Nursing Practice, Fluids, and Immune Health Flashcards

Comprehensive practice flashcards covering Professional Nursing Practice, Medical-Surgical rehab, Health Promotion across the lifespan, Nutrition assessment, Fluid and Electrolyte imbalances with treatment and ABGs, IV complications, Immune system assessment, and HIV/AIDS management.

What are the five stages of Maslow's Hierarchy of Needs?

1. Physiological needs (food, water, warmth, rest)

2. 2. Safety needs (security and safety)

3. 3. Belongingness and love (intimate relationships)

4. 4. Esteem needs (feeling of accomplishment)

5. 5. Self-actualization (achieving one's full potential)

Ethics Vs Morality

Ethics: study of moral beliefs to understand right and wrong

Morality: values and characteristics

Define the ethical principle of Autonomy.

The right to receive information to make a choice.

What is the clinical definition of Beneficence?

Performing acts to benefit others.

Define the ethical concept of Double Effect.

The justification of actions that produce both good and evil effects.

What is the difference between ADLs and IADLs?

ADLs (Activities of Daily Living) are self-care activities

IADLs (Instrumental Activities of Daily Living) are complex skills needed for independent living and how the patient performs ADLs.

Factors affect adherence

Demographic factors

Gerontological considerations

Chronic illness

Sensitivity to meds

Inadequate support

Cognitive and mobility impairments

Lifespan health problems

Infants: immunizations, safety, development, parent class

Toddler: safety nutrition, swimming lessons

School age: safety, nutrition, stranger danger, immunization, protective equipment

What are the BMI classifications provided in the text?

Less than $18.5$ is poor nutrition

between $25$ and $29.9$ is overweight

$30$ or more is considered obese.

What waist circumference measurements indicate excess risk for males and females?

Greater than $40\text{ in}$ for males and greater than $35\text{ in}$ for females.

Biochemical assessment

Serum prealbumin, albumin, serum transferrin, retinol, CBC, electrolytes, urine test

What are the normal range values for serum Osmolality?

$275$ to $290\text{ mOsm/kg}$

Hyperosmolar

Higher than 290

Fluid is thick due to blood concentration

Dehydration, high sodium, high glucose

Hypoosmolar

Lower than 275

Fluid is thin due to blood being diluted

Osmotic pressure

The pressure or tension of solutes which will have an impact on the concentration and normal functioning

Osmosis

The diffusion of water caused by fluid and solute concentration

Osmolarity is by

Volume literally

Osmolality is by

Weight

Calcium range

8.5 to 10.5

Potassium range

3.5 to 5.0

Sodium range

135 to 145

Define Hypertonic, Isotonic, and Hypotonic fluids in terms of particle concentration.

Hypertonic: Greater concentration than plasma (cells shrink). Isotonic: Same concentration as plasma (cells stay the same). Hypotonic: Lesser concentration than plasma (cells swell).

Hypotonic

Water is pulled into the cell

More water

Anything below 0.9% is hypotonic

can be used to draw fluid out of blood vessels to correct hypernatremia and cellular dehydration

Hypertonic

Water moves out of the cell into intravascular

More salt

Anything above 0.9% is hypertonic

Can be used to draw fluid from intracellular to intravascular to correct reverse fluid overload and cerebral edema

Isotonic

Water is moved in and out equally

Equal water and salt

5% dextrose starts as isotonic and becomes hypotonic when metabolized

typically first line to replace fluid loss

What causes hypovolemia?

body sensed decrease in circulation volume or an increase in serum osmolality

decreased intake and absorption

Bowel resections, hemorrhages, NGT suction, diuresis, vomiting or diarrhea

What is the thirst mechanism - hypovolemia

Body interpret problem and responds with urge to drink

Antidiuretic hormone is released by pituitary gland because of decrease in circulating volume and promotes retention of fluid

Signs and symptoms of hypovolemia and how it’s treated

Thirst

Tachycardia

Poor skin turgor

Hypotension

Oliguria

• stop loss than replace volume

Causes of hypervolemia

inadequate sodium and water excretion or excessive sodium intake

Cushing syndrome

Heart failure

Renal failure

Contrast the roles of RAAS and ANP in fluid regulation.

RAAS (renin-angiotensin-aldosterone system) saves sodium and fluid to raise pressure

ANP (atrial natriuretic peptide) is released when the atria stretch to dump salt and water and lower blood pressure.

Signs and symptoms and treatment of hypervolemia

crackles 

high HR and BP

high urine output

low serum sodium

JVD

High ECF volume

Increase in blood volume

peripheral and pulmonary edema

hypertension

venous distention

acute weight gain

• should be focused on correcting the underlying cause and possibly restricting fluid intake

Identify EKG changes associated with Hyperkalemia and Hypokalemia

Hyperkalemia: Widened QRS and tall peaked T waves.

Hypokalemia: Prolonged PR interval and flattened T waves.

