UNIT 6 Flashcards
(120 cards)
1
Q
Body Fluid
A
A mixture of water, chemicals called elctrolytes and nonelectrolytes, and blood cells.
2
Q
Fluid Compartments
A
Where body fluid is located.
usually two general components
3
Q
Intracellular Fluid
A
- Fluid inside the cell
- Represents the greater portation of water in the body.
4
Q
Extracelluar Fluid
A
- Remaining body fluid
- Fluid outside the cell
5
Q
Interstitial Fluid
A
Fluid in the tissue space between or around cells
6
Q
Intravascular Fluid
A
The watery plasma,or serum, portion of the blood
7
Q
Electrolyetes
A
- Chemical compounds such as sodium and chloride
- Essential for maintaining cellualar, tissue, and organ functions
8
Q
Ions
A
Substances that carry either a positive or a negative electrical charge
9
Q
Cations
A
Electrolyetes with a positive charge
10
Q
Anions
A
electrolytes with a negative
11
Q
Nonelectrolyetes
A
Chemical compounds that remain bound together when dissoloved in a solution and do not possess an eletrical charge
12
Q
Average Blood for adults
A
3L Plasma
2 L of blood cells
5L average circulating volume
13
Q
Sodium Na
normal serum level
A
cation
135-148
14
Q
Potassium K
normal serum level
A
cation
3.5-5.0
15
Q
Chloride Cl
normal serum levels
A
Anion
90-110
16
Q
What are 3 fluid components?
A
- intracellular
- extra cellular
- intrasituial
17
Q
Examples of Nonelectrolyetes
A
Carbs
Protein
Fat
18
Q
How are nonelectrolytes distruibuied in our body?
A
Osmosis Filtration Passive Diffusion Facilitated diffusion Active Transport
19
Q
What can we not get rid of fluid?
A
Heart Failure
Edema
Kidney Failure
Pregnancy
20
Q
What is everything measured in?
A
mL
21
Q
Hypovolemia
A
Low volume of extracellular fluid
which results in dehydration and weight loss
22
Q
MILD Dehyrdration
A
3%-5% loss of body weight
23
Q
MODERATE Dehydration
A
6%-10% loss of body weight
24
Q
SEVERE Dehydration
A
9%-15% loss of body weight
25
Hypervolemia
Higher than normal volume of intavascular fluid compartment
- Edema Develops
- also can cause circulatory overload
26
Foods HIGH in sodium
```
Peanut Butter
Processed meat
Processed foods
Dairy
Pickles
Snacks
... you know sodium , like sodium(:
```
27
Circulatory Overload
Severly compromised heart function
28
3rd Spacing
Movement if intravascular fluid to non vascular fluid compartments
29
Hypoalbuminemia
Low albuminin the blood
| -might indicate liver diease or kidney diease
30
Isotonic Solution
* Stays in vein
- 0.9% normal saline
- 5% Dextrose water
- Ringers solution or lactated ringers
* Maintain fluid balance
31
Hypotonic Solution
* Out of the vessels
- NaCl 0.45% also called half strength saline
- 5% saline in 0.45% saline
* People who need more fluid
32
Hypertonic Solutions
```
*Enters The vessles
3% saline
10% d10W
20% dextrose in water
*Critical care unit
```
33
Crystalloid Soultions
Isotonic Solution
Hypotonic Solution
Hypertonic Solution
34
What do we include in patients intake?
- All the liquids a client drink
- foods that are liquid by the time they are swallowed
- IV solutions
- Fluid amdinstered through feeding tubes
35
What do we include in patients output
- Urine
- Emesis
- Blood loss
- Diarrhea
- wound/tube drainage
- aspirated irrigation
36
Fluid balance restored by?
- Ristricting or limiting oral fluids
- Reducing salt consumption
- Discounting/ Reducing IV fluid infusion
- Adminstering drugs to promote fluid elimination
- Combing all these interventions
37
when giving a dieretic you need to watch what?
The Electrolytes
38
Why are intravenous fluids infused into a vein?
