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Lake Land 2016 > Fluid balance, CHF, Clotting > Flashcards

Fluid balance, CHF, Clotting Flashcards

1
Q

WHat treats digoxin toxicity?

A

Digoxin immune fab, phenytoi or lidocaine

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2
Q

Why would you give morphine for CHF?

A

slows breathing to decrease oxygen demand, decreases anxiety

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3
Q

Why is low BP bad for a graft patient?

A

circulation has to be good or you could have clotting, and it could be a sign of hypovolemic shock

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4
Q

normal INR

A

0.9-1.2… on Coumadin 2-3

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5
Q

visual lab routine special

nurse watches out for these with diuretics

A

visual: signs of dehydration
labs: potassium level (up or down depnding on whether wasting or sparing), low sodium, low chloride, high blood sugar,
routine: low BP, watches I&O
special: weight gain

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6
Q

I think pt has FVE. Hct is 20, BUN is 8. Am I right?

A

Probably. Hct and BUN are usually low because of hemodilution in FVE, and normal HCT is 37-54, normal BUN is 9-23.

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7
Q

Why would you give aminophillin (Norphyll) for CHF?

A

it is a bronchodilator and vasodilator

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8
Q

6 p’s of nbypass surgery

A

pallor, paralysis, paresthesia, pulselessness, pain, poikolothermia

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9
Q

Watch out for these signs of compartment or worsening compartment syndrome.

A

look: slow cap refill, pallor, edema
touch: cold,
ask: numb, tingling, pain

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10
Q

look ask listen routine special

CHF nursing assessments

A

look: edema, JVD
ask: LOC
routine: I&O
listen: lung sounds, heart sounds,
special: daily weight

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11
Q

Look at my BUN. It’s 81. Do I have HF or none?

A

HF. Normal BUN is 9-23, and your kidneys aren’t getting good circulation

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12
Q

Why is hypokalemia so bad for CHF pts?

A

it causes tachycardia

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13
Q

normal PTT

A

55-75 sec

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14
Q

Arterial insufficientcy- dangle or raise legs?

A

dangle

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15
Q

sx of abdominal aortic aneurism

A

abdominal, flank or back pain (gnawing), pulsating abd mass, nausea

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16
Q

Isotonic IV fluids are

A

0.9% NS, Lacttated Ringers, D5W

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17
Q

a/o means

A

alert and oriented

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18
Q

give special listen routine

CHF nursing interventions

A

give: O2/digoxin/diuretics as ordered,
special: sodium/fluid restriction, daily weights, watch for side effects (digoxin, diuretics), monitor ekg changes,
listen: assess heart sounds, assess for cough/dyspnea
routine: i&O, rest, comfort care, avoid stress, pt education

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19
Q

Fluid volume excess inteventions

A

raise HOB, notify MD, slow the IV fluids, monitor VS

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20
Q

signs of digitalis toxicity

A

hypokalemia, visual disturbance, fatigue, arrhythmia, anorexia

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21
Q

my creatinine level is 5. is that ok?

A

no. normal is 0.5 to 1.3. Your kidneys are not working.

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22
Q

What is the tool to remove a clot?

A

fogarty catheter

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23
Q

What labs do you need to give digoxin?

A

potassium and digoxin

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24
Q

Nurse process planning for dehydration

A

rehydration, comfort measures, medication therapy for the cause, client education

