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Jaysha’s flash cards > Fluid, Electrolyte, & Acid-Base Imbalances, IV Therapy, Integumentary Disorders,EX > Flashcards

Fluid, Electrolyte, & Acid-Base Imbalances, IV Therapy, Integumentary Disorders,EX Flashcards

1
Q

Differentiate between crystalloid & colloid solutions

A

Crystalloid solution is water and undissolved substance its has three types
Colloid solution- water molecule and undissolved substances (blood product)

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2
Q

Describe the difference between isotonic, hypotonic, and hypertonic solutions.

A

Isotonic - contains same amount of concentration as normally found in the plasma ( helps maintain fluid balance
Hypotonic- fewer dissolved substance compared with the plasma, re hydrate the client (dehydrated patients) cells swell
Hypertonic- more concentrated draws fluid out the cell

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3
Q

difference between whole blood, packed cells, blood products, and plasma
Expanders.

A

Whole blood is administered when a client needs fluids restoration as well as blood cells.
Packed cells are preferred for client who need cellular replacement but do not need/ be harm by additional fluids
Blood products- that are extracted from blood plasma, albumin, granulocytes and cryoprecipitate. Administered to clients that need specific product not all
Plasma Expanders- non blood pull fluid into the vascular space more effective then hypertonic solution

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4
Q

nursing responsibilities when preparing the patient for IV therapy.

A

Educated the patient Purpose IV site location & any limitations Length of the procedure
Signs of complications, gather equipments, verified the patient,

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5
Q

Describe nursing actions involved in performing venipuncture, including sites and
devices commonly used.

A

Assess the client to detect alterations in fluid volume, follow the agency infection control policies, using aseptic technique when caring for the IV site or changing the equipment

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6
Q

Explain equipment that must be replaced during IV therapy

A

Solutions are replaced after infusion or 24hr, IV tubings every 72 hrs, Y tubing for blood can be reused one time, venipuncture devices are replaced every 72- 96 hrs or immediately if complications occur.

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7
Q

List complications of IV therapy and signs/symptoms for which the nurse monitors.

A

Phlebitis- inflammation of the vein, Thrombus formation- development of a clot, Localized edema if devices fail to remain in the vein, Circulatory overload - if the volume of infusing solution exceeds the heart’s ability to circulate effectively. Infection, air embolism

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8
Q

Discuss the purpose of a medication lock.

A

It allow intermittent access to the vein

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9
Q

Describe the nursing process for the patient requiring IV therapyThe nursing process for a patient requiring IV (intravenous) therapy involves several key steps:

A

Assessment: The nurse assesses the patient’s condition, including their medical history, current health status, vital signs, and specific needs related to IV therapy.
2. Planning: Based on the assessment, the nurse develops a care plan tailored to the patient’s needs. This plan includes selecting the right IV solution (e.g., saline, medication infusion), determining the insertion site, calculating the infusion rate, and considering any precautions or additional interventions needed.

  1. Implementation: This step involves the actual insertion of the IV catheter into the patient’s vein using sterile technique. The nurse administers the prescribed IV solution, monitors the infusion rate, and ensures proper functioning of the IV line.
  2. Evaluation: Continuous monitoring of the patient’s response to IV therapy is essential. The nurse assesses the patient for any signs of complications (such as infiltration, infection, or adverse reactions), evaluates the effectiveness of the therapy, and adjusts the care plan as necessary.
  3. Education and Follow-up: The nurse provides education to the patient and caregivers about the IV therapy, including the purpose, potential side effects, signs of complications, and proper care of the IV site. Follow-up care may involve routine assessment, changing IV sites, or discontinuing the therapy based on the patient’s progress.
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10
Q

List 3 chemical substances that are found in the body fluid

A

Electrolyte- substance that carry electrical charge
Acid- substance that releases hydrogen into fluid
Bases- substances that bind with hydrogen

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11
Q

2 main fluid locations in the human body and 2 subdivisions.

A

Extracellular
- Intrsituital, intravascular
Intracellular - K+ lives there

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12
Q

Identify 4 ways in which the body normally loses fluid

A

Sweating, urination, breathing, bowel movements

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13
Q

identify 5 processes in which water and dissolved chemicals are relocated in the body.

