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medsurg > Unit #1 > Flashcards

Unit #1 Flashcards

1
Q

Lab value: Sodium (Na+)

A

135-145

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2
Q

Lab value: Potassium (K+)

A

3.5-5.0

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3
Q

lab value: Calcium (Ca+)

A

8.5-10.5

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4
Q

lab value: Magnesium (Mg+)

A

1.3-2.1

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5
Q

lab value: Chloride (Cl-)

A

97-110

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6
Q

lab value: Phosphate (PO4)

A

2.5-4.5

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7
Q

lab value: Hydrogen ion concentrate or potential of Hydrogen (pH)

A

7.35-7.45

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8
Q

lab value: Partial pressure of Oxygen (PaO2)

A

80-100

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9
Q

lab value: Carbon dioxide (CO2)

A

35-45

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10
Q

lab value: Partial pressure of Carbon Dioxide (PaCO2)

A

35-45

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11
Q

lab value: Bicarbonate (HCO3)

A

24-30

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12
Q

lab value: Carbonic Acid (H2CO3)

A

1.2

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13
Q

lab value: BUN

A

8-25

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14
Q

lab value: Creatinine

A

0.6-1.5

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15
Q

lab value: Glucose

A

65-110

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16
Q

lab value: Serum Osmolality

A

280-300

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17
Q

lab value: Hematocrit percentage (Hct)

A

36%-52%

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18
Q

S/Sx of Hypernatremia

A

fluid overload- will see: lethargy, drowsiness, stupor, or comatose)
deep tendon reflexes decrease- will see muscle weakness, twitching, etc.

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19
Q

Disease process with Hypernatremia

A

Kidney failure- poor kidney excretion

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20
Q

Tx for Hypernatremia

A

Diuretics to promote Na loss

ie: Lasix or Bumex

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21
Q

S/Sx of Hyponatremia

A

Sudden onset acute confusion or increased confusion- can see seizures, coma, or death
General muscle weakness- will see decrease tendon reflexes

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22
Q

Disease process for Hyponatremia

A

Prolonged use of diuretics

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23
Q

tx for Hyponatremia

A

decreased use of diuretics, give IV fluids

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24
Q

S/Sx of Hyperkalemia

A

Bradycardia, hypotension, ECG changes (peak T waves)

tingling/burning sensations followed by numbness in hands and feet

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25
Q

Disease process for Hyperkalemia

A

hospitalized pts undergoing treatment, chronically ill, elderly pts, or kidney failure

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26
Q

Tx for Hyperkalemia

A

Give Potassium-excreting diuretics (loop diuretics- lasix)

Stop all potassium food/drug sources

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27
Q

S/Sx of Hypokalemia

A

Shallow respirations, check mucus membranes and nail beds

muscle weakness, orthostatic hypotension

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28
Q

Disease process for Hypokalemia

A

Cushing’s syndrome, diuretics, corticosteroids, insulin drip (regular insulin)

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29
Q

Tx for Hypokalemia

A

Give IV or PO potassium, change to potassium sparing diuretics

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30
Q

S/Sx of Hypercalcemia

A

Renal stones, bone pain, abdominal pain, N/V

Polyuria, insomnia

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31
Q

Disease process for Hypercalcemia

A

Hyperparathyroidism

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32
Q

Tx for Hypercalcemia

A

re-hydration, increase salt intake

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33
Q

S/Sx of Hypocalcemia

A

petechiae, Chvostek’s sign (facial twitch on one side)

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34
Q

Disease process for Hypocalcemia

A

Hypoparathyroidism, vitamin D deficiency

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35
Q

Tx for Hypocalcemia

A

IV calcium gluconate

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36
Q

S/Sx of Hypmagnesemia

A

Weakness, N/V, decreased Resp rate

Decreased BP, decreased blood Calcium

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37
Q

Disease process for Hypermagnesemia

A

Kidney failure, over dose of antacids and laxatives

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38
Q

Tx for Hypermagnesemia

A

IV calcium gluconate

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39
Q

S/Sx of Hypomagnesemia

A

muscle cramps, abnormal Heart rate or rhythms

tremors, parasthesia

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40
Q

Disease process for Hypomagnesemia

A

Chronic diarrhea, malabsorption, alcoholism. or diuretics

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41
Q

Tx for Hypomagnesemia

A

PO Magnesium or IV Magnesium Sulfate

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42
Q

To decrease pH level, give:

