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nur 334 > F+E > Flashcards

F+E Flashcards

1
Q

fluid overview

A

fluid processes -> diffusion and osmosis
colloidal osmotic P (oncotic P) -> albumin = pulling power (fluid in IV, 3rd space if not)
hydrostatic P -> pushing -> HF (IV -> interstitum)

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2
Q

FVE: cm

A

HA, confusion, lethargy, peripheral edema, JVD (IVF), S3, bounding pulse (IVF), htn, centravenous P - F in RA (ICU), polyuria (w normal function), dyspnea, pulm edema, muscle spasms, weight gain (water), seizures and coma (hypoNa)
pulm edema, peripheral edema, 3rd spacing

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2
Q

FVE: causes

A

excess isotonic or hypotonic -> older (HF)
HF, RF (not peeing), primary polydipsia (drink lots of water), endocrine (SIADH, cushing S, long term corticosteroids - also fluid retention)

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3
Q

FVD: causes

A

high insensible water loss or perspiration (high fever, heatstroke) -> insensible means cannot be measured in cylinder - breathing/fever/sweat)
SM insipidous -> endocrine
osmotic diuresis -> mannitol
hemorrhage
low intake -> no thirst, obtunded, older (most common issue)
GI loss: v, ng, d, fistula drainage
overuse of diuretics
3rd spacing: burns bc increase in cap perm, pancreatitis

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4
Q

FVD: cm

A

restless, drowsy, lethargy, confusion
thirst dry mucus (elderly!)
cold clammy
decreased turgor, decreased cap refill
postural hypoT, increased pulse (tachy bc CO = Hr x SV, so it is to maintain CO), decreased CVP
urine output, [] urine
increased RR
weak, dizzy, weight loss (water), seizure, coma

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5
Q

fluid status nc

A

daily weight (same scale, clothes, time)
I+O but unreliable
labs: BUN, Na, hct but can all be false high/low; urine and serum osmolality -> particles/solution -> [] specifically

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6
Q

FVD: nc

A

mild: oral rehyd
severe: replaces with blood (esp if d/t blood loss) or balances IV solutions (NS, LR)

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7
Q

FVE: nc

A

HF, CKD, liver
restrict

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8
Q

fluid status nc: CV

A

monitor VS
FVE = bounding
FVD = tachy to keep BP wnl, weak/thready, orthostatic hypoT

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9
Q

fluid status nc: resp

A

FVE = risk for pulm edema

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10
Q

fluid status nc: pt safety

A

Na
change in LOC, orthostatic

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11
Q

fluid status nc: skin care

A

dry v pitting edema

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12
Q

fluid status nc: fluid therapy

A

rate, hc, needed?

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13
Q

delegate

A

RN interprets assessment findings
daily weights and VS
other freq oral care
I+O, skin care and position change, encourage oral fluids as appropriate, elevate edematous extremities (FVE)

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14
Q

Na

A

major ecf cation, sucks and governs osmolality (most particles in body are Na), activate muscle/nerve cells (AP)
135 - 145

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15
Q

hyperNa: causes

A

> 145
excessive intake: hypertonic IVF, tube feed without h2o supplements - free water usually added
inadequate h2o intake: elderly, anorexia, v/d, depressed
excessive loss of h2o (Na retained): insensible water loss, d, diuretics
diseases: diabetes insipidous and cushings S are endocrine, uncontrolled DM like ketoacidosis

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16
Q

hypoNa: causes

A

< 135
excess loss: GI, renal, diuretics, skin (burns, wounds)
inadequate intake
excessive h2o gain (low Na dilution): hypotonic IVF
diseases: SIADH (counterpart to DI), HF and KF = fluid retention, cirrhosis

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17
Q

hyperNa: cm

A

cellular shrink: mental change -> HA, irritable, difficulty [], confusion, seizure, coma
if also ECF v deficit: postural hypoT, tachy, weak

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18
Q

hyperNa: nc

A

depends on cause
water loss = add h2o
Na excess = remove
monitor serum Na/osmolality
gradually over 48hr for cerebral edema

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19
Q

hypoNa: cm

A

cellular shrinking: mental change -> drowsy, restless, confused, lethargy, seizures, coma
if also ecf V excess: weight gain and htn

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20
Q

hypoNa: nc

A

mild: restrict F (HF, KF, liver disease), loop diuretic
acute: small IV hypertonic NS (3%)
avoid rapid correction (24-46hr)
safe env precaution prn