- Maintain/restore fluid balance
- Maintain/replace Electrolytes
- Adminster viatmins
- Provide source of calories
- Admin rugs
- blood and blood products
39
Collioid Steroids
- Blood
- Components of Blood
- Plasma,WBC,Albumen, Platelets
40
Needle stick contributions?
Student
Imporoper disposal
Recapping needle *NEVER DO*
41
Why is a filter used for IV?
Reduce air bubbles
pedatric patients
adminster blood
42
needle size for TRAUMA
18+
43
needle size for ELDERLY
20 or smaller
44
needle size for PEDATRIC
24-22
45
needle for non emergant blood transfussion
20
46
How long can you hang blood before it is bad?
4 hours
47
How often do you change tubing?
Every 24 hours, or as order or policy says
48
What is the only solution compatable with blood?
Normal Saline
49
Complications with IV therapy
- Infection
- Cicurlatory Overload
- Infiltration
- Phlebitis
- Thrombus Formation
- Pulmonary embolus
- Air embolism (greater than 5mL of air can be fatal)
50
How do we care for IV sites?
Document the appearance with every assessment
| Dressing changes every 72 hours
51
How do we adminster blood?
Through IV
52
What kind of IV do we need to adminster blood?
16-20 gauge IV catheter is needed
53
Why is blood tested?
STD
Herpies
HIV
Pysfalis (lol idk how to spell it but whatever alex got on greys anatomy from the nyrse)
54
Type of reactions to blood?
```
Incompatibility
Febrite
Septic
Allergic
Moderate Chilling
Overload
Hypocalcemia
```
55
Peripheral Parenternal Nutrition
Isotonic/Hypertonic can be given in vein
56
Total parental Nutriition
TPN
Jugular Vein (Central Line)
Picc Line
-a hypertonic solution of nutrients designed to meet -almost all caloric and nutritional needs
57
Why do you get TPN
```
Liver renal fail
Trauma
Diease
Cancer
10% or more loss of body weight
have not eaten in 5+ days
self imposed stravation (anorexia)
```
58
Lipid Emulsions
A mix of two liquids
| provide calories
59
Administering TPN
- Weigh the patient
- Use tubing that contains a filter
- Change tpn tubing daily
- Clamp central tubing and have patient bear down when disconnecting tubing from its catheter conections
60
Signs of Fluid deficit
```
weight loss
low bp
elevated
rapid,weak pulse
rapid, shallow respirations
scant dark yellow urine
dry stool
warm flushed skin
skin turgor
no energy
sleepy
basically being dehydrated!
```
61
Signs of Fluid Excess
```
Weight gain
high bp
moist respirations
Light yellow urine
pitting edema
moist skin
crackle lungs
```
62
what can cause fluid deicit?
```
starving
vomitting
gastric suctionong
diarrhea
Laxative abuse
potent diaretics
heat and hummity
draining wounds
fever and sweating
```
63
what can cause Fluid excess
```
Kidney failure
heart failure
rapid admin of IV fluid/bld
admin of albumin
corticosteriod drug therapy
exsessive intake of sodium
pregnancy
premenstral fluid retention
```
64
Urinary Elimination
process of releasing excess fluid and metabolic wastes.
65
Factors affecting urinary elimination
1. the degree of the neuromuscular development and the integrity of the soinal cord.
2. the volume of fluid intake and the amount of fluid losses, including those from other sources
3. the amount and type of food consumed
4. the persons circadian rythym, habiits, oppurtunities for urination, and anxiety.
66
How would you promote urination?
provide privacy
assuming a natural postion for urination
maintaing adequate fluid intake
using stimuli (running water)
67
What does normal urine look like?
```
Volume= 500-3000mL
color= light yellow
clarity= transparent
no odor ( faintly aromatic)
```
68
Voided speciman
sample of fresh urine collected in a clean container
69
Clean-Catch Speciman
Sample of urine concidered sterile
sometimes called a midstream speciman
70
How to gather a clean catch speciman
it is collected after the initial steam starts
71
How do we collect 24hr urine?
- instruct client to urinate just before starting the test and then discard that urine.