A

Bicarb

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43
Q

5% dextrose in water

A

hypotonic or isotonic

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44
Q

0.9% Sodium Chloride

A

isotonic

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45
Q

5% dextrose in 0.9% Sodium Chloride

A

Hypertonic

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46
Q

5% dextrose in 0.45% Sodium Chloride

A

Hypertonic

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47
Q

Lactated Ringers

A

isotonic

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48
Q

3% normal Saline

A

Hypertonic

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49
Q

5% dextrose in Lactated Ringers

A

hypertonic or isotonic

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50
Q

Isotonic solutions are similar to:

A

blood serum (stays in the vascular space and expands volume)

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51
Q

Hypertonic solutions:

A

pulls fluids out of cells, into the vascular space (given for fluid overload)

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52
Q

Hypotonic solutions:

A

pull fluids into the cells, out of the vascular space (given for dehydration)

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53
Q

3 advantages of IV therapy:

A

Therapeutic effect is quicker
Control over rate of administration
Great for pts who cannot tolerate otehr routes

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54
Q

3 disadvantages of IV therapy:

A

CANNOT reverse toxic dose as quickly or effectively
Increased drug to drug interference
Can be more expensive

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55
Q

3 common complications of IV therapy:

A

Phlebitis- inflammation of vein
Infiltration- fluids leak into tissues
Thrombosis- blood clot in vein caused by extremes in osmolarity or pH

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56
Q

Advantages and Disadvantages of PICC lines

A

Advantage: decreased r/f infection, short-term use
Disadvantage: easily damaged

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57
Q

Advantages and Disadvantages of Tunneled CVC

A

long-term (wks-months), harsh meds, no surgery, is placed RAD, 1-3 lumens
Disadvantage: Radiation exposer, used weeks-months

58
Q

Advantages and Disadvantages of Implanted Ports

A

Advantage: long-term 1+ years, 1-2 lumens, decrease r/f infection
Disadvantage: needle stick access, surgically implanted

59
Q

Advantages and Disadvantages of Non-Tunneled CVC

A

Advantage: short-term, 1-4 lumens
Disadvantage: Increased r/f infection, easy to fall out

60
Q

Acid-Base Balance

A

occurs through control of Hydrogen ion production and elimination
the body wants homeostasis

61
Q

Increase Hydrogen ions = decreased pH =

A

ACIDOSIS

62
Q

Decrease Hydrogen ions = increased pH =

A

ALKALOSIS

63
Q

Abnormal Acid-Base causes:

A

reduces the function of hormones and enzymes, changes distribution of electrolytes causing fluid/electrolyte imbalance, changes excitable membranes making body systems more or less active, and decreases the effectiveness of many drugs (acidosis)

64
Q

Acids

A

releases hydrogen ions to increase pH

65
Q

Bases

A

bind to hydrogen ions decreasing pH

66
Q

Buffers

A

react to acids or bases depending on the acid-base balance

67
Q

Carbonic Acid (H2CO3) is considered:

A

an UNSTABLE element

68
Q

Sources of Acids:

A

Carbohydrates
Fats
Lactic acid
Cell destruction
**COPD pts need low carb, high protein diet to decrease CO2 retention
**Increased lactic acid- depleted O2 stores with sepsis

69
Q

Sources of Bicarbonate:

A 
Oral intake of bicarb
Pancreatic production
Kidney reabsorption 
Breakdown of carbonic acid 
**Needs kidney function to produce bicarb, to pee out acids (kicks in @ 24hr)
70
Q

1st line of defense:

A

Buffers

71
Q

Buffers

A

chemicals buffers: bicarb or phosphate (binds to H to pee it out)
protein buffers: albumin or globulins or hemoglobin
**Bicarb- Hgb acts like a sponge and pulls in extracellular acid- will let go of extra acids when in acidotic state

72
Q

2nd line of defense:

A

Respiratory system (kicks in quickly and short lived)

73
Q

Respiratory System:

A

Acidotic state= Increased rate and depth of breathing to get rid of acids (blow off CO2)
Increased H+ = increased acid = Increased K+ (goes outside the cell) = CARDIAC ISSUES, muscle, respiratory, and CNS dysfunction

74
Q

3rd line of defense:

A

Kidneys

75
Q

Kidneys

A

takes 24-48 hours to respond
increase excretion and reabsorption rates
Excrete BICARB when blood H+ levels low, reabsorbs bicarb when blood H+ is high
**Formation of ammonium or phosphate in urine traps H+ for excretion

76
Q

Compensation:

A

body adapts to attempt to correct changes in blood pH and maintain A-B balance within normal range (7.35-7.45)
Respiratory compensation- rapid but easily overwhelmed
Kidney compensation- requires time, production/reabsorption of bicarb
*** Means body mechanisms are working; pH is maintained.