A

Osmosis, filtration, passive diffusion, facilitated diffusion, active transport

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14
Q

2 types of fluid imbalances

A

Hypovolemia, Hypervolemia, and third-spacing

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15
Q

Differentiate between the 3 types of edema.

A

Pitting edema, dependant edema- affected by gravity Brawny/ generalized edema-Fluid can no longer be
displaces excessive accumulation

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16
Q

Explain the concept of 3rd spacing.

A

ts fluid that moves out of the intravascular & intracellular space into the tissue compartments were it
become trap and useless

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17
Q

Explain the concept of 3rd spacing.

A

Its fluid that moves out of the intravascular & intracellular space into the tissue compartments were it
become trap and useless

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18
Q

Discuss the role of acid and bases in the body.

A

Acid- substance that releases hydrogen into fluid
Bases- substances that bind with hydrogen

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19
Q

Describe 2 major acid-base imbalances and subdivisions of each

A

Metabolic Acidosis & Metabolic Alkalosis
Respiratory Acidosis & metabolic Alkalosis

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20
Q

arterial blood gas findings to determine acid-base imbalances.

A

PH levels 7.35-7.45
CO2 35-45 Hco3 21-28

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21
Q

Fluids consists of

A

water, electrolytes, acids and bases

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22
Q

Intracellular VS
Extracellular

A

Intracellular fluid inside the cell wall
Extracellular fluid outside the cell walls

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23
Q

Hypovolemia- VS Dehydration

A

Hypovolemia- decrease vascular fluid
Dehydration- decrease of overall fluid in the body

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24
Q

LPN Job Duties With IVs

A

Start IVs
Maintain IV access
Administer most IV solution except ( Blood Products)
Hang most IV piggybacks

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25
Q

Reasons why we use IVs

A

For rapid drug effect
Restricted oral intake
Therapy requires continuous therapeutic blood levels
TPN ( Nutritional needs)
Blood transfusion

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26
Q

IVs Solutions

A

Crystalloid Solutions- water based with dissolved sugar & or electrolytes (Crystal Clear)
Isotonic- contains the same concentration as the dissolve substance
- administer to help maintain fluids when client temporary cannot eat or drink
Hypotonic- contains fewer dissolved substance
- administer to client that experience excessive fluid loss or no intake
Hypertonic - contains more concentration substance
- administer to draw out fluid

Colloid Solutions - used to replace circulating blood volume

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27
Q

Teaching provide IV therapy

A

Purpose
IV site location & any limitations
Length of the procedure
Signs of complications

28
Q

peripheral VS central iv

A

Peripheral IV - Inserts in the arm but runs to the SVC
Central IV- Inserts in the chest and runs directly to SVC

29
Q

Complications of IV Therapy

A

Infection, Phlebitis, Blood clot, Air bolus, Infiltration, Circulatory overload

30
Q

TPN ( Total Parenteral Nutrition)

A

Uses for severe malnourishment, inability to digest or absorb nutrition
Requires a filtered tubing & CVC/PICC
Monitor blood glucose closely

31
Q

Blood Transfusion

A

Requires 20G or higher
No medication can be added to blood
Y-type tubing

32
Q

If wrong blood type is giving

A

causes ( Flank (back) pain), Difficulty breathing, tachycardia, Hypotension
Septic- Infected blood ( fever, chills)
Rash, Itchiness, tingling fingers, Flushing face

33
Q

Body fluid is made up of 4 components

A

Water
Electrolytes
Acids
Bases

34
Q

Most body water is located

A

within cell ( intracellular fluid) mostly K+ lives there

35
Q

How do we move fluids

A

Osmosis, Filtration, Diffusion, Active transport-

36
Q

Third Spacing

A

movement of fluid from intravascular to interstitial space (useless fluid)

37
Q

What causes third spacing?

A

Malnutrition( Hypoalbuminemia), Burns, Allergic reaction, poor dietary choice (high NA in diet)

38
Q

Assessment findings, Management of third spacing

A

Assessment findings
Edema, elevated H&H
Management
Fluids, Albumin infusion, correcting nutrition
Correcting third-spacing to quickly can lead to fluid shift that may stress out the cardiovascular system, shock or hypotension

39
Q

Sodium- essential for maintaining what?

