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Nursing 101 > Exam3 > Flashcards

Exam3 Flashcards

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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
Why causes the cells to shrink in hypernatremia
Fluids move from the cells because of the increase extra cellular osmotic pressure,
26
What cells are affected by hypernatrima ?
The central nervous system resulting in Neurologic impairment Restlessness Weakness Disorientation Delusion Hallucinations
27
What is the major intracellular electrolyte
Potassium ( k) common electrolytes abnormality Loss through vomiting diarrhea, Gastric suctioning Alkalosis Diuretics
28
Typical signs of hypokalemia
Muscle weakness Leg cramps Fatigue Parenthesis’s Dysthymias
29
What happens with excess potassium
Can result in: Renal failure Hypo aldosteronism Potassium chloride Heparin Ace NSAID’s Potassium sparing diuretics
30
What are the vascular access devices?
Peripheral venous catheters Midline catheter Central venous access device
31
Midline catheter
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
32
What solutions should we avoid using the midline?(3)
Vesicant Hyperosmolar Irritating solutions
33
Central venous
Integral component of pt care in acute, ambulatory and subacute care settings Homes Long term care facilities
34
What can we use the central venous access device for? (6)
Iv fluids Medication Blood products Tpn Hemodynamic monitoring Blood sampling
35
All cvad
Requires radiographic confirmation of position after insertion and before use
36
What determines they type of CVAD used (5)
Type of carev Limited body acess Irritating drugs Pt request Long term use
37
Picc line
Insert at the beside or intervention radiology unit Radiographic verification always required before use Maybe have single or multiple lumens
38
Advantage using picc lines
Less risk of complications such as infection and pneumothorax
39
When should you not use the antecubital vein?
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 )
40
Why should you not use the veins in the leg of an adult
Danger of stagnation of peripheral circulation and possible serious complications
41
Factors that contribute to difficult iv cannula placement (5)
Obesity Extreme of age Hypovolemia Prior iv drug abuse Multiple hospitalization requiring access
42
What should we advice the pt about iv
That some medication may cause pain and discomfort and urge them to report any discomfort
43
When should you change dressing? (5)
Damp Loosened Soiled immediately Site tenderness Drainage
44
5% ( D5W ) Isotonic
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
0.9 nacl ( normal saline ) isotonic
Not desirable as routine because only provide na and cl provided in excessive amount Treat : hypovolemia Metabolic alkalosis hyponatremia Hypochloremia Blood transfusions
46
Lactates ringer ( isotonic )
Multiple electrolytes Same concentration as plasma ( lacking mg2 po4 3 ) Treat: hypovolemia Burns Fluid from gastrointestinal sources Metabolic acidosis
47
0.33 Na Cl ( strength normal saline )
Provides water Na , cl Allow kidney to select and retain needed amount Treat: hypernatremia
48
0.45 nacl ( half strength saline ) hypo
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
5%dextrose in 0.9 nacl hyper
Treat: siadh Temporarily used to treat hypovolemia if plasma expander is not available
50
What is cathartic
Medication that strongly increases gastrointestinal mobility and promotes defecation
51
What is a stoma ?
An artificial opening from waste excretion located on the body SURFACE
52
Tell me about the large intestine?
Primary organ of Bowel elimination , lower part of the gi tract Aka the colon extend from the ileocecal valve to the anus.
53
What are some functions of the large intestine aka colon
Absorption of water, formation of feces, and the expulsion of the feces from the body
54
What are some situations where there’s an issue with absorption ?
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
Valsalva maneuver is contraindicated for which pts
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
Breast milk/ breastfed vs formula
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
Medication that promotes or inhibit peristalsis
Cathartics and laxatives Antidiarreheal medications
58
Medications that decrease gi molitily with potential constipation (4)
Opioids Antacids containing aluminum Orion sulfate Anticholinertgic
59
What type of medication can cause diarrhea?
Meds with magnesium such as otc antacids If severe drugs may need to discontinue
60
Medication and stool color
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
What are some situations that can interfere with the normal timing of a pt bowel movement
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