77
Q

Acidosis

A

pH below 7.35

78
Q

Causes of Metabolic Acidosis:

A

DKA, starvation, seizures, heavy exercise. fever, hypoxia, ischemia, kidney or liver failure, dehydration, diarrhea

79
Q

Causes of Respiratory Acidosis:

A

Respiratory depression, electrolyte imbalance, inadequate chest expansion, airway obstruction, head trauma, increased intracranial pressure.

80
Q

Assessment for ACIDOSIS:

A

History: smoking Hx, diet, opioid use, etc.
Skin- pale skin, mottling (decreased perfusion)
Psychsocial- change in behavior
Labs- electrolytes and ABGs

81
Q

S/Sx of Respiratory Acidosis:

A

low pH, high CO2, high K+, normal or low bicarb, low PaO2

82
Q

S/Sx of Metabolic Acidosis:

A

low pH, low to normal CO2, low bicarb, normal or low PaO2, increased anion gap
**heart problems caused by increased K+ = wide QRS complex

83
Q

Intervention for Metabolic Acidosis:

A

hydration, medications (insulin and anidiarrheals), cardiac monitoring, close observation, fall precautions, skin care, treat underlying cause, bicarb replacement

84
Q

Interventions for Respiratory Acidosis:

A

improve ventilation and oxygenation, medications (bronchodilators, anti-inflammatories), cardiac monitoring, pulmonary hygiene, ventilator support, frequent vital signs, respiratory assessment
** CYANOSIS IS LATE FINDING

85
Q

Alkalosis

A

pH greater than 7.45

86
Q

Causes of Metabolic Alkalosis:

A

increase in base excess or decrease of acid, results of base ingestion; massive blood transfusion, NG suctioning or vomiting, thiazide diuretics

87
Q

Causes of Respiratory Alkalosis:

A

excessive loss of CO2 from fear, pain, inadequate ventilator support, fever, CNS lesions, salicylate toxicity, shock, early stage pulmonary problems

88
Q

S/Sx of Alkalosis:

A

dizziness, tingling, cramps, agitation, confusion, hyperfelxia, tetany, twitches, weakness, hypokalemia, depressed respiratory effort, hypotension, elevated HR, thready pulse, hyperventilation

89
Q

Interventions for Alkalosis:

A

prevent loss of H+, K+, Ca+, Cl-
restore fluid balances
patient safety for muscle weakness, CNS changes, hypotension, falls
Assess therapy used (NG suctioning, diuretics) to prevent further H+ loss
HYDRATION

90
Q

Oxyhemoglobin Disassociation Curve

A

Oxygen and Acid-Base changes the ability of teh oxygen to jump off changes
** can reach a point when oxygen can no longer jump off

91
Q

Question: A nursing instructor is explainig acid-base imbalance to a group of nursing students. Which statements by the instructor are correct regarding the body’s attempt to restore acid-base balance?

A

renal compensation is slow and long lasting

respiratory compensation is fast but temporary

92
Q

Question: A nurse is caring fora client who is at risk for metabolic acidosis. Which mechanism should the nurse identify as the first line of defense against changes in the pH of the blood?

A

Buffers: Bicarbonate, Phosphorus, and Hemoglobin

93
Q

Question: A nurse obtains the recent medical history of a newly admitted client. Which factors in the client’s history should the nurse identify as placing the client at risk for respiratory acidosis?

A

Oxycodone use and PNA

causes decreased respiratory efforts

94
Q

Question: The nurse prepares to interpret the ABG values of a client diagnosed with an acid-base imbalance. Which values are most important for the nurse to consider?

A

pH
PaO2
PaCO2
HCO3

95
Q

Question: A nurse assesses a pregnant client in her first trimester of pregnancy who has been vomiting for 3 days. The client is diagnosed with hyperemesis gravidarum. The nurse should correctly identify that the client is experiencing which fluid and acid-base imbalance?

A

Fluid volume deficit and metabolic Alkalosis

96
Q

Qualitative

A

focuses on MEANING and INTERPRETATION of human experience

**not always reliable, similar to subjective data

97
Q

Quantitative

A

MEASURABLE information and statistical analysis

98
Q

PICOT

A 
Population
Intervention
Comparison 
Outcome 
Time
99
Q

Fantastic Four research databases:

A 
Cochrane Library 
Joanna Briggs Institute 
Medline (MedPub)
CINAHL 
**AHRQ-- free research library
100
Q

Steps of EBP Process:

A
  1. ask the burning questions
  2. Find best evidence available to answer questions
  3. Critically appraise relevant evidence
  4. Make recommendations
  5. Implement accepted recommendations
  6. Evaluate outcomes.
101
Q

Scope of Nursing

A

Promote health and prevent illness/injury

**generalist- know a lot about a lot of things

102
Q

QSEN KSAs

A 
Communication 
Compassion
Culture 
Patient education and empowerment 
Respect patients and family
103
Q