A

normal nerve and muscle activity, regulating osmotic pressure, and preserving acid-base balance.

40
Q

Hyponatremia

A

Causes- Lack of sodium
Excessive diaphoresis (sweating), excessive ingestion of plain water, administration of nonelectrolyte IV fluids, excessive diuresis, loss of GI secretion Vomiting
Signs & symptoms-
Mental confusion, muscular weakness, anorexia, restlessness, elevated blood temp, tachycardia, nausea, vomiting and personal changes.
Treatment-
Oral administered sodium (foods high in sodium), IV solution

41
Q

Hypernatremia

A

Cause-
water diarrhea, excessive salt intake without sufficient water intake, high fever, decrease water intake, excessive administration of solution that contain sodium, severe burns, excessive water loss without loss of sodium
Sign & symptoms
Thirsty, dry sticky mucous membrane, decrease urine output, fever, rough dry tongue, lethargic
Treatment
Drink water, IV hypotonic solution

42
Q

Hyperkalemia

A

Causes
Severe renal failure (kidney cannot excrete potassium), severe burns, administration of potassium-sparing diuretics, overuse of potassium supplements,crushing injuries,
Signs Symptoms
Diarrhea, nausea, muscle weakness, parentheses, and cardiac arrhythmia
Treatment
Decrease intake of potassium, IV administration

43
Q

Hypokalemia

A

Causes- potassium- wasting, loss of fluid from the GI, large dose of corticosteroids
Signs Symptoms
Fatigue,muscle/ weakness, and paresthesia, anorexia, nausea,vomiting cardiac arrhythmia
Treatment
Oral intake of potassium-rich foods, potassium oral replacement

44
Q

Magnesium

A

transmission of nerve impulses and muscle excitability

45
Q

Hypomagnesemia

A

Causes
Chronic alcoholism, diabetic ketoacidosis, severe renal disease, severe burns, severe malnutrition, pregnancy-induced hypertension, intestinal malabsorption syndromes, excessive diuresis
Sign Symptoms
Tachycardia, cardiac arrhythmia, neuromuscular irritability, paresthesia of extremities, leg and foot cramps, hypertension, mental changes *positive Chvostek and trousseau sign, dysphagia and seizure
Treatment
Administer oral magnesium/ rich food, treat with IV

46
Q

Hypermagnesemia

A

Causes- renal failure, excessive use of antacids or laxative
Signs symptoms
Flushing, warmth, hypertension, lethargy, drowsiness, bradycardia, muscle weakness, depressed respiration and coma
Treatment
Decreasing of oral magnesemia, hemodialysis

47
Q

Integumentary system
Consist on

A

hair, nails, skin, sebaceous glands and nerve endings

48
Q

Integumentary system function

A

Provided protection
Temp regulation
Sensory information
Chemical synthesis-(Vitamin D production)

49
Q

Layer of the skin

A

epidermis -outerlayer
Dermis- Contains a lot of elastic fibers, blood vessels, sensory/motor nerves, sweat &
sebaceous glands, & hair follicles
Subcutaneous (hypodermis)- fat, connective tissue

50
Q

Proteins of the skin

A

Keratin- tough protein to provide protection in epidermis
Melanin- protect the skin for sun damage

51
Q

Glands

A

Sebaceous(oil) - produce sebum to lubricate skin prevent dry/cracked/skin/hair ( overproduction produce acne)
Eccrine- located everywhere ( releases excess water/electrolytes)
Apocrine- nipple, genital,eyelid,ear canal (odorless unless mix with bacteria)

52
Q

Dermatitis

A

inflammation of the skin: localized or generalized
Etiology- Allergic contact or primary irritant
Signs symptoms- blood vessel dilation, itching, vesiculation
Diagnostic finding- visual examination, skin patch test
Medical management- flushing skin with cool water, topical corticosteroids, wet dressing

53
Q

Acne Vulgaris

A

affects the sebaceous glands and hair follicles
Etiology- overproduction of sebum
Signs and symptoms-Oily scalp, comedones (black head)
Diagnostic finding- visual examination
Medical management- facial cleaning drying agents
containing benzoyl peroxide; topical, oral drugs; antibiotics; removal with
instruments; dermabrasion
Nursing Management- educated the patient

