

A

Lower track is short term ( 1 large dose vs 3 7 days of smaller doses

Longer antimicrobial therapy

Pt education can help with uti recurrence

84
Q

What can cause transient inconsistence

A

Medical treatment such as diuretics or iv administration
Confusion ( secondary to acute illness)
Infection

85
Q

Stress incontinence (5

A

Commonly occurs during coughing sneezing laughing or other physical activities
Childbirth
Menopause
Obesity
Straining from chronic constipation

86
Q

Brand new injury/ acute injury

A

Apply cold therapy
Vasoconstriction ( contrict blood vessels)
Reduce swelling
Decrease blood flow
Promotes comfort
Reduce muscle spasms

87
Q

Old injury /chronic injury

A

Apply warm therapy
Vasodilation ( widen blood vessels)
Increase tissue metabolism
Reduce blood viscosity
Reduce muscle tension
Relieves pain

88
Q

Phlebitis vs infiltration

A

Inflammation of the veins , red warm swelling site , can use hot/cold

When needle goes through the vein
Fluid enters tissues instead of bien
Can use hot/cold
Color pale swelling of site
Warms helps vasodilation

89
Q

Barriers to use for hot and cold therapy

A

Paper towel,
cloth
pillowcases
Sheets

Check every 15-20 min tops

90
Q

What are the different types of application

A

Ice pack/patch
Hot pack/patch
Hypothermia blanket

Measure pt temp and what the machine is set at

Small probe inserted into rectum that connects to the machine giving pt temp

Turn pt to avoid burning

91
Q

Indwelling/ Foley catheter

A

Catheter that remains in place for continuous urine drainage

Has an inflatable balloon at one end to prevent slipping out from bladder

92
Q

Straight catheter / intermittent

A

Single use catheter
Used to drain the bladder for shorter periods

Lower risk of CAUTI :
Nonsocomial
Improper insertion
Improper catheter
Trauma
Altered body system

93
Q

Condom catheter/ urinary stealth

A

External urinary Catheter that’s worn like a condom

94
Q

Prevention of cauti

A

Foley care
Asepsis
Maintain patency
Check for kinks
Secure to leg
Assess abdominal discomfort

95
Q

What are the 3 domains of teaching

A

Cognitive : teach back, test memory and knowledge
Psychomotor : demonstrating
Affective : change in behavior

96
Q

Teach acronym

A

Tune into pt
Edit pt info
Act on every teaching moment
Clarify often
Honor the pt as a partner in education process

97
Q

What are the 3 important questions

A

What is the main problem
What do I need to do
Why is it important for me to do it

98
Q

What are the possible causes of acute kidney injury?

A

Dehydration
Anaphylactic shock
Sepsis
Ureteral obstruction

99
Q

Possible causes of chronic kidney failure

A

Diabetes
hypertension
Glomerulonephritis

Progress can lead to kidney failure

Nursing 101 (3 decks)

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