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25
BUN is 8. Are they more likely dehydrated or overhydrated?
overhydrated. Those buns are floating in so much water there are only 8 per square meter instead of the normal 9-23.
26
infant FVE shown by
bulging fontanel
27
Causes of hypertonic dehydration
watery diarrhea, inadequate fluid intake, diabetes isipidous, too much solute intake
28
My patient's digoxin level is 2.1 mg/dL. Can I give the next dose?
no. Normal is 0.8 to 2.0
29
What could happen to blood vessels to impair perfusion?
atherosclerosis (gunk in artery), arteriosclerosis (narrowing), vessel insufficiency, clots
30
Why check potassium with digoxin?
it causes diuresis, so potassium can be lost
31
Why give ACE inhibitors for FVE?
It will stop the RAAS system so it will thirst from being stimulated, keep the body from making ADH, prevent vasoconstriction, prevent sodium retention, prevent water retention, allow diuresis
32
Normal resp rate
12-20
33
why would right sided HF cause kidney malfunction?
blood is diverted away from kidneys because it is needed more elsewhere
34
Why would you give nitroglycerine for CHF?
it is a vasodilator, decreasing afterload
35
CHF nursing diagnoses
fluid volume excess r/t ind cardiac output, anxiety r/t dyspnea & heart dysfunction
36
-prils are
antihypertensives
37
Why would you elevate my head when I have CHF?
blood will pool in your legs, decreasing preload
38
CABG means
coronary artery bypass graft
39
side effects of beta blockers
bradycardia, lethargy, GI disturbance, low BP, depression, CHF symptoms. Don't stop taking suddenly!
40
afterload def
resistance that must be overcome to circulate blood
41
Class 1 cardiac disability means high or low level of disability?
low, zero physical limitations
42
FVE diagnostics
chest xray, Hct, BUN, ABG
43
Why would you want digoxin to slow the haert rate for CHF?
ventricles will fill more completely with the blood that has backed up into the veins, the heart will use less oxygen for its work, heart size decreases, diureses occurs
44
beta blockers affect this organ. How do they work?
Heart. They block epinephrine form stimulating HR and BP. They reduce HR, contraction force, and rate of conduction
45
Nicotine's effect on blood vessels
vasoconstrictor
46
Why is decreasing venous return a goal of CHF treatment?
to decrease preload
47
Where do you do inflow graft?
above the superficial femoral arteries
48
WHy take beta blockers?
antihypertensive
49
O2 and CO2- low or high in FVE
02 low, CO2 high
50
MD will order this for FVE
fluid restriction, diuretics, ACE inhibitors
51
Serum osmolality is 265. Is FVE likely?
yes, normal is 280-300 in adults. Osmolality increases in dehydration, decreases in FVE.
52
Why heparing and Coumadin?
Coumadin will be needed outpatient, and it has a long onset.
53
signs of venous insufficiency
legs: brown discoloration, edema, dry flaky skin, ankle/calf ulcers. they DO have pulse and cap refill, pain helped by leg elevation
54
FVE nursing diagnosis
impaired gas exchange
55
What causes graft occlusion?
clots, infection
56
What happens to heart rate when dehydration subsides
it decreases because oxygen carrying blood is more available
57
Hct is 61. Are they more likely dehydrated or overhydrated?
dehydrated because they have hemoconcentration. That drop of water has 61 critters crowded onto it, and if there was more water, each would have 37-54 critters on it.
58
why would right sided HF cause nocturia
lying down with edema will cause fluid reabsorption
59
avg water intake, minimum water intake
daily: 2600mL, minimum 1500mL
60
How does cholesterol affect afterlaod?
increases it by increasing resistance to blood flow
61
Client's ABG PO2 is 70, PCO2 is 50. Is FVE likely?
yes, normal PO2 is 80-100, normal CO2 is 35-45
62
Assessments for FVE
neck- JVD, chest: CVP (central venous pressure), crackles, wheezing, ankles: periph edema, routine: VS (BP, HR, RR), urine output special: acute weight gain, high urine concentration
63
manifestation of left sided HF
exertional dyspnea, orhtopnea, cough, adventitious breath sounds, restlessness, anxiety, cynaosis, increased HR, fatigue, crackles, wheezes, blood tinged sputum
64
DVT interventions
bed rest, warmth to vasodilate, elevate limb to reduce pressure
65
Causes of hypotonic fluid excess
tap water enema, water intoxication, pushing IV fluids too fast
66
Why would you give digoxin for CHF?
increase contractility,
67
Why would FVE cause anorexia and nausea?
ascites
68
Where do you do an outflow grafts?
below the superficial femoral arteries
69
why do you cough with left sided heart failure
increased pressure in the heart has caused blood to back up into the pulmonary circulation
70
priority aneurism intervention
maintain BP
71
Hypertonic IV fluids are
3.0% saline, D5NS, D51/2NS, D5LR, Normosol-R
72
# prompt Surgery stress causes FVE by what mechanism?
Stress causes renin secretion.
73
Type of FVE in kidney failure
isotonic
74
70x70=4900 means what to me
heart pumps 70mL 70 times a minute, 4900ml a minute (@5L)
75
normal aPTT
23.3-31.9 sec
76
Why does it matter if PAD id from venous or arterial occlusion?
Elevate legs if venous. Elevate head if arterial.
77
list vasodilators
nitroglycerine, hydralazine (Apresoline), minoxidil (Rogaine)
78
Avoid this on heparin
vitamin K, aspirin, bleeding risk
79
PAD interventions
positioning, avoid nicotine/stress/cold
80
Hypotonic fluids are
1/2 NS (0.45%), 1/4 NS
81
why would leg, arm, etc. muscles atrophy in R sided HF?
reduced perfusion
82
PAD assessments
tissue perfusion, treatent compliance, wound care, education, home hazards (rugs, hot water)
83
What time should thiazide diuretics be given?
morning because they have long half-life
84
2 kinds of positive inotropic drugs
beta blockers and digitalis
85
Name important drug suffixes.
-zide for thiazide diuretics, pril for ACE inhibitors, -sartan for ANgiotensin II receptor blockers, olol for beta blockers,
86
noram glucose levels
74-106
87
Why does super high blood sugar causes confusion?
Sugar is a solute that pulls water out of brain cells.
88
Pt with FVE has sodium level of 119. WHy?
The sodium is diluted.
89
nursing assessment Qs for dehydration
history, age, acute weight loss, thirst, urine volume, urine color
90
Preload def
wall stress in ventricales at the end of the Filling phase (diastole)
91
manifestation of right sided HF
**dependent edema,** hepatomegaly and **liver** tenderness, **ascites**, GI distress, anorexia and nausea, respiratory distress, nocturia, fatigue, **DJV,** weight gain, increased BP
92
what lab values do we monitor with heparin
PT, PTT, INR
93
monitor during dehydration therapy for
confusion, IV infiltration, lung sounds, BP, urine output, heart rate
94
Nurse interventions for FVE
elevate HOB, client education, monitor for signs of dehydration or electrolyte imbalance due to therapy
95
Causes of hypotonic dehydration
water intoxication, renal failure

Lake Land 2016 (9 decks)

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