54
Q

Rosacea

A

skin disorder manifests in variety of ways generally characterized by rosy cheeks
Cause- genetic, bacteria of the skin,UV light exposure,
Etiology- Helicobacter pylori, mites, telangiectases
Signs and Symptoms
Intermittent blushing, papules, pustules, facial swelling, rhinophyma
Medical and Surgical Management: oral antibiotics, topical medications, pulsed
light treatment

55
Q

Plaque Psoriasis

A

Chronic, noninfectious inflammatory skin disorder
Etiology - likely genetic predisposition, keratinocytes, plaque
Signs and symptoms- Erythema with silvery scales, lesions
Diagnostic finding- visual examination, skin biopsy
Medical management - symptomatic treatment, drug therapy, biologic therapy,
Photochemotherapy

56
Q

Furuncles, Furunculosis, Carbuncles

A

Furuncle- is a boil Furunculosis- multiple furuncle Carbuncle- furuncle drain pus
Etiology- skin infection, diabetes mellitus
Signs and symptoms- Painful pustule surrounded by erythema, fever, anorexia, weakness, malaise (discomfort)
Diagnostic finding Culture of exudate identifies the pathogen
Medical management- hot, wet soaks; antibiotics; surgical incision, drainage (I&D)

57
Q

Scabies

A

common infection skin diseases
Etiology - itchy mites; spread from skin to skin
Signs symptoms - itching , excoriation( abrasion of the skin) webs of fingers other inner crevice
Diagnostic findings- visual examination, ink or mineral oil test
Medical management- scabicide application; thorough bathing, clean clothing,
avoiding contact with those infected

58
Q

Dermatophytosis (Ringworm, athlete foot, jock itch)

A

Signs and symptoms- rings of papules or vesicles, sore skin
Medical management- oral, topical antifungal agent

59
Q

Herpes Zoster ( Shingles)

A

Inflammation in the dermatome( a skin vesicle area that follows the nerve pathway
Signs and symptoms
Fever, headache, vesicles, itching
Medical management
Oral or topical acyclovir; corticosteroid, vaccine
Nursing management
Avoid contact with immunocompromised and people who have not had chickenpox

60
Q

Skin Cancer

A

Exposure to UV radiation; low skin melanin
Signs and symptoms
New appearance of growth; change in skin color; skin lesion
Diagnostic findings
Visual inspection, biopsy
Medical management
Electrodesiccation, surgical excision, cryosurgery, radiation therapy
Nursing management
Exam ABCDE

61
Q

Scleroderma

A

Scleroderma is an autoimmune connective tissue and rheumatic disease that causes
inflammation in the skin and other areas of the body. When an immune response tricks tissues
into thinking they are injured, it causes inflammation, and the body makes too much collagen,
leading to scleroderma.
Calcinosis: Calcium skin deposits
Raynaud’s phenomenon: A condition in which the blood vessels of the fingers and toes spasm when triggered by factors, such as cold, stress or illness. Cold, painful or numb fingers and toes result, which in severe cases may become gangrenous. Learn more about Raynaud’s phenomenon.
Esophageal dysfunction: Problems with the esophagus
Sclerodactyly: Skin damage on fingers
Telangiectasia: Spider veins

62
Q

Alopecia

A

Pathophysiology and Etiology: alopecia areata, androgenetic alopecia (male
pattern baldness)
Assessment Findings: Signs and Symptoms
Thinning hair
Diagnostic Findings: determined by suspected physical disorder
Medical and Surgical Management: treating the underlying medical disorder, drug
therapy, hair replacement surgery, hair grafting, scalp reduction, skin flap transfer
Nursing Management

63
Q

Onychomycosis

A

Fungal infection
Signs and symptoms
Thick, distorted; yellow friable nails
Diagnostic finding
Visual inspection, microscopic examination
Medical management
Prolonged systemic drug therapy, nail removal, surgery

64
Q

Pediculosis (Head Lice)

A

Etiology - transmitted through direct contact
Signs and symptoms
Itching of the scalp; small, yellow-white ovals(nits) attached to hair shaft; small gray nymphs; silvery eggs(nits) attached to hair shaft
Diagnostic finding
Scalp, hair inspection
Medical management
Pediculicides, mechanical removal

65
Q
A

Jaysha’s flash cards (14 decks)

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