What’s the sequence for abdominal assessment?
Inspect Auscultation Percussion Palpation
63
Tell me about hypo active bowel sounds vs hyperactive
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
Tell me about absent bowel sounds!
Evidence only after listening for 5 min Commonly associated with peritonitis, paralytic ileus or prolong immobility
65
Characteristics odor of the stool is
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
Who’s at high risk for constipation (6)
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
How can we stimulate peristalsis (5)
Castro oil Cascara Senna Phenolphthalein Dulcolax
68
What is the mechanism of magnesium hydroxide and sodium phosphate
Act by drawing water into the intestines stimulating peristalsis
69
What are food low in fiber
Eggs, well cooked meat, fish, poultry, refrained bread and creak products Wel cooked fruits and veggies
70
What is the greatest concern of medication?
Nephrotoxic : causing kidney damage Abusing analgesics ( aspirin/ ibuprofen Antibiotics : gentamicin
71
What are some physiological changes that can affect urination in older adults
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
Tell me about diuretics
Cause increase urine production, may include possible urge incontinence Sedative and tranquilizers may diminish awareness of the need to void
73
Tell me about when the body is dehydrated
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
Tell me the effects of alcohol
Produce diuretic effect by inhibiting the release of antidiuretic harmones, increasing urine production
75
Affects of food and beverages
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
What can decrease the muscle tone of a pt ( 4)
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
What is renal failure vs acute renal failure
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
What is chronic kidney disease vs chronic renal failure
End result of irreparable damage to the kidneys , Developing slowly over many years Causes by condition such as diabetes, hypertension and glomerulonephritis
79
What do we asses for when looking at urine ?
Color Odor Clarity Presence of sediment : protein, blood, glucose, bacteria and ketone Not any abnormalities Monitor ph and specific gravity
80
Specific gravity
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
Normal ph of urine
6.0 Range : 4.6 to 8
82
How do you measure output for incontinent pt?
Note number of times pt is incontinent any notable urine characteristics ( color odor ) Intervention: scheduling toileting every 2 hrs
83
UTI in lower vs upper tract
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
What can cause transient inconsistence
Medical treatment such as diuretics or iv administration Confusion ( secondary to acute illness) Infection
85
Stress incontinence (5
Commonly occurs during coughing sneezing laughing or other physical activities Childbirth Menopause Obesity Straining from chronic constipation
86
Brand new injury/ acute injury
Apply cold therapy Vasoconstriction ( contrict blood vessels) Reduce swelling Decrease blood flow Promotes comfort Reduce muscle spasms
87
Old injury /chronic injury
Apply warm therapy Vasodilation ( widen blood vessels) Increase tissue metabolism Reduce blood viscosity Reduce muscle tension Relieves pain
88
Phlebitis vs infiltration
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
Barriers to use for hot and cold therapy
Paper towel, cloth pillowcases Sheets Check every 15-20 min tops
90
What are the different types of application
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
Indwelling/ Foley catheter
Catheter that remains in place for continuous urine drainage Has an inflatable balloon at one end to prevent slipping out from bladder
92
Straight catheter / intermittent
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
Condom catheter/ urinary stealth
External urinary Catheter that’s worn like a condom
94
Prevention of cauti
Foley care Asepsis Maintain patency Check for kinks Secure to leg Assess abdominal discomfort
95
What are the 3 domains of teaching
Cognitive : teach back, test memory and knowledge Psychomotor : demonstrating Affective : change in behavior
96
Teach acronym
Tune into pt Edit pt info Act on every teaching moment Clarify often Honor the pt as a partner in education process
97
What are the 3 important questions
What is the main problem What do I need to do Why is it important for me to do it
98
What are the possible causes of acute kidney injury?
Dehydration Anaphylactic shock Sepsis Ureteral obstruction
99
Possible causes of chronic kidney failure
Diabetes hypertension Glomerulonephritis Progress can lead to kidney failure

Nursing 101 (3 decks)

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