SBAR

A 
Situation 
Background 
Assessment 
Recommendations
**communication tool
104
Q

Delegation

A

transferring of tasks/activity
always accountable for tasks delegated
**NEVER delegate to someone if not in their scope

105
Q

Supervision

A

guidance, direction, evaluation, follow-up to ensure task performed appropriately

106
Q

Delegation vs Supervision

A

Delegation is pt care related

Supervision is workplace/efficiency related

107
Q

Five Rights of Delegation

A 
Right TASK
Right CIRCUMSTANCES
Right PERSON
Right COMMUNICATION 
Right SUPERVISION
108
Q

Question: The nurse is caring for a patient who has been admitted for heart failure. The patient begins to display signs of confusion. The nurse obtains vital signs showing that the BP dropped from 132/78 to 108/60, and his pulse is 115bpm. What is the appropriate action?

A

Activate the Rapid Response Team.

109
Q

Question: The nurse observes an increased incidence of contaminated blood cultures as indicated by lab report, thus requiring that the blood be redrawn. what quality improvement step could the nurse implement to reduce the blood culture contamination rates?

A

Evaluate trends and develop a plan for improvement.

110
Q

Homeostasis

A

Proper functioning of all body systems

111
Q

Filtration

A

Movement of fluid through cells or blood vessels

112
Q

Hydrostatic Pressure

A

“water-pushing pressure”

ie: blood pressure

113
Q

Diffusion

A

movement of particles across a permeable membrane

114
Q

Osmosis

A

Movement of water

115
Q

Minimum urine output need to excrete toxic waste

A

400-600ml/day

116
Q

Aldosterone balances

A

Sodium (Na+)

117
Q

Antiduretic hormone holds on to

A

water

118
Q

Natriuretic peptides are the body’s attempt to rid

A

water

normal value 449mg/mL

119
Q

Kidneys- are major regulators of:

A

water and sodium balance,

maintains blood and perfusion pressure

120
Q

Renin-angiotensin 2 pathway is stimulated by

A

shock or stress response

121
Q

Minimum urine per hour

A

30mL, below 30 requires intervention.

122
Q

ACE Inhibitors

A

block angiotensin 2 receptors, the blood pressure lowers

123
Q

1 Liter water weighs

A

2.2 pounds = 1 kg

124
Q

Weight change of 1 pound =

A

fluid volume change of 500mL

**best way to measure: DAILY WEIGHT

125
Q

Drink MORE water with diuretics to:

A

STOP R-A pathway from kicking in

126
Q

Alcoholics will have INCREASED BP because

A

of the Renin-Angiotensin pathway effect on body

127
Q

Fluid Overload:

A

Listen to HR and Lungs
give Lasix
restrict sodium/fluids
will see: edema, numbness, crackles, increased BP and RR, altered LOC; HA, renal failure, decreased urine

128
Q

Potassium is _____ and Sodium is ______.

A

K+ is intracellular

Na+ is extracellular

129
Q

Hyponatremia is caused by

A

NPO status, diaphoresis, decreased intake of Na, fluid overload, dehydration

To increase NA: given IV Lasix

130
Q

Hypernatremia is caused by

A

Increased intake of Na, Increased aldosterone, too much IVF

To decrease Na: give ISOTONIC fluids

131
Q

Potassium regulates

A

protein synthesis, glucose use and storage

132
Q

Hypokalemia is caused by

A

NG suctioning, diuretics, NPO, Vomiting or diarrhea

To increased K+: give IVF, PO/IV K+

133
Q

Hyperkalemia is caused by

A

renal failure, crush injury, burns, Potassium sparing diuretics, salt substitutes/food intake, Diabetes

To decrease K+: give Kayexalate, IVF, dialysis

134
Q

Calcium is responsible for:

A

heart health, muscle health, and bone health

135
Q

Hypocalcemia is caused by:

A

decreased vitamin D, hypoparathyroidism, Chrone’s disease, pancreatitis, Short-bowel syndrome

to assess: check cheek and BP cuff response

136
Q

Hypercalcemia is caused by:

A

increased calcium intake, bone demineralization, osteoporosis, dehydration.

137
Q

Phosphorus is in a reciprocal relation ship with:

A

Calcium
Increased phosphorus = Decreased Calcium
Decreased phosphorus = Increased Calcium

138
Q

Hypophosphatemia is caused by

A

antacids and starvation

139
Q

Hyperphosphatemia is caused by

A

renal failure and alcoholism

140
Q

Magnesium is responsible for:

A

neurovascular systems, muscle contraction/relaxation

** if Ca+ increased Mg+ increased \ if Ca+ decreased Mg+ decreased

medsurg (6 decks)

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