What is electrolyte balance

How body relayed messages and conducts normal functioning within the cells

Cations vs anions

Cations: positively charged electrolytes

Anions: negatively charged electrolytes

• Sodium, potassium, calcium, phosphorus, magnesium are key electrolytes that have important effects in normal functioning in cells

Sodium

135-145

Cation in bodies extracellular

Regulates fluid volume

Osmolality

Acid base balance

Conduct muscle and nerve activity

Body regulates sodium through

Dietary intake

Excretion through kidneys

Hormonal responses

Hypernatremia causes

excessive intake

Dietary intake or rapid infusion of isotonic or hypertonic solutions

excessive loss of water through diabetes inspidus

impaired thirst center

decreased intake

inability to concentrate urine

Hypernatremia signs and symptoms and treatment

thirst and dry mucous membranes

disorientation and hallucinations

aliguria or anuria

 rapid/weak pulse

• identify and treat

• an infusion of hypotonic solution can be used to replace fluid without increasing sodium levels

• If acute -

  •  aggressively therapy to reduce

• Chronic - 

  • reduce levels slowly

Oliguria is

low urine output

anuria is

 0-100 mL daily

What happens if you infuse water?

The water would move from low concentration to high

The cells would swell rapidly

Red blood cells burst

Hyponatremia causes

excessive diuresis (polyuria)

adrenocorticoid insufficiency

increased fluid intake

Ketoacidosis

syndrome of inappropriate antidiuretic hormone

Hyponatremia signs and symptoms and treatment

muscle cramps and weakness

lethargy and agitation

orthostatic hypotensions

Anorexia

seizures

Sodium levels less than 115 can cause permanent neuro dysfunctions

• fluids may be restricted to help correct imbalance

• aggressivmeness may be dependent on signs and symptoms

• asymptomatic patients - 

  • replacement of 8-10 over 24 hours

• Symptomatic patients - 

  • more aggressive replacement 

Potassium

3.5 to 5

cation in intracellular fluid

condition related to neuromuscular, cardiac, and skeletal muscle activity

Intake of potassium is through diet

80% is excreted through distal tubules of kidneys

20% is through sweat and bowel

Hyperkalemia causes and conditions

excessive intake

addisons dieases

impaired renal functions

metabolic acidosis

In extreme cellular trauma large quantities of intracellular potassium can be released into ECF

Hyperkalemia signs and symptoms and treatment

muscle cramps

weakness and parasthesis

hyperrelfexia 

-

• changing meds if needed

• Short term - 

  • sodium polystyrene sulfonate

  •  intravenous insulin and 50% dextrose

  • sodium bicarbonate or calcium chloride

  • Dialysis may also be used for rapid 

What is the difference between Trousseau's sign and Chvostek's sign?

Trousseau's sign: Inflated BP cuff causes muscle spasms. Chvostek's sign: Tapping below the zygomatic arch causes facial muscle contraction.

What are the normal ranges for pH, PaCO2, and HCO3 in Arterial Blood Gases (ABGs)?

pH: $7.35$ to $7.45$; $PaCO_2$: $35$ to $45$; $HCO_3$: $22$ to $26$

How do the lungs regulate pH during Hyperventilation vs. Hypoventilation?

Hyperventilation: $CO_2$ is blown off, lowering acid content (alkalosis). Hypoventilation: $CO_2$ is retained, raising acid content (acidosis).

Differentiate between IV Infiltration and Phlebitis.

Infiltration: Dislodged catheter/penetrated wall causing pallor, cold skin, and swelling. Phlebitis: Inflammation of the vein causing redness, warmth, and red streaks.

Compare Natural (Innate) and Acquired (Adaptive) Immunity.

Natural: Present at birth, broad defense. Acquired: Developed after birth due to prior exposure, includes active (self-developed) and passive (external source).

Where do B and T lymphocytes mature and what are their primary jobs?

B cells: Mature in Bone marrow; produce antibodies (humoral response). T cells: Mature in Thymus; carry out cellular immune attacks (cell-mediated response).

Specify the CD4 count ranges for HIV Disease Staging.

Stage 1: \text{CD}4 \text{ count} ge 500. Stage 2: $\text{CD}4 \text{ count} 200 \times 499$. Stage 3 (AIDS): $\text{CD}4 \text{ count} < 200$.

What are the goals of Antiretroviral Therapy (ART)?

Reduce HIV-associated morbidity, prolong survival duration and quality, and reduce viral load to protect immunity.

What is PrEP and how is it administered?

Pre-exposure prophylaxis for high-risk HIV-negative individuals; it is taken once daily and protection begins after 4 days of consistent dosing.

Define the four types of Hypersensitivity reactions.

Type 1: IgE mediated (anaphylaxis). Type 2: Cytotoxic (autoimmune). Type 3: Immune complex (Rheumatoid arthritis/Lupus). Type 4: Delayed (T-cell response, e.g., poison ivy/PPD).