- All urine voided there after becomes part of the collected specimen. Exactly 24hr, nurse will ask patient to void one last time to complete the test collection.
72
Hematuria
urine containing blood
73
Pysuria
urine with pus
74
Proteinuria
Urine containing plasma protein
75
Albuminuria
urine containing albumin
76
Glycosuria
urine containing glucose
77
Ketonuria
urine containing ketones
78
abnormal patterns of urinary elimination
```
Anuria
Oliguria
Polyuria
Nocturia
Dysuria
Incintinence
```
79
Anuria
absense of Urine or a volume of 100mL or less than 24hrs
80
Urinary Retention
the pts produces urine but does not release it from the bladder
81
Oliguria
- urine output less than 400 mL in 24 hours
| - determines inadequate eliminiation of urine (partially emptying bladde
82
Residual Urine
More than 50 ml of urine that remains in the bladder after voiding
- can support the growth of microorganisms
- can cause stones
83
Stasis
lack of movement
84
Polyuria
greater than normal urine elimination
85
Nocturia
night time urination
86
dysuria
difficult or uncomfortable voiding
| symptom of trauma
87
frequency
peeing often
88
urgency
feeling of needing to pee
89
Intocontinance
inablity to control urinary or bowel elimination
90
Diffrenent types of incontinence
```
Stress
Urge
Reflex-spontanous loss
Functionial-control over loss
Total-loss without any warning
Overflow- urine leakage cause badder is not emptied
```
91
Stress incontinance
Loss of small amounts of urine when intradbominal pressure rises
92
Urge incontinance
need to void felt frequently short lived ability to sustain control of the flow
93
Continence traing
Restore the control of urination involves teaching the client to refrain from urinating until an apporpuate time or place
94
who is canidates for continence training?
clients with lower body paralyisis
95
Why would a atient need a foley catheter?
- Keeping incontinets clients dry
- relieving bladder distention
- assesing fluid balance accuracy
- keeping bladder from becoming distended during surgerys
- measuring the risdual of urine
- obtaining steril urine speciman
- instilling medication with in the bladder
96
What kind of procedure is a catheter?
Sterile
97
How do we prevent CAUTIs?
- keep drainage bag below bladder level
- empty bag regulary
- keep tube from kinking
- maintain closed drain system
- perform perinal hygenie care daily
- remove urinary catheters in a timely fashion
- provide rigouris catheter care
98
What is the purpose of continuous bladder irrigation (Murphy drip)?
keep a catheter patenet after prostate or urologic surgery in which blood clots and tissue debris collect within the bladder cath.
It works by gravity
hung on an IV pole
Sterile solution
99
What is the average amount of urine elimination for the average person?
1500-3000mL
100
When does the need to urinate become apparent?
When the bladder distends with approximately 150-300mL of urine.
101
What does 3rd spacing mimic?
pregnancy
102
what is shock?
High HR Low BP
103
Hypertonic in the body cause?
Causes cell and tissue to shrink
104
what are fluid compartments?
Electrolytes
Non electrolyetes
blood
105
How many checks when you are adminstering blood?
3 checks
106
What defense mechanism tells you to drink?
Thirst
107
what is the main way to see if patient is retaing fluid?
by checking the weight
108
Edema ranking
+1
+2
ptting edema
109
How can we increase oral intake?
Offer bevarages
Ice chips ice cream
jello
110
what meds can make you incontinent?
high blood pressure meds
antidepressent
diuretics
sleeping pills
111
Providing continence training steps
- log of patients urinary patterns
- set realtisic short term goals
- Discourage strict limination of liquid intake
- plan a schedule
- communicate the plan
- assist client if needed
112
externial catheter
condom cath
113
retention catheter
foley cath
| indwelling cath
114
why would someone need continous irrigation?
prostate or urniary surgery
| helps reduce risk of infenction
115
How do we provide cath care
clean to dirty
| warm soapy water
116
Urinary diverson
Urostomy
117
How long can you clamp and get sterile procedure from folley?
30 mins
118
Phosphate
1.7-2.6
119
calcium
4.5-5.5
120
magnesium
1.3-2.1