21
Q

K

A

intracellular cation, helps regulate cell excitability and electrical status

22
Q

hyperK: causes

A

excess intake: parenteral admin (40meq KCl), renal insufficiency (not clearing well)
shift out of cell: acidosis (pH), tissue catabolism, intense exercise
fail to eliminate: renal disease (oliguria), adrenal insuff

23
Q

hypoK: causes

A

excess loss: G (v/d), kidney, skin (diaphoresis), dialysis (CKD), loop and thiazide diuretics (question k sparing or need for supplement
shift into cells: high insulin release (IV dextrose), insulin therapy (w/ dka), alkalosis
lack of K intake: starvation or low diet with k, no K in IVF if NPO

24
hyperK: cm
ekg change -> cardiac dysrhythmias (put pt in tele) fatigue, irritable, muscle weak loss of tone paresthesia confusion
25
hyperK: nc
stop intake increase excretion: loop and thiazide diuretics, dialysis, patiromer or Na polystyrene sulfonate (take hrs - days to work) K into cell: insulin and dextrose, NaCO2 if acidotic (temporary fixes, keep pt safe long enough to address cause)
26
hypoK: cm
ekg change fatigue, muscle weak, cramps paresthesia
27
hypoK: nc
increase med intake (oral or IV) increase PO intake (food) IV KCl -> safety alert: always dilute, never push, should not exceed 10meq/hr unless in ICU setting and has CVAD, infiltration can cause necrosis hypoK precipitates digitoxicity (digoxin for HF) - narrow therapeutic index
28
K foods
fruits: apricot, avocado, banana, cantaloupe, dried fruits, grapefruit juice, honeydew, oranges, prunes, raisins veggies: baked/refried/black beans, butternut squash, cooked broccoli, raw carrots, greens (x kale), canned mushrooms, potatoes (white and sweet), cooked spinach, tomatoes or products, veggie juices other: bran or bran products, choc, granola, all milk, nutritional supplements, nuts and seeds, PB, salt substitutes, salt free broth, yogurt
29
Ca
effects membrane potentials and nerve excitability most Ca inside bone, provide bone strength 1% in cells (1/2 p bound, other 1/2 ionized/avail)
30
hyperCa: causes
hyperparaT hematologic: cancer -> perineoplastic disorders, cancers secrete things with no purpose (lung cancer!) others less common
31
hypoCa: causes
renal fail paraT deficiency or removed multiple blood transF (citrate used in blood binds with Ca)
32
hyperCa: cm
excess is like sedative -> decrease excitability of muscles and nerves confusion, psychosis seizures, coma
33
hyperCa: nc
mild: stop Ca meds, decrease Ca diet, increase weight bearing and maintain adequate hydration severe: IV isotonic saline, bisphosphonate (pamidronate if cancer) and calcistronin injections (increase renal excretion but short term)
34
hypoCa: cm
tetany (nerve excitability and sustains muscle contraction): chvostek (face), trousseau (carpal) ekg changes
35
hypoCa: nc
mild: diet high in Ca rich foods, Ca supplements + vit D S: IV Ca gluconate
35
Mg
stabilize heart and smooth muscle
36
hyperMg: causes
renal rail and high Mg: CKD with Maalox IV Mg (preg)
37
hypoMg: causes
GI loss and malN (low intake): d, v, NG suction, chronic OH, prolonged malN
38
hyperMg: cm
nerves and muscles slowed down lethargy, drowsy, muscle weak, decreased DTRs
39
hyperMg: nc
avoid drugs and limit intake (green veggies, nuts, bananas, oranges, PB, choc) dialysis if CKD FF if kidneys okay -> urinary excretion IV Ca gluconate if S (oppose excess Mg on cardiac muscle)
40
hypoMg: cm
nerves and muscles reved up like hypoCa: confusion, muscle cramp, tremors, seizure, vertigo, hypoactive DTRs, chvosteks/trousseaus, increased P/BP/dysrhythmias
41
hypoMg: nc
treat cause and S oral: mylanta, MgSO4 IV MgSO4: several days, IVP if needed (rapid can cause hypoT)
42
P
inverse to Ca
43
hyperP: causes
renal fial, lax/enemas w/ P, hypoparaT
44
hypoP: causes
malN, vit D def, chronic OH, severe d
45
hyperP: cm
usually asymp typically only S of hyperCa = muscle spasms, paresthesia, tetany
46
hypoP: cm
CNS depress (confusion, coma) muscle weak (resp muscles)
46
hyperP: nc
treat cause Ca based P binders (CaCO3) hemodialysis if severe
47
hypoP: nc
IV (long time) v oral replace (dairy, P supplement) resolve CKD or hyperCa

nur 334 (11 decks)

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